Profit Before People: The commercial determinants of health and lessons from the tobacco epidemic (2023)
Gateshead and smoking
Tobacco has had a lethal impact on the health of Gateshead over many years. The Director of Public Health annual report 2015 / 16, 'Tobacco: a smoking gun', detailed this and showed that the co-ordinated multi strand approach to tobacco control locally and regionally, had made good progress in reducing smoking rates. We know that smoking prevalence does not continue to decline without continued action - there were periods in the 1990s when reductions in smoking rates slowed and even stopped. Progress started with the introduction of local stop smoking services in the late 1990s supported by media campaigns promoting quitting, but by the mid 2000s this progress was beginning to stall. As mentioned, the Fresh (opens new window) comprehensive Tobacco Control approach was introduced in the North-East in 2005, with Gateshead as a part of this. At that time, 33% of adults in Gateshead continued to smoke12, including 17% of women who smoked throughout pregnancy, 39% of young people aged 11 to 15 had tried smoking at least once and 9% reported that they were regular smokers. Girls were more likely to smoke than boys with 10% being regular smokers compared with 7% of boys. A large majority of young people named shops, newsagents or tobacconists as one of their usual sources of cigarettes13, something that our Trading Standard teams were tasked to tackle and continue to support as part of Gateshead's multi strand approach of reducing smoking prevalence.
The Fresh programme took the evidence base around tobacco control and coordinated a consistent approach which further strengthened this evidence. Fresh supported the vision that efforts were best focused on raising motivation to quit and offering support for adult smokers, and in that way changing the world our children grow up in. Since that time major achievements include the introduction of Smokefree legislation in 2007, making it illegal to smoke in any pub, restaurant, workplace, and work vehicle anywhere in the UK.
This was a landmark moment for tobacco control and showed that efforts to improve health and wellbeing enjoyed overwhelming public support. In the year following the introduction of smokefree laws there was a 2.4% reduction in hospital admissions for heart attacks and a 12.3% reduction in hospital admissions for childhood asthma nationally14. By the time of the 2015/16 DPH report other measures were coming into effect - tobacco was no longer openly displayed and promoted in shops, smoking in cars with children present was banned, and plain packaging with picture warnings was introduced.
By 2016, smoking prevalence had reduced to 18.3% in Gateshead, with 20% of men and 17% of women continuing to smoke. However, 13.3% of pregnant women who gave birth in Gateshead were still recorded as smokers at the time of delivery15, which means more than one in eight babies were born to mothers who smoked. Each year 462 Gateshead residents died due to a smoking related disease and smoking was still the leading cause of preventable death16. The NHS costs related to smoking amounted to over £9.92 million in Gateshead17.
Although smoking prevalence continued to decrease between 2016 and 2021, it continued to disproportionately affect those on lower incomes who were more than twice as likely to smoke and less likely to quit18. This significantly contributes to health inequalities seen in our local populations
This clearly shows that while we have seen continued progress, health inequalities persist, and many areas of Gateshead still have significantly higher smoking prevalence rates than others, and this continues to impact life expectancy in our least affluent wards. The following graphic shows a short bus route in Gateshead and highlights the unacceptable difference in life expectancy for both males and females - just a few stops apart
Gateshead has seen smoking rates more than halved since 2005 - from the 33% of adults smoking to 14.1% of adults smoking in 202119. However, that is still 22,251 smokers and smoking related disease is still estimated to kill 337 people each year and account for 1,899 years of life lost annually20. Although reductions have been seen, we continue to see widening inequalities and the numbers of residents who quit from more at-risk populations, such as those with severe mental illness, are significantly lower. Smoking in pregnancy is still five times more common in the most deprived groups compared to the least. Latest figures show that in Gateshead, 11.8% of women smoked at time of delivery and 15,733 children live in households with adults who smoke which not only damages their health but increases their chance of becoming smokers 4-fold21. In Gateshead, 29.8% of those in routine and manual occupations smoke22, 3.5 times higher than for those in professional and managerial work.
Smoking rates are also much higher among people with a mental health condition. Links around housing tenure have also been identified, we now know that people living in social housing have smoking rates which are double the national average. In Gateshead 33.2% of people who rent from local authority or housing association smoke compared to 7.4% who own their home outright23. People living with social and economic hardship find stopping smoking far more difficult. Smoking is more common in the communities they live in, they tend to have started younger and have higher levels of dependency on tobacco, all of which make it harder to quit successfully.
We continue to see the burden smoking on our health and social care systems. Every year in Gateshead, smoking causes:
- 2707 hospital admissions
- 94940 GP appointments
- 52520 GP prescriptions for smoking related conditions
This results in annual healthcare costs for the NHS in Gateshead of £9.31 million, 15% of the overall cost of smoking for the borough16 . Current smokers are also 2.5 times more likely to require social care support at home and need care on average 10 years earlier than non-smokers, accounting for 8% of local authority spending on adult social care24.
So, progress has not been equal across our population. This demonstrates how important it is to deal with public health issues in a range of innovative ways, based on the best available evidence, and to do this in a comprehensive and consistent way over a long period of time. There is no single, simple intervention to these complex problems and no quick wins. It also shows us that the job is not done, and we need to keep moving forward together to end smoking once and for all, especially because we know that when efforts reduce smoking prevalence begins to rise.
These numbers, whilst stark, only tell part of the story. We must not overlook the huge personal costs of tobacco, not just for smokers but for their loved ones too.
References
12. General Household survey 2005
13. Smoking, drinking and drug use among young people. NHS Digital, 2017NHS digital - Smoking, drinking and drug use among young people in England (opens new window)
14. GOV.UK - impact of smokefree legislation evidence review March 2011 (opens new window)
15. GOV.UK - Local tobacco control profiles for England (opens new window) PHE, 2016
16. ASH Ready Reckoner (opens new window)
17. Smoking and poverty calculator. Action on Smoking and Health, 2016
18. ASH - health inequalities and smoking 2019 (opens new window)
19. Public Health Outcomes Framework - data OHID (opens new window)
20. Smoking Prevalence in adults (18+) Annual Population Survey (APS) 2021: Local Tobacco Control Profiles - Data - OHID GOV.UK HID - tobacco control data (opens new window)
21. DHSC press release for Better Health Campaign GOV.UK - Children whose parents smoke are 4 times as likely to take up smoking themselves (opens new window)
22. GOV.UK HID - tobacco control data (opens new window)
23. Annual Population Survey (APS) 2019: Smoking Prevalence in adults (18+)- Current Smokers by housing tenure. Local Tobacco Control Profiles - Data - PHE, GOV.UK HID - tobacco control data (opens new window)
24. (H Reed (2021), The costs of smoking to the social care system and related costs for older people in England: 2021 revision.ASH cost of smoking to the social care system March 2021 (opens new window)