Smoking as a Public Health Issue

Smoking as a Public Health Issue

  

Importance of smoking as a public health issue in the UK

 

Introduction

Smoking is by far the single most preventable cause of death globally. Today, we have over one billion smokers worldwide, or nearly 25% of all adults. In the UK, smoking puts a significant strain on the NHS (National Health Service) on account of the health problems which are directly associated with this habit. Consequently, successive Governments in the UK have implemented varied measures and strategies in an effort to reduce the prevalence of smoking in the country. For example, the NHS is committing to providing free assistance to smokers who wish to stop smoking. The UK Government has also imposed an age restriction for smoking at 16 years. Thanks to the concerted effort by various stakeholders to deal with smoking as a public health issue, smoking fell to a record level of 16.9% in 2015.  Smoking is a leading cause of various illnesses, including heart diseases, cancers, asthma and bronchitis, and stroke. Additionally, cigarette smoking has been identified as a leading cause of health inequalities especially amongst lower socioeconomic groups where it accounts for nearly 50% of the health inequalities. In addition, smoking leads to lost working days every year. According to Cancer Research UK (2014), smoking accounts for 11 million lost work days per annum due to smoking-related illnesses

Prevalence of Smoking

Local Level

Statistics released by Public Health England (2014) reveal that Hyndburn Unitary Authority which is part of Lancashire had a 30.1 smoking prevalence. This was by far the highest rate of smoking prevalence in the UK, with Kingston upon Hull and Blackpool following closely at 29.8 percent and 29.5 percent, respectively. On the other hand, the smoking prevalence at Lancashire-12 area was estimated at 18.3%, and it not far off the national estimate of 16.9% (Office for National Statistics 2016). Conversely, the number of hospital admissions attributable to smoking in the Lancashire-12 area in 2014/15 was 1,891 per 100,000. This was slightly higher than the national average of 1,671 per 100,000. Also, in 2012-14, the Lancashire-12 area recorded a considerably higher smoking attributable mortality of 312.8 per 100,000 relative to the national average of 274.8 per 100,000 (Office for National Statistics 2016)

National Level

            Although the UK has experienced a year-on-year decline in the number of smokers, still 20 percent of women and 21 percent of men still smoke on a regular basis, with the Office of National Statistics (2011) reporting that nearly two-thirds of smokers begin to smoke before they have reached the age of 18.

A 2013 Opinions and Lifestyle Survey revealed that almost one out of five adults in the UK aged 16 and above were smokers. This represents a 19 percent prevalence of smoking among 16 years olds and above. While this represented a slight decline to the rate reported in 2012, it has nonetheless remained unchanged for the most part in recent years. Conversely, in 2003, 26 percent of adults in the UK aged 16 and above were reported to smoke or about one out of four adults (Office for National Statistics 2014). The Health and Social Care Information Centre (2015) indicates that in 2013, the highest prevalence of tobacco use in the UK was recorded amongst individuals aged 25 to 24 and 16 and 24 at 25 percent and 23 percent, in that order. On the other hand, the lowest prevalence was recorded among individuals aged 60 and over, at 11 percent.

In 2014 more men in the UK (20.7%) were likely to smoke in comparison with women (15.9%), according to the Office for National Statistics (2014).The highest smoking rate in the UK was recorded in Scotland, at 20.3%, while the lowest rate was recorded in England, at 18.0%. In addition, individuals who worked in manual or routine occupation reported the highest smoking rate, at 28.2% (Office for National Statistics 2014). At the same time, gay, bisexual, and lesbian adults were more likely to smoke (25.3%) in comparison with straight/heterosexual adults (18.4%).

According to a 2014 report by the Health Survey for England, between 1993 and 2013, there was a 9 point increase in the percentage of UK Men who did not smoke on a regular basis from 39 percent to 48 percent. Conversely, there was an 8 point increase in the percentage of women who did not smoke on a regular basis from 52 percent to 60 percent (Health Survey for England 2014). The proportion of women who currently smoke has been shown to decline steadily over the past few decades. For example, 1993, the percentage of women smokers in the UK was estimated at 26 percent. However, by 2003 it had reduced to 24 percent and by 2013, with a further decline to 17 percent by 2013 (Health and Social Care Information Centre 2015). At the same time, the proportion of current men smokers in 1993, 2003 and 2013 was estimated at 27, 27, and 24 percent, in that order. Nevertheless, the percentage of men who smoke has been shown to fluctuate year on year over the past decade, as opposed to a continuous downward trend.  

According to Thompson (2014), “smoking detrimentally affects every organ of the body and is the leading cause of preventable deaths and disease in the UK” (p.18). In 2013/14, England witnessed more than 1.6 million admissions for adults aged 35 and above, or the equivalent on 4,500 daily admissions. These adults presented with a main diagnosis that was attributed to the effects of smoking. In 2003/04, England reported 1.4 million admissions for the same age group or nearly 3,800 daily admissions. This is a clear indication that tobacco use has had a major effect on the UK health care system.  At the same time, the highest prevalence of smoking was reported among unemployed people (35 percent) while those in employment or economically inactive (for instance, those in retirement and students) was estimated at 19 percent and 16 percent, respectively.   

There has also been a significant rise in UK household expenditure on tobacco over the years. For example, in 1985 the UK household expenditure on tobacco was slightly over £7 billion but by 2014, it had increased markedly to £19.4 billion. On the other hand, the average UK household has seen its expenditure on tobacco in proportion to its total expenditure reduce over the same period. For instance in 1985, the average UK household spent 3.3 percent of its expenditure on tobacco, compared to 1.8 percent in 2014.

Global Level

In its 2016 report on the global prevalence of tobacco smoking, WHO noted that as of 2015, more than 1.1 billion individuals worldwide smoked tobacco. Of these, almost 80% are form middle-income and low-income countries (WHO 2016). These countries are also characterised by the heaviest burden of tobacco-related morbidities and mortalities. Tobacco use is associated with such undesirable outcomes as premature deaths of users, thereby depriving their families of valuable income. In addition, the families are faced with an increase in health care cost as they have to take care of smokers who contract tobacco-related illnesses, not to mention that tobacco use hinders the economic development of families especially those in low-income and middle-income countries. The number of male smokers globally is significantly higher in comparison with that of females. WHO (2016) further noted that while there has been a general global decline in the prevalence of tobacco smoking, the African Region and Mediterranean Region were experiencing an increase in tobacco use. Hunter and Ewles (2005) report that smoking is more prevalent among marginalised people such as those in prison, individuals with mental health problems, and in individuals from poorer socio-economic groups. Additionally, a higher number of younger people smoke in comparison with older people.

Estimates by WHO show that smoking accounts for nearly six million deaths globally every year, inclusive of some 600,000 individuals are estimated to die prematurely each year as a result of the effects of second-hand smoke.  According to WHO (2017), tobacco use accounts for 1 in 10 deaths globally. Doll et al (2004) reports that nearly 50% of all life-long smokers shall die prematurely. While tobacco smoking is mainly linked to ill-health, death and disability due to non-communicable chronic diseases, it is further linked to increased risk of death owing to communicable diseases. Elsewhere, ASH (2013) reports that about 25 percent of all cancer deaths are as a direct result of smoking, which is also a leading cause of high blood pressure. 

WHO (2016) notes that a comprehensive ban on advertising, sponsored, and promotion of tobacco could reduce its consumption by between 7 and 16%. However, only 29 countries, most of them in the developed economies, have so far managed to completely ban all types of advertisement, sponsorship and promotion of tobacco. This represents a mere 12% of the global population. WHO further reports that taxing tobacco is by far the most cost effective strategy to reduce tobacco consumption, particularly among poor and young people. For example, a 10% rise in the price of tobacco products could reduce tobacco use by nearly 5% in middle-income and low-income countries.

Social determinants of health and wellbeing

Tobacco use is a global issue of public health concern and if we do nothing to change current consumption patterns, we will be faced with high rates of mortalities and morbidities in coming years (Eriksen et al. 2015). An integration of various public health efforts have in recent years led to a general reduction in global prevalence of tobacco use; nonetheless, the global rise in population has in turn resulted in an increase in total number of smokers (Ng et al. 2014). Moreover, the most marginalised, vulnerable, and poor members of society are yet to benefits from such efforts and as such, these groups are still characterised by high rates of tobacco consumption, resulting in rising health inequalities and devastating outcomes (Hiscock et al. 2012).

Other disadvantaged people include the homeless people, people of low socio-economic status, minority and indigenous ethnic groups, as well as patients with such debilitating health conditions as HIV, tuberculosis, and mental disorders. This is quite devastating considering that the disadvantaged status of such individuals increases their probability of tobacco use as a “coping strategy”. Also, their consumption of tobacco further escalate their disadvantage through less money to cater for essentials, poor health and an increase in economic burden (Eriksen et al. 2015). If at all we are to reduce the global; consumption rates of tobacco even further, it is important that tobacco control communities focus more attention on attempts to reduce health disparities affiliated with tobacco use.

The comprehensive tobacco control and prevention strategies that have thus far been implemented include increased taxation on tobacco, smoke-free air by-laws, evidence-based cessation treatments, and anti-smoking media campaigns. These strategies have proven effective in reducing tobacco consumption ain the general population. Garrett et al. have identified tobacco control interventions as effective strategies “in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities” (2015, p. 893). Nonetheless, failure to implement these interventions equitably will marginalise certain population groups or worsen disparities in tobacco consumption.

Disparities in tobacco consumption are partly due to inequalities in the adoption and implementation of tobacco controls programs and polices to reach and change the lives of the most vulnerable groups in the population characterised by the higher smoking rates, such as those with lower income and education. Low social economic status us a powerful determining factor of tobacco use either alone or in combination with other factors. Other factors that interact with low social economic status to influence smoking behaviour include acculturation, ethnicity/race, stress, cultural characteristics, tobacco industry influence, limited community empowerment, social marginalisation, and lack of detailed policies to control tobacco use (Jha 2006). These factors constitute the social determinants of health and addressing them will go a long way in realising equity and eradicating disparities with regards to tobacco control and prevention. Economic and social conditions (for example, education, poverty, power, and unequal distribution of resources) cause the greatest effect on public health along with the various risk factors associated with it, including smoking (Hill et al. 2013).

Conclusion

Smoking constitutes a key public health issue at local, national, and global levels. Besides being a leading cause of preventable ill health, smoking is also a major cause of disability and premature death. There is a clear relationship between tobacco consumption and inequality with more deprived and/or marginalised groups characterised by higher likelihood of smoking. Tobacco use accounts for more deaths annually than tuberculosis, HIV/AIDS, and malaria. More importantly, most of these deaths are preventable. This makes tobacco smoking a leading public health concern globally, seeing as it is implicated in the causation of various forms of cancer, cardiovascular diseases and premature death.

While most developed countries, including the UK have witnessed a decline in rates of smoking over the years, developing countries in Asia and Africa have been recording an increase in prevalence of smoking. Smoking represents the single largest preventable cause of inequalities with health care. Various policies and strategies have been implemented at the local, national and international levels in order to address the factors that influencing smoking behaviour. These including increased taxation on cigarettes and imposing a ban on advertising, sponsorship and promotion of tobacco can reduce its use. Equitable and consistent implementation of policy intervention to control the use of tobacco would go a long way in dealing with the social determinants of health in tobacco control and prevention. This would in turn improve the health and wellbeing of tobacco users.

 

References

Cancer Research UK (2014). 11 million work days lost smoking each year. Retrieved from

http://www.cambridgecancer.org.uk/news/latest-news/11-million-work-days-lost

smoking-each-year

Eriksen, M.P., Mackay, J., Schluger, N.W., Islami, F., & Drope, J. (2015). “The Tobacco

Atlas”. American Cancer Society, Atlanta, Ga, USA, 2015.

Garrette, B.E., Dube, S.R., Babb, S., & McAfee, T. (2014). Addressing the Social

Determinants of Health to Reduce Tobacco-Related Disparities. Nicotine Tob. Res.,

17(8),892-897.

Health and Social Care Information Centre (2015). Statistics on Smoking: England 2015.

Retrieved from http://content.digital.nhs.uk/catalogue/pub17526/stat-smok-eng-2015

rep.pdf

Hill, S., Amos, A., Clifford, D., & Platt, S. (2013).“Impact of tobacco control interventions on

socioeconomic inequalities in smoking: review of the evidence,” Tobacco Control, 23,

89-97.

Hiscock, R., Bauld,  L., Amos, A.,  Fidler, J.A., & Munafò, M. (2012). “Socioeconomic status

and smoking: a review,” Annals of the New York Academy of Sciences, 1248(1),107

123.

Hunter, D.J., & Ewles, L. (2005).  Key Topics in Public Health. London: Elsevier Health

Sciences UK.

Jha, P., Peto, R., Zatonski, W., & Boreham, J., Jarvis, M.J., & Lopez, A.D. (2006). “Social

inequalities in male mortality, and in male mortality from smoking: indirect estimation

from national death rates in England and Wales, Poland, and North America,” The

Lancet, 368(9533), 367-370.

Ng, M. K., Freeman, T. D., Fleming, et al. (2014). “Smoking prevalence and cigarette

consumption in 187 countries, 1980–2012,” The Journal of the American Medical

Association, 311(2),183-192.

Office for National Statistics (2014). Opinions and Lifestyle Survey, Smoking Habits Amongst

Adults, 2013.  Retrieved from.

http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-

380033

Office for National Statistics (2015). Integrated Household Survey (Experimental statistics):

January to December 2014. Retrieved from

https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/sexuality/bulleti

s/integratedhouseholdsurvey/2015-10-01

Office for National Statistics (2016). Annual Population Survey, April 2014 - March 2015.

Retrieved from http://dx.doi.org/10.5255/UKDA-SN-7742-3

The Health and Social Care Information Centre (2014). Health Survey for England-2013.

Retrieved from http://www.hscic.gov.uk/pubs/hse2013

WHO (2016).  Prevalence of tobacco smoking. Retrieved from

http://www.who.int/gho/tobacco/use/en/

WHO (2016). Tobacco. Retrieved from http://www.who.int/mediacentre/factsheets/fs339/en/

WHO (2017). WHO global report on trends in tobacco smoking 2000-2025. Retrieved from

http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/

 

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