A survey published by Action on Smoking and Health (ASH) and Cancer Research UK on January 24 revealed how local governments in England managed to improve their smoking cessation services in 2021, despite significant funding challenges.
The report, “Give a hand”, documented how local councils have adapted to coronavirus protocols, offering remote face-to-face sessions and finding new ways to reach the most vulnerable smokers, such as engaging homeless populations brought into hotels during the pandemic.
The authorities paid particular attention to “poor and disadvantaged groups with high rates of smoking”.
The survey, conducted in August 2021, collated responses from 118 respondents, who provided data on 126 of 150 local authorities “with public health responsibilities”. (These included city councils, unitary authorities, metropolitan boroughs and London boroughs.) The researchers determined that 76% of local authorities commissioned “some form of specialist quit smoking services”, in which expert advisors help people quit smoking using a variety of methods– including frequent meetings to discuss progress, carbon monoxide breath tests and nicotine replacement products like lozenges and gum.
As the UK embraces vaping as a harm reduction tool, the National Health Service (NHS) cannot yet prescribe e-cigarettes as medicine– although it should happen soon. But quit smoking counselors can — and do — recommend them informally.
Authorities that offered smoking cessation services paid particular attention to “poor and disadvantaged groups with high smoking rates”. For example, 91% conducted work focused on “disadvantaged communities or routine/manual workers”; 97% with “pregnant or postpartum women”; 77% with people with mental health issues; 44% with “black communities and ethnic minorities”; 43% with “housing associations or other social housing providers”; and 21% with LGBTQ communities.
“It’s really good to see how flexible and responsive smoking cessation services can be, especially during the difficult times of the past few years,” said Louise Ross, acting president of the New Nicotine Alliance. Filtered. Ross was previously in charge of the smoking cessation service at a psychiatric hospital in Leicestershire. When the facility became smoke-free in 2017, it implemented a program that offered free e-cigarettes to all patients who smoked.
In short, the proportion of local authorities “mandating or providing a specialized service” has increased over the years: from 65% in 2018, to 69% in 2019 and to 77% in 2020.
“It’s great to see the authorities engaging with the people who have the highest smoking rates. However, this report also shows the harmful impact of budget cuts.
However, they also reported that a lack of funding was making an already difficult situation even more difficult: the NHS remains strained by the pandemic response and budgets have only shrunk in recent years. From 2013 to 2021, ‘Reaching Out’ notes that net spending by local authorities in England on stop smoking services has fallen by 45%, from around $170 million to $94 million, the level of priority given to tobacco control has also dropped.
“Smoking is one of the biggest causes of health inequities, so it’s great to see local authorities engaging with the people who have the highest smoking rates,” said Malcolm Clark, senior manager policies at Cancer Research UK, said in a press release. “However, this report also shows the detrimental impact of years of cuts to public health budgets. To close the inequality gap, all smokers must have access to effective specialist support to help them quit. Funding increased and sustainable local tobacco control is essential for this to happen.
Ultimately, the report recommends that the national government levy “a levy on tobacco companies to fund services”, that local governments address “tobacco use in their COVID recovery plans as part of tackling inequality and that the new integrated care councils are working with local authorities to “maximize the opportunity to help more smokers quit.”
It’s a plan that has been met with some skepticism. Some critics like Clive Bates, tobacco control expert and former director of ASH (UK), tend to fear that vaping is falling into a purely medical paradigm – as it is in Australia, where you can‘t get nicotine e-liquid without a prescription. The fear is that a model that treats vaping products as nothing more than sterilized, one-size-fits-all smoking cessation tools fails to take into account the real appeal of vaping. However, once the NHS starts prescribing e-cigarettes, they will continue to be available in stores for any adult to purchase.
As in the rest of the UK, England‘s adult smoking rates dropped steadily over the past decade (from 19.8% in 2011 to 13.9% in 2019) – a period that has seen an increase public health notices, availability and social acceptability of vaping.
“Vaping is a consumer-driven market phenomenon, in which elements such as enjoyment, branding, identity and enjoyment play a role,” Bates said. Filtered. “None of these elements are at work in the more medicalized models advanced in these publications. dynamic and innovative consumption, not an alternative.
“It should come as no surprise that public health authorities in the UK act like public health authorities on tobacco and nicotine issues.”
All of this is in stark contrast to what is happening in the United States, where the Food and Drug Administration (FDA) has been reluctant to allow marketing applications for most e-cigarette manufacturers, and public health organizations continue to trumpet the dangers of vaping by being almost exclusively evoking the use of young people. Teen vaping rates have recently dropped significantly, while adult smokers—many of whom come from marginalized populations, as is the case in the UK, are generally excluded from the public health debate.
“It should come as no surprise that public health authorities in the UK act like public health authorities on tobacco and nicotine issues,” said David Sweanor, industry expert and chairman of the advisory board of the Center for Health Law, Policy and Ethics. at the University of Ottawa, said Filtered. “It should, however, enrage us that those who hold such positions in many other countries are not.”