Keeping it local – A CLeaR commitment to tobacco control

Four in 10 cancers can be prevented. That works out as 600,000 extra cases of cancer over the past five years, simply as a result of changeable lifestyle factors.

And as the UK’s single greatest cause of avoidable early death, tobacco has accounted for more than half of those cases.

But the impact of smoking is most devastating among Britain’s most deprived and marginalised people, as recently noted by Health Secretary, Jeremy Hunt, at the recent Local Government Association’s annual conference:

“Half the difference in life expectancy between the most and least affluent areas is caused by smoking-related illnesses.”

In some respects, the success we’ve seen in driving down national smoking rates has hidden the persistent challenges remaining in deprived regions where we need more targeted approaches.

And, since the 2013 health reforms, local authorities have been working to combat the problem.

On Tuesday, the Challenge, Leadership and Results (CLeaR) partnership held its annual awards ceremony to  recognise those who were excelling in their efforts to protect the health of their communities.

Sharing best practice through CLeaR

Developed by Action on Smoking and Health (ASH), supported by Cancer Research UK, and now managed by Public Health England (PHE) the CLeaR process aims to support local tobacco control advocates by allowing local authorities to scrutinise and report on each other’s tobacco control policies and activities.

This creates opportunities to identify and share best practice among peers – something recognised by the 70 or so authorities that have already signed up.

Speaking at the awards ceremony Martin Dockrell, head of the Tobacco Control Programme at PHE, said that CLeaR “draws a picture of tobacco control and how it should be”.

Recipients of this year’s awards were not short of praise for CLeaR’s tangible benefits. Hertfordshire County Council was the overall winner for its work on reducing smoking in its  area, as well as on tackling the illicit trade of cigarettes.

Its director of public health, Jim McManus, said the process “pinpointed our strengths and usefully identified opportunities to consider for improvement…The review was instrumental in helping us get every NHS agency in Hertfordshire to sign up to a new NHS plan for smoking including making smoking cessation in mental health settings a priority… So CLeaR has done the job for us.”

In aiming for today’s youth to grow up free from tobacco, Durham County Council was recognised for its successes in reducing local smoking rates, as well as its work with NHS trusts in supporting smokefree environments. Bristol was recognised for its leadership in bringing in strong smokefree policies, and, as a result of taking part, Bexley, who won the award for ‘Results’, will launch its tobacco control alliance next week.

But there are benefits beyond tobacco control. Many authorities have told us that the collaboration it encourages can also help to tackle other significant health challenges, such as alcohol misuse and obesity, which are also accountable for a number of preventable cancers.

Looking to the future

There’s clearly a lot of top-class activity going on around the country in tackling tobacco. So – job done? Far from it – there are still huge challenges ahead.

We’ve set a bold ambition for a tobacco-free future within the next 20 years, where less than five per cent of the UK’s adult population are hooked on a product which kills up to two-thirds of its long-term users. A tobacco-free society relies on local authorities striving for tobacco-free communities, and this means making tobacco control a priority in their public health strategies. So alongside CLeaR, there are other initiatives helping local councils to focus their efforts.

By signing up to the Local Government Declaration on Tobacco Control – endorsed by the Chief Medical Officer – many councils have shown their commitment not only to clamp down on smoking, but also to protect public health from the pernicious influence of the tobacco industry.

It’s a commitment we hope many more local councils will make.

Counting the costs

Earlier this year we released a report, ‘Taking a Reading’, which explored the impact of the health reforms that moved tobacco control funding from the NHS to local authorities. It was generally a positive picture; however there were warning signs about the impact of future Government cuts to services. We’ll be repeating the study later this year, to see how local authorities are adapting to the changes as the financial realities sets in.

Smoking continues to place a significant strain on health finances, not to mention the social fabric and wellbeing of communities everywhere. Shockingly, in England alone, its net financial cost to society is more than £6 billion a year. We’ve done the maths, and industry claims that it’s paying its ‘fair share’ through tobacco taxation, do not add up.

When every £1 spent on smoking cessation saves £10 in future health care costs, it’s hard to make sense of the Government’s decision to single out public health budgets for £200 million of extra cuts while  acknowledging the importance of prevention to protect the NHS. Measures such as standardised packaging of tobacco products will give children one less reason to start smoking, which is vital when two-thirds of smokers start before the age of 18.

But we also need to give smokers  the best chance to kick the habit – which we know is through a stop smoking service.  Unfortunately, the additional cuts to local public health funding means these services are at risk of being hit the hardest.

Plugging the gap

So where could extra funding come from?

Cigarettes didn’t fall from the sky. The companies who have manufactured, marketed and misled must carry some of the burden for the harm their products continue to cause.

But in Wednesday’s budget, the Government missed an opportunity to plug a gap in the country’s health finances by not introducing a financial levy on the tobacco industry.

By introducing a levy on tobacco companies, the Government could secure £500 million a year for stop smoking services and mass media quit campaigns, and act to tackle the illicit trade in cigarettes, making those responsible for the damage fully responsible, right to the end.

Quitting tobacco is the best thing an individual can do for their health – but comprehensive tobacco control is the best thing society can do for the public’s health.

It’s vital that the Government provides adequate support for local authorities in this crucial work.

– Emily Stewart works in Cancer Research UK’s prevention policy department