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England leading the world: New Tobacco Control Plan sets the bar high

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We are at a pivotal point in our fight against tobacco where an end is now in sight, and as the plan aspires, a smokefree generation a reality.

The government’s new Tobacco Control Plan sets the bar high with a series of challenging ambitions by 2022:

  • Reduce adult smoking rates from 15.5% to 12% or less
  • Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less
  • Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less

In June I wrote about the best ever new smoking prevalence figures, with the rate in England now at 15.5%.

But the final push, reaching and encouraging those still smoking to quit and preventing the more vulnerable groups of young people from starting, will undoubtedly be the hardest.

Both these groups have much higher numbers coming from poorer communities or from the most disadvantaged and vulnerable populations. In 2015, there were almost three times as many smokers among the lowest earners in comparison to the highest earners.

This focus on health inequalities provides the backbone of the whole plan with virtually all specified actions working to reduce this gap, across the range of disadvantaged groups.

The strength of the plan is that it targets efforts at these groups using the most effective channels, with actions very much focused at the local level; prioritising more deprived areas and manual workers, vulnerable young pregnant women, people with a mental health problem and prisoners (the latter two groups having smoking rates far higher than the national population average at 33% and 80% respectively).

Many longer term smokers will already be in poor health and be in regular contact with their GPs, the NHS and wider community health services; this will also be true for many people with mental health problems and pregnant women.

A quarter (25%) of all NHS inpatients are smokers and the number of patients using mental health services that smoke are staggeringly higher, estimated to be around 64%.

That is why NHS settings provide a great opportunity to engage many of the harder to reach smokers. The plan capitalises on this with a series of actions for PHE and NHS England working together to support acute and mental health trusts and all frontline health staff to take every opportunity to encourage anyone using, visiting and working in the NHS to quit.

The plan sets out a range of actions, including:

  • All local councils to receive support from PHE experts to help them develop tobacco control policies tailored to local needs
  • PHE to continue to monitor effectiveness of stop smoking services and support local authorities to refocus support to quit
  • PHE and NHS England to develop a joint plan setting out recommendations for how local areas can work together to achieve the smoking in pregnancy ambition
  • Local areas, especially those with higher smoking in pregnancy figures, to have local Smokefree Pregnancy Champions to promote implementation of best practice
  • To drive forward implementation of smokefree policies in all hospitals, mental health services and prisons
  • NHS England and PHE to support commissioners’ implementation of the tobacco CQUIN, which incentivises frontline health staff to assess patients’ “risky behaviours” and arrange for stop smoking support
  • All health professionals to be given access to training and the tools to effectively support quitting
  • PHE to update their evidence base on e-cigarettes annually and include its advice in all quit smoking campaign messaging
  • PHE to develop advice for how employers across different industries can best support their workforces to stop smoking

The plan strongly endorses PHE’s leadership on e-cigarettes, charging us to go further on our work to educate professionals and the public.

Acknowledging that e-cigarettes are now the most popular aid to quitting in England, it recognises the potential that innovative technologies can have to minimise the risk of harm and promotes maximising the availability of safer alternatives to smoking – calling on PHE to include messaging on e-cigarettes in its marketing campaigns.

The plan has been enthusiastically welcomed by the public health family and beyond. This support is fundamental to its ultimate success in achieving a smokefree generation, as only by everyone pulling together can we hope to end the loss of life and suffering smoking has wreaked for far too long.

PHE will do everything possible to make this happen.

Read our blog on how our ambition for a smokefree nation is in sight.

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  1. Comment by Bob posted on

    The problem for me with the latest prevalence figures, is that at a district level the sample sizes are quite small. Particularly for the routine and manual indicator, which left us feeling that they are not useable.

    Also, there are some concern that after years of only gradual movement in the prevalence, why did they last survey uncover a noticeable drop ? What happened in 2016 to cause this, was anything about the survey changed or was 2016 really a breakthrough year ?

    • Replies to Bob>

      Comment by Clare Griffiths - Deputy head of indicators and risk factors, knowledge and intelligence team - Public Health England posted on

      This is an excellent point. The good news is that we are now using the APS survey which has a very large sample of over 250,000. This makes our local estimates more reliable than ever before. Fortunately, we have several years of overlapping data so we can see that they two surveys have a pretty good fit at national level. Obviously, when you break down to local authority level the margin of error gets bigger so there is more scope for differences but the new data is more authoritative than the data that came before. Finally, you ask if the reduction is different because the survey is different. This doesn’t seem to be the case. We have a number of national surveys including the UCL monthly Smoking Toolkit Survey. The various surveys give a consistent message that in previous years we were seeing a decline of around 0.5 percentage points per year but that this has accelerated over the last few years. The fact that many surveys are giving us the same message makes us confident that our very large national survey is giving us an accurate picture, certainly at the national level.