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Health Matters: preventing ill health from alcohol and tobacco use

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Welcome to the latest edition of PHE’s Health Matters, a resource for local authorities and health professionals, which for this edition focuses on preventing ill health caused by alcohol and tobacco use.

Harmful use of alcohol and smoking are amongst the most significant risk factors for ill health in England.

In England, 10.4 million people consume alcohol at levels above the UK Chief Medical Officers’ low-risk guideline and increase their risk of alcohol-related ill health.

Alcohol misuse contributes to 200 health conditions leading to hospital admission, due either to acute alcohol intoxication or to the toxic effect of alcohol misuse over time. Conditions include:

  • cancers
  • cardiovascular conditions
  • depression
  • liver disease

What’s more, harmful use of alcohol affects the most vulnerable groups in society - those in the lowest income bracket and those experiencing the highest levels of deprivation.

There are nearly 22,500 alcohol-attributable deaths per year.  In 2015/16, there were 1.1 million admissions specific to alcohol consumption, of which alcohol was the main reason for admission for about 339,000 cases.

Around three quarters of the cost to the NHS is incurred by people who are not alcohol dependent, but whose alcohol misuse causes ill health.

Smoking also places a huge burden on the NHS costing approximately £2.5 billion a year for treating diseases caused by smoking.

Tackling smoking provides the biggest opportunity for making services across the entire health and care system more sustainable. PHE is committed to working towards a truly smokefree NHS.

We can reach a large number of smokers in England through health services; they are in hospital waiting rooms, consulting rooms and beds, and many are NHS staff. 1 in 4 patients in our acute hospital beds are smokers.

However, we know from The British Thoracic Society audit of smoking cessation for secondary care in 2016 that over 1 in 4 (27%) hospital patients were not even asked if they smoke, and nearly 3 in 4 (72%) hospital patients who smoked were not asked if they would like to stop.

The national CQUIN scheme 2017-19: No.9 Preventing Ill Health by Risky Behaviours offers the chance to identify and support inpatients who are increasing or higher risk drinkers and to identify and support inpatients who smoke, and importantly to embed these interventions into routine care for patients.

Implemented well the CQUIN has the potential to reduce future hospital admissions and reduce the risk of a number of chronic conditions such as heart disease and, stroke and cancer.

The Ottawa model has shown just how effective hospital-initiated smoking cessation advice can be when offered to every person admitted to hospital regardless of what they are in for.

Compared to patients receiving usual care, those who received smoking cessation advice in hospital were more likely to have given up smoking after 6 months and 50% less likely to be readmitted to hospital for any cause after 30 days.

The Preventing ill health CQUIN provides an important opportunity to improve patient health across England through the delivery of short, simple and evidence-based interventions – alcohol identification and brief advice (IBA) for increasing or higher risk drinkers and very brief advice (VBA) for smoking cessation.

For it to be effective we need all health professionals, commissioners and local authorities to play their part. Read more about how to put the CQUIN into practice in this edition of Health Matters which includes a set of infographics and slides to support local commissioning and service delivery, as well as best practice case studies.

Visit the Health Matters area of GOV.UK to see the wide range of topics Health Matters has covered (other recent editions have looked at cervical screening, child dental health and obesity/food environment) or sign up to receive the latest updates through our e-bulletin.

And if you found this blog helpful, please view other Health Matters blogs.

Health Matters
Health Matters is a resource for professionals which brings together the latest data and evidence, makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action. Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, please view other Health Matters blogs.

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