action on smoking and health the evolving fight against tobacco clive bates director action on...
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Action on Smoking and Health
The evolving fight against tobacco
Clive Bates
Director
Action on Smoking and Health
ASH
Action on Smoking and Health
3 layers of understanding
1. Smoking and disease
2. Impact of passive smoking
3. Addiction to nicotine
ASH
Action on Smoking and Health
Understanding of smoking
1. Smoking and disease
ASH
Action on Smoking and Health
Deaths attributable to smoking (1995)
Main causes of death attributable to smoking (UK)
Cancer 46,50046,500
Heart, stroke, circulation 40,30040,300
Lung diseases, COPD 34,30034,300
Digestive diseases, ulcers 1,9001,900
123,000123,000
ASH
Action on Smoking and Health
Other conditions associated with smoking
• Angina risk 20 x risk• Buerger’s disease• Cataracts 2 x risk• Crohn’s disease• Depression• Duodenal ulcers• Chronic rhinitis• Fertility 30% lower• Graves’ disease• Hearing loss• Immune system impaired• Decreased lung function• Ocular Histoplasmosis
• Optic neuropathy 16 x risk• Menopause 2 years early• Sudden Infant Death syndrome• Osteoporosis• Peripheral vascular disease• Psoriasis 2 x risk• Rheumatoid arthritis• Reduced sperm count• Tuberculosis• Macular degeneration 2 x risk• Low child birth weight 4 x risk• Vocal chord polyps• Increased sperm abnormalities
ASH
Action on Smoking and Health
The contribution of the main known, quantifiable risk factors to NHS preventable life years lost
4% 2%
27%
14%15%
13%
13%
6%6% Drugs
Atrial fibrillation
Smoking
Diet
Cholesterol
Blood pressure
Physical inactivity
Obesity
Alcohol
Contribution of different risks factors
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Action on Smoking and Health
Smoking in overall decline
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Action on Smoking and Health
Disease follows
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Action on Smoking and Health
Consequences
• Defeats the ‘harmless pleasure’ argument – Justifies state intervention
• Main response– Marketing controls– Warnings– Public education– Taxation
ASH
Action on Smoking and Health
Understanding of smoking
2. Passive smoking
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Action on Smoking and Health
Passive smoking – the effects
• Fatal risks– Several hundred lung cancers (UK)– Several thousand heart disease cases
• Non-fatal impacts– Lung function, cough, wheeze, phlegm– Asthma aggravation
• Children– SIDS, middle ear infection, lung disease– 17,000 under-5s
• Other effects
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Action on Smoking and Health
• “compelling confirmation” that passive smoke is a cause of lung cancer
• Excess risk of lung cancer 24%
• Corresponds to 100s of deaths in the UK annually
Passive smoking evidence – Hackshaw et al.
Risk of lung cancer: non-smoking women living with smoker compared to non-smoker
ASH
Action on Smoking and Health
Attitudes to passive smoking Smoking status
Percent agreeing that smoking should be restricted…
Current smoker
Ex-smoker
Never smoked
All adults
…at work 73 88 92 86
…in restaurants 73 92 94 88
…in pubs 28 59 65 53
ASH
Action on Smoking and Health
Consequences
• Defeats the ‘freedom’ argument– Others are harmed
• Justifies measures to control passive smoking– Workplace– Public places– Home
ASH
Action on Smoking and Health
Consequences
WorkPublic Places
Home
Health and Safety at Work Act
Charter and market forces
Campaigns and culture
ASH
Action on Smoking and Health
Understanding of smoking
3. Addiction to nicotine
ASH
Action on Smoking and Health
Comparison
“Nicotine is highly addictive, to a degree similar or in some respects exceeding addiction to ‘hard’ drugs such as heroin or cocaine”
Royal College of Physicians of London, 2000 Nicotine Addiction in Britain
ASH
Action on Smoking and Health
2. Addiction to nicotineCharacteristics of dependenceStrong desire to take substance, taking more than intended for longer
Difficulty quitting or controlling use Considerable time spent obtaining, using and/or recovering from use
Higher priority given to the drug than other social activities
Continued use despite knowledge of harm Tolerance develops Withdrawal syndrome
ASH
Action on Smoking and Health
Addiction to nicotine
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Action on Smoking and Health
Addiction to nicotine
• Defeats the ‘choice’ argument– 83% of UK smokers would not start if they
had their time again
• Policy implications – Justifies treatment of tobacco dependence– Explains why ‘lights’ do not work– Product regulation and harm reduction
ASH
Action on Smoking and Health
UK policy
ASH
Action on Smoking and Health
UK Policy
• Ban tobacco advertising, sponsorship• Raise tobacco taxes• Tackle smuggling• Fund national education programme• Smoking cessation services and drugs• Passive smoking at work• Passive smoking in public places• Consumer protection measures (labelling etc)
ASH
Action on Smoking and Health
Policy drivers
1. Smoking and disease
2. Impact of passive smoking
3. Addiction to nicotine