A snap shot of policy making

Name Policy: Smoking Cessation  

Legislation: smoking ban in enclosed spaces

The policy aim is to create the first ‘smoke free generation’ by 2022,

In the case of smoking, the smoking cessation policy backed up by Legislation to ban smoking in public places was established in 2006, following Scotland and Wales. The long and laborious challenge to expose cigarette effects on health post WW2 has ended in upstream public policy which has been classed as an exemplary public policy success story and ahead of Europe. The policy climbed the intervention ladder from 1950’s – 2006 and can be seen through multiple lenses:

The coalition Framework is effective for explaining the stability of long-term power sitting with the tobacco companies (De Andrade et al., 2020). Despite the link to lung cancer discovery in the 1950’s, a complex war between scientists and policy proceeded with little attention given to emerging epidemiological studies over the next 20 years. The tobacco company had considerable power due to the environment of the time. Public health was set up to reduce infectious disease only at that time. (Holden & Lee, 2009).

 Issue attention cycle framework highlights the small window needed to push through policy and the role that media plays in pushing sensationalizing stories to keep public attention (Jann & Wegrich, 2007). At the time tobacco companies attracted positive media, smoking was framed as glamorous and consumption was high, adding considerable revenue to the central Government and employing large groups (Pollay,1994

The subsystems of actors, researchers, journalists, and legislators were intertwined in a complex dance which evolved overtime. (Ashforth et al., 2008). Government remained in bed and in support of tobacco lobbyists (pro-tobacco) ensured relationships with senior civil servants, Health Treasury and department of trade were maintained, so they remained in favour, during this time where Government sat in policy learning. They continued to ignore scientific evidence until the link between smoking and passive smoking was made (Branston & Gilmore, 2020).

A shift in power

 This gave Anti-smoking campaign groups power to apply pressure on the Government, due to it no longer being just a moral issue but scientific evidence that passive smoking effects children, families and community members. Coalition framework suggests that core beliefs are only changed within parties when there is an external shock, environmental changes such as declining rates of smoking in line with emerging evidence of its effects on health saw smoking rates fall year after year in affluent groups, a class divide started to appear in the 90’s where studies showed those who had manual labour / unskilled jobs were three times as likely to smoke and negative media made tobacco the enemy which saw smoking rates continue to fall (Wood, 2006: Boushey, 2012: Cairney, 2007).

Media Framing and windows of opportunity

 There is an activist aspect of journalism, how the public perceives and understands messages. The power of public figures and political candidates delivering the messages have a huge impact on attitudes and behaviours around the agenda setting (Nisbet & Huge, 2006). Post war views of policy were that it was democratic, mutually beneficial, that government responded to strong public opinion (Jacobs & Mettler, 2011). This is a time where tobacco companies lost power and sat in policy learning (Chapman & Wakefield, 2001).

Government libertarian style of intervention

 Government stuck with issuing facts and figures and leaving the masses to decide whether to stop or not as a neolibertarian style of Governance. Thatcher’s Government saw a suggested ban on sports sponsorship and advertising as a war on freedom and blocked

Further scientific evidence shift power further to anti-tobacco campaigners

 Further pressure was applied when the link between smoking and air pollution was highlighted (Berridge, 2003). Actors often switch beliefs strategically to compete for power as well as in light of new evidence. With the rise in anti-tobacco groups tobacco companies had to yield to pressure and implement safety measures such as filters, and the restriction on advertising. Overtime tobacco companies had to provide ventilation in public places to reduce passive smoking.

Balancing the books and public health protection

 Evidence was ignored, questioned and level of risk was weighed up against a report to government highlighting that a 20% reduction in smoking would lead to a significant rise in retired population, leading to a 50m reduction in balanced payments over a five-year period. The close relationship between drug regulators, industry and public health was the norm and emphasis was on safety rather than risk.  The legislation come into existence during a time where Government favoured a neolibertarian style of Governance, whereby Public health England would provide information so that the public voluntarily stopped smoking, through harm reduction techniques. Delivery of legislation which is least damaging to political parties according to public opinion is vital to stay in power. policy legislation stayed just behind majority public opinion, following Europe’s recommendations and health agenda’s, Uk related jobs fell from 40,000 to 11,000, tax income fell to one quarter of 1950 figures, illegal imports rose exponentially, smoking prevalence had fallen by 51% men and 41% of women, surveys highlight strong public support of smoking ban in pubs (86%).

Government forced to provide legislation

The evidence suggests that the Uk had very little option but to enforce legislation based on Scotland implementing it first, the EU initiative and mass public pressure The evidence suggests that while public opinion was changing quickly from 2004, the UK government line did not, but possibly felt it had no choice but to follow suit (window of opportunity) (Cairney, 2007)

 How can (government) policy impact upon the health of the nation?

The 2006 legislation banning smoking in enclosed places along with policy restricting advertising, warnings on products, products to be covered in supermarkets, smoking cessation support, more recently banning smoking in cars with children in 2015 to reduce harmful passive smoking effects on children.  All NHS grounds are now smoke free. The legislation / policies have affected the Uk in different ways. Data shows Uk smoking rates (up to 2017) since the ban have reduced from 20.2% to adults to 15.5%. These figures as a blanket ban are seen to affect a large % of the Uk population nationally, and there are still 7.3 million adult smokers, 8% of 15 years old and >10% of pregnant mums. (Jha, 2020).

Local Level

 However local level impact has shown a widening inequalities gap.

Smoking rates are almost three times higher amongst the lowest earners

People with mental health issues show the highest rates of more than 40%

Disadvantaged groups, particular postcodes are very disadvantaged

Government have stated they will train all health professionals to support patients to quit (Lawrence et al. 2022).

 Evaluation

The objectives of the tobacco control plan are to: the ambition to create the first ‘smokefree generation’ by 2022,

·        reduce the number of 15 year olds who regularly smoke from 8% to 3% or less

·        reduce smoking among adults in England from 15.5% to 12% or less

·        reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population

·        reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less

There is more work to be done before hitting the target to become smoke free. The 2022 target has not been reached and up to date figures have not been released.

The next steps are to reduce:

 The uptake of smoking of young people

Assist pregnant mums to quit who currently only accept 10-20% of support of NRT and counselling. At present, only 10–20% of pregnant smokers take up the offer of free SSS (Sinclair et al., 2020).

Providing support to help smokers quit is highly cost-effective (Keeney et al., 2021).

Smokers who use NRT are up to four times as likely to quit successfully as those who choose to quit without help or with over-the-counter nicotine replacement therapy products (Watkins et al., 2020:  Dawkins et al., 2019).

Since 2011-12 attendance at local stop smoking services has been declining (Fulton et al., 2019).

Professionals are reluctant to help people with mental issues quit as they are concerned about causing harm (Gilbody et al., 2019).

Address inequalities: there is a strong association between smoking and where an individual lives: most smokers live in the most deprived areas of the country

In 2016 it was estimated that 2 million consumers in England had used these products and completely stopped smoking and a further 470,00056 were using them as an aid to stop smoking (Dutcher et al., 2021)

PHE will support research around E cigarette safety

Nationally PHE will continue with mass campaigns to promote smoking cessation. . Investment into behaviour change training, cross-regional approaches

On the 23 June 2016, the UK voted to leave the European Union

COVID 19 studies showed a range of outcomes, some studies highlighted an increase in smoking and drinking behaviours and other studies highlighted an increase in smoking support remotely and apps downloaded One qualitative study found an increase in prevalence due to boredom (Jackson, et al., 2022).

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