A survey published by Action on Smoking and Health (ASH) and Cancer Research UK on January 24 revealed how local governments in England managed to improve their smoking cessation services in 2021, despite significant funding issues.
The report, “Reaching Out,” documented how local councils adapted to coronavirus protocols, offering face-to-face sessions remotely and finding novel ways to reach the most vulnerable smokers, like engaging homeless populations brought into hotels during the pandemic.
The authorities paid special attention to “deprived and disadvantaged groups with high rates of smoking.”
The survey, conducted in August 2021, collated answers from 118 respondents, who provided data on 126 of the 150 local authorities “with public health responsibilities.” (These comprised city councils, unitary authorities, metropolitan boroughs and London boroughs.) Researchers determined that 76 percent of the local authorities commissioned “some form of specialist stop smoking services,” in which expert advisers help people quit using a variety of methods—including frequent meetings to discuss progress, carbon monoxide breath tests and nicotine replacement products like lozenges and gums.
While the UK embraces vaping as a harm reduction tool, the National Health Service (NHS) cannot yet prescribe e-cigarettes as medicine—although this is set to happen soon. But stop smoking advisers can—and do—informally recommend them.
The authorities that offered stop smoking services paid special attention to “deprived and disadvantaged groups with high rates of smoking.” For example, 91 percent conducted work focusing on “deprived communities or routine/manual workers;” 97 percent with “pregnant or post-partum women;” 77 percent with people with mental health conditions; 44 percent with “Black and Minority Ethnic communities;” 43 percent with “housing associations or other social housing providers;” and 21 percent with LGBTQ communities.
“It’s really good to see how stop smoking services can be flexible and responsive, especially during the difficult times of the last couple of years,” Louise Ross, the interim chair of the New Nicotine Alliance, told Filter. Ross was formerly the stop smoking service manager for a mental health hospital in Leicestershire. When the facility went smoke-free in 2017, it implemented a program that offered free e-cigarettes to all patients who smoked.
In short, the proportion of local authorities “commissioning or providing a specialist service” has gone up over the years: from 65 percent in 2018, to 69 percent in 2019 and to 77 percent in 2020.
“It’s great to see authorities engaging with people who have the highest rates of smoking. However, this report also shows the harmful impact of funding cuts.”
However, they also reported that a lack of funding made an already-difficult situation even more challenging: The NHS remains strained from the pandemic response, and budgets have only decreased in recent years. From 2013 to 2021, “Reaching Out” notes that net expenditure by local authorities in England on stop smoking services decreased by 45 percent, from about $170 million to $94 million, as the level of priority given to tobacco control also sank.
“Smoking is a leading cause of health inequalities, so it’s great to see local authorities engaging with people who have the highest rates of smoking,” Malcolm Clark, a senior policy manager at Cancer Research UK, said in a press statement. “However, this report also shows the harmful impact of years of funding cuts to public health budgets. To close the inequality gap, everyone who smokes must have access to effective specialist support to help them stop. Increased and sustainable funding for local tobacco control is vital for this to happen.”
Ultimately, the report recommends that the national government levy “a charge on tobacco companies to fund services,” that local governments address “smoking in their COVID recovery plans as part of addressing inequalities,” and that new integrated care boards collaborate with local authorities to “maximize the opportunity to support more smokers to stop.”
It is a plan that has been met with a bit of skepticism. Some detractors like Clive Bates, a tobacco control expert and a former director of ASH (UK), tend to worry about vaping falling into a purely medical paradigm—as it has in Australia, where you can’t obtain nicotine e-liquid without a prescription. The fear is a model that treats vaping products as nothing more than sterilized, one-size-fits-all smoking cessation tools does not take vaping’s actual appeal into effect. Once the NHS begins prescribing e-cigarettes, however, it will continue to be available in stores for any adult to buy.
As in the rest of the United Kingdom, England’s adult smoking rate has fallen consistently over the past decade (from 19.8 percent in 2011 to 13.9 percent in 2019)—a period that has seen increasing public health endorsements, availability and social acceptability for vaping.
“Vaping is a consumer-driven market-based phenomenon, in which things like pleasure, branding, identity and fun play a role,” Bates told Filter. “None of these are at work in the more medicalized models advanced in these publications. I’m all for this sort of development providing it is an addition to a vibrant and innovative consumer market, not as an alternative.”
“It shouldn’t be surprising that public health authorities in the UK are acting like public health authorities on issues of tobacco and nicotine.”
It’s all a stark contrast to what’s happening in the United States, where the Food and Drug Administration (FDA) has wavered on authorizing the marketing applications for most e-cigarette manufacturers, and public health organizations continue to trumpet the dangers of vaping by almost exclusively evoking youth use. Rates of vaping among teenagers have recently dropped significantly, while adult smokers—many of whom are from marginalized populations, as they are in the UK—are typically left out of the public health discussion.
“It shouldn’t be surprising that public health authorities in the UK are acting like public health authorities on issues of tobacco and nicotine,” David Sweanor, an industry expert and chair of the advisory board for the Centre for Health Law, Policy and Ethics at the University of Ottawa, told Filter. “It should, however, enrage us that those holding such positions in many other countries are not.”