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** 28 April 2021
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** UK
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** Miscarriage rates over 40% higher in black women, study suggests (#1)
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** NHS England to set new “test” for ICS structures (#2)
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** Blog: Big Four + Big Four: Adding up the Government’s lobbying links (#3)
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** International
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** Facebook allows advertisers to target children interested in smoking, alcohol and weight loss (#4)
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** BBC World Service: Africa Daily: Is Malawi really done with tobacco? (#5)
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** US lawmakers introduce a new bill to increase tobacco and e-cig taxes (#6)
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** UK
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** Black women face a significantly higher risk of having a miscarriage than white, research suggests. Findings from The Lancet’s analysis of 4.6 million pregnancies in several countries show that being from a black background increases the risk of miscarriage by up to 43%.

Currently, in the UK, referrals to specialist clinics usually occur after three consecutive losses. An estimated 15% of pregnancies end in loss, and 1% of women will experience recurrent miscarriage. The report also found that women who suffered a miscarriage from all ethnic backgrounds are more vulnerable to long-term health problems, such as blood clots, heart disease and depression. The research also suggests significantly increased risks of suicide, depression and anxiety for those who miscarry and says the impact on partners needs further investigation.

Findings from the report reveal miscarriage costs the UK at least £471 million a year due to a direct impact on health services and lost productivity.

Professor Siobhan Quenby, from the University of Warwick, who worked on the study and also runs a recurrent-miscarriage clinic, said: "There are things we can do to prevent miscarriage. It's not a condition that's hopeless."

Lifestyle changes could help - and about 30% of people referred to her clinic smoked, had uncontrolled diabetes, a high body-mass index or blood pressure.

"That means the health services missed three opportunities to get them into a better state for their next pregnancy," Prof Quenby said. A "graded response" was needed, she added, providing:
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** targeted advice after one miscarriage
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** additional tests after two
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** further investigations after three.
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** Source: BBC news, 27 April 2021

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** See also: Tommy’s - Miscarriage Matters: Findings from The Lancet Miscarriage Series and Implications for Policy with Recommendations ([link removed])

The Lancet - Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss ([link removed](21)00682-6/fulltext )
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Read Article ([link removed])


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** According to one of its directors, NHS England will be setting a “test” for the various ways in which integrated care systems want to organise their governance structures.

All areas are currently debating their Integrated Care System (ICS) structure as they are due to be created as legal entities for the first time in April next year if proposed government legislation is passed. One major consideration is the extent to which accountability and decision making will be positioned at the “place” level and how to decide the shape and size of each “place” area.

At an event on Monday (25 April), Bill McCarthy, regional director for the North West, said national leaders would recognise differences between ICS areas, meaning they will be allowed to structure themselves in ways that suit their communities. But he suggested NHSE will then scrutinise the proposed arrangements and decide whether they are justified.

Although the government’s white paper, published in February, specified several requirements of the over-arching ICS structures, and further guidance will come from NHSE, it is expected to leave room for variation. There have been tensions emerging in parts of Mr McCarthy’s region around the “primacy of place” and where funding is held. Local authorities are typically concerned about any new structures that will move decision making and accountability to a centralised ICS body. Proposed “place” arrangements typically match areas covered by top-tier/unitary local authorities, although this is not the case for all ICSs.

Speaking at the virtual event organised by the Health Devolution Commission, Mr McCarthy suggested “place” level arrangements will be more important in larger systems such as Greater Manchester, West Yorkshire, and Cheshire and Merseyside, and that this would help boost transparency.

Other governance issues which ICS are grappling with include future financial flows; how to deal with providers which span multiple ICSs; the relationship between the two boards they will be required to have (an “NHS body” and “partnership” board); what decisions each board can make; how to choose their leaders and whether they will span both boards; and the makeup of the rest of the two boards.

Last month NHSE chief Sir Simon Stevens said of the restructure: “We want to keep it as simple as possible and as flexible as possible locally and to do it in as evolutionary away as possible. Simple, local, evolutionary — those are the three watchwords.” He described the partnership board as “an advisory partnership arrangement.”

Source: HSJ, 27 April 2021
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** Andy Rowell and Phil Chamberlain of Tobacco Tactics at the Tobacco Control Research Group have written a blog piece where they attempt to unravel the complex relationships between the tobacco industry, those who speak for them and the people in power.

They highlight that The Big Four tobacco companies (British American Tobacco, Imperial Brands, Philip Morris International and Japan Tobacco International) have been running a long-standing campaign against legislation and product restrictions since people first realised the dangers of smoking in the 1940s. The UK, being a party to the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) has obligations to protect government policy making from the tobacco industry’s commercial and vested interests.

They point out that the UK has been relatively successful in meeting the obligations of the Framework, but its standards may be slipping. The UK Tobacco Industry Interference Index, which measures the extent of tobacco industry interference in national policymaking, reported the UK dropped from first place in 2018 to fourth in 2019.

They note that Boris Johnson’s administration has had direct links with the tobacco industry and “is the most tobacco-friendly administration we’ve seen in decades.” They point out that “It is riddled with ministers and advisors who have taken money from tobacco companies, voted against smoking proposals, promoted messages supportive of the industry, or who are ideologically opposed to public health measures.” This is a significant concern for public health measures and tobacco control advocates.

They highlight how tobacco industries have links with the global accounting firms Deloitte, PwC (PricewaterhouseCoopers), KPMG and EY (Ernst & Young). They state the tobacco industry has employed the Big Four as “both auditors and advisors for many decades.” The Big Four have helped the tobacco industry by “providing seemingly independent evidence to win public policy debates and advising on corporate responsibility to shift public perceptions of tobacco companies.”

The authors point out that the Big Four have long been influential voices in politics in Britain and worldwide, and they are calling on the Government to ensure rules to prevent lobbying and cronyism are “fit for purpose”.

Source: University of Bath, 28 April 2021
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** International
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**

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** Facebook allows businesses to advertise to children as young as 13 who express an interest in smoking, extreme weight loss and gambling for as little as $3, research by the lobby group Reset Australia has found.

Reset Australia set up a Facebook page and an advertising account under the name “Ozzie news network” to ascertain what options the company would provide through its Ads Manager platform. Even though Facebook does not allow advertising alcohol to people aged below 18, it has no mechanisms in place to stop advertisers from targeting children who have shown interest in alcohol.

The lobby group found that Facebook offered the page the ability to advertise to approximately 740,000 Australian children aged 13 and 17. In addition, they found that the page could advertise to teenagers aged below 18 who may have shown interest in alcohol, smoking, vaping, gambling, weight loss, fast foods and online dating services.

According to their findings, it would cost $3.03 to reach 52,000 teenagers for alcohol ads, while it would take $11.24 to reach 14,000 teens who may have shown interest in gambling. To reach about 1,000 teenagers interested in cigarettes or electronic cigarettes would cost between $138.50 and $210.97. Reset Australia has called on the federal government to develop a code regulating how data about young people can be collected and used. They say children and parents’ consent be involved in the process and full transparency over how the data is used, with only necessary data collected.

Chris Cooper, executive director of Reset Australia, said: “Facebook appears to use teenagers’ data in the same way as adults. This opens a can of worms about just how Facebook profits from underage data, and exactly what protection they have against inappropriate targeting.”

Source: The Guardian, 28 April 2021
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** For many decades Malawi’s economy has been based on tobacco. Tobacco is by far Malawi’s most lucrative export and is considered “green gold.” Following the long history of exploitation and influence of big tobacco, President Lazarus Chakwera says farmers need to turn to other crops.

Listen to Alan kasujja as he discusses Malawi’s most lucrative export and how easily can farmers adapt?

Source: BBC World Service: Africa Daily, 27 April 2021

Available for over a year.
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**
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** Several federal legislators have introduced the Tobacco Tax Equity Act of 2021 in the US Senate and the House of Representatives. The bill would establish a federal e-cigarette tax and increase the tobacco tax rate for the first time in a decade.

The Tobacco Tax Equity Act of 2021 aims to “close tax code loopholes for tobacco products by increasing the federal tax rate on cigarettes, pegging it to inflation to ensure it remains an effective public health tool, and setting the federal tax rate for all other tobacco products at this same level.”

Senate Majority Whip Dick Durbin said: “Tobacco-related disease accounts for one out of every five deaths in America, and I know that story firsthand. Data shows that the most effective strategy to prevent children from starting this deadly habit is to price it out of their range.”

Major public health and tobacco control groups like the Campaign for Tobacco-Free Kids (CTFK), the American Heart Association and the American Cancer Society Cancer Action Network have endorsed the proposal.

Source: Convenience Store, 26 April 2021
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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