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** 30 June 2021
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** UK
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** Jaw-dropping fall in life expectancy in poor areas of England, report finds (#1)
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** Dido Harding unlikely to “get the nod” to run NHS England (#2)
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** DHSC hiring three £110,000 policy directors (#3)
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** South East England: St Leonards man convicted for £250,000 illegal tobacco haul (#4)
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** International
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** Up in smoke: States are using the tobacco settlement money to balance their budgets (#5)
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** US: DC Council votes to ban the sale of flavoured tobacco, including menthol cigarettes (#6)
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** UK
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** Boris Johnson’s post-Covid “levelling up” agenda will fail unless it addresses declining life expectancy and deteriorating social conditions in England’s poorest areas, a leading authority on public health has warned, as he published figures showing the impact of the pandemic on Greater Manchester.

Sir Michael Marmot revealed the coronavirus death rate in Greater Manchester was 25% higher than the England average during the year to March, leading to “jaw-dropping” falls in life expectancy and widening social and health inequalities across the region over the past year.

The findings of the Greater Manchester report were “generalisable” across other deprived areas of England, added Marmot, saying: “It’s pretty bad for life chances to live in poorer parts of London, too. Levelling up shouldn’t only be about the Midlands and the northeast and the northwest [of England]. Deprived parts of London need attention as well.” The report shows life expectancy in northwest England fell in 2020 by 1.6 years for men and 1.2 years for women, compared with an average in England of 1.3 years and 0.9 years, respectively. Within the region, life expectancy dipped most sharply in the more impoverished areas. Such a rapid decline was in life expectancy terms “enormous”, Marmot said. Life expectancy had gone down all around the country, but the degree to which people were affected depended on two things: level of deprivation and the region of the country in which they lived.

Marmot called for a doubling of healthcare spending in the region over the next five years and a refunding of local government to tackle and prevent these inequalities and growing problems such as homelessness, low educational attainment, unemployment, and poverty. Future spending should prioritise children and young people, who had been disproportionately and disproportionately harmed by the impacts of Covid restrictions and lockdowns and had experienced the most rapid increases in unemployment and deteriorating levels of mental health.

A decade of government spending cuts had left the poorest parts of England in a weakened state when Covid hit in 2020, and there was an urgent need to do things differently, Marmot said, adding that as the UK emerges from the coronavirus pandemic, it would be a “tragic mistake to attempt to re-establish the status quo that existed before.”

Marmot proposed a “moral and practical” plan for government investment in jobs, housing, local services and education to tackle longstanding health and social inequalities in Manchester and similar areas. “If [the] government is serious about levelling up, here’s how to do it,” he said. Marmot’s proposals suggest the focus should be widened to address the social conditions that cause inequalities at a community level. “Levelling up really ought to be about equity of health and wellbeing,” he said.

The report was commissioned by the Greater Manchester Health and Social Care Partnership.
The mayor of Greater Manchester, Andy Burnham, said: “The pandemic has brutally exposed just how unequal England actually is. People have lived parallel lives over the last 18 months. People in low-paid, insecure work have often had little choice in their level of exposure to Covid and the risk of getting it and bringing it back home to those they live with. Levelling up needs to start in the communities that have been hit hardest by the pandemic. To improve the nation’s physical and mental health, we need to start by giving all of our fellow citizens a good job and good home.”

Source: The Guardian, 30 June 2021

See also: Institute of Health Equity - Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives ([link removed])
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** According to several senior government officials, Baroness Dido Harding’s chances of becoming the next head of NHS England have sharply diminished following Matt Hancock’s resignation as UK health secretary for breaching COVID-19 rules.

Amanda Pritchard, the health service’s chief operating officer, is seen as a frontrunner if Boris Johnson opts for an experienced continuity candidate. The prime minister and Sajid Javid, the new health secretary, have a veto on the successor to Sir Simon Stevens, who is due to step down on 30 July. Harding, regarded in Whitehall as a close ally of Hancock, has seen her reputation badly tarnished during her time heading NHS Test & Trace, damned by the independent National Audit Office as having failed to make “a measurable difference” to the spread of the coronavirus pandemic last year.

Following Hancock’s resignation on Saturday (26 June) after breaching social distancing rules, senior government officials with knowledge of the process suggested that Harding’s chances of snagging the post were fading. An ally of the prime minister said he “did not want further controversy” at the Department of Health and Social Care, adding: “I can’t see Dido getting the nod, especially after the last couple of days.” Unlike Hancock, Javid is not a close friend of Harding, according to the new health secretary’s allies. “I’ve never thought of her as a frontrunner, and that won’t change,” one senior Tory said. One senior Conservative MP said: “There’s no chance [Harding’s] going to get it. It would be politically toxic, given how disastrous test and trace has been. Hancock was the only one pushing her.”

However, a senior Downing Street official insisted it was an “open process”, and no formal decision had been taken on which candidate would be favoured to succeed Stevens. Whitehall insiders said Downing Street was still weighing whether it wanted a seasoned health service insider, able immediately to grasp the reins of a pandemic-battered NHS or a “change agent” from outside the system who could think radically about how to ease the strain on the health service.

Javid has yet to indicate to officials his preferred choice to lead the NHS. As well as Pritchard, other candidates are understood to include Sir James Mackey, head of the NHS in Northumbria, Tom Riordan, chief executive of Leeds city council, and Mark Britnell, vice-chair of advisory service KPMG and a former long-serving senior NHS executive.

Source: Financial Times, 28 June 2021
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** The Department of Health and Social Care (DHSC) is looking for three policy directors for its new Office for Health Promotion (OHP), to be paid £110,000 or more. The OHP is taking on responsibility for the prevention work of Public Health England, which is due to be abolished later this year.

The directors will report to the OHP’s joint leads: its director-general Jonathan Marron, who was latterly DG for public health at DHSC, and the deputy chief medical officer for health promotion, who has yet to be recruited.

The new OHP will focus on “a range of major themes, including healthy weight, addiction and inclusion, and children’s health.” Two of the new directors will cover two of these themes. With a wide-ranging and potentially powerful remit, a third director will take on “cross-cutting and enabling functions.” The director of addiction will develop and deliver a government strategy for “tackling key addictive risks to health – drugs, alcohol, gambling and tobacco”. They will “focus on driving down the prevalence of addiction and dependency, and prevention of all forms of violence”, as well as working on “related policies to support vulnerable or excluded groups.”

The director of diet, obesity and healthy behaviours will deliver “an ambitious package of regulation” around nutritional reformulation, weight management, and increasing physical activity in pursuit of the 2030 obesity reduction targets. They will also oversee “three large scale government contracts” worth £250 million, covering health food schemes, school sports and physical activity, and the healthy weight programme.

Source: HSJ, 29 June 2021
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** A St Leonards man has been jailed following the largest ever haul of illegal tobacco in East Sussex. East Sussex County Council (ESCC) said the man was handed a three-year prison sentence after pleading guilty to five counts relating to trademarks, tobacco packaging and money laundering offences.

The conviction follows an inspection at a Hastings self-storage company by East Sussex Trading Standards, with a specially trained tobacco detection dog, in October 2018. ESCC said officers found large amounts of cigarettes and hand-rolling tobacco, the majority of which was counterfeit.

Councillor Rupert Simmons, East Sussex County Council’s lead member for economy, said: “Our officers work tirelessly to reduce the supply of illegal tobacco in East Sussex and this latest conviction, the largest haul they have ever uncovered, demonstrates how committed they are. The sale of illegal tobacco brings organised crime into our county and encourages smoking among young people due to cheaper prices and undermines efforts to discourage smoking. We hope that every conviction sends a clear message to anyone involved in the supply of illegal tobacco that we will not tolerate this in East Sussex and will do everything in our power to bring them to justice.”

Source: The Argus, 30 June 2021
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** International
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** US states are “penny-wise and pound-foolish” when it comes to public health, and spending money warns tobacco control advocate, Campaign for Tobacco-Free Kids (CTFK).

In 1998, 46 states and several US territories came to a ground-breaking settlement with major tobacco companies. The “Master Settlement Agreement (MSA)” set rules restricting tobacco marketing and sales while also requiring the industry to pay states billions of dollars annually — amounts intended to help local governments address the economic toll stemming from tobacco use. But 23 years later, as states finalise their fiscal 2022 spending plans, those tobacco settlement revenues are generally being counted to balance the budget, rather than to fund stop-smoking programs or treat smoking-related health problems, such as lung cancer.

Kentucky plans to balance its general fund budget next year with $103 million from its tobacco settlement revenues. In Kansas, settlement revenues will go toward “various children’s programs.” And Connecticut counts its money as just another general fund revenue source.

According to CTFKs most recent annual report, states will collect $26.9 billion from the tobacco companies in Fiscal Year 2021 but spend only 2.4% of it, or $656 million, on cessation and prevention initiatives. That $656 million is barely one-fifth the amount that the Centers for Disease Control and Prevention recommends the states spend. “Not a single state currently funds tobacco prevention programs at the level recommended by the CDC,” the report adds.

John Schachter, who runs the state advocacy effort at the national CTFK, said: “We know that investing in these programs is financially wise. It will keep kids and others from smoking and, ultimately, in the long term, bring down healthcare costs. But it is a long-term process, and if a state moves the money elsewhere, they can see that impact now.”

The MSA’s legacy has been disappointing enough that advocates say it should not serve as a template for future settlements as the money starts flowing from agreements to end opioid-crisis lawsuits. Some caution that any such settlements should have more teeth. “Make sure you put in details about how much should be spent and on what,” Schachter said.

Source: Market Watch, 29 June 2021

See also: Tobacco Free Kids report - A State-by-State Look at the 1998 Tobacco Settlement 22 Years Later ([link removed] )
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**

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** The District of Columbia (DC) Council voted Tuesday (29 June) to ban the sale of flavoured tobacco products and menthol cigarettes.

The 8 to 5 vote came after a debate in which council members who opposed the ban raised concerns that the law could create opportunities for Black smokers, who are more likely to smoke menthol cigarettes, to be harassed by police. It was the council’s second vote in favour of the legislation, meaning that it now heads to the desk of Mayor Muriel E. Bowser, who supports the ban for health reasons and is expected to sign it into law.

The District joins Massachusetts and some other cities to ban menthol cigarettes and other flavoured tobacco products around the country.

The Biden administration has also vowed to eventually outlaw such flavoured tobacco products, including menthol, nationwide.

Source: The Washington Post, 29 June 2021
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