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** 12 July 2021
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** UK
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** Put health and wellbeing at heart of levelling up, Marmot tells ministers (#1)
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** Covid: NHS backlog in England could reach 13 million, says Javid (#2)
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** International
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** Nicotine by-product can predict recurrence of bladder cancer (#3)
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** Canada: Cigar lounges exempted in new Alberta smoking and vaping regulations (#4)
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** Opinion - Australia: A decade on from plain packaging, what is the result? (#5)
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** UK
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Michael Marmot has called on the Government to put health and wellbeing at the heart of its levelling up policy to show that it is ''serious about levelling up’’. The comments from Professor Marmot came at the Local Government Association conference last Thursday (8 July) amidst new evidence of falling life expectancy. A study released by Professor Marmot last week showed that female life expectancy has fallen by 1.2 years in Greater Manchester whilst for men the fall was 1.6 years.

Marmot said that figures like these meant that local government should be ''serious about addressing the conditions through the life course in which people are born, grow, live... the social determinants of health to get health equity - and there's much that can be done at local city regional level, but it does need central government to come in behind. If they're serious about levelling up, they have to put equity, health and wellbeing at the heart of all government policy.”

Also speaking at the session was Bradford City MDC chief executive Kersten England, who said half of all of her city’s deaths from Covid had happened in 20% of neighbourhoods – those which were the poorest. Ms England was critical of the government’s vision of levelling up, which has often been perceived to revolve around centrally led competitions for regeneration cash, including the towns fund and the levelling up fund. Ms England said that levelling up was more ''about equity, about places having plans for how they can produce equitable outcomes across the critical things that make the quality of life.”

Source: LGC Plus, 9 July 2021
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** The health secretary has warned that NHS waiting lists in England could more than double in the coming months. Sajid Javid told the Sunday Telegraph that he was ''shocked’’ when officials warned him that the backlog could reach 13 million patients, up from the current figure of 5.3 million patients who are waiting for routine operations and procedures in England.

A BBC analysis found in May that almost a third of hospitals had seen long waits for treatment increase - with more than 10% of patients going a year or more without treatment. In March, around five million patients were waiting for surgery - the highest number since modern records began. Increasing Covid numbers are also applying pressure on hospitals with a few hospitals in the UK announcing that non-urgent surgery is being postponed because of rising Covid admissions.

Javid also told the Sunday Telegraph that waiting lists were his priority. Among the solutions being considered, according to Javid, would be to pay private healthcare providers to treat NHS patients and keeping virtual doctors’ appointments.


Source: BBC News, 11 July 2021
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** International
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** New research has found that a biproduct of nicotine found in the urine of smokers could be used to identify when bladder cancer has returned. The research found that patients with high levels of cotinine were four times more likely to have their bladder cancer return compared to those with lower levels of the chemical. The researchers hope that the results might enable a simple urine test for cotinine to replace the numerous invasive investigations that cancer patients currently undergo following diagnosis and treatment.

The study, led by researchers from the Notre Dame de Secours University Hospital in Lebanon, checked the cotinine levels of 135 patients who were attending hospital for follow up cystoscopies over an 18-month period. The patients were those with low-risk bladder cancer who had not received chemotherapy or radiotherapy and had no other condition. Smoking is a major risk factor for bladder cancer whilst cotinine is a chemical that is made by the body from nicotine.

The study found that eighty of the patients had levels of cotinine consistent with heavy smoking: over 550 ng/ml. Three-quarters of these patients went on to develop cancer again compared to just 18% of moderate smokers (those with cotinine levels below 550 ng/ml). The researchers are now actively looking for other hospitals around the world interested in collaborating on the research to broaden its participants.

Source: Scienmag, 9 July 2021
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** Health groups in Canada have criticized the Alberta government’s decision to put forward an exemption allowing cigar lounges in the province. Health groups say that the exemption, contained within an order-in-council approved by cabinet on June 23rd, will set back anti-smoking legislation by more than a decade.

The exemption allows cigar lounges to exist if they prohibit food, beverage, and cleaning services during hours of operation and forbid minors from entering. The lounges must have floor-to-ceiling walls completely separate from any area they are connected to, self-closing doors, and a separate ventilation system that maintains negative air pressure and exhausts smoke outside the building.

Angeline Webb, regional manager of health policy and health promotion with the Canadian Cancer Society, said: "We believe it's a very regressive reversal of 13 years of effective public health policy that protects the public and particularly hospitality workers' from exposure to second-hand smoke. The allowance of smoking in cigar lounges serves the desires of a few."

Health ministers have so far been vague in explaining why the exemption was allowed.

Source: CBC, 11 July 2021
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** The Sydney Morning Herald asks what the results have been 10 years on from plain packaging in Australia.

By all metrics, plain packaging has been a success. Twenty countries have since bought in their own versions of plain packaging, including the UK, Turkey, France, Sweden, Belgium, the Netherlands, and Ukraine. Smoking rates in Australia have continued to fall. Data from the National Drug Strategy Household Survey estimated about 11.6% of adults smoke daily, down from 12.8% in 2016 and more than half the 25% who smoked in 1991.

Professor Melanie Wakefield, who heads the centre for behavioural research at the Cancer Council of Victoria and was also on the advisory group to government on plain packaging implementation, said plain packaging has had a measurable impact. “Plain packaging accounted for about a quarter of the total decline in smoking prevalence in three years after plain packaging. And so Australia had about 100,000 fewer smokers as a result,” she says. She also says it has had an impact on youth smoking rates. “In the last national survey, only 5% of secondary school students had smoked in the last week, and that was down by a third from before plain packaging.”

Professor Wakefield says it’s time to revisit and update our tobacco regulations as the industry evolves new marketing strategies to recruit and hold customers. “There’s always more to be done because the industry never stands still, it’s very agile,” she says, pointing to gimmicks including crushable menthol capsules in filters as an example, or bonus cigarettes in packs. “We’d like to see the return of a fully-funded national tobacco campaign, which will bring to life some of the new harms caused by smoking that people don’t know about.”


Source: Sydney Morning Herald, 12 July 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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