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** 18 March 2022
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** UK
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** Trusts told to make savings 'never delivered before by the NHS' (#1)
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** International
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** Opinion: Big Tobacco's future in Russia goes up in smoke (#2)
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** US adult smoking rate fell during first year of pandemic (#3)
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** Parliamentary Activity
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** Lords Private Member's Bill third reading: Health warnings on cigarette sticks (#4)
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** Links of the Week
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** The King's Fund - Equity and endurance: how can we tackle health inequalities in this time? (#5)
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** The Leader podcast: A top addiction psychologist taking on Big Tobacco (#6)
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** UK
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** NHS trusts are facing challenging savings targets as high as 5% of their total costs which many say will be impossible to deliver. Sources told HSJ that there is widespread doubt whether the asks for 2022-23 will be deliverable. Trusts with underlying deficits will be given the highest efficiency targets with one trust’s audit committee saying this “has never been delivered by the NHS in a single year” and another finance director saying that 3% savings in one year would normally be seen as a good result.

The new financial year will see an end to more generous COVID-19 funding arrangements and a return to the kind of financial oversight that has not been seen for two years. Previous research has suggested trusts averaged long-run savings of about 1% per year in the years running up to the pandemic and the baseline assumption set in the 2019 NHS long-term plan was for annual efficiencies of 1.1%.

Many trusts are saying that they will have to make savings of more than they did before COVID-19 even though they have greater care backlogs now, more demand for services, and workforce shortages. Trusts are also expressing concern about rapidly rising inflationary pressures including energy and fuel costs. In the spending review last October, the NHS was given real-terms annual growth of 3.8%, yet the Institute for Fiscal Studies warned this week that rising inflation had already eroded a quarter of the value of the planned NHS spending boost over the coming years. It said inflation forecasts produced before Russia’s invasion of Ukraine, which is expected to send inflation even higher, would see average NHS real-terms growth drop to 2.9% per year.

Despite these pressures, Ben Zaranko, senior research economist at the IFS, said there was little prospect of Rishi Sunak looking again at the health service budget at the spring statement next week.
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Source: HSJ, 18 March 2022
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** International
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** John Gapper, business columnist at the Financial Times, says that Big Tobacco has been slow to pull out of Russia because of the importance of the Russian market for its heat-not-burn tobacco devices.

Gapper says that Big Tobacco’s retreat from the Russian market has been “halfhearted”. Philip Morris is suspending investment in Russian and “scaling down” manufacturing whilst British American Tobacco and Imperial Brands will transfer their operations to local partners. However, exactly what happens to the brands and how the operations will work remains unclear.

Professor of public health at University of Bath Anna Gilmore is sceptical. Gilmore says: “I think they’re fudging. I predict Marlboro and Lucky Strike will still be sold there, and they will keep the brands and take the profits.” Russia has been a profitable market for Big Tobacco, with Philip Morris and Japan Tobacco dominating what is the world’s fourth-largest market for tobacco.

However, Grapper says that Russia is most important as a “testing ground” for Big Tobacco’s tobacco alternative heat-not-burn tobacco products. One Big Tobacco executive hailed the “very spectacular progress” in Russia. Philip Morris’ IQOS products had 15% of the Moscow market in 2020 and nearly one-quarter of Philip Morris’ global heat-not-burn sales volumes are in Russia and Ukraine.

Gapper argues that “this is why Philip Morris and others are reluctant to beat a full retreat from Russia”. Gapper notes that the China National Tobacco Corporation is “waiting in the wings” in Russia, showing that even a Big Tobacco retreat may not seriously dent tobacco use in Russia.

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** Source: Financial Times, 18 March 2022
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** New survey data released on Thursday 17 March by the Centers for Disease Control and Prevention (CDC) shows that US cigarette smoking dropped to an all-time low in 2020. The data found that the first year of the Covid-19 pandemic saw more Americans drinking heavily or using illicit drugs but not smoking. The data found that one in eight adults say they were current smokers.

The CDC report was based on a survey of more than 31,000 US adults. It found that 19% of Americans used at least one tobacco product in 2020, down from about 21% in 2019. Cigarettes were the most commonly used tobacco product. Use of cigars, smokeless tobacco, and pipes remained fairly stagnant. However, use of electronic cigarettes dropped to 3.7% from 4.5% the year before.

The rate of smoking has been gradually dropping for decades in the US for various reasons including taxes and smoking bans. However, experts say that a big part of the recent rate of decline may be due to price hikes. For example, British American Tobacco increased prices four times in 2020, by a total of about 50 cents a pack. Pandemic lifestyle changes are also said to have had an effect.

However, the number of cigarettes sold in the US actually increased in 2020, the first such increase in two decades, the Federal Trade Commission reported last year. This shows that though fewer people smoked, those who did smoke were may have consumed more cigarettes due to having more opportunities to smoke because they were at home for longer and not going to work.
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Source: Medical Xpress, 17 March 2022
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** Parliamentary Activity
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Today, Peers debated Lord Young of Cookham’s private members Bill on Cigarette Stick Health Warnings at third reading in the House of Lords. The Bill would extend the logic of cigarette warnings on packs to the cigarettes themselves, requiring both cigarettes and cigarette papers to require health warnings such as ‘Smoking Kills’. Introducing the Bill, Lord Young of Cookham said that cigarette warnings would be particularly effective in dissuading young people from smoking and would help England to lead the way as the first nation to introduce the measure. Baroness Merron spoke in support of the Bill on behalf of Labour, describing it as a further step towards driving down smoking rates and discouraging young people from taking up smoking. Responding for the Government, Lord Kamall, Parliamentary Under-Secretary of State for Innovation, congratulated Lord Young for progressing his Bill to this stage, saying that he had been assured that a health disparities white paper and a “robust”
Tobacco Control Plan, focused on levelling up and tackling smoking in disadvantaged groups, would be published later this year.
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You can view a recording of the debate below (10:18:12 - 10:25) and read a briefing on the bill here ([link removed]) .
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** Links of the Week
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Toby Lewis, David Buck, and Lillie Wenzel of The King’s Fund offer their view on how the UK can tackle the health inequalities exacerbated by COVID-19. They say that concurrent action is needed at multiple levels: an enduring national mission to tackle inequality; a new local and national partnership to create the conditions for system success; and local leadership to nurture the disruption needed to sustain success.
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** As part of the Evening Standard’s International Women’s Day special series, listen to Ann McNeill, professor of tobacco addiction at King’s College London, discuss her interest in tobacco addiction, leadership in academia, and how her team’s pioneering research led to an overhaul of tobacco displays in UK shops. Professor McNeill, one of Britain’s leading tobacco addiction experts, has published over 350 research papers on subjects around the impacts of smoking and vaping.
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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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