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Letter: ‘Polluter pays’ levy can help the UK hit smoke-free 2030 target
When Javed Khan’s recommendations for how the government can level up health and wealth by delivering its smoke-free 2030 ambition were published last week, the FT, like other media outlets, made raising the age of sale the story.
However, while this will help stop hundreds of thousands of young people starting smoking each year, it will do little to solve the problem of how to get the 6mn already addicted to quit. To do that requires investment, which is why Khan’s top priority for the government was additional funding of £125mn for tobacco control. If the government is unable to find even this small amount, Khan has recommended a “polluter pays” levy on tobacco manufacturers. This is something we support, as does the House of Lords which passed, by a substantial majority, our proposed amendments to the health and care bill requiring a government consultation on such a levy.
Our model is not an additional tax passed on to smokers, so increasing the cost of living. Rather it is a system of price and profit control, modelled on the pharmaceutical price regulation scheme, introduced by a Conservative government and run very effectively by the Ministry of Health for over 65 years.
The government says it accepts the “polluter pays” principle, and pledged to consider funding tobacco control using this mechanism when it announced its smoke-free 2030 ambition in 2019. However, the minister, Lord Kamall, rejected our amendments because he said the government did not want to pre-empt the findings of the Khan review. That excuse has now run its course, and we will be urging the government to reconsider.
Lord Crisp
Former NHS Chief Executive: Permanent Secretary, UK Department of Health
Lord Young of Cookham
Former Conservative Health Minister
Lord Faulkner of Worcester
Lord Rennard
Vice Chairs, All Party Parliamentary Group on Smoking and Health
See also: FT article on increasing smoking age each year
Source: Financial Times, 15 June 2022
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Writing in the British Medical Journal (BMJ), Prof. Sanjay Agrawal, consultant in respiratory and intensive care medicine and clinical lead for the NHS tobacco dependency programme, discusses the implementation barriers for the recommendations in the recent Khan review on smoking.
Agrawal expresses doubt the four critical recommendations made in the report would be taken up by government, citing the immediate political climate “that has seen the government delay or dilute public health policy proposals” as the chief reason, such as recommendations to restrict foods high in salt and sugar, junk food advertising, and limiting two-for-one supermarket offers.
He highlights the high rates of tobacco addiction among deprived communities, arguing: “We need to prioritise measures that will help current smokers to quit and to reduce the number of young people ever starting this lethal habit. There is no silver bullet to achieve these ambitions, but instead a suite of measures is required, outlined in these reports.”
He concludes: “The biggest barrier to achieving this goal is not the knowledge of what works, it is the political will to make it happen.”
Source: BMJ, 15 June 2022
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Newham Council’s Trading Standards teamed up with specialist detection dogs to track down and seize illegal tobacco worth over £162,000 at a retail premises in the north of the borough during the weekend.
In the joint operation “Wagtails”, 250,000 cigarettes were successfully taken off the streets, as well as 30kg of hand-rolling tobacco, at a value of £9,000.
Commending the seizure, Councillor Carleene Lee-Phakoe, Cabinet Member for Crime and Community Safety said: “Illegal tobacco is dangerous and through our trading standards operations we are taking direct action to protect our residents by removing these harmful substances [...] Far from being a victimless crime, illegal tobacco trading provides affordable access for children and young people, makes it harder for people to give up as the product is cheaper, and affects the trade of legitimate retailers. This also supports the organised criminal gangs who smuggle the tobacco in and sell it on which has deep links to modern-day slavery.”
The crackdown was part of Operation CeCe, a national campaign which focuses on joint working between Trading Standards and HM Revenue and Customs.
Source: Newham Council, 15 June 2022
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Research published this week in JAMA Network Open shows the introduction of new eligibility criteria guidelines for individuals at high risk for developing lung cancer resulted in an increase in the proportion of African American patients who underwent annual lung screening. It is suggested that increased screening uptake will help reduce cancer disparities seen amongst the African American population.
The team reported that 54% of people eligible for screening by 2021 criteria were African American, whereas only 39% were African American in the group that were eligible for screening using the 2013 criteria.
Senior author of the study and pulmonologist Dr. Barta said: "Without screening, lung cancer is often discovered in late stages of the disease, when treatments are considerably less effective [...] This increase in the proportion of African Americans screened is encouraging as published data indicates that African Americans, specifically, will have a greater benefit, as defined as more lives saved from lung cancer screening."
The criteria first published in 2013 defined those at high risk for lung cancer as people from 55 to 80 years old who are in good health, have at least a 30 pack-year smoking history (smoking one pack of cigarettes per day for 30 years) and currently smoke or have quit within the past 15 years. In 2021, those recommendations expanded to include those between the ages of 50—80 and lowered the pack-year history to 20.
Dr Barta noted that for many “significant barriers persist long before a patient ever enters the exam room, such as lack of transportation, limited clinic hours, as well as attitudes and beliefs surrounding health care and smoking [...] To address these issues, the Jeffesron group is working towards expanding availability, increasing knowledge about screening, and implementing community-based approaches to outreach, especially to the historically under-resourced populations in the catchment area.”
Source: Medical Xpress, 15 June 2022
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A trial found that a new smoking cessation program administered by midwives was successful at facilitating more conversation with pregnant women about quitting. This trial was conducted at 20 midwifery practices and 3 hospital obstetric departments in the Netherlands in 2017 and the findings published in the journal Midwifery.
The existing V-MIS program comprised 6 steps in which the midwife or OB-GYN discussed smoking behaviour and motivations to quit and provided self-help materials and support. The PROMISE program in the trial complemented the V-MIS protocol with the addition of more referral options and distribution of educational leaflets and a carbon monoxide metre.
During the PROMISE protocol, the proportion of patients whom the practitioners discussed smoking cessation strategies with increased from 51.7% to 56.8%. Similarly, the proportion of smoking clients with whom the practitioners discussed smoking in general increased from 66.0% to 72.0%. Despite the increased discussion rate about smoking cessation, no significant increase in time spent conducting the intake interview or during consolation were observed.
The study authors concluded, “The PROMISE smoking cessation counselling protocol significantly improved the provision of smoking cessation support for pregnant women in the participating midwifery practices and obstetrics hospitals departments. Midwives and OB-GYNs are recommended to implement this protocol and its accessory materials in daily practice.”
Source: Psychiatry Advisor, 15 June 2022
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