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Opinion: The seemingly fair principle that is driving NHS inequality
Sally Gainsbury and Polly Mitchell in the Health Service Journal highlight the need to tackle growing inequalities in the healthcare industry. With the NHS principle of fairness promoted in the slogan “equal access for equal healthcare need”, they write that in practice, when it comes to elective care, a cruder principle prevails: first come, first served. Under the 18-week referral to treatment target, all non-urgent patients are, in theory, subject to the same standard waiting time.
Gainsbury and Mitchell state however that people from more socially deprived groups often present “late” for care and with more severe disease. After controlling for more severe symptoms, these patients also take longer to recover from surgery because of environmental factors linked to their socioeconomic position. The result is an approach that drives inequalities in actual rates of access and health outcomes.
They point to University Hospitals Coventry and Warwickshire Trust (UHCW), who, when making decisions about surgical waiting lists, considered social circumstance as well as clinical need and referral date. They suggest the UHCW initiative could be seen as an attempt to better ensure equal access rather than undermine it.
In the long term, sustainable change will require action beyond the NHS, for example on housing and income security. But until then, NHS organisations need clarity on what ethical principles to apply when prioritising resources to tackle healthcare inequalities. One suggested principle is a focus on unequal health outcomes. Scheduling deprived patients for surgery earlier than clinically similar but more affluent patients could help close the healthy life expectancy gap, by increasing, pro-rata, the allocation of healthy life years to those who have less of them.
Gainsbury and Mitchell conclude that setting an aim such as closing the HLE gap helps us to judge the value of interventions and move the conversation with the public beyond the unhelpful notion that inequalities can be resolved through a cost-free process of “levelling up”.
Source: HSJ, 15 September 2022
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Global study: Children whose parents breathed cigarette smoke more likely to get asthma
Children are much more likely to develop asthma if their father was exposed to tobacco smoke when he was growing up and they are at even greater risk of suffering from the common lung condition if their father was a smoker himself, a new study undertaken by a team of Australian, British and Sri Lankan researchers has found. The findings, published in the European Respiratory Journal, provide further evidence for the possible existence of a “transgenerational effect” in which smoking can damage the health of people born two generations later.
Scientists looked at rates of asthma in 1,700 children and compared that to whether their fathers or grandfathers smoked collected as part of the long-running Tasmanian Longitudinal Health Study in Australia. Children whose grandparents smoked were 59% more likely to have non-allergic asthma by the age of seven, meaning they were more likely to get asthma even if they had not been exposed to smoke themselves.
Children whose fathers also smoked after being exposed to it while growing up had a 72% greater risk. Scientists said this suggested that secondhand smoke damaged the development of sperm during puberty in a process called epigenetics - modifications to genes in which someone’s DNA sequence is not altered. Bui said that men should therefore avoid smoking to reduce the risk of ill health of their children.
Jon Foster, the health policy manager at Asthma + Lung UK, said: “This research is truly shocking, showing that the negative effects of smoking can last for generations. The fact that children born today have a 59% increased risk of developing asthma if their father was exposed to passive smoking as a child shows the huge impact smoking has on other people’s health.”
Prof Jonathan Grigg, the chair of the European Respiratory Society’s tobacco control committee, who was not involved in the study, said it added to the evidence of smoking’s intergenerational risk. Children needed to be protected from further damage by ministers taking further robust action to curb smoking, he said. He called for stop smoking services to be increased and for adults to be routinely asked at any NHS appointment if they smoked, and offered help to quit if they do.
Source: Guardian, 15 September 2022
See also:
The Times - Lung damage from smoking ‘passed down genetically’
Independent - Fathers who smoke risk giving asthma to grandchildren
Study - Pre-pubertal smoke exposure of fathers and increased risk of offspring asthma: a possible transgenerational effect
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US: Philip Morris appoints another FDA official to key role
Philip Morris International Inc (PMI), maker of Marlboro cigarettes, said on Wednesday it had appointed two former US Food and Drug Administration (FDA) officials to key positions at a time when tobacco companies have come under intense regulatory and public scrutiny.
Badrul Chowdhury, who spent more than two decades at the FDA, has been named chief life sciences officer, joining from a US-based biotech firm. Chowdhury's LinkedIn page shows he is the chief medical officer at Savara, a company focused on rare respiratory diseases.
Matthew Holman in July was named as the vice president of US scientific engagement and regulatory strategy, joining from the FDA, where he helped guide policy decisions and oversee a regulatory science research program for tobacco products.
Dr. Holman’s move has been described as an example of the “revolving door” between federal officials and the industries they regulate. Currently, federal rules governing “revolving door” career moves do not prevent an official from overseeing regulatory matters one week and joining a corporation with products under review the next. Dr. Holman’s move has also raised questions about agency approvals, including that of Philip Morris’s heated tobacco product IQOS, which some researchers have found troubling.
The appointments follow the addition of another former FDA official, Keagan Lenihan, to a senior role earlier this year.
Source: Reuters, 14 September 2022
See also: Tobacco Tactics - The revolving door
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US study: Many 'smoke-free' hotels expose guests to thirdhand tobacco smoke
A new study has explored how well hotels' smoke-free policies protect guests from secondhand smoke pollutants and thirdhand smoke residue that lingers in dust, carpets and furniture.
San Diego State University researchers analysed more than 332,000 TripAdvisor guest reviews about their experiences staying in 477 U.S.-based hotels across 10 states. Of the included hotels, 96% were smoke-free according to TripAdvisor but only 63% of the hotels' websites stated they were smoke-free. For every 100 reviews from non-smoking rooms, there were, on average, ten complaints related to tobacco, electronic cigarettes, or cannabis pollution. Of these complaints, 80% were about thirdhand smoke residue left behind from tobacco products used by previous guests rather than secondhand smoke from other guests actively smoking.
One of the study's researchers, Georg Matt, an SDSU professor of psychology and public health, noted, "Many hotels claim to offer their guests smoke-free rooms, but cannot live up to this promise. This is a particular concern for guests who cannot afford the more expensive hotels."
Some of this stark contrast can be attributed to whether hotels enforce smoke-free policies. On average, hotels that promised entirely smoke-free buildings had 26% fewer complaints than hotels that allow smoking in designated hotel rooms. Hotels with ratings lower than two out of five stars had twice as many tobacco-related complaints as higher-star hotels. And hotels in Los Angeles, Detroit, and Birmingham had the most complaints, while those in Salt Lake City and Omaha had the fewest. Each $20 increase in price per night was associated with a 13% reduction in complaints about smoking.
Matt said that hotels trying to create 100% smoke-free experiences for their guests and potentially improve their ratings should do away with designated smoking rooms, urging that converting to smoke-free properties and remediating designated smoking rooms are the only ways to protect guests from secondhand and thirdhand smoke.
Source: Medical Xpress, 14 September 2022
See also: Study – Guest complaints: Lessons for Implementing Smoking Bans
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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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