11.09.2015 The cooperation of all stakeholders for comprehensive action is the key to success
Interview Jo Locker. As guest speaker at the 4th Tobacco Prevention Partner Conference, Jo Locker, Tobacco Programme Manager from Public Health England (PHE) gave a presentation on the work of her organisation. We spoke with Jo Locker about ambitious goals, alliances and strategies for successful prevention –along the path leading to the PHE's vision of a «tobacco free generation».
spectra: Public Health England has a vision of a “Tobacco Free Generation”. What do you mean by this – zero prevalence?
Jo Locker: Our aim is to reduce smoking prevalence amongst 15-year-olds to five percent by 2025. This includes regular and occasional smokers. At the moment, about 13 percent of that age group are regular or occasional smokers. So, this is a fair job to do, but we think it is a very important job. We especially don’t want the occasional young smokers to become regular smokers.
How much of your success in dropping the smoking rate is due to regulation and how much to behavioural interventions?
It is not possible to give exact proportions. Both approaches are indispensable parts of the comprehensive package. We need regulations to restrict smoking, advertising, availability and so on. But we also need information, campaigns and stop-smoking interventions. People have to know about the harms of smoking, and where they can get help if they want to quit, so we need to follow both approaches.
What has been the biggest development in British tobacco control in the past years?
Over the past ten to fifteen years we have been implementing a comprehensive tobacco-control strategy. In order to help people quit smoking, we must have effective communication, action on smoke-free legislation, regulations on advertising, and influencing both on supply and demand of tobacco products. We have strong leadership and strong voices across the system. That includes the government, the NGO community, and health services as well. Furthermore, everything we do is based on evidence. To put it in a nutshell: we have a comprehensive approach with a strong leadership and a strong evidence base. You mentioned the strong voices advocating tobacco control.
Are you referring to certain individuals?
By that I meant mainly organisations. Earlier I talked about “One message, many voices” which means that different organisations can carry the message into different settings. So, depending on the issue, different people can frame the message in a way that resonates with the members of their particular community, whether that is the government, the population, or medical professionals. There are a range of people and organisations coming from different perspectives, but they can carry the same consistent message.
What is the role of Public Health England?
Public Health England was established in 2013 and is an executive agency of the Department of Health, providing expert advice and information on the full range of public health topics. Whilst the Department of Health has a regulatory focus, Public Health England is more focused on implementing, providing, and presenting the evidence base of public health issues to the government. Since PHE was established public health issues have been able to develop a much higher profile - communication with both stakeholders and the public is an important factor.
Who coordinated this cooperation?
The Smoke Free Action Coalition coming together in the lead up to the smokefree legislation in 2007 was certainly quite fundamental. It was led by the main charities, such as Action on Smoking and Health (ASH), Cancer Research UK, and the British Heart Foundation, who together formed an umbrella organisation for the NGO community in order to become a more powerful collective voice and to achieve more consistency among their own organisations. So there weren’t just NGOs engaging in heart issues, or respiratory issues, or cancer issues. Everybody came together to form a stronger force. Organisations become very powerful when they build good relationships among one another, as well as with politicians and other communities. There is, for instance, an “All Party Parliamentary Group” consisting of politicians from all political parties that focuses on tobacco and health issues. They take advice and evidence from other organisations, such as ASH and Cancer Research UK, as well as academics and regulatory bodies. This is a good way of the getting the evidence into the parliamentary debate. There is also an organisation called the UK Centre for Tobacco Control Studies, in which academics come together to coordinate research activity. This helps them to create better projects with more funding and to share their findings across a broader spectrum of researchers.
That is a model worth copying.
In my opinion yes, definitely. Everything we have achieved is the result of collective, collaborative, and comprehensive action.
How does the general public react to the tobacco control measures?
We know from annual surveys that people are generally very supportive of tobacco control issues. Over 80 percent of those surveyed think that the government should do more to protect children from starting to smoke. Seventy percent think that the government is either doing enough or should do more to reduce smoking rates. It is very helpful to understand what the general public are thinking and to know that they are so supportive of tobacco control measures and want to see more of them. It is also important for politicians to be aware of this as they are obviously influenced by what the electorate think. Understanding where the general public are on these issues helps to foresee how the measures you propose might be received.
The smoking rate in England dropped from 27 percent in 2000 to 18.4 percent in 2014.What is the goal for the future?
The current tobacco control plan for England comes to an ends this year. The ambitions within that plan are to reduce the general smoking rate to 18.5 percent or less, the rate among pregnant women to 11 percent or less, and the rate amongst 15-year-olds to 12 percent or less. We are on track to achieve all of these goals by the end of this year. The Public Health minister recently announced that there will be a new Tobacco Control Plan for England to follow on from this, so we now await the development and publication of this.
The newest legislation in England in the field of tobacco control is the Children and Families Act. What are its main measures?
There are a number of tobacco control related measures within this Act, but on of the main aspects means that it becomes an offence to smoke in a car carrying children under 18. This will be in force from 1st October of this year.
How did the general public react to this?
They are again is very supportive. The most recent figures show that around 80 percent are supportive of a ban on smoking with children in the car. When it comes to measures protecting children and young people there is generally very little resistance.
Would the next step be to ban smoking at home if children live in the same household?
This is not a measure that is being debated at the moment. The recent legislation is specifically about smoking in cars since we know that toxicity in such an enclosed, confined space is very high. We also know that since 2007, the number of children being exposed to smoke in their homes has already dropped. Since the introduction of the Smoke Free Legislation for enclosed work and public places, the number of people smoking in their homes has reduced as well. Initially there were some concerns that once people were not allowed to smoke in restaurants and bars they would smoke more in their homes, however, research shows that this is definitely not the case. Raising awareness and providing information are key here.
In 2007, the minimum age for purchasing cigarettes was increased from 16 to 18. How do 15-year-old and younger smokers get their cigarettes?
Unfortunately they get them from friends, older siblings, or their parents. There is also an issue relating to illegal tobacco with smuggled or counterfeit tobacco being sold by criminals to young people. Therefore, another big part of the tobacco control programme is around reducing the supply and availability of illicit tobacco.
How has tobacco control changed over the years and decades?
The focus has not changed, it has always been around preventing deaths caused by smoking. Tobacco is the main cause of preventable deaths in the UK. So the objective has always been to reduce smoking prevalence. We try to achieve this objective with a comprehensive strategy.
Is there a limit to what can be achieved by regulations?
Regulations are a very important part of the strategy and we should make the best of the regulations already in place. For example, the ban on advertising has been in place since 2002, so there will now be a generation of young people who have never seen a tobacco advertisement on TV or billboards, or watched sporting events sponsored by tobacco firms. There will be a whole generation who has not been exposed to this advertising and imagery. Continuing this trend is very important and the implementation of standardised packaging in 2016 will help to ensure future generations of young people are further protected from advertising and promotion of tobacco. We also know that the prevalence of adult smoking has a big impact on young people smoking. So we have to reduce the prevalence overall in order to reduce the prevalence among young people.
How did people react to the standardised packaging?
Current research shows that at least 60 percent of people support it. A big part of the overall information strategy has been to explain how strong the influence of glitzy packaging is on young people. According to surveys in Australia, where standardised packaging was implemented a year ago, people reported that their cigarettes do not taste as good when they come in standardized packaging, so there are likely to be opportunities to reduce tobacco use in current smokers as well as for future generations.
How did the industry react to the ban on advertising and sponsoring?
There was a number legal challenges, none of which were successful. There was also some contention that banning tobacco companies from sponsoring events would be harmful to sports, such as Formula 1 racing and snooker. But of course, the financial void was filled quickly with other companies, industries, and organisations.
Your message today is “Smoking still kills”. Why the “still”?
Yes, “Smoking still kills” is the new report being published by ASH today. “Smoking kills” was the government white paper in 1998. Ten years on from that ASH published a document called “Beyond smoking kills” which was about what we had achieved and what should happen next. Their new focus and plan is to emphasise that smoking still kills, meaning that the tobacco control job is not done yet, that smoking is still causing 80'000 preventable deaths every year in England alone, and that young people are still starting to smoke. So we still have a lot of work to do.
What is your main message in the media campaign?
It depends on the audience. PHE has different media campaigns throughout the year. In the January to March period, we have run a “health harms” campaign for a few years now, with a different strapline every year. Most recently, “Every cigarette rots you from the inside” or “Every 15 cigarettes you smoke cause a mutation that can become cancer”. Every year in October we run a campaign called “Stoptober”, which is a mass quitting event designed to engage people from different communities in stopping together for 28 days, to get started with quitting altogether.
You said that successful tobacco control needs strong leadership. Who is it in the UK that takes on this leadership?
The government, Public Health England, NGOs, the health service, all together. You need strong leaders across the whole system and on all national and local levels to be able to stand up and put a voice to the messages, to present the evidence and to be ambitious in terms of the goal of reducing the harm of smoking.
Do you consider e-cigarettes to be a threat to your efforts and achievements?
More than two and a half million people in the UK use e-cigarettes today. Current evidence shows that e-cigarettes are around 95 percent less harmful than regular cigarettes. We are not saying that they are completely without risk, but they are substantially less harmful. People now use them as part of their quitting attempts or to reduce the risk from smoking. At the moment, it is very rare that anybody who is not already a smoker starts using e-cigarettes. So considering the evidence, e-cigarettes seem to be part of the solution, not part of the problem. But we need to be mindful of this rapidly evolving agenda and continue to monitor what is happening, who uses e-cigarettes, and what the messaging around them is.
Simone Buchmann, Communication Manager of Tobacco section, firstname.lastname@example.org