Essay: UK's National Legislation On Smoking And Tobacco Shapes Public Health Strategy.

Introduction to Public Health Strategy

This paper is focused on the public health strategy. The public health strategy of any country always aims to protect the health of its citizens by all means and obviate diseases and injuries as far as possible. Every Nation has its public health policy which revolves around laws, legislations, regulations, and actions which are executed and implemented in that particular country to protect the health of its citizens and also make sure that the particular health goals are achieved. These public health policies or strategies may include community outreach programs as well as formal legislation. The sectors where the public health strategy can play an important role are – health care, education, insurance, agriculture, business are just to name a few. There are various agencies which are governmental as well as non-governmental that are an important part of the public health strategy, for example, the World Health Organization (WHO), the Centers for Disease Control and Prevention, Food and Drug Administration are among the many organizations. These organizations target to promote and protect the health of the citizens of the world and they also undertake research and execute health and education initiatives for a targeted population. These organizations also implement laws and regulations where they make sure that the Nations has enough nutritional food for the purpose of consumption, is equipped with clean water for drinking purposes, the sick citizens are getting jabbed with vaccines on time and everyone has equal access to health care irrespective of their class, caste, gender, religion, sex, political views, sexual orientation, disability in any form, and any other discrimination. Public health strategies deal with various disciplines altogether but ultimately boil down to the health care system of the country as its only target (Metcalf, Edmunds, and Lessler 2015). 

The National level public health strategy in the UK which is discussed in this section is the legislation of ‘Smoking and Tobacco’. This legislation is a part of the ‘All Our Health’ program of the government of the UK (Smoking and tobacco: applying All Our Health, 2021). The citizens of every Nation must be made aware of the causes and effects of smoking. Smoking causes remarkable harm both to the smoker as well as the people who are surrounding the smoker. In England, there is a wide disparity of health among the citizens and the root cause lies in smoking. Recently, the percentage of smokers in the UK has decreased but still, the percentage amounts to 13.9%. The data of England shows that in 2019, 64000 people died as a result of smoking. It is leading among the other cause of death in the country. The data also suggests that each time a person dies in the UK due to smoking, 30 other people are getting affected due to smoking. These numbers are quite dangerous. Further, according to this data, in the year 2019 -2020, the number of patients who were admitted to the hospital due to smoking numbered up to 506,100 which if divided, comes up to 1400 illnesses per day! Every 1 patient out of 4 patients in the hospital beds of the UK is a smoker. The NHS Long Term Plan of UK prioritizes that the smokers who are in contact with the health care system of UK should quit smoking first. The target of the government of the UK is to achieve a smoke-free country by 2030 where the prevalence of smoking in society might be 5 % or even lesser. The diseases that arise as a result of smoking are many since every organ of the body is affected by smoking. It causes diseases such as lung cancer, respiratory ailments, and diseases related to the cardiovascular system of the body. It may also cause cancer in any organ of the body like the kidney, stomach, lip, mouth, throat, bladder, liver, and cervix. Smoking inevitably reduces the rate of fertility and increases eye diseases and also dementia. The bone mineral density of the smoker also gets reduced thereby increasing the risk of osteoporosis which ultimately leads to bone fractures, degenerative disc diseases, and even back pain (Jacob et. al. 2018). If a pregnant woman smokes, then it may lead to miscarriage, stillbirths, premature births, neonatal complications, low birth weight, and even diseases like sudden infant death syndrome (SIDS). Every 1 child out of 10 children in England is born to mothers who were chain smokers all throughout their pregnancy period. As people suffer from mental health problems, they tend to smoke more than the general population. The rate of mental health patients smoking is 2.5 times more than the general population. 40.5% of people smoke who are suffering from mental health problems. The patients who are suffering from mental health diseases along with their increased rate of smoking lead to a decrease in their life expectancy rate of about 10 to 20 years. The NHS Long Term Plan based on the Ottawa Model for Smoking Cessation states that by the end of the year 2023-2024, the patients who will be admitted to the hospitals will be offered a treatment known as the NHS funded tobacco dependency treatment. This will also be applicable for pregnant mothers and their husbands where there will be sessions conducted for the pregnant mothers in the maternity settings. The execution of the NHS Long Term Plan started way back in 2020 with a target of covering 100% of the smokers residing in England by the end of 2023-2024. The country is working hard to make smokers quit smoking. A diverse range of stop smoking kits is available which includes Nicotine Replacement Therapy (NRT) products, for example, sprays, patches, gum and lozenges, e-cigarettes or vapes, and some medicines like Champix and Zyban. Usage of these medicines prescribed by a practitioner doubles the chance of the smoker quitting smoking. For the entire Nation to quit smoking, there are certain principles which health care professionals must undertake, for example, the health care must have a detailed discussion about the cons of smoking with their patients, offer routine based advice and guidance or support to quit smoking as a daily health care routine, and following NICE guidance, they can implement evidence-based mediation. The data on the use of tobacco in England, the harmful effects of tobacco consumption, and how to mitigate it is provided in The Local Tobacco Control Profiles for England. However, over half of the population of smokers (52.7%), they say that they want to quit smoking and every 1 person out of 5 people has a genuine intention of performing this within the next 3 months. Recently, more than half the population of England has been successful in quitting smoking based on willpower alone. But this willpower does not work always work. If the victim who is addicted to smoking gets a little push from the health care professionals in the form of pieces of advice and support, then it becomes very motivational for the smoker to quit smoking. The professionals can also provide the quit kits that are available in the market so that it becomes easier for the patients to sustain their motivational level. These discussions between the health care professionals or the clinicians and the patients were published in PHE as ‘Stop smoking options: guidance for conversations with patients’. Recently, an e-learning session has also been launched by the Public Health England (PHE) and Health Education England’s ‘eLearning for healthcare'. This e-learning session was primarily launched because there was the need for boosting morale in the health care professionals to aid them in the process of making prevention a part of their daily routine. The harmful effects of smoking are quite dangerous as discussed above but passive smokers also are exposed to a lot of harmful effects, for example, it is especially harmful to kids as it results in rapid breathing and their airways and lungs and the immunity systems become less developed. The country has also been trying other ways to make the citizens quit smoking like the local stop smoking services which are based on several factors which includes the lifestyle services, the pharmacies which belong to the entire community, or GP surgeries. The services envisaging the quitting of smoking are also free by nature so that it draws more and more customers due to the free rider problem and also offer a choice which can be either individual or a group behavioral support from an advisor who is trained in the field of stop smoking services and along with this, apply pharmacotherapy. As per the suggestions of the data, it is evident from looking at the scenario of England that the legislation of Smoking and Tobacco has been very successful as implemented and executed by the government of UK and also by the willingness of the addicted victims to cooperate (Ford et. al. 2020).

Smoking and Tobacco as a National Health Concern in the UK

Now the focus of the paper will shift to the theoretical underpinnings of the smoking and tobacco legislation with the current health policy. One relevant theory which can be stated here is the Protection Motivation Theory (PMT). This theory studies the conceptual framework of adolescents in the usage of tobacco (Norman et. al. 2015). The cognitive process differs from person to person and at every age and stage. Hence, the adolescents also have a definite pattern of cognitive development that aid in their process of decision-making which ultimately forms their behavioral pattern. PMT diverts into two paths – Threat Appraisal and Coping Appraisal. The interaction of these two appraisals determines whether the adolescent will smoke or not. The Threat Appraisal has a total of four constructs divided into two groups: Perceived Threat (severity and vulnerability) and Perceived Rewards (extrinsic rewards and intrinsic rewards). The Coping Appraisal relates to the fact that how much the adolescent is able to cope up with the threats and it encompasses three constructs divided into two sections: Perceived Efficacy (Response efficacy and self-efficacy) and Perceived Cost (response cost). Adolescents who face higher rates of threats and their ability to cope is also high, are less likely to smoke (Xu and Chen 2016). 

A similar theory is a Theory of Planned Behavior (TPB) which states that the behavior of a person depends on several factors like the attitude of the person, or the societal pressure with which the person has to go through and their coping ability with that societal pressure. Studies have revealed that this theory predicts the smoking behavior of a person and also the rate of quitting capacity of the individual (Knauder and Koschmieder 2019).  

Another theory is perceived with the Health Belief Model (HBM). According to this theory, the motivational level of a person depends on the values and expectations of the particular person. This theory proposes that the engagement capacity of a person or the lack of engagement for health consciousness can be forecasted by the individual’s Perceived Susceptibility which is the personal beliefs of the individual about getting affected by a disease, Perceived Threat which is the personal beliefs of the person about the gravity of the illness, Perceived Benefits of the individual if he seeks to remedy, and Perceived Self-efficacy is the personal belief of the self to confront the disease. Concerning smoking, HBM predicts that an individual resort to smoking tobacco depending on the costs, benefits, and barriers which determines the smoking habit of the person or the quitting capability and the stimulation required to change the behavior pattern. 

The next theory pertains to the psychoanalytic theory as proposed by Sigmund Freud. He proposes that the psychological processes and the cognitive development of an individual depend on early childhood experiences. The developmental stages through which a child undergoes during the first few years of its life are – oral, anal, oedipal, latency, and genital, and frustration at any stage can cause malfunctioning personality. Sigmund Freud has related smoking as a fixation in the oral stage since the mouth is the place of eternal pleasure of human beings starting from the consumption of food to the consumption of alcohol and drugs too (Johnson 2016).  

Harmful Effects of Smoking on Health

The current public health policy of England pertains to the PHE or the Public Health England 2020 to 2025. This strategy predominantly works to safeguard and promote the health of the citizens of the UK, and also reduce the gap of the inequality that arises in the UK which is related to health for the upcoming 5 years (PHE Strategy 2020-25). The PHE Strategy works with some basic aims which are as follows:

• The PHE works 24/7 to protect the citizens of the UK from environmental hazards or diseases which are contagious in nature and the residents are exposed to these kinds of diseases both at home and from overseas. The PHE aims to protect and promote the health of its citizens or at least minimize the risks of the diseases if the citizens are already contaminated. PHE responds to the patients 365 days a year and 24/7 hours a day.
• The secondary aim of PHE is to help the citizens of UK live a long and healthy life and there should be less portion of the population who will be dependent on the NHS and the social care system, the majority of the population of UK should work for longer years in life and after retirement, they should stay at their homes for a longer period.
• UK suffers a lot from the health disparity or rather the inequality that arises as a result of health related matters between the citizens who are most deprived and the citizens who are least deprived. Many a time, the most victimized sections are the minorities. Hence, PHE aims to diminish these unjust and unequal health disparities.
• If the entire population force of the UK lives a healthy life, then the entire Nation will become more productive and that will become an asset to the economy. Therefore, the PHE works to secure the health of UK citizens and views it as an investment for the economic future.

The aims and targets are clearly stated as above for the upcoming five years which is predominantly to keep the citizens of UK in a good and healthy state, both mentally and physically. There are also some priorities which are set by the PHE for 2020 to 2025 for which PHE targets to benefit the maximum impact out of them. Those are as follows:

• Smoke-free society
• Healthier diets, healthier weights
• Cleaner air
• Better mental health
• Best start in life
• Effective responses to major incidents
• Reduced risk from antimicrobial resistance
• Predictive prevention
• Enhanced data and surveillance capabilities
• New National science campus

It is evident from the first and foremost priority of the PHE that it is their utmost priority to make UK a smoke-free society. PHE has even taken various steps to achieve this priority and are aiming to achieve it fully by 2023-2024. Some of the data which are published by the PHE are as follows:

• 1 person out of 6 people in the UK dies due to smoking. In order to work towards this target, PHE is striving to create a smoke-free society by 2030.
• Excess weight of the population leads to 1.2 million life years lost. PHE strives to make the diets of the population of the UK healthier and reduce the rates of childhood obesity.
• 28,000 to 36,000 deaths are caused by air pollution each year. For this priority, PHE strives to work so that the air pollution gets minimized and the rate at which people are exposed to the polluted air.
• £105 million pounds is the total annual cost of the society for mental ill-health patients. PHE wants to impact the good mental health of the patients and prevent mental ill-health as far as possible.
• There is a huge gap in the life expectancy rates of 19 years between the richest communities and the poorest communities.
• There is a 19.3% of the gap in smoking rates between the most deprived (27.2%) and least deprived (7.9%) of communities.
• 3% of children are not ready for school at the age of five years.

There are a lot more of these statistics which are stated by the PHE and the work that the legislation is doing to minimize these statistics. There are loads of visions that the PHE targets to achieve, the greatest of them pertaining to the reduction of the disparity in the smoking rates between the most deprived section and the least deprived sections.

Conclusion

Therefore, the paper had discussed intensely about the nuances of public health policies as part of the introduction. The next section of the paper moved on to discuss the National level public health strategy of the UK which is Smoking and Tobacco under the ‘All Our Health’ legislation. The last section dealt in detail with the theoretical underpinnings of smoking and tobacco and how the current public health policy relates to these theories. Therefore, it can be concluded that public health policies are very crucial for a Nation as it develops and build the health of the population of the country. These public health policies connect the theoretical underpinning of health with the practical reality of the Nations. These health policies provide solutions to the problems which were detected earlier and create the action from the research undertaken. A public health care professional has the responsibility to take action on strategies and policies which revolve around the concepts of health intervention and health prevention. If the health care professionals target to achieve flourishment in their section of the population, they need to target both the physical health of the population as well as the mental health of the population, and also the social and the economic well-being of the population needs to be taken into consideration. The health care policies implemented in a nation not only affect the cost which the citizens pay for the services but also the quality of the care and the access to the care that the targeted population is receiving and this is what impacts their general health.

References 

Ford, A., MacKintosh, A.M., Moodie, C., Kuipers, M.A., Hastings, G.B. and Bauld, L., 2020. Impact of a ban on the open display of tobacco products in retail outlets on never smoking youth in the UK: findings from a repeat cross-sectional survey before, during and after implementation. Tobacco Control, 29(3), pp.282-288.

Jacob, L., Freyn, M., Kalder, M., Dinas, K. and Kostev, K., 2018. Impact of tobacco smoking on the risk of developing 25 different cancers in the UK: a retrospective study of 422,010 patients followed for up to 30 years. Oncotarget, 9(25), p.17420.

Johnson, A.L., 2016. Psychoanalytic theory. Counseling and psychotherapy: Theories and interventions, pp.227-252.

Knauder, H. and Koschmieder, C., 2019. Individualized student support in primary school teaching: A review of influencing factors using the Theory of Planned Behavior (TPB). Teaching and Teacher Education, 77, pp.66-76.

Metcalf, C.J.E., Edmunds, W.J. and Lessler, J., 2015. Six challenges in modelling for public health policy. Epidemics, 10, pp.93-96.

Norman, P., Boer, H., Seydel, E.R. and Mullan, B., 2015. Protection motivation theory. Predicting and changing health behavior, pp.70-106.

PHE Strategy 2020-25, 2019. PHE Strategy 2020-25. [online] Assets.publishing.service.gov.uk. Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/830105/PHE_Strategy__2020-25__Executive_Summary.pdf> [Accessed 12 March 2022].

Smoking and tobacco: applying All Our Health, 2021. Smoking and tobacco: applying All Our Health. [online] GOV.UK. Available at: <https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health#measuring-local-impact> [Accessed 12 March 2022].

Xu, Y. and Chen, X., 2016. Protection motivation theory and cigarette smoking among vocational high school students in China: a cusp catastrophe modeling analysis. Global health research and policy, 1(1), pp.1-9.