3. A call to action
As a population we’re living longer but spending more years in ill-health. The burden of disease is an indication of the number of years of life lost to disease (mortality) and the number of years lived with disability (morbidity) as a result of disease. Tobacco use is the single greatest cause of preventable death in England, killing over 80,000 people per year. This is greater than the combined total of preventable deaths caused by obesity, alcohol, traffic accidents, illegal drugs and HIV infections. In general, behavioural risk factors make the greatest contribution to years lost to death and disability, tobacco use being the leading risk factor.
Nationally higher smoking prevalence is strongly correlated with areas of socio-economic deprivation. Smoking is highest amongst younger males from the routine and manual occupations, communities of mixed-heritage and minority groups such as LGBT.
The number of people who smoke in South Gloucestershire has declined from 19.8% in 2010 to 13.9% 2014. However smoking prevalence in the most deprived communities remains disproportionately high, approximately 24.6% in the most deprived areas compared to 10.6% in the least deprived areas.
In addition to smokers who fall within the lowest income brackets, smoking rates are much higher in other sub-groups of the population. Smoking is responsible for the largest proportion of the excess mortality of people with mental illness. Prevalence in this group is much higher than in the general population; 32% of people with a common mental disorder smoke, and rates are even higher in people with more severe disease. Furthermore, current smoking is associated with an increased risk in the onset of depression and anxiety disorders, and smokers are 50% more likely to suffer from a mental disorder than non-smokers. Of the 10 million smokers in the UK today, almost one in three reports mental health problems. However, smoking cessation is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke.
There is a disproportionate impact of smoking in pregnancy for young and poorer women. Women in routine and manual jobs are almost three times as likely to smoke during pregnancy than those in managerial and professional roles. Quitting rates during pregnancy are also much higher amongst more affluent women. Teenage mothers are almost six times as likely to smoke throughout pregnancy than women who are aged 35 or older, and are also less likely to quit before or during pregnancy.
Smoking during pregnancy not only causes inequalities, but it also exacerbates them. Children whose mothers smoke in pregnancy are more likely to smoke in later life, reinforcing existing inequalities and cycles of disadvantage.
Success will not be achieved through any one measure, and whole population approaches such as regulation must be supported by interventions which are driven by, and meet the needs of, local communities.
Costs to society
Every year it is estimated that smoking costs South Gloucestershire £57.5 million, which equates to £1,923 per smoker per year (ASH Ready Reckoner, 2015). This total amount has been broken down in chart 1 below.
Current and ex-smokers who require care in later life as a result of smoking-related illnesses cost South Gloucestershire £5 million each year. This represents £2.8m in costs to the local authority and £2.1m in costs to individuals who self-fund their care. Smoking related disease cost the local NHS economy £7.95m per year.
Chart 1: Estimated cost of smoking in South Gloucestershire (£millions).
Source: ASH Ready Reckoner tool.
Our vision is for a Smokefree South Gloucestershire where future generations are protected from tobacco related harm and live longer, healthier lives. We believe this comprehensive tobacco control strategy will support all South Gloucestershire’s communities in moving towards a future free from tobacco.
 Health & Social Care Information Centre Statistics on Smoking in England 2014.
Available online at www.hscic.gov.uk/catalogue/PUB14988/smok-eng-2014-rep.pdf
 Public Health England. National General Practice Profiles.
Available online at http://fingertips.phe.org.uk/profile/general-practice
 Public Health England (2015) Smoking cessation in secure mental health settings.
Available online at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432222/Smoking_Cessation_in_Secure_Mental_Health_Settings_-_guidance_for_commis….pdf
 Royal College of Physicians (2013). Smoking and Mental Health.
Available online at http://www.ncsct.co.uk/usr/pub/Smoking%20and%20mental%20health.pdf
 Taylor G., and Aveyard, P. (2014) Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal, 348 pp.1151
 Action on Smoking and Health (ASH) (2015. The Case for Local Tobacco Control – Ready Reckoner.
Available online at http://www.ash.org.uk/information/ash-local-toolkit