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E-cigarettes: the challenge for local Public Health systemsThe e-cigarette Summit, 12 November 2015
Prof. Jim McManus, CPsychol, Csci, AFBPsS, FFPH
Director of Public Health for Hertfordshire
Winners 2015
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What I say today...
• Is in the context of reading and reviewing the literature, with peers and others, and critiquing it
• Our positions are the product of reflection, reading and judgement
• As with everything they are provisional and will be reviewed regularly
• Public health have no pre-eminence of knowledge in this debate, distributed knowledge and leadership
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Herts Ambitions 2015-2017Reduce Adult smoking prevalence• by 1% per year from 15.5% baseline*• in Routine and Manual workers by 2% per year
from the 25.7% baseline*Reduce Young People uptake• continuous reduction in REGULAR and
OCCASIONAL smoking in 15 year olds to 5% by 2017 (from a baseline of 10% in 2014)
Reduce Smoking in Pregnancy• smoking prevalence at the time of delivery
(SATOD) is less than:– 5% for women registered with HVCCG (from a
baseline of 6.6% in14/15) and to – 7% for women registered with ENHCCG (from a
baseline of 9.2% in 14/15).
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Context 1: Fundamental First Principles
1. E-cig users (i.e. the taxpayer) have a right to respect, unbiased information and support
2. The end game for tobacco is still what we want, yes? Denormalising tobacco
3. We want to do no harm. Doing nothing can do harm.4. If we cant make a thing completely safe, at least reduce
harm as much as possible• Safer Sex, Drugs, Alcohol
5. Hermeneutic of suspicion or hermeneutic of generosity in a rapidly changing scientific world?
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Context 2: for an endgame on tobacco control – changing the game• Not just systems but culture
and landscape changed• Bottom falling out of footfall• E cigarettes, Stoptober and
their impact on stop smoking services
• Digital services and platforms (probably lower impact than above)
• Confused Landscape – who should do what?
• What does good look like in the new world?
• Mental health• Rise of inequalities
and hard end smokers, poverty
• Harm reduction
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Our reading of that context...
Hertfordshire will follow the lead of Leicestershire and become as e-cigarette friendly as we can be, in the recognition that the public health gains from e-cigarettes significantly outweigh the risks.
We will keep this under regular review
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Why?
1. Fundamental demographic paradigm shift in smoking behaviour
2. Good Stewardship of the Public Purse3. The 4 Es duty
– Economy– Efficiency– Effectiveness– Equity
The gains for mental health and income equality!Some LAs challenging DsPH on continued smoking spend
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One thing at a time....
At a time when people are still dying from tobacco related illness, the priority is to stop the deaths, disability and misery.
We have enough evidence for this
The debate about nicotine addiction and ecigs is a longer “burn”...or have we learned nothing from work on safer sex, drugs and alcohol
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Staying on course in paradigm shift
1. Which authority do we listen to?2. The fiscal challenges 40% cuts?3. Are there models we can use?4. How do we steer our course?5. Be clear – tobacco control remains a
substantial gain for the health of the public and the public purse
6. But the world we are in has shifted
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Challenges
1. Who do you trust? Where does your information come from? How provisional is it?
2. Who has authoritative voice?3. Re-normalisation?4. Is it really caution or is the bogey man?
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The Big Wins• E cigarettes as part of the tobacco control repertoire • Reduce deaths, disease and disabillity• An acceptable route for people with mental health issues• Normalising e-cigarette use does NOT mean
renormalising smoking• Save some money in austerity climate• Help people to help themselves
1
Am J Public Health. 2015 Oct;105(10):1967-72. doi: 10.2105/AJPH.2015.302764. Epub 2015 Aug 13.Smoking Norms and the Regulation of E-Cigarettes.
1
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Safe Retailers are important, we should support them
• We tried licensing an e-cigarette vendor who applied through our trading standards scheme
• The regulatory and insurance infrastructure made it impossible at the time
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Local authority investments in tobacco
• At this moment in time hitting local authorities about their pension funds is a distraction and you are not going to win overnight
• Making tobacco an unattractive investment proposition is a much better economic strategy
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Thank you
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Winners 2015
