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Magic wand - or fag end of hope?
Sunday's smoking ban may clear the air, but it is unlikely to cut deaths among the poorest people
Alison Benjamin
The Guardian,
Wednesday June 27 2007
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This article appeared in the Guardian
on Wednesday June 27 2007 on p7 of the Society news & features section. It was last updated at 10:34 on July 09 2007.
Six weeks ago, Ronnie Prest called his local smoking cessation service and invited them to hold sessions on Thursday nights at the Horden Conservative club in Easington, Co Durham, where he works as club steward. Prest, 55, has smoked for 40 years and was anxious to kick his 60-a-day habit before the ban on smoking in public enclosed areas comes into force in England on Sunday."If I'm working by myself, I can't afford to leave the bar unattended while I nip out for a smoke," he explains. "I don't really have a choice."About 20 regulars have joined Prest at the quitters group, but not all his customers are so keen: "Some have told me that they will go round each other's houses instead of coming here. I expect a couple of clubs in the area will have to close."Although the purpose of the smoking ban from July 1 is to protect people from the harmful effects of passive smoking, the government expects it to reduce the number of smokers in England by 600,000. Yet anti-smoking campaigners are concerned that it will have little impact in deprived areas, such as Easington, where smoking prevalence is 37%, compared to the national average of 24%.Clare Matthews, head of Easington primary care trust (PCT) smoking cessation services, confirms that few smokers are following Prest's lead: "I'm not aware of an increase of people approaching us."Campaigners say there is a danger of smoke-free legislation being viewed by the public and policy makers as a magic wand to stamp out smoking and address health inequalities. "The affluent in their smoke-free pubs and restaurants are likely to forget that, for most disadvantaged people, rates of smoking are still very high," says Deborah Arnott, director of Action on Smoking and Health (Ash). "Among the most deprived groups, three out of four families still smoke. It is the greatest single factor in the difference in life expectancy between the social classes."The percentage of men who die under 70 ranges from 22% in the highest social class to 48% in the lowest social class, and around half this disparity is accounted for by higher smoking rates. In 2005, 32% of men and 29% of women in routine and manual occupations smoked, compared to 18% of men and 16% of women in managerial and professional occupations. The government hopes to reduce smoking to 21% among adults by 2010 and 26% in manual occupation groups. But with more resistance among lower socio-economic groups to quitting, this seems unlikely.Ash has produced a map of England that shows the link between smoking and poor areas. Smoking rates vary from 52% in the most deprived ward in Knowsley, Merseyside, to just 12% in the least deprived ward in Rushcliffe, Nottinghamshire.Chris Owens, head of tobacco control at the Roy Castle Lung Cancer Foundation, which delivers Fag End, a PCT-funded smoking cessation service in Liverpool, says: "The unfortunate truth is that in areas where more people smoke, people trying to quit are surrounded by friends and family who smoke, which can make quitting even more difficult." Fag End's community-based services are credited with helping most of the 17,500 Liverpudlians (4% of the local population) who have quit smoking over the last three years. But its 50% success rate is much lower in Speke, Breckfield and Granby - three of the most deprived wards in England.Andy Hall, Liverpool city council's public protection manager and chair of SmokeFree Liverpool, which lobbied for a city-wide ban, doubts the national legislation will help bring smoking rates in these areas in line with national figures. "The ban will reduce opportunities for everyone to smoke, but it is not going to tackle health inequalities," he says.Foot on the gasAilsa Rutter is director of Fresh, a campaign funded by PCTs in the north-east, which has the highest number of smokers in England. She says it is important that, following Sunday's milestone, government doesn't take its foot off the gas. "Tobacco remains the number one driver of health inequality," she says. "We must keep MPs engaged." Other measures she wants to see introduced include banning point-of-sale advertising for cigarettes, removing restrictions on the sale of nicotine replacement therapies, and for customs and excise and the police to seriously tackle tobacco smuggling.The Department of Health has allocated Ј112m to PCTs for smoking cessation services over the next two years. This includes an additional Ј10m for PCTs based in the most disadvantaged areas. A DH spokeswoman says the money is not ring-fenced because "PCTs are best placed to assess local needs and to arrange services appropriately". In addition, she points to the health profiles, published last week by the department for the second year running, which identify key indicators for health inequalities to help local health services target their resources.Ash is lobbying on the local government white paper for one of the outcome-based indicators for local authorities to be smoking prevalence. It is also calling for GPs to deliver more advice on smoking cessation as part of their routine care.Back in Easington, Prest has put on hold his attempts to quit: "I'm under too much pressure with this ban coming in. I've been told I'll get a Ј250 fine and the business will be fined Ј2,000 if anyone is found smoking here. But what happens if someone comes in and I don't see them, or if I've got to tell a dozen big lads to put out their cigarettes or leave?"· Email your comments to society@guardian.co.uk. If you are writing a comment for publication, please mark clearly "for publication"· This article was amended on Monday July 9 2007. We referred to the Fag Ends stop smoking group. It is run by the Roy Castle (not, as we said Royal Castle) Lung Cancer Foundation. This has been corrected.
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About this article
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This article appeared in the Guardian
on Wednesday June 27 2007 on p7 of the Society news & features section. It was last updated at 10:34 on July 09 2007.
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