Health Inequalities and Smoking

Dr. Helen McAvoy, Senior Policy OfficerInstitute of Public health in Ireland

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European Week Against Cancer 2013Aviva Stadium , Dublin

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Tobacco and Health Inequalities

Dr Helen McAvoy Institute of Public Health in Ireland

www.publichealth.ie

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www.publichealth.ie

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All-island bodyo Inequalities in healtho North-South cooperation

Three work strands:o strengthening public health intelligenceo building public health capacityo policy and programme development and evaluation

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Outline

Cancer & inequalities in life expectancy Inequalities in tobacco-related harmInequalities in smoking behaviours Social & commercial determinants Time to develop a more comprehensive

approach to addressing inequalities in tobacco-related harm?

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Source:

NI Health and Social Care Inequalities Monitoring System – 2013

An overview of changes in NI life expectancy 2001-03 to 2008-10

Comparison of life expectancy ‘deprivation gap’ in Northern Ireland

- most deprived vs. least deprived

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Source:

NI Health and Social Care Inequalities Monitoring System – 2013

An overview of changes in NI life expectancy 2001-03 to 2008-10

Contribution of the life expectancy gap of 7.6 years between NI most & least deprived areas 2008-10 by cause of death (males).

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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie

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Age-standardised incidence of cancer by deprivation category of patient residence 2007-2009 – Republic of Ireland

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Source: National Cancer Registry Ireland, 2011 – Lung Cancer Incidence, Mortality, Treatment & Survival in the Republic of Ireland 1994-2008.

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99Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie

10Source: Cancer in Ireland 2011. National Cancer Registry of Ireland - www.ncri.ie 10

5 year survival for cancers diagnosed during 1994-1997, 1998-2002, 2003-2007

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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie

5 year relative survival for cancers diagnosed in men and women 2003-2007

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Behind the lung cancer statistics

Delays in presentation? (men especially) Knowledge & differentiation of symptoms Shame, guilt and stigma Inequalities in multi-morbidity Choices about where to die ( Sharp et al, IMJ, 2010)

Fewer empowered survivors to carry the flag for early detection, research, political attention and investment

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Cancer inequalities are multifaceted

Risk – incidence, type, age of diagnosis

Finding out – achieving a timely diagnosis

Health system, social and economic assets for optimal treatment, survival and recovery

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Inequalities in tobacco-related harm

Health harms

Social and economic harms

Socio-economic disadvantage associated with life-course accumulation of cancer risk

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Smoking in pregnancy by deprivation in Northern Ireland 2005 – 2011

Source: NI Health & Social Care Inequalities Monitoring System 2012

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Risk profile of the low income smoker

- Exposure to tobacco in utero and SHS in childhood

-Grew up in family and community with high smoking rate

-Early initiation

-Heavier smoking

-Equally likely to attempt quitting (?)

-Less likely to succeed at quitting - definitely

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SHS exposure in childhood Young Persons Behaviour and Attitudes Survey 2010 Northern Ireland – 49.8% of 11-16 yr olds report adults smoke inside their home

ISAAC study – Ireland sample 2007 – 45%

CHETS study Northern Ireland – SHS exposure is socially patterned

Indoor Air Pollution and Health – STRIVE report 2013 - Mean 24-hour level in smoking homes of 143μg/m3 4 times higher than US EPA ‘ unhealthy’ level for sensitive groups

What children report

What adultsreport

Percentage of boys who report they are current smokers

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Source: The Irish Health Behaviour in School-Age Children Study 2010www.nuigalway.ie/hbsc

Percentage of girls who report they are current smokers

Source: The Irish Health Behaviour in School-Age Children Study 2010www.nuigalway.ie/hbsc

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Adult smokers by social class (2007)

Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report 20

Percentage of cigarette smokers who reported trying to quit in the previous 12 months

21Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report

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Tobacco industry role

Recruiting ‘FUBYA’ a priority

PPACTE report – adapting price strategies

Roll your own tobacco

Illicit tobacco

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Source:

Irish Independent

newspaper

2008

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Tobacco control through an equity lens How would we judge success/failure? Health intelligence requirements Regulation of tobacco industry and supply

chain Education, health promotion Smoking cessation services, monitoring

and review

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Dr Helen McAvoy Institute of Public Health in Ireland

helen.mcavoy@publichealth.ie

@HelenMcAvoy2

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