Narrowing the gap in smoking-related health inequalities Reply

Guest post by Celia Gardiner, Tobacco Control Organisational Lead, NHS Health Scotland

This Saturday marks 10 years since Scotland went smoke-free and set off on a remarkable journey in public health improvement.

The culture change is profound. When I started working in my first ‘real’ job, I was shown to a desk with a big, white ashtray on it. Everybody had one. People regularly smoked on buses, in trains and even on planes. When you went for a night out, people smoked in pubs, clubs and restaurants.

On 26 March 2006 Scotland was the first UK country to bring in smoke-free legislation. It was headline national news: TV cameras lurked outside well-known pubs in our major cities while people wondered if it would work. Would smokers not comply? Would they capture a fight on camera as smokers were thrown out of bars or even fined for lighting up indoors?

Actually, no.

In the teeth of strong opposition from the tobacco industry and pro-tobacco lobbyists, the big day passed smoothly and the silent, non-smoking majority reclaimed inside spaces.

The case for protecting the health of others from the harms of second-hand smoke was understood and accepted by the Scottish public and especially by smokers. This was largely down to the efforts of NHS Health Scotland and partners like ASH Scotland, who worked tirelessly to raise awareness of the harms of second-hand smoke and get smokers onside with protecting the health of others.

The rest of the UK soon followed, rapidly introducing smoke-free laws. A comprehensive evaluation commissioned by NHS Health Scotland showed that after one year there was:

  • an 89% reduction in exposure to second-hand smoke in bar workers
  • an 86% improvement in air quality in bars
  • a 39% reduction in second-hand smoke exposure in both adults and 11-year-old children

Wider health benefits to which the smoke-free legislation contributed included a 17% reduction in hospital admissions for heart attacks and a reduction in the rate of child asthma admissions by 18%, when previously they had been rising year on year by 5%.

The introduction of smoke-free public places marked the start of a legislative programme that has included other measures such as raising the legal age for buying tobacco to 18, banning the sale of tobacco from vending machines and the banning of tobacco displays in shops. The Scottish Parliament recently passed a law against smoking in cars with children present and new legislation to support smoke-free NHS grounds and to prohibit the sale of e-cigarettes to under 18s.

It started with smoke-free public places but this law has been built on to achieve a comprehensive and successful tobacco control programme that strives to protect the health of the population, and in particular, the young and the vulnerable.

But it can’t stop there.

Although rates of smoking have declined, we still smoke more in Scotland than in the rest of the UK and rates of smoking are unequally distributed through our society.

A child born in a more socially deprived area of Scotland is more likely to be born into a family that smokes, is more likely to have a mother who smoked during her pregnancy and is more likely to be around smokers growing up. Role modelling and imitation are tremendously concerning: children of smokers are more likely to start smoking themselves and continue to repeat the cycle of their own experiences.

That’s why NHS Health Scotland is committed to delivering action in 2016-17 that will help every mother understand why smoking is harmful during her pregnancy and will support parents to give their children the opportunity to grow up in a smoke-free home.

The 2006 smoke-free legislation has started us on the path to reducing smoking-related health inequalities, but we still have some way to go. Preventing people taking up smoking can help improve health more equitably and is a crucial step towards creating a fairer, healthier Scotland.

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