Smoking must be in the mix on poverty question Reply

In this blog, Policy & Research Officer Mike Andrews reflects on the media coverage of recent poverty reports, and conversations around the office about them.

2017 has kicked off with a couple of very high profile reports and academic pieces which have demonstrated, pretty bluntly, the awful effects that poverty is having at both the start and end of people’s lives. It has to be said, though, that sometimes you have to dig under the headlines to really see what writers are saying.

This week, a major study in The Lancet looked at poverty as a cause of premature death, and researchers quantified low socio-economic status as being associated with a 2.1 year reduction in life expectancy. That’s 766.5 days of life lost, due to poverty. However, to me the salient figure was that the biggest factor in shortening lifespans, according to the report, is smoking. It takes off 4.8 years, on average. That’s 1752 days of life lost, due to smoking.

What frustrates me, however, is how these two risk factors are often viewed as existing in two separate silos. Smoking is not just an effect of poverty, it creates and sustains it too. This blog has previously looked at how crucially interlinked smoking and poverty are: disadvantaged groups are more likely to smoke; those that can least afford it are more likely to smoke; and disadvantaged communities are less likely to be accessing the free, expert stop-smoking advice which is available in Scotland.

Smoking costs an average of £1,626 per year. With more than two thirds of Scottish smokers wanting to quit, meaning that smoking inflicts huge costs on an unwilling population, think how many people would be lifted out of poverty, and live longer, were they able to stop smoking? ASH Scotland wants to see people living longer lives, freed from the shackles of the health and economic harms which smoking causes. Two birds, one stone, in many ways.

All of this, of course, follows on from the widespread coverage, last week, of the report from the Royal College of Paediatrics and Child Health about the state of child health in Scotland. It found that child health in the country is among the worst in Western Europe and notes that 30% of pregnant women in the most deprived areas are smokers, as well as calling for a ban on smoking in public spaces that involve children, such as playgrounds. Of course, this report caused some discussion, both in the media and at the kettle in the ASH Scotland offices.

Vicky Allan wrote in the Sunday Herald that the “thou shalt not smoke at the school gates” message is not going to save Scotland’s children. I think this is true enough. But I believe that taking a harm reduction approach to prevent smoking in the home, might be one step in the right direction.

We know that the take it right outside campaign was successful in raising awareness of the risks of second-hand smoke (SHS) exposure on children and also that the majority of parents have a desire to protect their children from its harmful effects. But we also know that for those who are living in constrained accommodation, with no outdoor space, no babysitter (even if it is just for a quick fag at 11.00pm), this leaves them little option but to sometimes smoke indoors. With this increased awareness and cultural changes in attitudes to smoking indoors, unfortunately comes increased levels of parental guilt, surely not something we want to promote.

Research in Scotland over the last few years has highlighted and explored this, yet I am concerned by the increasing focus on banning we are still seeing calls to ban smoking in outdoor areas, rather than focussing on initiatives which might address the children who are still exposed to SHS within their homes. Is it time for some practical, harm reduction smoke-free homes projects which are led by parental choice? Providing incentives such as gift vouchers, nicotine replacement therapies and even e-cigarettes, not as a tool to help them to quit, but rather tools that can be used at home in situations where going outside for a smoke just isn’t possible.

The upshot of this could be reduced use of tobacco, which would simultaneously reduce the harm it’s doing to our communities and increase the money in the back pockets of the people that need it most. We’d all like to see that, right?

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