Smoking – changing the frame 

I’d previously written about my thought experiment around being ambitious re really achieving a smoke free generation.
https://gregfellpublichealth.wordpress.com/2016/06/11/scaling-up-prevention-an-stp-thought-experiment/
I’d also suggested that the ambition is framed yes in terms of avoidable illness and early death (of course) but also in terms of economic concepts. 

Read the blog.
Another spin that I hadn’t thought of was how this money not spent on smoking plays out over time, and making it personal.
Fortunately other clever people have thought of this one

http://www.makeuseof.com/tag/quit-smoking-invest-profit-see-much-youd-retirement/

Looks like there’s a simple excel type model. It’s American, someone might localise it. The other interesting spin is interest on the unsmoked money – quite how we square with 0.0003% interest in uk I don’t know!)
The picture says it all.

Of course there’s the challenge of why would young people care about long term investments versus immediate pleasure. 

I rightly had this challenge on Twitter. (Someone else’s) response was immediate and interesting – you can put it in immediate terms too, though. Your rent, a new pair of shoes a month, etc.




So stopping smoking in any way you can is good for you, your wallet, the health and care system, the economy and pretty much everything else. Short and long term benefits


Hard to see what’s not to like 


Getting there
Getting from 17% smoking prevalence in Sheffield (far higher in some parts of town) to 10% will happen anyway looking at long term trends. Maybe by 2030. The challenge is to accelerate the trend, let’s try to achieve it in the next 5-7 years.
It’s a significant effort, no doubt.
We may need to think difficult things about a mix of clinical interventions and population focused policies, for example:

  • Wide range of interventions to stop, or at least slow rate at which people start. 5 a day in sheff according to @copddoc http://thorax.bmj.com/content/early/2013/11/25/thoraxjnl-2013-204379.full
  • illegal and illicit tobacco. Easily and readily available across large swathes of town, sold in singles and threes, at 1980s prices. So smarter and more enforcement, bigger fines and other deterrents
  • E cigs. They seem to be helping. Recent BMJ editorial suggested 1% impact on prevalence, and the Cochrane review said good things. Yes remains some uncertainties, and things to be watchful of (marketing and kids using for eg). But we take far more decisive action on far less evidence in other areas. 
  • Smarter models of stop smoking services – digital by default, support for self quitters, face to face for those who may need more help, scaled up implementation in ALL clinical pathways. Yes that means you, dear rheumatologists, Gastro docs and ortho surgeons. Everywhere! London Clinical Senate are doing amazing work here. We need to widely adopt. http://www.londonsenate.nhs.uk/helping-smokers-quit/
  • More difficult, but no reason not to have a conversation about these – How about Tobacco 21 and licensing of those who wish to sell tobacco.

I could go on. 
This is a doable challenge. It will only happen if we make it happen.

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