World Health Organisation World No Tobacco Day – 31 May 2022

Professor Sanjay Agrawal, clinical lead for the NHS tobacco dependency programme talks about the benefits of removing the toxins from our bodies by quitting smoking and the toxic impact smoking has on our communities and the environment.

As a consultant in respiratory care medicine, I see the impact smoking has on the lives behind daily statistics. Did you know that around 64,000 people die from smoking related illnesses in England every year or that thirty times as many people suffer from serious smoking related diseases? Behind these big numbers are the lived experiences of real people with families and loved ones and the damaging economic impact on smokers’ families.

Whilst we know the damage smoking tobacco does to smokers and their families’ health, there’s another danger the World Health Organisation (WHO) has brought to our attention today, World No Tobacco Day: it’s the environmental impact smoking has.

WHO data shows that 4.5 trillion cigarette ends are disposed of every year around the world, creating 1.69 billion pounds of toxic chemical waste. Waste which pollutes our atmosphere, the air we breathe, the quality of our water and soil. Emphasising the environmental impacts of the entire tobacco cycle, from cultivation, production and distribution to the toxic waste it generates. The WHO is calling for stronger policies and legislation to directly address tobacco waste and environmental and economic impact.

With global pollution extremely topical, we shouldn’t lose sight of tobacco’s impact and I think it’s something we too should highlight when making the case for getting people to quit. Just as we shouldn’t lose sight of the fact that smoking is the leading modifiable risk factor responsible for health inequalities. There’s a strong link between tobacco dependency and health inequalities according to data from the ‘Global Burden of Disease’ study. It reports life expectancy for smokers being at least ten years less than it is for non-smokers; with a disproportionate impact on those from poorer backgrounds where smoking prevalence is higher, as it is for people suffering from mental health conditions. Shockingly, nearly one in ten women still smoke at the time of delivery.  Further analysis from the maternity services dataset shows rates of smoking in pregnancy in the most deprived areas of England were nearly 6 times those in the least deprived areas (24.7% and 4.1% respectively).

My colleague Dr Bola Owalabi, Director of Health Inequalities Improvement at NHS England and NHS Improvement says, “Smoking is the single largest driver of health inequalities in England, with smoking prevalence higher amongst population groups with lower incomes. The health effects of smoking tobacco are implicated in all of the 5 key clinical areas of the National Core20PLUS5 approach we’ve developed to reduce healthcare inequalities. We recognise the importance of offering treatment to address tobacco dependency and the National Healthcare Inequalities Improvement and Prevention teams at NHS England and Improvement along with Action on Smoking and Health (ASH) are collaborating to create a Smoke Free NHS. Addressing the healthcare needs of our workforce including tackling health inequalities is fundamental in supporting the physical and mental wellbeing of NHS staff and in support patients and the public”.

And we are practicing what we preach as an organisation. The NHS is committed to achieving a smoke free society by 2030 (where smoking prevalence is less than 5%), in line with government ambitions. As part of this commitment, the NHS is currently piloting a staff tobacco dependence treatment service. Whilst these pilot sites gather pace anyone including NHS staff can access the Better Health site for support.

One example of the impact it’s already having on real lives, comes from some of our colleagues in North East and North Cumbria, one of the nine pilot sites in the country. It attracted some 1,200 staff members into the staff tobacco dependency service, within the first five months of launching. Quit rates reported at 12 weeks (where members of staff ceased use of cigarettes but may continue to use e-cigarette), where a large proportion of people attempted to quit smoking for the first time in their lives showed significant proportion succeeding. This is crucial step in creating smoke free workplaces and communities.

Dr Ruth Sharrock a consultant respiratory physician who led the effort in the North East and North Cumbria NHS Treating Tobacco Dependency taskforce, reflects on the staff offer: “I see one colleague per year die from smoking related disease from our hospital alone. These were wonderful staff members, who worked incredibly hard in difficult times, giving their ‘all’ to patient care and the NHS. There isn’t a more important workstream I could be involved with as we try to step into a period of recovery from COVID and truly value the physical and mental health of our colleagues.  This is such a critical and meaningful intervention”.

The WHO’s World No Tobacco Day highlights tobacco’s environmental impact whilst reminding us of the importance of preventing lifelong illness and avoidable early deaths by stopping smoking.  I firmly believe the NHS’ ambition is also firmly rooted in the future sustainability of the health service with the welfare of patients paramount.

Find out more about services available to support smokers to quit:

Professor Sanjay Agrawal, National Specialty Adviser for Tobacco Dependency at NHS England

Professor Sanjay Agrawal is the National Specialty Adviser for Tobacco Dependency at NHS England, Chair of the Royal College of Physicians Tobacco Advisory group and Consultant in Respiratory and Intensive Care Medicine.

Over the past decade Professor Agrawal has highlighted the need to address the treatment of tobacco dependency and is now supporting the NHS Long Term Plan programme to implement tobacco dependency treatment services across the NHS.