Tobacco Control Strategy - Creating a Tobacco-Free Generation

Chapter 1 Introduction

Effective tobacco control is central to realising the right to life and the right to the highest attainable standard of health for everyone in Scotland. It recognises that people deserve to live in a nation free from the harms caused by tobacco, where people choose not to smoke and enjoy longer, healthier lives. This Strategy has been developed with input from NHSScotland, COSLA, the Third Sector and research community and sets out the next steps on Scotland's journey to becoming tobacco-free.

Scotland has already come a long way in shifting cultural attitudes to smoking and is now seen as a world leader on tobacco control. We should all be proud of this achievement. Since the Scottish Parliament was established in 1999, it has overseen:

• legislation to ban tobacco advertising in 2002
• implementation of historic smoke-free legislation in 2006
• increase in the age for tobacco sales from 16 to 18 in 2007
• overhaul of tobacco sale and display law, including legislation to ban automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops
• establishment of the first Tobacco Retail Register in the UK in 2011
• comprehensive awareness-raising campaigns
• record investment in NHS smoking cessation services helping hundreds of thousands of people to attempt to quit smoking.

However, while there is clear evidence that action, such as the smoking ban, has lead to a range of health benefits including: reduced heart attack admissions to hospital^[1]; reduced childhood asthma admissions to hospital^[2]; and fewer premature births^[3], tobacco use still remains one of Scotland's most significant public health challenges.

Smoking is associated with a range of illnesses and is the primary preventable cause of ill health and premature death. Each year, tobacco use is associated with over 13,000 deaths (around a quarter of all deaths in Scotland every year) and 56,000 hospital admissions in Scotland^[4]. Annual costs to Scotland's health service associated with tobacco-related illness are estimated to exceed £300m and may be higher than £500m each year^[5].

The number of people who smoke in Scotland has declined from 31% in 1999 to 23.3% in 2011^[6]. However, smoking rates in the most deprived communities in Scotland remain disproportionately high - 40% in the most deprived areas compared to 11% in the least deprived areas^[7]. This is a key factor in contributing to Scotland's persistent health inequalities that result in the unfair differences in life expectancy between the richest and poorest of our communities.

Tackling health inequalities and their underlying causes is part of our collective responsibility to advance the right to life and to increase life expectancy, taking steps to protect us all, particularly children, from risks to life^[8]. Such measures are also clearly required to advance the right to the highest attainable standard of health^[9]. This is why tobacco control remains central to achieving the Scottish Government's Purpose and Objectives, as well as to meeting our international obligations such as the World Health Organization's Framework Convention for Tobacco Control. For Scotland to become a more successful country, with opportunities for everyone to flourish, we need to remove the burden of ill health which tobacco contributes to.

This five-year strategy therefore sets out a range of actions across the following themes:

• Prevention - creating an environment where young people choose not to smoke
• Protection - protecting people from second-hand smoke
• Cessation - helping people to quit smoking

It is, however, clear that a key factor cutting across these three themes is how they take account of inequalities. We will not achieve our ambition of a tobacco-free Scotland without addressing the stark socio-economic inequalities in smoking prevalence rates. The actions set out in this Strategy consider the impact on those at risk of unequal health outcomes. This places our continued action on tobacco control firmly within the Scottish Government's commitment to tackling the underlying causes of poor health which contribute to the health inequalities that exist across Scotland's population.

Success will not be achieved through any one measure. That is why this Strategy builds on the multi-faceted approach, set out in our previous tobacco control strategies, balancing a range of national and local actions that complement and reinforce each other. In implementing decisive tobacco-control policies, the Government, the NHS and Local Authorities must show leadership in responding to the direction of travel set out in the Strategy. However, communities themselves must also have a role in achieving our vision of a tobacco-free generation. The Third Sector, with its unique abilities to engage with and represent local populations, will be key in supporting this contribution.

Whole population approaches such as regulation and investment in services must be supported by interventions which are driven by, and meet the needs of, local communities. We all need to consider, as individuals and communities, what we can do to support each other to make smoking a thing of the past and improve, not only our own health, but also the health of our local areas. Only by taking this approach can we achieve our ambition of a tobacco-free Scotland and accelerate our efforts to tackle the underlying causes of health inequalities.

These ingredients of a strong and successful tobacco control strategy also reflect and support the wider approach to achieving sustainable quality in healthcare across Scotland as set out in the strategic narrative and 20:20 vision for health and social care. In other words, a holistic and whole system approach, greater collaboration with other partners, and more emphasis on prevention, co-production, creating health and wellbeing and reducing inequalities.

We know that the demands for healthcare and the circumstances in which it will be delivered will be radically different in future. In setting out the steps and the milestones that will help us to realise our 20:20 vision, we are clear that tobacco control has a significant part to play.

Action: The Scottish Government will maintain the tobacco control budget at current levels across the 5-year lifetime of this Strategy.

Lead: Scottish Government