This presentation was developed for our CLeaR (local government tobacco control standards) assessment in July 2014. It sets out our vision for tobacco control in Hertfordshire, summarises our strategies and current position and identifies our future work including commitment to harm reduction, getting positive gains from e-cigarettes and driving tobacco related harm down

1. www.hertsdirect.org
Public Health and Tobacco Control:
Our Vision and Leadership in
Hertfordshire
Jim McManus
Director of Public Health
Hertfordshire County Council
This presentation was developed for our CLeaR assessment for 22nd
July 2014

2. www.hertsdirect.org
Why Tobacco Control Remains Important
to us
• Major importance to our public health ambitions and vision
• Single most important cause of premature morbidity and
mortality
• Kills 80,000 people prematurely in England alone
• Accounts for 50% of health inequalities between
better and worst off – gap is widening
• Disproportionately affects
most deprived
communities and groups

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Why we must move towards the
endgame for tobacco in Hertfordshire
• Tobacco still kills and harms too many people in Hertfordshire
• It accounts for over half the gap in avoidable and preventable death
between us and our statistical neighbours
• It costs far more in death, disease and disability than we can
countenance
• It costs more in money than we get in tax revenue or jobs or
economic gain
• The US Surgeon General’s report 2014, 50 years after the famous
Dolland and Hill study, implicates tobacco in even more diseases
than ever – diabetes included

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We want to
• Drive down prevalence of tobacco use
• Reduce numbers of people taking up tobacco
• Work with people not ready to give up tobacco
to reduce harm as much as possible in line with
NICE guidance
• Recognise, welcome and apply the potentially
significant positive gains from e-cigarettes in
reducing harm from tobacco for our population
• We recognise we are still “in the lab” on this

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Hertfordshire Smoking Prevalence* %
District
Smoking Prevalence (%)
2011
Smoking Prevalence (%)
2012
Change in Percentage
Points
Broxbourne 23.6 19.3
-4.3
Dacorum 18.0 17.4
-0.6
East Herts 15.6 15.2
-0.4
Hertsmere 15.1 20.8
+5.7
North Herts 20.8 17.0
-3.8
St Albans 19.7 16.2
-3.5
Stevenage 27.7 22.3
-5.4
Three Rivers 24.6 15.5
-9.1
Watford 18.5 14.3
-4.2
Welwyn Hatfield 21.5 20.4
-1.1
Hertfordshire 20.0 17.7
-2.3
England 20.2 19.5
-0.7
Local Tobacco Profiles 2012*:
http://www.tobaccoprofiles.info
*Note - wide confidence intervals

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Local Ambitions
• Reduce Smoking Prevalence
to 18.5% or less in each
district
• Reduce the uptake of Smoking
in Young People to less than
9% by 2015
• Reduce Smoking in Pregnancy
to 7% or less by 2015
• Reduce the harm from second-
hand smoke
• Promote Smokefree public
sector organisations and
healthy workplaces

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Tobacco Control Progress:
Reducing Adult Prevalence
Reduce smoking in every district to 18.5% or less by 2015
0
5
10
15
20
25
30
2010
2011
2012
2010
2011
2012
2010
2011
2012
2010
2011
2012
2010
2011
2012
2010
2011
2012
2010
2011
2012
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2011
2012
2010
2011
2012
2010
2011
2012
England Hertfordshire Stevenage Hertsmere Welwyn
Hatfield
Broxbourne Dacorum NorthHerts St Albans Three Rivers East Herts Watford
PercentageofSmokers
Percentageof adults who smoke
Source: Integrated Household Survey published by Public Health England

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Tobacco Control Progress:
Reducing Prevalence in Young People
Reduce smoking in young people, so that less than 9 per
cent of 15 year olds smoke by 2016
0
5
10
15
20
25
2008
2010
2012
2008
2010
2012
2008
2010
2012
2008
2010
2012
2008
2010
2012
2008
2010
2012
2008
2010
2012
2008
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2008
2010
2012
Hertfordshire Broxbourne Dacorum East Herts Hertsmere NorthHerts St Albans Stevenage Three Rivers Watford Welwyn
Hatfield
Percentageofchildrenwhosmokeregularly
Percentageof children aged 15 who smoke regularly
Male Female
Source: Health Related Behaviour Survey

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Tobacco Control Progress:
Reduce the number of women who are
smoking at the time of delivery to less than
7% by 2015
130 142 134 119 122 125 126 124
0%
2%
4%
6%
8%
10%
12%
14%
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
England ENHCCG HVCCG
Percentageof women smoking at the time of delivery (by CCG)
% women smoking at time of delivery Target Source: Health & Social Care Information Centre

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What we have done since the Public Health
function transferred to the County Council:
1. Public Health Strategy adopted Nov 13 with clear priority
commitments on tobacco
2. One of the Health and Wellbeing Board 9 Priorities
3. Hertfordshire Tobacco Control Policy approved by Cabinet (based
on LGA declaration but goes further) Nov 13
4. Established multi agency Public Health board – advocates of
Tobacco Control and route to sharing best practice and advocacy
5. Collaborating with national agencies on harm reduction and e
cigarettes in tobacco control
6. Tobacco Control Strategic Plan 2014-2016 approved by Public
Health and Localism Panel May 2014 and by Health and Wellbeing
Board

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What we have done since arriving in Local
Government cont.
1. Work with CCGs and Commissioners to include Tobacco Control
and Smoking Cessation in NHS targets (mental health, NHS
Hospital Trusts and Community Provider)
2. Public Health now lead on the JSNA
3. Detailed profiles for every District and CCG locality on impact of
tobacco as part of JSNA
4. £2m investment in District Council led public health. Tobacco one of
top priorities
5. Smoke free homes, cars and playgrounds campaign
6. Invested in psychology skills in services
7. 300+ stop smoking service points in Hertfordshire across a variety
of settings and agencies

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Hertfordshire Tobacco Control
Strategy Group
• Tobacco Control Strategic Plan 2014-2016
developed with stakeholders
• Responsible for delivery of each of these
priorities working with TC Alliance partners
• Reports to DPH, Public Health and Localism
Panel and to HWB Board
• Project management approach to delivering
ambitions

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Coming shortly…..
• Report to the HWb Board to and advocate
refresh of ambitions in view of progress in Herts
• Feasibility study from TFF/ASH/Fresh on
Regional Tobacco Control Office
• Director of Public Health Report 13-14 about to
be published. Focus on ‘Early Avoidable Death’
and prioritises smoking-related behaviour
• Tobacco Control in PH communication and
marketing plan 2014-2015

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Harm Reduction and e-cigarettes
• We are starting to develop harm reduction guidelines in
line with NICE guidance
• Our ultimate aim is to get people quitting tobacco but we
recognise harm reduction is a must do
• We will include psychology skills as core to harm
reduction
• We will develop e-cigarettes guidance and work with e-
cigarette users and stakeholders to get this right
• E-cigarettes are an important tool in reducing harm from
tobacco though we recognise we are still feeling our way
on this and welcome help and guidance

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thank you