TOBACCO POLICY SPECIAL
“But fear arousal can absolutely work. We also need to rotate the messages, so there needs to be an accumulation of differing messages, you can’t just stick to the same campaign and run it over and over again. People need new news which is what Aus- tralia’s done – they’ve introduced various different health effects of smoking over the years. And what we’ve found, certainly in the UK in particular, is motivation around quitting for your family, being around for your family, is a really strong positive mo- tivator, which is why we’ve picked a mum with her son and 20 years later basically the roles are reversed and he’s looking after her.
“It was ten focus groups over the summer that led us to the really strong conclusion that the days of hard-hitting health cam- paigns are definitely not over. The younger smokers in the focus groups particularly hadn’t been exposed to hard-hitting mass media campaigns – there is a scarily low awareness of the fact that it causes 16 types of cancer, the fact that heart disease is caused by smoking, and so on.
“They need to be integrated mass media campaigns, so obviously TV and radio, but also a really strong public relations an- gle where you bring it to life, you use real local case studies but also increasingly with a digital element. For example, with ‘Every breath’, the biggest response has been through the digital channels: 5,500 unique visitors to
everybreath.tv, our web- site, 2,000 clicks through to the SmokeFree website, but most importantly for us we’ve had people queuing outside drop-ins of the stop smoking services in the north east. I’ve heard a lot of really powerful anecdotes coming through, people saying ‘blimey I saw that, it really shocked me, I can really identify with that’, so we’ve been absolutely delighted by the response from the public and our stakeholders.”
Mix and match
Are there any public health messages and tactics on smoking cessation that have been tried in the past but are now being left be- hind because they’re less effective?
Rutter explained that a mix of messages was important – even the most effective sort of messaging would be less powerful if used completely in isolation.
She told us: “The campaigns we’ve had over the last ten years have all had a really effec- tive role to play, so I’m not criticising any of them. I just think that we need to reach out to as many smokers as possible and not make assumptions. People say that all smokers know that smoking kills, and actu-
“INVESTING IN TOBACCO CONTROL MAKES ABSOLUTE ECONOMIC SENSE FOR THE NHS. IT HAS THE STRONGEST EVIDENCE BASE OF ANYTHING IN PUBLIC HEALTH.”
ally, I would dispute that. They may think smoking’s bad for them but personalising it to them, in the sense that ‘every cigarette is doing you damage’, is something that we really want to focus in on, and smokers’ awareness of things like chronic obstructive pulmonary disease are really worryingly low – yet it’s the fifth biggest killer in the UK.”
Invisible victims
COPD has been “hidden away”, Rutter said, so it didn’t surprise her to learn that so few smokers are aware of the condition and its health impacts.
She said: “Often, late-stage sufferers are housebound, they’re on oxygen, so it doesn’t have the visible prominence and it hasn’t had the kind of profile that cancer and heart disease have had.
“The Department of Health’s COPD out- comes framework, which was published in July of this year, is about how we as the NHS need to do much more around COPD. A big priority is primary prevention – around 80- 90% of COPD is caused by smoking, so it’s important we stop it in the first place.
“But certainly, experience shows that any- thing the tobacco industry would like as a campaign generally does not work – so they would love ‘youth focus’ campaigns that suggest ‘smoking is an adult behaviour, wait until you’re 18’, which we know they have funded in the past. Youth-focussed cam- paigns generally do not work because youth aspire up – they are very influenced by adult campaigns. If you’re going to do youth cam- paigning, it seems from the evidence much more effective to do it from the aspect of the tobacco industry exploiting and manipulat- ing young people, tricking them into start- ing smoking in the first place and before they know it they can become addicted.”
Return on investment
Many public health messaging campaigns claim a massive return on advertising in- vestment in terms of health outcomes and NHS spending, sometimes based on incon- clusive evidence, but tobacco control is a clear-cut case, Rutter said.
“Investing in tobacco control makes ab- solute economic sense for the NHS. It has the strongest evidence base of anything in public health: smoking is our biggest cause of health inequalities and the biggest cause
of premature death and disease, and the re- turn on investment is clear even in the short term – people often think you don’t reap the gains for at least ten years.”
She cites research from Brunel University due to be published at the end of 2011 – an economic analysis of the tobacco control programmes in the north east, north west and south west of England – which has found that in the north east alone, the NHS saved roughly £6m over two years by having a regional comprehensive tobacco control programme, coupled with properly com- missioned local stop smoking services.
Rutter added: “It is a really small budget that we function on, but the savings to the NHS are very significant.”
Strategic leadership
Fresh also gets involved in lobbying on health policy more widely, aiming to influ- ence decision-makers as well as the public.
Rutter said: “We’ve got 80 strands of work, which we’ve had in place since 2005. We do a lot of work speaking out on the evidence base and influencing decision making. Lob- bying is a part of what we do – but when I say lobbying it’s about saying ‘this is the evi- dence on why children take up smoking and this is why they should be protected from retail displays’, for example.
“We also do a lot of work on strategic lead- ership around tobacco control, really sup- porting our local authorities so they under- stand what needs to be done across the 12 locations in the north east and which are the things that need to be done once.
“We do a lot of practice sharing and we pull together all 12 localities and really help to coordinate the whole north east. And we are also leading, as Fresh, with colleagues in the north west and Yorkshire, a world first programme on tackling illegal tobacco – an independent evaluation will be published in December by the UK Centre for Tobacco Control Studies. We’ve been working for three years now to reduce the demand for and supply of illegal tobacco across the north of England. Our work’s very cross-cutting – we work at motivating and supporting smok- ers to stop, turning off the tap for a new generation, but also a lot of work on protec- tion from second hand smoke as well.”
Visit
www.freshne.com/everybreath Ailsa Rutter
FOR MORE INFORMATION national health executive Nov/Dec 11 | 21
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