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Knowing what works


Katie Mackintosh Health Correspondent


Evaluating population level public health policies


Over the past decade Professor Sally Haw has worked closely with governments to help shape public health policies. She led the evaluation of Scotland’s smoke-free legislation, working with a collaboration of over 50 researchers to produce what has been described as “one of the most comprehensive evaluations of public policy yet conducted”. Haw calls the policy itself “a massive success”. “It exceeds even our greatest expectations. It seriously does,” she says, pointing out that they have been able to show health gains such as a reduction in heart attacks, a reduction in asthma admissions, improvements in respiratory health, as well as social changes such as a change in the acceptability of smoking. “I think what we were able to show was it actually had a population level effect on exposure. So everybody, you and I, irrespective of where you live, everybody had lower levels of exposure and this translated into health effects which were extraordinary.” Haw recently joined the University of Stirling


as Professor Public Health and Population Health where she will be working with its


Opinion


National evaluation of Scotland’s smoke-free legislation


The evaluation found that after the legislation came into force there was:


• a reduction in the rate of child asthma admissions of 18 per cent per year compared to an increase of 5 per cent per year in the years preceding it


• a 17 per cent reduction in heart attack 44 www.holyrood.com 12 December 2011


admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of 3 per cent per year in the decade before the ban


• a 39 per cent reduction in second-hand smoke


up a new cross-cutting programme on complex interventions in public health, which aims to build a portfolio of research that examines the impact of public health programmes and policies on public health in Scotland. One of its current projects is the continuing evaluation of Scotland’s smoke-free legislation. As there is no serious suggestion that the ban on smoking in public places will be repealed, Haw says she has been asked whether there is a need to evaluate the policy. “My response was the research we’ve done in one jurisdiction brought all the information together, which hadn’t been done. It also had a great influence on other jurisdictions that are thinking about it.” Taking a closer look at the policy also revealed some lessons about implementation, she says. “We have just published a paper that shows


Professor Sally Haw


Centre for Public Health and Population Research. Te centre aims “to contribute to clinical practice and public health policy in Scotland and beyond with a focus, in a number of programmes, on user and community engagement and on addressing health inequalities.” It had already identified four research programmes that focus on: epidemiology; occupational and environmental health; physical activity, diet and health; and substance use and addictions. However, since joining earlier this year Haw has been heading


a reduction in smoking prevalence around the time of the legislation. So what happened was in the three months prior to the legislation there was an increase in quitting attempts and we did get a reduction in smoking prevalence. But by a year post-legislation it had returned to the previous trend. So what it means is that the legislation accelerated quit attempts and we got a short-term effect, but it was short lived.” Haw hypothesises that we may have “missed a trick” by perhaps curtailing the supporting media campaigns promoting smoking cessation too soon. “Up until the legislation there was a big effort


in promoting smoking cessation services and really emphasising the issues around smoking and second-hand smoke. But when the


exposure in 11-year-olds and in adult non- smokers


• an 86 per cent reduction in second-hand smoke in bars


• an increase in the proportion of homes with smoking restrictions


• no evidence of smoking shifting from public places into the home


• high public support for the legislation even among smokers, whose support increased once the legislation was in place.


Source: Ash Scotland


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