Health Inequalities and Smoking Dr. Helen McAvoy, Senior Policy Officer Institute of Public health in Ireland
May 13, 2015
Health Inequalities and Smoking
Dr. Helen McAvoy, Senior Policy OfficerInstitute of Public health in Ireland
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European Week Against Cancer 2013Aviva Stadium , Dublin
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Tobacco and Health Inequalities
Dr Helen McAvoy Institute of Public Health in Ireland
www.publichealth.ie
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www.publichealth.ie
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All-island bodyo Inequalities in healtho North-South cooperation
Three work strands:o strengthening public health intelligenceo building public health capacityo policy and programme development and evaluation
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Outline
Cancer & inequalities in life expectancy Inequalities in tobacco-related harmInequalities in smoking behaviours Social & commercial determinants Time to develop a more comprehensive
approach to addressing inequalities in tobacco-related harm?
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Source:
NI Health and Social Care Inequalities Monitoring System – 2013
An overview of changes in NI life expectancy 2001-03 to 2008-10
Comparison of life expectancy ‘deprivation gap’ in Northern Ireland
- most deprived vs. least deprived
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Source:
NI Health and Social Care Inequalities Monitoring System – 2013
An overview of changes in NI life expectancy 2001-03 to 2008-10
Contribution of the life expectancy gap of 7.6 years between NI most & least deprived areas 2008-10 by cause of death (males).
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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie
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Age-standardised incidence of cancer by deprivation category of patient residence 2007-2009 – Republic of Ireland
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Source: National Cancer Registry Ireland, 2011 – Lung Cancer Incidence, Mortality, Treatment & Survival in the Republic of Ireland 1994-2008.
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99Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie
10Source: Cancer in Ireland 2011. National Cancer Registry of Ireland - www.ncri.ie 10
5 year survival for cancers diagnosed during 1994-1997, 1998-2002, 2003-2007
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Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie
5 year relative survival for cancers diagnosed in men and women 2003-2007
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Behind the lung cancer statistics
Delays in presentation? (men especially) Knowledge & differentiation of symptoms Shame, guilt and stigma Inequalities in multi-morbidity Choices about where to die ( Sharp et al, IMJ, 2010)
Fewer empowered survivors to carry the flag for early detection, research, political attention and investment
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Cancer inequalities are multifaceted
Risk – incidence, type, age of diagnosis
Finding out – achieving a timely diagnosis
Health system, social and economic assets for optimal treatment, survival and recovery
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Inequalities in tobacco-related harm
Health harms
Social and economic harms
Socio-economic disadvantage associated with life-course accumulation of cancer risk
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Smoking in pregnancy by deprivation in Northern Ireland 2005 – 2011
Source: NI Health & Social Care Inequalities Monitoring System 2012
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Risk profile of the low income smoker
- Exposure to tobacco in utero and SHS in childhood
-Grew up in family and community with high smoking rate
-Early initiation
-Heavier smoking
-Equally likely to attempt quitting (?)
-Less likely to succeed at quitting - definitely
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SHS exposure in childhood Young Persons Behaviour and Attitudes Survey 2010 Northern Ireland – 49.8% of 11-16 yr olds report adults smoke inside their home
ISAAC study – Ireland sample 2007 – 45%
CHETS study Northern Ireland – SHS exposure is socially patterned
Indoor Air Pollution and Health – STRIVE report 2013 - Mean 24-hour level in smoking homes of 143μg/m3 4 times higher than US EPA ‘ unhealthy’ level for sensitive groups
What children report
What adultsreport
Percentage of boys who report they are current smokers
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Source: The Irish Health Behaviour in School-Age Children Study 2010www.nuigalway.ie/hbsc
Percentage of girls who report they are current smokers
Source: The Irish Health Behaviour in School-Age Children Study 2010www.nuigalway.ie/hbsc
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Adult smokers by social class (2007)
Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report 20
Percentage of cigarette smokers who reported trying to quit in the previous 12 months
21Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report
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Tobacco industry role
Recruiting ‘FUBYA’ a priority
PPACTE report – adapting price strategies
Roll your own tobacco
Illicit tobacco
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Source:
Irish Independent
newspaper
2008
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Tobacco control through an equity lens How would we judge success/failure? Health intelligence requirements Regulation of tobacco industry and supply
chain Education, health promotion Smoking cessation services, monitoring
and review
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Dr Helen McAvoy Institute of Public Health in Ireland
@HelenMcAvoy2
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