Policies for health

Topic: Critically discuss the contribution that healthy public policy can make in tackling a particular public health issue.

Introduction

Definition of public policy

Public policy may be defined as the guide to actions taken by decision makers within a country regarding certain political, social and health issues that affect members of the public. The decisions made must be consistent with the laws of the land (Browson, Chriqui & Stamatakis, 2009). When considering smoking, it is important to note that research should play a critical role in development of these policies. This should happen through the process of communication and interaction. However, at times there is limited interaction between scientific data and policymakers. This interaction is limited by the complex nature of the scientific data that is not easily understood by policymakers (McNeill et al. 2012).

In England smoking leads to more than 100,000 deaths every year (Health and Social Care Information Centre, 2012). Tobacco smoking harms almost every organ of the body thereby reducing the life expectancy and quality of life of individuals. For example, smoking leads to different forms of cancer including mouth, lip, bladder, throat, cervix, kidney and stomach. Smoking also reduces the functioning of the liver (Action on Smoking and Health, 2014). The prevalence of smoking has been declining over the years but this has not been happening fast enough. Apart from these concerns, almost 460,900 NHS hospital admissions in England were attributable to smoking; this accounts for almost 5% of all hospital admissions for people aged 35 years and above (Action on Smoking and Health, 2014). Smoking costs the NHS £2 billion a year (Action on Smoking and Health, 2014).

Public policy for smoking

The comprehensive smoking public policy in the UK was developed after the passage of the Smoking Kills: a White Paper on Tobacco in 1998. This policy document set out the strategies that were to be used in tackling smoking. Some of the strategies that were developed include ban on advertising, increasing the price of tobacco, reducing smoking in public places and at work and reducing the availability of tobacco to children (Murray & McNeill, 2012).

The United Kingdom developed a comprehensive policy that outlawed the publication of any material that was deemed to be promoting consumption of tobacco. The first of such policies occurred in 2003 through the passage of the Tobacco Advertising and Promotion Act that was enacted in 2003 (Harris et al. 2006). This policy was developed because tobacco advertising may increase experimentation or initiation of smoking, increase the rate of cigarette smoking of an individual, decrease the success of quit attempts and persuade successful quitters to get back to smoking (Kasza et al. 2011). Through passage of the act, advertising of tobacco products was prohibited in any electronic, print, billboards and any other media. In addition, tobacco companies were also prohibited from sponsoring sports and other events (Langley et al. 2012). Through the implementation of the policies, there has been a relative reduction in the prevalence of cigarette smoking in the UK (Sims et al. 2014). The effectiveness has mainly been seen in reducing exposure of children and youth to cigarette smoking. However, the susceptibility to smoking and early exposure through parents and other avenues is not considered in most of the studies done in the UK and other developed nations (Kasza et al. 2011). One implementation problem with this policy is that displays in small shops can still be used in promoting cigarettes. There is need for banning of all eye-catching displays in all shops as has been done in supermarkets. This will help in reducing the attraction for purchase of cigarettes.

The second policy that has been implemented is one that prohibits smoking in public places including workplaces, public parks and other public spaces. The aim of this legislation is to help reduce exposure of non-smokers to passive smoking which is equally harmful. There has been evidence on the effectiveness of these policies as people’s heath and health behaviour has significantly improved since the policy was first implemented (Bauld, 2011). Initially, there was an implementation problem because it was thought that banning smoking in public places would increase children’s exposure to tobacco smoking. However, this has not been the case as parents have understood the dangers of second hand smoke to the children (Bauld, 2011). Over the past few years, there have been policies implemented to totally ban smoking in all environments where children are present. This also includes prohibiting smoking in cars. The objective of this is to help reduce imagery among the children’s lives. This can help in reducing the exposure of children to second hand smoke. However, such a policy has ethical issues because a car can be considered as a private space of an individual in which he or she should not be controlled.

The other policy that has been implemented is tax policy where tax on tobacco products has been increased to increase the price of cigarettes. This has been premised on the fact that higher prices may be prohibitive for some people especially the youth and young adults. This means that higher cigarette prices may lead to higher smoking cessation rates or lower rates of initiation in smoking (Sims et al. 2014). The effectiveness of tax policies depend on the initial price of cigarettes before they are increased due to taxation; the tax size when compared to the initial price and the income of the smoking population. For a higher income population, an increase in smoking prices will increase the level of satisfaction of the smokers. This is because many smokers would perceive the taxation as a self-control mechanism implemented by the government. They therefore increase their happiness when they can still afford cigarettes despite the high taxes (Hinks & Katsoris, 2012). The other implementation problem with tax policy is the issue of smuggled or untaxed cigarettes which increases the availability of low priced cigarettes for the population. It is important that the Department of Health and other government agencies enforces stricter penalties and enforcement standards so that the smuggling problem is reduced. The Department of Health has also promised to provide regular updates to make it easy for the development of trading standards. This will allow customs office and other government departments to coordinate their efforts in tackling sale of fake and smuggled tobacco in the UK (Department of Health, 2015). One of the advantages of higher taxes is that they can be an important source of revenue for the government. This revenue can be used to finance tobacco control marketing campaigns that are implemented by the government. The tax policy has been integrated with a requirement that cigarette packs have a graphic warning on the adverse dangers of smoking (Murray & McNeill, 2012).

The fourth policy that has been implemented by the government is the mass media policy. This is where the government working through different agencies runs different media campaigns geared towards educating the general public on the negative effects of tobacco smoking. The media campaigns have also focused on eliciting the public support towards for the policies that are already being implemented by the government. The objective of the campaigns has also been to help reduce the effects of second hand smoke to the non-smokers (Graham, 2012). However, within the UK there are very few studies that have evaluated the effectiveness of mass media campaigns in reducing prevalence of tobacco smoking. The effectiveness of the policies is based on the immediate impact of the policies (Langley et al. 2012). This means that there is need for evaluation of effectiveness of mass media campaigns conducted by the government. Apart from the government, there are international and national pharmaceutical companies that have promoted nicotine replacement therapy (NRT) as a means of reducing the withdrawal symptoms of cigarette smoking. However, these campaigns are usually motivated by commercial interests making it difficult for their effectiveness to be measured over a period of time (Langley et al. 2012). The good thing about the campaigns is that they provide information on how NRT helps in reducing withdrawal symptoms and may increase the number of people who attempt to quit cigarette smoking. From this, it is important for the Department of Health to increase people’s awareness on the dangers of smoking. This will help in reducing the number of people especially children and youth who may start smoking. The Department of Health should also try to encourage as many people as possible to quit and if they cannot to reduce children’s exposure to cigarette smoke (Department of Health, 2015). The problem with the mass media campaigns is that some of them are not developed for the population groups in question. There are some that have been developed universally for everybody. This makes it difficult for a certain population or age group to identify with the campaigns. There is therefore need for a change of these mass media campaigns to make them more focused on particular population or age groups. This may be complex and expensive to achieve but can go a long way in helping improve the effectiveness of such policies.

The UK government has had an interest in reducing the prevalence of smoking especially among the disadvantaged in the society. This is because the negative effects of smoking are likely to be manifested easily among the disadvantaged making them to die easily from smoking (David et al. 2010). This means that while the strategies on reducing the prevalence of smoking have been effective for the other social classes, the strategies targeting the low income people have been relatively weak. This has been occasioned by the lack of evidence on the best strategy that can work for this population group (McNeill et al. 2012). There is need for more mass media and other policy programmes to be tailored to the low-income earners to help in reducing smoking prevalence within this group. For example, tax, mass media and other policies can be tailored to ensure that they capture the demographics and economic welfare of these people (McNeill et al. 2012).

The other policy that has been implemented is the increasing the minimum purchasing age of cigarettes. In 2007, this age was increased from 16 to 18 years (Millett, Lee, Gibbons & Glantz, 2011). There are different studies that have been done to determine the effectiveness of this strategy. In most of the studies, the results have shown that increasing the minimum purchasing age has had an effect of reducing the prevalence rate of smoking especially among adolescents (Fidler & West, 2010). However, most of the studies have not evaluated the effectiveness of the policies in tackling smoking especially among the low-income earners within the society. It is important that policymakers consider this social group because youth among this group may have increased access to cigarettes from their homes, their neighbourhoods and through other illicit sources (Borland & Amos, 2009). Studies have also shown that low income earners are likely to continue with smoking tendencies (Gilman, Abrams & Buka, 2003). The policy of increasing smoking age should not be implemented as a standalone policy. This policy should be integrated with other policies that have been mentioned like banning of adverts and banning of smoking in public places. This is based on past actions of some tobacco companies that have advertised their products even to young people thereby eliciting their consumption of tobacco despite their young age (Action on Smoking and Health, 2006). The activities of tobacco companies must be looked at keenly. This is because by marketing tobacco as an adult only product, they may want to increase the desirability of cigarette smoking to adolescents and children thereby increasing purchase of cigarettes (Action on Smoking and Health, 2006). Despite the challenges it is facing, raising the minimum age of purchasing cigarettes has helped in ensuring that children understand the dangers of cigarette smoking. From the above, it has been seen that policies on children smoking should tackle the whole population. This would help in reducing the inequalities that may exist when individual policies are implemented. For example, individual related policies like citizen education may create inequalities because there is a group within the citizenry that may not be able to adequately understand the course content being delivered. In addition, this group may also not be able to access some materials needed for the completion of citizen education.

The other policy that has been implemented is the support for the NHS’s Stop Smoking Services (SSS). These are services done by the NHS to help in promoting smoking cessation within the population (Murray & McNeill, 2012). The SSS is one of the most important tools that can be used to help reduce smoking related health inequalities. The NHS SSS provide support in different forms including one-on-one or closed group support. The SSS also provides telephone support thereby improving access of support services to people who may find difficulty in attending the structured appointment based services (Wiltshire, Bancroft, Amos & Parry, 2001). The SSS services have been effective in helping smokers to quit. However, there is need that the services are made more accessible to people living in disadvantaged neighbourhoods. This is because the success rate of the intervention is only experienced among the more affluent within the society (Murray & McNeill, 2012). The policies should focus on eliminating barriers like fear of failure, lack of knowledge and difficulty in accessing venues for the disadvantaged people (Roddy et al. 2006).

 

Evidence base for public policy

Policy making evidence can take different forms. When considering the case of smoking, it is important that the policies are developed based on evidence. However, as has been mentioned, many of the policymakers are not trained on how to handle the complex data that is generated from research. This makes it difficult for the policy makers to separate between good and bad data (Browson, Chriqui & Stamatakis, 2009).

Quantitative and qualitative evidence

This can take different forms including data from the surveillance systems and public health data that can be obtained from peer reviewed journals. The other source of quantitative data is the success of the programmes and policies that are implemented by the government (Browson, Chriqui & Stamatakis, 2009).

Qualitative evidence mainly involves non-numerical observations. This is mainly collected through group interviews, participant observation and focus groups. This form of evidence can be very important in setting the policy direction (Browson, Chriqui & Stamatakis, 2009).

Ethical and legal issues within the government policy systems

From the above analysis, it has been seen that the government’s public policy on smoking does not have a definite limit on the ‘safe’ level of smoke. The policies are designed to help smokers to quit the habit entirely. This is a more realistic approach to cigarette smoking because of the dangers of addiction to nicotine that smokers have been exposed to. However, there is no express policy that bans smoking despite the numerous evidence of the harmful nature of nicotine to the human body. The government policy makers have often argued that smoking has increased the health burden for the NHS. However, smokers have disputed this claim by asserting that the increased taxes on cigarettes compensate and should cater for the divergent needs of the smokers.  To help finance its budget, the government has an interest in retaining the tax revenue from smoking. In addition, the government does not want to adversely affect the tobacco industry due to the number of jobs that are created in the value chain. For example, almost 89% of the cost of smoking packet is excise duty that is levied by the treasury. This has made some pro-smoking organisations to consider the packets as nationalised products to the heavy taxation. The government is also concerned with the high number of cigarettes that are available in the black market. This not only poses a health risk to the citizens but also result in loose of revenue for the government.

Conclusion and recommendation

            One possible consequence of enforcement of the policies is that they have helped in reducing the availability of cigarettes and smoking information to the public. This has created an environment where many people source for cigarettes from the black market because they are not able to afford the cigarettes offered in formal channels. It is very difficult to determine the scale of the problem because there have been very few government studies to help determine the extent of the problem (Bader, Boisclair & Ferrence, 2011). It is therefore important for the government to perform a research to determine the extent of this problem (Action on Smoking and Health, 2006). This will help in implementation of strategies that can help reduce the negative effects of smuggled tobacco especially for youth and children in low socio-economic classes. This can be done by use of tracking and tracing technologies that have been implemented in other nations like Canada. The tracking and tracing policy should be implemented to the later so that any unscrupulous businessperson who is found selling cigarette to an underage is brought to book.

The other recommendation is that the policies should focus on reducing inequalities in cigarette smoking. One of the ways in which inequalities can be reduced is through the focus on population-wide initiatives (Murray & McNeill, 2012). This will help in development of effective policies that can tackle the entire population. For example, more programmes should be geared at improving consumer education through mass media. However, the media should be chosen carefully to ensure that there is no inequality created.

In conclusion, cigarette smoking is one problem that has affected the UK society for quite some time. This is based on the high number of cigarette-smoking related deaths (Health and Social Care Information Center, 2012). There are different policies that have been implemented to help in reducing the prevalence rates of cigarette smoking in the UK. Some of the policies include ban on adverts, media campaigns, increased taxation and increasing the minimum purchasing age. The effectiveness of these policies is based on the manner in which they have been implemented. It is important that their implementation does not create inequalities.

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