PQ: Health Inequalities

John Bercow (Buckingham, Conservative): To ask the Secretary of State for Health what progress he has made towards meeting the target to reduce health inequalities by 10 percent by 2010; and if he will make a statement.

Dawn Primarolo (Minister of State (Public Health), Department of Health; Bristol South, Labour): The national health inequalities public service agreement target (PSA) aims to reduce inequalities in health by 10 per cent. by 2010, as measured by infant mortality (by socio-economic group) and life expectancy at birth (by geographical area).

Since the 1997-99 baseline the infant mortality gap has widened, and latest 2005-07 data show the infant mortality rate among the Routine and Manual group was 16 percent higher than in the total population. However, the gap has narrowed in recent years and if the rate observed since 2002-04 continues, the infant mortality element of target will be met.

Life expectancy in England and in the Spearhead Group (the 70 local authority areas with the worst health and deprivation indicators, and the 62 primary care trusts mapping to them, and a focus of action for this element of the target) is at record levels. If the rest of England still had the life expectancy it had in 1995-97 (the target baseline), Spearhead areas would not just have narrowed the gap by 10 per cent., they would have closed it completely. However, the increase in Spearhead areas is not as great as in non-Spearheads so the gap has not narrowed. The latest 2005-07 data show that the percentage gap in life expectancy between the Spearhead Group and the England average has increased to 4 percent above baseline for men and 11 percent above baseline for women (the target is a 10 percent. narrowing for both).

The health inequalities target was deliberately set to be ambitious. Some progress has been made. However, we acknowledge that more remains to be done. "Health Inequalities: Progress and Next Steps" (June 2008), a copy has already been placed in the Library, reaffirmed our commitment to tackling inequalities, and meeting this PSA target. Our focus now is to provide tailored, intensive, support to the Spearhead areas, and areas with high infant mortality, including: an additional £34 million in spending for inequalities programmes in 2008-09; investing more in the National Support Team for health inequalities to reach all Spearheads by summer 2009, enhancing the National Support Team for Tobacco Control, and establishing new National Support Teams for Alcohol and Infant Mortality; and support to local partners for planning and commissioning of services through the "Health Inequalities Intervention Tool".

Source: Hansard, Column 964W, 15 January 2009
Link: http://tiny.cc/mdyKR

US: Senate backs expansion of health program by raising Tobacco taxes

The U.S. Senate has voted to expand a popular children's health program and raise tobacco taxes to pay for it in what could be a big step toward fulfilling President Barack Obama's promise of making affordable health insurance available for all Americans. The Senate voted 66-32 for the $32.8 billion plan to expand the State Children's Health Insurance Program to insure as many as 11 million children. The program currently covers about 7.4 million children.

The House of Representatives has approved similar legislation and the two bodies have to work out their differences before sending the bill to Obama for his signature. House Speaker Nancy Pelosi, a California Democrat, said she expected the House to approve a final version of the bill next week.

Former President George W. Bush twice vetoed similar legislation even though it enjoyed broad bipartisan support. "It is a new era," said Senate Finance Committee Chairman Max Baucus, a Montana Democrat who helped write the legislation. "We have a new opportunity, and I think most senators are proud of the efforts we are undertaking to help more kids get better health insurance." Baucus has called the bill a start toward the national health care reform promised by Obama during his presidential election campaign.

Senate Republicans balked at the latest version of the bill because it omitted provisions in earlier versions aimed at preventing states from offering the program to higher-income families. They also voiced concern about families and employers dropping private insurance in favor of the government program. "It doesn't do us any good to add somebody to the government-run program if the only effect of that has caused them to lose their insurance policy from their family's employer," said Sen. Jon Kyl, an Arizona Republican.

The Republicans complained that the bill would allow New York to enroll children from families earning as much as $88,000, and New Jersey to enroll families earning as much as $77,000. Republicans also criticized a provision backed by Democrats that would drop a ban on legal immigrants enrolling in the program until they have lived in the United States at least five years. The Senate rejected Republican efforts to impose stricter income levels and maintain the waiting period for legal immigrants.

The program aims to help working families who earn too much to qualify for Medicaid health care coverage for the poor, but who cannot afford private health insurance. The bill passed by the Senate, like the House legislation, includes a 61 cent per pack increase in cigarette taxes, bringing the total federal tax to $1 a pack. The tax on cigars and other tobacco products would also rise.

Source: Reuters, 29 January 2009
Link: http://tiny.cc/cZK57

The Framework Convention on Tobacco Control (FCTC) and the adoption of domestic tobacco control policies: the Ecuadorian experience

Abstract

Background: The present work concerns the adoption of domestic tobacco control legislation in Ecuador after ratification of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). 

Methods: Analysis of legislation, and data collection via interviews with key actors involved in the adoption and implementation of domestic legislation passed purportedly to implement the FCTC and research of the Ecuadorian Congressional Archives.

Results: While the FCTC helped raise awareness about tobacco’s imminent and future threats to public health, paradoxically, it had the effect of further entrenching tobacco-friendly norms. Philip Morris, with 87% dominance over the Ecuadorian tobacco market, subtly harnessed the FCTC to protect its interests. This outcome was also influenced by poor governmental readiness and intervention, lack of legislative technical capabilities and weak civil society involvement.

Conclusions: The Ecuadorian experience suggests that more support should be provided to health ministries, legislatures and local tobacco control organisations to offset the power of the tobacco industry as developing nations get ready to adopt domestic tobacco control legislation.

Source: Albuja, S. & Daynard, A.R., Tobacco Control 2009, vol. 18, p18-21
Link: http://tiny.cc/s5AAs

Imperial Tobacco reorganizes UK legal team

UK-based tobacco company Imperial Tobacco has reorganized its legal team. This restructuring is driven by Imperial Tobacco's acquisition of Spanish tobacco rival Altadis. The merged company has about 35-40 lawyers, 10 of them are in the legal team's Bristol headquarters. In line with this restructuring, the company's lawyers in Bristol will be organised across four legal disciplines - Company/commercial, intellectual property, litigation and regulatory.

Lawyers within the wider group will then report to the relevant UK discipline head. Imperial Tobacco is also looking at expanding the legal team in Bristol from 10 to 12 lawyers. Adrian Welsh, head of Imperial Tobacco's legal operations, said: "I wanted to move away from providing group legal support on a market-by-market basis, where each of my team would have first point of contact responsibility for certain countries, and develop a structure more closely aligned to the private practice model of specialist departments with experts in specific legal disciplines."

Source: Datamonitor, 26 January 2009
Link: http://tiny.cc/zNbfp

Government releases 2007 adult smoking prevalence figures

Key figures are as follows:

• There was a 1% fall in overall prevalence from 2006 to 2007: from 22% to 21%; overall male smoking 22% and women 20%
• There has been a bigger decline among routine and manual groups: from 29% to 26%; a 1% drop among intermediate groups from 21% to 20%; and no change among professionals at 15%.
• Consumption has not changed significantly: average daily consumption among men was 14 in 2007 (15 in 2006); among women 13 (same as 2006)

Responding to the latest smoking prevalence figures released on the 22nd January 2009, ASH Chief Executive Deborah Arnott said:

"The Government is to be congratulated for achieving its smoking reduction target ahead of schedule but the latest results just show that new, more challenging targets are now urgently needed. We are calling for a new target to reduce overall adult smoking prevalence to 11% by 2015. This target is ambitious but achievable, if the government moves quickly to implement the comprehensive new tobacco strategy it recently announced was in development ."

Note: The 11% target was published in 'Beyond Smoking Kills', a report marking the tenth anniversary of the first tobacco white paper 'Smoking Kills', published by ASH and endorsed by over 100 health and welfare organisations.
Link: http://ash.org.uk/ash_3xe9h0zo.htm

Source: ASH, 22 January 2009

Wales: 22m counterfeit cigarettes found

The biggest ever single haul of counterfeit cigarettes in Wales has been discovered in Cardiff. The fake branded Classic Gold and Raquel cigarettes were hidden in three 40ft containers, within a cargo of bed linen and towels on a ship from Dubai. Customs officers found the consignment, worth £5m just before Christmas. It was the biggest haul in the UK last year.

Investigation officers have been working to find the source of the haul and its UK destination. They say the investigation into the seizure which was made on 19 December are continuing. Details have only now been revealed because of the previous sensitivity of inquiries.

Andrew Pavlinic, assistant director of criminal investigation, HM Revenue & Customs (HMRC) said: "The sheer quantity involved in this attempt suggests that these cigarettes could have ended up in locations across the UK. "Had it been successful, it would have undermined the business of honest traders who only sell duty paid tobacco products. We have prevented UK consumers from being conned into buying cigarettes which are counterfeit and could have more serious risk to health than legitimate brands.

Mr Pavlinic added: "The huge profits reaped from the sales of these cigarettes would have been ploughed straight back into the criminal underworld, feeding activities like drug dealing and fraud. Buying cheap, smuggled cigarettes isn't a bargain - it means trading with criminals," he said.

Source: BBC News, 16 January 2009
Link: http://tiny.cc/mCN46

Tobacco: The growing epidemic in China

Abstract

Summary: China, with 20% of the world’s population, produces and consumes about 30% of the world’s cigarettes, and already suffers about a million deaths a year from tobacco. This is more than in any other country, and the hazards are expected to increase substantially during the next few decades, over and above the effects of demographic changes, as a delayed effect of the large increase in cigarette use between the 1950s and 1990s and of a further sharp increase in cigarette consumption since 1999.

In developed countries cigarette smoking became popular during the first half of the twentieth century, but the main increase in tobacco deaths was not seen until several decades later, during the second half of the century. In the US, mean cigarette consumption per adult in 1910, 1930 and 1950 was 1, 4 and 10 a day, respectively, after which it remained fairly constant for a few decades. As a delayed result of this increase in cigarette smoking, the proportion of all US deaths at ages 35–69 attributed to tobacco rose over the next few decades from ‘‘only’’ about 12% in 1950 to 33% in 1990.

In Chinese men, the pattern of increase in cigarette smoking that had been seen between 1910 and 1950 in the US was repeated 40 years later between 1952 and 1992. In most parts of China women now smoke far less than men. Mean cigarette consumption per Chinese man in 1952, 1972 and 1992 was 1, 4 and 10 per day, respectively, after which it leveled off for a few years, then continued to rise. Nationwide retrospective and prospective studies in China indicate that by 1990 tobacco already caused about 12% of all male deaths at ages 35–69, and by 2030 it will probably cause about one third of them, unless there is widespread cessation among those who already smoke. Although the overall hazard per cigarette smoker may be about the same in China as elsewhere, the chief diseases by which tobacco caused death in the 1990s were very different in China, with about half of the tobacco deaths involving emphysema rather than cardiovascular disease. The patterns of tobacco death also differed between one region and another, and may change substantially over time as a result of changes in diet and other factors. Large prospective epidemiological studies are now in place to monitor the evolution of the growing tobacco epidemic in China and elsewhere over the next few decades.

Source: Peto, R. et al., CVD Prevention and Control, December 2008
Link: http://tiny.cc/j8wrl

Japan Tobacco criticizes UK's proposed tobacco display ban

Japan Tobacco International has criticized the UK government's proposed tobacco display ban, reported Talking Retail. The company has said that there is no trustworthy proof to support this ban.

The company has found faults with the consultation process as some 79,272 responses have been taken from people working for government or non-governmental agencies.

Eddy Pirard, regional president of the UK and Ireland for Japan Tobacco International, said: "This emphasis clearly creates a distorted view of the consultation process. The answer was guaranteed before the question was asked."

Japan Tobacco has also expressed discontent over the authenticity of the figures used in the official report into consultation.

Source: Datamonitor, 20 January 2009
Link: http://tiny.cc/p0ZlN

Health Bill

The Health Bill was introduced to the House of Lords by Lord Darzi on the 15th January 2009.

The Bill includes provision for the control of the promotion and sale of tobacco products.

The second reading and the general debate on all aspects of the Bill - takes place on the 4th February

Source: Westminster Review, 23 January 2009
Link: http://tiny.cc/hg1qP

Germany: Bavaria lights up again

The state of Bavaria in Germany has decided to water down its strict smoking ban after complaints from entertainment venues. Bavaria's Health Minister has said it was impossible to enforce the legislation. From August, small bars and festival events will be able to introduce special smoking areas.

Bavaria's smoking ban was the strictest in Germany and did not even allow for separated smoking areas. The ban led to fierce protests, and special smoking clubs were set up to beat the law.

Source: Irish Sun, 21 January 2009
Link: http://tiny.cc/yJ2My

Effectiveness of a web-based self-help smoking cessation intervention: protocol of a randomised controlled trial

Abstract

Background
Cigarette smoking is a major risk factor for many chronic and fatal illnesses. Stopping smoking directly reduces those risks. The aim of this study is to investigate the effectiveness of a web-based interactive self-help programme for smoking cessation, known as the StopSite, by comparing it to an online self-help guide. Both interventions were based on cognitive-behavioural and self-control principles, but the former provided exercises, feedback and interactive features such as one-to-one chatrooms and a user forum, which facilitated mutual support and experience sharing.

Methods and design
We conducted a randomised controlled trial to compare the interactive intervention with the self-help guide. The primary outcome measure was prolonged abstinence from smoking. Secondary outcomes were point-prevalence abstinence, number of cigarettes smoked, and incidence of quit attempts reported at follow-up assessments. Follow-up assessments took place three and six months after a one-month grace period for starting the intervention after baseline. Analyses were based on intention-to-treat principles using a conservative imputation method for missing data, whereby non-responders were classified as smokers.

Discussion
The trial should add to the body of knowledge on the effectiveness of web-based self-help smoking cessation interventions. Effective web-based programmes can potentially help large numbers of smokers to quit, thus having a major public health impact.

Source: Kramer, J. et al., BMC Public Health 2009
Link: http://tiny.cc/gIfbt

PQ: Tobacco Public Consultation

Michael Penning (Shadow Minister, Health; Hemel Hempstead, Conservative): To ask the Secretary of State for Health how many of the responses to his Department's consultation on the future of tobacco control were from (a) retailers or shop owners and (b) organisations funded wholly or in part by his Department.

Dawn Primarolo (Minister of State (Public Health), Department of Health; Bristol South, Labour): The Department received 10,586 responses from small retailers (including pre-prepared postcards or emails made available to respondents by third parties), 11 responses from larger retailers and 21 responses from retail industry representative organisations, including trade associations.

The Department received seven responses from organisations that receive funding directly from the Department for programmes of work related to smoking. Identification of respondents that receive funding from the Department for other purposes could not be provided without incurring disproportionate cost.

The Department received 85,565 responses from members of the public (including pre-prepared postcards or emails made available to respondents by third parties).

Source: Hansard, Column 689W, 13 January 2009
Link: http://tiny.cc/Nx9hl

Yorkshire lawyer tackles illegal tobacco trade

A Lawyer from Sheffield is working with the World Health Organization (WHO) to tackle the illicit trade in tobacco products. 

Sarah Maylor, who works in the Sheffield office of Halliwells, will travel to Durban later this month to work as a legal consultant at the third Conference of the Parties of the WHO Framework Convention on Tobacco Control (FCTC).

Last month she travelled to Geneva to support the Intergovernmental Negotiating Body on Illicit Trade in Tobacco Products established by the FCTC.

Source: TheBusinessDesk.com, 30 January 2009
Link: http://tiny.cc/I7CmD

Nicotine activates more than just the brain's pleasure pathways

Duke University Medical System researchers have discovered there are differing taste pathways for nicotine, which could provide a new approach for future smoking-cessation products. "We learned some of nicotine's secrets," said Albino Oliveira-Maia, M.D., Ph.D., a postdoctoral fellow of the Duke Department of Neurobiology. "This is the first study to explore both the peripheral taste pathways activated by nicotine, and how these pathways are integrated in sensory areas of the brain." The peripheral nervous system refers to nerves that are outside of the brain and spinal cord.

Using genetic engineering and measurements of nervous system activity in mice, the researchers found that nicotine sends signals directly to the brain's sensory systems by several pathways, similar to the way taste is perceived. These findings complement what is known about the effects of nicotine in the dopamine pathway. This is the classic pleasure pathway in the brain, much studied by addiction experts. "Our study in no way contradicts prior findings about nicotine and dopamine," Oliveira-Maia said. "Our findings add to what is known and suggest new approaches for further study."

The findings appeared in the PNAS (Proceedings of the National Academy of Sciences) Early Edition. "One reason that our findings are interesting is because they relate to previous work that looked at humans with lesions in the insula region of the brain - they had an easier time giving up cigarettes than most people," Oliveira-Maia said. "We found that a part of the insula, the gustatory cortex, has robust responses to nicotine and a capacity to integrate diverse peripheral information to create a unique sensory representation for nicotine."

One taste pathway the Duke researchers uncovered involves nicotinic acetylcholine receptors (nAChR), which scientists previously proposed were taste receptors for nicotine. The researchers found a previously unknown link between these receptors and activity in the taste region of the insula. They then found a second pathway, the peripheral Trpm5 protein pathway - one that helps animals sense a bitter taste. Mice which had their Trpm5 pathway deleted were unresponsive to several different tastes, including bitterness, but they could still sense the presence of nicotine. "The mice preferred plain water to the nicotine solution, suggesting that there would be a second taste pathway in play, besides the one that had been knocked out," Oliveira-Maia said.

The researchers then measured nerve activity in the chorda tympani (CT), which is a branch of the facial nerve that serves the taste buds in the front of the tongue and found that activity in CT nerve fibers increased when nicotine was put on the mice's tongues. Looking ahead, Oliveira-Maia said that drugs thath block the nAChR receptors are now being used in the treatment of tobacco addiction, mainly because of their effects on the central nervous system, "but it is possible they could also modify the sensory effects of cigarette smoke."

Source: mediLexicon, 25 January 2009
Link: http://tiny.cc/z6x2K