health inequalities and smoking, dr. helen mcavoy
TRANSCRIPT
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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