A report, published today (Tuesday 30 January 2024) by Northern Ireland’s Auditor General, has concluded that the health service has made significant progress in reducing smoking prevalence among the local population, but that levels remain concerningly high among some of the most vulnerable groups in society.
Dorinnia Carville’s report on “Tackling the Public Health Impacts of Smoking and Vaping” considers trends in smoking and vaping prevalence in Northern Ireland, and action taken to reduce smoking levels.
The report notes that an estimated 320,000 people aged 16 and over currently smoke in Northern Ireland, representing 14 per cent of the total population - this compares with 24 per cent of the population in 2010-11. However, challenges remain – the report notes that smoking prevalence is significantly higher among the most deprived areas (24 per cent) compared to the least deprived (7 per cent). In addition, around 2,200 pregnant women continue to smoke annually, and emerging research suggests a high smoking prevalence amongst people with mental health issues.
The impact of smoking on public health and public finances remains significant
The report notes that:
- Around 15 per cent (2,200) of deaths in NI are attributable to smoking every year.
- There are around 35,000 smoking-related hospital admissions recorded in NI annually.
- The Department of Health estimates that local hospitals incur annual costs of around £218 million in treating smoking-related illnesses.
- A Public Health Agency (PHA) estimate of other factors, including premature deaths and excess sickness absence, indicates that local annual economic costs arising from smoking are around £450 million.
- Smokers with a 20-a-day habit incur annual costs of over £4,600, impacting disproportionately on lower income households.
Over the last decade, the tobacco control budget has predominantly been directed towards encouraging existing smokers to quit, with 75 per cent spent on specialist services and therapies aimed at encouraging existing smokers to quit. However, the report notes that both the uptake and impact of these measures has reduced dramatically in recent years. For example, in 2010 around 34,000 set quitting dates via smoking cessation services, but this fell to around 14,000 in 2019-20, and to 8,000 in 2022-23. The report recommends that the Department of Health and Public Health Agency consider the merit to increasing support for preventative measures aimed at discouraging people from starting smoking.
The increased prevalence of vaping presents new challenges
While the report acknowledges notable progress in reducing overall smoking prevalence in NI over the last decade, it also observes that the rapid emergence of vaping has presented new challenges.
Vaping levels among adults have almost doubled from 5 per cent of the population to 9 per cent between 2014-15 and 2022-23.
In addition, the most recent Department of Health survey suggests that 9 per cent of local 11-16 year olds here are vaping, with 6 per cent doing so regularly (an increase from the respective levels of 6 percent and 3 per cent in 2019). Underlying this, 24 per cent of Year 12 children currently vape.
While research to date has highlighted benefits of adults vaping to help them quit smoking, it has also highlighted that not enough is known yet on potential long-term health effects. UK public health bodies all agree that children should not vape.
There is scope to improve enforcement
The report also considers the enforcement of tobacco control legislation by local councils on behalf of the PHA, including ‘spot checks’ at retailers and businesses, to identify if tobacco or vaping products are being sold to children. While over 5,000 tobacco test purchases were made by councils between 2011-12 and 2018-19 (identifying 570 age-of-sale offences), the report notes that targets set by the PHA for the required number of annual visits and test purchases were often not met.
In addition, the report highlights that local businesses stocking vapes do not currently have to register with councils, even though a requirement for tobacco retailers to register has been in place since April 2016. It recommends that the health service reassess the budgetary requirements for delivering a future combined tobacco and vaping strategy, and that it considers quality standards to ensure a more consistent approach to enforcement across councils.
Commenting on the report’s findings, Dorinnia Carville stated:
“As well as remaining the greatest cause of preventable illness and death globally, smoking is also the cause of some of the largest health inequalities locally. In Northern Ireland, smoking related deaths are 98 per cent higher in the most deprived areas compared with the least deprived. Similarly, lung cancer deaths are 151 per cent higher and women are more than four times as likely to smoke during pregnancy.”
“The reduction in overall smoking prevalence over the last decade highlights how progress is achievable in this area, but the issue clearly remains a major threat to public health and a strain on public finances.
As the Department of Health develops its new strategy, due for publication later this year, my report highlights several recommendations and issues for consideration.
Whilst smoking levels have been reducing, vaping amongst adults and children is increasing, and there is evidence of a greater need to focus on prevention, supported by enhanced enforcement of tobacco and vaping regulations.
A renewed strategic approach, that responds to these changes and emerging challenges, will be vital to sustain the advances made to date and reach those most impacted by smoking and vaping.”