Addressing the Public Health Challenge

Introduction

Public health is important to be managed through effective interventions and implications of policies so that prolonged life of the people can be ensured and effective aiding for controlling health issues can be provided (Chandan et al., 2020). In the UK as well as internationally, one of the key public health issues is Smoking. According to WHO, cigarette smoking is the most common form of tobacco intake and it kills nearly 8 million people every year. Among them, 7 million of them are directly involved in the act while the rest 1.2 million are non-smokers that are exposed to second-hand smoking leading to their death (WHO, 2021). At the national level in the UK, it is found that 13.9% of adults in the England are involved in active smoking as of 2019 and in 2020 detailed figures informed there are 6.9 million smokers in the country (ethnicity-facts-figures.service.gov.uk, 2021). This indicates smoking tobacco is one of the major issues in the UK and the world due to effective actions are to be taken to control the prevalence of the condition.

In this purpose, the current presentation is developed where the determinants of health influencing smoking are to be identified to understand the spread of the condition. Moreover, theories or models of public health is to be implemented to determine the way and efficiency with smoking can be controlled. The ethics and values regarding smoking is also to be informed. Thereafter, the policies existing in the UK for smoking control and its impact is to be assessed. The targeted health promotion intervention for smoking prevention at the national and universal level are to be compared to determine way they different in controlling the condition. The partnership working and integrated care for smoking control is also to be critically evaluated.

Determinants of Health

The five key determinants of health are biological, behavioural, environmental, physical influences and social influences (Yearby, 2020). The biological determinant of health regarding smoking informs that the key harmful chemical released from the smoking of tobacco is nicotine. It creates adverse impact such as inhibition of contraction of stomach leading to hindered digestive control, heart rate acceleration leading to the risk of stroke and other heart diseases, increased release of epinephrine leading to hindered emotion and body controls and others (Alvidrez et al., 2019). The nicotine in the smoke of tobacco adversely affects the airways of the individual making them develop damaged lungs leading to chronic obstructive pulmonary disorder (COPD), emphysema, shortness of breath, increased coughing and others (Paci et al., 2020). Thus, the biological determinants inform the effect of smoking on individuals.

The behavioural determinants of health inform that smoking is influenced by the behaviour of the family or peers, and age. This is because more young people are seen to be actively involved in smoking due to the affinity to try it to create a place among the peers who are involved in smoking (Efendi et al., 2021). Moreover, the family environment supporting smoking also influences the other members to involve in smoking due to easy availability of tobacco and the presence of value of smoking in the family (Heris et al., 2020). It is argued by Valencia et al. (2019), the environmental influence of socio-economic status, income level, education and occupation influence smoking habit in individuals. This is because people from the lower income level are found to be often stressed regarding the ability to manage their livelihood which drives them to involve in smoking to overcome the stress. Moreover, the lack of education makes the individual unaware of the adversities of smoking leading to involve in the habit and gradually develop addiction (Thomson et al., 2019).

The physical determinants of health inform that smoking is harmful because it leads to cause cancer, chronic bronchitis, tuberculosis, diabetes, lung diseases and others (Ng et al., 2020). The mental impact of smoking includes immediate feeling of relaxation due to increased dopamine release causing stress and anxiety in individuals to be resolved (Plurphanswat et al., 2017). In contrast, the study by Holliday et al. (2020) argued that social influences of smoking include improving the social functioning of the people involved in the habit and they are found to show improved awareness of the social life along with facial cues of people. Thus, it can be determined that smoking causes increased socialisation, but it leads to deteriorate the physical health of the individuals that compromise their good health and well-being.

Theories and Models of Public Health

In healthcare, the implication of theories or models of public health helps in developing concept regarding the factors influencing the development of disease or any health issue along with provide ideas to explain the state of the health issue and way it can be managed in people (Mohammadi et al., 2017). One of the key public health models is Health Belief Model (HBM) which mentions the way social and behavioural changes in individuals involved in hindered health-related activity are to be made to ensure their good health and well-being (Panahi et al., 2017). The HBM informs key theoretical constructs to be followed in making social and psychological behaviour change regarding health which are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, modifying variables and cues to action (Panahi et al., 2018). The perceived susceptibility aspect of HBM predicts that individuals who have an idea regarding their risk of susceptibility to a health issue would engage in improved behaviour to reduce the risk of the health issue (Green et al., 2020). It is argued by Milcarz et al. (2018), lack of information regarding the health risk for individuals makes them involved in hindered health-related activity. This is because they feel no fear regrading the way the action would negatively impact their health and would deny making any change in behaviour to avoid contracting the health issue. Thus, the HBM mentions that physical and mental health risk related to smoking are to be informed to the public to make them develop changed behaviour and quit smoking.

In HBM, the perceived severity informs that idea regarding the seriousness of the health issue would led people to engage in healthy behaviour so that they can prevent the problem to affect them (Larki et al., 2018). However, the study by Reddy et al. (2021) argued that lack of idea of the severity of the health issues leads individuals to act in a casual way and show resentment in making behaviour change regarding health. This is because they do not understand the intensity of the health issue and way it would be life-threatening for them to develop the zeal in making behaviour change for health improvement. It indicates that people intend to involve in smoking as they do not understand the life-threatening condition to be faced due to the habit and therefore, it is to be informed to them in making them develop behaviour towards smoking cessation.

In HBM, perceived benefits and barrier concept informs that individual in making any behaviour change regarding health are to be informed regarding health benefits of the behaviour action and determine the barriers which is challenging the behaviour change to be resolved (Panahi et al., 2018). As argued by Harris et al. (2019), the presence of barriers towards making any health-related changes causes individuals to be demotivated in making the change. This is because they struggle to overcome them and feel exhausted due to which they avoid intending to make further change. Thus, the aspect of the model informs that individuals involved in smoking are to be informed of the health benefits of smoking cessation. Moreover, they are to be assisted in identifying the barriers hindering them to reach the behaviour change for avoid smoking so that it can be resolved to ensure them reach the change in smooth manner.

The modifying variables concept in HBM mentions that demographic (sex, race, ethnicity, education, etc) and psychological (social class, family, peers, etc) variables influence the perception of making change in behaviour (Larki et al., 2018). It is evident as peers would are involved in smoking makes the individual who may be a non-smoker feel the nee top smoke with them as it is way of socialising with the group (van Amsterdam et al., 2018). However, the presence of strong family support who disapprove and assist in overcoming smoking habit leads individuals to avoid smoking (Zaborskis et al., 2021). The HBM through cues of action mention that health-promoting behaviour in individual could be created through external cues that are mostly support health behaviour improvement and promoting events and internal cues which are physiological cues (Acquavita et al., 2017). In making people avoid smoking, the external (Smoking policy, Smoking prevention programs, etc) and internal cues (chest pain, hindered breathing, extensive coughing, etc) are to be appropriately used to influence them in quitting to smoke.

The Theory of Planned Behaviour mentions that attitude, subjective norms and perceived control of behaviour shape the behavioural intention of the individual (Frater et al., 2017). As asserted by Arshad et al. (2019), the presence of an addictive attitude towards smoking leads individuals unable to avoid performing the action of smoking. This is because the addictive attitude makes the individuals develop affinity towards using tobacco and makes them unable to avoid it. As argued by Gallaway et al. (2019), the presence of positive attitude to cease smoking leads individuals to make active change in behaviour to adopt the action. This is because the positive attitude makes the individual makes right decision and feel zeal to take change in action to quit smoking. The subjective norms referred to the belief which is approved by most people in society (Donnadieu‐Rigole et al., 2019). In the living environment, where the subjective norm considers smoking to be positive action and way of socialisation, it is seen that people in the family and area are actively involving in smoking habit. However, the subjective norms among peers where there is smoking restrict and smoking is regarded as adverse health activity, it is seen that people living in such conditions are mostly non-smokers and are seen to show positive attitude in early quitting of smoking behaviour. Moreover, individual who show enhanced behavioural control to avoid smoking by rejecting peer pressure and other influence are seen to avoid smoking. This is because it leads them to develop positive intension in avoiding smoking (Shahab et al., 2021).

Ethical and Values regarding Smoking

In ethical context, the cognitive globalisation of the tobacco products creates threat for the autonomy of the nations as well as their ability in protecting the health of the public. This is because it creates independence among the people of the world as well as across nations to uncontrollably buy and use tobacco for the purpose of smoking which is harmful to health (Moehlecke, 2020). The action also causes violation of the ethical context of non-maleficence which is evident as the globalisation of the use of tobacco products without restrictions in advert creates a medical action that increases the risk and promotes negative health consequences for the people. This is because the promotion of tobacco products makes public attracted to buy them for use (Vremaroiu-Coman et al., 2018). The other aspect of ethics in healthcare is beneficence which indicates that actions are to be performed to ensure beneficial health consequences and promotion of health of individuals (Bester, 2020). In this context, the promotion of smoking in society would violate the ethical context as smoking is highly injurious health as it causes breathing problem, heart issues and others along with major forms of cancer that are not beneficial to the health of the individuals (Bester, 2020).

Policies and Practices regarding Smoking

In the UK, the Smoking Ban policy was implemented in 2007 in England, Wales and Northern Ireland and in 2006 in Scotland. According to the policy, any nature of smoking was completely banned within closed and public places (gov.uk, 2015). The impact of the policy was that it led to 2.4% reduction of hospitalisation of patients due to heart attacks in England developed as a result of smoking. Moreover, it caused 1200 fewer smoking-related admissions which created a saving of £8.4 million for the NHS in the first year only (smokefreeaction.org.uk, 2015). According to Ozierański et al. (2019), smoking ban in public provided limited time and area for smokers to indulge in the habit. It made them intend to quit it as they lack freedom in performing the action which helped to reduce second-hand smoking impact on the public leading to create overall control of the condition. Another smoking cessation policy developed between 2010 to 2015 is increasing the tobacco tax of the products (gov.uk, 2015). This is because higher taxes on tobacco would raise the overall price of cigarettes and would make the individuals intend to avoid smoking as they would avoid spending increased money for buying cigarettes (Wilkinson et al., 2019).

The UK to cease and lower the prevalence of smoking developed the policy of banning the advertisement of cigarettes and tobacco products on television and any other public media. The eye-catching displays on the shops for cigarettes are banned from 2015 through the Smoking Cessation government policy (gov.uk, 2018). As argued by Reinhold et al. (2017), lack of advertisement of products creates less interest for the people to buy them. This is because without the advert, the people are unable to determine the nature of the products and it fails to create a psychological need of the product making individual forget buying the product. Thus, the policy action is considered to be effective in controlling smoking behaviour in individuals. In 2020, the UK government developed the policy of Towards a Smoke-free generation in lowering the smoking rate in young people, adults and pregnant women. The policy targeted to reach 3% from 8% smoking rate in individuals of 15 years of age and intends to reduce percentage of smoking pregnant women from 10.7% to 6%. The policy also intends to lower the inequality in smoking prevention created according to social class and occupation (gov.uk, 2018a).

Universal and Targeted Health Promotion Intervention for Smoking prevention

In order to control the prevalence of smoking, various universal and targeted health promotion campaigns are created by international organisations as well as the government of UK. In 2020, WHO launched the “Commit to Quit” campaign which universally targeted to assist all the live smokers around the world to cease smoking (WHO, 2021). In the current Covid-19 condition, many active smokers have expressed wish to quit the habit as they have realised the adversity created by the action towards their health and way it makes them to be at increased risk of negative consequences of Covid-19 condition (Eisenberg and Eisenberg, 2020). In this context, the “Commit to Quit” campaign is created that includes intervention such as talk therapy through online process to make smokers motivated to avoid smoking and overcome the urge of the urge of smoking. The campaign mentioned recommendations of medication to be used by smokers in overcoming smoking habit to led a healthy life and personal tips to be followed by each individual based on their condition in achieve cessation of smoking (Chen et al., 2018).

The mentioned actions in “Commit to Quit” are effective as proper anti-smoking medication are seen to lower the affinity of smoking urge and ease the symptoms of nicotine withdrawal in individuals to help them gradually quit smoking (WHO, 2021). As argued by Reynolds et al. (2017), lack of verbal support in smoking cessation through therapeutic intervention makes smokers unable to effectively control tobacco craving. This is because they are unable to share their attitude and receive information from other way to control their craving behaviour to be successful in quitting smoking. In 2020, the WHO’s World No Tobacco Day campaign focussed on enabling protection of children of 13-17 years to be lured into addiction into tobacco by making them aware of the tactics used by the tobacco industry. The campaign intends to mention way concerts and parties, e-cigarette representation, product placement and others are made to make the youth addicted to smoking (WHO, 2021a). This is an effective approach as it would make the children interpret the reality of the tobacco industry and understand the motives used to lure them which they are to avoid to led a healthy life. Thus, the universal campaign is seen to create information of way to quit tobacco for all whereas the targeted campaign for the youth is developed to inform ways used in luring them which they are to avoid for develop enhanced health.

In the UK, Stoptober is an annual NHS campaign in October which is set with the purpose of persuading smokers in avoiding cigarettes for 28 days. This is done with the intention that quitting for 28 days would make the individual quit for long-term conditions. In the campaign, personal support, inspiration, effective insight regarding adversities of smoking on health and amount of money to be saved by quitting smoking are informed to make people avoid smoking (blf.org.uk, 2021). The action is effective as emotional support required for the active smokers who intend to quit smoking are provided through the campaign to people of all ages. In 2018, Public Health England is seen to have launched Vapril which is a campaign that target individuals to quit smoking with the help of e-cigarettes (ukvia.co.uk, 2018). The different between Vapril and Stoptober is that the first is a continuous campaign whereas the latter is an annual campaign executed in a particular month indicating the latter do not provide support for cessation of smoking in long-term manner. Moreover, Vapril helps to provide physical measure such as e-cigarettes in helping a smoker quit smoking whereas the latter provide emotional support and motivation to smokers in quitting smoking. This indicates that both the campaigns are equally required as both physical and emotional support is required for the smoker to quit smoking in permanent manner (Warner and Mendez, 2019; ukvia.co.uk, 2018).

Partnership Working to prevent Smoking

The NHS to create cessation of smoking among the youth has developed partnership working to educate children and young people regarding the adversities of smoking and way it impacts their health in long-term way. It is evident from the Tobacco-Free School action plan in which the NHS is found to form partnership with Local Boards and Authorities in the voluntary sector to access informative and physical support in develop the smoking-related campaign in the UK schools (ashscotland.org.uk, 2018). This is an effective approach as local authorities can effectively reach each educational institution to promote effective anti-smoking habit as they have local resources available to be used and directly provided to required individuals in controlling smoking (Naughton et al., 2020). The NHS has developed working partnership with social workers around localities to use them directly reaching the smokers in any area to be provide anti-smoking support in quitting smoking (Iacobucci, 2018). The Tobacco Control Plan is created by the NHS in which the government along with local agencies are involved in partnership to campaign the adversities of smoking and ways to overcome them in the public to create smoke-free population (assets.publishing.service.gov.uk, 2017). The method is effective as it would create holistic improvement in lowering smoking prevalence in the UK as all the authorities can share valuable ideas and work with them to innovatively lower the smoking rate in the UK.

Conclusion

The above discussion informs that smoking cigarettes is one of the key leading health issues in the UK as well as globally. The health determinants mention that age, social status, education and others influence the rise of smoking rate in youth and adults. The biological and physical determinants of health mentioned that smoking is creating health risk and physical hindrance in individuals which compromising their good health and well-being. In the UK, Smoking Cessation policies are developed to ban the sale of tobacco to minors, prohibiting public smoking and others. The partnership working is developed by the NHS with the local authorities and social workers in limiting the prevalence of smoking in the UK.

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