POLICY AND EVALUATION IN PUBLIC HEALTH

Introduction

Smoking is referred to the habit of inhaling and exhaling tobacco smoke mainly for the purpose of pleasure and calmness. The effect of long-term smoking includes development of coronary heart disease, respiratory issues and others (Jamal et al., 2018). In the UK, smoking is a serious issue because in 2018 nearly 14.7% individuals are found to be smoking which is above the national target of 12% and less (NHS, 2019). In this context, in the current study the associated issue to be discussed is smoking and the policy to be focused on is “Towards a Smokefree Generation” which is a tobacco control policy plan in England.

Background

A policy is referred to deliberate system containing principles for guiding decision and achievement of rational outcomes. It is a statement of intent which is implemented as protocol or procedure to be generally adopted by the governance body in an organisation (Josten and Lordan, 2020). In healthcare, an effective policy is important because it allows to set general plan of care to be used for guiding desired outcome and it acts a fundamental guideline for making enhanced care decision. It helps the stakeholders involved in care to understand the roles and responsibilities to be played to achieve set foundation of the quality of care for the service users (Salloum et al., 2017). The England’s tobacco and smoking control policy that is “Towards a Smokefree Generation” is one of the policy guidelines set from 2017 to 2022 for achieving to reduce concerned smoking prevalence in the country among the population (assets.publishing.service.gov.uk, 2017).

In England, UK, there are 14.4% of the adults are found to be classified as current smokers which is equivalent to above 6 million individuals in the country. In respect to locality in England, the smoking prevalence is found most in the Blackpool and Sunderland area (2,900 per 100,000 population) and lowest in the Wokingham area (721 per100,000 population) (ons.gov.uk, 2019). The percentage of smokers though have lowered from 14.9% which was present in 2017, but it is still found to be above the present national ambition of 12% and less (NHS, 2019). Moreover, it is found that the number mothers who were smokers at the time of delivery were 10.6% of the population and it has fallen down from 15.8% in 2006-07, but still, the figures have not reached the current national target of 6% and less (NHS, 2009). This informs that though the smoking prevalence among the population in England, UK has decreased but it still has not reached the national ambition that ensures better control of the situation.

The further statistic revealed that in 2018 nearly 489,300 hospital admissions are required to be made for smoking-related health issue and the number indicates 4% of all hospital admission in the year along with 1% increase in hospital admission rate due to smoking (commonslibrary.parliament.uk, 2020). Among the admission made, 47% were due to cancer caused by smoking and 22% due to other respiratory issues caused by smoking. Further, 77,800 deaths due to smoking are reported in England in 2017 which similar to the previous year and it represents 16% of all the deaths in England in the year (ashscotland.org.uk, 2020). This indicates that smoking creates deteriorated health issue and leads considerable number of people to face death. Thus, discussion regarding the current policy of England in respect to smoking is important to determine regarding the way the prevalence of the condition can be further lowered to gain better control on the health situation in the country.

A healthy public policy is one which considers proving that health and equity matters in the healthcare environment. The value of healthy public policy development regarding smoking in England was to create a systematic guideline to be followed by health professionals and service providers in the area so that they can take appropriate actions to promote health well-being of the individuals. It acts as fundamental tool to improve the health of the public (Khouja et al., 2020). Moreover, the value of healthy public policy is that it assists in creating a supportive care environment that enables people to lead healthy lives. This is because it led to create an environment for delivery of effectively processed care to families, individuals and people in the community by resolving their problem in making change in behaviour and action needed to cope the health condition (Cannonier et al., 2019).

Evaluation of health policy

The England’s tobacco and smoking control policy that is “Towards a Somkefree Generation" is planned and implemented in 2017 with the key to achieve the policy goals by 2022 regarding smoking. In regard to history regarding the policy, it is seen that the first policy for the smoking cessation in England was “Healthy Lives, Healthy People” which was established in 2011. It was the framed on the context that smoking rates have reduced since 1960s in the England, by in the current condition (2011), still 8 million people in England was mentioned to be smoking. This indicated that increased number of people are active still smokers and strict as well as well-maintained policy plan is required to control the situation (assets.publishing.service.gov.uk, 2011). Thus, the aim of developing tobacco control policy plan was determined to promote healthy lives and lower smoking rate.

The initial tobacco control policy set in 2011 as “Healthy Lives, Healthy People” expressed aim of creating support to lower the overall tobacco use in the next five years in the public health system. It also aimed to create comprehensive tobacco control within the local communities (assets.publishing.service.gov.uk, 2011). This is because at the time an effective momentum for reducing smoking was lost which is evident as only 1% decrease in smoking prevalence for adults in reported in the country for 4 years that is from 2007- 2011 (20% adult smokers in 2011, 21% adult smokers in 2009 as well as in 2007) (NHS, 2009). However, with time the policy evolved in 2017 to aim creating a smoking free generation in England. This is because the initial policy was successful to create effective management of reducing smoking among the public that was previously lost (assets.publishing.service.gov.uk, 2017). Thus, the policy focus on creating a smoke-free generation where they will be no smokers or negligible number of smokers who can be easily controlled to quit smoking with success in progressing years (assets.publishing.service.gov.uk, 2011; assets.publishing.service.gov.uk, 2017).

The social factor that influenced the development of “Towards a Smokefree Generation” policy is the concerning number of fatal health consequences and deteriorated health condition being faced due to smoking among the population. This is evident as 54% deaths for cancers were reported to be caused due to smoking and 38% deaths in case of men and 27% deaths in case of women were caused due to the condition as a result of long-term smoking (NHS, 2019). Moreover, 12% of the smokers reported suffering from deteriorated health condition compare to 5% of non-smokers and smoking contributed to cause loss of 13.3 years of average life of smokers (ons.gov.uk, 2019). Thus, the number of adults reported hindered health are seen mainly to be smokers due to which effective action in cessation of smoking in the generation is required to be achieved to develop enhanced public health.

The economic factor that influenced the framing of “Towards a Smokefree Generation” policy is increased expenditure to be faced by NHS due to providing treatment for smoking which if controlled could be better used in managing more complicated health issues. This is evident as NHS required to spend nearly £3.6 billion each year to treat patients with smoking-attributable diseases and needs to spend nearly to £1 billion for extinguishing house fires related to smoking and gathering cigarette buds (iea.org.uk, 2017). The environmental factor which influenced the “Towards a Smokefree Generation" policy development is the increased amount of waste being created due to smoking in England and overall UK. It is evident as in 2016 it was reported that 31 billion cigarettes are being smoked which leads to development of 5225 tonnes of waste each year with 1202 tonnes of the cigarette wastes are discarded to be collected separately by the government (ash.org.uk, 2016). This indicates that increased amount of waste is created due to smoking and influencing people to stop smoking would help in reducing waste production which is important for the environment. This is because increase waste production is seen to contribute towards climate change and land pollution (Zafeiridou et al., 2018).

The vision of the “Towards a Smokefree Generation" policy is to create a smoke-free generation which could be achieved when the prevalence of smoking in England reduces to 5% or below of the entire population. The objectives of the policy are to create smoke-free generation at all age groups, develop smoke-free among all pregnant women, improve mental health condition of people and deliver support to allow people quit smoking effectively (assets.publishing.service.gov.uk, 2017). In relation to the objectives, the aim includes reduction of smoking prevalence among 15 years old from 8% to 3% or less, reduce smoking prevalence to 12% or less, reduce smoking prevalence in pregnant individuals, make inpatient mental health sites to be smoke-free and use innovative technologies along with safe alternative in assisting people to quit smoking (assets.publishing.service.gov.uk, 2017). One of the first key element in the policy was to create prevention of addiction towards smoking in the childhood and people before they reach 18 years (assets.publishing.service.gov.uk, 2017). This is appropriate from public health perspective because smoking habits are mainly initiated at the early stage which later progress to addiction. Thus, intervention for prevention of smoking at early years would be an effective approach is stopping the development of the habit (Cobos-Campos et al., 2017).

The “Towards a Smokefree Generation” policy’s other key intervention to achieve its aim is creating stop smoking services to be delivered free to the people to help them quit smoking (assets.publishing.service.gov.uk, 2017). This is appropriate from public health perspective because the smoking cessation services would continuously support smokers to learn action they are to take to avoid smoking (McKelvey et al., 2017). Moreover, the policy mention smoking cessation services intendeds to monitor the cessation of smoking on individual which is appropriate. This is because it would allow making changes in the policy interventions accordingly for its effectiveness to be successful in fulfilling the aim (assets.publishing.service.gov.uk, 2017). An important element of “Towards a Smokefree Generation” policy is its intension to support people with mental health condition to avoid smoking. This is effective element of the policy from the public perspective because in England nearly 40.5% of the people with mental illness are found to be increasingly addicted to smoking and creating inequal prevalence of the condition (NHS, 2019). Thus, additionally targeting the mentally ill people to be supported to overcome smoking is an effective approach as it would led to improve their physical health and well-being along with reduce inequalities in smoking prevention.

The “Towards a Smokefree Generation” policy intends to create public awareness regarding the harmful effects of smoking and promote smoking cessation (assets.publishing.service.gov.uk, 2017). This is appropriate approach from public perspective because according to Health Belief Model, people intends to make change in behaviour when they understand the harmful impact on the disease and the usefulness of the health services provided to them (Mohammadi et al., 2017). Thus, perception of the harmful impact of smoking and usefulness of smoking cessation as mentioned to be created through the policy is effective approach in meeting the aim of creating smoke-free generation. The other element of the policy is developing smoke-free places which is an effective approach from public perspective as it led to protect people from second-hand smoking is equally harmful to health as direct smoking (assets.publishing.service.gov.uk, 2017). Moreover, the policy intends to create strict enforcement of law for taxation of tobacco and illicit drugs use for smoking. This is appropriate approach in creating smoke-free generation as strict laws would limit sell and use of tobacco in turn making people leave addiction towards smoking (Pavlikova and van Dijk, 2020).

The stakeholders likely to be included in the policy process are general physicians, social workers, government officials and local authorities. The general physicians would be involved in the policy to act with the government to share facts about smoking cessation to potential smokers who they care to encourage them to quit smoking. They would likely influence the adults availing care from to quit smoking because they can provide them scientifically provide evidence regarding harmful effect of smoking, in turn, making the individual trust them to follow smoking cessation activities (Meijer et al., 2019). The social workers have the role to improve the outcomes of the individuals in public (Milcarz et al., 2017). In this respect, they would likely be participating with the local authorities under the policy guidelines to spread awareness regarding smoking cessation and the services available for quitting smoking as per the policy in creating a smoke-free generation. The social workers are seen to interact in person with the individuals due to which they could likely reach every individual in the locality to individually educate and aware them about smoking cessation which may intend the adults to get gradually inspired to quit smoking (Askew et al., 2019).

The policy guides the local authorities to learn regarding the way they are to frame their services so that smoking cessation is achieved (assets.publishing.service.gov.uk, 2017). Thus, they have the role to use the policy and implement the idea of smoking cessation in every part of the locality in creating smoke-free generation. They would likely influence to implement the policy in each area of the locality because they are the governing body that support health management in localities. The government officials are likely to be involved in monitoring the progressive implementation of the interventions in the policy as they would use the information developed from the monitoring to determine the way further the policy is to be amended to ensure fulfilment of its goal (Murphy and Crossley, 2019). The policy addresses the equity and health inequality issue regarding smoking raised in case of pregnant women. In this purpose, the policy intends to implement NICE guidance on preventing pregnant women from smoking in the local community (assets.publishing.service.gov.uk, 2017). The policy to resolve inequality in smoking services created for pregnant women intends to involve Public Health England (PHE) to examine carbon monoxide (CO) level in pregnant women and accordingly offer them smoking cessation services (assets.publishing.service.gov.uk, 2017). Moreover, it intends to involve NHS England to record CO level in the Maternity Service Dataset to determine which pregnant women are smoking beyond self-reporting and accordingly specific care can be offered to them to help them quit smoking (assets.publishing.service.gov.uk, 2017).

The “Towards a Smokefree Generation” policy is implemented and put into operation through online and offline interaction. This is evident as the policy mentions to personally interact with physician and other health professionals to establish its use to create smoke-free generation. Moreover, it intends to use mass media campaign in promoting smoking cessation and awareness of harmful effect of smoking which are the key elements of the policy (assets.publishing.service.gov.uk, 2017). The use of mass media, as well as offline mode to implement policy, ensures it wider reach to the people as limitation created through use of either of the promotion strategy is resolved with strength of another (Bala et al., 2017). There is no existing evaluation present regarding the policy and outcome evaluation of the policy is to be made so as to determine its actual success. The outputs and impacts to be monitored is the policy's effectiveness in meeting the target percentage of smoking cessation for public (Baskerville et al., 2018).

Conclusion

The above discussion led to conclude that the policy could be modified for enhancing its effectiveness if they try to identify and take actions to resolve the key factors that are intending people to start smoking. This is because it would lead the policy to take advanced step in avoiding smoking at all among generation rather than taking actions after addiction towards smoking. In future, it is determined that the policy might change to create steady smoke-free generation in England as already the smoking prevalence is decreasing but it would require active support and ongoing awareness to maintain the reduced number of smokers. The policymakers to better evaluate the policy required to make process evaluation to understand the changes required in which systematic aspect of the policy for its better effectiveness.

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