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A BREATH OF FRESH AIR FOR SCOTLAND IMPROVING SCOTLAND'S HEALTH: THE CHALLENGE TOBACCO CONTROL ACTION PLAN

CHAPTER 2: THE APPROACH

2.1 Smoking has long been recognised as the most important preventable cause of ill-health and premature death in Scotland, accounting for more than 13,000 smoking-related deaths every year. We know that it is linked to diseases of the heart and blood vessels, the lungs, stomach, kidneys and other organs and that as a result, it has been estimated the NHS in Scotland spends up to 140 million ⁵ every year on treating smoking-related disease - at current prices this would amount to over 200 million. We also know that it is not just smokers themselves that are at risk.

2.2 This plan is based on the vision of a non-smoking Scotland; a country in which everyone is aware of the health risks associated with smoking, the health of our children is protected and where people can go out and enjoy themselves free from the dangers of second-hand smoke.

2.3 The Scottish Executive does not believe that it is right to force people to stop smoking. However, nicotine is highly addictive and we need to bring home to Scots the harm smoking is doing to their own health and that of others. Our long-term aim is for no Scot to be exposed involuntarily to second-hand smoke at work or anywhere else and for them to choose, to reject smoking as being an outdated and unfashionable practice which doesn't have a place within a healthy, forward-looking nation.

Social Inclusion

2.4 Improving Health in Scotland: the Challenge makes it clear that efforts to improve health are inextricably linked to the pursuit of social justice.

2.5 We know that some of the highest rates of smoking are to be found amongst our most disadvantaged communities. This plan sets out to close that gap by describing actions which give most help to those communities, be that through the provision of services or access to communication and education material.

Integration

2.6 A reduction in smoking levels in Scotland requires clear priorities and targets backed by action across a wide range of health and non health related fields. Actions in this plan are therefore set out in four broad categories:

• Prevention: action to accelerate reductions in smoking prevalence including a major review of prevention, education and communications efforts.

• Provision of services: action to further extend and improve cessation services with new funding for the Executive to support this.

• Second-hand smoke (passive smoking): action to reduce the health risks from second-hand smoke and reinforce efforts to 'de-normalise' smoking in Scotland.

• Protection and controls: legislative and other action to reduce the attractiveness and availability of cigarettes.

2.7 Evidence to support policy development in each area is taken from the NHS Health Scotland/ASH Scotland review of tobacco control policies.

Long-term commitment

2.8 We are, of course, describing a vision and a programme that cannot be achieved overnight. Although this document describes a number of short-term actions, these are merely first steps. We need to commit ourselves to a long-term strategy and design processes and support structures which are capable of delivering results, monitoring progress and identifying new and subsequent actions based on the evidence of what has delivered results both within Scotland and elsewhere in the world.

Partnership working

2.9 A successful strategy will require partnership working at both local and national level. Individuals hold the key to effective culture change so we need to engage communities, employers, trade unions and other employee representative bodies, government, the NHS and the voluntary sector in our plans. Crucially, we need to see broad-based action on tobacco control featuring strongly in the community planning process, joint health improvement plans and NHS Board local health plans. We also need action on smoking to form a core part of employers' workplace health and welfare policies for their employees.

2.10 Scottish Ministers and officials play a full part in debating, discussing and developing UK and international tobacco control policy. In Scotland, the Health Improvement Directorate co-ordinates action across Scottish Executive departments and works closely with national organisations and forums - such as ASH Scotland, Health Scotland, the Scottish Tobacco Control Alliance and Partnership Action on Tobacco and Health - in delivering tobacco control policies. The Scottish Executive Health Department's Public Health Division also has a close relationship with the HSE in Scotland.

2.11 The Scottish Tobacco Control Strategy Group, set up by the Scottish Executive to guide the implementation of Smoking Kills in a Scottish context has proved extremely valuable over the past few years and has played a leading role in the development of this Plan. However, in order to generate momentum behind this plan, we agree with the review report that this Group should be upgraded to a Ministerial Working Group chaired by a Minister. The new Working Group will have a Scotland-wide remit to gather and analyse national and international information and provide advice to Ministers, in order to ensure that tobacco control policy continues to reflect the best available evidence about the effects of tobacco on our nation's health. The core membership will include authoritative figures in the tobacco control and related areas in Scotland, including health professionals, academics, young people's representatives, public relations experts, retailing interests and others with recognised expertise and experience in the tobacco control field.

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