Tobacco Smoking As A Social Determinant Of Health In Lambeth

Demographic Profile of Lambeth in Relation to Smoking

Tobacco smoking is estimated to be among the the highest single cause of poor health and preventable early death in Lambeth (Amroussia et al 2017). In fact, according to Berkman (2009), tobacco-related deaths; from vascular diseases and cancer are estimated to be quite high in Lambeth as because it is among the densely populated boroughs in England and such deaths are encountered by both men than women. This report aims to evaluate the tobacco smoking as a social determinant of health in Lambeth. In doing so, there will be an analysis of the borough’s demographic profile in relation to smoking, and the health inequalities they are is exposed to as a result of smoking. The report will also highlight the policy issues related to tobacco smoking in Lambeth before identifying the tobacco-targeted health provisions in the borough.

Social determinants of health (SDH) are defined as socioeconomic factors that dictate a person’s health and well-being status (Chapman 2010). The author proposes that SDH may include: socio-economic status (SES)/income, education, smoking/drug abuse or gender. Studies by WHO have largely reported a positive correlation between a population’s SES and their health status – in the sense that the lower the SES of a community the poorer health conditions they are exposed to (Chapman 2010). Erwat et al (2017) also comment that several theories have attempted to explain the relationship between SES and health inequality, but a majority of them indicate poorer families are exposed unhealthy living environments, deprived clinical services and poor health behaviour that contributes to poorer health conditions than those with better SES.

Literacy and education have also been mentioned by many scholastic studies (Finn et al 2017; Goli et al 2017; Goldblatt 2016 and Haafkens et al 2014) to be a great determinant of health and well-being. For instance, House (2016) claim that educated people tend to have more income which enables them to tackle most of the health challenges they encounter. Iqbal & Nawaz (2017) also write that educated people tend to understand normal life safety and health precautions enabling them to maintain good health than uneducated people.  Hence, at is emerges from these authors, better education exposes one to better health and well-being while illiteracy exposes one to health risks.

Gender is also a social determinant of health. Studies by Jayasinghe (2015) show that women, especially those living in patriarchal (Although not experienced in Lambeth) societies where gender-based social discrimination is practiced experience more health-related challenges than their male counterparts. This is partly because they fail to receive much attention in response to the health issues facing them (Marmot 2005). Murty et al (2009) also argue that such women are deprived the opportunity to make important health decisions, a phenomenon that has serious health implications for them. 

Impact of Smoking as a Social Determinant of Health

Smoking is a major social determinant of a person’s health and well-being, especially in the presence of various intervening variables which mainly consist of social determinants. For instance, according to Masayoshi et al (2017), poverty can inhibit a smoker from seeking medical attention when confronted with the health complications lung cancer associated with tobacco. Marmot (2005) also argues that a tobacco user with poor housing is more exposed to the risk of smoking-related respiratory health complications than a non-smoker. Thus, when smoking is combined with other social determinants of well-being, the individual becomes more susceptible to health risks.

The latest reports on Lambeth population indicate that the borough has an estimated population of 283,879 (Paul & Valtonen 2016). Among this population, the authors estimate that about 28.1% of adults are smokers, a rate which is slightly higher than the average adult smoking rate in the UK (26%). Moreover, statistics by Amroussia et al (2017) indicate that Lambeth’s adult sm0king rates (28%) are higher than the average smoking rate in England (24%) and in London (23.3%), meaning that the prevalence of smoking within the borough is alarming.

Scholars have established a strong relationship between social disadvantage and tobacco smoking in Lambeth. For instance, Pons-Vigues et al (2014) say that there is a disproportionate effect of smoking on economically disadvantaged persons which contribute to serious health inequality. This confirms the results of previous studies exploring the relationship between smoking and health inequalities. Among the studies include a Health Survey of England Report which revealed that young adults, women and children who live in deprived areas of Lambeth are more likely to smoke than those in non-deprived areas (Erwat et al 2017). Furthermore, Amroussia et al (2017) estimate that at least one in five people dies out of tobacco-related health complications in England, and considering that Lambeth has a higher prevalence of smokers than England, the same picture might be  true in Lambeth.

Tobacco smoking has emerged as a major health issue in Lambeth. Reports by Finn et al (2017) indicate that tobacco smoking is the single most determinant of geographical mortality rate variation in the borough. The author shows further that while there is an estimated 15% higher mortality rate in socio-economically disadvantaged areas than affluent areas in Lambeth, smoking behaviour accounts for 85% of that difference. As a result, the Lambeth local authorities consider smoking as a major target of its health inequality reduction programs, one of them being a reduction of the smoking population within the borough (Finn et al 2017). 

Policies Related to Tobacco Smoking

Smoking is a big contributor to health inequality in Lambeth because it has the highest prevalence than other parts of the UK, with acutely high levels experienced among the youth. Nonetheless, the impact of tobacco on young people on the health or both adults and young people in Lambeth is well known. According to Amroussia et al (2017), long-term tobacco smoking has largely been associated with health complications such as stroke and coronary heart diseases. The author approximates that smoking causes 90% and 80% of lung cancer deaths among Lambeth men and women respectively, as well as 90% of all deaths related to obstructive pulmonary disease.

The most affected group of smokers in Lambeth are the youth because according to Rooks & Rael (2013), tobacco smoking at an early age has adverse immediate health effects than at adult age. Some of the health complications faced by the youth rather than adults as a result of smoking include early cardiovascular damage, compromised lung growth, poor lung function, and severe wheezing; which explains why young smokers are more likely to develop asthma compared to adults (Storm et al 2016).

Tobacco smoking is also associated with health inequality among women. According to Schulz & Northridge (2004), smoking among young pregnant women in Lambeth stands at a prevalence rate of 17% and has largely been associated with miscarriage, ectopic pregnancy, cot death and low birth weight. Studies by Sara (2016) also reveal that such neonate ill-health have been rampant in Lambeth within the past five years due to the high smoking rates among women of age 25-34 years.

While there has been an improvement in health, health-related behaviours and life expectancy within Lambeth in the last 50 years, there has been an observed more rapid improvement among the advantaged groups than the disadvantaged groups, indicating a gap of improvement between populations in the two extreme socioeconomic strata (Taylor et al 2016). However, according to Sharanya et al (2009), the existence of this gap does not mean that policies on public health have not had any positive impact on health inequalities within Lambeth. Berkman (2009) comments further that were it not for adequate education, free universal healthcare, better housing, progressive taxation, environmental quality controls and income support among other policy initiatives, the health inequality situation in Lambeth could have been worse.

According to Amroussia et al (2017), reducing health inequalities would require adequate ‘upstream’ (a change in living and working conditions of people) policies.  The author also acknowledges that upstream policies against health inequalities have been popular partly because downstream interventions are much unreliable. For example, services that promote smoking cessation would be less effective because the new cohort of smokers will always arise. Nonetheless, Berkman (2009) argue that both upstream and downstream policy interventions are important especially in the case of smoking because they can help create an environment of fewer new smokers and help people to stop smoking as well.

Tobacco-Targeted Health Provisions in Lambeth

Some individuals have criticised the introduction of policies meant to reduce health inequalities by quoting that it is wrong to make some people less successful or healthy simply because there is a need to create a ‘levelled playing field’. However, according to Berkman (2009), a policy can be focused towards levelling up rather than levelling down. The scholar further comment that understanding the health gaps that exist between different social strata in Lambeth helps in realizing the possibilities and setting the goals to be achieved in respect to reducing health inequalities.

Finn et al (2017), Erwat et al (2017) Chapman (2010) acknowledge that the NHS has little control on most of the major drivers of equal health distribution within Lambeth and other boroughs in England. But, as argued by Goli et al (2017), NHS should play an important role in preventing disease, promoting health, and reducing health inequalities caused by disadvantage. Furthermore, the Health and Social Care Act 2012 advocates against the ‘inverse care law’ (where quality health care services are delivered only to the people who need the least). The NHS is therefore mandated to address healthcare needs across all population demographics to ensure that health inequalities in Lambeth and other boroughs of England are tackled.

Realizing the serious health challenges presented by the high rate of tobacco smoking in Lambeth, the local authorities have initiated several interventions to ensure that the borough experiences reduced smoking rates among both its adult and youth population. Implemented under the framework of Lambeth Tobacco Control Strategy, the interventions include programs aimed at reducing tobacco consumption among young people, creating supportive environments for tobacco cessation, protecting communities and families from tobacco related harm, and several other NHS based interventions aimed at the same objective. For instance, the Lambeth Stop Smoking Service has been focusing on offering effective and evidence-based support to all the smokers within the borough who show intent to quit smoking. According to Amroussia et al (2017), the service helps anyone who wishes to quit smoking by assisting them to adapt to change in lifestyle through counselling and education. Similarly, the Lambeth Stop Smoking Service has also worked closely with the Lambeth Council to help in increasing cessation among the smoking staff of the council (Berkman et al 2009). In doing so, the two organizations establish a toll-free phone service to enable potential quitters to seek help from the Stop Smoking Council.

Several other governance-based initiatives have been established in Lambeth through the Lambeth Tobacco Control Alliance in collaboration with other organizations committed to the same mission of reducing tobacco-related health inequalities. According to Chapman (2010), the alliance has a representation from different organizations including Lambeth Community Services, NHS Lambeth, St. Thomas NHS trust, LB Lambeth, London Fire Brigade, the Metropolitan Police and the Prison Service. Its main objective is to collaborate and involve its members in initiating anti-tobacco campaigns guided by the Lambeth Control Strategy (Ewart et al 2017). In the period of 2010 to 2011, the joint initiative facilitated the delivery of effective, equitable, and integrated smoking-free programs such as coordination with the local pharmacists and general practitioners to deliver stop-smoking training services to the borough’s community (Finn et al 2017).

The Lambeth Stop Smoking Service has also engaged in programs meant to health inequalities by reducing tobacco smoking among targeted groups such as pregnant smokers, minority, and black communities, as well as manual and routine workers through tailored stop-smoking services (Goli et al 2014). For the records, this program was initiated in the period between April 2010 and March 2011 and was mainly facilitated by practitioners, and Lambeth Community Health service provided.

In conclusion, smoking has emerged as a serious health concern and a contributor to health inequality in all societies across the globe. Its impacts are greatly experienced by societies and cultures which high tobacco addiction prevalence such as Lambeth. Significant progress has collectively been made by the NHS, the British government and the Lambeth Council authorities reduce tobacco consumption together with the health inequalities that accompanies it. A major recognizable initiative is the Lambeth Tobacco Control Strategy. However, this report recommends that there is still more to be done by the relevant stakeholders to reduce smoking as a social determinant of health inequality; including proper funding for anti-tobacco initiatives.

References

Amroussia, N, Gustafsson, P, & Mosquera, P 2017, ‘Explaining mental health inequalities in Northern Sweden: a decomposition analysis’, Global Health Action, 10, 1, p. N.PAG.

Berkman, LF 2009, ‘Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?’, Minority Health Archive.

Chapman, AR 2010, ‘The social determinants of health, health equity, and human rights’, Minority Health Archive.

Ewart, S, Happell, B, Bocking, J, Platania-Phung, C, Stanton, R, & Scholz, B 2017, ‘Social and material aspects of life and their impact on the physical health of people diagnosed with mental illness’, Health Expectations, 20, 5, pp. 984-991.

Finn, S, Herne, M, & Castille, D 2017, ‘The Value of Traditional Ecological Knowledge for the Environmental Health Sciences and Biomedical Research’, Environmental Health Perspectives, 125, pp. 1-9.

Goli, S, Singh, L, Jain, K, & Pou, L 2014, ‘Socioeconomic Determinants of Health Inequalities Among the Older Population in India: A Decomposition Analysis’, Journal Of Cross-Cultural Gerontology, 29, 4, pp. 353-369.

Goldblatt, PO 2016, ‘Moving forward monitoring of the social determinants of health in a country: lessons from England 5 years after the Marmot Review’, Global Health Action, 9, pp. 1-5.

Haafkens, J, Blomstedt, Y, Eriksson, M, Becher, H, Ramroth, H, & Kinsman, J 2014, ‘Training needs for research in health inequities among health and demographic researchers from eight African and Asian countries’, BMC Public Health, 14, 1, pp. 201-222.

House, JS 2016, ‘Social Determinants and Disparities in Health Their Crucifixion, Resurrection, and Ultimate Triumph(?) in Health Policy’, Journal Of Health Politics, Policy & Law, 41, 4, pp. 599-626.

Iqbal, N, & Nawaz, S 2017, ‘Spatial Differences and Socioeconomic Determinants of Health Poverty’, Pakistan Development Review, 3, p. 221.

Jayasinghe, S 2015, ‘Social determinants of health inequalities: towards a theoretical perspective using systems science’, International Journal For Equity In Health.

Marmot, M 2005, ‘Public Health: Social determinants of health inequalities’, The Lancet, 365, pp. 1099-1104.

Murty, S, Franzini, L, Low, M, & Swint, J 2009, ‘Policies/Programs for Reducing Health Inequalities by Tackling Nonmedical Determinants of Health in the United Kingdom’, Social Science Quarterly (Wiley-Blackwell), 90, 5, pp. 1403-1422.

Masayoshi, M, Kazuhiro, N, Matsumoto, M, & Nakayama, K 2017, ‘Development of the health literacy on social determinants of health questionnaire in Japanese adults’, BMC Public Health, 17, 1, pp. 1-11.

Marmot, M 2005, ‘Social determinants of health inequalities’, Minority Health Archive.

Paul, P, & Valtonen, H 2016, ‘Inequalities in perceived health in the Russian Federation, 1994-2012’, BMC Public Health, 16, 1, pp. 1-12.

Pons-Vigués, M, Diez, È, Morrison, J, Salas-Nicás, S, Hoffmann, R, Burstrom, B, van Dijk, J, & Borrell, C 2014, ‘Social and health policies or interventions to tackle health inequalities in European cities: a scoping review’, BMC Public Health, 14, 1, pp. 1-23.

Rooks, R, & Rael, C 2013, ‘Enhancing Curriculum through Service Learning in the Social Determinants of Health Course’, Journal Of The Scholarship Of Teaching And Learning, 13, 2, pp. 84-101.

Storm, I, den Hertog, F, van Oers, H, & Schuit, A 2016, ‘How to improve collaboration between the public health sector and other policy sectors to reduce health inequalities? – A study in sixteen municipalities in the Netherlands’, International Journal For Equity In Health, 16, p. 1.

Schulz, A, & Northridge, M 2004, ‘Social determinants of health: implications for environmental health promotion’.

SARA, R 2016, ‘Hospital Community Benefit Spending: Leaning In on the Social Determinants of Health’, The Milbank Quarterly, 2, p. 251.

Simões, N, Crespo, N, Moreira, S, & Varum, C 2016, ‘Measurement and determinants of health poverty and richness: evidence from Portugal’, Empirical Economics, 50, 4, pp. 1331-1358.

Taylor, L, Tan, A, Coyle, C, Ndumele, C, Rogan, E, Canavan, M, Curry, L, & Bradley, E 2016, ‘Leveraging the Social Determinants of Health: What Works?’, Plos ONE, 11, 8, pp. 1-20.

Sharanya, M, Luisa, F, M. David, L, & J. Michael, S 2009, ‘Policies/Programs for Reducing Health Inequalities by Tackling Nonmedical Determinants of Health in the United Kingdom’, Social Science Quarterly, 5, p. 1403.