Impact of tobacco
The Welsh Health Survey (Welsh Assembly Government, 2011), found that 23% of adults reported that they currently smoked. Twenty-one per cent of adult non-smokers reported being regularly exposed to other people's tobacco smoke indoors. Tobacco smoking has an impact on many areas, including health and financial. Published by the Public Health Wales Observatory and Welsh Government,Tobacco and health in Wales 2012 is a comprehensive summary of statistics on tobacco use and its impact on health and health services in Wales. It updates Smoking in Wales: current facts which was published in 2007 by the Welsh Government and Wales Centre for Health.
Smoking is the largest single cause of avoidable ill health and early death in Wales. Overall, it is estimated that smoking causes some 5,650 deaths each year in Wales (Public Health Wales Observatory, 2010). This is broken down to:
- 100+ deaths per week
- 15 per day
- 1 per 120 minutes
Smokers are at a greater risk of developing a number of diseases, including lung cancer, heart disease, and obstructive pulmonary diseases (such as bronchitis). Smoking is thought to account for 8 in 10 deaths due to lung cancer, 3 in 4 deaths from chronic obstructive pulmonary disease and 1 in 5 deaths due to heart disease (Royal College of Physicians, 2000).
Other cancers which are linked to smoking include those of the mouth, throat, bladder, pancreas, stomach and cervix (International Agency for Research on Cancer, 2002).
Around half of current smokers will be killed by their habit if they continue to smoke and 25-40% of smokers will die in middle age (Doll et al., 1994).
There is also evidence that smoking damages the health of non-smokers. The UK Scientific Committee on Tobacco and Health (SCOTH) concluded in 1998 that contact with second-hand smoke increases the risk of lung cancer by 24% and heart disease by 25% among adult non-smokers. It is also associated with respiratory disease, cot death and asthma among children (SCOTH, 2004).
Mothers in Wales were more likely to smoke and less likely to give up than in other UK countries (The Information Centre, 2007). Over a third of mothers in Wales (37%) smoked at some stage during their pregnancy or the year before it, with just under half of these (41%) giving up at some point before the birth. Almost a quarter (22%) of mothers smoked throughout their pregnancy (including some who gave up but started again, and some who cut down the amount they smoked).
Pregnancy-related health problems include: risks to the baby’s growth; complications during pregnancy, labour, and after birth; and effects on infancy and childhood.
Risks to the baby’s growth if the mother smokes during pregnancy include:
- Low birth weight: Babies are on average 200 grams (8 ozs) lighter than babies born to comparable non-smoking mothers. The more cigarettes a woman smokes during pregnancy, the greater the probable reduction in birth weight. Low birth weight is associated with higher risks of death and disease in infancy and early childhood (Action on Smoking and Health, 2006).
- Impeded flow of blood in the placenta which in turn restricts the amount of nutrients that reach the foetus (Larsen et al., 2002).
Women who smoke during pregnancy may experience:
- A substantially higher rate of spontaneous abortion (miscarriage) (British Medical Association, 2004).
- More complications of pregnancy and labour which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes (Poswillo & Albeman, 2002).
- Increased risk of ectopic pregnancy (Haddow et al., 1993), even when comparatively few cigarettes are smoked.
Infants whose mother smoked during pregnancy have:
- Increased risk of perinatal mortality (still-birth or death of an infant within the first four weeks of life) by about one-third (Action on Smoking and Health, 2006).
- Three times increased risk of cot death. The greater the quantity of cigarettes smoked, the higher the risk (Department of Health, 1998; US Department of Health and Human Services, 2001).
- An increased risk of infant mortality by an estimated 40% (Department of Health, 2007).
Women who are exposed to second-hand smoke during pregnancy have an:
- Increased risk of lower birth weight babies (Hruba & Kachlik, 2000)
- Increased risk of giving birth prematurely (Windham et al., 2000)
- May have an increased risk of miscarriage (George et al., 2006).
Costs to the NHS in the UK of treating diseases caused by smoking are approximately £2.7 billion per year (Callum, Boyle & Sandford, 2006).
Smoking costs the NHS in Wales £385,703,869 in 2007, more than £7 million is spent each year treating diseases caused by smoking, and amounting to £129 per person in Wales and 7% of total healthcare expenditure (Phillips & Bloodworth, 2009). Two-thirds of the cost is incurred by secondary care and one-third by primary care; which differs from English estimates, due to higher prevalence of smoking in Wales and the differentials in prevalence associated with respiratory disease and circulatory disease.
Primary care costs
It is known that 17% of the population aged 16 years and over contacted their GP in the past two weeks and 9% consulted with a practice nurse. GP visits due to smoking cost the NHS in Wales an estimated £43,093,442, which represents over 13% of all costs in the age-group 16 years and over (Phillips & Bloodworth, 2009). Practice nurse visits due to smoking cost the NHS in Wales an estimated £6,179,339, which represents over 12% of all costs in the age group 16 years and over.
Prescriptions: Smoking is estimated to have accounted for over 14% of prescriptions issued by GPs in Wales in 2007-08, which amounts to £79,346,241 (Phillips & Bloodworth, 2009).