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Creating a smoke-free society for children
Editorial
BSIP Medical/Photo Library
Creating a smoke-free society for children
For more on the RCP report see http://www.rcplondon.ac.uk/ professional-Issues/PublicHealth/Pages/Tobacco.aspx
The UK Government’s decision to make enclosed public spaces smoke-free in Scotland in 2006, and in Wales, Northern Ireland, and England in 2007, has been a public health success. There have been reductions in passive smoking exposure and smoking-related illnesses, such as acute cardiovascular disease. Businesses have adapted to the smoking ban and it has achieved widespread compliance. Now it is time to go further, according to a new report on passive smoking and children by the Royal College of Physicians (RCP) released on March 24. The report calls for a sea change in attitudes towards smoking around children. As well as documenting the yearly burden of disease in children exposed to passive smoke in the UK—165 000 new episodes of disease such as asthma and middle ear infections, 300 000 primary care contacts, 9500 hospital admissions, and about 40 sudden infant deaths—the report also draws attention to smoking uptake in children. Children who grow up with a parent or other household member who smokes are about twice as likely to become smokers themselves. The report estimates that about 23 000 children in
England and Wales start smoking by the age of 16 years because of exposure to smoking by family members, increasing their risk of serious illness and early death in adulthood. The RCP is calling for measures that prevent children’s exposure to smoke and their exposure to the sight of people smoking. Although the health profession has recognised for some time that children who grow up in contact with smokers are more likely to be smokers themselves, the general public are less aware of this link. Powerful mass media campaigns will be needed to get this message across and instil an ethical responsibility on people not to smoke around children. Such campaigns should be backed up by extensions of the UK’s current smoke-free legislation—eg, a ban on smoking in vehicles and areas where children frequent, such as playgrounds, parks, and beaches, as called for in the RCP report. Doctors should advocate for these changes powerfully. They must also help families that include a smoker to quit and make their homes free of not only smoke but also the sight of people smoking. ■ The Lancet
Australia throws down the gauntlet for reform
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The Australian Commonwealth Government has announced major reforms to its public hospital system, following over 100 consultations with doctors and patients nationwide. If implemented, the Commonwealth Government would take a 60:40 controlling stake in state-run hospitals, up from the current 35:65 split it currently shares with State and Territory governments. The cost of this plan is substantial. To fund it, the government will use AUD$50 billion (US$46 billion) in Goods and Services Taxes (GST) from the States and Territories—one third of their GST revenue. A key part of this reform is the creation of around 200 Local Hospital Networks nationwide—each comprising between one and four hospitals. Networks will have local clinician and community input, and be paid per service they provide. Recognising that costs differ depending on location, a rural loading will be added for smaller and more isolated hospitals. The Australian Medical Association (AMA) has praised the plan, describing it as “substantial reform”. Under the proposals, the Commonwealth would also have 100% 1054
responsibility for primary care and outpatient services. The AMA believes this strategy minimises blameshifting opportunities between the Commonwealth and States and Territories, in situations where patient care is inadequate. The States and Territories will say yes or no to the plan at the Council of Australian Governments meeting on April 11. A no vote would mean the Commonwealth Government will instead seek a mandate from the Australian people, either through a referendum or at the general election later this year. Previous major reform plans in Australia, such as those that introduced Medicare, faced substantial opposition but became law. Australia’s population is ageing, and its health costs escalating. The status quo cannot continue. Major areas of this health reform still require fleshing out—for example elderly and mental health care. But provided these and the other issues specific to each State and Territory can be navigated, this reform package is one that the States and Territories should not delay. ■ The Lancet www.thelancet.com Vol 375 March 27, 2010
BSIP Medical/Photo Library
Creating a smoke-free society for children
For more on the RCP report see http://www.rcplondon.ac.uk/ professional-Issues/PublicHealth/Pages/Tobacco.aspx
The UK Government’s decision to make enclosed public spaces smoke-free in Scotland in 2006, and in Wales, Northern Ireland, and England in 2007, has been a public health success. There have been reductions in passive smoking exposure and smoking-related illnesses, such as acute cardiovascular disease. Businesses have adapted to the smoking ban and it has achieved widespread compliance. Now it is time to go further, according to a new report on passive smoking and children by the Royal College of Physicians (RCP) released on March 24. The report calls for a sea change in attitudes towards smoking around children. As well as documenting the yearly burden of disease in children exposed to passive smoke in the UK—165 000 new episodes of disease such as asthma and middle ear infections, 300 000 primary care contacts, 9500 hospital admissions, and about 40 sudden infant deaths—the report also draws attention to smoking uptake in children. Children who grow up with a parent or other household member who smokes are about twice as likely to become smokers themselves. The report estimates that about 23 000 children in
England and Wales start smoking by the age of 16 years because of exposure to smoking by family members, increasing their risk of serious illness and early death in adulthood. The RCP is calling for measures that prevent children’s exposure to smoke and their exposure to the sight of people smoking. Although the health profession has recognised for some time that children who grow up in contact with smokers are more likely to be smokers themselves, the general public are less aware of this link. Powerful mass media campaigns will be needed to get this message across and instil an ethical responsibility on people not to smoke around children. Such campaigns should be backed up by extensions of the UK’s current smoke-free legislation—eg, a ban on smoking in vehicles and areas where children frequent, such as playgrounds, parks, and beaches, as called for in the RCP report. Doctors should advocate for these changes powerfully. They must also help families that include a smoker to quit and make their homes free of not only smoke but also the sight of people smoking. ■ The Lancet
Australia throws down the gauntlet for reform
Getty Images
The Australian Commonwealth Government has announced major reforms to its public hospital system, following over 100 consultations with doctors and patients nationwide. If implemented, the Commonwealth Government would take a 60:40 controlling stake in state-run hospitals, up from the current 35:65 split it currently shares with State and Territory governments. The cost of this plan is substantial. To fund it, the government will use AUD$50 billion (US$46 billion) in Goods and Services Taxes (GST) from the States and Territories—one third of their GST revenue. A key part of this reform is the creation of around 200 Local Hospital Networks nationwide—each comprising between one and four hospitals. Networks will have local clinician and community input, and be paid per service they provide. Recognising that costs differ depending on location, a rural loading will be added for smaller and more isolated hospitals. The Australian Medical Association (AMA) has praised the plan, describing it as “substantial reform”. Under the proposals, the Commonwealth would also have 100% 1054
responsibility for primary care and outpatient services. The AMA believes this strategy minimises blameshifting opportunities between the Commonwealth and States and Territories, in situations where patient care is inadequate. The States and Territories will say yes or no to the plan at the Council of Australian Governments meeting on April 11. A no vote would mean the Commonwealth Government will instead seek a mandate from the Australian people, either through a referendum or at the general election later this year. Previous major reform plans in Australia, such as those that introduced Medicare, faced substantial opposition but became law. Australia’s population is ageing, and its health costs escalating. The status quo cannot continue. Major areas of this health reform still require fleshing out—for example elderly and mental health care. But provided these and the other issues specific to each State and Territory can be navigated, this reform package is one that the States and Territories should not delay. ■ The Lancet www.thelancet.com Vol 375 March 27, 2010