Smoke-free Sheffield: a comprehensive approach to making smoking obsolete

Around 59,000 adults smoke in Sheffield and smoking causes 5,200 hospital admissions and 1,000 deaths in the city every year[i]. People who live in the most deprived areas of the city are three times more likely to smoke than people from the least deprived areas; 6 per cent of year 10 pupils smoke regularly; and one in nine pregnant women are smokers at the time their baby is born[ii]. Smoking costs the city £193m a year through lost productivity and costs to the NHS and social care[iii].

The city’s Tobacco Partnership Board, led by Sheffield City Council, has a five-year strategy to tackle these harms, Striving for a Smoke-free Future for All. The goal of the strategy is to make smoking obsolete, reaching 5 per cent or less smoking prevalence as fast as possible across all groups. The vision is for a smoke-free city by 2030 where people live longer and healthier lives and children grow up in environments where smoking is unusual. Driving down smoking prevalence will lift people out of poverty, reduce health inequalities, build resilience in health and social care systems, and boost the local economy.

The Tobacco Partnership is chaired by the Director of Public Health and has senior members from across the city including the Council, the NHS, housing, social care, the two local universities, and the voluntary and faith sector. All members share a commitment to a multi-component approach: creating smokefree environments; preventing the sale of illicit tobacco and vapes; supporting smokers to quit; harm reduction; and communicating with the local population and encouraging quit attempts. This approach aims to meet the needs of smokers who engage with services and of the larger population who do not, as well as discouraging uptake among young people.

The Tobacco Partnership seeks to shift social norms in the city by promoting and expanding smokefree environments as these reduce the visibility and acceptability of smoking and discourage young people from starting to smoke. The goal is to make smokefree the new social norm in Sheffield, with all major city centre spaces, health and social care premises, learning environments and sporting venues smokefree. In addition, smokefree homes are promoted through brief interventions, especially in high prevalence communities.

The council’s Trading Standards team leads the work in the city to reduce the availability of cheap and illicit tobacco which undermine tobacco taxation and enable children to buy cigarettes at pocket money prices. Surveillance operations, inspections, revocation of licenses and test purchasing are all used to combat illegal sales of tobacco and vapes.

Tobacco Dependence Treatment Services are the principal offer to smokers who seek help to quit. Sheffield City Council has worked hard with the local NHS to deliver an integrated service for local smokers: the NHS QUIT programme, which offers treatment of tobacco addiction in hospitals, refers discharged patients to the community Tobacco Dependence Treatment Service run by the council. The community service is open to all adult smokers in the city and to young people aged 11 to 17 years, with a target of 80 per cent adult uptake from priority high prevalence groups. A Specialist Midwifery Tobacco Treatment Service provides a city-wide service supporting pregnant women and their families to quit including an incentive-to-quit scheme.

The Tobacco Dependence Treatment Service provides smokers with stop smoking medications and offers vapes as a harm reduction measure to smokers who want either to switch or to quit tobacco with vapes. The Council has also developed a suite of resources with Action on Smoking and Health to support schools and parents in dealing with the rise in vaping among young people (see ASH resources on youth and vaping).

In order to reach out to those who do not engage with services, the council invests in a wide-ranging programme of marketing and communications. Local campaigns aim to change attitudes and social norms around smoking and to increase smokers’ quit attempts. Successful campaigns to motivate quitting include ‘Quit for Covid’, ‘We Care’, ‘Closer Each Time’ and ‘You are Strong Enough’ (see Smoke-free Sheffield).

During the last five years the work overseen by the Sheffield Tobacco Partnership Board has contributed to a fall in smoking prevalence in Sheffield from 17.6 per cent in 2017 to 13.3 per cent in 2021[i]. This means that the number of smokers in the city has fallen by 22,000 from around 81,000 to 59,000, a decline of 28 per cent.

Over this five-year period the number of smoking related deaths from heart disease, stroke, COPD and lung and oral cancer have also continued to fall, as has the prevalence of heart disease. In addition, an estimated £100m of cash previously spent on tobacco is now back in the pockets of local families, supporting the local economy.

The members of the Tobacco Partnership Board have common goals and support each other to deliver across the strategy. Strong senior leadership, a clear focus on outcomes and regular reviews have all contributed to the Board’s achievements. The council has a dedicated tobacco control lead officer who co-ordinates the programme, drives delivery and sustains enthusiasm for the strategy. Politically, it helps to frame tobacco as a commercial determinant of ill health, a driver of poverty, a burden on the economy and a cause of health inequalities.

• An ambitious partnership has enabled a truly system-wide approach to tackling the harms of tobacco in the diverse local population. A combination of cutting-edge research, local intelligence, innovation and creativity has enabled the partnership to deliver the broad range of interventions necessary to drive down smoking prevalence.
• Board meetings have focused presentations and discussions which stimulate collaboration, constructive challenge and shared ownership and learning.
• Councillors and partners have been persuaded to increase the smoke-free budget, in part by changing the narrative on smoking from a lifestyle choice to a chronic relapsing condition, linked to poverty and sustained by the highly profitable tobacco industry.