Tobacco Control Costs of Smoking in Hull and East Riding of Yorkshire

Tobacco Control Costs of Smoking in Hull and East Riding of Yorkshire Summary It is very difficult to estimate the costs of smoking to the NHS, local authority and economy. Any such estimates generally reply on statistical modelling and this invariably has a number of assumptions. So caution should be exercised when interpreting this data in this summary table, in particular, the economic costs in italics as these have been calculated from the total figure for England multiplied by the percentage of the population within that age range. Overall the costs to smoking in Hull and East Riding of Yorkshire are substantial. Cost of smoking attributable hospital admissions among those aged 35+ years, 2010/11 (total) Cost of smoking attributable hospital admissions among those aged 35+ years, 2010/11 (per resident) Hull East Riding of Yorkshire Hull & East Riding of Yorkshire 6,829,541 7,645,546 14,475,087 51.69 35.43 41.60 Cost of tobacco to adults 18+ (total) 117,709,248 76,759,164 194,468,412 Cost of tobacco to adults 18+ (per resident) 581.78 281.57 409,47 Economic costs lost of productivity due to premature deaths 15,004,200 17,874,955 32,879,155 Economic costs costs to businesses from smoking breaks 25,006,999 29,791,592 54,798,591 Economic costs costs to businesses from sick days 5,001,400 5,958,318 10,959,718 Social care cost for adults aged 50+ years (total) 6,827,358 8,568,334 15,395,692 Social care cost for adults aged 50+ years (per resident) 84.67 57.84 67.30 Fires 188,044 252,811 440,855 NHS 9,618,635 12,931,509 22,550,144 Total estimated costs (some duplication so individual rows won t sum to this and won t include costs of tobacco purchased by smokers) 62,040,195 83,408,233 145,448,428 1

Cost per capita of smoking attributable hospital admissions, 2010/11 ( ) Tobacco Control Costs of Smoking in Hull and East Riding of Yorkshire Cost of hospital admissions From the Local Tobacco Profiles (Public Health England 2014), the cost per capita of smoking attributable hospital admissions for 2010/11 has been estimated from modelling the number of hospital admission due to smoking (with each hospital admission assigned an smoking attributable fraction based on the diagnosis codes) and examining the tariffs. The figure relates to the cost among those aged 35 years and over. Hull has among the highest cost per resident aged 35+ years at 51.69 (Figure 1), which is substantially higher than the regional average ( 41.54) or England ( 36.92) and also higher than East Riding of Yorkshire ( 35.43). Only Rotherham and Barnsley have higher costs than Hull. The Office for National Statistics estimate that the mid-year population estimate for persons aged 35+ years for 2011 was 132,125 for Hull and 215,793 for East Riding of Yorkshire. Thus the total cost would be 6,829,541 for Hull and 7,645,546 for East Riding of Yorkshire giving a total of 14,475,087. Figure 1: Cost per capita in pounds of smoking attributable hospital admissions among those aged 35+ years, 2010/11 60 50 40 30 20 10 0 Local authority England Y&H Cost of tobacco to household From the Local Tobacco Profiles (Public Health England 2014), the indicative tobacco sales was produced by estimating household expenditure on tobacco among persons aged 18+ years based on the smoking prevalence from the national Integrated Household Survey (as sufficient numbers of people are surveyed within 2

Indicative tobacco sales (millions, ), total cost among adults over all households, 2013 each local authority an estimate of smoking prevalence can be obtained for each local authority). The total tobacco sales figure for the UK was divided among the local authorities based on their smoking prevalence. It should be noted that the smoking prevalence from local Health and Lifestyle Surveys have generally been higher than the IHS, probably due to the much higher numbers of people surveyed locally and the survey design making it less subject to response bias relative to the IHS. Furthermore, the household expenditure figure will be based on actual (known) sales and will not include illicit tobacco. Despite a lower estimated smoking prevalence, it is likely that the cost per household is lower in Hull than that stated in the Local Tobacco Profiles because a proportion of smokers in Hull will obtain cheaper illicit tobacco. The latest figures from the Local Tobacco Profiles are for the year 2013 and give the estimate total cost in millions of pounds (Figure 2). Note that the total cost is given so geographical areas cannot be compared directly as the total cost will depend on the number of households. It is estimated that among those aged 18+ years, estimated household expenditure on tobacco is 117.71 million in Hull and 76.76 million in East Riding of Yorkshire with a regional cost of 1,689 million and 15,446 million across England. Thus the total costs to households across Hull and East Riding of Yorkshire is 194.47 million for 2013. Figure 2: Total tobacco sales cost to households among residents aged18+ years 300 250 200 150 100 50 0 However, from Figure 2 from the Local Tobacco Profiles, it is possible to estimate the total cost per adult (18+) using the ONS population estimates for 2013. Not surprisingly, given that Hull has the highest prevalence of smoking of the regional local authorities, the estimated expenditure among those aged 18+ years in Hull is 3

Indicative tobacco sales (millions, ), average cost per adult, 2013 among the highest. It is estimated that Hull s 202,325 residents aged 18+ years spend on average 582 on tobacco each year, and that East Riding s 272,607 residents aged 18+ years spend on average 282 on tobacco each year. Hull s figures are considerably higher than England ( 365) or the region ( 402). Although as mentioned above, the total real cost is unlikely to be as high as this due to illicit tobacco sales. Figure 3: Average tobacco sales cost to residents aged18+ years 700 600 500 400 300 200 100 0 Local authority England Y&H ASH cost of smoking to the social care system Action on Smoking and Health (ASH; www.ash.org.uk) have commissioned research, for the first time, to estimate the cost of smoking to the social care system (Action on Smoking and Health 2014). The research shows that smoking not only contributes to the social care bill but also has a significant impact on the wellbeing of smokers who need care on average nine years earlier than non-smokers. Costs are also estimated for each local authority based on the size of their over 50s smoking population. ASH in their main report stated that The burden on smokers as a result of illnesses caused by their addiction is significant. In the past it has been estimated that for every smoker who dies, 20 are living with a smoking-related illness. This research shows that smokers are likely to need care on average nine years earlier than nonsmokers. It also found that being a smoker doubled the chances of receiving care of any sort and increased the risk for ex-smokers by 25%. 4

The research looked at the increased likelihood that smokers and ex-smokers would need help with 13 activities: Walking across a room Bathing or showering Eating Getting in and out of bed Using the toilet Using a map Preparing a hot meal Shopping for groceries Making telephone calls Taking medication Doing work around the house or garden Managing money The results show that current smokers are more likely than never smokers to have difficulties with 10 of the 13 activities listed above. The exceptions are: using the toilet; taking medication; and managing money. Ex-smokers have more difficulty than never smokers with two of the 13 activities: dressing; and doing work round the house or garden. Therefore, current smokers, and to a lesser degree former smokers, are more likely than never smokers to require domiciliary care. (Action on Smoking and Health 2014) Across England, using modelling it was found that the median 1 age at which current smokers required help from a spouse or partner was 62 years whereas for exsmokers and never smokers it was 69 years. Privately paid help was required at a median age of 75 years for current smokers compared to 82 years for ex-smokers and never smokers. Help from the local authority and/or social services was required at a median age of 71 years for current smokers compared to 86 years for ex-smokers and 84 years for never smokers. Whilst from this modelling, current smokers need social care earlier, it is not reported on how long the care is required. Many ex-smokers or never smokers will also have social care needs, and it is possible that whilst their social care may start later, if they are healthier, the duration of their social care could be longer, or the social care required by ex-smokers due to more co-morbidities may be more costly than the social care received by ex-smokers and never smokers. These factors should be considered when interpreting the information. 1 The median is the middle value when sorted into order, i.e. (n+1)/2th value when sorted where n is number of observations. For example, the median of the numbers 1, 2, 3, 4 and 5 is (5+1)/2=6/2=3 rd value which is 3. The median splits the population into half, so that 50% have that value or higher and 50% have that value or lower. So in the example, 50% of all the values are 3 or fewer, and 50% of the all the values are 3 or more. 5

Costs to society ASH have produced a factsheet on the costs of smoking to society (Action on Smoking and Health 2014), in which they state Research commissioned by ASH has shown that the total cost to society (in England) is approximately 12.9 billion a year (Action on Smoking and Health and LeLan Solutions 2014). This includes the cost to the NHS of treating diseases caused by smoking in England which is approximately 2 billion a year (Action on Smoking and Health and LeLan Solutions 2014). Other costs include: loss in productivity due to premature deaths ( 3bn) cost to businesses of smoking breaks ( 5bn) smoking-related sick days ( 1bn) social care costs of older smokers ( 1.1bn) costs of fires caused by smokers materials ( 391m) Spending on tobacco control measures can help reduce these costs. For example, it is estimated that about 380 million a year is being saved by the NHS as a result of public health strategies such as the ban on tobacco advertising and the creation of the stop smoking services which have resulted in fewer people smoking (Callum, Boyle et al. 2010). In the 2012-13 financial year the Government spent 87.7 million on the stop smoking services in England plus an additional 58.1m on medicinal aids (e.g. nicotine replacement therapy) (Health and Social Care Information Centre 2013). Expenditure on mass media health campaigns on smoking in 2012-13 was 8.21 million (Hansard 2014). (Action on Smoking and Health 2014) Based on ONS s mid-year 2012 population estimates, the number of adults in Hull and East Riding of Yorkshire aged 16-64 years (approximate working age) is 171,583 and 204,412 respectively, which represents approximately 0.5% and 0.6% of England s population aged 16-64 years (34,306,995). Applying these percentages (0.5% and 0.6%) to the overall costs above relating to loss of productivity due to premature death, cost to businesses of smoking breaks and smoking-related sick days, and applying similar percentages (based on adult population aged 18+ years) to cost of fires, costs to the NHS and total costs it is possible to obtain some estimates of the costs to the businesses in the local economy (Hull s population is approximately 0.48% of England s 18+ years population and East Riding is around 0.65%). There are numerous assumptions within the costing estimates already, and there will be even more when applied to locally as there is no reason to suppose the costs are distributed evenly across local authorities in England, indeed this is very unlikely to be case. Due to Hull s higher prevalence of smoking, if these costs are a reasonable estimate of total costs for England, then it is likely that the costs to Hull local authority, NHS Hull and local businesses in Hull could be higher than those estimated. Furthermore, the businesses may not be local businesses but national or international companies, and it is not known (without examining all the reports on ASH) how these economic and costs to society are derived. Table 1 gives the total estimated economic costs based on the total figures above for England. 6

Table 1: Total economic costs locally derived from assuming same costs as England but proportionate based on Hull and East Riding population Breakdown of cost Estimated cost by area England Hull ERoY Hull & ERoY Premature deaths 3,000,000,000 15,004,200 17,874,955 32,879,155 Smoking breaks 5,000,000,000 25,006,999 29,791,592 54,798,591 Sick days 1,000,000,000 5,001,400 5,958,318 10,959,718 Fires 39,100,000 188,044 252,811 440,855 NHS 2,000,000,000 9,618,635 12,931,509 22,550,144 Total 12,900,000,000 62,040,195 83,408,233 145,448,428 Estimated costs and modelled estimate of number of individuals with care needs From statistical modelling, the report commissioned by ASH gives the total spending on social care, the estimated number of individuals requiring additional social care, total authority spending on social care, total spending by self-funded individuals on social care and the number of individuals receiving informal care from family and friends among adults aged 50+ years for 2012-13 (Table 2). Using the ONS mid-year population estimates for 2012 for those aged 50+ years, it is possible to estimate the average cost per resident among the population aged 50+ years, and the percentage of the population aged 50+ years requiring social care (Table 3). ONS estimate the number of residents aged 50+ years is 18,646,592 for England, 1,885,165 for the Yorkshire and Humber, 80,635 for Hull and 148,137 for East Riding of Yorkshire. Not surprisingly, given Hull s high smoking prevalence, the modelling suggests that the cost per head among those aged 50+ years is considerably higher than East Riding of Yorkshire, England or the Yorkshire and Humber average. The percentage of individuals aged 50+ years requiring additional social care is also higher. 7

Table 2: Cost of smoking to the social care system among adults aged 50+ years during 2012-13 (total cost) Area Total spending on social care Estimated number of individuals requiring additional social care Total local authority spending on social care Estimated number of statedependent individuals Total spending by self-funded individuals on social care Estimated number of individuals receiving informal care from family and friends England 1,059,274,000 883,651 608,272,000 37,745 451,002,000 845,906 Y&H 124,102,288 96,936 71,263,853 4,422 52,838,435 92,513 Hull 6,827,358 4,822 3,920,507 243 2,906,851 4,578 ERoY 8,568,334 7,104 4,920,236 305 3,648,098 6,798 Hull & ERoY 15,395,692 11,926 8,840,743 548 6,554,949 11,376 Table 3: Cost of smoking to the social care system among adults aged 50+ years during 2012-13 per resident Area Total spending on social care per resident aged 50+ Percentage of individuals aged 50+ requiring additional social care Total local authority spending on social care per resident aged 50+ years Percentage of state-dependent individuals aged 50+ years Total spending by self-funded individuals on social care per resident aged 50+ years Percentage of individuals aged 50+ years receiving informal care from family and friends England 56.81 4.7 32.62 0.2 24.19 4.5 Y&H 65.83 5.1 37.80 0.2 28.03 4.9 Hull 84.67 6.0 48.62 0.3 36.05 5.7 ERoY 57.84 4.8 33.21 0.2 24.63 4.6 Hull & ERoY 67.30 5.2 38.64 0.2 28.65 5.0 8

References Action on Smoking and Health (2014). Action on Smoking and Health Factsheet: The economics of tobacco. www.ash.org.uk. London, Action on Smoking and Health. Action on Smoking and Health (2014). The Costs of Smoking to the Social Care System in England. www.ash.org.uk. London, Action on Smoking and Health. Action on Smoking and Health and LeLan Solutions (2014). ASH Ready Reckoner. London, Action on Smoking and Health and LeLan Solutions. Callum, C., S. Boyle, et al. (2010). Estimating the cost of smoking to the NHS in England and the impact of declining prevalence. London, Health Economics Policy & Law. Hansard (2014). Written Answers to Questions Tuesday 1 April 2014. http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm140401/text /140401w0001.htm. London, Parliament. Health and Social Care Information Centre (2013). Statistics on smoking: England, 2013. London, Health and Social Care Information Centre. Public Health England (2014). Local Tobacco Control Profiles. www.tobaccoprofiles.info. London, Public Health England. Mandy Porter, Public Health Sciences, Hull City Council. 3 rd February, 2015. 9