Avoiding the danger that stop smoking services may exacerbate health inequalities: building equity into performance assessment.
BACKGROUND
The UK is the only developed country to have established a nation-wide stop smoking treatment service. Apart from addressing tobacco dependence, which is the leading preventable cause of ill health and premature death, smoking cessation has been identified by the UK department of health as a service priority for reducing gaps in health between disadvantaged groups and the country as a whole. However smoking cessation tends to be more successful among affluent than disadvantaged groups. This means that for stop smoking services there is a trade-off to be had in terms of maximising the number of quitters and reducing socioeconomic inequalities in smoking prevalence. Current performance targets for the national stop smoking services in the UK are set only in terms of numbers of quitters, which does not encourage the adoption of strategies to reduce socioeconomic inequalities in smoking prevalence.


CONCLUSIONS
This paper proposes an assessment framework, which allows the two dimensions of overall reduction in smoking prevalence and reductions of inequalities in smoking prevalence to be assessed together. The framework is used to assess the performance over time of a stop smoking service in Derwentside, a former Primary Care Trust in the North East of England, both in terms of meeting targets for the overall number of quitters and in terms of reducing socioeconomic inequalities in smoking prevalence. The example demonstrates how the proposed assessment framework can be applied in practice given existing records kept by stop smoking services in England and the available information on smoking prevalence at small area level. For Derwentside it is shown that although service expansion was successful in increasing the overall number of quitters, the service continued to exacerbate inequality in smoking prevalence between deprived and affluent wards.


CONCLUSIONS
The Secretary of State for Health in the UK has warned about the dangers of health promotion services and messages being taken up more readily by the better-off, thus exacerbating health inequalities. Because smokers from affluent backgrounds are more successful at quitting than those living in deprived circumstances, it is important to build an equity element into the monitoring of individual stop smoking services. Otherwise the danger highlighted by the Secretary of State for Health will go undetected and unaddressed.
Low
Allan
A
Wales, UK. alow@btinternet.com
Unsworth
Louise
L
Low
Anne
A
Miller
Iain
I
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D004739:England / Q000453:epidemiology; D006292:Health Priorities; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D015995:Prevalence; D011314:Preventive Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration; D015397:Program Evaluation; D011635:Public Health Administration / Q000941:ethics*; D012907:Smoking / Q000191:economics / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012935:Social Justice; D012959:Socioeconomic Factors; D013222:State Medicine; D014029:Tobacco Use Disorder / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
J Public Health (Oxf). 2004 Dec;26(4):388-95
15598860
BMJ. 2005 Apr 2;330(7494):760
15778229
Addiction. 2005 Apr;100 Suppl 2:12-8
15844287
Eur Psychiatry. 2005 Aug;20(5-6):431-41
16171657
BMJ. 2006 Apr 22;332(7547):967-9
16627518
CMAJ. 2001 Sep 4;165(5):601-7
11563213
MMWR Morb Mortal Wkly Rep. 2001 Nov 9;50(44):979-82
11724152
Tob Control. 2003 Sep;12(3):296-301
12958391
J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5 Suppl 1):S26-7
14626521
Thorax. 1998 Dec;53 Suppl 5 Pt 2:S1-38
10226676