Smoking as a Social Determinant of Health Inequality in Lambeth

This report evaluates tobacco smoking as a social determinant of health in Lambeth, analyzing the borough’s demographic profile in relation to smoking and the health inequalities they are exposed to as a result of smoking. It also highlights the policy issues related to tobacco smoking in Lambeth before identifying the tobacco-targeted health provisions in the borough.

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Smoking As a Social Determinant of Health Inequality
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Introduction
Tobacco smoking is estimated to be among the the highest single cause of poor health and
preventable early death in Lambeth (Amroussia et al 2017). In fact, according to Berkman
(2009), tobacco-related deaths; from vascular diseases and cancer are estimated to be quite high
in Lambeth as because it is among the densely populated boroughs in England and such deaths
are encountered by both men than women. This report aims to evaluate the tobacco smoking as a
social determinant of health in Lambeth. In doing so, there will be an analysis of the borough’s
demographic profile in relation to smoking, and the health inequalities they are is exposed to as a
result of smoking. The report will also highlight the policy issues related to tobacco smoking in
Lambeth before identifying the tobacco-targeted health provisions in the borough.
Social Determinants of Health
Social determinants of health (SDH) are defined as socioeconomic factors that dictate a person’s
health and well-being status (Chapman 2010). The author proposes that SDH may include: socio-
economic status (SES)/income, education, smoking/drug abuse or gender. Studies by WHO have
largely reported a positive correlation between a population’s SES and their health status – in the
sense that the lower the SES of a community the poorer health conditions they are exposed to
(Chapman 2010). Erwat et al (2017) also comment that several theories have attempted to
explain the relationship between SES and health inequality, but a majority of them indicate
poorer families are exposed unhealthy living environments, deprived clinical services and poor
health behaviour that contributes to poorer health conditions than those with better SES.

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Literacy and education have also been mentioned by many scholastic studies (Finn et al 2017;
Goli et al 2017; Goldblatt 2016 and Haafkens et al 2014) to be a great determinant of health and
well-being. For instance, House (2016) claim that educated people tend to have more income
which enables them to tackle most of the health challenges they encounter. Iqbal & Nawaz
(2017) also write that educated people tend to understand normal life safety and health
precautions enabling them to maintain good health than uneducated people. Hence, at is emerges
from these authors, better education exposes one to better health and well-being while illiteracy
exposes one to health risks.
Gender is also a social determinant of health. Studies by Jayasinghe (2015) show that women,
especially those living in patriarchal (Although not experienced in Lambeth) societies where
gender-based social discrimination is practiced experience more health-related challenges than
their male counterparts. This is partly because they fail to receive much attention in response to
the health issues facing them (Marmot 2005). Murty et al (2009) also argue that such women are
deprived the opportunity to make important health decisions, a phenomenon that has serious
health implications for them.
Smoking is a major social determinant of a person’s health and well-being, especially in the
presence of various intervening variables which mainly consist of social determinants. For
instance, according to Masayoshi et al (2017), poverty can inhibit a smoker from seeking
medical attention when confronted with the health complications lung cancer associated with
tobacco. Marmot (2005) also argues that a tobacco user with poor housing is more exposed to the

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risk of smoking-related respiratory health complications than a non-smoker. Thus, when
smoking is combined with other social determinants of well-being, the individual becomes more
susceptible to health risks.
Lambeth’s Smoking Demographics
The latest reports on Lambeth population indicate that the borough has an estimated population
of 283,879 (Paul & Valtonen 2016). Among this population, the authors estimate that about
28.1% of adults are smokers, a rate which is slightly higher than the average adult smoking rate
in the UK (26%). Moreover, statistics by Amroussia et al (2017) indicate that Lambeth’s adult
sm0king rates (28%) are higher than the average smoking rate in England (24%) and in London
(23.3%), meaning that the prevalence of smoking within the borough is alarming.
Scholars have established a strong relationship between social disadvantage and tobacco
smoking in Lambeth. For instance, Pons-Vigues et al (2014) say that there is a disproportionate
effect of smoking on economically disadvantaged persons which contribute to serious health
inequality. This confirms the results of previous studies exploring the relationship between
smoking and health inequalities. Among the studies include a Health Survey of England Report
which revealed that young adults, women and children who live in deprived areas of Lambeth
are more likely to smoke than those in non-deprived areas (Erwat et al 2017). Furthermore,
Amroussia et al (2017) estimate that at least one in five people dies out of tobacco-related health
complications in England, and considering that Lambeth has a higher prevalence of smokers than
England, the same picture might be true in Lambeth.

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Tobacco smoking has emerged as a major health issue in Lambeth. Reports by Finn et al (2017)
indicate that tobacco smoking is the single most determinant of geographical mortality rate
variation in the borough. The author shows further that while there is an estimated 15% higher
mortality rate in socio-economically disadvantaged areas than affluent areas in Lambeth,
smoking behaviour accounts for 85% of that difference. As a result, the Lambeth local
authorities consider smoking as a major target of its health inequality reduction programs, one of
them being a reduction of the smoking population within the borough (Finn et al 2017).
Smoking is a big contributor to health inequality in Lambeth because it has the highest
prevalence than other parts of the UK, with acutely high levels experienced among the youth.
Nonetheless, the impact of tobacco on young people on the health or both adults and young
people in Lambeth is well known. According to Amroussia et al (2017), long-term tobacco
smoking has largely been associated with health complications such as stroke and coronary heart
diseases. The author approximates that smoking causes 90% and 80% of lung cancer deaths
among Lambeth men and women respectively, as well as 90% of all deaths related to obstructive
pulmonary disease.
The most affected group of smokers in Lambeth are the youth because according to Rooks &
Rael (2013), tobacco smoking at an early age has adverse immediate health effects than at adult
age. Some of the health complications faced by the youth rather than adults as a result of
smoking include early cardiovascular damage, compromised lung growth, poor lung function,

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and severe wheezing; which explains why young smokers are more likely to develop asthma
compared to adults (Storm et al 2016).
Tobacco smoking is also associated with health inequality among women. According to Schulz
& Northridge (2004), smoking among young pregnant women in Lambeth stands at a prevalence
rate of 17% and has largely been associated with miscarriage, ectopic pregnancy, cot death and
low birth weight. Studies by Sara (2016) also reveal that such neonate ill-health have been
rampant in Lambeth within the past five years due to the high smoking rates among women of
age 25-34 years.
Health Inequality Policy Issues
While there has been an improvement in health, health-related behaviours and life expectancy
within Lambeth in the last 50 years, there has been an observed more rapid improvement among
the advantaged groups than the disadvantaged groups, indicating a gap of improvement between
populations in the two extreme socioeconomic strata (Taylor et al 2016). However, according to
Sharanya et al (2009), the existence of this gap does not mean that policies on public health have
not had any positive impact on health inequalities within Lambeth. Berkman (2009) comments
further that were it not for adequate education, free universal healthcare, better housing,
progressive taxation, environmental quality controls and income support among other policy
initiatives, the health inequality situation in Lambeth could have been worse.

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According to Amroussia et al (2017), reducing health inequalities would require adequate
‘upstream’ (a change in living and working conditions of people) policies. The author also
acknowledges that upstream policies against health inequalities have been popular partly because
downstream interventions are much unreliable. For example, services that promote smoking
cessation would be less effective because the new cohort of smokers will always arise.
Nonetheless, Berkman (2009) argue that both upstream and downstream policy interventions are
important especially in the case of smoking because they can help create an environment of
fewer new smokers and help people to stop smoking as well.
Some individuals have criticised the introduction of policies meant to reduce health inequalities
by quoting that it is wrong to make some people less successful or healthy simply because there
is a need to create a ‘levelled playing field’. However, according to Berkman (2009), a policy
can be focused towards levelling up rather than levelling down. The scholar further comment
that understanding the health gaps that exist between different social strata in Lambeth helps in
realizing the possibilities and setting the goals to be achieved in respect to reducing health
inequalities.
Finn et al (2017), Erwat et al (2017) Chapman (2010) acknowledge that the NHS has little
control on most of the major drivers of equal health distribution within Lambeth and other
boroughs in England. But, as argued by Goli et al (2017), NHS should play an important role in
preventing disease, promoting health, and reducing health inequalities caused by disadvantage.
Furthermore, the Health and Social Care Act 2012 advocates against the ‘inverse care law’

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(where quality health care services are delivered only to the people who need the least). The
NHS is therefore mandated to address healthcare needs across all population demographics to
ensure that health inequalities in Lambeth and other boroughs of England are tackled.
Interventions to Reduce Tobacco Smoking In Lambeth
Realizing the serious health challenges presented by the high rate of tobacco smoking in
Lambeth, the local authorities have initiated several interventions to ensure that the borough
experiences reduced smoking rates among both its adult and youth population. Implemented
under the framework of Lambeth Tobacco Control Strategy, the interventions include programs
aimed at reducing tobacco consumption among young people, creating supportive environments
for tobacco cessation, protecting communities and families from tobacco related harm, and
several other NHS based interventions aimed at the same objective. For instance, the Lambeth
Stop Smoking Service has been focusing on offering effective and evidence-based support to all
the smokers within the borough who show intent to quit smoking. According to Amroussia et al
(2017), the service helps anyone who wishes to quit smoking by assisting them to adapt to
change in lifestyle through counselling and education. Similarly, the Lambeth Stop Smoking
Service has also worked closely with the Lambeth Council to help in increasing cessation among
the smoking staff of the council (Berkman et al 2009). In doing so, the two organizations
establish a toll-free phone service to enable potential quitters to seek help from the Stop Smoking
Council.
Several other governance-based initiatives have been established in Lambeth through the
Lambeth Tobacco Control Alliance in collaboration with other organizations committed to the

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same mission of reducing tobacco-related health inequalities. According to Chapman (2010), the
alliance has a representation from different organizations including Lambeth Community
Services, NHS Lambeth, St. Thomas NHS trust, LB Lambeth, London Fire Brigade, the
Metropolitan Police and the Prison Service. Its main objective is to collaborate and involve its
members in initiating anti-tobacco campaigns guided by the Lambeth Control Strategy (Ewart et
al 2017). In the period of 2010 to 2011, the joint initiative facilitated the delivery of effective,
equitable, and integrated smoking-free programs such as coordination with the local pharmacists
and general practitioners to deliver stop-smoking training services to the borough’s community
(Finn et al 2017).
The Lambeth Stop Smoking Service has also engaged in programs meant to health inequalities
by reducing tobacco smoking among targeted groups such as pregnant smokers, minority, and
black communities, as well as manual and routine workers through tailored stop-smoking
services (Goli et al 2014). For the records, this program was initiated in the period between April
2010 and March 2011 and was mainly facilitated by practitioners, and Lambeth Community
Health service provided.
In conclusion, smoking has emerged as a serious health concern and a contributor to health
inequality in all societies across the globe. Its impacts are greatly experienced by societies and
cultures which high tobacco addiction prevalence such as Lambeth. Significant progress has
collectively been made by the NHS, the British government and the Lambeth Council authorities
reduce tobacco consumption together with the health inequalities that accompanies it. A major
recognizable initiative is the Lambeth Tobacco Control Strategy. However, this report

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recommends that there is still more to be done by the relevant stakeholders to reduce smoking as
a social determinant of health inequality; including proper funding for anti-tobacco initiatives.

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