Public Health Wales failing Public Health

It is well-known that within the UK, each of the devolved areas have completely different priorities when it comes to “running” their little piece of the country. Wales tried, and spectacularly failed last year to bring in a new “Public Health (Wales) Bill” which would, in effect have severe negative consequences for Welsh vapers. That Bill, the demented offspring of one Mark Drakeford, was defeated at the final hurdle, not by the weight of evidence as it should have been long before it got to the final vote, but by the “cheap date” comment.

A victory is a victory. Whether you win by an inch or a mile, winning is winning. In the case of Labour’s attempt to place a gagging order on the Welsh vaping community, we won.

You’d be surprised to hear that Public Health Wales, one of the main supporting public health bodies behind the failed Bill, have supposedly updated its position statement on Electronic Nicotine Delivery Systems (ENDS) – no guesses where they got that from – to “provide advice to the public about the potential impacts of e-cigarettes on health”. Reading the press release that accompanies the “updated position” you could be forgiven for thinking that they have changed. They haven’t.

The updated advice says that, for children and young people and non-smoking adults, the use of e-cigarettes is likely to be harmful to health.

Current smokers who want to quit are advised to find out about the range of help available to them and choose the approach that is best for them. This help includes proven NHS services like Stop Smoking Wales and community pharmacies.

In the opening lines it’s all about the children and young people. Yet the statement of “the use of e-cigarettes is likely to be harmful to health” is evidence of how grudging this statement is. If e-cigarettes are likely to be harmful to health (as PH Wales claims), than those harms are likely to affect former smokers as well wouldn’t you think? For many of the long-term vapers this will come as a bit of a surprise. Or not. Y’see, once again PH Wales are showing how utterly inept they are at handling public health.

The advice for committed smokers who can’t or won’t quit is that switching completely to e-cigarettes will significantly benefit their health.

Well which is it? You can’t say that the use of e-cigarettes is “likely to be harmful to health” and in the very next breath say that they’ll be “significantly beneficial to health”. No wonder folk in Wales are so confused!

It doesn’t get much clearer from the commentary of on Dr Julie Bishop, Director of PH Wales:

“We recognise that there are a lot of confusing and contradictory messages around e-cigarettes. This is because there isn’t one simple answer – it is different for different groups of the population.
“In simple terms, if you don’t smoke, don’t vape. But if you are a committed smoker who is unwilling or unable to quit, switching completely to e-cigarettes will be beneficial to your health.”

Good grief! Yet in their updated document lies all the crud and rubbish that you’d expect:

The use of nicotine by children and young people is unsafe, it can cause addiction and can harm the developing adolescent brain – there are no benefits to children and young people in using ENDS.

“No benefits” except if you happen to be a youth smoker, in which case knock yourself out – according to PH Wales.

There is concern that ENDS are seen as ‘safe’ but this is not the case, while the health risks of ENDS are significantly lower than cigarettes they are not without risk.

Ah the “renormalising” commentary that was a large part of Drakeford’s reasoning behind his misguided Bill. I guess Public Health Wales haven’t been paying attention to the figures. Youth smoking is at an all time low, and never-smoking youth aren’t regularly using e-cigarettes. But why let a tiny thing like facts and evidence get in the way of a good statement eh?

Some of the bullet points from the “children and young people” section:

  • ENDS should feature alongside other health-harming substances e.g. tobacco and alcohol, in all health education for children and young people, and be presented as harmful to health.
  • A systematic enforcement programme should be developed to minimise the sales of ENDS to those less than 18 years of age, including development of a register of retailers and systematic test-purchasing, prosecution and media activity.
  • ‘Confectionary-like’ flavours of e-liquid should not be permitted, in order to reduce the appeal of ENDS to children and young people.
  • There should be restrictions on the use of ENDS in settings predominantly used by children e.g. in schools and school grounds and around the entrances to schools.
  • There should be restrictions on the advertising of ENDS in all media that would be regularly viewed by children and young people.

Good grief! Aside from the flavour ban, it is pretty much Drakeford’s Bill alive and well!

Then there’s the “for the non-smoking general population”:

There is some evidence of the potential for ENDS use to have a negative impact on indoor air quality and therefore represent a risk to health. Currently, the available evidence is inconclusive on the level of potential harm and more work is required. Voluntary restrictions on the use of ENDS in many public spaces are already in place.

Goodness gracious! ENDS have a negative impact on air quality? Get outta town! They are half right, more work is required but the evidence is far from inconclusive, they just don’t bother to read it. Maybe their English counterparts can send them a copy of their statement? In crayon.

  • Until a more definitive risk assessment can be completed, voluntary restrictions on the use of ENDS in enclosed public spaces should continue.

Natch. Isn’t that part of what Drakeford wanted? Public space bans?

For the smokers who want to quit:

NHS stop smoking services which provide behavioural support and access to licensed pharmacotherapy currently offer the greatest likelihood of stopping smoking. However, the majority of smokers who make a quit attempt do so without specialist support. For these smokers, ENDS may prove helpful in achieving a successful quit from tobacco although they are not currently licensed as a medicine for this purpose.

In other words, don’t go trying an e-cig straightaway, go down the route that thousands have tried (and failed), go see your Stop Smoking Service and get the wonderfully effective NRT (7% success rate).

The only concession to progress Public Health Wales have made to e-cigs is the statement of “For committed smokers who are unwilling or unable to quit there is a high degree of consensus that the benefits of using ENDS significantly outweigh the harms.”. The rest of their position statement is cherry picked from the US Surgeon General and Drakeford’s favourite, the World Health Organisation.

You can almost hear them gritting their teeth when they cite the Cochrane Review. All those facts getting in the way of ideological beliefs is troublesome. But then, Public Health Wales has never been about health.

(image credit Diego Schtutman/shutterstock)

  • Roberto S

    “ENDS may prove helpful in achieving a successful quit from tobacco
    although they are not currently licensed as a medicine for this purpose.”

    This is what they would like “ENDS” to be: another product to be marketed and -$sold$- by the pharmaceutical “sponsors” together with NRT. I guess nobody believes that Drakeford and associates are just some inept misguided idealists.

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