Enhancing Health and Wellbeing Across Populations: Smoking as a Lifestyle Choice


Public health is described as a tool and techniques for protecting the health of the population and implementing all measures for the safety of health of the local population. There are several public health issues such as drug addiction, aids and smoking. In this assignment the targeted public health issue is smoking as a lifestyle choice within the population of United Kingdom. Smoking has been assumed as a critical public health issue. It has been examined that smoking caused severe threats to the individual health as well as to the third world countries and developed countries (Rentería, et al., 2016). Amongst multiple significant reasons of deaths and medical ill-ness, smoking is also considered as the main cause. This assignment is conducted to underline the general evidence on how smoking can cause severe death and diseases. The main part of the assignment debates several smoking-related risk factors to public health and assesses risks. The other main aim of the assignment is to emphasis smoking as a major public health issue. Since Health promotion is essential to reduce chronic disease globally due to smoking. Smoking can be identified as an addictive disease. As nicotine is known to be a highly addictive and harmful substance.

Therefore, health promotion, disease prevention and health protection measures are utilized to address smoking issues. Additionally, multiple disadvantages of smoking habit have been discussed in accordance with the Joint Strategic Needs Assessment (JNSA) and the Clinical Commissioning (CCG) process. Moreover, 5 A’s approach along with Tannahills Health (1985) is elaborated to highlight the effective measures for smoking interventions. This assignment will discover the Public Health Outcomes Framework provided by Public Health England along with the effective discussion on how health expectancy would be increased through quitting smoking habit. Lastly, the WHO framework guidelines will be highlighted in order to reduce smoking habit globally.

Public Health

Public health can be elaborated as the techniques and methods of securing and maintaining the safety of health of communities through their proper education system, research and developments or policies relevant to disease preventions (Maziak, et al., 2017). Hence the definition of public health varies from person to person.  In the domain of public health, conducting a laboratory test or researching process are performed to improve the health of the Community. The successful execution of initiatives to increase the improvement of community health need deep insight into the complex and various procedures that develop healthy habit in societies. Health can be seen to depend on various factors including medical care, individual behaviour and genetics, social and economic conditions of the region for both individual and populations.

Public Health can also be considered as a complete science of improving the health of the public by promoting health precautions, healthy living standards, disease preventions, treating and preventing multiple infections (Fu, et al., 2018). Professionals of this respective field always work for the preventions of any health concerning issues. This work can be done through certain health promotions policies, adoption of educational programs and research and development procedures performed by the field professionals such as doctors and nurses. The main focus of these professionals is to treat the suffering ones, once they are diagnosed from any disease or infection. A major part of public health is promoting healthcare quality and accessibility. Additionally, public health deals in the promotion as well as protection of the health of the public (Xiao and Wang 2019).

Public Health awareness can be generated through performing scientific research to educate population regarding their health issues along with guiding the staff as well who are working for the provision of health measures such as vaccines for children, other measures to prevent adults from the disease. It the main responsibility of the public health to regulate certain effective safety standards in order to secure workers and establish programs related to the nutrition to assure that children have easy access to healthy food. Public health is also accountable to follow the disease, prevention of the injuries and highlight reasons behind suffering from poor health issues. The many aspects of public health include laws for promoting smoke-free indoor air and usage of seatbelts whilst driving.

Within the United Kingdom agenda, public health is considered as a continuous issue whereas all professionals of the domain will participate in it (Chertok and Archer 2015). Public Health emphasis on the well-being and healthy living habit of an individual and considered as the most efficient methodology of preventing health-related issues in the public. It identifies the root causes of the sickness, disease or illness. Additionally, it underlines all other factors including biological or social environment and provision of the services regarding health care. Public health completely depends on the skills, judgment and evidence. Moreover, public health promotes the involvement of the public who are members of the policymakers and actions of United Kingdom Public Health Association (UKPHA).

Smoking Habit as a Public Health Intervention

The main reason for selecting smoking habit is considered as a serious and essential public health issue. It has been examined that smoke is very harmful to the human tissues whilst smoking (Tanner, 2019). Furthermore, it has been observed that smoking tobacco not only affect an individual’s health but also accountable for creating an impact on the economy, society and environment as well (Tanner, 2019). Smoking habit are dangerous as it causes a severe effect on the entire body, smoking causes lungs diseases as well as it reduces the life expectancy and quality. It has been investigated that around 364,000 individuals admitted in the National Health Service (NHS) hospital of England on yearly basis due to diseases caused by smoking habit (Bauld et al., 2009)

Further, it has been critically examined that in the United Kingdom, 114,000 individuals die, amongst them, the majority are premature having an average age of 21 years. Approximately 42800 premature deaths are caused by Lung and coronary cancer that are caused by frequent smoking. Almost 29100 chronic obstructive heart diseases and 30600 coronary heart diseases result in deaths every year (Bauld et al., 2009).

It has been noticed that smoking is the root cause for more other diseases such as impotence, asthma, and gum diseases, infertility and psoriasis. Additionally, it has been justified by several types of research that non-smokers are also at risk due to the smoke emission from smokers. Such a process is also termed as passive smoking. Aronow, W. S. (1978).  It is further also termed as environmental tobacco smoke (ETS) and second-hand smoking (SHS).

Tannahills ladder of intervention

Health promotion strategies in this model are assumed as the primary tools to develop awareness in the public for smoking prevention (Ramsey, et al., 2018). Also, according to Tannahills model (1985) Public education is an integral part of the efforts to both prevent the initiation of smoking and encourage smoking cessation. Higher health promotion helps to make individuals aware of the dangerous effect of smoking. These health promotions also increase the power to quit smoking along with subsequent quitting amongst all other users. Health specialists may support and encourage all those smokers who want to quit by adding up their knowledge regarding smoking cessation techniques (Sorlí-Aguilar, et al., 2016).

Various health promotion techniques such as Tannahills promotion are being utilised for the purpose of smoking prevention. A positive impact on the deduction of smoking habit has been shown by an evaluation of the health promotion intervention studies. Presently it has been examined that the provision of effective smoking prevention to the population is very important. For youngsters there should be school-based prevention education Smoking prevention education programs must be arranged for the smoker. These prevention programs will emphasis on skills training strategies that are effective in minimising smoking.  Along with the prevention techniques, there must be health protection measure especially for those who indirectly effected by the smoke exhales by the smokers. The ladder of intervention framework, Nuffield Council Bioethics, can also be use, which commence with observing the situation/do nothing, give information, by giving out leaflets, advertisements, posters and campaigns, allowing  people to make their  own choices, to enable change in pattern of behaviours, a better choice option giving them options to choose from, incentives guides offering financial rewards for making a healthy behaviour, disincentives guide  which are shoves, such as discouraging people from smoking, through bans, restricting, their choice and removing choice totally such as restrictions on places where people can smoke.  Using this intervention have an ethical issue in place, of taking the autonomy power of an individual away from them but this is not so, the purpose is to encourage the society to live a healthy life through restrictive and  measures by saying it an illegal to smoke in the car while there is a minor present. putting age limit to those that wants to purchase cigarettes, changing the package to making it less inviting.  harmful choice of life, also providing a designated area for smoking, all these to discourage smoking habits and finally, eliminating choices through restrictions in places to smoke.

The Health and Social Care Act (2012)

The health and social care act oversee all the activities of public health UK. Local government has been empowered with the responsibility of funding and also the power in enhancing health as well as decrease inequalities in health of the public by the health and social care act.

Joint Strategic Needs Assessment (JSNA)

Joint Strategic Needs Assessment (JSNA) is a keystone of social care commissioning. JSNA ensure that organisations of heath concern and local administrations understand local populations and the challenges in handling health issues (Mazzonna and Salari 2018). A JSNA is based on an evaluation of present and forecasted health outcomes. Furthermore, it is accountable for what people want from their services. Additionally, JSNA is responsible for predicting potential or new requirements. A JSNA can be considered as a continuous procedure which recognises the big picture in regard to the wellbeing and health needs population of the region. JSNA has provided the assessment report regarding the smoking behaviours of an individual.

Clinical Commissioning Groups (CCGs)

All Clinical Commissioning (CCGs) were working for the National Health Service (NHS) statutory bodies from 1 April 2013. Clinical commissioning is accountable for commissioning most NHS services such as emergency care, mental health services, acute care and community services.

Smoking as a Disadvantaged

According to JSNA and CCG, smoking has been considered as a disadvantaged. There should effective preventions for reducing the smoking habit amongst the local communities within the United Kingdom. Smoking as a disadvantage has been evaluated due to certain reasons discussed below.

Heart Issues

It has been examined by Joint Strategic Needs Assessment (JSNA) And Clinical Commissioning Groups (CCG) that smoking habit effect the blood circulation within the human body as it changes the overall structure of vessels of the blood (Oikonomou, et al., 2019). This variation in a structure that is caused due to smoking build plaque in the vessels making them harder and narrow minimising the proper blood flow in the body. But according to JSNA it causes a general disease that leads to heart attacks and peripheral artery disease. This disease can be termed as atherosclerosis. Additionally, smoking cause high blood pressure as well due to inhaling to carbon monoxide from smoking. As per CCG smoking habit also increase the chances of blood clots in the blood that further cause severe strokes.

Functions of Lungs

According to the viewpoint of JSNA and CCG, lungs are mainly affected by the habit of smoking because inhaling chemical from smoke is directly linked with lungs. It has been examined that smoking cigarettes are the main reason behind the disease of chronic obstructive pulmonary (COP) (Porter and Greene, 2016). These diseases further create an effect on the functionality of the lungs. COPD contains emphysema and chronic bronchitis along with the variation in the structure of lung tissue. As per JSNA, smoking increases the attacks if the patient already suffers from asthma. In the contrary to JSNA’s statement CCG claims that, smoking effect the overall function of lungs, so the patients face breathing issues.

Problems within the Fertility

It has been examined that smoking also creates an effect on fertility within the human. According to JSNA, smoking lower down the chances of conception in either women or men (Porter and Greene, 2016). All those men, who smoke tend to have minimum sperm that will further lower down the ability of the sperm to fertilize. Smoking habit further reduce the ability of an ovary to produce eggs that are able for healthy fertilization. Although CCG general report it has been estimated that 20 to 30 percent of low-weight babies are born and 14% of premature births are caused due to smoking in pregnancy. Further, smoking in pregnancy will cause asthma in baby and it has been observed that in some cases babies have reduced the function of lungs if women smoke whilst pregnancy.

Initiative towards Cancer

It has been evaluated by JSNA, that 1 in 3 deaths are caused due to cancer occurred due to frequent smoking. On other hand, a report was provided by the CCG that highlights the relationship in between diseases and smoking habit (Porter and Greene, 2016). The report configures that 87% of lungs cancer death penalties are caused due to smoking habit. Smoking also initiates cancer in many other parts of the human body other than the lungs. Individuals who smoke, face a high risk of cancer of throat, stomach, mouth and oesophagus.

Smoking Effects Surroundings

It has been observed that smoking is a major reason for preventable deaths. CCG has estimated that many of the local population die from diseases related to smoking including all those individual who does not smoke but get affected indirectly (Porter and Greene, 2016). A blend of smoke from the burning of cigar or cigarette and smoke exhaled by the smoker is termed as second-hand smoke and it has been examined that low level of second-hand smoke is dangerous for human health. Second-hand smoke cause asthma attacks in young individuals, and a higher risk of infant deaths syndrome, ear infections and many other smoking diseases in the local population who do not smoke. More dangerous impacts of second-hand smoke involve lethal diseases.

Smoking can be considered as one of the most prevalent habit found in the local population. It has been examined that smoking intervention is generally inspired by the behavioural change theories such as the Transtheoretical model (Stockings, et al., 2016). Further, it has been observed that behavioural interventions required discussions, pieces of advice and other activities. These all align together to have successful attempts for the smoking interventions. Generally, it has been found that interventions involve behaviour changing methods highlighting the factors including motivation and self-efficacy. According to multiple studies, it has been evaluated that motivation is an essential component within the entire intervention process of smokers because it increases the eagerness of an individual to quit (Ferrante, et al., 2015).

These interventions further tend to increase skills and self-control to prevent smoking habit. It also involves the provision of suggestions on increasing social support. It has been observed that some behavioural change is complexed therefore interventions should be designed according to the need of an individual so that interventions should be more effective (Holmes, et al., 2016). No improvement has been examined in the effectiveness of behavioural change for the last 20 years. To fill this gap, the UK medical research has attempted behavioural changes techniques project. This will be helpful for smoking intervention and increase the effectiveness of behavioural change as well.

5 A’s Approach

This approach which consists of 5 A’s include ask, assess, and advice, assistance and arrange (Özdal, et al., 2017). ‘Ask’ asking queries is a fundamental step for motivating patients for further interview. Further, extract the required information from the individual which will directly lead to assess the provided information. Hence it is important to assess the status of the health for smoking interventions. Moreover, asking and assessing develops a collective relationship in which the complexity is recognised for the individual. The foremost step after asking and assessing is advising the individual on the harmful effects of the smoking and how it can be prevented. Patients must be recommended treatment including monitoring lifestyles and behavioural counselling.

Prior to the treatment process, it is essential to have an agreement regarding the treatment plan. All treatment plans must utilise effective principles of behavioural change including behaviour shaping. Right after an agreement to the plan professionals must assist patients. Hence, this 5 A’s approach tends to be more effective and this approach must be encouraged for smoking interventions. However, 5A’s approach is more widely implemented for behaviour change in the smoking intervention. Classical conditioning is referred to as a concept where a person learns to link two unrelated stimuli. Individual associate smoking with multiple events such as being stressful and such circumstances then develop cravings smoking behaviour. Another behaviour has been noticed that there is a fast release of dopamine when nicotine is inhaled. It develops feelings of pleasure or reinforces the behaviour which further drives the addiction.

Behavioural approaches to cessation focus on changing habit and patterns of smoking, replace smoking habit and emphasising the advantages of quitting. All such theories underlined the smoking patterns that can be minimised through the effective Transtheoretical model. Health Promotion Model (HPM) is used for research and practice. It emphasises on helping people to obtain well-being. There are four major assumptions of the health-promoting model for the effective intervention of smoking habit. These assumptions focus on controlling individual’s own behaviour through to have control over their smoking habit. The second assumption highlights the process through which they can regulate their behaviour through nicotine replacement therapy that is having chewing gum. According to health promotion model, the third assumption is to make improvements in their behaviour and their environment, and the last assumption of health promotion model is a self-initiated change of person and his entire characteristics to enhance his behaviour.

Public Health Outcomes Framework

The Public Health Outcomes Framework (PHOF) refers to a higher level of overview of Public Health outcomes at the local level that has been supported by a numerous set of indicators. The Public Health Outcomes Framework is utilised as a technique for local accountability whilst providing a means for progress in each local authority. The forecasters of the well-being of the population of United Kingdom highlighted by PHOF includes life expectancy, determinants of health, improvement in health, protection and preventing early deaths (Haluza, et al., 2015). With respect to life expectancy, it has been examined that early deaths due to lungs cancer are mainly caused due to smoking for 50 years.

Life Expectancy

It mainly emphasises on overarching health and healthy life expectancy. It has been observed that lifecycle of a smoker is ten years shorter as compared to non-smoker (Kezar and Maxey 2016). All those smokers who stop smoking by the age of 40 may live as long as those who do not smoke. Habitual smokers have a higher risk of dying than those who never smoked.

Health Determinants

The determinants of health include economic, social and environmental factors that impact the health and well-being of an individual. It has been observed that smoking tobacco not only affect the human health but also create a negative impact on the surrounding, such as it affects the environment due to the exhaling of carbon monoxide.

Health Improvement

The outcome in the domain of public health which highlights the methodologies of improving health is termed as health improvement. These health improvement methods are promoting smoking cessations, increase the awareness about health effects caused by direct smoking or smoke exposures.

Public Healthcare and Prevention

National Institute for Health and Clinical Excellence (NICE) have produced guidance on preventing the addiction of smoking amongst people. This prevention guideline emphasis on mass-media and strategies to prevent the smoking habit. The preventions that can be utilised for reducing smoking includes cessations awareness through media and educational programs. Public health can be secure through the implementation of smoke prevention laws.

WHO recognises numerous goals for the health system? WHO efforts to trigger not only the minimisation of disease, death and disability but also an enhancement in an individual’s response to their illnesses. It has been evaluated that smoking habit are accountable for almost six million death penalties every year (Palanisamy and Thirunavukarasu 2017). There are several effective measures to reduce the smoking habit. Hence the implementation of those measures varies with in the World Health Organisation (WHO). The smoking industry faces great lobbying of the tobacco industry which has impacted the measures to accomplish public health objectives. The WHO framework 2020 convention on tobacco control has been established. The main purpose of this framework is to control the increasing smoking habit and regulate the tobacco industry.

The framework majorly involves foreign investment, advertisement of the smoking tools, promotions and trade of smoking products. Therefore, it has been stated that FCTC is the first platform developed by WHO, which is accountable for assuring the provision of all health standards and control the smoking habit as well (Edelman, et al., 2017). The Framework Convention on Tobacco Control (FCTC) is sub-divided in 10 sections. FCTC is assumed as one of the essential conventions because it regulates tobacco control and public health policies both. The FCTC has indorsed smoke-free law to be adopted within the entire world. According to this law, smoking has been banned in all public areas such as restaurants, bars, sports stadiums, railway stations, shopping centres and cinema halls.

According to the analysis of who framework, unfortunately 9% of countries in the world are implementing the smoke-free rule whereas 65 countries are not following smoke-free laws. Within the UK, the government has introduced the first effective tobacco strategy termed as ‘Smoking Kills’ (Reisner, et al., 2015). This strategy was a milestone strategy within global smoking control. This strategy emphasis on the reducing effects of passive smoking, minimising marketing of smoking within the teenagers and helping smokers to quit this habit. According to the reports of WHO, smoking habit increases problems in breathing in teenage smokers with the rate of almost three times greater than those teenagers who do not smoke (Masters, et al., 2017).

Smoking during pregnancy can cause the risk of cervical and uterine cancer in females. According to WHO, the country should implement the smoke-free laws generated by FCTC, in order to control the rate of smoking within the population (Euro.who.int, 2019). The pregnant women and teenagers should be provided greater importance for planning the strategies to stop smoking. According to WHO, the rate of cigarettes must be increased to minimise the smoking addictions amongst the people (Euro.who.int, 2019). This particular tactic will minimise the difference in between socioeconomic groups in smoking. Further, the smokers who tend to stop smoking should be motivated and encouraged by the government in helping them to quit smoking. The direct smoking must be under controlled by adopting smoke-free law within the entire globe.


Tobacco smoking is considered as a significant factor to early deaths and widely contributes to the global burden of disease. Smoking is now considered as an essential public health issue that is affecting human health of the smokers. Smoking not only effects the smoker’s health but also harmful for those who do not smoke. Several health promotions such as aware of smoking cessations are highlighted to make individuals aware of cessation processes. It has been examined that smoking habit hold various disadvantages according to the observations of JSNA and CCG. These advantages include lungs cancers, heart diseases and environmental issues.

For the process of smoking intervention, 5 A’s approach has been developed. This approach is considered as an effective cessation. Public Health Outcomes Framework (PHOF) was developed which indicates two major outcomes focusing on the life expectancy and health determinants. Effective smoking prevention is discussed supporting these outcomes. Lastly, the World Health Organisation (WHO) 2020 framework also emphasise that smoking habit should be reduced for providing health to the population. Within the WHO, the law was introduced to stop smoking which was implemented by a few countries. For the effective prevention of smoking, this law should be enforced within an entire world.


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