Background and challenges to implementation:
The North East of England (pop 2.6m) has significant health challenges, largely resulting from an historic industrial past, and subsequent high rates of tobacco use. The region united in pooling public health budgets in order to deliver key interventions at scale. Eight key strands of tobacco control have been delivered synergistically over the last decade including smoking cessation, advocacy and media, regulation, research, secondhand smoke protection.

Intervention or response:
The overall annual budget of USD 915k is used cost-effectively and funds a small regional multidisciplinary team supporting the work of the localities providing expertise, strategic support, advocacy, mass media campaigns, coordinating practice sharing and industrializing system wide reform, and delivering work at scale on complex issues. The work is guided by international best practise and informed by national tobacco strategies including those from ASH UK, Department of Health and Public Health England.

Results and lessons learnt:
There has been a 41% reduction in the smoker population - the biggest regional decline in the last decade. A social movement has grown with high levels of public support for future regulation. Making tobacco control 'everyone's business' has been important and having a clear vision for the future vital to maintain funding commitment and focus. It is important to constantly reinforce the rationale for this investment from a health inequalities perspective and the strong return on investment tobacco control gives.

Conclusions and key recommendations:
Significant economies of scale have been achieved with high value for money. In the UK there is a need for effective tobacco action from the community grass roots level right up to the national and international stage. A similar approach is in place around alcohol denormalisation now through the regional programme "Balance" and the two programmes are working together with notable success.The North East England provides a useful model for others.