Memorandum from Action on Smoking and
Health (ASH) (WP 07)
INTRODUCTION
1. Action on Smoking and Health (ASH) generally
welcomes and supports the proposals in the White Paper on Public
Health.
2. In particular, we welcome the proposal
for legislation to end smoking in the great majority of workplaces
and enclosed public places. This has the potential to be the most
significant public health reform for many years, as it would both
protect non-smokers from the damaging effects of secondhand smoke
and encourage many smokers to quit. We consider this to be an
essential step if the Government wishes to achieve its public
health goals, and to represent excellent value for money in terms
of health gain in relation to public expenditure.
3. However, we have serious concerns about
the timescale for the proposed legislation and particularly about
the proposed exemptions for pubs that do not serve prepared food
and for private membership clubs. We believe that these exemptions
cannot be justified on health and safety grounds, would significantly
undermine the purpose of the legislation, and in particular would
sharply reduce the impact of the legislation on health inequalities.
4. In publishing the White Paper, Dr John
Reid committed the Government to spend "at least £1
billion in public health over the next three years." ASH
recommends that the Health Select Committee asks for an undertaking
that this £1 billion represents new spending exclusively
on public health, and that the Delivery Plan for the White Paper
to be fully costed, including a timetable of spending over this
three year period.
5. The remainder of this evidence sets out
our detailed comments on the White Paper proposals on secondhand
smoke, and also comments on other key issues in relation to tobacco
control. A summary of recommendations is given at the end of this
note.
January 2005
SUMMARY OF
PUBLIC HEALTH
GOALS IN
RELATION TO
SMOKING (Source: http://www.hm-treasury.gov.uk/media/4B9/FE/sr04_psa_ch3.pdf)
"1. Substantially reduce mortality
rates by 2010:
— from heart disease and stroke and
related diseases by at least 40% in people under 75,with at least
a 40% reduction in the inequalities gap between the fifth of areas
with the worst health and deprivation indicators and the population
as a whole;
— from cancer by at least 20% in people
under 75,with a reduction in the inequalities gap of at least
6% between the fifth of areas with the worst health and deprivation
indicators and the population as a whole . . .
2. Reduce health inequalities by 10% by
2010 as measured by infant mortality and life expectancy at birth.
3. Tackle the underlying determinants of
ill health and health inequalities by:
— reducing adult smoking rates to 21%
or less by 2010, with a reduction in prevalence among routine
and manual groups to 26% or less . . ."
SMOKING IN
WORKPLACES AND
PUBLIC PLACES
4. Paragraphs 8 and 9 of the Regulatory
Impact Assessment, published with the White Paper, estimate that
ending smoking in all workplaces and enclosed public places would
reduce overall smoking prevalence rates by 1.7%. 0.7% of this
effect is estimated to result from the direct effect of ending
smoking in employees' own place of work, and 1% from more places
outside smokers' own place of work going smoke free. This is by
far the simplest and most cost effective step the Government could
take to achieve its public health targets in relation to smoking.
Without it, these targets will not be achieved.
5. However, the Government's proposal to
exempt some pubs and membership clubs from new legislation on
smoking in workplaces and enclosed public places threatens to
undermine key objectives of the White Paper—to reduce smoking
prevalence rates and tackle health inequalities.
6. The White Paper makes the following statement
about health risks associated with secondhand smoke: "The
evidence of risk to health from exposure to second-hand smoke
points towards an excess number of deaths, although debate on
the precise scale of the impact continues. The consultation demonstrated
clear concerns about both the health impact and discomfort felt
by many in smoke-filled environments, with particular concerns
about locations such as work places, where people may not have
been able to choose to be in a smoke-free environment."
7. This is an unhelpful formulation of a
serious health and safety issue. The wording is both vague (for
example, the evidence "points towards" excess deaths)
and subjective (for example, there are "concerns" about
health impacts). It is particularly unhelpful that the White Paper
states that "debate on the precise scale of the impact continues".
This debate will of course continue indefinitely, because the
tobacco industry and its front groups have a powerful vested interest
in ensuring that it does.
8. The evidence of risk to health, and to
a significant number of excess deaths, is in fact clear and overwhelming,
and is well summarised in the report of the Government's Scientific
Committee on Tobacco and Health (SCOTH) published at the same
time as the White Paper, and in paragraphs 5 to 9 of the Partial
Regulatory Impact Assessment (RIA), published with the White Paper.
9. SCOTH's conclusions as to risk should
have been quoted in the White Paper—specifically the conclusions
in paragraphs 2 and 3 of the report:
— Paragraph 2 states that: "SCOTH
concludes that there is an estimated overall 24% increased risk
of lung cancer in non-smokers exposed to SHS"
— Paragraph 3 states that: "SCOTH
therefore concludes that SHS causes heart disease and that the
best estimate of increased relative risk of heart disease in non-smokers
exposed to SHS remains at about 25%.
Paragraph 6 of the SCOTH report concludes
that "it is evident that no infant, child or adult should
be exposed to SHS. This update confirms that SHS represents a
substantial public health hazard".
10. Nowhere in the White Paper is there
any estimate of the numbers of employees exposed to secondhand
smoke at work. Yet this estimate is relatively easy to make, and
some of the essential statistics are given in paragraph 8 of the
RIA. With support from the Office of National Statistics, and
using data from the Government's Labour Force Survey for 2003
and the National Statistics Omnibus Survey smoking-related behaviour
and attitudes module carried out in October and November 2003,
ASH has calculated that:
— 2,182,000 people work in places with
"no restrictions on smoking at all". This is 8% of those
in work in Great Britain
— 10,366,000 people work in places
where smoking takes place in "designated areas". This
is 38% of those in work.
11. Using risk factors virtually identical
to those in the SCOTH report, Professor Konrad Jamrozik, formerly
of Imperial College London, estimated in May 2004 that secondhand
smoke in the workplace generally causes about 700 deaths each
year in the UK[22].
For comparison, the total number of fatal accidents at work from
all causes in the UK in 2002-03 was reported by the Health and
Safety Executive as 226[23].
The evidence therefore supports an objective assessment (and not
just a subjective reporting of "concerns") that secondhand
smoke is a large workplace health and safety risk. This is by
far the most important argument justifying legislative action
on secondhand smoke, and it is remarkable that the White Paper
entirely fails to make it.
12. Nowhere in the White Paper is there
any mention of specific occupational groups who are likely to
be particularly exposed to secondhand smoke at work. Yet paragraph
5 of the SCOTH report states that "some groups, for example
bar staff, are heavily exposed at their place of work".
ASH therefore recommends that:
— the Government should make a clear
public statement accepting the assessment of health risks from
secondhand smoke set out in the SCOTH report, including SCOTH's
statement in relation to bar workers, and stating explicitly that
secondhand smoke is a serious workplace health and safety risk;
— this statement should form the basis
of information prepared for employers and others in the run-up
to legislation;
— the Government should publish its
best estimate of the number of people (a) regularly and (b) occasionally
exposed to secondhand smoke in the workplace; and
— the Government should refer the conclusions
of the SCOTH report to the UK Committee on Carcinogens and ask
it to assess whether secondhand smoke is a workplace carcinogen
13. Chapter 4, paragraph 76 of the White
Paper states that: "we propose to regulate, with legislation
where necessary, in order to ensure that:
— All enclosed public places and workplaces
(other than licensed premises . . .) will be smoke free;
— Licensed premises will be treated
as follows:
— all restaurants will
be smoke-free
— all pubs and bars
preparing and serving food will be smoke-free
— other pubs and bars
will be free to choose whether to allow smoking or to be smoke-free
— in membership clubs
the members will be free to choose whether to allow smoking or
to be smoke-free
— smoking in the bar
area will be prohibited everywhere."
14. This proposal is poorly drafted, confused,
probably unworkable and certainly undesirable. It is poorly drafted
because the words "regulate, with legislation where necessary"
leaves open the possibility of a return to the failed `voluntary
approach' in respect of smoking in pubs and bars. This will simply
encourage the most backward elements in the pub trade to try to
push the Government backwards from the White Paper proposal, to
something closer to the failed "Public Places Charter",
introduced the last time a Labour Government backed away from
effective action on this issue.
15. The proposal is confused because there
is no useful line to be drawn between pubs which "prepare
and serve food" and those which do not. From their public
statements, Ministers appear to have only the vaguest idea how
many pubs do not serve prepared food and no idea at all where
such pubs are concentrated. It is also evident that no clear definition
of prepared food was arrived at before the White Paper was produced.
16. Chapter 4, paragraph 79 of the White
Paper suggests that between 10% and 30% of pubs will be exempted.
There are about 55,000 pubs across the country, so this exemption
may cover anything between 5,500 and 16,500 establishments.
17. Private clubs not admitting children
could also be exempt, following a vote of members. There are 19,913
registered clubs—clubs owned by the members—in England
and Wales (Source: Department for Culture, Media and Sport Statistical
Bulletin Liquor Licensing, England and Wales, July 2003-June 2004).
18. Common sense suggests that many exempt
pubs will be in poorer communities. These communities will have
higher than average smoking prevalence rates, and will be suffering
from the sharp health inequalities that the class distribution
of smoking brings. Many membership clubs—for example Labour
Clubs—will also be in such communities. Research undertaken
by Northamptonshire Primary Care Trust and local authorities in
the country shows that 54% of pubs and bars in Northamptonshire
serve only drinks and would be exempt from the controls on smoking
in public places. In the borough of Corby, an area where mortality
rates are significantly higher than the national average, 85%
of pubs and bars would be exempt (source: Northampton PCT,
research published 24 January 2005).
19. Chapter 4, paragraph 77 of the White
Paper notes the risk that some pubs may cease to serve prepared
food in order to qualify as premises that can continue to permit
smoking. This fear is dismissed with the words "we believe
that the profitability of serving food will be sufficient to outweigh
any perverse incentive for pub owners to choose to switch".
This assertion has been contradicted by senior figures in the
pub trade, for example, Tim Clarke, chief executive of restaurant
and pubs group Mitchells & Butlers has warned that: "the
enforced specialisation between food and smoking risks commercially
incentivising more pubs than the White Paper currently anticipates
to remove food and retaining smoking throughout."[24]
20. The proposal to prohibit smoking in
the "bar area" of exempted pubs would fail to provide
adequate protection for employees or members of the public. Smoke
drifts. Most pubs currently have any separated smoking and non-smoking
areas in the same open space. Ventilation systems are expensive,
hard to maintain, and as even Philip Morris has admitted, do not
provide good protection from the health effects of secondhand
smoke. ("While not shown to address the health effects of
secondhand smoke, ventilation can help improve the air quality").[25]
21. Chapter 4, paragraph 77 of the White
Paper states that the Government intends to "consult widely"
on, inter alia. "the special arrangement needed for
regulating smoking in certain establishments—such as hospices,
prisons and long stay residential care". It is notable that
this list does not included exempted pubs and clubs. Nowhere in
the White Paper is there any commitment even to consider minimum
health and safety standards for such premises. This is unacceptable.
22. Any attempt to exempt a category of
workplaces from smokefree legislation would be subject to legal
challenge. The date of "guilty knowledge" under the
Health and Safety at Work Act 1974 (HSWA) has now passed in relation
to secondhand smoke. The evidence, not least from the two SCOTH
reports (1998 and 2004), is now sufficiently strong and sufficiently
well known for any employer to be expected by the courts to know
of the risks associated with exposure to secondhand smoke. Therefore,
employees made ill by such exposure in the workplace will have
a case for damages against their employer, claiming negligence
and citing a breach of the HSWA as evidence. This would remain
possible in respect of any premises exempted from a general prohibition
on smoking. ASH has been working with the UK's largest personal
injury and trade union law firm, Thompson's, to identify such
cases, which will begin to reach the courts early in 2005.
ASH therefore recommends that:
— the Government should assess the
impact on health inequalities of the proposed exemptions, and
publish the results of this assessment;
— the Government should assess the
impact of exempting pubs which do not serve prepared food on "binge
drinking" and its wider alcohol strategy. It should consult
with Alcohol Concern and other expert groups on this issue; and
— the Government should consult health
and safety experts on whether proposal to restrict smoking in
the "bar area" of exempted pubs would provide satisfactory
protection for staff and members of the public.
23. The Government has yet to announce its
intentions in relation to Wales, where a Committee of the National
Assembly is due to report in May 2005 on the issue of secondhand
smoke, and in relation to Northern Ireland, where all the major
Parties from Sinn Fein to the Democratic Unionists have made public
statements in support of smokefree legislation.
ASH therefore recommends that:
— the Government should make a clear
statement of intent in relation to Wales and Northern Ireland,
giving the National Assembly in Wales powers to introduce comprehensive
smokefree legislation and introducing such legislation directly
in Northern Ireland.
24. Chapter 4, paragraph 77 of the White
Paper sets a relatively long time-table to implement smoking restrictions,
as follows:
— by the end of 2006, all government
departments and the NHS will be smoke-free;
— by the end of 2007, all enclosed
public places and workplaces, other than licensed premises (and
those specifically exempted) will, subject to legislation, be
smoke-free;
— by the end of 2008 arrangements for
licensed premises will be in place.
ASH believes that this timescale—around
18 months longer than is proposed in Scotland—is too long
and arises mainly from the excessive complexity of the proposed
legislation. A simple piece of legislation ending smoking in all
workplaces would be easier and quicker to introduce, as well as
being subsequently easier to publicise and enforce.
25. The RIA gives no assessment of the reduction
in prevalence rates that would be achieved if the Government's
proposed exemptions were adopted, however it does assess the health
benefits to non-employees ("customers") of this option
as worth £150 million a year, as opposed to £350 million
for the full ban. In total, the RIA assesses the net benefits
of a full ban at £1,344 to £1,754 million a year, compared
to £998 to £1,486 million for the Government's preferred
option.
26. Dr Reid and ministerial colleagues have
sometimes suggested that the reason for the proposed exemptions
is to prevent displacement of smoking from workplaces and public
places to the home. A Parliamentary answer dated Monday 24 January
from Public Health Minister Melanie Johnson, to a series of Written
Questions on this point from David Taylor MP, shows that the Government
has no research evidence to back this assertion. Evidence from
other countries and jurisdictions that have introduced workplace
smoking bans suggests that this concern is in fact groundless.
ASH therefore recommends that:
— Ministers should not raise unfounded
concerns about displacement of smoking from workplaces to homes
as a result of comprehensive smokefree legislation
headline=smoking-ban-threat-to-food-in-smaller-pubs-name_page.html
— the Government should reconsider
its proposed exemptions, and opt for the simplest and most effective
legislative option—all workplaces and enclosed public places
should be smokefree.
TOBACCO AND
NICOTINE REGULATION
AND HARM
REDUCTION
27. Even if the Government achieves its
PSA targets in relation to smoking, around one in five of the
adult population will still smoke, and smoking will remain a leading
cause of preventable death. As smoking prevalence rates fall,
it must be assumed that remaining smokers are particularly resistant
to the standard policy levers. Therefore, the Government should
consider developing a harm reduction strategy in relation to remaining
smokers and nicotine users. Although this is a complex matter,
an effective harm reduction strategy has the potential to achieve
major advances in public health. ASH believes it to be the essential
next step in tobacco control policy, once legislation on secondhand
smoke is in place.
28. The public health goal in relation to
smoking tobacco must be to reduce the death and disease it causes.
It is not simply to reduce tobacco or nicotine consumption as
an end in itself. Nicotine is an addictive drug in precisely the
same sense as are many illegal drugs, such as heroin and cocaine.
Harm reduction strategies are an important part of work to cut
the damage cause by illegal drugs; the same principle now needs
to be applied to nicotine. Not all nicotine addicts will readily
or quickly succeed in breaking their addiction, but all can be
helped to stop consuming their drug by the dangerous and damaging
means of smoking cigarettes.
29. There is now substantial experience
with medicinal nicotine. It is at least 100 times less risky than
smoked tobacco, and has only relatively minor negative effects
on health. However, medicinal nicotine is currently only available
as an aid to giving up smoking.
30. New products are therefore needed to
give people access to clean forms of nicotine in a form and at
a price that is attractive as an alternative to smoking. To achieve
this revision of the current regulatory system is required. This
is because less harmful nicotine products competitive with cigarettes
are currently either not licensed for use in this country or are
not being developed. Even if they were developed, they could not
be promoted, because of regulatory obstacles.
31. The Royal College of Physicians, ASH
and others have called for a new regulatory body to ensure uniform
regulation of all products containing nicotine, based on harm
reduction principles. However, we recognise that there may be
alternatives to an entirely new body and would welcome the opportunity
to work with the Department of Health to develop a strategy for
this area.
32. Chapter 8, paragraph 8 of the White
Paper states that the Government does not "think there is
a case for setting up a brand new UK agency to regulate tobacco",
although it gives no reasons for this conclusion. Paragraph 8
also states that the Government does "recognise the need
for more work to look at how best to regulate tobacco products"
and that it intends to "develop a strategy for taking this
work forward".
33. We would suggest a three stage approach.
First, the Government should consult on the principles of harm
reduction in relation to tobacco and nicotine products. Secondly,
it should consult on the appropriate body or bodies to regulate
nicotine products, including tobacco, in accordance with harm
reduction principles. Thirdly, it should implement the necessary
legislative and regulatory changes, as recommended by this body
or bodies. We anticipate that this process could take between
four to five years.
ASH therefore recommends that:
— the Government should commit itself
to developing a harm reduction strategy in relation to nicotine,
and publish a timetable for consultation and consequent decisions.
TOBACCO CONTROL
STRATEGY
34. ASH welcomes the White Paper's recognition
that public health needs to be given priority at Cabinet level
and that the "Secretary of State for Health will co-ordinate
action through the new Cabinet Sub Committee, set up to oversee
the development and implementation of the Government's policies
to improve public health and reduce health inequalities."
(p 177 para 12)
35. However, there is a need for a specific
planning mechanism to help oversee the development of the new
tobacco strategy and ensure that it is properly evaluated, revised
and updated on a regular basis.
36. Such a mechanism is also necessary to
conform to the guiding principles of the Framework Convention
on Tobacco Control (FCTC) which the UK has now ratified. Under
Article 5 of the FCTC there is a general obligation to: "develop,
implement, periodically update and review comprehensive multisectoral
national tobacco control strategies, plans and programmes in accordance
with this Convention and the protocols to which it is a Party".
37. Therefore one priority project should
be setting up a Tobacco Advisory Group (TAG), with membership
both from Government and civil society meeting regularly. The
current Scientific Committee on Tobacco and Health (SCOTH) should
be established as a technical subgroup to the TAG.
38. This group should oversee implementation
of the DH's six-pronged strategy which includes :
(1) Social marketing to encourage cessation
and denormalise smoking.
(2) Building cessation services and
strengthening local and regional action.
(3) Reducing supply and availability
of tobacco.
(4) Enforcing the advertising ban and
reducing tobacco promotion.
(5) Regulating tobacco.
(6) Reducing exposure to secondhand
smoke.
39. In addition, there is a need for information
and intelligence to inform effective implementation and development
of the strategy. We are pleased to see that the Government plans
to establish "a Health Information and Intelligence Task
Force to lead action to develop and implement a comprehensive
public health information and intelligence strategy." (p
191 para 24).
40. Public health information and intelligence
on tobacco consumption and its impact is better developed than
most areas of public health information. However, there are areas
which can be improved. Key information on the tobacco industry
should be collected and published as part of the strategy including:
— An annual report on the tobacco market
should be published. This should detail its structure, price variations
within categories, calculated price-elasticities, consumption
patterns by socio-economic group, ethnicity, age, sex and other
demographics, market share by brand, etc.
— A smoking module, covering knowledge,
attitudes and behaviour, should be incorporated in the ONS Omnibus
survey every month. The results should be made widely available,
in order to be able to, for example, monitor the impact of media
campaigns or price changes on smoking prevalence.
— Existing data relating tobacco price
and smoking, particularly of smuggled product, are inadequate
to determine effects on consumption and cessation. New ways of
studying this important policy issue need to be found.
— A longitudinal panel survey should
be established specifically to monitor smoking behaviour and its
response to policy initiatives.
41. ASH is concerned that there is no commitment
in the White Paper to specific funding for long-term social marketing
mass media and public education campaigns. This is needed to motivate
and encourage quitting and "denormalise" smoking. Such
campaigns will be crucial, for example, in ensuring effective
implementation of smokefree workplaces.
42. A comprehensive review and analysis
of the effectiveness of the public education campaigns over the
last five years is needed, to ensure that future spend is set
at optimal levels and that messages are sharply defined and effectively
delivered.
43. ASH has serious concerns that repeated
cuts to central DH staffing, particularly among staff working
on tobacco control, has left the Department's central resources
dangerously stretched. This may make implementation of the White
Paper proposals, particularly legislation on secondhand smoke,
more difficult and potentially less effective.
ASH therefore recommends that:
— the Government should establish a
Tobacco Advisory Group to include experts from Government and
civil society to oversee development of the tobacco control strategy;
— the Government should review and
improve the collection of key data in relation to tobacco consumption;
— the Government should commit itself
to continuing long-term mass media and public education campaigns
to reduce tobacco consumption, based on comprehensive evaluation
of the effectiveness of previous campaigns; and
— the Department of Health should review
staffing levels in relation to tobacco control and ensure that
they are sufficient to introduce the White Paper proposals and
maximise the consequent public health benefits.
STOP SMOKING
SERVICES
44. The Government's support for Stop Smoking
Services through the NHS has been a very important step forwards
in tobacco control. This is rightly noted in the White Paper.
Chapter 2, paragraph 15 states that the government will continue
with its campaign to: "reduce smoking rates and motivate
smokers in different groups to quit supported by clear and comprehensive
information about health risks, reasons not to smoke, and access
to NHS support to quit, including Stop Smoking Services and nicotine
replacement therapy".
45. However, there remains a need to continue
to improve Stop Smoking Services, and particularly to develop
the performance indicators these services are required to meet.
Chapter 6, paragraph 51, of the White Paper states that: "In
2005-07, the Healthcare Commission will examine what PCTs are
doing to reduce smoking prevalence among the local population,
including their own staff, through tobacco control campaigns,
championing smoke-free environments and provision of NHS stop
smoking services. Ongoing progress will be assessed against national
standards and indicators." In addition, the White Paper promises
that the Government will establish a taskforce to help increase
the effectiveness and efficiency of the NHS stop smoking services.
46. However, the White Paper does not meet
the criticism set out in the latest Wanless report and elsewhere
on in particular the four week quit targets, which potentially
give an exaggerated and misleading impression of success.
47. Smoking cessation also needs to be fully
integrated as a high priority into clinical guidelines for all
chronic diseases influenced by smoking in the community and in
secondary care. This should include cardiovascular disease, respiratory
disease, diabetes, and all others where smoking affects outcomes
significantly.
ASH therefore recommends that:
— the Government should reframe targets
for cessation services to cover both referrals and success rates
(both of which are routinely collected by the Department of Health);
and
— best practice guidelines should be
developed and widely implemented in order to bring the level of
the least successful services up to those of the most successful.
TAX AND
SMUGGLING
48. Chapter 8 of the White Paper, paragraph
6, states that: "The Government will continue to take tough
action on tobacco smuggling. Over the past two decades, establishing
and maintaining a high level of tax on cigarettes—as has
been the policy of successive governments—has been shown
to help reduce smoking prevalence. Cigarette duty was subject
to a sustained period of real-terms increases during the 1990s,
and has been held at the present high level in real terms since
2000-01. Compared to many other countries, the UK has high duties
on tobacco products and high-priced cigarettes.
However, an increase in the availability of
cheaper, illegally smuggled cigarettes and hand-rolling tobacco
has meant that some smokers have been able to by-pass higher prices,
undermining the impact of price on smoking prevalence rates and
meaning that further real increases in duty would be likely to
be of limited effectiveness."
49. ASH does not accept that smuggling constitutes
a reason to abandon a policy of rising taxation on tobacco products.
Smuggling is a criminal activity which should be prevented through
adequate enforcement. The UK Government should work to support
the development of a specific international protocol with binding
obligations on smuggling, to ensure that the Framework Convention
on Tobacco Control (FCTC) is fully effective once it comes into
force.
ASH therefore recommends that:
— the National Audit Office should
be asked to produce and publish a report by the end of 2004 on
the effectiveness of HM Customs and Excise's current tobacco smuggling
strategy and how it might be improved;
— the Government should ensure closer
co-ordination between Customs and Excise, the Treasury, the Department
of Health and local authority Trading Standards Officers to ensure
that action on smuggling and counterfeit cigarettes is a high
priority for all relevant Departments and agencies; and
— the Government should push for a
smuggling protocol to be on the agenda of the first Conference
of the Parties of the Framework Convention on Tobacco Control,
and start work within the EU to develop such a protocol.
CHILDREN AND
YOUNG PEOPLE
50. Chapter 3, paragraph 104 of the White
Paper states that: "We propose that legislation be brought
forward to create new powers to ban retailers from selling tobacco
products, on a temporary or permanent basis, if they repeatedly
flout the law. This complements the work already under way to
improve proof of age schemes. We intend to support this measure
by looking at higher fines and updated guidance for magistrates,
along with education for retailers on better compliance with they
the underage sales law. Before introducing these measures, we
will consult local authorities, the retail industry and other
key stakeholders. We will support this with a communications programme
for local authority enforcement."
51. ASH supports the need for firm action
against retailers who knowingly or negligently sell tobacco products
to minors. Current standards of enforcement vary widely between
local authorities and this is not desirable. However, it would
be an error to think that this measure will be the most effective
in stopping children from starting to smoke. Research shows that
most teenagers begin to smoke as a "rite of passage to adulthood".
It follows that discouraging adult smoking is likely to be the
best way of preventing young people from starting.
52. Chapter 2 of the White Paper also refers
to the need to protect children from tobacco promotion via film
& TV. The White Paper recognises that smoking in films and
TV programmes may influence young people to start smoking. Paragraph
65 states: "The British Board of Film Classification has
assured the Government that it does consider whether a film targeted
at children and young people is actively promoting smoking. The
Board's classification guidelines are currently under consideration
and one aspect of that review includes the public's attitude to
smoking in films with particular appeal to children and young
people, and the potential impact on their smoking behaviour."
ASH believes that classification guidelines should state explicitly
that the portrayal of smoking in films likely to be seen by children
and teenagers should not glamorise the activity and this will
be a relevant factor considered when the BBFC determines classifications.
53. Paragraph 66 of the White Paper notes
that "there seems to have been a reduction in the portrayal
of smoking on television in recent years". It refers to Ofcom's
consultation on the new broadcasting code which is due to come
into effect in 2005. The draft code contains rules about smoking
in the section entitled "protecting the under-18s".
Paragraph 67 states that: "The Government welcomes Ofcom's
consultation. In this consultation Ofcom has proposed tightening
the rules so that smoking would be prohibited in children's programmes,
unless there is a clear educational purpose, and in programmes
before the watershed, unless there is an editorial justification.
Ofcom is considering the wording of these rules and whether additional
rules may be required in the light of responses and evidence they
receive."
54. However, the Ofcom proposal fails to
mention the portrayal of smoking in programmes likely to be seen
by teenagers—the key group in this context—whether
before or after the watershed. Ofcom's proposals therefore need
revision and the Government should encourage this. Again, the
portrayal of smoking in such programmes should not glamorise the
activity.
ASH therefore recommends that:
— the Government should support including
the portrayal of smoking in films as a relevant factor in determining
classifications. It should also support the issuing of clear guidance
to TV producers about the portrayal of smoking in programmes likely
to be seen by teenagers.
SUMMARY OF
RECOMMENDATIONS
Introduction
— the Government should give an undertaking
that the £1 billion promised by the Health Secretary represents
new spending;
— the Delivery Plan for the White Paper
should be fully costed, including a timetable for spending over
a three to five year period.
Smoking in Workplaces and Public Places (paragraphs
5 to 26)
— the Government should make a clear
public statement accepting the assessment of health risks from
secondhand smoke set out in the SCOTH report, including SCOTH's
statement in relation to bar workers, and stating explicitly that
secondhand smoke is a serious workplace health and safety risk;
— this statement should form the basis
of information prepared for employers and others in the run-up
to legislation;
— the Government should publish its
best estimate of the number of people (a) regularly and (b) occasionally
exposed to secondhand smoke in the workplace; and
— the Government should refer the conclusions
of the SCOTH report to the UK Committee on Carcinogens and ask
it to assess whether secondhand smoke is a workplace carcinogen;
— the Government should assess the
impact on health inequalities of the proposed exemptions, and
publish the results of this assessment;
— the Government should assess the
impact of exempting pubs which do not serve prepared food on "binge
drinking" and its wider alcohol strategy. It should consult
with Alcohol Concern and other expert groups on this issue;
— the Government should consult health
and safety experts on whether proposals to restrict smoking in
the "bar area" of exempted pubs would provide satisfactory
protection for staff and members of the public;
— the Government should make a clear
statement of intent in relation to Wales and Northern Ireland,
giving the National Assembly in Wales powers to introduce comprehensive
smokefree legislation and introducing such legislation directly
in Northern Ireland;
— Ministers should not raise unfounded
concerns about displacement of smoking from workplaces to homes
as a result of comprehensive smokefree legislation; and
— the Government should reconsider
its proposed exemptions, and opt for the simplest and most effective
legislative option—all workplaces and enclosed public places
should be smokefree.
Tobacco and Nicotine Regulation and Harm Reduction
(paras 28-34)
— the Government should commit itself
to developing a harm reduction strategy in relation to nicotine,
and publish a timetable for consultation and consequent decisions.
Tobacco strategy (paras 35-44)
— the Government should establish a
Tobacco Advisory Group to include experts from Government and
civil society to oversee development of the tobacco control strategy
— the Government should review and
improve the collection of key data in relation to tobacco consumption
— the Government should commit itself
to continuing long-term mass media and public education campaigns
to reduce tobacco consumption, based on comprehensive evaluation
of the effectiveness of previous campaigns
— the Department of Health should review
staffing levels in relation to tobacco control and ensure that
they are sufficient to introduce the White Paper proposals and
maximise the consequent public health benefits.
Stop smoking services (paras 45-48)
— the Government should reframe targets
for cessation services to cover both referrals and success rates;
— best practice guidelines should be
developed and widely implemented In order to bring the level of
the least successful services up to those of the most successful.
Tax and smuggling (paras 49-50)
— the National Audit Office should
be asked to produce and publish a report by the end of 2004 on
the effectiveness of HM Customs and Excise's current tobacco smuggling
strategy and how it might be improved.
— the Government should ensure closer
co-ordination between Customs and Excise, the Treasury, the Department
of Health and local authority Trading Standards Officers to ensure
that action on smuggling and counterfeit cigarettes is a high
priority for all relevant Departments and agencies
— the Government should push for a
smuggling protocol to be on the agenda of the first Conference
of the Parties of the Framework Convention on Tobacco Control,
and start work within the EU to develop such a protocol.
Children and young people (paras 51-55)
— the Government should support including
the portrayal of smoking in films as a relevant factor in determining
classifications. It should also support the issuing of clear guidance
to TV producers about the portrayal of smoking in programmes likely
to be seen by teenagers.
22 http://www.rcplondon.ac.uk/news/news.asp?PR_id=216 Back
23
http://www.hse.gov.uk/press/2003/c03065.htm Back
24
http://icbirmingham.icnetwork.co.uk/0150business/0200news/tm
objectid=14936209&method=full&siteid=50002& Back
25
http://www.philipmorrisusa.com/en/policies_practices/public_place_smoking.asp Back
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