Select Committee on Health Written Evidence


Memorandum by the British Lung Foundation (WP 30)

  The following evidence is submitted to the Health Select Committee, from the British Lung Foundation (BLF), for the inquiry into the Government's Public Health White Paper.

  The BLF welcomes this inquiry by the Health Select Committee and the recognition of the serious public health issues it addresses.

  Using the Committee's terms of reference as a structure, we have concentrated our remarks to the issue of Smoking, where we feel we can most effectively contribute to the debate. We would be delighted to supply additional information, or clarification on any of the points raised in our response at a later stage.

1.  BACKGROUND

  1.1  The British Lung Foundation (BLF) is the only charity working to help the eight million people in the UK with all lung conditions.

  1.2  The BLF runs a network of support groups across the country for people living with lung disease. There are more than 120 Breathe Easy Groups across the UK, all run by patients to support patients.

  1.3  The BLF provides a wide range of information on all 43 lung conditions, in the form of leaflets and fact sheets, all of which can be accessed via our website (www.lunguk.org).

  1.4  The BLF also funds medical research with the aim of finding solutions to lung diseases.

2.  WILL THE PROPOSALS IN THE WHITE PAPER ENABLE THE GOVERNMENT TO ACHIEVE ITS PUBLIC HEALTH GOALS?

  2.1  The BLF welcomes the restrictions on smoking in public places announced in the public health white paper as these do represent real progress on this issue, however, we feel they do not go far enough and will therefore fall short of achieving the Government's public health goals. We will discuss these in more detail in section three.

  2.2  We support the additional focus on smoking cessation services, and helping people to quit. We feel that this is the most important element of any comprehensive package to reduce the burden of smoking related disease. Many smokers find giving up incredibly difficult—in February 2000, the Royal College of Physicians published a report on nicotine addiction which concluded that "Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine." [74]The BLF believes it is vital that the NHS leads the way in providing effective support to quitters in the most appropriate settings and at the most convenient times.

  2.3  We welcome the renewed investment in public health advertising campaigns to encourage people to stop smoking. The Department of Health is using different messages and different mediums to reach a wide audience and we fully support this approach.

  2.4  We approve of the strengthening of regulations surrounding the promotion and sale of tobacco products and fully support the use of visual warnings on pack and a clamp-down on underage sales. Evidence suggests that if you can prevent people from smoking until they reach the age of 20 it is very unlikely they will ever start. It is vital to provide support to young people to prevent them from smoking in the first place, or to support them to quit if they do start. There is a need for more smoking cessation support aimed specifically at teenagers.

  2.5  We are concerned about the levels of tobacco smuggling in the UK and welcome the plans to reduce this outlined in the white paper.

3.  ARE THE PROPOSALS APPROPRIATE, WILL THEY BE EFFECTIVE AND WILL THEY REPRESENT VALUE FOR MONEY?

  3.1  On the issue of smoking in enclosed public places, restrictions have been announced which make provision for all NHS premises to be smoke free by 2006, all enclosed public places, excluding licensed premises, by 2007 and all licensed premises which serve food by 2008. We are concerned about the delay in implementing these proposals. We believe restrictions should be implemented much sooner to provide staff, and members of the public alike, with protection from the damaging health risks associated with Secondhand tobacco smoke.

  3.2  It is our fear that the "compromise" measures of allowing smoking to continue in pubs and bars which do not serve food will only serve to increase the health inequalities gap that the Government has been trying to reduce. Initial data from research currently being conducted suggests that the majority of these so-called "wet pubs" are situated in the most deprived wards in the country, where smoking prevalence, and therefore the rate of smoking related disease, is significantly higher.

  3.3  Following on from 3.2, it is not clear what definitions the Government will use to distinguish between pubs and bars preparing and serving food, where smoking will be prohibited, and those where smoking will be allowed. There is no indication in the white paper as to how the distinction will be measured, what procedures will need to be put in place to implement such a two-tier policy and what additional cost this will incur. It is fairly obvious though, that this approach will be more complicated and expensive to enforce than an all inclusive comprehensive ban.

  3.4  The report from the Government's own Scientific Committee on Tobacco and Health (SCOTH), published on the same day as the Choosing Health? white paper, identifies bar workers as the most at risk from the negative health effects of secondhand smoke. Professor Konrad Jamrozik, formerly of Imperial College London, estimated that exposure to secondhand smoke at work leads to approximately 700 deaths from lung cancer, heart disease and stroke combined, he also estimates 49 deaths—or about one a week—from exposure at work in the hospitality trades. Therefore, we are concerned that the Government is failing to protect the health of workers in those pubs and bars which do not serve food.

  3.5  The white paper makes provision for smoking to be prohibited around the bar area in all licensed establishments, however, it is not possible to stop smoke spreading from one area to another and therefore this will not be an effective way of reducing the health risk faced by bar workers in pubs where smoking continues. Evidence collated in Seattle, USA, in 2003 shows that air conditioning and filtering does not provide the complete protection needed. "Using current indoor air quality standards, ventilation rates would have to be increased more than a thousand-fold to reduce cancer risk associated with secondhand tobacco smoke to a level considered acceptable to federal regulatory agencies. Such a ventilation rate is impractical since it would result in a virtual windstorm indoors." [75]In managing workplace secondhand tobacco smoke risks, smoking policies such as separating smokers from non-smokers in the same space or on the same ventilation system expose non-smokers to unacceptable risk. [76]

  3.6  There would be no additional financial burden on the Government from the introduction of comprehensive smoke free legislation. Indeed evidence quoted by the CMO, in his 2003 annual report, demonstrates that a policy of creating smoke-free workplaces and public places would yield an overall net benefit to society of £2.3 billion to £2.7 billion annually, equivalent to treating 1.3-1.5 million hospital waiting list patients. [77]In addition to this, evidence from around the world, where such measures are in place, suggests that till receipts within the hospitality industry have actually increased since the introduction of the legislation.

  3.7  Again, taking evidence from around the world, where legislation has been introduced, it is clear that comprehensive laws banning smoking in all enclosed workplaces actually help reduce the smoking prevalence rate and the overall consumption of cigarettes among smokers. A survey by the national Quitline service in Ireland has revealed that around 10,000 smokers report that they have reduced their consumption since the ban came into force and according to the Irish Revenue Commissioners, sales of cigarettes fell almost 16% in the first six months of 2004. [78]This reduction in smoking would have a positive impact on the morbidity and mortality statistics for smoking related diseases and would certainly reduce the financial burden that these diseases place on the NHS.

4.  WHETHER THE NECESSARY PUBLIC HEALTH INFRASTRUCTURE AND MECHANISMS EXIST TO ENSURE THAT PROPOSALS WILL BE IMPLEMENTED AND GOALS ACHIEVED

  4.1  The British Lung Foundation has been concerned for some time about the long term funding for smoking cessation services. Many services are given initial funding to start up but do not have secure guaranteed funding to ensure the services can continue. We hope that the commitment in the White Paper to expand smoking cessation services will resolve this situation. We will be monitoring it closely as we feel it is vitally important that appropriate support to help people stop smoking is at the centre of any moves to reduce smoking prevalence in the country.

January 2005










74   Nicotine Addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians, February 2000. http://www.rcplondon.ac.uk/pubs/books/nicotine/index.htm. Back

75   Repace, J, "Smoking in the workplace: ventilation. In: Smoking Policy: Questions and Answers, No 5," Seattle: Smoking Policy Institute, [nd]; Repace, J, "An air quality survey of respirable particles and particulate carcinogens in Delaware hospitality venues before and after a smoking ban," Bowie, MD: Repace Associates, Inc, 7 February 2003. Back

76   Repace, JL, "Risk management of passive smoking at work and at home," St Louis University Public Law Review 8(2); 763-785, 1994. Back

77   http://www.dh.gov.uk/assetRoot/04/08/66/57/04086657.pdf. Back

78   www.ash.org.uk-Impact of smoke-free legislation in Ireland. Back


 
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