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 difficultin 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 deathsor
about one a weekfrom 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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