Memorandum by The Roy Castle Lung Cancer
Foundation (WP 54)
The Roy Castle Lung Cancer Foundation is the
only lung cancer charity in the UK wholly dedicated to defeating
lung cancer through smoking prevention, research and patient care.
There is a direct link between lung cancer and both smoking and
exposure to second hand smoke. This is an issue of vital importance
to lung cancer patients and their families who suffer the devastating
consequences of this disease. For this reason, although the White
Paper is a detailed document looking at many areas of public health,
this response deals only with the tobacco-related elements of
the White Paper and our response takes into account the views
the Foundation's many patient and carer contacts.
The Foundation welcome the Health Select Committee's
Inquiry into the Government's White Paper on Public Health and
is pleased to submit the following written evidence.
Will the proposals enable the Government to achieve
its public health goals?
1. We congratulate the Government on several
of the White Paper's proposals including the establishing of a
task force to help increase the effectiveness and efficiency of
the NHS stop smoking services and the proposal for most workplaces
to be free of second hand tobacco smoke.
2. Continued improvement of Stop Smoking
Services is needed; the White Paper promises that the Government
will establish a taskforce to help increase the effectiveness
and efficiency of the NHS stop smoking services. The Foundation
welcomes this and, as a provider of one of the successful smoking
cessation services, feels that they have a valuable contribution
to make to this task group.
3. The Government should seize this opportunity
to extend the proposals to impose a complete ban in all workplaces,
including pubs and private clubs, thus saving even more lives.
The Roy Castle Lung Cancer Foundation do not believe that it can
be acceptable for a worker in a non food pub or private members
club to suffer the damaging effects of second hand tobacco smoke.
The evidence on the harmful effects of second hand smoke is undisputable
and we note the comments of the Chief Medical Officer to this
effect. We also note that the report of the Scientific Committee
on Tobacco and Health, whose report was published with the White
Paper, identified bar workers as the occupational group at most
risk from other people's smoke. It is clear that it is often the
case that people do not have a choice about where they work and
employees in exempted premises would therefore be exposed against
their will and they will continue to suffer the same health inequalities.
4. The Roy Castle Lung Cancer Foundation
are concerned that a White Paper with the stated aim of reducing
health inequalities could actually contribute to widening health
inequalities by exempting a vulnerable group of employees from
protection from second hand smoke in their workplace.
5. Public opinion supports a total ban on
smoking in the workplace as does the evidence contained in the
Government's own Scientific Committee on Tobacco & Health
(SCOTH) report.
Are the proposals appropriate, effective and do
they represent value for money?
6. Failure to act on the conclusions of
the report the Government commissioned from the Scientific Committee
on Tobacco & Health (SCOTH), which was published at the same
time as the White Paper, must be considered inappropriate.
7. The proposal to prohibit smoking in the
"bar area" of exempted pubs cannot provide adequate
protection for employees or members of the public. Smoke cannot
be confined to one area of a pub. Ventilation systems are expensive
and at best only partly effective. A comprehensive end to smoking
in all workplaces and enclosed public places would be simpler,
cheaper and more effective.
8. It is often claimed by the tobacco industry
that ventilation will remove the effects of secondhand smoke from
work and public places. However, it is interesting to note that
the tobacco companies who endorse ventilation systems have issued
disclaimers about such systems having any ability to address the
health effects of secondhand smoking. Tobacco companies have a
vested interest in maintaining and promoting smoking in public
places as it has been shown that effective smoke free policies
in public places can reduce smoking prevalence by up to 4%[103].
9. Everyday at least three million workers
in the UK, unwillingly, become secondhand smokers. Secondhand
smoke causes or exacerbates a wide range of adverse health effects,
including cancer, a range of respiratory diseases, including asthma,
and heart disease. Shockingly, it is estimated that one employee
in the hospitality industry dies every week from the effects of
secondhand smoke[104].
There are no safe levels of exposure to secondhand smoke.
10. Ventilation is not effective. Tobacco
smoke is a toxic mix of over 4,000 chemicals including over 50
cancer-causing agents[105].
Ventilation may remove the smell of tobacco smoke but it does
not eliminate all the cancer-causing particles and gases from
the air. Just because the air is not visibly smoky does not mean
it is safe. In the case of separate smoking areas with discrete
ventilation systems, pollution levels may be slightly reduced
but tobacco smoke drifts and therefore staff and customers will
still have no choice but to breathe secondhand smoke[106].
For ventilation to have any significant effect, it would need
to be "tornado strength". The scientific evidence is
strong and robust: Ventilation systems cannot eliminate the risk
of disease or death from secondhand tobacco smoke[107].
11. Ventilation systems cost tens of thousands
of pounds but do nothing to guard against the real health dangers
of secondhand smoke. Furthermore, the cost of maintaining and
cleaning systems is such that reports have shown that many proprietors
leave their ventilation systems switched off, as they find the
running costs too high[108].
Poorly maintained ventilation systems are even less likely to
be an effective means of reducing the effects of secondhand smoke[109].
Recent research in venues in Sydney, Australia, shows that designated
"no-smoking" areas in the hospitality industry provide
at best partial protection and at worst no protection at all against
the damaging effects of secondhand smoke. [110]As
all environmental health practitioners are aware, in any risk
reduction hierarchy, ventilation, whether general background or
local exhaust ventilation are techniques of last resort.
12. The tobacco industry and its lobby organisations
(particularly FOREST) advocate "ventilation solutions"
as a "reasonable" alternative to the establishment of
smoke free work and public places. They fully understand that
smoke free environments reduce the consumption of cigarettes and
they therefore have a vested interest in maintaining the smoking
status quo. They seek to mislead the public by maintaining that
ventilation systems effectively address the issue of secondhand
smoke. And yet, Philip Morris the largest tobacco company in the
world admits on it's website that ventilation systems have ".
. . not been shown to address the health effects of secondhand
smoke." [111]
13. There are many pubs which may be covered
by the proposed exemptions, will be in poorer communities. These
communities will have higher than average smoking prevalence rates
and largely as a result will be at the wrong end of sharp health
inequalities.
Does the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
14. The White Paper proposals give no clear
definition for "pubs that serve food", it seems that
they would be extremely difficult to enforce and it is clear that
many loopholes will be found.
15. The proposals need to be amended to
include legislation to make all workplaces smoke free including
those pubs which do not serve food in order that reductions in
health inequalities can continue to be made.
RECOMMENDATIONS FOR
ACTION
16. The Roy Castle Lung Cancer Foundation
requests that the committee encourage the Government to legislate
to prohibit smoking in all workplaces in the United Kingdom in
line with the provisions of the private bills being brought by
Liverpool and London.
January 2005
103 Wanless Report. "Securing Good Health for
the Whole Population". 2004. Back
104
Estimate by Professor Konrad Jamrozik, Imperial College London,
presented to conference of the Royal College of Physicians, May
2004-http://www.rcplondon.ac.uk/news/news.asp?PR-id=216. Back
105
WHO International Agency for Research on Cancer 1986, Monograph
vol 38 WHO IARC Lyons. Back
106
Carrington J, Gee I L, Watson A F R, Environmental Tobacco Smoke
in UK Pubs and Bars: the effects of smoking status and ventilation,
ARIC Manchester Metropolitan University, Atmospheric Environment
International-Europe 37 (2003) pages 3255-3266. Volume number:
3 issue number: 1. Back
107
Repace J. A Killer on the Loose. 2003. Back
108
Report of the New Zealand Health Select Committee Commentary
on ventilation, 2003. Back
109
Report of the West Australian Taskforce on Passive Smoking in
Public Places, 1997 pp 27-30. Back
110
Cains, T et al. Designated "no smoking" areas provide
from partial to no protection from environmental tobacco smoke.
Tobacco Control 2004; 13: 17-22. www.tobaccocontrol.com Back
111
Policies, Practices & Positions: Public Place Smoking.
www.philipmorrisusa.com/policies—practices/public—place—smoking.asp.
2004.
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