Memorandum by SmokeFree Cities and Communities
Network (WP 75)
INTRODUCING THE
SMOKEFREE
CITIES AND
COMMUNITIES NETWORK
The SmokeFree Cities and Communities Network
brings together local authority and health professionals from
across England who are currently involved in the process of achieving
smoke freedom for their cities, towns and communities.
The SmokeFree Cities and Communities Network
welcomes the Health Select Committee's Inquiry into the Government's
White Paper on Public Health and values the opportunity to submit
written evidence.
Will the proposals enable the Government to achieve
its public health goals?
1. Firstly we would like to offer our congratulations
on the tobacco control proposals contained in the White Paper.
The White Paper proposes to end smoking in the great majority
of workplaces and public places. This will inevitably cut the
toll of illness and premature deaths caused by secondhand smoke.
It will also, of course, encourage many smokers to quit.
Smoking is the major cause of preventable death
in many of our cities and is responsible for shocking health inequalities
in our most deprived communities. We are deeply concerned by the
serious health and safety risk other people's smoke poses to employees
and the general public, particularly but not exclusively in the
hospitality trades. The White Paper offers an important opportunity
to provide protection to non-smokers and to achieve a sharp cut
in smoking prevalence rates.
2. However, we believe that the Government
has missed an opportunity to save lives by not imposing a complete
ban in all workplaces, including pubs and private clubs. The SmokeFree
Cities and Communities Network does 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. We
believe the evidence on the harmful effects of second hand smoke
is clear and unequivocal 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 you
published with the White Paper, identified bar workers as the
occupational group at most risk from other people's smoke. In
many cities and communities people frequently do not have a choice
about where they work and employees in exempted premises would
therefore be exposed against their will and continue to suffer
the same health inequalities.
3. There is growing evidence that most pubs
in England, 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. We believe that
these exemptions, which cannot be justified on health and safety
grounds, would significantly undermine the purpose of the legislation,
and in particular would sharply reduce the contribution of the
legislation to achieving the Governments public health goals as
listed below:
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.
Reduce health inequalities by 10% by 2010 as
measured by infant mortality and life expectancy at birth.
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.
Are the proposals appropriate, effective and do
they represent value for money?
4. The Government has failed to act on the
conclusions of the report it commissioned from the Scientific
Committee on Tobacco & Health (SCOTH), which was published
at the same time as the White Paper, these are:
"Knowledge of the hazardous nature
of secondhand smoke (SHS) has consolidated over the last five
years, and this evidence strengthens earlier estimates of the
size of the health risks."
"This is a controllable and preventable
form of indoor air pollution."
"It is evident that no infant,
child or adult should be exposed to SHS".
"This update confirms that SHS
represent a substantial public health hazard."
5. 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. There is
no indication of the estimated drop in smoking prevalence that
a partial ban would bring. A complete ban would be 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.
6. 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. We believe it would cause significant
economic damage in cities and towns across England if hospitality
venues were required to install expensive and inefficient systems
of this kind. The proposed exemptions would add unnecessarily
to the regulatory burden on business. A comprehensive end to smoking
in all workplaces and enclosed public places would be simpler,
cheaper and more effective.
7. There is growing evidence that most pubs
in England, 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. We believe that
these exemptions, which cannot be justified on health and safety
grounds, would significantly undermine the purpose of the legislation.
In particular, they would sharply reduce the contribution of the
legislation to achieving the Government's public health goals
to reduce the inequalities gaps in the areas of heart disease
and cancer, life expectancy and smoking prevalence.
8. We also believe that the Government's
proposed 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.
Does the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
9. The proposals in the White Paper give
no clear definition for "pubs that serve food", would
be extremely difficult to enforce and leave many opportunities
for loopholes to be found. 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;
and
— smoking in the bar area will be prohibited
everywhere.
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. It is confused
because there is no useful line to be drawn between pubs that
"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. Indeed the Chartered Institute of Environmental
Health has described the Government's proposals for the licensed
sector as unworkable.
10. The goal of reducing health inequalities
cannot be achieved unless the proposals are amended to include
legislation to make all workplaces smoke- free including all pubs
and clubs.
Recommendations for action
11. At a meeting held in Manchester on 26
January it was agreed that the SmokeFree Cities and Communities
Network would provide an official response to the White Paper
and urge the Government to think again on this important issue.
The Network also wished to make known its support of the pioneering
work of the Liverpool and London local authorities, which are
currently pursuing Private Bills on this issue. We believe you
should consider adopting comprehensive legislation along the lines
of the Liverpool and ALG Bills so that employees and the public
across England can enjoy the same protection from the public health
hazard of second hand tobacco smoke as those in Scotland and Wales.
Other cities and towns are currently considering the moving forward
with local legislation, however, we would all prefer to see comprehensive
legislation for England.
12. We ask the Committee to urge the Government
to include a commitment to legislate to prohibit smoking in all
enclosed workplaces in the United Kingdom in its first legislative
programme after the General Election.
January 2005
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