Memorandum by the British Heart Foundation
The British Heart Foundation (BHF) welcomes
the opportunity to provide evidence to the committee on this important
public health issue. The aim of the BHF is play a leading role
in the fight against disease of the heart and circulation so that
it is no longer a major cause of disability and premature death.
The BHF is also a member of the Smokefree Action
coalition, alongside the British Medical Association, Cancer Research
UK, the Royal College of Physicians, Asthma UK and ASH, which
is campaigning to protect non-smokers from the effects of passive
smoking in all workplaces.
This response replicates many of the points
made to the recent Department of Health Consultation on the Smokefree
Elements of the Health Improvement and Protection Bill. We would
be delighted to help the Health Select Committee further where
2. EVIDENCE IN
The BHF believes the scientific evidence in
support of a comprehensive ban on smoking in all enclosed public
places is overwhelming. The link between smoking and CHD is well-established,
and a number of studies show an elevated risk of heart disease
in people regularly exposed to secondhand smoke. In particular,
we would draw attention to the research carried out by BHF-funded
Professor Peter Whincup and his team at St George's Hospital in
London, which has shown that the full effects of passive smoking
on the heart have been historically underestimated. This study,
part-funded by the BHF as part of the British Regional Heart Study,
provides an estimate of non-smokers' overall exposure to tobacco
smoke (at home, work and in public) and shows that the increased
risk of heart disease for passive smokers is around 50%double
the earlier estimate of 25%.
Furthermore, exposure to cigarette smoke does
not have to be particularly prolonged for it to damage your heart.
One study has shown that just 30 minutes exposure is enough to
reduce coronary blood flow to the heart.
This study came to the conclusion that all non-smokers at risk
of CHD should avoid indoor environments that allow smoking where
possible. The BHF believes it is the Government's duty to protect
workers by making all workplaces smokefree.
Policies restricting smoking in public places
help decrease the prevalence of smoking, which is estimated to
cause over 30,000 deaths a year from cardiovascular disease in
the UK. The Government's own Regulatory Impact Assessment, published
with the White Paper, estimates that ending smoking in all workplaces
and enclosed public places would reduce overall smoking prevalence
rates by 1.7%. We can therefore expect that a ban on smoking in
enclosed public places would prove an extremely cost effective
way to reduce the prevalence of smokingand thereby dramatically
reduce rates of heart disease in the UK.
3. VIEWS ON
We are pleased that the Department of Health
has recently consulted on smokefree workplaces in England and
Wales. However, we believe that the proposals to continue to allow
smoking in pubs and bars that do not serve food is a policy that
would leave thousands of bar workersand countless customersexposed
to the dangerous effects of secondhand smoke.
The BHF does not support the exemption of any
pub or bar which does not serve food from the proposed smokefree
legislation. We base this on health and safety grounds, and also
believe that concerns over public opinion and economic impact
of smokefree legislation have been over-exaggerated.
Health and Safety
Using risk factors virtually identical to those
in the Government's own SCOTH report, Professor Konrad Jamrozik,
formerly of Imperial College London, estimated in May 2004 that
secondhand smoke in the workplace causes about 600 deaths each
year in the UK and one death among employees of the hospitality
trades each week.
Given the strength of this evidence, the BHF
is of the view that there can be no justification whatever for
protecting the great majority of employees from this serious workplace
health and safety risk while continuing to leave some of the employees
at greatest risk (bar staff in exempt premises) exposed.
There is every reason to think that the majority
of the public would back a comprehensive smokefree law without
piecemeal exemptions for certain pubs and bars. In April 2004,
MORI was commissioned by Action on Smoking and Health to conduct
by far the largest and most representative poll so far conducted
on the issue (poll size4,000 adults across Great Britain).
The question asked was:
"Ireland, Canada, Norway and New Zealand
have each passed laws to ensure all enclosed workplaces are smoke
free. How strongly, if at all, would you support or oppose a proposal
to bring in a similar law in this country?"
The results were as follows:
8% neither support nor oppose.
In addition, it is apparent that smokefree legislation
becomes more popular after its successful introduction. In Ireland,
a survey conducted for the Office of Tobacco Control in March
2005 demonstrated that 93% of respondents, including 80% of smokers,
thought the law had been a good idea.
We are aware that the hospitality and licensed
trade industry has concerns about the impact of any legislation
on levels of trade, and on the viability of some establishmentsconcerns
that were also voiced in Ireland and New York when proposals to
restrict smoking in public places were tabled.
However, indications suggest that experiences
in Ireland and New York did not reflect the fears of the industry
and that, in some cases, trade actually improved. For example,
in March 2004, a report on the impact of the legislation was issued
by the New York City Department of Finance, the Department of
Health and Mental Hygiene, the Department of Small Business Services,
and the Economic Development Corporation. It concluded that:
"One year later, the data are clear . .
. Since the law went into effect, business receipts for restaurants
and bars have increased, employment has risen, virtually all establishments
are complying with the law, and the number of new liquor licenses
issued has increasedall signs that New York City bars and
restaurants are prospering."
In Ireland, the Vintners Federation of Ireland
has claimed that the smokefree law has reduced pub takings by
"20-30%". However, the retail sales index for bars volume
in Ireland (2000=100) shows that the value of bar sales in Ireland
decreased by 3.3% in the year following the introduction of smokefree
legislation (April 2004 to May 2005), but this was continuing
a behavioural trend that began at least two years before the legislation
came into force.
What we do know for certain is that banning
smoking in public places will save lives. Any potential fall in
revenue in the industry, for which there is little evidence and
which has certainly not been proved, is in our view of far less
importance than saving the lives of those who are currently being
killed as a result of the industry's failure to protect its own
4. EFFECT ON
It is clear that the pubs and clubs that would
be exempt under the Government's proposals are concentrated in
poorer communities. There is a strong association between smoking
and socio-economic position, meaning that these communities already
have higher than average smoking rates. There is a direct link
between poverty and heart disease, with a broad range of environmental
factorsincluding smokingto blame. The BHF believes
that exempting pubs and clubs in the most deprived areas will
undermine the progress that is being made towards meeting the
Government's targets of reducing health inequalities by 10% by
2010, and tackling underlying determinants of ill health (including
reducing smoking prevalence among routine and manual groups to
26% or less). We believe these public health objectives cannot
be met without comprehensive smokefree legislation, including
all pubs and bars, in England and Wales.
A recent study conducted by Telford and Wrekin
Primary Care Trust estimated that two-thirds of English pubs in
deprived areas would be exempt from the proposed legislationcompared
to only a quarter exempt in affluent areas. This evidence again
suggests that many of those pubs in the poorest, most disadvantaged
parts of the country would be exempt from the ban, and that health
inequalities would widen as a result of the proposed policy to
exempt pubs and bars not serving food.
Secondhand smoke in workplaces and enclosed
public places is a serious health risk to employees and members
of the public. Everyone has a right to a smokefree workplace and
no-one should be forced to breathe in someone else's tobacco smoke.
The BHF believes that the Government must introduce
legislation to end smoking in all workplaces and enclosed public
places, and that exemptions for some pubs, clubs or other workplaces
are unacceptable because they would fail to protect many workers
and others at most risk. Additionally, a comprehensive law would
give many smokers the encouragement they need to give up.
A comprehensive smokefree law would be popular,
simple, easy to enforce and would lead to a dramatic improvement
in public health across all sections of society including the
most disadvantaged. The BHF is urging the Government not to delay
in implementing this legislation and calls on the Health Select
Committee to use its influence to support this objective.
28 Whincup P et al (2004) Passive smoking and risk
of coronary heart disease and stroke: prospective study with cotinine
measurement BMJ 329 (7459) pp 200-205. Back
BMJ Volume 328, 24 April 2004. Terry F Pechacek and Stephen Babb. Back
Academic paper on "Environmental Tobacco Smoke and the Hospitality
Industry" presented by Professor Jamrozik 17/05/04, Royal
College of Physicians Annual Conference. Back
MORI Survey April-May 2004 www.ash.org.uk/html/press/040611NAT.html Back
The State of Smoke-Free New York City: A One-Year Review March
Woodall A A et al. "The partial smoking ban in licensed establishments
and health inequalities in England: modelling study". BMJ
doi: 10.1136/bmj.38576.467292.EB Back