Select Committee on Health Written Evidence

Memorandum by the British Heart Foundation (SP27)


  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 appropriate.


  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%[28].

  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[29]. 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 smoking—and thereby dramatically reduce rates of heart disease in the UK.


  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 workers—and countless customers—exposed 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[30].

  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.

Public Opinion

  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 size—4,000 adults across Great Britain)[31]. 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:

    —  54% strongly support.

    —  25% tend to support.

    —  8% neither support nor oppose.

    —  7% tend to oppose.

    —  4% strongly 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.

Economic Impact

  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 establishments—concerns 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 increased—all signs that New York City bars and restaurants are prospering[32]."

  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 workforce.


  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 factors—including smoking—to 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 legislation—compared 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[33].


  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.

September 2005

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

29   BMJ Volume 328, 24 April 2004. Terry F Pechacek and Stephen Babb. Back

30   Academic paper on "Environmental Tobacco Smoke and the Hospitality Industry" presented by Professor Jamrozik 17/05/04, Royal College of Physicians Annual Conference. Back

31   MORI Survey April-May 2004 Back

32   The State of Smoke-Free New York City: A One-Year Review March 2004 Back

33   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

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