Memorandum by Smoke Free North East (SP28)
INTRODUCTION
Smoke Free North East is a new body funded by
each of the sixteen Primary Care Trusts in the North-East and
Public Health Group North East. The North-East is the only region
in England to have adopted this regional approach to delivering
tobacco control and is overseen by an Advisory Panel with a multi
agency membership representing both voluntary and statutory organisations.
We welcome the proposed legislation to end smoking
in the majority of workplaces and enclosed public places and also
welcome the Committee's inquiry into Smoking in Public Places.
We have serious concerns about both the timescale for the proposed
legislation and the proposed exemptions and are therefore keen
to make a submission based on several elements of the Bill.
KEY POINTS
— The proposed exemptions will leave
North East populations disproportionately exposed to second hand
smoke and will, we believe, both exacerbate the disadvantage in
health suffered by the people of this region and widen inequalities
in health.
— Legislation to cover all enclosed
public places, without staggered implementation, has been shown
to be practical, fair and popular elsewhere.
— Public opinion in the North East
shows strong support for such action, and this has grown in recent
years.
— We strongly oppose exemptions for
licensed premises serving food and for private members clubs.
SECOND HAND
SMOKE (SHS)
Second Hand Smoke (SHS) is acknowledged world
wide as a major health hazard—a class A carcinogen and the
third leading cause of preventable death. It has an immediate
impact on health, reducing coronary flow velocity reserve and
thus placing a strain on the heart within 30 minutes of exposure,
(Otsuka et al 2001; SCOTH 2004). The Scientific Committee on Tobacco
and Health (SCOTH), reported in November 2004 that: "overall
exposure to secondhand tobacco smoke in the population has declined
somewhat as cigarette smoking prevalence has continued to come
down. However, some groups, for example bar staff, are heavily
exposed at their place of work." The report concluded
that: "it is evident that no infant, child or adult should
be exposed to secondhand smoke . . . Secondhand smoke represents
a substantial public health hazard". We are aware of
no independently funded research which suggests that SHS is not
harmful. All workers deserve protection from second hand smoke
and there is no justification 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
exposed.
COMMENTS
1. The Bill suggests that premises licensed
for the sale and consumption of alcohol should be given longer
to either become smokefree or to become smoking premises. We oppose
this proposal. While evidence from abroad has shown that a lead-in
period of up to a year is important, there is no evidence that
licensed premises need a longer time to implement a smokefree
ban than other businesses. Both Ireland and New York introduced
their Smoke Free Legislation on a set date. One year evaluations
show "New Yorkers overwhelming support the law", while
Ireland reports "overwhelming support for the smoke free
law amongst smokers and non smokers", (Office of Tobacco
Control, 2005; New York City, 2004).This proposal would simply
continue to expose people to the hazards of second hand smoke
and cause further confusion and uncertainty for the hospitality
industry, of whom many have expressed their desire for a "level
playing field" as soon as possible. The legislation should
be brought in as quickly as possible on a single date.
2. However, some organisations, such as
the BBPA, suggest that a phased approach aiming for 20% smoking
floor space in pubs by 2010, with separate smoking rooms, is best.
We strongly oppose this approach as it would simply continue to
expose people to SHS. Separate ventilated smoking rooms leak smoke
into the rest of the building, harming everyone in the building.
A recent research study showed that up to 10% of smoking room
air enters non-smoking areas just by opening and closing of a
swing type entry door (ASHRAE, 2003).
3. Some organisations also claim that good
work has been done by the industry through voluntary agreements.
These include measures such as stopping smoking at the bar. In
fact, the proposed legislation suggests that exempted premises
should do just this. However, there is no scientific evidence
to support the health benefits of banning smoking specifically
at the bar in the absence of a ban in other parts of the same
room. A recent study found that "no smoking" areas provided
virtually no protection from second hand smoke, and suggest that
the term "smoke-free area" is misleading and deceptive.
Within minutes of someone lighting up a cigarette, the respirable
particles, which carry cancer-causing agents into the lungs, contaminate
the entire room (Cains 2004). We also do not support the use of
ventilation systems which may remove the smell of smoke, but have
been shown to be wholly inadequate in removing the toxins in second
hand smoke and are expensive and cumbersome to maintain.
4. These sorts of measures simply result
in a partial ban of the type advocated by organisations such as
FOREST. The tobacco industry understands very well the benefits
of partial smoking restrictions as opposed to comprehensive legislation.
A Philip Morris internal document states that "total prohibition
of smoking in the workplace strongly affects industry volume.
Smokers facing these restrictions consume 11% to 15% less than
average and quit at a rate that is 84% higher than average . .
. these restrictions are rapidly becoming more common. Milder
workplace restrictions, such as smoking only in designated areas,
have much less impact on quitting rates and very little effect
on consumption".(Heironimus, 1992)
5. The Bill proposes that all licensed premises
that do not prepare and serve food should be exempted from the
proposed legislation. It is also proposed to exempt membership
clubs, where the members will be free to choose whether to allow
smoking or not. However, the Bill is a health & safety measure
and so this proposal would fail to protect staff in many pubs
and membership clubs. Evidence from other countries, which have
introduced smokefree legislation without exemptions for licensed
premises, has shown that their popularity increases following
implementation, establishing the norm of protecting all workers
from a known health hazard. We oppose this proposal for reasons
of health and safety, increasing health inequalities, regulatory
impact, public opinion and economic impact.
6. Health and Safety—All workers deserve
protection from second hand smoke. There is no justification for
protecting the great majority of employees from a serious workplace
health and safety risk while continuing to leave some of the employees
at greatest risk (bar staff in exempted premises) exposed. Using
risk factors virtually identical to those in the SCOTH report,
Professor Konrad Jamrozik, estimated that second hand smoke in
the workplace generally causes about 600 deaths each year in the
UK and one death among employees of the hospitality trades each
week (Jamrozik 2004). This equates to 35 North-East workers dying
annually from breathing other people's smoke and this is unacceptable.
For comparison, the total number of fatal accidents at work from
all causes in the UK in 2002-03 was reported by the Health and
Safety Executive as 226 (HSE 2003).
7. Widening of inequalities—The North-East
has one of the highest smoking rates in England (GHS 2003) and
also the highest cancer and heart disease incidence. Smoking is
the leading cause of health inequalities. (Ogilvie et al 2004).
Smokefree environments encourage people to quit smoking, and so
will help reduce inequalities currently seen between the poorest
and the well off in our society (Chapman et al 1999). At least
70% of people in the lower socio-economic groups who smoke want
to quit but they find it much more difficult to do so and have
higher relapse rates because of living in an environment in which
smoking is the norm (Jarvis et al 2001).
Choosing Health estimated that 10-30% of pubs
would be exempt from legislation. This was based on a survey of
existing risk assessments for food safety carried out by Local
Authorities. We have undertaken our own mapping in the North-East
of the premises that would be exempt under the Government's preferred
legislation and it is apparent that exempt premises are much higher
than the predicted figures. An average 52% of premises would be
exempt. The mapping exercise showed that these premises are also
concentrated in our poorer communities, with the highest smoking
rates, worst deprivation and highest Lung Cancer Standardised
Mortality Rates. Headline results in the North-East are Easington
with 81% premises exempt/IMD rank of 6/Lung Cancer SMR of 141;
Gateshead with 72% exempt/IMD rank of 30/Lung Cancer SMR of 165;
and Wansbeck with 71% exempt/IMD rank of 43/Lung Cancer SMR 170.
The consequence of this is that the health benefits, in reduced
exposure to second hand smoke and in reduced smoking prevalence,
will be less in these communities than in better-off communities,
thereby increasing health inequalities. There is also evidence
to show that up to a third of pubs might stop serving food to
avoid the smokefree legislation, (ASH 2005).
In the absence of comprehensive legislation
to restrict smoking in all public places, it is unlikely that
targets for reduction in smoking prevalence by 2010 will be achieved,
particularly in manual groups.
8. Regulatory impact—In Ireland legislation
was enforced by Environmental Health Professionals. It was found
that the legislation is almost entirely self enforcing if it is
simple, widely enough publicised and understood by all parties.
In Ireland compliance rates were well above 90% from day one.
This required a comprehensive education programme, particularly
for the hospitality trade, and a media campaign for the public.
It also showed the advantages of implementing legislation in all
workplaces simultaneously. To split workplaces and hospitality
venues risks undermining compliance rates. It is also important
that a pre and post legislation surveillance and research programme
is put in place so that it is possible to properly assess the
effectiveness of the legislation. Ireland and Scotland both have
programmes in place that could be used as a model. The proposed
exemption for pubs not serving prepared food would require more
frequent and more intrusive inspections by enforcing bodies, particularly
Environmental Health Officers. The Chartered Institute for Environmental
Health has warned that the exemptions would "add to red
tape and lead to a more complex licensing regime", (CIEH,
2004).
A partial ban will be difficult to interpret,
compared to a comprehensive ban, which would be straightforward
and easily understood. We know that even undertaking our wet/dry
pub survey was difficult for the local authorities in the North-East
given the confusion over definitions of food. Enforcement will
clearly be more time-consuming, difficult and thus more expensive
at a local level if the exemptions proposed at present apply.
The view of the environmental health officers who are members
of local tobacco control alliances and networks in our region
is unambiguous.
The Health and Safety Commission Board on 25
July 2005 itself stated that the arguments for a wider ban in
all licensed premises include better regulation—for regulation
to be effective it must be capable of ready application by those
to whom it is addressed. Differing restrictions in the UK will
lead to confusion and lessen benefits. A uniform approach to smoking
will be easier for employers, employees and the public to understand
and comply with. A simpler regime, with fewer and less complex
exemptions, will aid enforcement by the Local Authorities.
9. Public opinion. The majority of the public
would back a comprehensive smoke free law. In the North-East a
telephone survey of adults in May 2005 of 1202 randomly sampled
residents throughout the region* showed that:
— 73% supported all enclosed workplaces
and public places to be smoke-free.
— 70% would support a law to achieve
this.
— 55% supported all bars and pubs being
smokefree.
*Other data are available and is broken down into
six sub-regions of the northeast.
These figures demonstrate a marked increase
in public support for comprehensive restrictions when compared
with survey data from earlier years. There has been substantial
editorial support from major newspapers in the region with the
clear backing of their readership.
We believe that public acceptance can and will
grow as a result of planned communications activity if the Government
chooses to act—indeed, smoke-free measures internationally
have tended to become more popular once implemented. Support for
the smoking ban in Ireland was at 67% before the legislation was
announced but has since risen to 93% (including 80% of smokers)
according to a poll conducted by the Office of Tobacco Control.
It is clear that everyone has the right to work
in a safe environment. We frequently receive queries from workers
being exposed to second hand smoke in their workplace and asking
what they can do. Since our website was launched on 31 May 2005
we have had over 100,000 hits. We have had a huge response to
our North-East consultation on the legislation and in total 145,000
postcards have been distributed. During the Tall Ships Races in
Newcastle/Gateshead in July 2005 we had a prominent FRESH—Smoke
Free North East stand on the Quayside. Over 2,400 members of the
general public have approached the stand and individually signed
postcards.
10. Economic impact. It has been suggested
that smokefree legislation would affect business. However, evidence
from around the world shows that smokefree legislation is not
bad for business. A comprehensive review (Scollo et al 2002) of
97 studies published before September 2002 on the economic effects
of the smoke free policies on the hospitality industry found:
— Of the 35 studies on this topic published
that found a negative impact, none were funded by a source clearly
independent of the tobacco industry, and none used objective measures
and were peer reviewed.
— The 21 best designed studies found
that smoke-free restaurant and bar laws had no negative impact
on revenue or jobs.
In Ireland, the Vintners Federation of Ireland
and other groups have claimed that the smoke free law has reduced
pub takings by "20-30%". This claim is false. 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 smoke free legislation (April 2004 to May
2005), continuing a trend that began at least two years before
the legislation came into force. The decline in volume at drinking
places in Ireland is a function of changing social habits—not
smoking laws. This decrease in revenues (not the much higher figure
claimed by the Irish LVA and lobbyists in the UK) simply continues
a trend which started back in 2001, well before smokefree legislation
was introduced. The volume of sales in bars in Ireland increased
until 2000, but decreased by 3% in 2002, 4% in 2003 and 5% in
2004.
In his Annual Report for 2003, the Government's
own Chief Medical Officer, Professor Sir Liam Donaldson, said
that a comprehensive smokefree law could benefit the British economy
by up to £2.7 billion. This could include up to £680
million saved by having a healthier and consequently more productive
workforce, £140 million saved through fewer sick days, £430
million saved because less production would be lost to cigarette
breaks and £100 million saved by not having to clean up behind
smokers.
SUMMARY
The proposal to exempt some pubs and membership
clubs clearly threatens to undermine key Government public health
objectives to reduce smoking prevalence rates and tackle health
inequalities. Voluntary measures and staged approaches simply
continue to expose workers to a recognised workplace health and
safety risk. Some organisations suggest this is an issue of human
rights and that people should have the choice to smoke. We suggest
that the issue is not about whether people smoke, but where. The
great majority of people do not smoke and their right to be protected
from the harmful effects of SHS must take priority.
September 2005
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