Select Committee on Health Written Evidence

Memorandum by Smoke Free North East (SP28)


  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.


    —  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) 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.


  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.


  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

REFERENCESOtsuka et al. Acute effects of passive smoking on coronary circulation in healthy young adults. JAMA 2001; 28436-411.

Scientific Committee on Tobacco and Health (SCOTH). Second Hand Smoke: Review of evidence since 1998. Update of evidence on health effects of secondhand smoke. Department of Health, November 2004.

Office of Tobacco Control (2005) Smoke Free Workplaces in Ireland—A One Year Review.

New York City (2004) The State of Smoke-Free New York City: A One-Year Review.

ASHRAE, (2003) "Shutting the Door on ETS Leakage." ASHRAE Journal, July 2003.

Cains T, Designated "no smoking" areas provide from partial to no protection from environmental tobacco smoke Tobacco Control 2004; 13:17-22.)

Heironimus, J. (1992) Memo Impact of Workplace Smoking restrictions on Consumption and Incidence. Bates Number 2044762531.

available at:,

Jamrozik K. Estimates of deaths attributable to passive smoking among UK adults: database analysis. BMJ 330: 812-5. No 7495. April 2005.

Health and Safety Executive—workplace accident data 2002-03.

Department of Health (2004) Living in Britain—the 2002 General Household Survey. London

Ogilvie D et al. Reducing social inequalities in smoking: can evidence inform policy? Tobacco Control 2004; 13:129-131.

Chapman S, Borland R, Scollo M, et al. The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States. Am J Public Health 1999;89:1018-23.

Jarvis M, et al. Social patterning of individual health behaviours: the case for cigarette smoking. In Marmot M, Wilkinson R, eds. Social determinants of health. Oxford University Press.

ASH/Cancer Research UK, (2005) Press Release, 5 September 2005.

Chartered Institute of Environmental Health, 2004.

Health and Safety Commission (2005) HSC Paper/05/100.

Public attitudes in the northeast towards smoking in public places May 2005. Smoke Free North East.

Scollo M et al. Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control 2002; 12: 13-20.

Department of Health (2004) On the state of Public Health—Annual report of the Chief Medical Officer 2003. London.

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