Examination of Witnesses (Questions 80-99)
PROFESSOR DAME
CAROL BLACK,
DR RICHARD
EDWARDS, DR
ALLAN HACKSHAW
AND DR
RICHARD ASHCROFT
20 OCTOBER 2005
Q80 Dr Naysmith: Presumably it would
be possible to get extractor fans which were capable of taking
the majority of the pollutants out of the atmosphere, would it
not?
Dr Edwards: If you could get the
technical fix, but the trouble is you would need such enormously
powerful fans and air change that you would be sitting in a wind
tunnel.
Q81 Dr Naysmith: Dr Adshead told
us that there was a linear relationship between exposure to tobacco
smoke, whether passively or actively, and predicted backwards
from that to the suggestion that passive smoking was going to
have an effect as well, plus there are a few not particularly
terribly well controlled studies which give the same view. If
that is the case, then if you take stuff out of the atmosphere
it must have some effect. I am not saying that is the answer,
I am not saying it should, but from a scientific point of view
I think it is overstating the evidence to say it is practically
useless.
Dr Edwards: I said it does have
an effect but it does not reduce it to a level at which you would
expect it to protect against the health effects and there is no
evidence that it does that.
Q82 Dr Naysmith: Does it reduce it
at all?
Dr Edwards: Yes, I think it reduces—
Q83 Dr Naysmith: You were talking
about a particle that is particularly dangerous. Could these particles
be reduced by extractor fans?
Dr Edwards: I would imagine they
could be reduced, yes, but if you are reducing from a very, very
high level to a very high level, that is not necessarily that
helpful and it is not an effective solution to the problem which
is the health effects of second-hand smoke.
Dr Hackshaw: The relationship
between passive smoking and lung cancer is linear but for heart
disease it is not. You only need a small amount of exposure and
that gives you your big risk of heart disease. That has been shown
in lots of studies of active smokers, as in passive smokers as
well.[3]
Q84 Dr Naysmith: It was lung cancer we
were talking about when we were doing the projections.
Dr Hackshaw: Together: lung cancer,
heart disease and chronic obstructive lung disease.
Q85 Dr Naysmith: It seems that one
of the things the Government are considering is having smoking
rooms. This question of having some pubs with smoking rooms and
others which are completely clean links into the equality agenda,
does it not? Some parts of the country know that if this were
to apply, then there would be places which had smoking rooms,
and the same applies to the other situation where smoking is banned
if you provide food. All of these things would impinge, would
they not? It would tend to be in the lower income areas where
smoking rooms were allowed or where smoking was allowed.
Professor Dame Carol Black: To
reiterate, on the smoking room idea: if you have a smoking room,
you have a door that is being opened and closed. If it is going
to be within the building of the pub, the smoke is going to come
out every time the door is opened, and presumably you would have
to not have any bar worker in there. The idea that within the
confines of a pub you could put a smoking room that would still
protect the workers in that pub is not reasonable. I would like
to emphasise again that this partial ban would simply disadvantage
the poor in this country and it would make the gap between good
health for the poor and for the rich even larger. That is something
we very much do not wish to see happen.
Dr Edwards: Someone has to go
in and collect the glasses from the smoking room; someone has
to clean the smoking room; so staff are still going to be exposed.
I think also the licensing authorities might have something to
say about partitioned-off rooms which no one is going into most
of the time, drinking dens, and what might go on in there, let
us say, in terms of drug dealing and things like that, where there
is no supervision whatsoever. As Carol said, there is the issue
of open doors: if you are going to have a smoking room you have
to have quite a complex ventilator arrangement, including, ideally,
negative pressure within the room to make sure that there is not
contamination within the rest of the pub. That is a pretty complex
thing to do and maybe it is not that effective.
Q86 Chairman: You probably know that
the Committee is going to Ireland in a few weeks time to have
a look there. With regard to this concept of non-smoking and smoking
areas and the opening of doors, we understand—and we will
see for ourselves—that people stand immediately outside
the public house to smoke, and yet people will be going in and
out all the time presumably. What is your comment on that?
Professor Dame Carol Black: I
think that once you are outside in the open air, the smoke and
the particles within it are dispersed very, very rapidly. I think
that would be true.
Dr Edwards: I have not seen evidence
on that.
Q87 Chairman: We will ask the questions
ourselves, but I wondered if you had any thoughts on it.
Dr Edwards: We have talked about
smoking rooms. The alternative—and we are talking not about
whether people can smoke but where—is that all they have
to do is go outside. There is an alternative policy, which is
the smoke-free policy. It is simple, cheap, and the experience
from Ireland and New York and California and so on is that it
is highly effective and very popular.
Q88 Dr Taylor: Turning to ethical
issues, Dr Ashcroft, people are telling us that this change is
going to be quite draconian, that we are attacking people's liberty,
that we are attacking freedom of choice. I think Howard has already
referred to this: How do we balance the rights of smokers against
those who should be protected from its effects? Would you talk
to us generally about the ethical aspects, to make us feel comfortable
with the proposals if we support them?
Dr Ashcroft: It is a rather simple
idea, first set out most clearly by John Stuart Mill in the mid
19th century, the idea that the main way in which you can justify
restricting someone's liberty is where they are causing harm to
others. In the case of smoke-free public places, the policy is
clearly about controlling harm to specific vulnerable individuals
and groups, rather than being directed coercively, to force people
to give up smoking. That the policy may have the foreseen but
unintended consequence that people may give up smoking is of course
useful from the public health point of view, but it is not really
the main thrust of the policy, because justifying a policy which
would force people to give up smoking is clearly not something
that the public consensus would stand, even if it could be justified
on paper. In this case, if what you are concerned about is the
welfare of workers in public places and the freedom of non-smokers
to move safely through them without exposure to tobacco smoke
and the freedom of children not to be encouraged to take up smoking,
then I think it is relatively clear that a policy that is a ban
on smoking in public places meets Mill's test very easily.
Dr Taylor: Thank you for pointing to
the difference between attempting to ban smoking for everybody
across the country, which would be unacceptable. Thank you, that
is very clear.
Q89 Dr Naysmith: Dr Ashcroft, is
there a difference between public places to which people have
to go (public offices or something like that) and public places
which people choose to go to of their own volition—leaving
aside the question of bar staff for the moment.
Dr Ashcroft: I am not sure it
is helpful to leave aside the question of bar staff.
Q90 Dr Naysmith: I will come back
to that.
Dr Ashcroft: Fine. There is a
difference between places where people have a free decision whether
to go there or not and a place where they are confined or obliged
to go—which is why some of the exceptions I think do make
some sense. Obviously I can choose not to enter a premises where
smoking is going on, but if that places a significant lack of
amenity on me, then there is the question of whether that is fair
in point of equity. If there is only one pub in town and that
is the only place I can go to meet my friends and associates,
and it is a smoking pub, then there is a significant lack of amenity
to me. The lack of amenity to the smoker who is asked simply to
go outside seems to me considerably less.
Q91 Dr Naysmith: If there are two
pubs in town and a smoker wants to go and smoke sitting down with
his pint, and one of the pubs is a non-smoking pub and the other
is not, what is the ethical justification for differentiating?
Dr Ashcroft: Then we start talking
about the health of workers and occupational health.
Q92 Dr Naysmith: I am not talking
about that at the moment, I am coming back to it; I am talking
about what you were talking about a moment ago.
Dr Ashcroft: The hard case would
be the private members' club, where there is a clear justification
in terms of freedom of association: if you and I and everyone
in this room decided to set up a club where we could go and smoke
cigars and tell tall stories, then on the face of it there would
be no moral justification for stopping us from doing that. The
question would then come in: "What if we were to employ somebody
who may have less freedom of choice about whether they"—
Q93 Dr Naysmith: I am not moving
there yet. We will come to that in a minute.
Dr Ashcroft: I am not going to
overstate the case. If that is what we did and it was our private
members' club, then I cannot see a ban would be justifiable on
that. It is just that there are no private members' clubs which
do not employ people.
Q94 Dr Naysmith: But then—and
I am not saying anything more about my personal views—can
you not apply the same question to someone who chooses to work
in that particular establishment? Do they not have a choice of
whether they work or do not work in a smoky atmosphere?—especially
at a time when employment is now very high and most people can
get jobs.
Dr Ashcroft: Relatively speaking,
the kinds of people who are choosing to work in bars are the low
paid, who may have particularly few other alternatives. Typically
my students, for example, will work in bars to pay their way through
college. It is not that their health effects are any less severe
just because they are young.
Dr Naysmith: It is an interesting area
to speculate about.
Q95 Dr Taylor: I have a specific
concern: elderly ladies, whose one outing a week is to the bingo
hall, where smoking goes on. How do we address their concerns?
Dr Ashcroft: I am sorry, you might
have to expand a little further.
Q96 Dr Taylor: I am concerned about
the little old ladies who live alone, who only get out once a
week and they go to a bingo hall. They still smoke. They smoke
in their own home, there is nobody else there and they are not
causing any harm to them. The fact that smoking is banned in their
bingo hall means they cannot go to bingo. How can we counter that?
Dr Ashcroft: I am not sure it
does mean they cannot go to bingo; it means they can go to bingo
and nip out every so often for a cigarette.
Q97 Dr Taylor: It does not mean that
they cannot, but it means they would lose their sense of enjoyment,
which is to have a fag while they are playing bingo.
Dr Ashcroft: The experience suggests
that those who are really committed to the enjoyment of cigarette
smoking, or tobacco smoking in any form, find other ways of sociability
around their smoking. Smoking with their friends outside is no
less a form of social interaction than smoking inside.
Chairman: I have a picture in my mind
of somebody standing outside with their bingo card. It is probably
not going to work, in that respect! We could pose that question
to some witnesses we are having later on in this inquiry.
Q98 Dr Stoate: I would like to stick
with the ethical principles for the time being. When I was a student,
working in a pub in order to pay my way through university, I
have to say that the greatest danger in my particular pub was
not second-hand smoke but flying glass.
Dr Ashcroft: Somebody should ban
that.
Q99 Dr Stoate: Good idea. There are
many occupational hazards in everyday life. Many jobs have particular
hazards attached to them: car mechanics, for example, who might
be exposed to diesel fumes whilst working in their car plant;
building workers exposed to cement dust. In other words, many
jobs do have a particular hazard with them. Obviously health and
safety legislation is designed to reduce that hazard as far as
possible. As employment, generally speaking, is a free occupation—you
either choose to work in a particular sector or not—can
it not be argued ethically that bar staff know what they are letting
themselves in for when they apply to be a bar worker, and, ethically
speaking—and I am not talking about health effects now—does
that not act as a defence? The industry might say: They freely
chose this job, therefore we do not have a moral duty to be so
concerned about their health as we might be if they were forced
to do that job.
Dr Ashcroft: It is an important
argument and one that has been raised throughout the history of
workplace health and safety legislation. One important point is
empirical: Do people actually know the level of risk to which
they are supposedly consenting?
3 Dr Hackshaw later informed the Committee that the
estimated risk of heart disease in someone who smokes 1 cigarette
per day is about half that of the risk of someone who smokes 20
cigarettes per day (Law & colleagues. BMJ 1997). This provides
strong evidence that low tobacco smoke exposure (ie non-smokers
exposed to ETS) will also be associated with a significant risk
of heart disease. Back
| 
