Examination of Witnesses (Questions 100-119)
PROFESSOR DAME
CAROL BLACK,
DR RICHARD
EDWARDS, DR
ALLAN HACKSHAW
AND DR
RICHARD ASHCROFT
20 OCTOBER 2005
Q100 Dr Stoate: The same applies
to a car mechanic. Does a car mechanic know the effects of diesel
fumes? The answer is that nobody really knows the effect of diesel
fumes. The unknowables are unknowable. That does not change the
moral argument.
Dr Ashcroft: No, you are quite
right. Another part of the argument would be the relative risk
to which people are choosing to assent: the relative risk of inhaling
diesel fumes day and night; the relative risk of inhaling cement
dust; the relative risk of inhaling tobacco smoke particles—and
I defer to my colleagues on that; perhaps they can help me on
this one. In terms of the choice that someone makes about assuming
a particular employment, a lot of factors go into it and sometimes
people are making decisions which are, all things considered:
"Well, it is the least-worst option for me."
Q101 Dr Stoate: That applies to all
employments.
Dr Ashcroft: Well, it applies
to some employments. There will be some forms of employment where
people specifically choose them because they like taking a particular
risk. They might join the Fire Service because of the danger and
also because of the public service aspect. You could say the same
about joining the Armed Forces, for example—another context
where people do heavily smoke, as it happens. I do want you to
distinguish between areas where people are voluntarily assuming
a risk for that risk's own sake and areas where people are assuming
a risk as a side-effect of their principle reason for taking up
an employment. Where people are taking on employment for reasons
of lack of suitable alternatives or a straightforward need to
address some short-term need for money as opposed to long-term
considerations of their own interest, those are the sorts of cases
where we have always considered that workplace health and safety
legislation is justifiable.
Q102 Dr Stoate: From a purely moral
ethical standpoint, you are satisfied that there is no defence;
that workers know what they are letting themselves in for and
therefore that cannot be used as an argument against this legislation.
I am not talking about health at all—that is a separate
issue—but specifically about the ethical issue and the ethical
duty we have to the workforce. You think that is a non-justifiable
argument.
Dr Ashcroft: I think, taking all
things together with the other arguments in favour of a ban on
smoking in work places, it is not a compelling argument. It makes
sense to some extent, but it does not at the end of the day trump
the other arguments.
Dr Edwards: There is also the
other argument about how easy is it to deal with an occupational
risk. In this case we have a very simple way of dealing with it:
you make the workplace smoke-free, and the occupational risk is
taken away. There is also the question: Are you excluding people
from the workplace? For young women who are pregnant or at risk
of becoming pregnant, there is a clear link between passive smoking
and effects on pregnancy. For people with angina, which is worsened
by passive smoking, or people with asthma, is it an ethical, allowable
thing that we exclude certain people from the workplace?
Q103 Dr Stoate: Ethically, it is
about testing things to destruction. I would argue that we should
not have garages: we should have all car mechanics working in
the open air because that way you would remove the effects of
inhaling diesel smoke and, therefore, we have a duty to take the
roof of all garages in the country. If you test ethical arguments
to destruction, you do get some very strange situations arising.
That is why you have to look at the practical, reasonable argument.
Dr Ashcroft: There is a practical
reasonable alternative here, which is to make working places smoke-free.
Dr Stoate: Thank you.
Q104 Charlotte Atkins: Turning now
to the economic impact of a comprehensive ban, your reports suggests
there will be an overall economic gain of something like £4,000
million per annum. How do you come up with this figure? What evidence
do you have for it?
Professor Dame Carol Black: I
think, if I am right, on the economics and the figures it was
Dr Godfrey who put together that evidence. We had hoped she would
be here with us today. I am sorry she is not. But I could get
that information.
Q105 Charlotte Atkins: If you could
send us a note.
Professor Dame Carol Black: Absolutely.
I do apologise.
Q106 Charlotte Atkins: We particularly
want to know what the impact of a partial ban on those figures
overall would be, and also what the impact would be if we continued
the exemptions of private members' clubs, for instance.
Professor Dame Carol Black: You
would like a breakdown.
Q107 Charlotte Atkins: If you could.
Professor Dame Carol Black: Most
certainly, we will.
Charlotte Atkins: Rather than questioning
you on something you are not in a position to deal with. Thank
you very much.
Q108 Anne Milton: There are issues
around pubs and community life. The village pub is the mainstay
of the community. Particularly in some rural areas, it is the
heart of the community. If you ban smoking in licensed premises,
people will smoke at home, which will cause the community to break
up. There are also issues around young people, that if they want
to smoke, they will be outside in parks, as we have already seen
this summer. They will be outside, drinking there, and it will
increase anti-social behaviour. I would be interested in your
comments on that. I am sure you would like people to go to the
pub and not smoke, but there will be some effects.
Dr Edwards: If you look at the
evidence from around the world, and particularly from Ireland,
where you have these pubs that are at the heart of the community,
the world has not stopped because pubs have been made smoke-free.
The pubs are still very popular, the communities are still together.
I have been to Dublin and the pubs are vibrant and people are
happily smoking outside. There was a survey from Ireland released
this week about the popularity of the measures one year on, and
this is overwhelmingly popular, even with smokers. With non-smokers,
it is 98% or something. What about the people who were previously
excluded from those pubs because they were very smoky? Are they
not becoming more community orientated, because non-smokers, who
previously did not want to be exposed to that, now feel able to
go to those pubs? With respect, there is no evidence for that,
and it is probably the other way round.
Q109 Anne Milton: What about young
people drinking and smoking outside? They will not go to the pub
any more because they want to have a cigarette and drink. They
will drink in public places and smoke in public places and it
will increase anti-social behaviour.
Dr Edwards: Young people, like
other smokers, can smoke outside the pub. I do not know that there
is any evidence whatsoever that in Ireland, for example, because
of this legislation, young people are more congregated in the
parks and drinking.
Q110 Anne Milton: You look very puzzled.
You should not look so puzzled. I am sorry, you should not look
so puzzled, because if you came to my constituency you would see
exactly that there is an issue.
Dr Edwards: I am sure there is
an issue. I do not think this legislation is going to—
Q111 Anne Milton: Make it any worse?
Dr Edwards: If smoke-free legislation
came in, that it would make it any worse.
Dr Hackshaw: You have two very
different environments which show it works. Rural Ireland, as
you have just commented, and the centre of Manhattan. A smoking
ban has worked in both those environments quite well, I understand.
We are behind here in implementing these bans, We are fortunate
to have evidence from these other countries to show that it does
work, and effectively so, and that you do not lose customers and
also you do not lose revenue.
Anne Milton: This is an important question,
because we have all had letters, particularly from rural communities,
about this.
Q112 Mike Penning: The first thing
I would like to say is that the questions we are asking, especially
from us new people on the Committee, are not necessarily our views,
but just the Committee trying to get as much information as possible.
Would a complete ban on smoking in licensed premises encourage
more people to follow this trend of drinking and smoking at home,
thus endangering, as we were talking about earlier, the younger
people whom we want to protect? If we have more people smoking
at home, then the children will be adversely affected.
Professor Dame Carol Black: The
evidence of smoking is the opposite, that more people do not smoke
at home. If you make public places smoke-free, then there is good
evidence that the amount of smoking decreases and that more people
wish to make their homes smoke-free. Contrary to what we perhaps
thought and was perhaps thought by the previous Secretary of State
for Health, that is not what the evidence would show. I am sorry,
I do not know about the article, but, certainly from a smoking
point of view it will have a beneficial effect rather than a negative
effect.
Q113 Mike Penning: The Department
earlier on were saying that they think there would be a reduction
of about 4% in smoking if a ban went ahead. That would still leave
an awful lot of people smoking If they are not going to be smoking
at work and they are not going to be smoking in the pub, they
are going to be smoking somewhere, and it is not always going
to be in the garden shed.
Professor Dame Carol Black: I
do not think they necessarily will be smoking somewhere. If you
combined any policy, any new legislation with very, very good
support for giving up smoking, helping people to stop smoking,
I do not think they are necessarily going to be smoking somewhere.
Most smokers want to give up. That is known to be the fact. If
smokers want to give up, you really put a lot of effort and energy
into providing them with all the facilities to give up and you
add on top this legislation, and then I think we would see a decrease
in smoking, not the opposite.
Dr Edwards: In the first Royal
College of Physicians' report, which was called For Smoke-Free
Public Places it said it may well help in reducing passive
smoke exposure elsewhere by changing social norms about what is
acceptable. As Carol said, that is what the evidence shows. Even
this week, there was some evidence from Ireland looking at the
proportion of smokers whose homes were smoke-free (that is, they
did not allow smoking in the home) and, since the smoke-free legislation
in Ireland, that has increased and it is the exact opposite effect.
It is perfectly plausible. If at every public place you go to,
you are being told, "You should not smoke here, and the reason
you should not smoke here"—and you need to introduce
smoke-free legislation with good public information and education—"is
because you are harming the health of non-smokers, particularly
vulnerable people like children and pregnant women and so on.
Therefore it is not acceptable and that is why we are doing it,"
then you are probably less likely to go and smoke in your own
home in front of your own children. It is not a great leap in
logic, and that seems to be borne out by the evidence.
Q114 Mike Penning: A leap in logic
would mean that people would not smoke in the first place because
they know it is going to kill them, which is an assumption, I
am afraid, which has not been borne out for the last 100-odds
years.
Dr Edwards: The other thing is
that it encourages people to stop smoking. Therefore, those people
of course do not smoke in their homes because they are not smoking,
full stop.
Q115 Mike Penning: Most smokers are
aware of the damage they are doing; they just carry on smoking.
Dr Ashcroft: I think most people
may be able to rationalise their own smoking but do not particularly
want to hurt those closest to them. That would be a more powerful
reason for them.
Q116 Anne Milton: From this point
of view, when a ban is introduced, more homes become smoke-free
because people give up.
Dr Edwards: Because people give
up and because the people who continue to smoke are more likely
to say, "I don't want to smoke in my home."
Q117 Anne Milton: Do you know how
that splits up? Is it mostly due to people giving up or is it
mostly due to the fact that they decide it is inappropriate to
smoke?
Dr Edwards: We have evidence from
Boston, from Australia and now from Ireland—and there is
some evidence from the UK, although obviously there has not been
a ban here—about the proportion of homes of smokers that
are smoke-free. We have that evidence. We also have evidence of
the number of households which have a smoker in them. On both
counts, say in the UK, that has been reducing, so the number of
households with a smoker is reducing.
Q118 Mike Penning: How much are we
talking about?
Dr Edwards: The proportion of
homes that are smoke-free which have a smoker in them I think
increased from about 22 to 37%.
Q119 Mike Penning: We have not seen
any evidence of that.
Dr Edwards: The evidence is in
the report.[4]
4 Going smoke-free: The medical case for clean
air in the home, at work and in public places. A report on passive
smoking by the Tobacco Advisory Group of the Royal College of
Physicians, ISBN: 1860162460, July 2005. Back
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