Memorandum by the Tobacco Manufacturers'
Association
PART 1 OF
THE HEALTH
BILL
Environmental Tobacco Smoke and Risk
Part 1 of the Health Bill currently in Parliament
bans smoking in all public and work places, subject only to a
few minor exemptions that will be determined by Parliament, in
the first instance in the primary legislation, and later in regulations
made under the Act that will be subject to the affirmative procedure.
Smoking or permitting smoking in a smoke free place, and failing
to display required notices, will become criminal offences.
Justification for the ban is claimed to lie
in scientific evidence concerning the risk that environmental
tobacco smoke may have for the health of the non-smoker. However,
the legislation is also seen and promoted by its proponents as
an important means of substantially reducing the prevalence of
smoking in the population, by creating circumstances—much
reduced opportunities for the smoker to smoke—that it is
claimed will influence many smokers to quit the habit.
On tobacco issues—including environmental
tobacco smoke—government has been advised by the Scientific
Committee on Tobacco and Health, but the future of the committee
is now uncertain. In its reports of 1998 and 2004, SCOTH concluded
that, on the basis of the published scientific evidence, environmental
tobacco smoke is a serious hazard to the health of the non-smoker.
Whilst minutes of certain meetings of the SCOTH have been made
available after requests under the Freedom of Information Act,
those papers have been redacted, most particularly where it has
been considered that content falls under s.35 of the Act which
protects information relting to the formulation of public policy.
Thus the proceedings of the SCOTH are far from being transparent.
Anti-smoking activists—most now part of
a formal alliance led by Action on Smoking and Health (ASH)—have
long campaigned for a comprehensive smoking ban. Their campaign
has concentrated on media activity which has been successful in
convincing the public that environmental tobacco smoke is a substantial
hazard to the health of the non-smoker.
From 1997 (and in its 1998 White Paper, Smoking
and Health) to the beginning of 2004, the Government gave
its support to voluntary action as being the most appropriate
means of achieving its tobacco targets. It endorsed the Public
Places Charter which sought to achieve best practice in the hospitality
sector. Although the most significant targets of the Charter were
met, in the face of intense pressure from anti-smoking activists
and perceived public opinion, in 2004 the Health Secretary launched
a major consultation, Choosing Health, of which smoking
policy was one major part.
The outcome was a White Paper in 2004 that proposed
a smoking ban in all public and work places, subject to certain
exemptions, one of which was licensed premises that did not prepare
and serve food. This became an election manifesto commitment.
After the election, there was public consultation
on the framework of the smoke-free provisions of a Bill and possible
regulations. A Bill was then introduced (together with a Partial
Regulatory Impact Assessment) and was argued in Committee in the
Commons in the terms that it was originally drafted. However,
it emerged that the proposed legislation did not have the wholehearted
support of the new Health Secretary, certain other Ministers,
and a body of government backbenchers, all of whom wanted a more
inclusive smoking ban. The outcome was the declaration of a "free
vote" at Consideration of the Bill on 14 February. The free
vote is to be on amendments standing in the name of the Health
Secretary and Public Health Minister. These provide three options—the
ban to include genuine private membership clubs; to include all
licensed premises; or the exemption provisions to stand as originally
stated in the Bill (exempting genuine private membership clubs
and exempting certain licensed premises meeting the conditions
stated in regulations).
Given this very brief re«sume«, it
might be reasonable to presume that in determining public policy
and legislation, the scientific evidence on environmental tobacco
smoke has been considered in detail in a thorough and objective
manner and that the conclusions that have been drawn are robust;
that there can be confidence in the Regulatory Impact Assessment
that has been made on the legislative proposals; that the facts
have been accurately and fairly reported by the media; and that
there is public support for the policy that is being promoted.
Such presumptions would be wrong.
There has not been a thorough and objective
assessment of the scientific evidence that is available. Even
on the basis of the pronouncements of the SCOTH and others to
the effect that there is an elevated risk of serious diseases
(lung cancer and heart disease) in non-smokers exposed to environmental
tobacco smoke, the level of risk is of such a low order that most
epidemiologists would generally refuse to acknowledge it as worthy
of even the slightest concern were it not to be such a useful
tool in the "war" against smoking.
The main components of the Regulatory Impact
Assessment published with the legislation were inevitably largely
speculative as to the outcome of the proposed ban on health and
smoking prevalence. Major items were based on estimates of health
gain derived from the application of the insecure and very low
relative risks found in the epidemiology.
The public has a poor perception and understanding
of the ways in which risk can be measured and expressed, and understandably
so in the case of environmental tobacco smoke which involves complex
epidemiological and statistical methods and manipulation. Public
understanding has not been assisted by the way in which the scientific
evidence has been reported. That has invariably been in headline
terms that have alarmed by misinterpreting or misunderstanding
the original research, or by using prepared press handouts rather
than relying on analysis or questioning of the research paper(s).
The decision made in the White Paper Choosing
Health and in the Health Bill as introduced in Parliament,
to exempt licensed premises that did not prepare and serve food
from the smoke free provisions of the Health Bill, was one of
a political nature. It was a means of providing a small measure
of choice and freedom for smokers and, most importantly, also
a means of responding to public opinion. The latter was expressed
formally by the Office for National Statistics in its report,
Smoking Behaviour and Attitudes: when offered a choice
of options, a substantial majority of people favoured facilities
being provided for smokers and non-smokers in licensed premises.
The state of public opinion was deliberately confused by the publicity
afforded to repeated opinion polls that were not representative
of the population as a whole and deliberately did not offer respondents
a choice of smoking policy options, but only asked whether a ban
was favoured or not.
The proposed compromise that the exemptions
clause of the Bill represented was, however, disrupted by disagreement
amongst Ministers and government backbenchers. For the Prime Minister,
the issue of smoking was sui generis.
In the case of environmental tobacco smoke:
the population has not been provided with an
accurate portrayal of the scientific evidence on risk upon which
preferences and attitudes could be determined and expressed properly;
nonetheless, the majority of the public favours facilities for
smokers and non-smokers being provided in licensed premises and
does not favour a comprehensive ban on smoking;
it is virtually impossible to attribute monetary
values that have any real validity to environmental tobacco smoke
as a risk factor, if risk factor it is at all: the order of risk
reported in epidemiological studies is inconsistent, uncertain
and, in any event, of a very low order and may be accounted for
by bias and confounding; furthermore, there are no relevant data
on the actual, real world impact of environmental tobacco smoke
on the health of the non-smoker, if there is any effect at all;
if the same "principles" were to be
deployed consistently elsewhere, there would be cause for the
banning of a very great many other activities, products etc.;
there has not been independent, objective, expert
assessment of risk and what has been promoted to the public has
been further distorted by the nature of the reporting of the available
evidence.
In 2004, the Tobacco Manufacturers' Association
made two major submissions—to the Health Department for
England and Wales and to the Scottish Parliament, respectively
in response to the Choosing Health consultation and to
a request from the Health Committee of the Scottish Parliament
for supplementary evidence on the scientific evidence on environmental
tobacco smoke and the health of non-smokers. These submissions
were identical in many respects but, whilst the submission in
England and Wales summarises the scientific evidence, that to
the Health Committee in Scotland provides detailed listings. Copies
of the two submissions follows.[45]
13 February 2006
45 Evidence submitted but not printed. Documents can
be found at www.the-tma.org.uk Back
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