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May 2003 |
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Right to a smoke-free workplace |  Back to contents | |
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The Government’s white paper, Smoking kills, published in 1998, cited smoking as the single greatest cause of preventable illness and premature death in the UK. Over 120,000 people die a year as a result of smoking – more than 13 people an hour.1 But while smokers enjoy the freedom to “light up” in public places, arguably non-smokers do not have the same freedom to enjoy clean air. The Smoke Free Workplaces Coalition, an umbrella group that includes Action on Smoking and Health (ASH), the UK Public Health Association, the National Asthma Campaign and the National Heart Foundation, estimates that at least 1,000 people die from second-hand smoke or environmental tobacco smoke (ETS) exposure each year in the UK. A further three million people meanwhile continue to have their health put at risk in the workplace. The coalition cites the British Medical Association’s (BMA) report Towards smoke-free public places, published last November, which claims that evidence against second-hand smoke is “now so damning that further action by the Government is necessary” (EHN 43, 8 November 2002, page 3). The report claims that second-hand smoke increases the risk of lung cancer in adults by 20-30 per cent and the risk of coronary disease by 25-35 per cent. Last month, pressure on the Government to do more to protect workers from the effects of passive smoke (see below) was stepped up when the Trade Union Congress (TUC), the CIEH and ASH hosted the “Don’t choke on the smoke” campaign conference.
The three organisations have called on the Government to introduce the long-delayed Health and Safety Commission’s (HSC) draft approved code of practice (ACoP) on workplace smoking, which was presented to the Government in October 2000 but then returned to the HSC for redrafting following opposition from some sectors of the hospitality industry, which claims that it will place unnecessary burdens on small businesses. The ACoP, should it be introduced, would require employers to take all reasonable and practical steps to ensure that workers can work in a smoke-free environment. To achieve this, employers could, for instance, introduce smoke-free areas, improve ventilation and prevent smoking at bars (EHJ, October 2002, page 314). Though short of a ban in all workplaces, it would, effectively, prevent employers from taking a “do nothing and ignore it” option. However, while the ACoP has remained “on the shelf”, the drive for change continues. In January, Alun Pugh, Labour MP for Clywd West, introduced a motion at the Welsh Assembly calling on the UK government to bring forward a Health Bill for Wales, which would enable the Assembly to make regulations to limit the public’s exposure to tobacco smoke in indoor, public places.3 The motion won all-party support as well as backing from a majority of Assembly members, and according to the Welsh evening newspaper, the Western Mail (23 January 2003), work will now start on drawing up an enabling Act, which must first be passed by the Westminster government. Should it proceed, the Assembly will be able to draw up pro-health regulations, which could see smoking completely prohibited in restaurants and cafes, on public transport, in shopping centres and other public buildings. As Mr Pugh explains, these are places in which there is already widespread public support for a ban. And while there is as yet no guarantee such regulations will be introduced, Mr Pugh adds that should public opinion favour further controls in the future, smoking restrictions could eventually be extended to pubs and nightclubs. However, according to critics, any legislation that introduces a ban will present an array of problems, not least in terms of policing a non-smoking policy. Arguing against the motion in the Welsh Assembly, Alun Cairns, conservative MP for South Wales West, warned: “Banning smoking in a restaurant where the restaurateur and customers are content to allow such an activity could not be controlled without enormous additional resources”. Commenting on the implications of legislation being considered in Wales, Scotland and the Republic of Ireland, Nick Bish, chairman of the Charter Group told the weekly trade magazine, the Licensee and Morning Advertiser (6 February 2003): “You can’t just go from no controls at all to a total ban. There will be all sorts of problems with civil-disobedience, non-enforcement, and smaller pubs going out of business.” Mr Cairns believes that ultimately it is up to businesses to decide if they want to promote a non-smoking policy, and like Mr Bish, he advocates the public places charter (PPC) – a voluntary initiative between the Government and the hospitality industry – “which allows potential customers of an establishment to identify whether or not smoking is permitted there and whether there is sufficient ventilation to reduce the nuisance effect.” Introduced in 1999, the voluntary PPC has no legal status. To comply, pubs and restaurants need to have a written policy on smoking and external signage indicating the type of policy in operation. The PPC also encourages pubs and restaurants to set up non-smoking areas and install better ventilation. When it was introduced, the hospitality industry agreed with the Government a set of targets that would be met by January 2003. As Mr Bish explains, these targets require that 50 per cent of all pubs and half of the restaurants that are members of the Restaurant Association will adopt one or other of the charter policies and the appropriate signage. In addition, 35 per cent of the policies adopted will be one or other of the “good practice” options, ie introducing smoking restrictions and/or effective ventilation. However, several studies suggest the PPC is not working effectively. According to Sue Blakeley, head of district services at Birmingham CC, a survey in Birmingham found a very low level of compliance among businesses (EHJ, December 2002, page 360). A similar picture emerged in Leeds, where a survey carried out by Leeds environmental health service and Leeds Health Authority found that despite efforts to raise awareness of the charter, the number of venues complying formally with the PPC and the number of venues interested in creating smoke-free areas was “abysmally low” (EHJ, December 2002, page 356). Others have been more critical. Marsha Williams from ASH argues, “The PPC is not working because an initiative with a do nothing option is not a solution.” Maurice Mulcahy, senior environmental health officer at the Western Health Board in Galway in the Republic of Ireland, goes further and says that even the ACoP would not protect people’s health because ventilation and smoke-free areas are not effective solutions (EHJ, November 2001, page 330). “There is no accepted ventilation standard that will remove the gas or vapour phase of ETS, and so ensure worker safety,” he says. “The countries that have looked at either the biological uptake of tobacco constituents or indoor air quality standards have recognised that the only safe level of ETS for those working in smoking environments is zero.” Mr Mulcahy points to a four-year study by Manchester Metropolitan University, which looked at the effectiveness of health and safety measures in 60 bars and pubs in Manchester. The study’s author, Joanna Carrington, a PhD researcher, found that ventilation did not appear to significantly reduce the levels of ETS compounds measured.4 Introducing smoking restrictions, however, does raise the issue of civil liberties. When the Welsh Assembly was debating Mr Pugh’s motion earlier this year, Peter Law, Labour MP for Blaenau Gwent raised a number of concerns that will be familiar with public health practitioners working in deprived areas. “I come from a community where there is great deprivation, hardship and poverty. For many of those who are unemployed and feeling great stress, a cigarette helps to calm them down…it is not easy to herd all those people out of public buildings and stigmatise and ghettoise them, as this legislation would require.” He also voiced concerns about linking smoking with the cost of treating smoking diseases. “If we tell people that they cost us a great deal of money because they have taken advantage of a civil liberty by smoking, what comes next? Do we ban chocolate and fatty foods? …There are also problems associated with alcohol consumption,” he adds. Those supporting tougher measures on smoking will probably sympathise with some of the sentiments made. For instance, many no doubt will agree that tackling the growing problem of obesity, linked to fatty foods, is a key public health challenge. However, while it can be argued that consuming small quantities of chocolate and alcohol are unlikely to cause problems, some research suggests that this is not the case with cigarette smoke. According to TobaccoScam, an anti-smoking project at the University of California, even short-term exposure to second-hand tobacco smoke has a damaging effect on health. In an article entitled “A little is dangerous”, the project’s author, Stanton A Glantz looks at how different exposure times affects a non-smoker’s health. For instance, Mr Glantz claims that only 30 minutes’ exposure can be equated to a stiffening and clogging of arteries. He adds, “A non-smoker’s coronary arteries can dilate and boost flow to heart muscle better than a smoker’s. After half an hour of second-hand smoke exposure, a non-smoker’s arteries loses the ability to dilate to the same extent as a pack-a-day smoker’s.”5 Opposition to anti-smoking legislation appears to rest mainly on the perception that restrictions will lead to a loss of trade. Arguably, village pubs and small establishments may well be susceptible to losing valuable business from regular patrons. However, it is almost impossible to predict how smoking restrictions will influence patrons’ behaviour until they are introduced. Evidence from Ottawa (see below) where a smoking by-law was introduced in August 2001, despite opposition from some local traders, suggests that it may not be as damaging as critics profess. A survey carried out by Decima Research Inc, a market research analyst, in September 2001 and July 2002 claims that there has been no net reduction in visits to bars and restaurants following the ban. According to Keith Neuman, senior vice president, “While specific establishments may have experienced a decline in business, across the city, overall the loss of customers due to this restriction is largely offset by others who are now more likely to visit bars and restaurants because they are smoke-free.”
Furthermore, research carried out in the UK in 1999 by the South Staffordshire Smoke-Free Alliance claims that rather than damaging business, smoking restrictions can have a beneficial effect. The Alliance’s survey of 10 pubs in Staffordshire found that pub takings were up by 7 per cent when no-smoking areas were introduced.8 In order to win support for smoke-free workplaces, changing public attitudes will be a key factor. Speaking to the Welsh Assembly during the motion, Jane Hutt, Minister for Health and Social Services, acknowledged that winning widespread public support for anti-smoking legislation will probably require a staged approach. She said that evidence from UK public opinion surveys consistently shows that restrictions on smoking in workplaces, restaurants and on public transport generally receive the highest levels of public support, while restrictions on pubs have the lowest.
Referring to California (see above), Ms Hutt said smoking restrictions had been successfully implemented following a high-profile media campaign to raise awareness and change public attitudes. Anti-smoking legislation was then applied in stages across different sectors. She added that smoking restrictions in bars had been introduced three years after being introduced in restaurants.
With the debate raging in Wales, now may be an opportune moment for the Government to rethink its position on smoking in the workplace. Recent moves in Europe to introduce legislation, most notably in the Republic of Ireland (EHN 5, 7 February 2003, page 2) and Norway (see above), together with restrictions in New York, introduced at the end of March, will arguably mount pressure on the UK government to be more proactive. Speaking as a member of the hospitality trade and as a smoker, David Elliott, managing director of Greene King Pub Partners, insists that the industry must be prepared for possible action by the Government, adding: “Many licensees I speak to would welcome a complete ban, especially the non-smoking ones,” he says. “If countries like Australia can do it and still have a great pub culture, why can’t we have it in this country?” Mr Elliott says that the hospitality industry should look at a ban as an opportunity to boost trade. He believes that many non-smokers are put off my smoky environments and avoid pubs and bars. Since non-smokers comprise the majority of the population, the industry is potentially losing out on a huge market. From a public health perspective, the benefits of a ban would be far reaching. According to an HSC study leaked to the Independent in March, up to 2,340 lives a year could be saved by outlawing workplace smoking, while total savings to the Government and business, including the NHS, could amount to £21bn.10 As Paul Hooper, NHS public health lead for tobacco control in Warwickshire, explains, while great gains have been made in the workplace to improve conditions, it is the low-income occupations that continue to have the least protection. And because these groups arguably are less likely to be in a position to complain about their environment, he adds, it is up to public health practitioners to get out there and champion their rights to a safer workplace. References
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