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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Towards a Smoke-free Environment:
Lessons from Home and Abroad - Report of a National Conference
9 September 2004
EXECUTIVE SUMMARY
Background
In January 2004 the Scottish Executive published the first ever Action Plan on Tobacco Control specifically for Scotland. This plan
A Breath of Fresh Air for Scotland, set out proposals for reducing tobacco-related harm. The plan indicated the need for more public education on the health risks involved with second-hand smoke, also known as "passive smoking" or "environmental tobacco smoke" (ETS); firm action to extend smoke-free zones in enclosed public places; and the need for an open public debate, including a major conference, on the dangers involved with second-hand smoke and how to reduce exposure.
The public debate has involved a number of different elements, including consultation materials (hard copy and on-line), regional public seminars; focus group work with targeted sectors of the population; an opinion survey; work with young people; and a national conference.
This is the report of the national conference
Towards a Smoke-free Environment: Lessons from Home and Abroad, held at the Edinburgh International Conference Centre on Thursday 9 September 2004. It has been prepared by the Smoking in Public Places Consultation Team at the Scottish Executive and the Centre for Tobacco Control Research at the University of Stirling. The main findings from the report will be incorporated into a final evidence report on the consultation which is being prepared by independent consultants.
Organisation of Conference
The Conference was organised by the Smoking in Public Places Consultation Team at the Scottish Executive, aided by a reference group comprising Prof Gerard Hastings, Director, Centre for Tobacco Control Research at the University of Stirling and the Open University; Maureen Moore, ASH Scotland; Gordon Millar, the Scottish Beer and Pub Association and member of the Scottish Voluntary Charter Signatory Group, and Moira Scobbie, Media and Communications Group of the Scottish Executive.
Aims of the Conference
The aims of the Conference were to:
overview the research on the harm caused by second-hand smoke;
look at the ways in which other countries have reduced exposure and the impact of controls on health and business; and
assess the practicalities of a range of approaches in Scotland.
The Conference was designed for policy makers at both a national and local level, health practitioners, trade unionists, the voluntary sector and business people, particularly from the licensed and hospitality sectors.
Attendance
Invitations were extended to health interests, the business sector, including the licensed trade, the voluntary sector, local authorities, trade unions, the Scottish Executive and other UK government health departments. Over 200 delegates attended the conference, comprising representation from business (approx. 14%, mainly licensed trade), NHS Boards and other health professionals (30%), local authorities, including CoSLA (17%), the voluntary sector (13%), universities, environmental health, trade unions, the Health & Safety Executive, the Scottish Executive, the Scottish Prison Service, the Scottish Parliament, the Scottish Youth Parliament, the Scottish Tourism Forum and other UK government departments.
Conference Programme
The programme for the Conference is at
Annex A. Biographies of the speakers are at
AnnexB .. An evaluation of the conference prepared from delegate evaluation forms, is at
Annex C.
The overall Chair for the day was Prof Gerard Hastings, University of Strathclyde, a member of the Scottish Ministerial Working Group on Tobacco Control. Dr Sinead Jones, Prof Phil Hanlon (also members of the Ministerial Working Group) and Dr Ron Borland, Cancer Control Research Institute of Australia, chaired individual sessions, with Prof Hastings summing up the proceedings, from his personal perspective, at the end of the Conference.
The programme was split into four sessions: Scene Setting, Learning from Our Neighbours, Worldwide Experience and The Way Forward for Scotland.
Findings from the day
A summary of the presentations and the Chair's summing up can be found in the next Chapter. A substantial level of evidence and anecdotal information was presented throughout the day. The following attempts to summarise the main evidence and feelings which emerged throughout the day, under the main topic areas of discussion and interest.
Scottish Executive policy
Current policy on smoking in public places relies on a voluntary agreement with the business sector to deliver smoke-free provision. The Scottish Executive has signalled its intention to increase smoke-free places, either through statutory controls, a continuation / extension of the voluntary approach or a combination of both.
In order to inform decisions on appropriate action, the Executive is carrying out a public consultation to gauge the public's views on the issue and has also commissioned a number of pieces of research to assist its decision making. In discussion, some delegates from the licensed trade voiced concerns that the Executive had already made up its mind to legislate for a total ban, citing statements already made by the First Minister and Deputy First Minister. Assurances were given by the Deputy Minister for Health and Community Care, Mr Tom McCabe, during his opening address that the consultation on smoking in public places was genuine, and that no decisions would be taken until Ministers had had the opportunity of assessing the views from the consultation and other commissioned research.
There was also criticism from some in the licensed trade that the conference programme was itself biased with only two speakers in support of freedom of choice for smokers and the rest in support of statutory controls.
The health risks of passive smoking
Robust scientific evidence was presented which demonstrated that there are significant health risks associated with second-hand smoke, both in the home and the workplace. These include links to lung cancer, cardiovascular disease, acute strokes and a range of other conditions. Risks increase with exposure and health risks are greater among the most deprived members of society, where smoking prevalence is highest.
Researchers modelling the health impacts of ETS for Scotland found that, concentrating on lung cancer and heart disease alone, 439 lung cancer and ischaemic heart disease deaths in Scotland per annum are due to passive smoking, 71 of which were calculated as being attributed to non-domestic exposure. Over the next thirty years this is due to rise to 233 deaths per annum, from a total of 500 deaths due to passive smoking.
The health risks were disputed by the representative of the Vintners' Federation of Ireland, who cited results of research by the American Cancer Society which stated that the causal links between ETS and tobacco related mortality had not been proven, although they did not rule out a small effect. He indicated that further research on the effects of ETS and the hospitality industry was required. It was pointed out from the floor of the conference that the research referred to was funded by the Tobacco Industry and was not robust.
Setting controls on environmental tobacco smoke (ETS) and its impact
The UK lags behind many other developed countries in controlling ETS. Evidence presented from Canada, the USA (including New York) and Australia suggested that bans were more likely in restaurants than in bars, most smokers came to embrace smoke-free (but only accept it in bars), compliance is high where bans have been introduced and there are no apparent adverse economic effects of smoke-free areas. The economic evidence did not rule out, however, that some individual businesses might be affected, although this would be hard to ascribe to smoking free regulations as, particularly in the licensed sector, there is a high turnover in business openings and closures.
The evidence also suggested that controls on smoking in the workplace, combined with enhanced cessation services, decrease smoking prevalence and denormalise smoking amongst younger people.
Whilst the Irish Government had tackled passive smoking on the basis of workplace health and safety rather than the grounds of public health, it was felt that Scotland could learn from the Irish experiences to date. Independent economists, commissioned by the Office of Tobacco Control (OTC) in Ireland, have predicted little or no economic effect of the ban in aggregate, based on evidence from elsewhere. An OTC report on the impact of the ban, six months on, shows that compliance levels are high, tourism numbers are up and bar sales are down by 1.3% (continuing a downward trend in sales over the last few years). However, it was noted that the ban had only been in place since March 2004 and that therefore it was not possible to assess the impact of the legislation during the winter months. The Vinters' Federations in Ireland disputed the economic evidence and argued that their members have seen a drop in sales of between 15-25% since the introduction of the ban. No data was presented in support of this.
Ventilation
The usefulness of ventilation systems in removing ETS was discussed at some length. The majority of speakers pointed to the weight of international evidence which suggested that current ventilation systems could not provide protection against the harmful effects of ETS and that this has been acknowledged by the tobacco industry.
Proposals from the licensed trade in Scotland
The licensed trade in Scotland argued that significant progress has been made through the Voluntary Charter. However they now recognised that legislation is required to create a level playing field within the industry. They claimed, however, that if a total ban were to be introduced quickly, then there would be a catastrophic effect on large and small businesses and the wider economy as a whole. No evidence was presented to support this.
The Scottish Voluntary Charter Signatory Group, comprising the Scottish Licensed Trade Association, the Scottish Beer and Pub Association, the British Hospitality Association and the Scottish Tourism Forum, proposed a five point plan over a three year period, which would be reviewed after that time. The plan consisted of - no smoking at the bar, smoking should not be permitted where and when food is being served, all licensed premises should be required to allocate a minimum of 30% of total floor space as non-smoking (rising to 40% in year 2 and 50% in year 3), every licensed premise should have a smoking policy sign at the entrance, and smoking should not be permitted back of house (where the public are excluded). They indicated that this was similar to arrangements which had been in place in Norway, who were now moving to a total ban over a number of years.
Taking forward legislation to increase smoke-free legislation
Those speakers who provided evidence in support of controls on smoking in public places, including the workplace, provided advice about implementation and enforcement. This suggested that:
public support for legislation will increase with public awareness and education; it is not a trade-off between health and business;
a level playing field is very important to business; a total ban is easier to implement and enforce;
compliance measures need to be built up with employers and managers in the run up to legislation, including the preparation of model procedures;
there is a need for sound baseline information and on-going monitoring to review progress and the impact of action taken;
there is a need to be prepared for extensive lobbying by the tobacco industry;
smoke-free legislation should be only one component of a comprehensive tobacco control programme, comprising taxation, cessation and education.
The way ahead for Scotland
The Scottish Executive has undertaken to look at all of the evidence presented at the conference, along with other commissioned research and the results of the current public consultation before reaching a decision on how to take action to reduce exposure to second-hand smoke in Scotland.
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