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					National Public Health Service for Wales   Response: Consultation on the Smokefree
                                           Elements of the Health Improvement and
                                           Protection Billl




Consultation on the Smokefree Elements of the
   Health Improvement and Protection Bill

    A response on Behalf of the National Public
            Health Service for Wales




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Version: 28 July 2005                          Date:           Status: Final
Authors: Carolyn Lester and Ian Scale       Page: 1 of 18
Wider Determinants and Inequalities Team
National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl


Introduction
The National Public Health Service for Wales (NPHS) welcomes the opportunity to respond
to this important consultation on smoking in workplaces and specified public places.
Community interventions for reducing smoking among adults have not had great success.
Indeed a Cochrane review has shown that the largest and best conducted studies fail to detect
any significant effect (Secker-Waller, 2004). Smoking should, therefore, be actively
discouraged by responsible governments, who should protect non-smokers from the health
damaging effects of environmental tobacco smoke (ETS) by legislating for totally smoke free
workplaces and enclosed public places.

The NPHS will use the best available evidence to respond to the issues raised by this
consultation, based around the following findings:
   health risks: ETS increases the risk of serious illness and premature death
   economic impact:: no adverse impact has been found by independent studies
   effectiveness of ventilation: ventilation and extraction are ineffective
   human rights issues: right to a smoke-free environment should take precedence
   impact of smokefree legislation on prevalence: likely to reduce prevalence
   enforcement:: smokefree legislation has been successfully enforced in other countries.



The evidence base demonstrates that the most effective route to protecting the public is to
require specified public places and workplaces to be totally smoke free. This is likely to have
a positive economic impact, a good deal of public support and experience from countries
where such legislation has been enacted shows that it would be enforceable.

ETS in workplaces and public places remains a threat to public health, even where „no
smoking‟ areas are provided. Both the UK Government and the Welsh Assembly Government
(WAG) have signed up to Article 8 of the WHO Framework Convention for Tobacco Control
(2003). This states that signatories should adopt or implement “effective legislative, executive,
administrative and/or other measures providing for protection from exposure to tobacco
smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other
public places”.



Responses to specific questions raised in the consultation
Q 1: Does the proposed definition of smoke and smoking raise any concerns, in particular,
that non-tobacco cigarettes are not covered?

Since there is no evidence that herbal cigarettes are harmful to health (possibly because such
research has not yet been carried out), the main issue here would appear to be enforcement.
However, any smouldering substance in a workplace or public place is a health and safety
issue: there is increased risk of burns to those in close proximity and a fire risk. Enforcement
would be much more straight-forward if the legislation were to cover any smoked substance.
If environmental health officers (EHOs) have to take samples of cigarettes to be analysed to
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Wider Determinants and Inequalities Team
National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

detect tobacco, this will add to the costs and difficulty of enforcement. There is also a
possibility that this might increase the risk of customers attempting to smoke cannabis masked
with herbal substances.



Q2: Is the definition of enclosed public places sufficiently clear or subject to loopholes?

The definition is fairly clear but some questions remain.

Presumably the restrictions would include structures with a moveable roof, such as the
Millennium Stadium. In such structures the ban should be present whether or not the roof is
open, as it could be necessary to close the roof during a match or performance.

The implication of including “fixed or movable, permanent or temporary” structures would
imply that marquees and tented structures would be subject to the legislation, but it would
helpful to state this clearly. It should also be made clear that the ban could not be avoided by
opening a high proportion of side panels.

The intention of the legislation is unclear regarding establishments such as beer gardens,
outdoor bar areas and pavement cafes serving drinks only, as they are not enclosed within the
given definition. In the interests of clarity, NPHS would advocate that all such areas should be
smoke free.



Q3: Views on other public places and workplaces outside the definition of enclosed.

All workplaces where people are in close proximity or share rest areas should be smoke free.
Railway, bus and coach stations, shelters and places where people congregate in close
proximity should, ideally, be included. (In practice, the „close proximity‟ definition may be
difficult to enforce, so the Bill may need to be more specific). Outdoor events including
concerts, theatre, and sports should be smoke free, as should children‟s play areas. No-
smoking seating should be provided in parks and streets. Public opinion is strongly in favour
of protecting children, who may be present in all these settings. In a recent ONS survey 94 per
cent of respondents thought that there should be smoking restrictions in places where there are
likely to be children under the age of 16 years (ONS 2004).



Q4: Is the longer lead in time for licensed premises appropriate?

It should not be necessary to provide a longer lead in time for licensed premises. Licensees
have known for several years that this type of legislation is likely to be introduced and have
had adequate time to consider the implications. This is not an isolated attempt at legislation
and there is abundant evidence of the likely positive outcome, both for the industry and for
public health, from the USA, Australia, Ireland and other European countries. The recently
passed Scottish legislation comes into force in March 2006 and there appears to be no reason
to delay enforcement in England beyond March 2007. Whatever date is finally chosen,

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Wider Determinants and Inequalities Team
National Public Health Service for Wales        Response: Consultation on the Smokefree
                                                Elements of the Health Improvement and
                                                Protection Billl

legislation should be brought in on a single date so that employers, employees and citizens in
general are absolutely clear about what is required of them.



Q5: Views on exceptions for certain types of licensed premises

The NPHS together with organisations including the British Medical Association, Royal
College of Physicians, Faculty of Public Health and Cancer Research UK strongly oppose the
proposed exemptions, as they will leave thousands of high risk workers unprotected.

Figures from the Irish Tobacco Action Plan (DHSSPS, 2003) show that, before the smoke free
legislation, 52 per cent of men and 45 per cent of women were regularly exposed to ETS.
Exposure is highest in the 16-24 age group (76 per cent of males and 74 per cent of females),
probably reflecting time spent in bars and clubs. The type of bars and clubs frequented by
young people are likely to be those that will continue or choose not to serve food if
exemptions are allowed. This alone would be a good enough reason not to allow exemptions,
as young people should be protected from environments that encourage the uptake and
continuance of smoking.

The definition of “prepare and serve” is problematic: would it, for example, include
microwaving pre-packaged products such as pies and pasties? The definition of allowable
products in smoking pubs is given as “pre-packaged ambient shelf-stable products”, but this
means very little to members of the public. Is it only crisp and nut type snacks, or would it
include long life pastry based products and pickled food? The exemption rules will be difficult
to define and enforce and may require multiple visits by environmental health officers. It is
likely that the cost of enforcement will be passed on to the hospitality trade, in the form of
charges for exemption applications. If this was made clear to the relevant trade associations,
they might be less favourable towards exemptions.

Choosing Health (DOH 2004) estimates that 10-30 per cent of pubs will choose not to serve
food and would be exempt. Many of these premises are likely to be „locals‟ in disadvantaged
areas, for example, pubs in the north east of England, are more likely to be “drinking pubs”
that do not serve food. There is already a higher risk of respiratory and heart disease in such
areas and the exemption has the potential to increase health inequalities.

The risk of increasing health inequalities also applies to bar staff in „local‟ pubs and social
clubs, who are among the lowest paid workers in the UK. Bar staff are the group at greatest
risk of ill health and premature mortality linked to ETS (SCOTH 2005) and the continued
exposure of staff in exempted premises cannot be justified.

Exempting a category of workplaces from smoke free legislation may be subject to legal
challenge under the Health and Safety at Work Act (1974). Employees suffering adverse
health effects linked to ETS in the workplace would be able to bring an action for damages
under the Act and trade associations should be aware of this potential cost to the industry.

It is also possible that licensees who presently serve food may fear that trade will be lost if
smoking is not allowed, so may cease serving food, which could result in increased alcohol
consumption and increased risk of intoxication when drinking without food. Among smokers
included in the recent ONS survey (2004) only 12 per cent said that they would be likely to
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                                                 Elements of the Health Improvement and
                                                 Protection Billl

visit pubs less often if they became smoke free. This should be balanced against the 30 per
cent of non-smokers who said that they would go more frequently. In the same survey 73 per
cent of the smokers said that they would like to quit and a smoke free venue for socialising
can only aid this intention. The fear of loss of trade is unfounded, as the small decrease in
alcohol consumed in Irish pubs when they became smoke free was in line with previous trends
which were similar to other parts of the UK and Europe, where there has been a trend towards
drinking at home rather than in bars. This trend is confirmed by two surveys for the licensed
trade (Mintel, 2003, Interbrew 2004). A spokesperson for Cancer Research UK explained this
neutral outcome by saying, “Because the Irish smoke free law covered all licensed premises, it
created a level playing field for the pub trade. This was undoubtedly an important factor in
ensuring that no elements of the hospitality trade were affected.” (Cancer Research UK,
2005). The British Beer and Pubs Association has said that creating an opt out for clubs would
produce “a gross distortion of the market” and has stated that the legislation should be
“applied equally across all sectors of the hospitality industry” (ASH 2005).

It has been observed that better quality research shows that smoke free legislation does not
have a negative impact on profits in the hospitality industry (DOH 2004, Scollo 2003). This is in
direct contrast to work funded by the tobacco lobby. The lack of adverse economic impact and
sometimes noticeable positive impact on the licensed trade is confirmed by research in several
places where smoke free legislation has been enacted (Glantz 1997, 1999 & 2000, Wakefield
2002, Scollo 2003).

Public opinion has been moving in favour of smoking restrictions from 48 per cent in the mid
1990s favouring restrictions in pubs to 65 per cent in 2004 (ONS 2004). The increase in those
in favour of totally smoke free pubs has accelerated even faster from 20 per cent in 2003 to 31
per cent in 2004, probably because more people are becoming aware that the risks cannot be
effectively dealt with by „no smoking‟ areas or by ventilation systems. This change in public
opinion seems to be a linear trend which will continue to increase those in favour of smoke
free pubs. It is also likely that the legislation will become more popular once it comes into
force: in Ireland post legislation support has risen to 93 per cent (ASH 2005).



Q6: Exemptions for residential premises, including individual human rights

Places where people normally live are obvious candidates for some form of exemption and
NPHS suggestions are as follows:

Hotels, B & B, hostels, halls of residence: Owners should have the option to designate not
more than 25 per cent of the rooms for smokers to reflect the prevalence of smoking in the
population. This proportion should reduce in line with targeted reductions is smoking
prevalence. Public/communal areas should be smoke-free.

Adult hospices, psychiatric hospitals/units: Smoking should be confined to specified areas
in order to protect other residents and staff.

Prisons and detention centres, police premises: Consultation should take place with the
prison service and the police to ensure that that there is a change in the culture of places of
detention, so that smoking is actively discouraged. This change should be linked with
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National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

effective cessation services available on request. Most prisoners who smoke resemble
smokers in the free population, in that they would also like to quit. (Lester, 2003)

Private or privately hired vehicles: As a general rule, vehicles for hire should be non-
smoking.

Single self-employed persons: People who work entirely alone should be free to choose, but
where clients visit the workplace, it should be smoke free.

Vehicles used for work by one person: This definition is unclear. Does it mean never used
by another person or used by one person at a time. If the latter, i.e. vehicle with consecutive
sole users, the vehicle should be smoke free.

Oil and gas platforms: It is unclear why these should be exempted, other than the difficulty
of enforcement. Workers on these installations should also have the right to a smoke free
atmosphere.

On the general point of respecting human rights, the right of non-smokers to breathe
unpolluted air should always take precedence. This approach is both democratic and
beneficial to public health. Under the Human Rights Act it may be illegal to expose
employees or members of the public to avoidable health and safety risks. This is particularly
important in the case of pregnant women or women of childbearing age who might
unknowingly be in the early stages of pregnancy, as research shows that ETS is a serious risk
factor in low birth weight (SCOTH 1998). This would deny women in this category the right
to safely use exempted premises.

A primary principle of public health legislation should be that the right of the individual to
choose must be balanced against potential adverse impacts that any choice will have on
others. It has been argued that it is an infringement of human rights to restrict consumers‟ use
of a legal substance. Banning smoking in public places and workplaces, however, is no more
than a logical extension of established and accepted restrictions: for example, smoking is not
usually allowed on public transport or in cinemas, theatres and concert halls. The use of other
legal substances is also restricted in public places: for example, some cities prohibit the
drinking of alcohol outdoors in areas which are not part of a restaurant, bar or café.

The human rights argument is frequently raised by smokers but, from a public health point of
view, the rights of the non-smoking majority who are subjected to involuntary health risks are
of paramount importance. The Scottish courts have decided that there is no right to smoke at
work and in England employment tribunals have recognised the right to be protected from
passive smoking (BMA 2002). It could be illegal under the Health and Safety at Work Act
(1974) to discriminate against any class of employee or member of the public by exposing
them to avoidable health and safety risks.



Q7: Membership clubs

There is a risk that smokers may move from pubs to membership clubs, especially in
disadvantaged areas, so exempting these premises would tend to disadvantage small „local‟

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National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

pubs and increase health inequalities. Ideally the NPHS would prefer that private clubs were
smoke free, but if this is not possible, the following suggestions are offered.

Regarding the proposed annual ballot on smoking, it is not specified whether this should be of
committee members only or the full membership. It is suggested that the ballot should be of
the whole membership and that at least a two thirds majority should be required to continue
the exemption.

Staff in membership clubs would remain at risk if the premises were exempted In such
premises, bar staff should be protected by separating the bar from a designated smoking room,
as happens in some establishments in Italy, i.e. the bar itself should be smoke free.

There is no mention of clubs that admit children, who are particularly vulnerable to the health
impacts of ETS (SCOTH 1998). As mentioned previously, 94 per cent of the public believe
that there should be smoking restrictions in places that admit children under the age of 16
(ONS 2004).



Q8: Potential difficulties within respondent’s workplace

NPHS is an NHS organisation and is already smoke free.



Q 9: Views on arrangements for signage

There are no problems envisaged regarding the proposed regulations for signage.



Qs 10 & 11: Views on offences, penalties and defences

    i)      Not displaying a sign: The fine seems rather low. Is it planned to rise in line with
            the period over which a sign was not displayed or for repeat offences? Not being
            aware that the sign was not displayed seems an inadequate defence if signage was
            absent for more than a day.
    ii)     Failing to act to prevent smoking: Again the level of fine is very low: the
            Scottish legislation provides for fines up to £2,500. The defence of being unaware
            is probably inadequate in most circumstances. The defence of having asked the
            smoker to stop, whilst warning that it was an offence is reasonable. Will there be a
            defence of intimidation – i.e. the responsible person had been threatened not to
            intervene?
    iii)    Knowingly smoking on smoke free premises: As above, the level of fine is much
            lower than in Scotland, where it can be up to £1,000. Perhaps a banning order for
            repeat offences could be considered.




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Wider Determinants and Inequalities Team
National Public Health Service for Wales          Response: Consultation on the Smokefree
                                                  Elements of the Health Improvement and
                                                  Protection Billl

For offences i) and ii), there is no mention of loss of license for persistent offences and this
should be considered as an option.



Q12: Views on enforcement

The law would be much simpler and cheaper to enforce if there were no exemptions for
licensed premises. As stated in the Regulatory Impact Assessment, enforcement work in
Ireland is already decreasing due to very high compliance rates (97 per cent). This is probably
so because the law is clear and unambiguous, providing no opportunity to exploit loop holes
or necessity to bring test cases. An important contributory factor to Irish success is thought to
be early prosecutions, which set the scene for rigorous enforcement at the outset.

Enforcement by environmental health officers may entail repeated visits to premises applying
for exemption and it is likely that there will need to be a number of test cases before the law is
completely clear and lack of clarity may undermine compliance.



Q13: Smoking at the bar in exempted premises

Creating totally smoke free work environments is the most effective measure for reducing
exposure to ETS (NICE 2005).

As the document states, there is no proven benefit to banning smoking in a small area near the
bar and this is purely a cosmetic offer by the industry which allows them to appear to be
caring employers. There is no point in encouraging this voluntary activity if it means that bar
staff remain at risk. This is a health inequalities issue as bar staff in local membership clubs
and in the type of small pub that is likely to apply for exemption are amongst the lowest paid
in the UK. These individuals may have only a very limited choice of jobs available to them
and may be compelled to continue working in an unhealthy environment.

The best course of action is to have no exemptions. A World Health Organisation working
group recommended that public health policy and actions should aim to eliminate exposure to
ETS by creating smoke free environments for all, by means of education and legislation
(WHO, 2000). It concluded that voluntary arrangements are not sufficient. An example of the
failure of voluntary compliance is evident in Scotland where the Public Places Charter has
been largely ineffective: three years following introduction only 15 per cent of those
businesses surveyed were fully compliant (Scottish Executive 2003).

Regarding risks to bar staff in exempted premises, higher concentrations of salivary cotinine
are found in workers exposed to ETS. This demonstrates the internal presence of tobacco
smoke products at a level associated with substantial involuntary risks of cancer and heart
disease (Bates, 2002). The MONICA study in Scotland has demonstrated that levels of ETS
exposure show a linear relationship with poor lung function (Chen, 2001). ETS is, therefore, a
significant occupational hazard for bar staff. A review of exposure in the workplace (Siegel,
1993) has concluded that, controlling for active smoking, bar staff had an increased risk of
lung cancer of around 50 per cent compared with the general population. It has recently been
calculated that those working in bars are at especially high risk as they are exposed to three
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National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

times the level of ETS as non-smokers living with a smoker. Consequently this group is
almost twice as likely as those exposed at home to die from a smoking related disease
(Bhattanchanya, 2004).

The fact that smoke drifts means that attempts at segregation, particularly within the same
open area, are totally ineffective. Ventilation systems are expensive and, though they can give
the illusion that ETS is reduced (Philip Morris USA, 2004), fail to remove carcinogens and
other pollutants harmful to health (Carrington, 2003).

Smoke-free legislation has a positive effect on the health of bar workers. Research in
California found that self-reported exposure at work declined from a median of 28 to 2 hours
a week Eisner 1998) and that of thirty-nine bartenders who initially reported respiratory
problems, the lung function of 32 (78 per cent) significantly improved.



Q14 Timetable for enforcement

The proposed dates seem overly generous and it is felt that enforcement could be accelerated.
As stated elsewhere in the document, the government has been working with the hospitality
industry since 1998 on voluntary measures with little success. Given this long „notice period‟,
and factors including Irish and Scottish legislation, and Welsh aspirations, plus the expressed
desire of several major English cities to become smoke free, the hospitality industry is well
aware that an England and Wales bill is inevitable. The Scottish legislation will come into
force in March 2006, so it would be reasonable to expect all premises covered by an England
and Wales Bill to be compliant by March 2007, with no exemptions. (See also response to Q
4.)



Q15: Binge drinking

There is a genuine risk that bars may stop serving food in order to permit smoking and this
could encourage more drinking and more intoxication due to lack of food. This will clearly
undermine the Government‟s alcohol strategy. The risk could be avoided by requiring all
public places serving food or drink to be smoke free.



Q16: Public health implications, including health inequalities

Exempted pubs and clubs are most likely to be in disadvantaged communities where smoking
prevalence is already higher. This will hinder Government objectives to cut smoking
prevalence and reduce health inequalities. The Regulatory Impact Assessment gives detailed
estimates for some aspects of the four proposed options, but fails to show the likely difference
in smoking prevalence between overall smoke free legislation and legislation with
exemptions. In 1992 an internal Philip Morris document stated, “Milder workplace
restrictions… have much less impact on quitting rates and very little on consumption.” (ASH
2005). A policy similar to that of Ireland is likely to be more effective in supporting cessation

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Wider Determinants and Inequalities Team
National Public Health Service for Wales        Response: Consultation on the Smokefree
                                                Elements of the Health Improvement and
                                                Protection Billl

as 99 per cent of smokers who visit Irish pubs now only smoke outside or not at all. (See also
responses to Qs 5 & 7)




Annex B: Partial Regulatory Impact Assessment


8 & 9: The potential reduction in smoking will be less if smokers change their drinking place
to one where smoking is allowed, i.e. a non food pub or private members club. Maximum
effect can only be achieved if this is not an option, i.e. no exemptions.



10: Smoking Kills (1998) states that “completely smoke free public places are the ideal” and
this Bill should be bold enough to aim at attaining the ideal. As previously stated, public
opinion is changing and a publicity campaign should accelerate this process by informing the
public that segregation and ventilation are ineffective. Progress in partnership with the
industry has been largely cosmetic and especially poor in areas of socioeconomic
disadvantage where a larger proportion of the clientele smoke. This indicates that the industry
is likely to take advantage of any legislation with exemptions and loopholes, which is unlikely
to help disadvantaged smokers who wish to quit or bar workers, who will continue to be
exposed.



12. Bullet 1 - Having a “formal written smoking policy” does not necessarily equate with a
meaningful reduction in smoking on the premises and without legislation these policies are
unenforceable.

Bullet 2 – “ventilation that meets the agreed standard” may improve the appearance of the
atmosphere, but many carcinogenic particles will remain. There is no safe level of exposure to
ETS (BMA 2002). Filtration systems can only deal with particles and cannot remove the gas
phase of ETS. An assessment of filtered tobacco smoke concluded that it was no less
carcinogenic than unfiltered smoke (BMA, 2002).

Evidence that ventilation systems are ineffective in protecting customers from the effects of
ETS is growing. A UK study (Carrington, 2003) examined ETS concentrations in bars and
pubs to investigate the effects of smoking area status and ventilation. The authors concluded
that the use of ventilation systems had no significant effect on ETS marker concentration in
either smoking or non-smoking areas. Many of those who do not support totally smoke free
pubs mistakenly believe that „no smoking‟ areas and ventilation provide effective protection
against ETS




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National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

A major cigarette manufacturer, (Philip Morris USA, 2004) in its position statement on Public
Place Smoking acknowledged that ventilation fails to provide protection from the adverse
health effects of ETS, whilst giving the illusion of doing so:

“While not shown to address the health effects of second-hand smoke, ventilation can help
improve the air quality of an establishment by reducing the sight and smell of smoke and by
controlling smoke drift.”.



14 & 15 – Benefits could be lower than predicted if pubs in disadvantaged areas continue as
“drinking pubs”, as is likely, or people in these areas move to private members clubs. Those
living in poorer areas will have more adverse health determinants in other aspects of their
lives, so are more likely to be susceptible to smoking related illness due to multiple risk
factors.



16 International evidence, including that from Ireland, shows that becoming smoke free does
not reduce bar sales. A review of the quality of studies examining the effects of smoke-free
policies in the hospitality industry found that the highest quality studies reported no impact or
a positive impact on sales and/or employment (Scollo 2003). The authors concluded that
policy makers could be confident in acting to protect workers. Studies which suggest that
smoking bans are damaging to the hospitality trade tend to be of poorer quality and are often
funded by tobacco interests (DoH, 2004).

Enforcement costs are likely to be higher under legislation that allows exemptions. If a
helpline is installed to deal with enquiries regarding the smoke free policy, this could be
linked with telephone advice on quitting smoking. Review level evidence shows that
telephone advice can be effective in increasing cessation rates as part of an anti-smoking
campaign (Health Development Agency 2004, NHS Centre for Reviews and Dissemination,
2000).

Loss of profit may be a risk in „local‟ pubs where clientele may move to membership clubs
where smoking is allowed, such as British Legion so, in the interests of a „level playing field‟
it would be better if these were not exempted.

Unintended consequences – The most important possible unintended consequence which has
been raised is the question of whether or not people who used to smoke in establishments that
become smoke free may smoke more at home, thus exposing those who share the home,
especially children, to increased ETS. However, a recent report from the Royal College of
Physicians (2005) states that, “By helping smokers to quit smoking, and by changing usual
patterns of smoking behaviour, smoke-free policies in public and workplaces increase the
number of smoke free homes.”




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Wider Determinants and Inequalities Team
National Public Health Service for Wales        Response: Consultation on the Smokefree
                                                Elements of the Health Improvement and
                                                Protection Billl

Option 1

20 & 21 NPHS agrees that the industry proposals are wholly inadequate. Voluntary self
regulation of smoking is largely ineffective. To comply with the 1999 Public Places Charter
which was supported by the main hospitality industry organisations have only to have a
written policy on smoking and external signage indicating the type of policy in operation. The
targets were for 50 per cent of premises to adopt the policy and for 35 per cent of these to
include restrictions on smoking, so it would have been surprising if this had caused a
significant increase in smoke free licensed premises. Where change did occur it was often no
more than signage to indicate that smoking was allowed throughout or that the premises were
ventilated. Reports from major English cities including Leeds and Birmingham confirm that
after four years of the voluntary Charter there was a low level of compliance and “abysmally
low” interest in creating smoke free areas (Environmental Health Journal 2003).

The predicted loss of tobacco revenue under Option 1 is stated as half those of Option 2. This
is overstated as previous experience shows that, in a regime that allows exemptions,
reductions are likely to be minimal.



26 The low proportion reported as favouring a total ban probably reflects the commonly held
erroneous belief that segregation and ventilation are effective. (See response to point 12.)



27. It would be difficult to enforce legislation on smoking at home when a workman is on the
premises. However, as a general rule, a person entering another‟s home for the purposes of
work should be entitled to refuse to carry out the work if the occupants are smoking in the
same room. (See response to Q6)



28 As previously stated, enforcement costs would be lower under legislation covering all
bars, and clubs, without exemptions.



29 Local legislation has even greater potential to increase health inequalities and UK wide
legislation would be both the more equitable option and easier to enforce. If local authorities
are allowed to make individual decisions, it is possible that councils representing the most
deprived areas, which also have the highest proportion of smokers, would be reluctant to
impose restrictions. This would further disadvantage those in the most deprived areas and
could make enforcement more difficult, particularly in bars and restaurants in adjoining local
authorities. This approach is not favoured by the industry due to difficulties in premises near
local government borders. Similar problems could arise if different rules apply in England,
Scotland and Wales.




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Wider Determinants and Inequalities Team
National Public Health Service for Wales         Response: Consultation on the Smokefree
                                                 Elements of the Health Improvement and
                                                 Protection Billl

32 Public opinion is changing with more people subscribing to the view that ETS is a health
risk which needs to be controlled by legislation (ONS 2004). Most research on the affects of
smoking restrictions has been carried out in the United States and has shown positive impacts
for businesses and for the public. Outcomes in the UK are likely to be even more positive as a
survey carried out by Philip Morris Incorporated demonstrated that European smokers were
more accepting of smoke-free regulations than were Americans (Glantz, 1999).



33 It is stated that loss of benefit will be in “non-workplace enclosed places (for example
pubs)” Pubs are workplaces for bartenders, who have been shown to be at considerably
increased risk of ill health due to ETS. (See response to Q 13.)



34 It has been estimated that 10-30 per cent of pubs will be defined as not preparing and
serving food. This is a very broad estimate, so it would seem irrational to estimate the benefits
as being 40 per cent of a total ban rather than being also expressed as a range. If the
proportion of non-food pubs reached anywhere near to 30 per cent then it is highly unlikely
that benefits would reach this level partly because the most vulnerable people would be likely
to use the „drinking pubs‟.



35 The cost for Option 4 is estimated at £20m+, compared with £20m for Option 2. Whilst
this acknowledges that there is likely to be an additional cost, it rather underplays the likely
extent. The costs for enforcing Option 2 are likely to decrease rapidly in line with the Irish
experience, whilst costs for Option 4 are unlikely to fall due to the added and continuing
complexity of enforcement.



Cost benefit table – page 33-34

It is illogical to give the averted deaths in employees as 21 for both options 2 and 4, as more
bar staff will be exposed to ETS in Option 4 and therefore there will be fewer deaths averted.
Similarly for Option 3, the number is highly unlikely to reach 21. This principle applies to
most of the table, which tends to underplay the advantages of Option 2.



38 Equity and fairness – The fairest approach is to require all workplaces and public places to
be smoke free. If exemptions are allowed, the situation of bar tenders in smoking
establishments will be grossly inequitable. There is also the risk that this measure may
increase health inequalities for the reasons previously stated.

There will be some issues around working with communities where smoking is very much a
cultural norm, such as male Bangladeshis where over half are smokers. Bangladeshis are
prominent in the „Indian‟ restaurant trade and compliance problems may arise within a group
where smokers are still in the majority.
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39 Regarding competition, Option 2 is fairer as it provides an even playing field. and avoids
the risk of loss of trade when clientele move from non-smoking to smoking pubs or clubs.



40 Rural proofing – For many people there will be only one pub that is easily accessible
without driving, so no genuine choice for drinkers would be possible under any option.
Allowing exemptions may encourage smokers to drive to „drinking pubs‟ and thus increase
the risk of road traffic accidents.



41 Small businesses – See response to point 39 above.



43 Enforcement – See previous comments regarding ease and economy of enforcement
without exemptions.



47 Public opinion – see previous comments on how opinion is gradually changing and
possible reasons why public opinion is not even more in favour of completely smoke free
pubs.




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