“Acts of whatever kind, which, without justifiable cause, do harm to others, may be, and in the more important cases absolutely require to be, controlled by the unfavourable sentiments, and, when needful, by the active interference of mankind. The liberty of the individual must be thus far limited; he must not make himself a nuisance to other people.”
John Stuart Mill “On Liberty”, Chapter 3
Legislation to require all employers to ensure that their workplaces are smokefree is a key public health measure for three reasons.
- First, secondhand smoke is dangerous to the health of non-smokers and in particular is a workplace health and safety risk.
- Secondly, the current law offers wholly inadequate protection to employees and members of the public
- Thirdly, ending smoking in the workplace would be probably the single simplest and most effective means of cutting smoking rates and would most benefit poorer and socially excluded communities.
This paper also shows that the level of public support for smokefree workplaces is high, and that this is likely to mean that enforcement of a new law would be relatively simple and cheap.
Health
There is more than sufficient evidence for policy-makers to conclude that secondhand smoke is a very serious and inadequately regulated workplace health and safety hazard.
Tobacco smoke contains over 4000 chemicals in the form of particles and gases.[1] The particulate phase includes tar (itself composed of many chemicals), nicotine, benzene and benzo(a)pyrene. The gas phase includes carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde, hydrogen cyanide and acrolein. Some of these have marked irritant properties and almost 70 are known or suspected carcinogens (cancer causing substances). The Environmental Protection Agency (EPA) in the USA has classified environmental tobacco smoke as a class A (known human) carcinogen along with asbestos, arsenic, benzene and radon gas. [2]
Some of the immediate effects of passive smoking include eye irritation, headache, cough, sore throat, dizziness and nausea. Adults with asthma can experience a significant decline in lung function when exposed, while new cases of asthma may be induced in children whose parents smoke. Short term exposure to tobacco smoke also has a measurable effect on the heart in non-smokers. Just 30 minutes exposure is enough to reduce coronary blood flow. [3]
In the longer term, passive smokers suffer an increased risk of a range of smoking-related diseases. Non-smokers who are exposed to passive smoking in the home, have a 25 per cent increased risk of heart disease and lung cancer. [4] A major review by the Government-appointed Scientific Committee on Tobacco and Health (SCOTH) concluded that passive smoking is a cause of lung cancer and ischaemic heart disease in adult non-smokers, and a cause of respiratory disease, cot death, middle ear disease and asthmatic attacks in children. [5] A more recent review of the evidence by SCOTH found that the conclusions of its initial report still stand i.e. that there is a “causal effect of exposure to secondhand smoke on the risks of lung cancer, ischaemic heart disease and a strong link to adverse effects in children”. [6] The review concluded:
“SCOTH’s conclusion is that knowledge of the hazardous nature of SHS has
consolidated over the last five years, and this evidence strengthens earlier estimates
of the size of the health risks. This is a controllable and preventable form of indoor
air pollution. It is evident that no infant, child or adult should be exposed to SHS.
This update confirms that SHS represents a substantial public health hazard.”
More than two million people in Great Britain still work in workplaces where smoking is allowed throughout. Another ten million people work in places where smoking is allowed somewhere on the premises.
The figures were calculated by ASH using the Government’s Labour Force Survey for 2003 and the National Statistics Omnibus Survey, smoking-related behaviour and attitudes module, carried out in October and November 2003. The results have been verified by the Office for National Statistics. The detailed figures show that:
- 2,182,000 people work in places with “no restrictions on smoking at all”. This is 8% of those in work in Great Britain
- 10,366,000 people work in places where smoking takes place in “designated areas”. This is 38% of those in work.
Using SCOTH estimates of risk, Professor Konrad Jamrozik of the University of Queensland has estimated in an article for the British Medical Journal that exposure to secondhand smoke in the workplace:
- causes 54 premature deaths each year among hospitality industry employees – or more than one a week
- causes more than 600 deaths each year across the UK
For comparison, the total number of fatal accidents at work from all causes in the UK in 2003/4 was reported by the Health and Safety Executive as 235. [7]
Current Law
Current UK law provides inadequate protection against the risks of secondhand smoke. For example, although secondhand smoke is a workplace carcinogen it is not listed under the UK’s Control of Substances Hazardous to Health Regulations (COSHH). The Trades Union Congress says that the evidence clearly shows that failure to treat tobacco smoke in a similar way to other dangerous chemicals leads to the deaths or incapacity of many thousands of workers across the EU from lung cancer, emphysema, bronchitis and asthma. [8] Legislation to protect employees from secondhand smoke is also supported by most of Britain’s largest Unions, including the GMB, TGWU and UNISON.
The Health and Safety at Work Act (HSWA) 1974 may permit actions for compensation for health damage from secondhand smoke at work. But use of the HSWA will be slow and cumbersome. Illness may occur many years after exposure, and many victims may have been exposed to secondhand smoke both at home and at work. Strong cases will therefore be hard to find. Many claims will be settled out of court, and will therefore set no precedent.
Smoking Prevalence
Smoking is the biggest single cause of preventable illness and premature death in the United Kingdom, killing more than 100,000 people each year.
It is also the biggest single cause of inequalities in health. In Britain, health inequalities by class have actually increased over time, as the decline in smoking prevalence has been far higher in social class I than in other social classes. Smoking is the greatest single factor in the different life expectancy between social classes. The Wanless Report gave the following table (5.1):
Proportion of Males Dying Under Age 70
| |
Social Class I |
Social Class V |
Difference |
Actual proportion |
22% |
48% |
26% |
Actual proportion predicted if all population were non smokers |
15%
|
27%
|
12%
|
Estimate proportion attributed to smoking |
7%
|
22%
|
15%
|
Source: Department of Health analysis
Local data on smoking prevalence illustrate the close link between smoking and deprivation. An interactive map of wards in England and Wales, showing smoking prevalence rates mapped against relative rankings of deprivation can be found on the ASH main website. [9] Smoking prevalence rates are highest in social class V. As a result those in social class V who do not smoke are also more likely than other non-smokers to be exposed to secondhand smoke at work.
The impact of smoking on health inequalities is carried down from generation to generation. Children whose parents smoke are three times as likely to smoke themselves and are also more heavily exposed to the harmful effects of tobacco smoke pollution.
In consequence children from more deprived families have a higher risk of cot death, the onset of asthma as well as asthma attacks, respiratory diseases and ear infections. (1.5 million children in the UK have asthma – one in seven). Children in social class V may be doubly disadvantaged because they are also more likely to go on to become smokers themselves and suffer the ill effects of smoking, in particular lung cancer, heart disease and lung disease.
Therefore, improving the nation’s health requires a significant reduction in the number of people who smoke. This is not easy to achieve. Although 70% of smokers want to give up, less than 5% succeed each year. Tobacco in smoked form is the most highly addictive drug legally available and 90% of regular smokers start smoking before they are 18.
But most smokers want to quit. This is true for all socio-economic classifications. The 2003 survey by the Office of National Statistics, “Smoking Related Behaviour and Attitudes”, gave the following results for smokers wanting to quit: [10]
Would like to give up (%): |
Managerial &
Professional |
Intermediate |
Routine & Manual |
Never worked & Unemployed |
Very much indeed |
25 |
23 |
25 |
24 |
Quite a lot |
22 |
20 |
24 |
14 |
A fair amount |
19 |
14 |
14 |
29 |
A little |
6 |
9 |
7 |
6 |
TOTALS |
72 |
66 |
70 |
73 |
The Government already accepts the case for intervention to prevent people from starting to smoke and, once they’ve started, to help them give up. In 1998 it published the White Paper ”Smoking Kills”, which set out the strategy for achieving this. However, the White Paper targets are not sufficient to achieve the ‘fully engaged scenario’ set out in successive reports to Government by Derek Wanless. [11] This would require a fall in the number of smokers from 26% now to 17% of the population by 2011 and 11% by 2022. The Government will not be able to contain NHS spending as proposed under the ‘fully engaged scenario’ unless these targets are achieved.
When a workplace goes smokefree it can reduce smoking prevalence amongst workers by up to 4%. [12] People in lower paid jobs are far more likely to work in places where smoking is allowed, so legislation on smokefree workplaces would also help reduce health inequalities.
In his latest report to the UK Government (“Securing Good Health for the Whole Population”) Derek Wanless stated that: “voluntary approach to smoking in the workplace has had limited success” and that “A number of other countries have now implemented a workplace smoking ban via legislation. Some of this experience has been shown to be successful in reducing the prevalence of smoking. Public support for smoking restrictions has also been found, in surveys, to be high…” (para 4.21). “Some studies estimate that a workplace smoking ban in England might reduce smoking prevalence by around 4 percentage points – equivalent to a reduction from the present 27 per cent prevalence rate to 23 per cent if a comprehensive workplace ban were introduced in this country.” (Box 4.2).
For young people smoking is a social activity. It has been described by Professor John Britton (Professor of Public Health at Nottingham University) as “like an infectious disease which spreads from one person to another”. Therefore smokefree legislation which prevents young people from smoking in coffee bars, pubs, bars, clubs and other places they congregate is an effective means of reducing the numbers starting to smoke. For example, research has shown that young people in colleges with a no-smoking policy for staff and students were half as likely to smoke as those in colleges that allowed smoking. And those who did smoke consumed fewer cigarettes. [13]
The true reason for tobacco industry opposition to smoking restrictions in workplaces was revealed by Philip Morris in an internal document from 1992. The company said that “total prohibition of smoking in the workplace strongly affects industry volume. Smokers facing these restrictions consume 11% to 15% less than average and quit at a rate that is 84% higher than average … these restrictions are rapidly becoming more common … Milder workplace restrictions, such as smoking only in designated areas, have much less impact on quitting rates and very little effect on consumption”.[14]
Enforcement and Public Support
Smoking restrictions generally do not require intensive or costly enforcement. This has been the experience in Ireland and New York, and of course on the London Underground, other UK metro systems, buses and elsewhere. The reason for this is that such restrictions are generally observed by popular concensus.
In Ireland, the latest report from the Office of Tobacco Control shows that:
- Compliance with the smoke-free workplace legislation is very high
- 94% of all workplaces inspected under the National Tobacco Control
Inspection Programme were smoke-free
- 92% of all workplaces inspected by the Health and Safety Authority were smoke-free
- 93% of all hospitality workplaces inspected were smoke-free
- There is overwhelming support for the smoke-free law among smokers and nonsmokers
- 98% of people believe that workplaces are healthier
- 96% of people feel that the smoke-free law is a success
- 93% of people think the smoke-free law is a good idea
- Air quality in pubs has improved dramatically since the smoke-free law
- Levels of carbon monoxide have decreased by 45% in non-smoking bar workers
- 96% of all indoor workers report working in smoke-free environments since the
introduction of the smoke-free workplace law. [15]
In Britain, it is likely that a new law would be enforced through local authority Environmental Health Officers.
Support for smokefree legislation is strong across social classes. The most authoritative survey was conducted by MORI and commissioned by Action on Smoking and Health. More than four thousand people were interviewed between 15th April and 4th May 2004. The results showed:
Four out of five (80%) of those polled support a law to ensure that all enclosed workplaces must be smokefree.
- 86% of social class AB supported the proposal, 83% of social class C1, 79% of social class C2 and 72% of social class DE.
- Even regular smokers support a new law: the poll shows support from 59% of daily smokers and 68% of infrequent smokers.[16]
The least support for restrictions on smoking relates to pubs. But even here, in the 2003 ONS survey, 90% supported restrictions on smoking. [17] Pubs are among the workplaces with the highest levels of exposure to tobacco smoke amongst employees. Therefore if the principle is accepted that employees should be protected from this serious health and safety risk, it would not be justified to exclude pubs from any regulations. This level of support for ending smoking in pubs is also higher than in Ireland before smokefree legislation came into effect.[18]
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