Workplace Smoking Legislation – 10 years on, Dr Ross Morgan

Dr Ross Morgan2

All of us can look back with pride on the decision of the Irish government to introduce workplace smoking legislation on 29th March 2004 – 10 years ago. This health initiative has been replicated by countries all around the world, and the Irish government, that took such a brave and revolutionary decision have been rightly complimented for this lifesaving health initiative.

When we look back some 10 years we have to ask how an Irish government could have developed consensus around this initiative, tackled major opponents and simply put the health of the nation ahead of the wishes of well-established profit based vested interests. It all seems so obvious now, but at the time and in its time, this was ground-breaking.

There were a number of key factors which perhaps contributed to the Irish government’s decision. There was significant exposure of key information regarding the international Tobacco Industry in the 1990’s. This primarily emerged through major litigation against the industry in the United States. The World Health Organisation also decreed that environmental tobacco smoke was a Class A carcinogen and this essentially changed the entire debate. One could say that the individual has a right to smoke and suffer the health consequences, but that no individual should have the right to smoke in areas where other persons could be harmed. Clearly the workplace, which included bars and restaurants in particular, could be clearly defined as areas where environmental tobacco smoke harmed the non-smoker.

The revelations around the practices and activities of the Tobacco Industry through the US litigation also led to a significant reduction in the impact of their global advocacy machine. Governments, especially in the US, Europe and Australia became more questioning and in many ways were left with little option but to address the serious issues which had now been clarified in regard to the harmful effects of smoking and crucially, second-hand smoke.

During the 1990’s some major pro-health and anti-tobacco advocates became more prominent in Ireland, one of those being ASH Ireland. Two of its leading spokespeople at this time, Professor Luke Clancy and Dr Fenton Howell, had a deep interest in the harmful effects of tobacco, and the questionable practices of the Tobacco Industry. Groups such as ASH Ireland, the Irish Cancer Society and the Irish Heart Foundation ensured that the Joint Oireachtas Health Committee, under Deputy Batt O’Keeffe, examined the possibility of a workplace smoking ban in 2001.

In 2002 Dr Shane Allwright from Trinity College researched a range of available evidence on environmental tobacco smoke and produced a report entitled “The health effects of environmental tobacco smoke in the workplace”. This report essentially found that employees must be protected; that ventilation was ineffective; that environmental tobacco smoke causes heart disease, respiratory problems and cancer; and critically that legislation was required to deal with this. In responding to the report Minister Micheál Martin said “There is no moral option open to me other than to take action…. this report changes everything”.

The old arguments which had been put forward by the vested interests who were opposed to a workplace smoking ban were:

• Environmental tobacco is harmless;

• Ventilation works;

• Severe economic consequences will emerge from such a ban;

• This ban represents a nanny state policy.

These arguments were firmly rejected by the Allwright report and the leadership taken at this time by Minister Martin in introducing the legislation was critical.

It is also very clear that Tom Power, a most astute and strategic civil servant in the Department of Health, now deceased, was a key player in the entire process of planning for, and the introduction of the workplace smoking legislation.

From early on it was obvious that Minister Martin and the government would have significant support; emerging from opposition parties, the public service, the unions, and in particular major health bodies within the NGO sector. The introduction of the legislation in March 2004 represented a major success by the pro-health coalition and a major defeat for the Tobacco Industry and its partners. As other countries examined the possibility of introducing workplace smoking bans, they consulted with some of those organisations involved here in Ireland, and essentially adopted the Irish model as a way of implementing this health initiative.

The overall support among the Irish public for the workplace smoking legislation runs continuously, at 90% or greater. Whereas there is no direct scientific correlation, smoking prevalence in Ireland has been reduced from 29% to 21.7% over the past 10 years. In evaluating the drop in prevalence we also have to consider the introduction of the ban on advertising and promotion in retail outlets, and the greater awareness worldwide of the health risks directly linked to smoking and passive smoke.

In more general terms, we now have bars and restaurants that are generally smoke free and more importantly, carcinogen free. We are also aware that people who suffered from respiratory diseases such as asthma found it very difficult to socialise in bars and restaurants prior to the ban. Thankfully for them this is not now the case.

Evidence continues to accumulate for large public health benefits since the ban. Immediate improvements in lung function tests and reductions in symptoms were reported by barmen. Subsequently reductions in death rates, with specific benefits observed in heart attack, stroke, and respiratory disease have been found and these findings replicated in other parts of the world. Importantly, these benefits have persisted with longer follow up and been shown to be proportional to the extent of the smoke-free environment; the more comprehensive and encompassing the legislation the more significant the public health benefit.

At a recent seminar to celebrate the 10th anniversary of the introduction of the ban Professor Luke Clancy of the TobaccoFree Research Institute Ireland advised us that, as a direct result of the ban in Ireland, over 3,700 smoking-related deaths have been prevented in this country – and this is a very important bottom line. In addition, the smoking ban has been shown to reduce the number of small-for-gestational age or pre-term birth rates, demonstrating benefits from early life in a vulnerable population group.

ASH Ireland is firmly of the view that we must continue to introduce legislation and support initiatives which continue to denormalise smoking and protect the health of our citizens. Without doubt all of us in the medical profession have a specific responsibility in this area. ASH Ireland is strongly supportive of Minister Reilly’s plans to introduce a ban on smoking in cars transporting children; an initiative first raised by ASH Ireland, and we are also strong supporters of the proposal to introduce standardised packaging of tobacco. Currently ASH Ireland is involved in encouraging all county councils to introduce smoke-free children’s play areas and we have had a 75% positive response on this initiative.

Over the past 3 years we have been liaising with the third level sector with a view to voluntarily introducing smoke-free campuses and we are very pleased to confirm that several of our third level institutions are evaluating this health initiative.

Recently we have contacted the three main sporting bodies in this country, the FAI, IRFU and the GAA to again ask them to consider voluntarily introducing smoke-free stadia at local, regional and national level. This has the potential to be a vitally important initiative in regard to the de-normalisation of smoking among our young population.

Much has been achieved in this country in fighting the scourge of tobacco and nicotine addiction, but there is much more that can be done in assisting our citizens to quit and discouraging our young people from commencing the habit.