From ashtrays full of cigarette butts to smoke-free environments
(28 June 2017)
This week, it will be ten years since the smoking ban for enclosed workplaces in the UK came into force. Dr Andrew Russell from the Life of Breath research project takes a look at how things have changed.
Do you remember what it was like pre-2007?
It is hard to think back now to what English pubs and clubs were like before the law about smoke-free public places came into force. I remember the dense fog, the smell of tobacco smoke on your clothes after a night out, the ashtrays loaded with cigarette butts. Those lucky enough to be much younger than me probably won’t remember as it’s ten years ago when the law began. But it has been described as ‘the most important piece of public health legislation for a generation’.
What were the challenges in getting to that point?
Various options were proposed, including a plan to exempt private clubs and pubs that didn’t serve food (the so-called ‘wet pubs’). In some parts of England this would have excluded over half of all licensed premises. Lots of lobbying from a broad range of campaigners led to this proposal being quashed.
The clinching argument was that smoke-free enclosed public places were a workers’ health issue. People with jobs forcing them to remain in smoky environments often had no choice but to do so. The idea that these people were involuntarily subject to the health risks of second-hand smoke eventually pushed the legislation through.
What were the immediate results from the new law?
Apart from making public places more pleasant and healthier to be in, there was a spike in people deciding to stop smoking as a result of the ban. Everyone knew the health risks of smoking – the ban simply cut out many of the places where people might have wanted to light up.
There were other, unforeseen benefits as well. Figures soon showed a significant decline in hospital admissions for heart attacks, asthma and lung infections. In the year following the law, there were 2.4 percent fewer heart attack cases recorded in Accident and Emergency departments than the year before. 2.4 percent may not sound very much, but that represents 1200 fewer cases in the country as a whole.
These figures are even more dramatic if you bear in mind that many workplaces had already gone smoke free before the law came into effect. This makes the fact we can see a distinct drop before and after July 1st 2007 even more remarkable.
Were there any other consequences?
Some companies went further than required by the new law. The Association of Train Operator Companies and Network Rail decided to make all station premises smoke-free. Perhaps they were remembering the fire at Kings Cross underground station in 1987. It killed 31 and was blamed on a lit match thrown away by a smoker leaving the station.
The smoke free law also made people more aware of the dangers of second hand smoke everywhere, including in their own homes. In addition, the success of the measure gave people the courage to tackle other smoking-related issues that might once have seemed impossible to address, such as smuggled tobacco, plain packaging and other forms of advertising at the point of sale.
Just think of the slew of further policies which have come into place since then.
Vending machines (where young people could often obtain their cigarettes out of the watchful eye of adults) are a thing of the past. It is now illegal to buy cigarettes if you are under 18. Taxes on tobacco products have continued to rise. Smoking in private cars where children are present is banned. Ever since the law came into force, smoking rates have gone down year on year. Young people in particular seem to be going off the idea of smoking.
Where do we go from here?
Challenges remain, of course.
Smuggled cigarettes make it much cheaper for people to carry on smoking and are a problem in some parts of the country. Smoking rates in pregnancy, with the risks this carries for mother and baby, are also high in some parts.
Surprisingly, given the ease with which tobacco addiction can be managed these days, smoking is still allowed in some NHS grounds. E-cigarettes have muddied the waters of tobacco control, although they are without doubt safer than cigarettes. One of the questions about e-cigarettes is whether they should be part of the smoke-free laws, or whether they are harmless for bystanders.
Whatever one’s views on that score, support for smoke-free places is higher now than it was when the law first came in.
What research is taking place at Durham?
Durham University, through FUSE, the Centre for Translational Research in Public Health, works closely with Fresh, the regional tobacco control office, on a number of different projects. We are also conducting research into what is being done at the global level to counteract the power of tobacco and the pervasive influence of the tobacco industry.
The Wellcome Trust funded Life of Breath project at Durham and Bristol universities works closely with members of the British Lung Foundation’s ‘Breathe Easy’ groups. Some of the people in these groups are suffering the consequences of a long term, smoking-related illness. Findings from this research show how frequently people with lung conditions are highly sensitive to air quality. A smoke-filled environment for them is a nightmare. Children also suffer more from second hand smoke than adults, because their airways are smaller and they breathe faster.
There are certainly very few people, whether smokers former smokers or second hand smokers, who would like us to return to the smoke-filled clubs and bars of pre-2007 times.