SUCCESS, DIFFICULTIES AND CHALLENGES OF SMOKE-FREE BANS: THE POLISH EXAMPLE
Krzysztof Przewozniak, WHO Collaborative Center for Tobacco Control, Maria Sklodowska-Curie Cancer Center
Estimates showed that over 8,700 adult Poles, including 1,800 non-smokers died in 2002 from secondhand smoke (SHS). Although Poland has enforced smoke-free policy in worksites since the mid-1970s, those regulations were not comprehensive and complied.
When the Tobacco Control Law was enforced (1996) and the FCTC ratified (2006), Poland made attempts to introduce comprehensive measures. The law amendment proposed in December 2006 assumed complete smoking ban in many worksites, including hospitality venues. Unfortunately, the legislative work has been prolonged by new parliamentary election. In 2009-2010, many activities were conducted to popularize the best practice in smoke-free policy. While tobacco industry (TI) called for the Spanish model, tobacco control advocates showed its weak sides. Scientific arguments and strong public support convinced the Health Commission to vote for complete ban of smoking in gastronomic venues and other workplaces. However, this proposal was not supported by the ruling party that had majority in Parliament. During first reading, the Spanish model has been again proposed. Then medical society, NGOs and media counter-acted, organizing public support campaign and pressing senators to change the “bad law”. Finally, Parliament compromised to enforce the Italian-like smoking ban. In some workplaces, including gastronomic venues, manager might establish separate smoking room equipped with “effective” ventilation. However, recent studies show that both the law enforcement and education campaign addressed to workplace managers reduced a number of such venues and SHS exposure to low level. Nevertheless, tobacco smoke was not eliminated from worksites.
Polish example shows how the Spanish model might be used both by TI and tobacco control advocates, especially when TI has easy access to politicians who have no will for improving tobacco control measures. There is an urgent need to disclosure the TI conflict of interests and exclude them from participating in political public health committees and meetings.
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REGRESSION OF SMOKIN BANS: THE CASE OF THE NETHERLANDS
Lies van Gennip, STIVORO- Dutch Centre for Tobacco Control
The smokefree law was introduced in the Netherlands 1st January 2004, but the hospitality sector was allowed self-regulation. As this self-regulation did not work at all, the law was applied for the hospitality sector as well from 1st July 2008. The industry fought this law, partly directly, but mostly through groups such as “Foundation smokers interests” and “Forces”. Chairmen of these two groups set up a foundation “Save the small bars” and lobbied heavily to the politics, especially towards the Liberal party. The foundation “save the small bars” started law suits for bars that were fined because they were not smoke-free. Initially they won some law suits, but in the end the higher court decided the law was OK and the fines justified. However, in the mean time, there was a lot of media around these law suits and public opinion shifted.
In the elections in 2010, the Liberal party won. In the government agreement, the breaking down of tobacco control is explicitly stated, reversing of smoke-free and cutting budget for tobacco control. See the Zembla documentary of October 2011 at http://tinyurl.com/728j6j7, revealing the contacts of the liberal party Ministers Edith Schippers (Minister of Health) and Halbe Zijlstra (current Minister of Education) with the tobacco industry lobbyists. Zijlstra promised to Wiel Maessen reversal of smoke-free. Edith Schippers first public statement was reversing the smokefree law in October 2010.
As it was expected from experiences in other countries, it soon became clear that smoking returned also in other bars and discotheques. In the Spring of 2011, only 58% of the bars and discotheques that should be smoke-free were in fact smoke-free. For comparison, two years before in Spring of 2009, the compliance was much higher (83%).
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DOES THE MODEL OF COMPREHENSIVE SMOKE-FREE BAN MATTER?
Luke Clancy, Tobacco Free Research Institute
The EC Green Paper ‘Towards a Europe free from Tobacco Smoke (2007)’, defines comprehensive smoke-free law as a total ban on smoking in all enclosed or substantially enclosed workplaces and public places. Nevertheless the scope of smoke-free regulations varies widely and many countries have failed to enact FCTC compliant, comprehensive legislation creating smoke-free workplaces and indoor public places.
To compare the effect of the type of law on exposure to SHS, data on PM2.5 concentrations were identified in 7 EU countries. France, Ireland, Italy, Scotland were regarded as having comprehensive smoke-free laws and Spain, Greece and Portugal who at the time had partially compliant laws. For each country, local tobacco control experts provided TFRI with original datasets containing PM2.5 concentration levels and other details.Factors other than tobacco control policies in each of the countries that may influence the success of smoke-free policies were also considered including income/wealth, health expenditure, equity and social cohesion.
There was a decrease in PM2.5 concentration observed in all 7 countries. As expected the countries with partial laws all showed reductions in PM 2.5 which were less than in countries with comprehensive laws. Ireland and Scotland showed the greatest decrease in PM2.5 concentrations from pre to post smoking ban period. France and Italy also had levels lower than countries with partial laws however their overall reductions were notably smaller than in Ireland and Scotland, countries with truly fully comprehensive smoke-free laws. This suggests some level of secondhand smoke persists in nominally designated non-smoking venues in the hospitality sector in Italy and France. When all factors were considered in a regression analysis lower smoking prevalence among men and stronger enforcement of smoke-free legislation was associated with higher percentage changes (reduction) in PM2.5 concentrations. The level of enforcement made a stronger contribution to the final model.
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