Friday 1 July marks four years since England’s public places went smokefree. The Health Act 2006 protects the health of millions of us from the harmful effects of secondhand smoke by ensuring that all workplaces and most public work must be smokefree. A testament to the success of concerted collective campaigning by health charities and tobacco control advocates, this is a piece of legislation that has led to a genuine societal shift in behaviour. It now seems extraordinary that someone could light up in a bar, a taxi or a restaurant. A smokefree environment has simply become part of our culture.
But not so long ago, making public places smokefree seemed to be an impossibility. Back in 2002, I was working as a public affairs officer at Cancer Research UK. The charity – like many others – was increasingly concerned at the rising death toll from tobacco. We had strong evidence that secondhand smoke was harmful to health, contributing not only to cancer but to heart attacks, asthma and other respiratory conditions. Yet when we raised possibility of making England smokefree with policymakers we were met with resistance: the public weren’t ready, we were told, to put out their cigarettes to protect other people’s health.
The Labour Government had come to power with a strong commitment to tackling health inequalities. It had set out its stall in the Smoking Kills White Paper and taken firm action on smoking through the ban on tobacco advertising. The Government wanted to be really sure of public acceptance for further legislation, knowing they’d be tarred with the nanny state brush. Meantime, the ‘civil liberties’ lobby and Big Tobacco were vociferous in their opposition to any restrictions on where people could smoke – no matter what the health cost to others.
The political scepticism about the public’s willingness to go smokefree was such that for a while we toyed with campaigning for a half-way house, an Approved Code of Practice to which smokefree workplaces would voluntarily sign up. But a voluntary code would never protect the thousands of people in the hospitality industry who had to spend every day breathing in other people’s smoke. The charities came together and decided that it wasn’t good enough. We needed to be ambitious and to reclaim the civil liberties argument: it should be the right of every worker to be protected from secondhand smoke in their workplace.
It was a real campaigning lesson for me: always go all out for the thing you really want. There will always be those who argue against you – in our case the tobacco industry and its front groups – so why make it easy for them by starting with a compromise?
It took time but gradually the health community chipped away at the arguments against smokefree legislation, showing the weight of public opinion in favour of change. The Chief Medical Officer, Sir Liam Donaldson, backed a ban in his Annual Report, claiming it could not only save lives but save the economy as much as £2.7bn. At Cancer Research UK we harnessed the power of our donors and supporters, signing thousands of people up to supportive petitions at our fundraising events and in our shops. Large-scale polls showed to the press and politicians that smokers, as well as non-smokers, wanted to see England become smokefree. Key parliamentarians, including Kevin Barron MP and the late David Taylor MP, along with Lord Faulkner worked hard to bolster grassroots support in both Houses. Every organisation played its part, and it’s pretty hard to argue against collective weight of the British Heart Foundation, Asthma UK, ASH, the British Lung Foundation, The Roy Castle Lung Cancer Foundation, the British Medical Association, the Royal Colleges and many, many more. Together we won the argument and changed politicians’ minds. The day when, in a free vote, MPs voted by a majority of more than 200 for a smokefree England was the culmination of years of campaigning.
Four years on the evidence shows that the smokefree law has been a success. A review of the evidence commissioned by the Department of Health showed that it had rapid and positive effects on public health. In the first year after the ban, there were 1,200 fewer emergency admissions for heart attacks in England. Smokers cut down on their tobacco and around 300,000 smokers tried to quit around the time the ban came into force. Exposure of children – especially vulnerable to the effects of secondhand smoke – fell by nearly 70%. And despite the dark warnings of the tobacco industry that the ban would sound the death knell for the hospitality industry, there is no evidence that smokefree legislation had any harmful effect on pubs and restaurants. Indeed bar workers exposure to secondhand smoke reduced on average between 73 and 91%, with consequent improvements in their respiratory health.
Yet there is still more to do. The smokefree legislation, with all its benefits, was never going to be a silver bullet for the problem of smoking, which is still the single biggest cause of disease and death in the UK. Continued efforts will be needed to drive down smoking rates still further, prevent new smokers from taking up the habit and support those smokers who want to stop. Andrew Lansley’s stated ambition was to be Secretary of State not just for Health but for Public Health. He will need to ensure that the steps set out in the new Healthy Lives, Healthy People: a tobacco control plan for England are implemented effectively in the shifting backdrop of the new world to maximise outcomes for public health and the public purse.
There will be some big battlegrounds – not least whether cigarettes should in plain packaging or put out of sight under the counter. Lansley can count on support from health advocates but, as ever, Big Tobacco is marshalling its arguments and will be there to ‘throw sands in the gears’ of public health policy as ASH put it in their excellent new report Tobacconomics. Required reading for any healthcare advocate, the report comprehensively busts the pseudo-economic myths and misinformation spread by the tobacco industry about the impact of tobacco control policies. Personally, my general rule of thumb is that if the tobacco industry doesn’t want something to happen, it’s probably because it’ll reduce the number of their customers. As the now Chancellor George Osborne put it when questioning Imperial Tobacco on their impossibly high sales in Afganistan, Modova and Latvia, back when he was a member of the Public Accounts Committee, in March 2003: “One comes to the conclusion that you are either crooks or you are stupid, and you do not look very stupid.”
So today, I shall be taking a moment to celebrate the success of the smokefree legislation. It’s not often you get to work on a campaign that really does change society, and I’m still really proud of the tiny part I played in making it happen. And, as it’s my birthday, I shall be raising a celebratory pint in a smokefree pub. Cheers!