Yesterday was the fifth anniversary of the smoking ban in public places. It seems like a life time ago that smoking in pubs was the norm and that after a night out I would have to wash everything I had been wearing to get rid of the smell of cigarettes. As a fierce advocate for the ban (and not just because it has reduced the amount of washing I have to do!) it is great to see that, five years on, evidence continues to emerge to prove both the social and health benefits of the ban and that the campaign is continuing.
As Sarah Winstone has commented previously on this blog, back in the early noughties making public places smoke-free seemed to be an impossible task. Following tireless campaigning from the voluntary sector and incremental steps by previous governments, including the banning of tobacco advertising, it was the introduction of the Health Act 2006 which meant that people would not be able to smoke in public places and work places. Given that five years have now passed since this important step forward it is necessary to look at the evidence to measure the impact of the ban and to help determine what should be done next on this important public health initiative.
A review of the evidence on the impact of smoke-free legislation was published last year. This found that second hand smoke exposure in children had reduced over time and that there is no significant evidence to suggest that the introduction of smoke-free laws has encouraged people to smoke more at home. The review also found that in the five months prior to the legislation taking effect 19% of smokers who attempted to quit reported that they were doing so in response to the introduction of smoke-free public places.
Further evidence to support the direct health benefits of the legislation was shown in a study published in the British Medical Journal, which found that in the first year after the legislation was introduced there were 1,200 fewer emergency admissions for heart attacks. This adds to a growing body of evidence that smoke-free legislation leads to reductions in heart attacks, although the causal link has been more difficult to establish. If this reduction is sustained, it will demonstrate individual health improvements as well as benefits to the wider system, reducing the burden on some of the NHS’ most costly services.
However, it is worrying to see evidence published by Cancer Research UK this weekend which shows that there is still a low level of understanding about the links between smoking and certain types of cancer. In the survey of over 4,000 people, more than two thirds of people knew the link between smoking and lung, throat and mouth cancers, but less than 20% knew that there is a link between smoking and eight other cancers, including leukaemia, bowel and ovarian cancers. There is, then, still more to be done in educating people about the serious impact that smoking can have on their own health.
The smoking ban in public places has not been the end of attempts to ‘nudge’ people to stop smoking. Graphic health warnings on cigarette packets were introduced in 2008, cigarette vending machines were banned late last year and a ban on cigarette displays at the point of sale was introduced in all large shops and supermarkets in April 2012 which will be extended to all shops in 2015.
The next phase in the campaign on smoking is to make plain packaging of cigarettes mandatory. The Government is currently consulting on whether tobacco should be sold in standardised plain packaging. The consultation, which is open until 10 July 2012, is asking for views on what requirements for standardised packaging could consist of, including no branding, a uniform colour and a standard font and text for any writing on the packet. As a non-smoker I have never really looked at cigarette packets, but when I went in to my local corner shop and actually looked at the packaging on display I was amazed to see how attractive some of the packets were and how tempting they might be to children. Cancer Research UK’s film, The answer is plain, and The Roy Castle Lung Cancer Foundation campaign, Drop dead gorgeous, are further testament to this. The introduction of plain packaging could therefore be a good way to stop children and young people starting to smoke in the first place.
With the smoke-free legislation another year older, after the early confirmation that this is has been a social success, we are beginning to see the first signs that it has been a public health success too. However, it is clear that there is still more to do in educating people about the risks associated with smoking and in stopping people taking up the habit in the first place.