tobacco - passive smoking
July 2003

The BMA's report on passive smoking, 'Towards smoke-free public places', concludes that there are at least a thousand preventable deaths every year as a result of passive smoking. Second-hand tobacco smoke is now the main source of indoor air pollution. There is no longer any debate about whether passive smoking is a health risk. The debate now is what should be done to protect and improve people's health from the damaging effects of tobacco-polluted air.

The BMA is calling on the Government to introduce legislation immediately to ban smoking in public places. By not introducing such a ban, the Government is putting the health of vast numbers of the population at risk and is also placing a huge burden on the NHS.

Tobacco smoke is a potent cocktail of over 4,000 chemicals. More than 50 of these cause cancer. Evidence has existed since 1983 that passive smoking harms health and yet the Government has only focused on voluntary measures to curb smoking public places. It is not enough.

Second-hand tobacco smoke consists in the main of non-inhaled sidestream smoke combined with a lesser proportion of mainstream smoke that has been exhaled by the smoker. There is no safe level of exposure to second-hand smoke and certain people are particularly vulnerable to adverse effects. Exposure to other people's tobacco smoke causes a number of life-threatening health problems including lung cancer, heart disease and the development of asthma.

Smoking in the workplace
In the UK, three million workers are regularly exposed to second-hand smoke, and another 1.3 million workers are exposed to second-hand smoke 75% of the time. The BMA definition of a workplace covers business premises used for any trade, business or profession, and open to members of the public. It also includes public conveyances, including taxicabs and any other vehicle used for the transportation of the public. Those at highest risk of exposure are workers in the lowest socio-economic groups. Exposure to second-hand smoke in the workplace is linked to work disability caused by respiratory conditions, especially adult asthma. Employers also bear indirect costs of workers' smoking, including higher maintenance and cleaning costs, higher risks of fire damage, explosion and accidents, and higher fire insurance premiums. The economic and health costs of passive smoking in the workplace include increased levels of absenteeism due to illness, and decreased productivity. The BMA report recommends that employers should take immediate action to protect the health of workers, a step that would enjoy strong public support. 86% of the public is in favour of smoking restrictions in the workplace, in banks and in other public places.

Health hazards
Scientific and medical evidence demonstrates that exposure to second-hand smoke causes illnesses – including fatal illnesses – and worsens existing health problems. There is conclusive evidence that passive smoking causes lung cancer, coronary heart disease, asthma attacks, the onset of symptoms of heart disease and worsening of symptoms of bronchitis in adults. In addition, there is substantial evidence that passive smoking causes stroke, reduced foetal growth and premature birth. In children it causes cot death, middle ear diseases, respiratory infections, the development of asthma in those previously unaffected and asthma attacks in those already affected. Other proven health effects of smoking include shortness of breath, airway irritation, coughing, nausea, headache and eye irritation.

The current legislative position
In the UK there is no single piece of legislation that protects against passive smoking in public places or the workplace. Governments have sought to control exposure to second-hand smoke through a series of voluntary measures. However, the present UK health and safety law offers no explicit protection from the health effects of second-hand smoke.

The Approved Code of Practice (ACoP)
The Government proposes an Approved Code of Practice on smoking in the workplace. It would provide legal guidance to employers on the steps they should take in order to comply with their duties under the 1974 Health and Safety at Work Act, the principal piece of legislation currently covering smoking in the workplace.

The Approved Code of Conduct would have a special status under the law. It is not in itself an offence not to comply with the code. However, a code can be introduced as evidence in a prosecution. Compliance with the code offers some legal protection to employers against claims that they have failed to protect employees from passive smoking. Despite the first round of Government consultation on the code having been completed in 1999, at the time of writing it has yet to receive final approval.

The tobacco companies
The tobacco industry promotes a scheme called "courtesy of choice" to the service industry. This scheme advises establishments to allow smoking in certain areas, relying in part on ventilation systems to provide non-smoking areas. Evidence shows that conventional ventilation and air-cleaning systems do not provide effective protection against the health hazards of second-hand smoke.

The BMA is calling for a new tax on all tobacco company profits to fund public awareness campaigns on the health risks of passive smoking and the development of smoke-free public places. In line with the polluter pays principle, it is time the tobacco companies picked up the tab for the harm their products are doing. The Government could make a start on this by taxing them to pay for public health campaigns on the risks of passive smoking.

Other BMA recommendations include
- Introduction of smoke-free public places and workplaces coupled with support for smokers who wish to quit
- Public information campaigns on the health risks of passive smoking
- Health warnings on cigarette packets clearly explaining the real risks of passive smoking, including the risks to babies, children, pregnant women and those with existing heart and lung disease

Note
The most recent estimated cost to the NHS of treating smoking-related diseases was for 1997 and was between £1.4 billion and £1.7 billion for England. This represents between 4.2 and 5.4 per cent of total net NHS expenditure for the year 1996 - 97. (Commons Hansard, 1/7/03, col. 224W)

For further information, please contact the Parliamentary Unit.