In brief

UK workplaces had been moving towards being smoke-free since the 1980s. In July 2007, a ban on smoking in enclosed public spaces took effect throughout the UK under the 2006 Health Act. The evidence of the health risks of passive smoking had been growing, and public opinion had been persuaded by the arguments and by personal experience. The controversial element was the ban on smoking in licensed premises, but despite initial opposition the policy has been accepted throughout the country.

The challenge

In the 1960s and 1970s, public places in the UK, such as a buses, trains, cinemas, theatres, public houses and restaurants allowed smoking, and the effects were clear: diseases for smokers and poor air quality for all. The same was true of the workplace, where smoking was an accepted part of office life, and the “smoke-filled room” was a widely-used metaphor for a room where political intrigue took place.

As the dangers of smoking, in causing diseases such as lung cancer and emphysema in smokers, and the risks of passive smoking became more apparent, public places and offices began to impose partial smoking bans through the 1980s and 1990s. For example, there was an increasing number of No Smoking carriages in trains, the underground railway in London banned smoking (in 1984), and smoking in offices became confined to one or two rooms before being banned completely.

As reports by the British Medical Association (BMA) and the International Agency for Research on Cancer (IARC) quantified the risks of passive smoking with regard to cancer, heart disease and strokes, it was evident that a partial ban was inadequate. It was widely accepted that this situation was only temporary, but there was strong resistance in some quarters to the idea of a complete ban, particularly in bars and restaurants and other licensed premises.

The initiative

In November 2004, the Department of Health published the public health White Paper, ‘Choosing Health: Making healthy choices easier’. It made clear the fact that there was a pressing need to protect citizens from secondhand smoke and that public opinion on the whole favoured legislative intervention. After consultation, the complete ban was effected through the Health Act 2006. The main provisions are set out in section 2 of the Act:

“Smoke-free premises

(1) Premises are smoke-free if they are open to the public ...

(2) Premises are smoke-free if they are used as a place of work—

(a) by more than one person (even if the persons who work there do so at different times, or only intermittently), or

(b) where members of the public might attend for the purpose of seeking or receiving goods or services from the person or persons working there (even if members of the public are not always present).

They are smoke-free all the time.”

Scotland had already banned smoking in public places in March 2006. The ban came into force in England in July, shortly after Wales and Northern Ireland, and the UK’s legislation was therefore complete in July 2006.

The public impact

The effect on formerly smoke-filled licensed premises was very noticeable, as radical in its way as the 1951 Clean Air Act. The air quality was markedly better. Compliance with the 2006 Act was widespread: during the first 18 months after enactment, authorities in England inspected almost 600,000 premises and vehicles, and found that 98.2 percent of premises and vehicles were smoke-free and 89.3 percent were displaying the correct No Smoking signs.

In the first year after enactment, there was an increase in the numbers of people giving up smoking, and there were 1,200 fewer emergency admissions to hospital for heart attacks, a reduction of 2.4 percent from pre-Act levels.

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What did and didn't work

All cases in our Public Impact Observatory have been evaluated for performance against the elements of our Public Impact Fundamentals.

Legitimacy

Stakeholder Engagement Strong

The main stakeholders were the government, in particular the Ministry of Health and the Health and Safety Executive, the Chief Medical Officer, along with rest of the medical profession, local councils, the owners of licensed premises and others who were obliged to comply with the Act, the police and the general public. There were mass media campaigns to raise public awareness of the dangers of passive smoking before the Health Bill in 2005.

As with any significant legislation, there had been a comprehensive consultation process with all stakeholders in drafting and reviewing the White Paper, and the policy had been designed with their input, particularly that of the medical profession –through bodies such as the BMA, not-for-profits such as the King’s Fund, and the National Health Service (NHS) trusts responsible for hospitals and clinics.

The main resistance to the change was from pro-smoking pressure groups and the owners of licensed premises, although some, such as those owned by the JD Wetherspoon chain, had already imposed bans (in 2005). There was a recognition that the legislation had public support and that it was part of an inevitable progression.

Political Commitment Strong

The government was committed to the legislation, which was seen as having major public benefits, with the health secretary, Patricia Hewitt, a vocal proponent, as was the UK’s then Chief Medical Officer, Dr Liam Donaldson. “The BMA's secretary in Wales, Richard Lewis, said: ‘this is the greatest public health initiative in Wales for over a century. The BMA has campaigned hard for years for it’”. [1]

The legislation went through the standard procedure:

  • In November 2004, the government published the white paper on public health, detailing its intention to introduce the provisions on smoke-free premises. The Health Bill drafted in the light of the consultation process.
  • The Health Bill received its first reading in Parliament on 27 October 2005.
  • On 14 February 2006, on the third reading of the Health Bill, MPs voted by 364 votes to 21 in favour of the Bill, and it was therefore approved to be made statutory.

The large majority in favour of the Health Bill indicates that there was strong commitment behind the smoking ban in all political parties.

Public Confidence Strong

Public support in favour of smoke-free premises had been growing. In 2004, a MORI opinion poll indicated that there was a majority in favour (51%). AA survey conducted by YouGov the following year found that 66% of adults supported the ban. In 2007, at the time when the 2006 Act came into effect, 72% of the public were in favour of the legislation. In 2012 the figure was 78%.

Policy

Clear Objectives Good

The government’s broad objective was to improve public health by banning smoking in public places and workplaces. This would have a positive effect on smokers, by encouraging them to give up smoking, and on non-smokers, by limiting their exposure to passive smoking. It then pursued these objectives through the standard parliamentary process.

Evidence Strong

The evidence takes two main forms forms: the medical evidence to indicate that the ban would have the desired impact on health; and the evidence of similar legislative bans enacted in other parts of the world.

There was clear evidence that exposure to other people’s smoking is dangerous to health and that passive smoking was a particular risk to those working in licensed premises The sources for the evidence were authoritative: the UK’s Chief Medical Officer, the US Surgeon General, the World Health Organization (WHO) and the IARC.

A similar ban was enforced in New York in 2003, under the New York City Smoke-Free Air Act of 2002. In March 2004, Ireland became the first European country to institute an outright ban on smoking in the workplace. Such bans were clearly enforceable and had positive impact on health.

Feasibility Strong

The fact that there had been a gradual movement towards banning smoking in enclosed spaces in workplaces and public places indicated that a complete ban was entirely feasible. It was becoming increasingly socially unacceptable to smoke, the medical evidence was considered to be very credible, public opinion was behind the move, and the consultation process on the 2005 White Paper indicated that the vast majority of public bodies approved of the smoke-free provisions.

The progress towards the smoking ban had been gradual but relentless, including such anti-smoking legislation as the Tobacco Advertising and Promotion Act 2002, and this indicated that the 2006 Act would be successful in terms of both enforcement and compliance.

Action

Management Good

The 2006 Act made clear provisions for enforcement of the relevant smoke-free premises, and imposed fixed penalties on those failing to enforce the ban (s.8) or contravening the ban (s. 7). Owners or managers of any relevant premises had to display ‘No smoking’ signs (s. 6) and take reasonable steps to ensure awareness of the ban and compliance with it.

The relevant local council was in charge of enforcing the law. Extra officers were taken on to ensure compliance.

Measurement Good

There were several parameters which were measured over the period of time to monitor the success of the initiative, such as the health of those working in licensed premises and hospital admissions for particular smoking-related infections. “A study of barworkers in England showed that their exposure reduced on average between 73% and 91% and measures of their respiratory health significantly improved after the introduction of the legislation ... In England, the legislation resulted in a statistically significant reduction (−2.4%) in the number of hospital admissions for myocardial infarction (MI). This amounted to 1,200 emergency admissions for MI in the year following the introduction of smoke-free legislation.” [2]

Alignment Good

There was a clear alignment of interests between the government, citizens and the medical profession in gathering evidence for the ban and imposing it. There was significant cooperation between the government and the parties who were consulted about the White Paper to ensure that the Health Bill reflected expert and general opinion. There was also cooperation between the various political parties, as reflected in the very large majority when the Bill was voted on in Parliament.

There was initial opposition to the ban from many owners of licensed premises, but as the Act’s effects on the use of such premises proved less severe than anticipated, the level of opposition declined.

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