Last night's decision by the House of Commons to ban smoking on all licensed premises and in private members' clubs in England is perhaps the most Draconian infringement of personal liberty yet imposed by this Government, and it is depressing that so many Conservatives and Liberal Democrats joined forces on so illiberal a measure.(My more considered thoughts on this issue can be read here.)
February 15, 2006
No smoke without ire
As the chance may not occur again, I am going to take this opportunity to quote with unreserved approval from this morning’s Torygraph leader:
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11 comments:
Although there is a good case to be made about avoiding a nany state in this issue, your argument that the damage caused by passive smoking is unproven is absolutely wrong.
There is very strong evidence about the harmful effects of second hand smoke, that more and more deaths are caused by it and the total ineffectiveness of ventilation in dealing with it.
As it happens I do not believe this is an issue of civil liberties. This is an issue about health and safety at work. Yes, people can smoke at home and harm their kids (though fewer are now doing so), but a non-smoker working in a bar or a restaurant cannot escape the effects of other's smoking. Just as we protect that worker against exploitation, fire risks and poor working conditions, so we should protect him or her from poor health brought on by working with smokers. That is why this ban is sensible and liberal.
Stephen Tall for leader! Say it again Sam!
Peter - lots of people do risky jobs. The HSE seeks to minimise workplace risks, but some are inevitable. And in many cases the risk in a job may be compensated for by differential wages. Surely a better, more liberal approach would be to seek to create a more level playing field where employees have the collective teeth to demand such premiums. Most of the ones in my SU bar are smokers already!
If 80% of the potential market wants smoke-free bars and restaurants, this should be incentive enough to provide them, plus a premium wage for people who work in smokey ones to further level the playing field and you've got a properly liberal solution.
You cannot buy off people's health with better pay. That is an outrageous suggestion. You will be asking them to work in fire risks next or to use cutting equipment without safety guards.
As for the market forces issue - it just does not work. The only way is to provide a level playing field.
Of course you can, and people already do. I know, because I've just been HERA'ed (job evaluation in higher education) where pionts mean cash and you get points for doing things with hazardous materials and such like. Loads of people do jobs despite the risk because it means more money. I know of a civil engineer in Iraq at the moment. Value at home, £30k per annum, value in Iraq, about £120k per annum repatriated after tax.
And I just do not believe that in general "market forces" do not work in this sort of thing. Consumer power can achieve a huge amount. The question here is why in this particular industry has it not worked. And my suspicions there are that no really big player wants to be the guinea pig so have all been waiting for legislation to force their hands so they can then say to their existing loyal customer base of smokers "we're not getting at you it's just the law".
There are many measures that could have been implemented that could have forced their hand other than a ban. One of which could be high wage costs (margins aren't huge in the trade), higher licensing costs, higher compliance costs for establishments that allow smoking and so on.
By the way Stephen, you and I are both in this fair city from which most of the evidence about the effects of smoking comes - Doll and Gray and co. I too have heard that some of this evidence is a load of FUD - along the lines that yes, you have a several hundred per cent chance of dying from lung cancer if you smoke or breathe others' smoke, but since you have a 0.000x% change of doing so anyway and you have to die of something the chance increases to a 0.00x% at most sort of thing. Can anyone point to non-partisan figures on these sorts of things?
By the way Peter, I don't think you and I understand the same thing by "level playing field" and that your apparent definition is not what it meant to the great liberals of the past.
A level playing field is one where, for example, the workers are empowered to demand more for taking risks, not be coerced into accepting them by the capitalists. Not where things are decided for them by the state or anyone else.
Much that is illiberal has been done in the name of this (erroneous AIUI) understanding of the "level playing field" and little done in the name of the true "level playing field" for fear of being seen as illiberal.
For example increasing the rates on Tesco superstores to give local stores a better chance of competing would be levelling the playing field. Not banning all stores over x000 square feet.
You cannot operate a market-led playing field when it comes to people's health. If anything is illiberal it is that.
Peter - many studies make an evidential link between passive smoking and cancer; others have not established causality. Personally, with no medical training, I'm unqualified to judge either way. To me, it seems unproven, but as I argued in my article, that still leaves open the precautionary approach.
But you have to carry through that argument to its logical conclusion. If it is exploitative of pub-workers to be subjected to smoke, how much more exploitative is it for kids to be exposed to smoke in the home day in, day out? You say a bar-steward cannot escape inhaling smoke (a dubious claim; it's a highly flexible job market with demand exceeding supply) - which seems to suggest you think a child can escape their homelife somehow...
If passive smoking is the killer many believe it to be, have the courage of your convictions: propose a ban on smoking, full stop. Anything else is just a cop-out.
This ban on smoking in public places - and I for one do not view pubs and clubs as such - has as much to with the middle-classes getting annoyed by their clothes smelling of smoke as anything else. (And, fwiw, it annoys me too. Smoking is desperately anti-social; but so are lots of other disagreeable personal habits.)
And I'm utterly bemused by your belief that, "You cannot buy off people's health with better pay", which Jock has answered better than I could. I've no idea how else you compensate people for undertaking jobs which carry with them some risk. Unless you're suggesting we eliminate all jobs which have risks attached. In which case, let's shut the pits, close down the rigs, and stop me typing at my computer immediately.
"I go about my life in a state of stress: borne of the fear that by venturing into public space I will be affronted by the stench of tobacco smoke."
That's a relief... I thought you were serious up to this point, then I began to appreciate the self-parody :-)
Btw, where do you live, AJH? Because I really do want to avoid the public parks and streets which smell of fag smoke.
Peter Black wrote: " You cannot operate a market-led playing field when it comes to people's health. If anything is illiberal it is that."
So many Liberal Democrats seem to think, that liberalism is a bunch of things they happen to like, and that things which they don't happen to like are illiberal. In reality, liberalism allows people to make also bad choices. That includes the choice to destroy your own health by smoking, and the choice to get emplyed at a bar, where you're exposed to other people's smoke.
Jock/Stephen, the difference between us seems to be that I do not believe in applying the employment methods of a 19th century mill-owner to the 21st Century. This is not about the great liberals of the past but about how Liberalism operates in the present. Yes a lot of people do risky jobs but the whole point of employment law. health and safety, measures and good practice is to reduce the risk. A work-place smoking ban falls into that category. That is why it is a liberal measure because it has regards to the rights of those least able to resist harm.
At the end of the day you cannot use market forces to either compensate for risk in this field or to mitigate against it. The market reacts completely different in the entertainment and hospitality industry than it does in a north sea oil field. In the latter you have a limited, highly skilled workforce, in the former you have a plentiful supply of largely unskilled people who can quickly be trained up. The only outcome of applying a risk-based minimum wage to bar staff will be to bankrupt businesses. If you expect them to do it voluntarily they will not because they will lose money. The other outcome is that many people who struggle to find other jobs will find that they have to choose between compromising their health or not working. That is not a liberal choice.
Where smoke-free bars have set up they have struggled to compete because non-smokers have chosen to accompany their smoking friends, even though they would prefer to go elsewhere. That is why there is no level playing field. This legislation will enable all businesses to operate on an equal basis.
The point is that this is about balance. I would not propose a total ban because that would outlaw a legal activity that can be carried out in a way that it does not cause a detriment to others. I do however support a workplace ban because I believe that the rights and health of workers who have no real alternative choice need to be protected. I am backing my convictions.
Let us also be clear, this is not about the smell of cigarette smoke, it is about the very harmful carcinogens and toxins that cannot be removed from an atmosphere by ventilation. Do not think that just because the smell of smoke has been minmimised that it is now safe, it is not.
As for the claims that there is no proven causal relationship between second hand smoke and ill-health/death, only the tobacco industry is saying this now. This is (a rather lengthy) extract from the report of the Welsh Assembly Committee set up to look at this issue:
"The Health Risks of Environmental Tobacco Smoke (ETS)
3.2 Most of the evidence cited to show that ETS is detrimental to health centred on six key documents. The authors of the documents have used evidence from numerous studies that have been peer reviewed and have carried out empirical analyses to show causal evidence of the health impacts. These five studies were produced over a period of six years and their findings each replicate those of the other reports.
3.3 The 1997 report of the California Environmental Protection Agency concluded that there was sufficient weight of evidence of a causal relationship between ETS exposure and developmental problems in babies; sudden infant death syndrome; some respiratory illnesses; lung and nasal sinus cancer; and cardiovascular disease. The report also found suggestive evidence of a causal link with spontaneous abortion, cervical cancer and further respiratory related problems.
3.4 In 1998 the Scientific Committee on Tobacco and Health (SCOTH) published a report commissioned by the four UK Health Departments. This concluded that ETS exposure:
• is a cause of lung cancer and, in those with long term exposure, the increased risk is in the order of 20-30%;
• is a cause of ischaemic heart diseases, and if current published estimates of magnitude of relative risk were validated, such exposure would represent a substantial public health hazard;
• is a cause of serious respiratory illness and asthmatic attacks in infants and children when parents smoke in their presence;
• is associated with sudden infant death syndrome, the main cause of post-neonatal death in the first year of life. The association is judged to be one of cause and effect;
• is likely to be a causal association with middle ear disease in children, linked with parental smoking.
3.5 SCOTH issued an update report on 16 November 2004 reviewing evidence since its report of 1998.5 It concluded that knowledge of the hazardous nature of second-hand smoke has consolidated over the previous five years, and that this evidence confirms that second-hand smoke is a serious public health risk.
3.6 In 1999 the World Health Organisation published its conclusions following consultation on environmental tobacco smoke and child health. It found that:
ETS is a real and substantial threat to child health, causing death and suffering throughout the world. ETS exposure causes a wide variety of adverse health effects in children, including lower respiratory tract infections such as pneumonia and bronchitis, coughing and wheezing, worsening of asthma, and middle ear disease. Children’s exposure to environmental tobacco smoke may also contribute to cardiovascular disease in adulthood and to neurobehavioural impairment.
3.7 The report also concluded that maternal smoking during pregnancy is a major cause of sudden infant death syndrome (SIDS) and other well-documented health effects, including reduced birth weight and decreased lung function. In addition, the consultation noted that ETS exposure among non-smoking pregnant women can cause a decrease in birth weight and that infant exposure to ETS may contribute to the risk of SIDS.
3.8 In his report for 2002 the Chief Medical Officer for England included a section on ETS.7 His introduction to the section stated:
Exposure to other people's cigarette smoke (second-hand smoke, passive smoking, environmental tobacco smoke) can: increase the risk of contracting smoking related diseases such as cancer and heart disease; place extra stress on the heart and affect the body's ability to take in and use oxygen; trigger asthma attacks; increase the chances of sudden infant death syndrome (SIDS); and harm children and babies even more than adults.
3.9 In 2002 the British Medical Association’s (BMA) Board of Science and Education published a report in collaboration with the Tobacco Control Resource Centre.8 The report summarised the scientific and medical knowledge on the nature and scale of the health effects of passive smoking:
• in adults, second-hand smoke increases the risk of lung cancer by some 20-30 per cent and the risk of coronary heart disease by 25-35 per cent. In children, exposure to second-hand smoke increases the risk of lower respiratory tract illnesses, asthma, middle-ear infection and sudden infant death syndrome.
• Certain population groups are particularly vulnerable: children, pregnant women, people with existing cardiovascular or cerebrovascular disease, and those with asthma and other respiratory disorders. Moreover, those in lower socioeconomic groups are at greater risk of exposure than those in better-off groups.
• There is no safe level of exposure to tobacco smoke, and adverse effects can be seen at low levels of exposure.
3.10 Ash Wales and the paper from the University of Aberdeen referred to the report of the International Agency for Research on Cancer, produced in 2002 and published in 2004 by the World Health Organisation, which reviewed links between passive smoking and cancer and concluded that tobacco smoke is carcinogenic to humans. This report presents international scientific concensus.
3.11 The following studies are also significant.
3.12 A study in Helena, Montana USA, looked at whether there was change in hospital admissions for myocardial infarction (heart attack) while a local law banning smoking in public and in workplaces was in effect.10 This found that during the six months in which the ban was in place the number of admissions of people from Helena fell significantly, while those admitted to the same hospital from outside Helena rose. When the ban was removed, the number of admissions from Helena increased. A commentary on the study suggested that although the study was small it focussed attention on a subset of literature on secondhand smoke and its consequences. The literature seems to indicate that relatively small exposures to toxins in tobacco smoke seem to cause unexpectedly large increases in the risk of acute cardiovascular disease.11
3.13 The Scottish MONICA study showed the effects of non-smokers exposed to ETS mainly at work having a significant reduction in pulmonary function.
3.14 A study showing that workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smoke-free workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.
3.15 Professor David Cohen of the University of Glamorgan, has undertaken a study modelling the economic and health impact of a ban on smoking in public places. The model predicts:
The estimated effect of eliminating exposure to environmental tobacco smoke (ETS) in public places in Wales is an annual reduction in deaths from lung cancer and coronary heart disease of 253 with a possible additional reduction in deaths from stroke and respiratory diseases of 153.
There may be an additional annual reduction in deaths of between 60 and 180 if active smoking is reduced as a result of the smoking ban.
3.16 The report of the Office of Tobacco Control, Ireland, on the first year of smoke-free workplaces says:
• that in a study of pubs in Dublin where exposure levels in 24 pubs before and after the ban have been analysed, there has been a significant reduction in particulate levels – Ave PM10 by 53 per cent and Ave PM2.5 by 87.6 per cent;
• a study of 81 bar workers before the introduction of the smoke-free law and a year later indicates a reduction in breath carbon monoxide levels. The results show that for the 56 workers whose tests have been completed and analysed there has been a 45 per cent reduction in non-smokers and a 36 per cent reduction in ex-smokers.15
3.17 A study undertaken for Smokefree London, published in the British Medical Journal estimated deaths from passive smoking in the UK. It found that passive smoking at work was likely to be responsible for 617 deaths a year, including 54 in the hospitality industry. This would equate to one-fifth of all deaths from passive smoking in the general population aged between 20 and 64 years and up to half of such deaths of employees in the hospitality industry.16
3.18 Of those organisations which gave evidence to the Committee, only FOREST,17 the Tobacco Manufacturers’ Association,18 and the National Association of Cigarette Machine Operators19 contended that there is no evidence that ETS could be significantly detrimental to the health of non-smokers.
3.19 Four scientific studies were cited in support of this view. The Committee noted that three of these were produced in the early 1990s before much of the evidence of harm had been established. However, one longitudinal study which followed a large cohort was published in 2003 by the British Medical Journal.20 The cohort comprised over 188,000 adults who were followed from late 1959 until 1998, with particular focus on 35,500 who had never smoked but had spouses with smoking habits. The report concluded that:
The results [of the study] do not support a causal relation between environmental tobacco smoke and tobacco related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed."
Finally, on the issue of ventilation the Committee reported:
"The British Medical Association (BMA) claimed that ventilation cannot protect against the health risk of passive smoking. They advised the Committee that ventilation does not remove the fine particulate matter that is breathed most deeply into the lungs and into the thorax and that filtered tobacco smoke has the same potential to ncause cancer in a cell system as unfiltered tobacco smoke. Their view was supported by, among others, the Chartered Institute of Environmental Health, the Public HealthAssociation Cymru and Ash Wales. Ash Wales and Professor Gerard Hastings contended that it would take an air flow comparable to a wind tunnel or tornado to be in any way effective."
Sorry to abuse your comments section in this way. I have now posted this on my own blog.
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