BMA Cymru Wales to petition parliament to ban smoking in public places unless Wales goes smoke free within 10 months

BMA Cymru Wales is seriously considering the possibility of petitioning Parliament for a ban in public places in Wales using the rarely used private bills procedure.

Private bills (not to be confused with private members' bills which are a type of public bill) are brought in by organisations outside Parliament to obtain powers for themselves in excess of, or in conflict with, the general law.. These bills have to be presented to Parliament on or before 27 November each year.

Private bills seek rights and powers for their localities over and above the current law or common law.

Welsh Secretary of the BMA, Dr Tony Calland is enthusiastic about the move. "Although the procedure is extremely complex, it would be worth it to make Wales a healthier place to live. The Scottish Executive is driving the issue forward in Scotland whilst we in Wales look on wistfully."

"Over thirty years of medical practice has shown me the devastating effects of illness on individual patients," he said. "Some of these illnesses come for no known reason but many come because of the choices patients make through their lives. No choice has a more devastating effect on health than the choice to smoke tobacco.

"I have seen it cause bronchial cancer, throat cancer, mouth cancer, lip cancer and bladder cancer. I have seen the victims of these cancers die an uncomfortable, premature and often undignified death.

"I have seen it cause coronary heart disease, stroke, peripheral vascular disease, blindness, deafness, miscarriage, respiratory disease, bowel disease and many more conditions.

"There must be even greater publicity of the dangers of tobacco smoke, an even greater effort to help people to give up smoking, but a government that fails to ban smoking in all public places is a disgraceful failure in protecting the health of the very population it claims to serve."

He added: "BMA Cymru Wales will do all it can to help bring in a ban on smoking in public places. We owe it to the hundreds of people who die each year in Wales alone of the effects of passive smoking. Such a ban would do more public health in Wales than any other initiative."

Welsh Secretary Dr Richard Lewis warmly welcomed the Scottish Executive's plans to ban smoking in all enclosed public places and is urging Peter Hain to follow Scotland's lead.

"This is a great day for Scotland and a great day for devolution north of the border. The new legislation will save lives and protect health in Scotland. Scottish politicians have listened to the evidence on second-hand smoke and have put the health of their citizens first. Unfortunately, this issue illustrates the shortcomings of Welsh devolution. Secretary of State Peter Hain should take the National Assembly's call for a ban in Wales to the UK cabinet table as a matter of great urgency.

"Whilst government at Westminster procrastinates, the Scottish Executive has consulted with the public, listened to the debate and decided that the health of the population is worth more than the biased economic arguments and junk science promoted by those who argue against legislation. The Assembly, on the other hand set up yet another committee to examine the issues despite public survey after survey showing that the vast majority of the people of Wales would prefer good health to smoking related diseases.

"Science and sense have prevailed in Edinburgh. After the National Assembly voted in November last year to ban smoking in public places, why have the people of Wales got to wait for the legislation that will reduce the risk to health caused by exposure to tobacco smoke, and make significant inroads in improving the health of the nation? It seems very unfair. Meanwhile, delay continues to cost lives every week."

Dr Lewis added: "The reason doctors are so passionate about wanting a smoking ban is that every day we see the devastating effects of smoking and second-hand smoke. We are the ones who have to tell our patients that they have lung cancer or heart disease. We are the ones who treat patients with chronic respiratory illness. It's heartbreaking to see someone's life end like that, bed-bound, struggling to breathe and unable to do simple tasks."

Key facts

• 85% of second-hand smoke is invisible and odourless, and is not filtered by conventional ventilation systems Tobacco Control Resource Centre. Tobacco FactFile. Published online at www. tobaccofactfile.org The risk of heart disease from passive smoking is equivalent to that from smoking half a pack of cigarettes per day. Women who work where smoking is allowed run more than twice the risk of developing lung cancer.

• Exposure of non-smokers to second hand smoke is known as passive smoking. It consists primarily of non-inhaled sidestream smoke, together with exhaled smoke.

• Almost 85% of second-hand smoke is invisible and odourless gases. Only the particulate matter, in the form of smoke, is visible National Research Council, Committee on passive smoking. Environmental tobacco smoke: measuring exposures and assessing health effects. Washington, DC: US National Academy of Sciences, 1986 . Tobacco smoke contains more than 4000 toxins, including over 50 that are known to cause cancer.

• Health effects of second-hand smoke Passive smoking causes illness, including fatal illness. It also worsens existing health problems British Medical Association Board of Science and Education & Tobacco Control Resource Centre. Towards smoke-free public places. BMA: London, 2002. Curbing the epidemic. Governments and the economics of tobacco control. Washington, DC: The World Bank, 1999. www.who.int/toh/ IARC Monograph on the Evaluation of Carcinogenic Risks to Humans. Vol. 83: Tobacco smoke and involuntary smoking. Lyon, France: WHO International Agency for Research on Cancer, 2002. (in press) Summary available online at: http://monographs.iarc.fr/. The known health effects of passive smoking are summarised below: Effects on adults A recent evaluation by the International Agency for Research on Cancer has concluded that there is a significant and consistent association between exposure to second-hand smoke and the risk of lung cancer[ Ref IARC monog Ref3].

• The risk of an acute coronary event is significantly increased Pitsavos C, Panagiotakos D, Chrysohoou C, Skoumas J, Tzioumis K, Stefanadis C et al. Association between exposure to environmental tobacco smoke and the development of acute coronary syndromes: the CARDIO2000 case-control study. Tobacco Control 2002;11:220-5 . The risk of stroke is increased and one study has found it to be doubled You R, Thrift A, McNeil J, Davis S, Donnan J. Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne Stroke Risk Factor Study (MERFS) Group American Journal of Public Health 1999;89:572?5..

• Exposure to second-hand smoke induces more severe symptoms in those with asthma, reduces the quality of life, reduces lung function and increases hospital admissions. It also triggers further attacks in up to 80% of asthmatics.

• Passive smoking exacerbates the symptoms of respiratory conditions such as bronchitis and of coronary and circulatory disease.

• Pregnant women who are exposed to second-hand smoke during pregnancy are at greater risk of having a low-birth-weight baby and of giving birth prematurely Windham G, Hopkins B, Fenster L, Swan S. Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight.

Effects on children

Passive smoking is associated with a variety of health problems in children. It increases the prevalence of lower respiratory tract illness such as pneumonia, bronchitis, bronchiolitis, coughing and wheezing.

Second-hand smoke can cause asthma in children. It also exacerbates the condition in those who are already affected Strachan D, Cook D. Parental smoking and childhood asthma: longitudinal and case-control studies. Thorax 1998;53:204?12. .

Passive smoking is also a cause of cot death (Sudden Infant Death Syndrome) Anderson H, Cook D. Passive smoking and sudden infant death syndrome: review of the epidemiological evidence. Thorax 1997;52:1003?9..

Dose-response relationship

The risk of most of the illnesses caused by second-hand smoke increases steadily with exposure ? a linear dose-response relationship. This includes lung cancer, induction of asthma, cot death and low birthweight.

The dose-response relationship for coronary heart disease is non-linear. Exposure to second-hand smoke at levels of just 1% of those of a smoker carries a risk of ischemic heart disease of almost 50% of someone smoking 20 cigarettes a day Law M, Morris J and Wald N. Environmental tobacco smoke and ischaemic heart disease: an evaluation of the evidence. BMJ, 1997;315:973?80. .

Best practice

Legislation for smoke-free places has been successfully introduced in a number of countries, including the USA, Canada, Finland, Australia, South Africa and Thailand.

State law introduced in California in1994 requires that all bars, restaurants and public places are smoke-free. A study has concluded that the introduction of smoke-free bars rapidly improved the respiratory health of bar workers Eisner M, Smith A, Blanc P. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA 1998;280:1909-1914.. Legislation in Finland bans smoking on public transport, in health and educational facilities, government buildings and all aircraft. South African law prohibits smoking in public places, including workplaces and most transport facilities.

In Finland and South Africa smoking is only allowed in restaurants if smoke cannot spread to the non-smoking area.

Model legislative texts for smoke-free public places have been produced by the World Health Organisation.

The tobacco industry has yet to admit that passive smoking causes serious illness. US House of Representatives (2002) Tobacco industry statements on the Department of Justice lawsuit. Special Investigations Division, Committee on Government Reform. In private the industry has conducted research that supports the conclusion that passive smoking harms health. Glantz SA et al (1996) Environmental Tobacco Smoke and the Non-Smokers Rights Movement, In Glantz SA, Slade J, Bero LA, Hanauer P, Barnes DE The Cigarette Papers, Berkely, University of California Press. Nevertheless, it has continually attempted to discredit the evidence concerning harms caused by passive smoking. Drope J and Chapman S (2001) Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents. Journal of Epidemiology and Community Health 55:588-94

Despite hospitality industry fears that smoke free workplaces could prove to be expensive, evidence shows that smoking bans do not result in a decrease in profit. Implementing work place cessation programmes increase employee productivity and bring about long term financial returns that far outweigh their costs. KE Warner, RJ Smith, DG Smith, BE Fries, "Health and Economic Implications of a Work-Site Smoking- cessation Program: A Simulation Analysis," J. of Occupational & Environmental Med. 1996;38: 981- 992.

Protection against passive smoking - key policy points

No safe level of exposure to second-hand smoke has been identified Otsuka R et al. Acute effects of passive smoking on the coronary circulation in healthy young adults. JAMA 2001;286:436-41.. Leading international bodies such as WHO and UNICEF have highlighted the need for effective measures to protect against the health effects of second-hand smoke. When a policy to protect against passive smoking is introduced, health improves Eisner M, Smith A, Blanc P. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA 1998;280:1909-1914..

• Research shows that the introduction of restrictions on smoking in the workplace helps motivate smokers to quit and increases the likelihood of success among those attempting to quit.

• Smoke-free workplaces reduce the prevalence of smoking as well as consumption. The combined effects of people stopping smoking and reducing consumption reduces overall cigarette consumption by 29% Fichtenberg C, Glantz S. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ 2002;325:188.

• Evidence shows that conventional ventilation and air cleaning systems do not provide effective protection against the health effects of second-hand smoke Witschi H, Espiritu I, Maronpot R, Pinkerton K, Jones A. The carcinogenic potential of the gas phase of environmental tobacco smoke. Carcinogenesis 1997;18:2035-42 [ Ref 1 Tobacco FactFile].

• Legislation for smoke-free places is more effective than voluntary measures in protecting health.