Should there be an outdoor smoking ban in England?
Merry Vole
Shipmate
in Purgatory
This was recommended by the Kahn review and the government is considering restricting smoking in some outdoor areas; such as pub gardens, pavement cafes, and all outdoor areas where children are likely to be present.
A recent YouGov poll found 35% would strongly support this and 18% would strongly oppose it.
By a curious coincidence the current BMJ carries an obituary of Norman Vetter an epidemiologist who studied the effects of secondhand cigarette smoke ('passive smoking') and whose research was used in developing the ban we already have against smoking in enclosed and substantially enclosed work places and public places including public transport and pubs etc. This was implemented in 2007 (seems longer ago than that!) and I'm sure none of us want to go back to the days when restaurants and planes etc had supposedly 'separate' areas for smokers and non-smokers.
I think the benefits to individuals would probably be very small if such a new ban were to be implemented but at the same time I think it is a logical extension to what we already have and would contribute to less people smoking -and I'm willing to wager that all of us know or knew at least one person whose health was seriously harmed by their smoking of tobacco.
Tangent:
As an interesting heart-warming PS here are two quotes from the obituary that was written by Norman's son;
"Compassion was, in my father's understanding, the ultimate expression of strength and courage. Humanity's extreme fallibility, in the end, only reinforced his love of people and life. He understood that the cost of love is grief and that only in embracing that terrible price can we find our purpose." And; "..the principal function of the NHS (is) not to treat sick people but to alleviate fear. Freedom from fear would, he wrote, help people to live more meaningful, more generous lives."
Food for thought!
A recent YouGov poll found 35% would strongly support this and 18% would strongly oppose it.
By a curious coincidence the current BMJ carries an obituary of Norman Vetter an epidemiologist who studied the effects of secondhand cigarette smoke ('passive smoking') and whose research was used in developing the ban we already have against smoking in enclosed and substantially enclosed work places and public places including public transport and pubs etc. This was implemented in 2007 (seems longer ago than that!) and I'm sure none of us want to go back to the days when restaurants and planes etc had supposedly 'separate' areas for smokers and non-smokers.
I think the benefits to individuals would probably be very small if such a new ban were to be implemented but at the same time I think it is a logical extension to what we already have and would contribute to less people smoking -and I'm willing to wager that all of us know or knew at least one person whose health was seriously harmed by their smoking of tobacco.
Tangent:
As an interesting heart-warming PS here are two quotes from the obituary that was written by Norman's son;
"Compassion was, in my father's understanding, the ultimate expression of strength and courage. Humanity's extreme fallibility, in the end, only reinforced his love of people and life. He understood that the cost of love is grief and that only in embracing that terrible price can we find our purpose." And; "..the principal function of the NHS (is) not to treat sick people but to alleviate fear. Freedom from fear would, he wrote, help people to live more meaningful, more generous lives."
Food for thought!
Comments
The amount of second-hand smoke I get from walking past a smoker on the high street, or sitting at an adjacent table to one in a beer garden, is pretty minimal.
So as you note, the benefit to non-smoking individuals that happen to be nearby is small - probably immeasurably small. It may, perhaps, discourage some individuals from taking up smoking, or make smoking more awkward and so help encourage some smokers to smoke less or quit.
Whether or not the latter is a good thing depends, I think, on the extent to which you think it's reasonable for a government to constrain an individual's choices because it is "good for them".
Even though what happens in England should not at all be influenced by me in any way, I would like to throw in my two cents.
Walking past a smoker, or sitting at an adjacent table to a smoker probably doesn't really matter to most people. However, for me and many others who have severe asthma and other respiratory diseases, and who are greatly affected by cigarette smoke, it can be a matter of life and death.
In my case, cigarette smoke causes my lungs to feel as if they are squeezed shut. I can't breathe for a few scary moments until I get into clear air and take my emergency inhaler.
I truly am very glad the smoke doesn't cause such a huge reaction in most people, but for some of us, it's a terrifying problem.
I object to the proposals but I would be in favour of a ban on smoking within 10 yards of a main pub entrance.
I was also against a total ban on smoking in pubs. When I was young there were 'Smoke rooms' I thought it was reasonable to have special rooms for smokers as long as any staff in the rooms were volunteers.
In reality the staff never can be guaranteed to be volunteers. The people who refuse to work the smoke room will sooner or later be "let go" on some pretext or other. That's the unfortunate reality of employment and employers.
Given the high societal cost of smoking in the form of disability and cancer treatment, I have no problem with government constraints on smoking. We have helmet laws and seatbelt laws that I support for similar reasons.
Smoking has a particular issue, in that there are questions of passive smoking. So others can be being forced to join in a drug experience without necessarily wishing to. And being able to sit outside in a pub wihtout having to check for existing smokers or hoping nobody comes out to smoke near you would be nice.
But, OTOH, what will smokers do? They will move to the nearest public place they are allowed to smoke and gather there. The chances are that those who will then inhale their smoke will be passers-by, maybe people who would not use the pub or area. And while they might ban smoking in a childrens play area - children and families who are arriving may find they have to experience the smokers on the way. Rather than, say, avoiding the top right corner where the smokers go.
In the end, the government is trying to ban smoking slowly (so as not to hit tax revenues). But I think there should be stronger measures to discourage it (that are not environmentally unfriendly as single use vapes). And deal with the problem,sn ot just move them on.
However one of the things that made me give up after 30 years was having to walk through the huddle of desperate smokers outside supermarket doors. I just didnt want to identify with them or that need.
Smoking rooms and particularly smoking areas were a real pain. You often had to go through the room or area to get to the bar. In some pubs the no smoking area was through the the smoking area. I’m one pub we went for lunch the no smoking area was one table surrounded by smokers.
I still remember when cinemas had smoking one side of the room. In a massive cinema that was bad enough. But small cinemas you may as well be smoking yourself
True, but I want to read that thread!
I'm torn on this.
Cigarettes are evil. Nicotine addiction is really tough to beat. Tobacco companies target young people. Always have because most people who reach the age of 20 without being a smoker will never smoke.
Government public health action works and has worked. Smoking rates are much lower than decades ago with consequential drops in heart disease and cancer.
The indoor smoking ban has been fantastic. Protecting people from other people's smoke is vitally important.
However, I do wonder if this is a step too far.
And - mea culpa - I like the occasional cigar and will smoke a pipe about 20 times a year...
The truth is though that I think this will happen and we'll all just adjust to it.
AFZ
Smoking costs the NHS about £2.5 billion per year, plus an additional £1.4 billion cost to social care services and an estimated £8.6 billion in lost productivity. That's a total cost of £12.6 billion. Smokers apparently lose an average of 10 years life, and smoking related deaths made up 16% of all deaths across the UK in 2016. Smoking is the largest cause of preventable death in England.
Now for a comparison.
Obesity costs the NHS about £19.2 billion per year, plus an additional £15.6 billion cost to social care services and lost productivity (I have not included the direct costs to individuals also mentioned in that article). That's a total cost of £34.8 billion. Obese people apparently lose an average of 3 to 7 years life, and tens of thousands of people die from obesity-related conditions every year. Obesity is the second largest cause of preventable death in England.
By virtually every measure, obesity is a far more significant cost to UK finances and society than smoking - and it's a growing problem* rather than one that's slowly shrinking. So when are we going to ban chocolate, sweets, cakes, crisps, patties, jam, butter, soft drinks, sauces, ice cream, fried food, and so on? None of those things are needed as part of a healthy, balanced diet - banning them would be demonstrably good for the NHS, the people involved, and society as a whole.
Of course, a lot of people would be denied the pleasure of consuming them and it would be a hideously oppressive imposition on people's freedom to decide their own lifestyle, but that's surely not important in the face of such obvious health and social benefits. Is it?
.
*= no pun intended.
If you banned commercially made biscuits and cakes, people could just bake their own.
Is that really a helpful comparison?
I eat all of the foods you list (I have bolded the text for clarity), among other foods. I am not obese, or even overweight. The same is true for many people: it is possible to consume moderate amounts of these foods without harm, and they are not addictive.
It is not possible to consume moderate amounts of tobacco products without harm, and they are addictive.
There are other approaches to handling obesity. You'd have a better case with the real elephant in the room - alcohol.
Agree with all of that.
As a pub lover (who has never smoked) I do worry about the effect on the pub trade of the outdoor ban. The indoor ban cut a swathe through pubs.
On the other hand, I would support legislation that banned the sale of alcohol in the UK in anywhere other than a pub (allowing off-sales) or restaurant. End free-standing off-licenses and get alcohol out of supermarkets.
Which might help.
Rather fails to grapple with either tied pubs or the massive shift away from consumption of beer and towards wine and spirits in the UK.
Tied pubs is a different problem. Wine and spirits on the other hand would have to be bought from pubs, even if not consumed there….
In contrast to Cameron, who eats all of the foods on that list and isn't overweight, I am obese, actively dislike two of those items, rarely eat others and would say that only two - chocolate and butter- have contributed to my weight. I do love ice cream, but don't eat it often enough to make a difference.
Also in contrast to Cameron, he finds it possible to consume moderate amounts, whereas that's a challenge for me.
I think the "banned" list for me would need to be butter, chocolate, pasta, mayonnaise, milky hot chocolate before bed, all the homemade puddings when our garden produces a glut of rhubarb or berries - crumbles, sponge puddings, queen of puddings etc. Also the custard which accompanies those puddings.
Banning smoking targets smoking. Banning some foods might target obesity in those people for whom obesity is caused by those foods, but I suspect it would be of minimal effect.
But if I pass by an obese person eating unhealthily, I don't involuntarily eat their food. Passing by smokers however .....
Yes, when visiting pubs I've often been struck by the large unused areas that could be dedicated to retail.
This very much seems to be a proposal to save pubs as businesses by turning them into something entirely different.
For some reason I dislike outdoor vaping more - the clouds of vape are huge and unavoidable!
Oh yes, very much so.
Firstly, it highlights the hypocrisy of calling for one harmful substance to be banned while being perfectly fine with other harmful substances being rife within society.
Secondly, it forces people to consider how they would feel if something harmful that they enjoy was being considered for a ban, rather than something they don't like and would never try. The easiest sin to condemn is the one you're never tempted to commit, after all. Are those calling for a ban really doing so on societal health and economic grounds, or just because it's something they don't like?
And thirdly, it neatly skewers any suggestion that the economic arguments for banning smoking are such that it's in a class of its own.
The amusement I gain from watching people twist and turn to say that their unhealthy habit is perfectly fine while someone else's unhealthy habit should be banned is just a bonus.
I smoke, have done so for more than half my life now, and have never suffered health impacts as a result. The same is true for many people. Our anecdata would seem to cancel out.
As for being addictive, the jury is out on that one.
Interesting.
That would be bad for me. I buy wine online because you get much better wine at better prices than you can get from a supermarket. Similarly, I like good whisky which you almost never get in a pub.
I do think there's scope to be creative. Maybe halve alcohol duty for consumption on the premises. (I checked the numbers. Alcohol duty brings in about £12Bn. Approximately 3/4s of consumption is off-premises so a half rate for pubs would cost ~£1.5Bn). I posit that this would affect neither prices nor consumption but would improve the margins for pubs. Just a thought.
Is this actually true? Does anyone know the data? It is definitely true that pubs are closing but that is a long-term trend. Did the smoking ban actually change anything or did it just coincide with a already existing trend?
Just wondering...
AFZ
People may be obese for medical reasons. As someone who is well over weight I see other people eating all the high calorie food they want and are not my size. I see people my size eat hardly any of the listed foods and stay large. Also remember it is not called a beer belly for nothing. Certainly for men age is a factor. I am middle age and a lot of men find it hard not to put weight on at this time.
OK say smoking is finally banned. How will the government replace the income stream tax on tobacco products brings in?
The data suggest that the smoking ban did indeed accelerate pub closures.
The ban came in a year before the GFC, and in the 10 years after that wages were largely stagnant, additionally binge drinking (which - let's be honest - was largely a pub based phenomenon) had been on a slide since the mid 00s.
Indeed. It seems to be a long term trend and the smoking ban may or may not have had an effect.
Statista has some nice data by decade. These data show that since 1980, 22,650 pubs have closed, taking the total number from 69,000 to 46350 (2021). That's a drop of 32.8% overall.
In the 80s, 5500 pubs closed, 2700 in the 90s, 5400 in the 00s and 9050 in the 2010s. So of the pubs lost in the last 40 years, we lost 24.3% in the first 10 years of this period, then 11.9% in the next period, then 23.8% in the third decade and finally 40% in the final decade.
Given that 2008-9 saw a massive recession and that the period 2010-2021 includes the pandemic, it's very hard to draw firm conclusions. It is true to say that the smoking ban may have contributed to pub closures. I don't think the data goes much further than that.
The data @Marvin the Martian linked to is too small a time window given the overall trends, whilst the Statista data I found only has 4 time points.
Anyone know of better datasets?
AFZ
That you know about so far.
- Cancer occurs when there are two changes in normal cells. Who knows how many have one of two switches already tripped, while you keep playing chance with the other.
- I would also be interested how you know that your lung function and cardiovascular system are as healthy as if you were a non-smoker, except of course you don’t know that.
And the study itself is commissioned by a "Smoking Advocacy" group funded by the tobacco industry.
I might have guessed. My first thought was "Cherry picked dates". For a smoking ban link we'd expect a drop off for a few years after then ban and then a levelling off - but the date range in the study is too narrow to show that.
My grandfather ditto - though in his case it was a heart attack as he got out of bed aged 54 (four years before I was born).
But here's the really bad news, the ones who get cancer are often the lucky ones. Heavy smokers who don't get lung cancer, get COPD.
The slow, debilitating decline of COPD is truly awful.
AFZ
So I think the danger of children being exposed to secondhand smoke at, say, a pavement cafe is worth the inconvenience to people who enjoy smoking of having to save it for their own house or garden or boat or wherever.
Edited to add: lung cancer is probably not the worse cancer smoking can cause; throat cancers can be unbelievably horrible.
One of my oldest friends had both. He was diagnosed with COPD around the middle of last year and diagnosed with lung cancer in November. He died less than a week later. I spoke to him on the phone a couple of days before he died, but his breathing was so bad he could barely speak and I could hardly understand a word he said.
I am, of course, a passive smoker but I do spend 90% of my time in another room.
Seconded
Dad's father died of a cerebral bleed the year I was born. I suspect there was a connection to smoking, but have never seen his death certificate.
When I started dating my husband he developed asthma. He had had pneumonia as a child, but the exposure to second hand smoke probably pushed him over the edge.
In later years my Dad gave up smoking because he wanted to spend his money on other things in retirement, Mum never gave up. Her one concession was to sit outside to smoke after Dad had pneumonia and his GP said she was going to kill him if he continued to be exposed to smoke. Dad was on home oxygen for the last year of his life and as weak as a kitten. It was terrible to watch.
Mum fortunately died quickly after developing dementia, which I suspect was mostly vascular.
My sister had childhood exercise asthma and I'm the one whose child had leukaemia. It used to frustrate me endlessly that when taking him to chemo, I had to walk past people sitting near hospital entrances puffing away (and some were staff). I noted every visit that of the parents staying in the charity supplied accommodation, we were one of the few families where neither parent smoked. Purely anecdotal, but I'd love to see a study done on that.
I think 50% of hospital funding should come from cigarette companies, given the way it impacts multiple body systems.
I remember sitting in on a talk our Oncologist was giving to Paediatricians one lunchtime where I was at the hospital. The subject of his talk was a free in service course for teachers to educate them about kids with chronic illness which had been funded by a large fast food corporation. The Paediatricians seemed less interested in the course, than the manner in which it's funding had been sourced, honestly!
I've eaten my share of bad foods, perhaps more than most, but having given them away due to health concerns, none of my weight has shifted which is more than annoying. Perhaps my arteries are less clogged and if that's the case I am grateful.
I hugely regret my parents' smoking and am quite sad that in later life my sister has spent much time trying to hide the fact that she's now a smoker too.
The problem is not the foods people have been making and eating for hundreds, even thousands of years. The problem is the things passing for food that were introduced into the food supply in the second half of the 20th century.
Ultra processed foods should be banned. Companies should not be allowed to put products on the market that are so incredibly harmful. There have always been fat people, but the obesity rates in the developed world started to trend up in the 1960s and then began to skyrocket in the 1980s when highly palatable and minimally nutritious food substitutes became more and more prevalent. The human body coped pretty well with urbanization throughout most of the 20th century, as people who moved around less simply ate less, but it has not coped with the availability of concentrated amounts of fats and processed carbs (source: "Update on the Obesity Epidemic").
The other main thing we should do is change what we encourage people to eat through agricultural subsidies. In the US, the top seven subsidized agricultural commodities are corn, soybeans, wheat, rice, sorghum, dairy, and livestock. The more you eat of these things, the more they're likely to wreak havoc with your metabolism (source: "Consumption of Foods Derived from Subsidized Crops Remains Associated with Cardiometabolic Risk"). Most of the things we should be eating don't get large subsidies, so they're more expensive, and whole fruits and vegetables, that should be about 50% of what's on our plates, don't have huge marketing campaigns the way Frito-Lay, Coca-Cola and McDonald's do.
It would be fucking awesome for me if salty, highly processed carby things disappeared from the grocery store overnight. If I make crackers myself, I can easily limit how many I eat, as they weren't designed in a lab to be hyper-palatable.
No, it's really not, and the reality is people aren't deciding their own lifestyles. Global corporations and governments that refuse to regulate them are.
Both humans have endless health issues. They talk about their health being 'bad luck' and neither seems to make the connection with smoking.
Sauce for the goose - ASH is hardly an unbiased source either.
The Treasury actually likes smokers. While the Health and Social Services costs are significant, they are more than counterbalanced by the savings on pension payments. Smoking is actually a rather painful form of voluntary euthanasia and the death rates are a highly significant proportion of deaths prior to and shortly after retirement. That’s what the Treasury likes. With generally increasing life expectancies, anyone who contributes to a moderation in that trend is a friend.
These facts are not new. I discovered them in the early 1970s and gave up smoking immediately afterwards.
At my age (early 80’s) I aim to maximise my pension return and cheat the Treasury and the actuaries for as long as possible. It’s enlightened self-interest, really.
Of course you are also correct about obesity but the Treasury also likes the voluntary euthenasia dimension of that.
So, comparing the stats with the Statista numbers, is potentially revealing. One must be careful, of course but at first glance the rate of pub closures was high 2000-10 and did not noticeably change after 2007.
It is also true that pub closures rates were higher 2010+ which may be attributable to the smoking ban as sometimes there is a lag. Businesses suffer a hit but struggle on for a few years, trying to recover profitability before closing. It is possible. I suspect the pattern actually is that the smoking ban had a small effect on a long-term trend. It is certainly the case that we do not have clear evidence that the smoking ban lead to a high number of pub closures.
Which is what I was interested in. It is often stated as fact that the smoking ban hurt pubs but the data (from what we've looked at here) does not show that.
Conversely, the data on passive smoking, however...
AFZ
Sure; although that link (I can only see Doublethink referring to them) was on a different issue and provided a reasonable number of secondary references to fairly well respected health authorities that one could follow to ensure that they hadn't cherry picked the data to suit.
Although it's equally likely that there was a lag from the consequences of the financial crisis (most businesses that have lasted any length of time should be able to get through a 'normal' downturn in the business cycle, but are likely to feel the effects of prolonged stagnation post 2008).