The creation and maintenance of smoke-free public spaces in the UK

This article was exclusively written for The Sting by Ms. Caitlin Pley, a 5th year medical student at the University of Cambridge. She is affiliated to the International Federation of Medical Students Associations (IFMSA). However, the opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one. Tobacco is the deadliest legally available consumer product, killing up to two thirds of its long-term users¹. Another huge, yet frequently overlooked, tragedy is the mortality and morbidity caused by exposure to second-hand smoke. Around 890000 people die a year from second-hand smoke², with women and children suffering disproportionately³. A problem as pervasive, and dangerous, as tobacco addiction requires international collaboration. In an increasingly globalised world, trade liberalisation and the power of social media allow the tobacco industry to spread its scourge to all corners of the world. To this end, in 2003, the Framework Convention on Tobacco Control (FCTC) became the first legally binding treaty negotiated under the auspices of the World Health Organization⁴. Article 8.2 of the FCTC calls for Parties to adopt national law that prohibits smoking in indoor workplaces, public transport, indoor public spaces and, as appropriate, other public spaces⁴. Tobacco-free public spaces are recognised as a crucially important tobacco control measure, not just due to harm reduction for non-smokers, but also because the policy decreases the daily consumption of smokers, and dismantles the normalised status of smoking in society. The FCTC has been widely incorporated into European law. The European Council has issued a ‘Recommendation on smoke-free environments’ which aims to strengthen comprehensive smoke-free legislation, as well as foster cooperation, amongst EU countries⁵. In the UK, a right to smoke in public, or private, has never existed⁶. The four devolved countries each have their own pieces of law covering smoke-free spaces. Scotland’s Smoking, Health and Social Care Act entered into force in 2006, while England’s Health Act, Northern Ireland’s Smoking Order and Wales’ Smoke-Free Regulations entered into force in 2007. In the UK, there exists a total ban on smoking in the workplace, enclosed public places, restaurants, bars, healthcare facilities, education facilities and public transport⁷. These provisions are some of the strictest in Europe, and are unlikely to change following the UK’s exit from the European Union, given that these laws were adopted years before the EU council recommendation on smoke-free environments, and given the UK’s recent moves to adopt even stronger tobacco control measures such as plain packaging. The law on smoke-free public spaces in the UK is enforced through sanctions, either a fixed penalty notice or a court-issued fine, both for the offence of smoking in a smoke-free place and for failing to display the required no-smoking signs in these locations⁷. However, although compliance with the law is excellent in workplaces, bars and restaurants, it is largely disobeyed in other public, particularly unenclosed, areas. Furthermore, while law enforcement officers are able to issue penalties for these offences, this often does not happen, partly due to a lack of evidence were the case to be tried in court, partly due to the offence not being regarded as serious enough to warrant the penalty. Unaddressed, the tobacco epidemic will claim the lives of one billion individuals in the 21st century⁸. To help kick tobacco to the curb, we need to kick smoking off our streets. References:

1. Banks E, Joshy G, Weber MF, et al. Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med. 2015;13(1):38. doi:10.1186/s12916-015-0281-z
2. Tobacco Fact Sheet. World Health Organization. http://www.who.int/news-room/fact-sheets/detail/tobacco. Published September 2018.
3. Lipetz S. Smoking and Disease Factsheet.; 2016.
4. WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL WHO Library Cataloguing-in-Publication Data. 2010. http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf?ua=1. Accessed February 22, 2018.
5. Council Recommendation of 30 November 2009.; 2009. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32009H1205(01)&from=EN. Accessed October 23, 2018.
6. Allen N. A human right to smoke? Has the government struck the right balance between the freedom of smokers and the welfare of non-smokers? New Law Journal. https://www.newlawjournal.co.uk/content/human-right-smoke. Published 2008. Accessed October 23, 2018.
7. Overview of smoke-free legislation and its implementation in the EU. European Commission. https://ec.europa.eu/health/sites/health/files/tobacco/docs/smoke-free_legislation_overview_en.pdf. Accessed October 24, 2018.
8. The global tobacco crisis Tobacco – global agent of death. WHO Rep Glob Tob EPIDEMIC. 2008. http://www.who.int/tobacco/mpower/mpower_report_tobacco_crisis_2008.pdf. Accessed February 26, 2018.

About the author Caitlin Pley is a 5th year medical student at the University of Cambridge, originally from Germany and resident in the United Kingdom for the past seven years. In her free time, she advocates for health equity and health in all policies at the local, national and international levels. She is particularly interested in non-communicable diseases, especially tobacco control policy, access to medicines and access to reproductive healthcare services.