1,500 lives saved per year and no memory of smoky bars: 20 years of the smoking ban
It was a report with stark findings. Bar staff, according to research conducted in the first couple of years of the 2000s, were 30pc more likely to suffer from heart disease than the general population. The reason? Passive smoking.
here is a generation of people today with no memory of how smoke-filled our pubs once were, with some drinkers not even born when one of the great social changes in recent Irish history was enacted.
But those in their late-30s and older won’t easily forget the stench of cigarette smoke on their clothes and hair when they got home from a night out, and anyone who worked in the bar, nightclub and, even, restaurant trade then certainly does not need to be reminded.
Although legislation had been introduced in 1990 to prohibit smoking in public places such as cinemas and hair salons, the law was often not rigorously applied, and breaches were commonplace.
Right up until the early years of the new millennium, many workplaces — including offices — tolerated smoking indoors and with roughly 30pc of the population consuming tobacco, there was a significant cohort of people who, perhaps, did not want change.
Media reports from the time show there was a wide range of views among smokers, with some arguing that it was their right to light up where they pleased and others hopeful that any future restrictions might help curb their own nicotine habit.
But it was research conducted by the now defunct state body, the Office of Tobacco Control — showing the potentially devastating impact of passive smoking on bar staff — that helped to drive change. Already, a number of pub workers were taking legal action for damage to their health as a result of smoky bars and the Mandate trade union was calling for an end to smoking in pubs and all workplaces.
Twenty years ago this week, then health minister Micheál Martin announced that he would introduce a ban on smoking in the workplace the following year. The legislation was duly enacted in March 2004 and, despite claims that it would be difficult to enforce, it was embraced by the general population from the off.
Professor Luke Clancy was one of the key people who pushed for change 20 years ago. “We set out to protect people from second-hand smoke,” he says. “People were dying from second-hand smoke because it caused cancer, heart attacks and strokes. As a respiratory physician, I knew that my patients were dying of lung cancer.”
Getting the unions on his side was key. “Traditionally,” Clancy says, “the unions had been against smoke regulation because they felt it was taking away workers’ choice, but when we said second-hand smoke was killing them and when that message got through, the unions accepted it.”
Clancy believes the legislation was a success from the off. “We looked, as early as one year after the ban had come into effect, and the levels of second-hand smoke in pubs and discos had fallen dramatically. You might say that would be self-evident but, in fact, the industry had claimed at the time that it probably wouldn’t make much difference because most of the pollution in pubs was from cooking and outside.”
There was another critical, albeit less tangible, side-effect of the ban. “It de-normalised smoking in front of other people. The way we saw the biggest effect of that was in children. The whole discourse around smoking at that time had a dramatic effect and people actively stopped smoking around children. At that time in 2003, the prevalence of smoking among 16-year-olds was 32pc and fell progressively, down to 13pc, when it was at its lowest in 2015.”
Clancy insists that the smoking ban has had a remarkable impact on the nation’s public health. It has, he says, saved 1,500 lives per year.
He cites studies conducted by the Tobacco Free Research Institute — of which he is a founding member — to illustrate the positive health implications. “We found that all-cause mortality was down by 13pc. In heart attacks, there was a 26pc decrease. There was a 32pc reduction in strokes and in the region of a 30pc reduction in chronic obstructive pulmonary disease [such as emphysema].”
Former senator Averil Power is the chief executive of the Irish Cancer Society. “It’s no exaggeration to say that the ban is one of the single most effective public health measures ever implemented in Ireland,” she says. “It’s been hugely successful on a number of levels. It had the immediate effect of reducing exposure to second-hand smoke. It’s hard to believe, 20 years on, that people used to smoke in offices, in public buildings, restaurants and hotels. It’s now so socially unacceptable.
“It also played a huge role in decreasing smoking rates in Ireland, which will lead to fewer deaths and fewer disabilities from cancer, and also from heart attacks and strokes. We had the fastest decline in smoking rates in Europe up to 2017 and the ban was one of the reasons for that. It’s an example of how leadership has delivered great results and saved lives.”
Power smoked when she was at school and was also exposed to second-hand smoke when she took on a job at college. “I worked in nightclubs and you’d wake up the next day and be aware of the smell of your clothes and hair. A lot of people had to work in those environments, particularly lower paid staff in hospitality, and they were putting their health at risk. It’s hard to believe that any of that was ever acceptable.”
Power quit smoking during her college years, largely as a result of her asthma. She says one of the enduring legacies of the smoking ban is how it made smoking “uncool” among school children, at least up to the point, about five years ago, where vaping and e-cigarettes started to take a stranglehold. More of that later.
Martina Blake is the national lead for the HSE’s Tobacco Free Ireland Programme. “It is a class A carcinogen,” she says, “and we were the first country in the world to bring forward such ground-breaking legislation. That was especially impressive in a country that had a strong pub and going-out culture. We forget now that there was a lot of opposition from various industry bodies and stakeholders, but then with the majority of the country not smoking, the majority of people were behind the proposals.”
She echoes Clancy’s insistence that thousands of lives have been saved in the past two decades, but says there is no time for complacency.
“Even now, smoking kills 100 people every single week. A thousand bed days are taken up in HSE services and HSE acute hospitals with people who are in there purely because of smoking-related diseases.
“That’s the equivalent of two large acute hospitals. We’re reading day-on-day the pressure the system is under so it would be a huge change to have that number of hospital beds available to us that weren’t filled with people who are in there from something that’s entirely preventable.”
Although the proportion of the population smoking today versus 2003 (30pc) is greatly reduced, it’s still way above the rates in places like Canada and Iceland.
“The most recent Healthy Ireland survey, which is commissioned by the Department of Health, showed that 18pc of the population above 15 were smoking last year,” she says, “and that comprises 14pc who smoke daily and 4pc who say they smoke occasionally.”
It can be difficult to get a handle on the number of smokers, especially among those who don’t have cigarettes on a daily basis. “Some people who smoke occasionally don’t consider themselves smokers.”
Luke Clancy, meanwhile, believes it is important to understand that other factors, in tandem with the smoking ban, helped reduce rates of smoking. The most important of those, he insists, are price increases on a pack of cigarettes. “It has been proven to be a significant deterrent, proven to work and that is why we call for price increases.”
It is a sentiment echoed by Martina Blake. “Taxation and pricing are the most effective measures, but continuing to warn against the dangers is essential too. Since 2011, we’ve had four different iterations of the Quit [smoking] campaign.”
The HSE’s latest campaign, Take Control, was launched last month.
“It’s about recognising the physical, psychological and emotional addiction of nicotine,” she says. “It’s not just willpower alone, if you access our services — such as weekly calls for the first six weeks and then follow you up for a year to bring you along that journey.
“We now have stop-smoking medication for the first time in the history of the State. Most people, unfortunately, think smoking is just a bad habit. They might say, ‘I’ll just quit myself and I’ll do cold turkey and I won’t take any medication’. But, they underestimate how challenging it is for that quit attempt to be successful.
“People have to ask themselves why they are smoking. It’s often seen as a stress relief, but it does the exact opposite by speeding up your heart rate and raising your blood pressure.”
Despite the healthy progress made since the introduction of the smoking ban, experts are worried that the rate of decline may have plateaued and could be on the way back up.
Luke Clancy is especially concerned by the proliferation of vaping and how successfully these companies — many of them owned by the traditional giants of the tobacco industry — have moved into both the high street and our consciousness.
“We’ve been measuring it since 2015. Vaping was rare back then, but it has since become very prevalent. The notion that it’s ‘a great way to give up cigarettes’ is just a smokescreen for the industry. They’re pretending that e-cigarettes are helping people. Now, something like 18pc of students aged 16 are regularly using vapes and 45pc of have tried them. Of those who’ve tried them, 40pc have never smoked a cigarette in their life.”
He contends that it is disingenuous of the industry to argue that the flavours used by vaping firms, such as bubblegum, are not aimed at children.
“E-cigarettes are not part of the solution [to tobacco control] despite the narrative. I’m worried that the rate of smoking in children and in adults has gone up for the first time in 20 years. Our studies show that in Ireland, if you use vapes at 16, you are twice as likely to smoke.”
Martina Blake says the tobacco industry is always trying to steal a march on legislators. She notes that while menthol cigarettes were banned in this country some years ago over fears that they helped make smoking more palatable, it is now possible to buy menthol-flavoured paper for those who like to roll their own smokes. “They’ve created this little diffuser thing, too, that you can put into a box of cigarettes to infuse them with menthol.
“It’s a multi-billion dollar industry and they have the best minds thinking about ‘How do we manage this?’ That’s why it’s so difficult to keep up with them, because it can be so slow to get legislation through.”
Blake believes dramatic intervention is required, to follow on from the forward-thinking policies of two decades ago. She believes the example of New Zealand is one Ireland should follow. In a stark move, that country has introduced legislation which will ban anyone born from 2009 from ever buying cigarettes in their lifetime.
“Just think about it,” she says. “If the cigarette was introduced for the first time today and with all the devastating health consequences it brings, there is no way it would be licensed for sale. We have to take bold action in order to protect ourselves and future generations.
“And you can’t rest on your laurels. Great as the smoking ban in the workplace was, there’s so much more now and into the future that needs to be done.”
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