Media advisory: Tenth anniversary of smokefree legislation
1. The first of July 2017 is the tenth anniversary of the most important public health reform in generations – the ending of smoking in enclosed public places in England.
2.This media advisory is designed to provide background to journalists in advance of the anniversary about out the reasons why and how the law was introduced, the health benefits it has brought, the strong public support it enjoys, and subsequent developments. It is fully referenced. Contact the ASH office on 020 7404 0242 if you have any questions.
Secondhand smoke is a killer
3. Decades of evidence have established beyond doubt that breathing in other people’s cigarette smoke is bad for health.  It significantly increases the risks of a range of diseases, including:
- lung cancer;
- heart disease and stroke; and
- chronic obstructive pulmonary disease (sometimes called emphysema)
4.Secondhand smoke make respiratory problems worse; cause asthma attacks; reduce coronary blood flow; and cause headaches, coughs, sore throats, dizziness, and nausea.
5. In 2003, around 11,000 adults in the UK are estimated to have died due to exposure in the home, and about 600 people in the UK died as a result of exposure to secondhand smoke at work. 
6.Children are particularly vulnerable to secondhand smoke. Exposure to secondhand smoke increases a child’s risk of cancer, asthma, bronchitis, middle ear infection, and sudden infant death syndrome (SIDs). 
Health Act 2006 
7. Following a strong campaign by parliamentarians and the public health community and with growing public support,  the Government announced its intention to introduce smokefree legislation in November 2004. The original plan was to include exemptions for licensed premises such as bars, private clubs and pubs where no food was served. This was after the Republic of Ireland had instituted an outright ban on smoking in the workplace without such exemptions in March 2004, and the Scottish Executive had already voted to introduce a complete ban on smoking in enclosed public spaces in Scotland.
8. Public support in England for comprehensive legislation including pubs and bars grew from 50% to 66% between May 2004 and December 2005.  Furthermore the proposed exemption for non-food pubs was widely criticised as unworkable, and as failing to protect workers (bar staff) who were exposed to particularly high levels of secondhand smoke.
9. In its December 2005 Report (‘Smoking in Public Places’: HC 485-1), the House of Commons Health Select Committee, then chaired by Kevin Barron MP, described the exemptions for non-food pubs and clubs as “unfair, unjust, inefficient and unworkable.”  Members of the Select Committee, from all Parties, proposed an amendment to the Health Bill, which the Government in effect adopted, tabling its own version and allowing a free vote on the issue in both Houses of Parliament. In the House of Commons the amendment was passed by a majority of 200 votes on 14th February 2006. The vote set a precedent for treating future tobacco control legislation, such as the introduction of standardised packaging, as in effect a cross-Party issue.
10. Smokefree legislation was implemented in England on the 1st July, 2007.  Similar laws were implemented in Scotland (March 2006), Wales (April 2007), and Northern Ireland (April 2007). 
What has smokefree legislation achieved?
11. In the year following smokefree legislation, there was a 2.4% reduction in hospital admissions for heart attack. That meant 1,200 fewer emergency admissions in a single year.  In the three years following the law’s introduction, there were almost 7,000 fewer hospital admissions for childhood asthma. 
12. Levels of exposure among barworkers (the group with the highest occupational exposure to secondhand smoke) reduced significantly and respiratory health improved after the legislation was implemented. Prior to implementation 67% of workers reported one or more respiratory symptoms compared with 40% one year later. 
13. The smokefree law, and the campaign that supported it, also helped to change attitudes and behaviour on smoking. An extra 300,000 smokers were inspired to make a quit attempt as the law came into force. 
What did the tobacco industry say?
14. The tobacco industry and its funded front groups claimed that the legislation would be widely flouted, that pubs and restaurants would be forced out of business, and that smoking in the home would become more common. All these claims were proved to be false.
15. Implementation was smooth and the legislation widely complied with from the start. Local councils were given responsibility for enforcement, and had powers to levy fixed penalty notices of £50 for those found smoking in prohibited places, with a maximum fine of £200 if the case went to court.  During the first 18 months of the legislation, authorities in England inspected almost 600,000 premises and vehicles and found that 98.2% of premises and vehicles were smokefree.  There were on average 2 fixed penalty notices a day issued to smokers for smoking in a smokefree area during this period.
16. The “smokers’ rights” group FOREST (almost entirely funded by the tobacco industry) claimed that: “after the [smokefree legislation] more people are going to smoke at home.”  In fact, the proportion of adults living in a smokefree home was 61% before the legislation, but by 2008/9, this had increased to 69%.  And in the period leading up to and immediately following the introduction of smokefree legislation in England, children’s exposure reduced rather than increased. 
17. The Institute of Economic Affairs (a right-wing think tank that refuses to disclose its sources of funds, but is known to have received tobacco industry funding over many years)  has claimed that (smokefree) “legislation is ‘particularly culpable’ for ‘the decimation of the UK pub industry.”  In fact, between March 2007 and March 2008, the number of premises with licenses to sell alcohol increased by 4,200.  And following the introduction of the smokefree laws, more people reported that they went to the pub more often than reported they went less often.  BBC journalist Mark Easton carried out a detailed analysis of the claims that large numbers of pubs had closed as a result of the legislation and concluded that British pubs weren’t dying they were just adapting and evolving as they always have done. 
What do the public think?
18. Support for the smokefree legislation has become even stronger in the ten years since its introduction. The current level of public support in England has been measured by YouGov surveys at 83%. Even the majority of those who smoke every day support the legislation (52% support; 25% oppose). 
19. The same survey found popular support for smoking to be banned in outdoor areas not covered by the legislation:
- 82% agreed with banning smoking in outdoor children’s play areas (7% disagreed).
- 72% agreed with banning smoking in hospital grounds (15% disagreed).
- 59% agreed with banning smoking in communal recreational spaces such as parks and beaches (23% disagreed).
Beyond smokefree legislation
20. Smokefree legislation was extended to cover smoking in private cars with children from October 2015 (smoking in public and work vehicles was prohibited under the original legislation from July 2007).  Opinion polls carried out in 2016 after the law was implemented found that 87% of adults supported the legislation  and 86% of children reported no exposure to smoking in cars. The Department of Health has no plans to extend the legislation further, although Scotland, Wales and Northern Ireland have done so (see below).
21. Smokefree places have, however, been extended beyond those required by legislation. The Association of Train Operator Companies (ATOC) and Network Rail introduced their own no smoking policies in addition to what is required by legislation. This means as well as in indoor areas, such as trains and cafes, smoking is prohibited on all station concourses, ticket halls, platforms (covered and uncovered), footbridges and subways at station premises.  The football league prohibited smoking in football stadia following a survey of supporters. Football League stadia are smokefree and smoking is not permitted inside the grounds. 
22. NICE guidance published in 2013 on smoking in acute, maternity and mental health services  recommended that smoking should be banned on the grounds of hospitals and such policies have been widely, though not yet universally, implemented. Public Health England is working to encourage hospitals to become smokefree by ensuring all smokers get help to quit as well as requiring premises to be smokefree.  Smoking in hospital grounds is already banned by law in Northern Ireland  and Scotland,  and legislation was passed in May to cover hospital grounds in Wales. 
23. Prisons were given a partial exemption from the 2007 legislation to allow prisoners to smoke in their cells. In October 2015 the National Offender Management Service (NOMS) announced that smoking would be phased out of prisons in England and Wales. Smoking in enclosed areas in open prisons was prohibited from the end of October 2015. All prisons in Wales went smokefree at the beginning of 2016 and starting in the southwest a complete ban on smoking in prisons is being rolled out through the rest of the estate, which is due to be completed over the next 12 months. As of May 2017 there are 21 smokefree prisons with remainder going smokefree in a phased process, with the exact timing dependent on operational readiness. 
24. A number of local authorities in England have put in place voluntary measures to discourage smoking in children’s play areas and outside schools, including Nottingham,  and Leicester.  Legislation was passed by the Welsh Assembly in May which will restrict smoking in children’s playgrounds, school grounds and hospital sites. 
25. Brighton and Hove City Council is encouraging local restaurants and pubs to introduce smokefree zones in their outdoor areas. This followed a consultation which found that around 65% of non-smoking residents agreed restaurants with outdoor seating should be smokefree, and 55% said the same about pubs. From initial discussions with 12 business they have found three already enforce a no smoking policy in their outdoor areas. 
26. Around the country businesses are making their own decisions in the light of needs to extend smokefree areas. For example, at the beginning of June, a pub in Leeds decided to turn its beer garden smokefree after spending more than £100,000 to build a purpose built play area for children and launching outdoor music events at the pub. 
27. On a voluntary basis many businesses have decided to extend the prohibition on smoking to e-cigarettes. [34,35] However, the Department of Health has confirmed that it has ruled out extending the smokefree laws to e-cigarettes , a position ASH supports as there is no evidence that e-cigarette vapour causes the same harm as tobacco smoke. 
28. A range of other legislative measures have been introduced in England since the smokefree laws including: increasing the age of sale from 16 to 18 (October 2007); prohibiting the sale of tobacco from vending machines (October 2011); prohibiting display of tobacco products in shops (April 2012 for large shops and 2015 for small shops); and a range of measures including larger health warnings and standardised packaging of tobacco packs (from May 2016). 
29. However, smoking remains the leading cause of preventable premature death in Britain killing nearly 100,000 people a year and there are still around 9 million smokers.  The last Government failed to introduce a new Tobacco Control Plan for England, although the previous one expired at the end of 2015. Cuts in local authority funding mean that public health activity, including the provision of stop smoking services, is seriously threatened in many areas, or has closed altogether. The evidence from other jurisdictions is that action to cut smoking rates has to be progressive and continuous – or smoking rates could stop falling and may even start to rise again.  Smoking remains the single most important public health problem facing the UK today. The public health community is calling on the Government to publish a new Tobacco Control Plan without further delay , backed up by cross party support in both the House of Lords  and the House of Commons.
Notes and Links:
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash
ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.
ASH staff are available for interview and for more information. Please contact Deborah Arnott on 020 7404 0242 or 07976 935 987.
 The evidence was summarised for the Government in a November 2004 by the Scientific Committee on Tobacco and Health. The Committee concluded that: “It is evident that no infant, child or adult should be exposed to SHS [secondhand smoke]. This update confirms that SHS represents a substantial public health hazard.”
 The Tobacco Advisory Group. Going smoke-free. The Royal College of Physicians 2005.
 ASH. Secondhand Smoke: the impact on children. March 2014.
 UK Government. Health Act 2006: Chapter 28. 2006.
 More detail on the campaign can be found in Comprehensive smoke-free legislation in England: how advocacy won the day.
 House of Commons Health Committee. Smoking in Public Places: First report of session 2005-06: Volume 1. 15 December 2005.
 Public Health England. The smokefree (premises and enforcement) regulations 2006. Statutory Instruments 2006 No. 3368.
 For more information about the legislation in each jurisdiction see table 1.1 in: Tobacco Advisory Group. Passive smoking and children. Royal College of Physicians 2010.
 Bauld L. The impact of smokefree legislation in England: Evidence review. Department of Health March 2011.
 NHS and Smokefree England. Smokefree regulations – February 2007 update. February 2007.
 Local Government Analysis and Research. Smokefree Legislation Compliance Data.
 Smeaton Z. Will the ban boost public health? BBC 1 July 2007.
 Institute of Economic Affairs. Tobacco Tactics. [Accessed 7 June 2016]
 Snowden, C. Closing time: Who’s killing the British pub? Institute of Economic Affairs 10 December 2014.
 Department for Culture, Media & Sport. Alcohol, entertainment and late night refreshment licensing, England and Wales, April 2007 to March 2008. 14 January 2010.
 Office for National Statistics. Smoking related behaviour and attitudes 2008/09, July 2009.
 Easton M. British pubs aren’t dying – they are evolving. BBC online news 31 July 2009
 ASH and YouGov, Smokefree Survey 2017. The survey was carried out online by YouGov for ASH; the total sample size was 10488 adults in England. Fieldwork was undertaken between 16th February 2017 and 19th March 2017. The figures have been weighted and are representative of all adults (aged 18+).
 Department of Health. Smoking in vehicles. 11 August 2015.
 YouGov survey. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 10058 adults. Fieldwork was undertaken between 2nd to 23rd March 2016. The survey was carried out online. The figures have been weighted and are representative of all England adults (aged 18+).
 YouGov survey. ASH Smokefree Youth Great Britain Survey 2016. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,331 11 to 18 year olds. Fieldwork was undertaken between 11th March and 10th April 2016. The survey was carried out online. The figures have been weighted and are representative of all GB 11-18 year olds.
 ATOC press release. End of the line for smoking on the railways. 4 June 2007.
 Sport Industry Group. Football league to reward non-smokers. 29 April 2008.
 NICE. Public health guideline [PH48]. November 2013.
 Selbie D. It’s time for a truly tobacco free NHS. Public Health England 6 December 2016.
 NI Direct. Smoking regulations in Northern Ireland. [Accessed 7 June 2017]
 Scottish Government. Smoke-free hospital grounds. 1 April 2015.
 Wales. Public Health (Wales) Bill. [Accessed 7 June 2017]
 ASH. Smokefree Prisons. October 2015.
 Nottingham playgounds to go smoke-free. BBC News Leicester 8 November 2011.
 Martin D. ‘No smoking’ request at 173 Leicester children’s play areas. Leicester Mercury 12 July 2016.
 Bastable B. Plans to cut smoking outside pubs and restaurants in Brighton. Brighton and Hove Independent 7 June 2017.
 Landlord of Leeds pub stubs out smoking in beer garden. Yorkshire Evening Post 31 May 2017.
 Glanfield E. BBC bans use of electronic cigarettes from all of its offices and studios across the country. Mail Online 16 July 2014.
 So where can you still vape? BBC Newsbeat 10 June 2015.
 Campbell D. E-cigarettes: no indoor smoking ban planned in England despite WHO call. The Guardian 26 August 2014.
 Royal College of Physicians. Nicotine without smoke: Tobacco Harm Reduction. London: RCP, 2016.
 ASH media release. All tobacco packs on sale will be in standardised “plain” packs from 20th May 2017. 15 May 2017.
 ASH. Smoking Still Kills. London 2015.
 Letter from 1100 healthcare professionals and public health experts including Presidents of medical royal colleges. The need for a new Tobacco Control Plan: an issue of justice. BMJ 2017;356:j342
 House of Lords. Tobacco Control Plan. 23 February 2017. Volume 779
 House of Commons. Tobacco Control Plan. 13 October 2016. Volume 615.