Smoking ban in England and Wales

IN BRIEF: UK workplaces had been moving towards being smoke-

free since the 1980s. In July 2007, a ban on smoking in enclosed
public spaces took effect throughout the UK under the 2006 Health
Act. The evidence of the health risks of passive smoking had been
growing, and public opinion had been persuaded by the arguments
and by personal experience. The controversial element was the
ban on smoking in licensed premises, but despite initial
opposition the policy has been accepted throughout the country.

THE CHALLENGE and smoking in offices became confined

In the 1960s and 1970s, public places in the
UK, such as a buses, trains, cinemas,
theatres, public houses and restaurants
allowed smoking, and the effects were clear:
diseases for smokers and poor air quality for
all. The same was true of the workplace,
where smoking was an accepted part of office
life, and the “smoke-filled room” was a
widely-used metaphor for a room where
political intrigue took place.
As the dangers of smoking, in causing
diseases such as lung cancer and
emphysema in smokers, and the risks of
passive smoking became more apparent,
public places and offices began to impose
partial smoking bans through the 1980s and
1990s. For example, there was an increasing
number of No Smoking carriages in trains,
the underground railway in London banned
smoking (in 1984),
to one or two rooms before being banned
completely.
As reports by the British Medical Association
(BMA) and the International Agency for
Research on Cancer (IARC) quantified the
risks of passive smoking with regard to
cancer, heart disease and strokes, it was
evident that a partial ban was inadequate.
It was widely accepted that this situation
was only temporary, but there was strong
resistance in some quarters to the idea of a
complete ban, particularly in bars and
restaurants and other licensed premises.
Smoking ban in England and Wales

THE INITIATIVE THE PUBLIC IMPACT

In November 2004, the Department of Health
published the public health White Paper,
‘Choosing Health: Making healthy choices easier’.
It made clear the fact that there was a pressing
need to protect citizens from secondhand smoke
and that public opinion on the whole favoured
legislative intervention. After consultation, the
complete ban was effected through the Health
Act 2006. The main provisions are set out in
section 2 of the Act:
“Smoke-free premises
(1) Premises are smoke-free if they are open
to the public ...
(2) Premises are smoke-free if they are used
as a place of work—
The effect on formerly smoke-filled licensed
premises was very noticeable, as radical in its
way as the 1951 Clean Air Act. The air quality
was markedly better. Compliance with the 2006
Act was widespread: during the first 18 months
after enactment, authorities in England
inspected almost 600,000 premises and
vehicles, and found that 98.2 percent of
premises and vehicles were smoke-free and
89.3 percent were displaying the correct
No Smoking signs.
In the first year after enactment, there was an
increase in the numbers of people giving up
smoking, and there were 1,200 fewer emergency
admissions to hospital for heart attacks, a
reduction of 2.4 percent from pre-Act levels.

(a) by more than one person (even if the persons

who work there do so at different times, or only
intermittently), or
(b) where members of the public might attend
for the purpose of seeking or receiving goods or
services from the person or persons working
there (even if members of the public are not
always present).

They are smoke-free all the time.”

Scotland had already banned smoking in public

places in March 2006. The ban came into force in
England in July, shortly after Wales and Northern
Ireland, and the UK’s legislation was therefore
complete in July 2006.

CENTRE FOR PUBLIC IMPACT

Smoking ban in England and Wales

WHAT DID AND DIDN’T WORK

All cases in our Public Impact Observatory have
been evaluated for performance against the
elements of our Public Impact Fundamentals.

Legitimacy

Stakeholder Engagement

The main stakeholders were the government, in

particular the Ministry of Health and the Health
and Safety Executive, the Chief Medical Officer,
along with rest of the medical profession, local
councils, the owners of licensed premises and
others who were obliged to comply with the Act,
the police and the general public. There were
mass media campaigns to raise public
awareness of the dangers of passive smoking
before the Health Bill in 2005.

As with any significant legislation, there had been

a comprehensive consultation process with all
stakeholders in drafting and reviewing the White
Paper, and the policy had been designed with
their input, particularly that of the medical
profession –through bodies such as the BMA,
not-for-profits such as the King’s Fund, and the
National Health Service (NHS) trusts responsible
for hospitals and clinics.

The main resistance to the change was from pro-

smoking pressure groups and the owners of
licensed premises, although some, such as those
owned by the JD Wetherspoon chain, had already
imposed bans (in 2005). There was a recognition
that the legislation had public support and that it
was part of an inevitable progression.

CENTRE FOR PUBLIC IMPACT

Smoking ban in England and Wales

Political Commitment Policy

The government was committed to the Clear Objectives

legislation, which was seen as having major
The government’s broad objective was to
public benefits, with the health secretary,
improve public health by banning smoking in
Patricia Hewitt, a vocal proponent, as was the
public places and workplaces. This would have
UK’s then Chief Medical Officer, Dr Liam
a positive effect on smokers, by encouraging
Donaldson. “The BMA's secretary in Wales,
them to give up smoking, and on non-
Richard Lewis, said: ‘this is the greatest public
smokers, by limiting their exposure to passive
health initiative in Wales for over a century. The
smoking. It then pursued these objectives
BMA has campaigned hard for years for it’”.
through the standard parliamentary process.

The legislation went through the standard

procedure:
• In November 2004, the government published
the white paper on public health, detailing its
intention to introduce the provisions on smoke-
free premises. The Health Bill drafted in the light
of the consultation process.
• The Health Bill received its first reading in
Parliament on 27 October 2005.
• On 14 February 2006, on the third reading of
the Health Bill, MPs voted by 364 votes to 21 in
favour of the Bill, and it was therefore approved
to be made statutory.
The large majority in favour of the Health Bill
indicates that there was strong commitment
behind the smoking ban in all political parties.
Public Confidence
Public support in favour of smoke-free premises
had been growing. In 2004, a MORI opinion poll
indicated that there was a majority in favour
(51%). AA survey conducted by YouGov the
following year found that 66% of adults
supported the ban. In 2007, at the time when
the 2006 Act came into effect, 72% of the public
were in favour of the legislation. In 2012 the
figure was 78%.
Evidence
The evidence takes two main forms forms: the
medical evidence to indicate that the ban would
have the desired impact on health; and the
evidence of similar legislative bans enacted in
other parts of the world.
There was clear evidence that exposure to other
people’s smoking is dangerous to health and
that passive smoking was a particular risk to
those working in licensed premises The sources
for the evidence were authoritative: the UK’s
Chief Medical Officer, the US Surgeon General,
the World Health Organization (WHO) and
the IARC.
A similar ban was enforced in New York in 2003,
under the New York City Smoke-Free Air Act of
2002. In March 2004, Ireland became the first
European country to institute an outright ban
on smoking in the workplace. Such bans were
clearly enforceable and had positive impact
on health.

CENTRE FOR PUBLIC IMPACT

Smoking ban in England and Wales
Feasibility
The fact that there had been a gradual
movement towards banning smoking in
enclosed spaces in workplaces and public
places indicated that a complete ban was
entirely feasible. It was becoming increasingly
socially unacceptable to smoke, the medical
evidence was considered to be very credible,
public opinion was behind the move, and the
consultation process on the 2005 White Paper
indicated that the vast majority of public
bodies approved of the smoke-free provisions.
The progress towards the smoking ban had
been gradual but relentless, including such
anti-smoking legislation as the Tobacco
Advertising and Promotion Act 2002, and this
indicated that the 2006 Act would be
successful in terms of both enforcement
and compliance.
Action
Management
The 2006 Act made clear provisions for
enforcement of the relevant smoke-free
premises, and imposed fixed penalties on
those failing to enforce the ban (s.8) or
contravening the ban (s. 7). Owners or
managers of any relevant premises had to
display ‘No smoking’ signs (s. 6) and take
reasonable steps to ensure awareness of
the ban and compliance with it.
The relevant local council was in charge
of enforcing the law. Extra officers were
taken on to ensure compliance.
CENTRE FOR PUBLIC IMPACT
Measurement
There were several parameters which were
measured over the period of time to monitor
the success of the initiative, such as the health
of those working in licensed premises and
hospital admissions for particular smoking-
related infections. “A study of barworkers in
England showed that their exposure reduced
on average between 73% and 91% and
measures of their respiratory health
significantly improved after the introduction of
the legislation ... In England, the legislation
resulted in a statistically significant reduction
(−2.4%) in the number of hospital admissions
for myocardial infarction (MI). This amounted
to 1,200 emergency admissions for MI in the
year following the introduction of smoke-free
legislation.” [2]
Alignment
There was a clear alignment of interests
between the government, citizens and the
medical profession in gathering evidence for
the ban and imposing it. There was significant
cooperation between the government and the
parties who were consulted about the White
Paper to ensure that the Health Bill reflected
expert and general opinion. There was also
cooperation between the various political
parties, as reflected in the very large majority
when the Bill was voted on in Parliament.
There was initial opposition to the ban from
many owners of licensed premises, but as the
Act’s effects on the use of such premises
proved less severe than anticipated, the level
of opposition declined.