Smoke gets in your eyes

It is two years since the Health and Safety Commission proposed an Approved Code of Practice on passive smoking. Where has it got to?

Key points The HSC's draft Approved Code of Practice on passive smoking appears to have stalled over the conflict between workers' and consumers' interests. Three million people are exposed to tobacco smoke at work (1.4 million in the hospitality sector). Total bans in other countries have had a significant effect on smoking cessation.

A total workplace smoking ban in the UK would cut cigarette consumption among employees by just under one-third (29%), according to research published in the British Medical Journal (BMJ)¹. Drawing on experience in the US, Germany and elsewhere of regulations banning smoking, the study points to the powerful effect of total workplace bans on smoking cessation, estimated to cause 3.8% of smokers to quit and a further 3.1% to cut down.

This August, government health minister Hazel Blears announced a public consultation on Regulations banning cigarette advertising and promotion by the end of 2002², which she estimates will save 3,000 lives a year.

Yet September 2002 marks the second anniversary of the Health and Safety Commission's (HSC's) submission to government of a draft Approved Code of Practice (ACoP) on passive smoking at work, designed to protect three million workers from exposure to environmental tobacco smoke (ETS) in their workplace³. Several hundred people a year are estimated to die from lung cancer brought about by passive smoking, according to the government's 1998 White Paper, Smoking kills⁴.

Smoking Code proposed

The HSC's plans to tackle passive smoking also followed public consultation. In 1999, of 490 individuals and organisations responding, 83.2% favoured new regulations. Accordingly, the HSC concluded that an ACoP (having similar legal force to, for example, The Highway Code) was the best way forward.

The HSC's draft ACoP (which has not been published) would require employers to:

implement a smoking policy, and consider, first, a partial or total ban;

consider the health effects of ETS on vulnerable employees (such as asthma sufferers) and others finding the smell unpleasant; and

take steps such as physical separation of staff from ETS where a total ban is not feasible, providing adequate ventilation and other measures to reduce exposure.

A key measure, apparently included in the draft ACoP, is the Public Places Charter (PPC)⁵ on smoking. This is a consumers' charter, encouraging pubs, hotels, restaurants and other leisure venues voluntarily to display signs at the door stating their policy on smoking on the premises.

The HSC has accepted that compliance with the industry's voluntary code would count as compliance with the ACoP for the first two years, originally due to come to an end in January 2003. However, in 2001, in response to concerns raised by sections of the business community, the government asked the HSC to reconsider the impact of the ACoP on the hospitality sector and small businesses. Our enquiries suggest that the HSC is having difficulty reconciling the interests of consumers with its mission to promote occupational health.

Charter alternative?

The PPC is supported by the "charter group" of 14 leisure sector employers' bodies, including the British Hospitality Association (BHA), the Restaurant Association and the Association of Licensed Multiple Retailers. According to the BHA, the UK hospitality industry employs just under 1.4 million staff in 262,517 outlets (table 1)⁶.

Latest research carried out for The Publican⁷ claims that two-thirds (64%) of the UK's 52,000 pubs are PPC-compliant, displaying one or more charter signs (table 2). Of these, one-third (36%) allow smoking throughout, while a fraction currently meet PPC ventilation standards. According to the trade paper, the pub sector "is in line to smash the smoking charter compliance target agreed with the government".

However, Nick Bish, charter group spokesperson, told IRS Employment Review that the paper's data were based on "self-selected" replies to a readership survey. For this reason, the PPC group was not convinced that the 50% target had been met nationally, although a lot of activity was taking place to "accelerate uptake further before the end of the year". Bish, chief executive of the Association of Licensed Multiple Retailers, said the charter group would carry out an independent survey of compliance next year.

In November 2001, charter group research showed that:

half of hotels ban smoking in their restaurants, and a further one-third created non-smoking areas in restaurants; and

29% of Restaurant Association members comply with the PPC - 9% are non-smoking.

Bish suggested that the PPC is applicable to all sorts of locations, not just the hospitality industry, although the "controversial area" was pubs. The charter group had not assessed the impact of the charter on the hospitality workforce, nor was any research planned. The group was "not in the smoking debate".

However, the charter group had introduced the concept of best practice in its provision of separate areas for non-smokers and improving air quality in pubs. As Bish explained, a universal ban on smoking in public places would have a significant immediate impact on the industry, although he recognised that the hospitality industry would seek to adapt to changes in customer demand, were that to happen.

Employee protection

The government asked the HSC to look again at the implications of an ACoP for the hospitality and small business sectors, and whether or not the PPC would be a suitable alternative. The HSC's head of health management strategy, Elizabeth Gyngell, told IRS: "We want to see if the voluntary PPC would help resolve the issue of employee protection. It is difficult from the industry's survey data to see what effect the charter is having on employees. The charter is a consumer choice project, and is not designed for employee protection. So it is difficult to see how to apply the PPC, designed for one purpose, customer choice, to another objective, employee health and safety."

The PPC permits smoking throughout as one option, and this is clearly not an arrangement to protect employees. As Gyngell says: "The challenge is not whether the PPC meets its own objectives, but will it really provide the protection we want for employees? Our challenge is to sort out the employee part of the equation."

Gyngell adds: "We are trying to align the two interests, and come up with an acceptable solution." The HSC hopes to conclude its review by the end of the year.

Health promotion?

The PPC was supported by the Department of Health (DoH) after the government's Smoking kills White Paper, which was aimed at ensuring that any customer entering public premises would know whether or not smoking was allowed inside. However, the DoH told IRS_Employment Review that the PPC was not intended to be restricted to the pub sector, but was applicable to "any place to which the public has access".

Information on the number of hospitality and small business premises and employees covered by the PPC was "not available". The DoH accepts the HSC's estimate that some three million employees are exposed to passive smoking. Asked about an apparent conflict of employee and consumer interests inherent in the charter, a spokesperson said that the PPC would look after the customers' interests, the ACoP would take care of workers.

The DoH would like to move forward on all fronts, "but in real life you have to take account of different interests", a spokesperson said. However, there is no set timetable to complete its review of the proposed ACoP. Other parties to the further round of consultations include the small businesses section of the DTI and the hospitality industry itself. "It's a problem that won't go away," a spokesperson said. "We want to make progress on the question as quickly as possible."

When workers kick the habit

In the BMJ study¹, researchers brought together the results of 26 projects assessing changes to smoking habits after workplace smoking regulations were introduced in the US, Canada, Germany and Australia. Totally smoke-free workplaces have about twice the effect on cigarette consumption as policies that tolerated smoking in some work areas. In the US, government estimates show that passive smoking kills about one non-smoker for every eight smokers that tobacco kills. In London, non-smokers working in pubs are in an occupational group with "extremely high exposure" to other people's tobacco smoke⁸.

The BMJ researchers estimate that using taxation policies to achieve an equivalent 29% drop in employee cigarette consumption would require a doubling of the average price of a pack of 20 cigarettes.

The study also found that teenagers respond to smoke-free environments at work and at home by decreasing their smoking. Teenagers working in totally smoke-free locations were two-thirds as likely ever to smoke as those that work in less restricted workplaces, the study shows. As the government's White Paper said: "The younger people start, the more likely they are to smoke for longer, and to die early from smoking."

1."Banning smoking in the workplace", Caroline Fichtenberg and Stanton Glantz, British Medical Journal, July 2002, www.bmj.com.

2.Consultation on the various draft tobacco advertising and promotion Regulations, www.doh.gov.uk/tobaccoregsconsult/index.htm. Closing date for responses is 15 November 2002.

3."Here's the evidence, where's the ACoP?", Becky Allen, Occupational Health Review 99, available from IRS, tel: 020 7354 6742, price £37.50 (single issue).

4.Smoking kills, 1998, www.archive.official-documents.co.uk/document/cm41/4177/4177.htm.

5.The Public Places Charter on smoking, www.airinitiative.com.

6.British hospitality: trends and statistics, 2002, BHA, tel: 020 7404 7744.

7.The Publican, 19 August 2002.

8.Scrutiny of smoking in public places in London, London Assembly: www.london.gov.uk/approot/assembly/smokemtgs/2002/smoking_report.pdf.

The Public Places Charter The PPC is a voluntary code agreed between the DoH and hospitality industry groups. The charter aims to improve consumer choice on smoking in public places (hotels, restaurants, pubs and other leisure venues). Customers can identify whether or not they can smoke in a venue, and whether or not it has restricted and/or ventilated areas. To comply, venues must adopt one or more of five policy options, and display the appropriate sign(s): Smoking allowed in public areas. Smoking not allowed in public areas. Smoking only in designated areas. Ventilation meets standard: smoking allowed. Ventilation meets standard: smoking only in designated areas. Source: www.airinitiative.com.

Table 1: Workforce and outlets in UK hospitality

Sector	Outlets	Workforce
Hotels	48,329	237,720
Restaurants	25,832	387,978
Pubs, clubs and bars	51,564	248,768
Contract catering	20,872	110,720
Hospitality services	Not stated	384,285

Source: British Hospitality Association.

Table 2: Meeting smoking charter targets

Charter targets, end 2002	Progress, August 2002
50% of all pubs to have a formal smoking policy and carry an external sign.	64% of pubs adopting/displaying a PPC policy sign.
Of these, 35% should be the "good practice" signs for non-smoking areas and/or charter	2% of pubs are totally non-smoking. 21% have separate areas for non-smokers. standard ventilation. 2% have separate ventilated areas. 36% allow smoking throughout.

Source: Charter group.