Where now for workplace tobacco controls?

Eighty per cent of the UK population does not smoke, but millions are exposed to the health hazards caused by environmental smoke fumes every day in public and workplaces. Does the recent ban on tobacco advertising and a voluntary code for smoke-free workplaces go far enough?

Key points

  • The government continues to give "careful consideration" to the adoption of an Approved Code of Practice (ACoP) on passive smoking, two years on from its original proposal by the Health and Safety Commission.

  • The ACoP appears to be bogged down by discussions between the Department of Health, DTI and Health and Safety Executive over its potential economic impact on the hospitality sector and small businesses.

  • Meanwhile, independent evidence suggests that the impact of tighter controls on smoking in public places would not be bad for business.

  • The launch of new guidelines for employers on implementing smoking policies, due in March 2002, has been indefinitely delayed.
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    Huge questions remain over whether and when controls on smoking at work will be introduced in England. An increasing number of states in the international community are getting to grips with the issue of environmental tobacco smoke - Ireland and Scotland are the latest countries considering making workplaces smoke-free - leaving England out in the cold among its economic neighbours.

    The Health and Safety Commission (HSC) proposed an Approved Code of Practice (ACoP) on passive smoking over two years ago. The draft now lies somewhere in Whitehall as government departments and the Cabinet wrangle over its potential impact on the hospitality sector in particular.

    Recent research presented at a conference organised by the TUC and others concludes that passive smoking causes the death of about 1,200 workers a year. The conference was the latest event to raise the workplace smoking issue up the political agenda - others have included an Early Day Motion (EDM 866) calling for legislation to resolve the matter and a Ten-Minute Rule Bill. So why the delay?

    Asked to comment on the current situation, a Department of Health (DoH) spokesperson acknowledged: "Passive smoking over a prolonged period is dangerous." Their advice? "We encourage all employers to introduce smoke-free workplaces. However, we recognise that is not always going to be possible, and in these circumstances encourage other measures to be taken to reduce people's exposure to smoke."

    Government "gives careful consideration" to ACoP

    According to the DoH, "the government is giving careful consideration" to the HSC's proposals for an ACoP on smoking in the workplace. Particular attention is being given to the implication of an ACoP on the hospitality sector and small businesses generally, and the role that the Public Places Charter could play (see Smoke gets in your eyes ). In reply to a parliamentary question in April, Hazel Blears, minister for public health, adds: "We recognise that making places entirely smoke-free is not always going to be possible, and encourage in these circumstances other measures to be taken to reduce people's exposure to smoke."

    The Public Places Charter is a strategy used by the hospitality industry "to provide customers with clear information on the type of smoking policy operating in a particular establishment and to allow them to make an informed choice", according to Parliamentary Under-Secretary of State for the Health Department, Lord Hunt. How this consumers' charter might be rolled out to include protection for employees is not clear.

    A recent progress report from the hospitality industry concludes that most pubs and restaurants signing up to the Public Places Charter have chosen to allow smoking to continue unrestricted. This is not surprising given the modest aims of the charter, which specify that only 35% of smoking policies in pubs and restaurants should restrict smoking to designated areas and/or have ventilation to an agreed standard. The report estimates that almost half of venues still allow smoking throughout.

    Meanwhile, the launch of guidelines for employers on good practice in developing smoking policies has been indefinitely delayed. Draft guidelines were developed by the DoH as part of a Tackling Tobacco in the Workplace project1. This project tracked the activities of nine employers in implementing smoking policies (see Procter & Gamble case study).

    Hospitality industry concerns

    The sensitivity of the workplace smoking issue in the hospitality industry is evident. Scottish & Newcastle - one of the nine businesses recruited in 2001 as "demonstration models of good practice" for the DoH's Tackling Tobacco in the Workplace initiative - declined our invitation to be included as a case study for this article.

    There is little evidence that controlling environmental smoke in pubs, restaurants and other parts of the leisure industry is bad for business. Research published in February 2003 by the specialist journal Tobacco Control refutes the claim that smoking bans have a negative impact on business2.

    In a meta analysis, the researchers found that none of the 60 studies funded from sources other than the tobacco industry arrived at negative economic conclusions. In startling contrast, "almost all (97%) of industry-supported studies . . . claimed a negative economic impact." The researchers conclude that "policy-makers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact."

    Given that non-smokers outnumber smokers two to one, Action on Smoking and Health (ASH) is not surprised by the outcome of the study. "Any fall (due to) the number of smokers removing their custom as a result of a smoking ban is more than likely to be offset by an increase in pub-goers who prefer a smoke-free environment," ASH adds.

    Small business worries

    For small businesses, fears centre on a belief that the introduction of an ACoP on passive smoking would lead to more "red tape", according to Amanda Sandford of ASH. However, ASH believes the opposite is more likely to be the case. "The ACoP would clarify the law and make it less likely that employers would be sued for harm caused by passive smoking."

    ASH also cite the tobacco industry as a key player blocking change, claiming that it has evidence to show that the tobacco industry has "lobbied hard behind the scenes and has been influential in stopping or slowing progress on smoking bans in many countries".

    Cost to public health

    On the other side of the argument, the NHS has absorbed the adverse economic impact of tobacco smoke for some time - including secondhand smoke. According the British Medical Association (BMA), 1,000 people die each year as a result of passive smoking. Those most at risk include people with heart and lung disease, pregnant women and anyone who has suffered a stroke.

    Dr Vivienne Nathanson, the BMA's head of science and ethics, has said that the failure of government to ban smoking in public places "is placing a huge burden on the NHS". In the spirit of making the user pay, the BMA is calling for the government to set a new tax on tobacco company profits to pay for public awareness campaigns that will make clear the health risks of passive smoking.

    Why legislate?

    The BMA estimates that in spite of the large number of workplaces with smoking policies, around three million people are still exposed to tobacco smoke at work. It believes that pressure is mounting on the government to act, particularly in the wake of growing evidence of the harm passive smoking causes to health. While the BMA welcomes the recent ban on tobacco advertising, it is calling for an outright ban on smoking in public places with no exemptions: "There is no safe level of exposure to 'environmental' smoke."

    In April this year, the TUC, the Chartered Institute of Environmental Health (CIEH) and ASH held a "Don't Choke on the Smoke" campaign conference where they called on the government to adopt the long-delayed ACoP on passive smoking.

    Ireland has announced its intention to ban smoking in all workplaces - including pubs and restaurants - within a year from January 2004. Scotland is planning to follow suit with a Regulation of Smoking Bill that, if enacted, will outlaw smoking wherever food is being served. The Bill is also expected to be law by early 2004.

    Scotland and Ireland will be joining the ranks of a long and growing list of countries in Europe and worldwide who have legislation in place on protecting people, including workers, from environmental tobacco smoke - including Australia, Canada, Hong Kong and the USA.

    New York City passed its Smoke-Free Air Act in 1995, which includes limits on public and workplace smoking. At the time, American tobacco giant Philip Morris managed to get an exemption from the law by threatening to move its headquarters out of the city. Last year, confounding its critics, Philip Morris made its Australian headquarters in Melbourne a smoke-free zone.

    Business case for change

    Smoking breaks can be made up by requiring employees to add the time taken to daily work hours. However, sickness absence caused or made worse by smoking, or working in a smoke-filled environment, cannot.

    In their guidelines to employers on workplace smoking policies (see extract in box 1), the DoH cites reduced sickness absence as one of the major benefits to employers of implementing a smoke-free policy. Other benefits - aside from less risk of litigation - include reduced cleaning, redecorating and fire insurance costs (smoking causes 12% of accidental fires at work).

    "Banning smoking does not automatically turn smokers into non-smokers, but given that 70% of smokers say they want to stop, a non-smoking atmosphere could help them reduce the amount they smoke, or help them to give up altogether - especially if you offer support and encouragement," according to the DoH's own advice.

    1. Details of the Tackling Tobacco in the Workplace initiative can be found at www.givingupsmoking.co.uk/employers/workplace/implementing.htm.

    2. Scollo, M et al. "Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry". Tobacco Control 2003; 12: 13-20.

    For examples of countries with smoke-free legislation, see: www.ash.org.uk/html/workplace/htmol/smokefreenews.html .

    Smoking kills - A White Paper on tobacco, http://www.archive.official-documents.co.uk/document/cm41/4177/4177.htm .

    Box 1: Workplace policy tool kit

    The NHS offers the following guidelines for developing a smoking policy:

    Set up a committee

    The committee should represent all elements of the workforce, including smokers, non-smokers, union representatives such as safety reps, and health and safety staff.

    Talk to the staff

    It is important to educate staff on the health implications of passive and active smoking. This can be done by distributing literature, through promotional materials, via in-house publications or by holding a presentation to employees.

    Staff should then be consulted about their views on workplace smoking to help identify the needs of staff, and resolve difficulties and conflicts of interest. This can be done through a questionnaire, discussion groups, interviews, or a suggestion box.

    Issues for discussion could include:

    ·    what kind of a policy they want;

    ·    whether they smoke;

    ·    whether tobacco smoke at work bothers them and how;

    ·    where in particular they think smoking causes problems, eg in meeting rooms, open-plan offices, corridors;

    ·    for smokers, how well they feel they would cope with different policy types;

    ·    for smokers, would they use help offered by the employer to encourage them to stop; and

    ·    for smokers, would a smoking policy make them smoke less or give up.

    Develop the policy

    Using the information obtained from consulting the workforce, draw up a policy that is right for your organisation.

    You may decide on one of the following options:

    ·    complete ban on smoking inside, or outside, the workplace during work hours;

    ·    complete ban on smoking in the workplace;

    ·    provision of smoking rooms or outside smoking areas etc;

    ·    smoking breaks during work hours;

    ·    clocking-off for smoking breaks; and

    ·    installation of ventilation throughout the workplace or in smoke rooms.

    Or you may develop another solution. A successful policy should include:

    ·    a timetable to bring in the changes - giving employees reasonable notice;

    ·    consequences of failure to comply with the policy;

    ·    concrete support for those wanting to give up smoking;

    ·    a complaints procedure; and

    ·    regular reviews of the policy.

    Implement the policy

    The final stage involves announcing the final policy to the workforce, checking that all necessary arrangements and adjustments have been made, and developing a mechanism to monitor the policy.

    Display copies of the policy in key locations, and distribute copies to all members of staff.

    Source: www.givingupsmoking.co.uk/employers/workplace/implementing.htm .

    Box 2: Case study - Procter & Gamble UK

    Interviewed:

    Dr Paul Nicholson, associate medical director responsible for UK and Ireland operations (plus two business units in Europe and the Middle East/Africa); Kathryn Glendinning, occupational health adviser.

    Business profile:

    Proctor & Gamble (P&G) is an American company that employs 103,000 people worldwide including 5,000 in the UK. All P&G business units operate as separate legal entities. Business activities include research and development, manufacture, distribution and marketing of beauty care, healthcare, babycare, feminine care and homecare products as well as pet food and snacks and beverages.

    Health protection policies and procedures:

    ·    Benchmarked to be at US best practice standards or higher, depending on the best practice in each country of operation. The company non-smoking policy rolls out across all UK locations.

    ·    Recruited by the Department of Health (DoH) for its Tackling Tobacco in the Workplace pilot project in 2001 (www.givingupsmoking.co.uk/employers/workplace/tacklingtobacco.htm ).

    Smoking policy:

    First introduced in 1992. Very much driven from the US, but developed in tandem with the strong focus on workplace smoking policies emanating from the DoH and the Health and Safety Executive. "Many UK companies were putting policies into place at that time."

    Key components:

    Smoking is not permitted in company buildings. Some sites have designated smoking areas outside the company buildings but specific manufacturing plants, warehouses and R&D sites prohibit smoking anywhere on site for safety and hygiene reasons. Smoking is not permitted in meeting rooms at off-site locations. Smoking must be done in personal break times.

    Support systems:

    Smoking-specific support procedures were in place while the policy was being introduced. These included a 50% subsidy to a maximum amount of £100 for nicotine patches, hypnotherapy and similar programmes.

    Current practice is to proactively support the health of all staff by facilitating activities and providing advice, rather than paying for benefits. This avoids bringing both equity and tax issues into the equation.

    Where possible, business units provide outdoor facilities for smokers. At the technical centre in Surrey, staff have "expensive and sophisticated" arbours to smoke under in bad weather. Paul Nicholson says: "The only complaint we get now is if there is someone smoking outside and smoke is coming in the window!"

    Health initiatives:

    As part of its health support system, P&G provides employees with access to a Canadian health website called Wellness Checkpoint (www.wellnesscheckpoint.com ). P&G pays for a personalised link for staff. The site provides an interactive risk assessment giving a score for an employee's individual health risk. The score is broken down to show the level of risk relating to each factor, such as high blood pressure or smoking. Staff can then work out a personal action plan and monitor the impact it has on their levels of risk.

    Paul Nicholson says: "At some sites we offer aerobics classes in the canteen, another site has a gymnasium. Elsewhere we have corporate rate arrangements with nearby health facilities."

    The company offers a 50% subsidy for health insurance and access to an EAP (Employee Assistance Programme) for both staff and members of their families. "Feedback has been that 100% found the counselling either helpful or very helpful and 68% felt they have taken less time off work and are concentrating better."

    Every employee is also offered a health screen every two years.

    Role in the Department of Health Tackling Tobacco in the Workplace pilot:

    The aim of the project was to provide demonstration models of best practice for the development of guidelines for employers. P&G was one of nine organisations that took part in workshops and subsequent audits of their policy and practice. "The idea was to get the best ideas from each group in order to formulate the tackling tobacco policy best practice." Some organisations had well-established policies, others were at implementation stage and still thinking it through. A number were not able to see the project through to completion for a variety of reasons, including organisational restructuring. Draft guidelines for employers were subsequently developed by the DoH but a planned launch in March 2002 has been indefinitely delayed.

    Recruitment issues:

    A health questionnaire at pre-employment includes a question about smoking. This information is not part of the P&G interview process. "The intent is to provide an opportunity to give one-to-one health advice. There is evidence that one of the most influential things in terms of stopping smoking is being asked about it and advised to stop by a health professional," according to Paul Nicholson.

    Outcomes:

    Figures for January 2003 show that, of the 30-40% of staff using the Wellness Checkpoint, 17% are ex-smokers, 13% are smokers and 10% of smokers are contemplating stopping. The aim is to get a bigger staff "buy-in" to the checkpoint programme to increase awareness of health risk factors such as smoking.

    At the beginning of 2002, a smoking cessation scheme called the Allen Carr Stop-Smoking Programme was run twice as a pilot at one of P&G's technical R&D sites at Newcastle. One year later, over 60% of those who attended the course have remained smoke-free and only 6% of all staff at the R&D site still smoke. (See www.allencarrseasyway.com ) According to Kathryn Glendinning, the positive outcomes from this include reduced sickness absence. Plus "there was no backlash from non-smoking staff because the course was such a huge success. Less cigarette breaks meant people were staying at their desks for longer so there was less resentment."

    Last words:

    ·    Paul Nicholson: "With any change that is potentially sensitive it's important to get employee involvement right at the beginning - although this is less of an issue now than it was 10 years ago."

    ·    Kathryn Glendining on giving up smoking: "People did best when they were involved in a group (such as the Allen Carr programme). It was the ones who tried to give up by themselves who fell by the wayside."

    Box 3: Smoking facts

    A survey of 2,000 adults by MORI on behalf of a coalition of cancer charities suggests that one in four workers is very concerned about the risks of passive smoking. (Source: 14 January 2003, www.bbc.co.uk/1/hi/health/2646079.stm).

    A US government estimate suggests that productivity increases by 3% when indoor air quality improves. (Source: NHS guidance on workplace policies.)

    Hospitality workers have a significantly increased risk of disease, including cancer, heart and lung diseases and strokes, compared with workers in places with no-smoking policies. (Source: March 2001 study commissioned by the New Zealand Ministry of Health.)

    More than 80% of people in Britain are in favour of smoking restrictions in public places and 87% support restrictions in restaurants. (Source: "Smoking-related behaviour and attitudes", National Statistics, June 2002.)

    No-smoking areas and ventilation in pubs and bars reduce smoke pollution by only 27%. (Source: May 2002 study by Manchester Metropolitan University.)

    Box 4: Policy timeline

    1998: The Scientific Committee on Tobacco and Health report concludes that exposure to tobacco smoke is a cause of lung cancer and that the increased risk for those with long-term exposure is around 20-30%.

    2000: A draft Approved Code of Practice on passive smoking at work is presented to government by the Health and Safety Commission (HSC) following a consultation showing that 83.2% of the 490 organisations taking part favoured new controls.

    2002: Planned March launch of guidelines for employers for "Developing and Implementing Gold Standard Workplace Tobacco Policies" is stalled.

    January 2003: When asked in the House of Lords exactly when consideration of the HSC's proposals would be completed, the Parliamentary Under-Secretary of State for the Department of Health, Lord Hunt, said he could not give "a definitive date when we shall come to a conclusion". He also said: "The government has no plans to introduce legislation."

    March-April 2003: Pressure on the government to announce its next moves on workplace smoking is raised by a number of events and initiatives, including new research on worker deaths from passive smoking, an Early Day Motion and a Ten-Minute Rule Bill in parliament.

    For international developments on smoking policies, see www.ash.org.uk/html/workplace/html/smokefreenews.html .