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EDITORIALS: Robert West Banning smoking in the workplace BMJ 2002; 325: 174-175 [Full text]

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Smoke-free Workplaces- A Return to the Norm

Richard D. Hurt, None   (29 July 2002)

Smoke-free Workplaces- A Return to the Norm 29 July 2002
Richard D. Hurt, Professor of Medicine, Director, Nicotine Dependence Center Mayo Clinic, Nicotine Dependence Center, 200 First Street, SW, Rochester, MN 55905, None Send response to journal: Re: Smoke-free Workplaces- A Return to the Norm	Dr. West’s editorial: “Banning Smoking in the Workplace” indicates that despite the evidence of the benefits of smoke-free work places, initiating smoke-free hospital policies in the U.K. is “stalled.” Even in a teaching hospital, the implementation of a smoke-free policy may be years in the future. Dr. West covers most of the issues surrounding this topic, but doesn’t highlight the inordinate political influence of the tobacco industry. The industry subverts such policies because smoke-free work places reduce cigarette consumption and encourage smokers to quit [1]. In fact, the two public policies the tobacco industry fear the most are increased tobacco taxes and smoke-free indoor air initiatives. What gets lost in the current discussion is that it was only about 50 years ago that the increase in smoking invaded previously smoke-free places “…even when and where patients seriously ill from respiratory diseases are under treatment” [2]. Thus, the issue is not banning smoking from the work place, rather it is returning the work place to the norm that existed before the cigarette epidemic. The smoke-free hospital movement began in the United States in the mid-1980s, ultimately leading the Joint Commission on Accreditation of Healthcare Organizations to implement a policy calling for smoke-free hospitals [3]. Not only do such policies protect non-smoking patients, but they also encourage smoking hospital employees to stop smoking [4]. Thus, if the government of the U.K. doesn’t have the political will to mandate such a public health initiative, organized medicine and overseers of hospitals should accomplish this on their own. It is essential that healthcare institutions take a leadership role in the smoke-free indoor air initiatives. To do otherwise would be shirking our responsibility as the principal protectors of the public health. To continue to allow smoking in hospitals is inconsistent with the healthcare profession’s goal of reducing morbidity and mortality. In fact, given the data from the systematic review reported in the BMJ, implementing smoke-free hospital policies is one of the most cost effective interventions available for treating tobacco dependence [5]. Dr. Johnston’s prophetic words should no longer apply in the 21st Century: “The problem of sanctuary for those who claim (as I do) that the right to breathe clean air–air free, at any rate, from irritant fumes–is as basic, in a civilised country, as the right to drink clean water, has become today almost insoluble even when they are ill” [2]. References 1. Muggli ME, Forster JL, Hurt RD, Repace JL: The smoke you don't see: uncovering tobacco industry scientific strategies aimed against environmental tobacco smoke. American Journal of Public Health 2001, 91:1419-1423. 2. Johnston L: Cure of tobacco-smoking. The Lancet 1952, 2:481-483. 3. Longo DR, Feldman MM, Kruse RL, Brownson RC, Petroski GF, Hewett JE: Implementing smoking bans in American hospitals: results of a national survey. Tobacco Control 1998, 7:47-55. 4. Offord KP, Hurt RD, Berge KG, Frusti DK, Schmidt L: Effects of the implementation of a smoke-free policy in a medical center. Chest 1992, 102:1531-1536. 5. Fichtenberg CM, Glantz SA: Effect of smoke-free workplaces on smoking behaviour systematic review. British Medical Journal 2002, 325:188-191.