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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.
Competing interests:
No competing interests
29 July 2002
Richard D. Hurt
Professor of Medicine, Director, Nicotine Dependence Center
None
Mayo Clinic, Nicotine Dependence Center, 200 First Street, SW, Rochester, MN 55905
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.
Competing interests: No competing interests