Doctors angry as smoking ban is limited and delayed until 2008

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1201
  1. Zosia Kmietowicz
  1. London

    Plans to ban smoking in only some public places and to delay the introduction of the policy until the end of 2008 have been greeted with frustration and condemnation by health campaigners.

    The announcement this week by the health secretary, John Reid, to restrict the smoking ban to restaurants and pubs which serve food, but to allow other pubs and private members' clubs to choose whether they ban smoking, will be confusing and difficult to enforce, said the BMA.

    “I recognise that John Reid has certainly gone a long way on tobacco but he has wasted an opportunity by not introducing a complete ban on smoking in enclosed public places,” said James Johnson, chairman of the BMA. “It makes no sense to allow smoking in some pubs—what about the health and lives of employees who work in them?

    “What concerns me is that by not introducing a complete ban, some pubs may find loopholes in the law to allow smoking. For example, if landlords brought in preprepared sandwiches would smoking be permitted?”

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    Pubs that do not serve food, and private members' clubs, will be exempt from the smoking ban


    Professor Alex Markham, chief executive of Cancer Research UK, commented, “It seems bizarre that the government has accepted the wisdom of a ban but is then happy to deny the benefits of it to people who work in private clubs and pubs where food is not served.

    “It's like having the legislation to fit all cars with seatbelts because we know seatbelts save lives and then stopping some passengers from wearing them.”

    The plans to ban smoking are included in the white paper on public health and are among more than £1bn ($1.9bn; €1.4bn) worth of initiatives for England to be phased in over the next three years aimed at improving people's health.

    There are also plans to give out vouchers to disadvantaged pregnant women and mothers with young children for fresh fruit and vegetables, milk, and infant formula; to improve and simplify food labelling; and to restrict the advertising and promotion of foods and drinks with high sugar, fat, and salt content to children.

    By March 2007 a national screening programme for chlamydia will have been introduced for England, and by 2008 patients referred to a genitourinary clinic will be guaranteed an appointment within 48 hours.

    The NHS Confederation called the white paper a landmark document that promotes a genuine cross-governmental approach to public health for the first time. However, it warns that more needs to be done to put these foundations into practice.

    Nigel Edwards, director of policy for the NHS Confederation, said “This white paper really pushes public health towards the top of priorities across the whole spectrum of government for the first time. For too long, there has been a focus on waiting lists and hospitals to the detriment of the real health benefits that could be gained by tackling public health issues. Now we have the foundations in place to make a real difference, but the hard work is still to come in putting this into practice.”

    The white paper was welcomed by the Royal College of Psychiatrists as “an important and timely new commitment to prevention and public health interventions,” but it also called for a complementary—but separate—public health strategy for mental health.

    What the white paper says

    • Smoking will be banned in all enclosed public places by the end of 2008. Private members' clubs and pubs that do not serve food are excluded

    • By 2007, the National Institute for Clinical Excellence (NICE) will prepare guidance on the prevention, identification, management, and treatment of obesity. This will be backed by new initiatives to implement the guidance

    • Sure Start will develop new programmes next year to improve support for parents to help them understand the things that impact on their children's social, emotional, and physical development in the early years

    • By 2007, volunteers will be available to visit families under stress

    • Guidelines on managing mild to moderate mental illness in the workplace to be published in 2005

    • More school nurses are promised. By 2010, every school cluster will have access to a team led by a qualified school nurse

    • NHS accredited heath trainers will be available from 2006 to give support to people who want to change their lifestyle in the areas of highest need. The service will be rolled out across England from 2007

    • New cycle routes, improved parks and other public spaces, free swimming, and other sports initiatives will be available

    • Doctors and other heath professionals will be encouraged to give out pedometers to help increase activity among patients

    • Local authorities are being given guidance on how to deal with shopkeepers who sell tobacco to underage children. New legislation is planned to strengthen these powers

    • Work is planned with the Portman Group to tackle binge drinking. Other measures to promote sensible drinking are to be agreed with industry


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