Ireland's workplaces, going smoke freeBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7444.847 (Published 08 April 2004) Cite this as: BMJ 2004;328:847
- Fenton Howell, dean ()
- Faculty of Public Health Medicine, Royal College of Physicians of Ireland, Dublin 2, Republic of Ireland
The result of sustained, evidence based, policymaking in support of better health
On 29 March 2004 Ireland became the first European country to implement legislation creating smoke-free enclosed workplaces, including bars and restaurants.1 Norway (June 2004) and Sweden (2005) are on schedule to introduce similar legislation. Though there are some minor exemptions in the Irish legislation, this move is ground breaking and is of immense public health importance. The legislation shines as a beacon for other jurisdictions that might want to follow Ireland's lead.
There were many twists and turns in the development of the Irish legislation. Over the past 15 years in particular, activity in all areas of tobacco control helped create the platform on which this legislation on secondhand smoke developed. Politicians, public servants, trade unions, and non-governmental organisations all played their part.
In the 1990s the government introduced legislation that prohibited smoking in a small number of public places, but it had no general application to the workplace.2 In the mid-1990s, despite the growing evidence of the harmful effects of secondhand smoke, a purely voluntary code of practice on smoking in the workplace was agreed between the government, employers, and trade unions.3 It offered little in the way of protection for those exposed to secondhand smoke and nothing for those working in the hospitality sector.
The non-governmental tobacco control community, along with others, including some public servants, pressed for further action. Politicians, public servants, and trade unions were extensively lobbied on a range of tobacco control actions including the need to protect workers from secondhand smoke. International research on the health effects of secondhand smoke and developments in the United States were kept to the fore in the media.4 The overriding strategy was to get tobacco control issues firmly on the agenda of policymakers in all sectors. On the issue of secondhand smoke, the strategy was simple: this was a health and safety issue and needed to be tackled accordingly.
The overall strategy had a fair degree of success. A key health strategy document highlighted the importance of tobacco control.5 In addition senior health officals published a blueprint document for creating a tobacco-free society, which was adopted by government.6 The political system also responded. The influential all party Oireachtas (Parliament) Joint Committee on Health and Children examined the issue of smoking and health. It sought input from a wide range of groups, including the tobacco industry. The tobacco industry insisted that there was insufficent evidence to link secondhand smoke to any illness in non-smokers. The committee rejected this argument, however, and unanimously recommended a new national antismoking strategy, to include restrictions on smoking in workplaces, including bars.7 8 A subsequent refusal by tobacco industry representatives to come before another meeting of the committee undermined their ability to lobby politicians once the legislation was published.
Subsequently an Office of Tobacco Control (http://www.otc.ie/) was established by the government to build capacity for tobacco control measures. It drew on international expertise on how to deal with the issue of secondhand smoke and brought experts to Ireland so that politicians, policymakers, the media, and trade unions representing hospitality workers might understand how best to proceed. Of particlur importance was the input of James Repace, a renowned US health physicist, who estimated that up to 150 Irish barworkers could be dying annually as a result of their exposure to secondhand smoke.9
A new tobacco bill was published in 2001, which gave the minister for health and children the power to create smoke-free workplaces. It was supported by the opposition parties and was signed into law in 2002. Further discussions continued on how widely restrictions on smoking in the workplace should extend. To help that debate, the Office of Tobacco Control and the Health and Safety Authority commissioned independent scientists to review the entire evidence on secondhand smoke. Their report concluded that secondhand smoke was harmful, that employees needed to be protected from it in the workplace, and that legislative measures were needed.10 So definitive were their findings that at the launch of this report in January 2003 the minister for health and children, Mr Micheál Martin TD, announced that he would make the necessary orders to ensure that all enclosed workplaces, including bars, would be smoke-free on 1 January 2004.
Not surprisingly, some difficulties were then encountered. After extensive lobbying by the hospitality sector to seek to have bars and restaurants exempted, some ministers buckled under pressure. However, with the support of the Taoiseach (prime minister) and the majority of the government, along with the opposition parties, the minister for health and children held firm. The minister also received strong support from the healthcare sector, trade unions, and the public throughout the debate.11 12 Further concerns arose when the proposed implementation date was twice changed because of the need to bring in some exemptions and to notify these changes to the European Union. Though there was concern that the whole thing might unravel because of the exemptions and the delays, the end result is that we now have legislation in place that is robust and more likely to resist any legal challenges. The legal challenges that were being threatened by the hospitality sector have fallen away, and a detailed implementation programme is being rolled out nationally (http://www.otc.ie/),(http://www.smokefreeatwork.ie/)
The development of this legislation and its subsequent implementation underscores the value of prolonged public health advocacy in helping good, evidence based policymaking. It also shows that politicians are prepared, if adequately supported, to tackle vested interests in the pursuit of better public health.
Competing interests FH was a member of the board and chairperson of ASH Ireland and is their current spokesperson. He was also a member of the board of the European Network on Smoking Prevention.