Dutch groups appeal against “irresponsible” plan to exempt small cafés from smoking ban

Plans by the Netherlands’ new centre right government to scrap the smoking ban in small cafés has sparked a “moral appeal” from more than 30 leading figures and medical organisations to reject what they describe as an “irresponsible” move.

The appeal is being led by the tobacco control body Stivoro, the Heart Foundation, the Asthma Funds, and the Cancer Prevention Society. They fear that small cafés, which may number as many as 10 000, may become the “breeding ground” for a new generation of smokers.

An open letter from the groups has been sent to the junior coalition partner, the Christian Democrats, whose health minister, Ab Klink, introduced the smoking ban in 2008. The letter claims that the ban was the best public health measure the minister took.

The new government’s legislative programme, launched under the slogan “freedom and responsibility,” argues that the law, intended to protect employees’ right to a smoke-free workplace, doesn’t apply to small, owner run cafés that don’t employ staff. It intends therefore to exempt all establishments in the hospitality sector smaller than 70 square metres.

A spokesman for the right wing, liberal People’s Party for Freedom and Democracy (VVD), the largest partner in the coalition formed after the election in June, said, “People can choose themselves whether to go to a smoke-free café or not. The government does not have to determine that for them.”

The letter from the antismoking lobby argues that making an exception for small cafés will result in confusion and failure to enforce the law elsewhere in the hospitality sector. When legal challenges in 2009 forced the suspension of the law in small cafés, the enforcement body, the Food and Consumer Product Safety Authority, found evidence of smoking in four in 10 cafés and clubs throughout the sector (BMJ 2009;339:b2824, doi:10.1136/bmj.b2824).

Stivoro’s director, Lies van Gennip, said, “If you make an exception then it is very hard to maintain the whole law, as other bars and restaurants will automatically allow smoking.”

She also feared that basing exemptions on size would also allow smoking in ice cream parlours and snack bars.

She rejected claims in the government programme that the Netherlands was following a German example. There policy was set by state governments, and in July a referendum in Bavaria voted for a comprehensive ban in recognition that exemptions had made the law ineffective, she argued (BMJ 2010;341:c3631, doi:10.1136/bmj.c3631).

One of the letter’s signatories, the chest specialist Pauline Dekker, said, “We know that our patients, especially those who have stopped [smoking] recently, relapse in cafés when they see other people smoking. A totally smoke-free hospitality sector is so important to motivate our patients.”

Currently 28% of Dutch people smoke (in the United Kingdom the figure is 21%), resulting in 19 000 deaths a year, 14% of the total. The Leyden Academy on Vitality and Aging recently concluded that smoking was the main reason why the Netherlands had fallen to ninth place in a European Union league table of life expectancy.