The workplace ban on smoking, with its clear restatement of the rights of workers to breathe clean air, is very significant, writes Prof Luke Clancy
Second-hand smoke causes heart attacks, stroke and lung cancer, and exacerbates asthma. It is also the third most important preventable cause of heart disease. The ban removes a significant cause of death and disease.
All of which reinforces how crucial it was that the ban be comprehensive. Frequently, workplace bans are enforced in white-collar situations where management and other office workers benefit much more than those in the service industries. The Irish ban, therefore, will help to reduce the socio-economic inequalities in health that are so prevalent in our society.
These direct benefits ensure that the primary aim of the legislation is fulfilled. There are other benefits, which are of importance to health and to the country as a whole. Ireland was the first country to introduce such a comprehensive ban on second-hand smoke in the workplace. This has focused attention from all over the world on Ireland.
It has rightly brought honour to Minister Micheál Martin and indeed the Irish Government, both at EU and world level.
At home, it has given us confidence that we can dare to be first, confidence that we can lead. Many felt that the Government would fail to enact the legislation and that even if it did, it would fail to apply the law, and that even if it tried, the people would not accept it. All of this was wrong.
The people overwhelmingly accepted the legislation. Despite the small number of environmental health officers expected to implement the law, they have done so with spectacular success and in a manner that is a testament to their professionalism. The courts, when asked to deal with challenges to the law, have done so with clarity and speed. The voices in opposition to the law have been largely silenced and one can admire the LVA ad proclaiming "the atmosphere's got even better".
Crucial to the success of this legislation is the support from the trade unions. Their strong support was and is crucial. They had the vision to realise the importance of this measure. It took courage to sustain support for the ban in the face of dire predictions from the employers and their organisations, but the unions persisted. They had the strength to exercise genuine concern for the health and safety of their members.
I believe this measure is a watershed in the battle for tobacco control. We are seeing a cultural shift. We are separating work and smoke, entertainment and smoke, pleasure and smoke, living and smoke. It cannot fail to help our young people who now have less incentive and less need to smoke to prove their cool image or to conform. It encourages smokers to quit. It encourages contented smokers to smoke less. All of this helps towards the Government policy of a tobacco-free society.
Ireland is doing well in tobacco control. A recent estimate puts us the fourth most effective in the EU and that was before the introduction of the workplace ban. It is therefore most disappointing that the recent Budget failed to capitalise on the great progress that is being made. Price is the most effective tobacco control measure and it is particularly important in helping the less advantaged in society.
The Government is pledged to a policy of a tobacco-free society, and claims to be making a significant effort to reduce inequalities in society. This is difficult to reconcile with the failure to increase the price of cigarettes in the last Budget when smoking is the principal cause of health inequality in Ireland
If the Government cared about the health as well as the wealth of the disadvantaged, it would have introduced a substantial price rise in cigarettes.
Tobacco taxation is accepted as being regressive but it should be possible to compensate the poor for this by fiscal adjustments. The inclusion of NRT (nicotine replacement therapy) on the GMS drug list and improvements in the availability of smoking cessation services, which go to lessen social and health inequality, was welcome in this regard.
Where does tobacco control go now? Smoking is a disease that still afflicts about a quarter of the population.
It cannot be cured easily and eradication is likely to prove extremely difficult. We know from the infectious disease models, particularly tuberculosis, that as a disease declines, we can become complacent and, in general, if we do, disaster looms.
The broad principles of tobacco control are now fairly well established but are not adequate. In our new role in the world, we can no longer depend on others to supply the entire evidence base for rational action.
We must develop the capacity and fund the research to contribute to World Tobacco Control as laid out in the Framework Convention for Tobacco Control. This is the first ever WHO treaty on health to which Ireland is a signatory, but most regrettably we are not one of the 40 countries to have ratified it.
The resource needed for this is estimated to be some four times our present level of €0.5 per capita: a small price to pay for a transformed health situation where heart attacks and strokes are greatly reduced, and chronic obstructive pulmonary disease (COPD) and lung cancer are rare diseases.
Prof Luke Clancy is a respiratory physician at St James's Hospital, Dublin and chairman of Action on Smoking and Health.