In 2004, Ireland went further than any other country and banned smoking in the workplace. Publicans led the outrage, but ultimately it was seen as a success. Now, however, there are more challenges — and Ireland is lagging, reports Caroline O’Doherty.
Fifteen years ago this week Ireland became a world leader overnight when the first workplace smoking ban was introduced.
No other country had gone so far in tackling cigarette addiction and there were doubts that Ireland would make it across the line either.
Publicans had been up in arms over the impending ban for the previous two years, predicting that driving out smokers would decimate their trade.
Employers were nervous, fearing factory-floor rebellions and onerous inspection regimes; the tourism industry was worried that visitors would feel unwelcome, smokers were claiming civil liberties abuses, and others with no real axe to grind were decrying the nanny state.
Padraic McGann, owner of McGann’s pub in Monivea, Co Galway, and currently president of the Vintners Federation of Ireland (VFI), was one of those who faced the countdown to the ban with trepidation. “None of us dreamed it would ever happen,” he says, recalling the alternating feelings of disbelief and foreboding in the industry at the time.
Martina Blake, head of the HSE’s Tobacco Free Ireland programme, agrees the ban came in smoothly despite the rows that preceded it.
In the months and years after it was introduced, numerous awards were bestowed on Ireland and the Department of Health for taking the initiative and making the ban work.
“It has driven a tobacco control agenda internationally. We are seen as world leaders,” says Ms Blake, who worries, however, that we may have spent too much time preening the same feathers in our cap.
There are still some 830,000 smokers in the country, some 680,000 of whom light up daily, and with the biggest proportion consistently in the 25-35 age category, it shows that new smokers are coming on board all the time.
“We still have a lot of work to do. People think we’ve been so successful with strong legislation, that we’ve it covered, we’ve it done, but that’s really not the case,” she says. “We still need to work hard.”
The following are some of the areas where work remains to be done.
In the early days of the ban, some publicans vowed to defy it on the grounds of principle or practicality but if they thought their actions would spark mass disobedience and render the ban unworkable, they were to be disappointed.
The owner of Fibber Magees on Galway’s Eyre Square and several other pubs was very public about his protest, ordering the ashtrays out of storage after enduring three months of prohibition.
Ronan Lawless complained at the time that business had fallen off dramatically and he was effectively being legislated out of existence. He declared an upstairs lounge a haven for smokers and a crowd turned up to take refuge there.
It was a short-lived rebellion. A few days later, faced with the threat of a High Court court injunction, he backed down.
“It was too big a risk to let people smoke,” says Padraic McGann.
So the majority in the pub trade fell in line quickly and consistently, undoubtedly assisted by the fact that pubs are open to the public and any transgressions are highly visible.
Still, a 2014 Eurobarometer report for the European Commission found that in Ireland, 5% of people had been exposed to smoking the last time they were in a pub [no more than six months prior to questioning] while 4% said the same about their last visit to a restaurant, so a lingering resistance was evident.
There were, and are, other workplaces where there is no admission to the public and where it is easier to get away with flouting the law.
The same survey found that 87% of people were never or almost never exposed to smoking in their workplace which means that 13% were exposed regularly or occasionally.
If that figure is accurate, it is higher than the overall level of compliance with smoking legislation which, according to the State of Tobacco Control in Ireland report published last year, stands at 80%.
That figure is based on inspections carried out by the HSE’s environmental health service, not just of licenced premises and other workplaces but also of retailers.
In all, 15,064 inspections were carried out in 2017, the most recent year for which figures are available, with 12,108 recording a satisfactory outcome.
The most common contraventions found were non-compliant outdoor smoking shelters, the absence of ‘no smoking’ signs in workplaces — mainly licenced premises — and, in the case of retailers and other outlets that sell cigarettes, failure to register on the National Tobacco Register or selling to U18s.
Members of the public can report contraventions to a lo-call compliance line — 162 did so in 2017. Their main complaints were about smoking where it was illegal to do so, non-compliant outdoor shelters, and, for the first time, e-cigarettes and vaping liquids.
Outdoor shelters for smokers can be a contentious issue. The specifications for their construction are clear — they can be enclosed but roofless or roofed but only partially enclosed with precise limits on the extent of any walls, fencing, windows, or other barriers erected.
But with so many different forms of shelter — some ad hoc, some tailor-made, some bought as a readymade package — and all the various types of furniture and decor used, it’s not always immediately clear if any given shelter is compliant.
“It’s tricky,” says Ms Blake.
“The regulations are very clear but while pubs and clubs are making spaces that are technically compliant, they’re designed to be very attractive spaces so you get a lot of people gathering in them and a lot of smoke in what can become quite a confined area. And then you have to have a lot of staff there too so they are being exposed to that smoke.
“It can be hard to tell too is this area an outdoor or an indoor area because of how they’re designed. We’d always say, if you’re unsure, report it, and then we can investigate it.”
Convictions for breaking the smoking laws are rare — just 13 in the first eight months of last year and only 17 for the whole of 2017. That was down from 33 in 2014, 28 in 2015, 31 in 2016, and an average of 25 per year from 2004 to 2013.
Given that there were 15,064 inspections carried out last year and breaches were recorded in 2,966 of them, the proportion resulting in prosecution and conviction is tiny.
The most severe penalty recorded last year was a €2,500 fine with €3,700 costs imposed on the Copper Room wine bar in Limerick for breach of section 47 of the Public Health (Tobacco) Act which is the main section prohibiting smoking in workplaces.
In another case, a €2,000 fine and €2,500 in costs was imposed on the Skeffington Arms Hotel in Galway for breach of the same section. In that case the judge also ordered a seven-day removal from the register — a
temporary ban on selling cigarettes.
Another case, against the Imperial Hotel in Cavan, resulted in a three-month removal from the register as well as fines and costs totalling €3,300.
It’s not clear how much of a penance removal from the register is for a pub. Mr McGann says his vending machines attract scant attention these days.
Undoubtedly, removal is of greater significance to shops but of the six convictions recorded against retailers last year — all for selling cigarettes to children — the longest prohibition was two days, the shortest 12 hours, and the most common one day.
Going back to 2016, there were a string of similar convictions where the removal was for just one hour.
Ms Blake admits it doesn’t send out a very powerful deterrent message.
“It’s really disappointing for our staff and for the environmental health service when they’ve gone through the process of bringing together a case and the court agrees it’s a clear case of non-compliance and then there’s a very lenient sentence coming through,” she says.
While the workplace smoking ban is often understood to be all-encompassing, there were exemptions built in at the time.
Fifteen years later, the question is being asked as to whether they are still justified.
Prisons, mental health facilities, nursing homes, other residential care settings, and even hotel rooms were given wriggle room for exclusion, although in the case of hotels and residential care providers, a no-smoking policy became the norm.
Designating separate smoking and non-smoking rooms was too difficult in most cases and it made more sense to have one clear-cut rule rather than face the perpetual question of when does a room occupied by a smoker but serviced by a staff member switch from being a private space to a workplace?
Some hotels still do allow smoking in accommodation blocks but generally only in larger suites with designated smoking balconies.
Nursing homes too have generally gone the non-smoking route apart from in strictly designated communal and/or outdoor areas. Even though it could be argued that a resident’s room is their home and therefore a private space, if the interior is tended to by staff or the resident is cared for within its confines, it is equally arguable that it is a workplace.
That approach has, however, not been taken in prisons where an inmate’s cell is regarded as their home and the freedom to smoke there is considered the same as in any private house. A reluctance to add to the tensions that already exist in prisons is a factor.
Smoking is banned in training and most recreation areas but is generally permitted outdoors or in designated smoking areas.
Jim Mitchell, deputy general secretary of the Prison Officers Association (POA), says the reasons for the exemption were understood and accepted at the time.
"This is where prisoners live and you’re entitled to be able to smoke where you live,” he says. “Also, I think the view has been that there were enough problems in prisons without making an issue of smoking.”
But, he says, attitudes around smoking have changed in society since the ban came in and prisons are now falling far behind.
Problems arise, he says, where cells are shared and a non-smoker could be assigned a room with a smoker. It’s also an issue for the prison officers and welfare staff who are in and out of the cells.
While smoking is restricted to cells and other areas, it does have an impact on air quality throughout the prison campus where other employees — administration, teaching, catering staff — also spend their working days.
The POA wants a commitment to making prisons smoke-free within a given period of time to allow for gradual adaptation and the development of bespoke solutions to particular problems, with much greater emphasis on smoking cessation programmes for prisoners in the meantime.
“The Prison Service was before the public accounts committee [in January] talking about the high level of sick leave among prison officers. They said it was unacceptable. But meanwhile they have prison officers working in a smoking environment which is one of the contributory factors,” says Mr Mitchell.
“You could have a claim against the State as a worker forced to work in a smoking environment. A prisoner could make a claim for being a non-smoker forced to live in a smoking environment.
“We understand there are certain difficulties unique to the prison system but for 15 years we have been understanding the difficulties and that’s more than enough patience for everybody.”
Ms Blake sympathises with the POA’s view and says it is time to review the exemption for both prisons and mental health facilities.
“The legislation, in an ideal world, would be strengthened. It would apply across the board and we wouldn’t have grades of staff that are still being exposed [to second-hand smoke] It isn’t on the legislative schedule but ideally it would be,” she says.”
In the meantime, the HSE has gone over and above the legislation by adopting tobacco-free campus policies — extending the indoor smoking ban to the outdoors as well.
Mental health facilities are included in the aims of the policy and where a mental health service is contained within a general hospital, it is subject to the rules.
But where the service is in a standalone facility, it stands apart from policy too. And when people are struggling with mental health difficulties, it can seem cruel to insist they give up smoking and whatever comfort or crutch it provides them.
“We are struggling at times to try and bring about changes in those services because we have patient advocates that object and patients themselves that object,” says Ms Blake.
“However, in the last year we have seen a bit of change with staff and patients kind of seeing a bit more clearly the benefit of a tobacco-free environment.
“A lot of the time mental health service users haven’t even been asked would you like to quit and told there’s support available for them if they do.
“It’s just been assumed that they are a smoker and will always be a smoker but sometimes the very act of asking them to quit and offering them appropriate medication to manage withdrawal and behavioural support can be a positive thing.
“We have seen really good examples where patients have quit and achieved lots of other things in their lives because one positive change can lead to others — the feeling that if I can do this, then I can achieve other things.”
Smoking rates among the Irish population have fallen over the past 20 years — from 33% in 1998 to 27% in 2002 when plans for the workplace smoking ban were announced.
Against expectations, the rate rose to 29% in 2007, but it has continued to fall since then and is now at 20% — 17% smoking daily and 3% occasionally.
Under the Tobacco Free Ireland programme, the aim is to reduce smoking to below 5% by 2025 which is beginning to look overly ambitious.
Educational campaigns and other deterrents are working — just not everywhere or for everyone. Most of the reduction seen in recent years has been down to women quitting smoking.
And it’s not just a gender thing. “The prevalence of smoking has come down but the reduction hasn’t been equal for those who are disadvantaged economically,” explains Ms Blake.
Working out why men, those on the lowest incomes, and, in particular, men on the lowest incomes smoke the most opens up a wide and complex area of discourse, much of which is beyond Ms Blake’s remit.
But she says it does force her and her staff to find ways of targeting their message in a way that will be heard and heeded by the most resistant smoking groups.
“We really need to have targeted approaches to specific population groups that are being left behind. There are various reasons why they are being left behind. With the lowest socioeconomic group, there can be lots of issues going on in their lives and quitting smoking is probably seen as the least of their worries when it’s actually costing them an awful lot in terms of their health, money, their general wellbeing.”
Women smokers come under pressure to quit when they start having children and caring duties bring them into contact with health services more often so it’s not surprising that the quit message gets through to them more easily.
They are still targeted for support through a dedicated ‘We Can Quit’ programme run in conjunction with the Irish Cancer Society.
The 12-week programme of women helping women involves free, weekly sessions with trained facilitators who meet groups in community centres and other local venues, offering face-to-face support, free nicotine replacement treatment, and the all-important encouragement and camaraderie in the difficult early days of quitting.
The results are good so the search is on for a similar way of engaging men. “We are doing focus groups with men because we’re planning a new campaign by the end of this year. To look at how best we target that campaign, we’ll be testing the message with smokers to see how they respond and make sure it’s effective,” says Ms Blake.
Gender differences are not evident with young smokers and boys and girls are equally likely to experiment in their teens and to carry on until the mid-twenties when the divide between men and women emerges.
But as long as there are new smokers coming on stream all the time — and the evidence is that there are — reducing the 20% figure to under 5% is going to remain a formidable challenge.
“We think that initiation is happening at a later stage now.
There may also be a trend for young people to begin smoking cannabis and to move on to cigarettes when the reverse may have been true in the past.
Among young people as with adults, however, class plays a part.
“We know that disadvantaged children who drop out of school have a much higher prevalence of smoking and that stands to reason.
"Everybody around them smokes, it’s part and parcel of their community. So while we’re targeting individual approaches for different groups, we have to think of every group that will influence the child and young person.”
E-cigarettes have created one big cloud of confusion for those in the business of tobacco control.
One argument goes that vaping is the greatest ever aid to smoking cessation and should be encouraged.
Another goes that it’s just a way of prolonging and even widening the pool of nicotine addicts in society and needs to be strictly controlled.
Some health experts are evangelists for vaping and some look at the big tobacco companies that are behind many of the major vaping brands and fear another public health disaster.
Others are treading a fine line between sceptical and hopeful while eagerly awaiting the results of studies into the health and other effects of vaping.
The Department of Health is adopting a wait and see attitude with regard to promoting e-cigarettes as an aid to quitting smoking.
Health Minister Simon Harris, replying to a parliamentary question in January, said the department was “actively monitoring publications by authoritative bodies internationally” and that “analysis of emerging research” would inform any future decisions on the issue.
“There is currently a lack of evidence to recommend their use as a smoking cessation aid,” he said.
“The safety of e-cigarettes is an evolving area of research. While potentially safer than smoking, evidence on its long-term safety has yet to be established.”
While sitting on the fence on this issue, the department has allowed vaping quite a free run to establish itself as an increasingly common activity here.
Regulations do govern the amount of nicotine that can be in vaping liquids sold here and there are requirements that labels warn of the addictive nature of nicotine. Nicotine-containing liquids are treated as tobacco products and can not be sold to under-18s.
Vaping liquids that don’t contain nicotine can currently be sold to children and they are often designed to appeal to a younger market.
While the vaping industry argues the value of their product as a smoking cessation aid — and the Healthy Ireland 2018 survey shows that many smokers attempting or succeeding at quitting use or have used e cigarettes — that is not generally the theme of the industry’s advertising which tends to promote vaping as a pleasurable activity in its own right.
Also, the candy- and fruit-flavoured non-nicotine vaping liquids with their brightly coloured, flower festooned, or cartoon-decorated labels that are much promoted by the industry are not a likely purchase by your average male, manual labourer looking for a smoking alternative.
So who are they aimed at? The Healthy Ireland survey shows 2% of people in Ireland who never smoked have used e-cigarettes in the past while just under 1% currently do, so whether there is a market for vaping among non-smokers is unclear.
Some online shops attached to physical stores sell non-nicotine liquids with a link to nicotine shots to add to them. That could provide a gateway for a non-smoker trying out vaping to add a little nicotine which will be the ingredient that will keep them coming back.
The Department of Health said a draft scheme of legislation to prohibit the sale of any vaping liquids, including non-nicotine varieties, to under-18s is “currently under development”.
Ms Blake would like to see it published and passed as soon as possible. She, like many others, questions why a product such as a bubble gum-flavoured vaping liquid even exists if not to be attractive to young people.
“We’re examining the studies that are looking at vaping and whether or not it has a role in smoking cessation or in tobacco control or not,” she says.
“A balance needs to be struck. The studies so far have shown that e-cigarettes may be useful in helping to quit smoking and that they are less harmful than tobacco but certainly not harm-free.
Vaping is not prohibited in public places or workplaces by law because it does not produce the second-hand smoke that the law seeks to provide protection against, but the majority of organisations and venues adopt a no-vaping policy all the same.
Ireland may have led the way on the smoking ban but other countries have firmly taken the lead on vaping. It is outlawed completely in a number of countries, mainly in Asia, but even Australia has banned liquids containing nicotine unless they are licenced as smoking cessation aids.
Mr Harris has said he has no plans to introduce legislation prohibiting the use of e-cigarettes in public places. “The introduction of the workplace smoking ban was based on clear and unequivocal evidence that second hand smoke is harmful to non-smokers.
"That evidence base does not exist for the aerosol generated from e-cigarettes,” he said.
The HSE is circumspect. Ms Blake says: “We have the precautionary principle at the moment where we don’t allow e-cigarettes on our HSE campuses.”