Let’s give Micheál Martin our full support for his smoking ban

WHEN his stint in the Department of Health is over, Micheál Martin will not be best remembered for the health service reforms he presented last month. His enduring legacy will be an initiative he announced last January.

And when future generations of health and political commentators look back at the year 2003 they are likely to conclude that the most important health report published this year was not the Prospectus Report nor the Brennan Report nor even the Hanley Report. The report with the greatest potential to transform health policy in Ireland is the Allwright Report.

Dr Sean Allwright is a senior lecturer in epidemiology at Trinity College and he chaired a scientific working group which published a report last January, officially named a report on the health effects of environmental tobacco smoke in the workplace. For shorthand it can be called the Allwright Report.

At its launch on January 30, Mr Martin announced that he was going to introduce a total ban on smoking in all workplaces, including public houses and restaurants, with effect from January 1, 2004.

It was inevitable that the campaign to oppose or water down Minister Martin's proposal would intensify as the day of clean pub air got closer. Those who oppose the ban on smoking in pubs include the tobacco industry, the publicans and a collection of high-profile smokers. Some have espoused the cultural value of the smoke-filled Irish pub. Some have contemptuously dismissed the scientific evidence. Others have sought to parody those who support the ban as fascist fanatics infringing the 'human right' of smokers to smoke whenever and wherever they want.

This week it appears the campaign has even prompted a Cabinet minister to break ranks. Having had his ear bent by publicans Minister for Agriculture Joe Walsh used the opportunity of a drinks industry event to call on his health colleague to compromise.

The publicans have mounted the cleverest of the campaigns opposing the ban. They are smart enough not to be seen to oppose the ban directly. Instead the Vintners Federation has tried to position itself as responsible, implying that the minister is rushing into the ban and is being unreasonable. The true object of the vintners' campaign however is to slow down or delay Mr Martin's proposal perhaps in the hope that a successor will show less resolve.

To give them credit, in addition to their quiet lobby campaign, the vintners have been prepared to go public. In this newspaper last month the Vintners Federation chief executive, Tadg O'Sullivan dismissed the scientific evidence which informed the minister's decision.

"The supposed link between ETS (Environmental Tobacco Smoke) and all the damage it is causing is vastly overstated and may be minimal," he said. But the evidence of the damage caused by environmental tobacco smoke is not minimal.

The Allwright committee undertook a review of 126 academic papers and studies on passive smoking by researchers in the USA, Britain, Australia, Canada, New Zealand, Japan, France, Luxembourg, Belgium, Ireland, Switzerland and Hong Kong. It conducted an examination of position statements on the health effects of passive smoking published by the World Health Organisation and more than 30 leading international organisations and university institutes.

The Allwright Report concluded that there is a growing international scientific consensus that passive smoking increases the risk of heart disease by between 25% and 35%. They concluded that there is compelling evidence that working with smoking co-workers increases the risk of lung cancer in non-smokers by between 20% and 30%. They pointed out that levels of exposure to passive smoking are highest for those who work in bars and restaurants. These conclusions cannot be dismissed.

Last week the heads of the faculties of medicine and allied professions in all of this country's universities, as well as leading physicians, surgeons and doctors, signed an unprecedented joint statement against tobacco smoking in which they expressly supported the proposal to ban smoking in workplaces including bars and restaurants. This cannot be dismissed either.

In addition to listening to representations from publicans, the Minister for Agriculture should also listen to public opinion. Since Mr Martin announced his proposal, there have been two opinion polls on the topic both have shown overwhelming and widespread support for the total ban.

On June 16, the Office of Tobacco Control published a TNS/MRBI poll which showed that 67% of the Irish population supported the Health Minister's proposal. Most strikingly, those supporting the proposal included four out of 10 smokers.

Some anti-ban commentators have argued that people in the older age group would be the most upset by the removal of our smoke-filled pub culture. However, in the poll 76% of those over 55 years of age supported the total ban. At the other end of the age spectrum 69% of students favoured the proposal.

Last week the Vintners Federation returned again to the "ventilation is the solution" spin. It issued a statement claiming that new research has proven that ventilation can be highly effective at protecting against the effects of environmental tobacco smoke. This research is said to be from the University of Glamorgan in Wales and shows that air ventilation technology, which changes the air 12 times an hour, could reduce the carbon monoxide levels in environmental tobacco smoke by 67%.

The research was carried out by university professor Dr Geens for an organisation called AIR the corporate responsibility face of the English licensing trade with close links to the British Institute of Innkeepers and the UK Federation of Retail Licensed Traders.

The question of ventilation was addressed comprehensively in the Allwright Report which concluded: "Research studies show that the current range of ventilation technologies, including conventional air-conditioning systems, cannot adequately control exposure to environmental tobacco smoke. While proposed new technologies such as displacement ventilation have potential to reduce ETS levels by 90% this would mean that exposure levels 1,500 to 2,500 times the acceptable risk for hazardous air pollutants."

Allwright concluded that outright smoking bans remain the only viable control measure to ensure that workers and patrons of bars, nightclubs and restaurants are protected from exposure to the toxic by-products from tobacco combustion.

We are not told how much the 12 air changes an hour ventilation would cost to install or run. Even if the average pub could afford the new ventilation system and even if they could afford to run it at all times there would always be the attraction to save costs by leaving it switched off.

We are winning the battle against tobacco smoking in this country, or at least we have turned the corner. The health and lifestyle survey published in April showed a small drop in the numbers of people smoking from 31% in 1998 to 27% in 2002.

The most important health reform is not reform of healthcare delivery systems but reform of our unhealthy habits. No Irish habit is as dangerous to our health or as costly to our health services as smoking. All the leading scientific evidence is that it can and does cause heart disease and cancer. Mr Martin should not be deflected or delayed in his initiative.