Wykres (na podstawie danych z badania INTERHEART, przeprowadzonego w 52 krajach – w tym w Polsce – na grupie ponad 15 tys. osób) pokazuje, że częstość występowania zawałów serca wzrasta liniowo wraz z liczbą wypalanych codziennie papierosów. Pokazuje także, że każda dawka – nawet jeden papieros - zwiększa ryzyko zawału serca. ŹRÓDŁO
Successes and challenges in polish smoke free policies
Successes and challengesof smoke-free policy in Poland Krzysztof Przewozniak WHO Collaborating Centre for Tobacco Control Cancer Epidemiology and Prevention Department Cancer Center and Institute of Oncology in Warsaw, Poland ICO-WHO Symposia on Tobacco Control „Implementing smoke-free policies of the WHO FCTC. The failure of the Spanish Model: lessons learned for global tobacco control” Catalan Institute of Oncology, Barcelona, Spain, July 5, 2012
I am here because of smoking in public places. And you?
SHS exposure and health burden in Poland Estimates from 2002 show that in Poland over 8,700 adult Poles die each year from secondhand smoke (SHS). This number includes 3,730 premature deaths, 1,800 deaths among non-smokers, 8,406 deaths caused by SHS exposure in home and 314 in worksite (1 worker is dying every 6 hours in working year). Source: Smoke Free Partnership. Lifting the smokescreen. Ten arguments for smoke-free Europe. ERSJ, Brussels 2006
From opportunistic to more comprehensiveapproach toward smoke-free policy in PolandOpportunistic approach in government ordinances (weak enforcement) 1974 (MoH) - indoor ban of smoking in hospitals and dispensaries (obligatory smoking rooms). 1980s (other ministries) - indoor smoking ban in schools, police departments, military services (obligatory smoking rooms). Mid-1980s - outdoor ban of smoking in bus stops and city parks.Comprehensive smoke-free policies in communities and worksites (strong enforcement) Late 1980s - complete ban of smoking in some city halls (Ciechanow, Bydgoszcz, Gdansk, Torun) 1990s - complete smoking ban in public transport means and objects (excluding selected train cars, ships and ferries). Since mid-1990s - complete ban of smoking in many commercial worksites, including supermarkets, banks, post offices, health, pharmaceutical and insurance companies, and food and cosmetic shops and manufactories.
Milestones in enforcement of smoke-free policy in Poland 1995 (Tobacco Control Law) - ban of smoking in all health care settings, schools and other educational premises and all worksites (except of smoking rooms). 1999 (the 1995 Law amendment) - obligatory separated smoking rooms in two-room gastronomic venues. Since late 1999s - smoke-free programs and guidelines for workplaces (McDonalds and other fast food restaurants became smoke-free). Since mid-1990s - juridical clarifications and litigation trials against employers and gastronomic venues. August 2006 - FCTC ratification by Polish Parliament.
Civil movement proposal (Sep 2006) Optimal A complete indoor ban of smoking in almost all public places and worksites, including bars and restaurants (based on Irish best practice). Possible compromise A complete indoor ban on smoking in major public places and worksites, including all health care settings, educational premises, cultural, sport and recreation objects, public transport means and objects, gastronomic venues. Smoking rooms can be created in other worksites but must be separated and equipped with the most effective ventilation system. If manager or owner does not want to create smoking room, worksite must be smoke-free. In December 2006, the Health Committee took above proposal as its own legislative initiative but main battle for its discussion, enactment and enforcement took place in 2009-2010 due to tobacco industry obstruction as well as new parliamentary and presidential election.
What did help tobacco control advocates? Support for complete ban of smoking by most of Poles (67-76%), Polish medical society and NGOs, and international tobacco control community. Smoke-free public support and media campaigns. Strong scientific evidence on health benefits of the ban enforcement. Positive experience with the ban enforcement in increasing number of countries. Warning about Spanish model of smoke-free policy. Step-by-step approach in enforcement of smoke-free policy in Poland. Positive changes in social norm for smoking at presence of others in Poland. FCTC ratification by Poland. Developing smoke-free policies by some employers and local governments. Supporting the complete ban by some parliamentarians.
What did not help? Access of tobacco industry representatives and lobbyists to MPs and government politicians, including participation in the Parliament Health Committee meetings (ties with some MPs and representatives of government). Lack of support by main labor corporations, including the Association of Waiters and Bartenders (ties with tobacco industry). Lack of direct support for civil society proposal by government and ruling liberal party (they had opportunistic or compromise approach to the smoking ban proposal). The Health Committee proposal was led by one of the opposition parties but not entire opposition supported the proposal. Problems in effective enforcement of comlete smoking ban in some countries. Unclear evidence on long-term effectiveness of the ban and its economic benefits. Spanish model of smoke-free policy as a potential alternative for political choice. Weak support for the smoking ban by private media.
Tobacco industry cons Smoking ban mostly concerns private premises, so decision has to be free and given to owners of gastronomic venues or managers of worksites. Restrictive laws limit the right of citizen to freedom and responsible choice. Smoking is private thing and should be not regulated by law. It is rather a totalitarian idea taken, for example, from Nazi state. As smokers will be limited in their behavioral habits and most of them are against complete ban of smoking, they should have a possibility to smoking in workplaces (smoking rooms or cabins) and bars and restaurants (separate gastronomic venues for smokers and non-smokers). Country experiences show that some bars and restaurants can bankrupt or at least reduce income after enforcement of complete smoking ban. 40,000 Polish employees can loose a job and state unemployment rate would arise 0,5%. Effective enforcement of complete ban on smoking in many public places is impossible or very weak. Ban of smoking does not have a serious impact on reducing tobacco consumption, so it is ineffective tobacco control tool and therefore is no need for its enforcement. Let’s concentrate on education of children as more effective method of tobacco control.
Industry Counter-Proposal (2009-2010) Optimal Separate gastronomic venues for smokers and non-smokers. Decision taken by bar or restaurant owner. Smoke-free policy in workplace under decision of employer and employees. No smoking ban in outdoor public places and worksites. Possible compromise Spanish-like model of smoke-free policy, especially in gastronomic venues (smoking ban depends on venue type and magnitude). Establishing smoking rooms or cabins is voluntary. If not established, smoking should be allowed. Although industry proposal was not taken under consideration by the Parliament Health Committee, they could lobby among MPs and goverment politicians for its acceptance and discuss it during the Committee meetings. The industry view for smoking ban was mainly expressed by labor corporations, lawyers, media representatives and producers of smoking cabins calling themselves ‘non-smoking groups’.
Efforts to support comprehensive smoke-free policy in Poland Materials for parliamentarians and the campaign supporters. Collaboratiove efforts of NGOs, medical society and government (in limited extent) for supporting complete ban of smoking during the Health Committee meetings. Advocacy meetings with parliamentarian clubs and government representatives Workshops and meetings with trade unions, employer’s corporations and institutions responsible for law compliance. Smoke Free Gastronomic Venue program. Media and public support campaign for smoke-free Poland. Visit of parliamentarians in smoke-free bars and restaurants in Paris.
Campaign outcomes The open letter of support for complete ban of smoking was signed by 80 acknowledged representatives of Polish medical society and 9 major Polish medical organizations. 5 former Ministers of Health supported the comprehensive smoke-free legislative proposal. 93 non-governmental organizations called parlamentarians and Polish government for complete ban of smoking in public places and worksites. Campaign was also supported by over 40 foreign and international organizations, including Public Health Department of the European Commission, Director General of the WHO Regional Office for Europe, CDC Foundation, European Network for Smoking Cessation. Representatives of all abovementioned entities sent letters to Polish parliament and government.
Letter of support sent by manager of the Cavern Club in Liverpool (former Beatles music club)“As the owner of the Cavern Club in Liverpool, the club known world-wide for itsassociation with the Beatles, I would like to state my whole-hearted support forthose in Poland who are working to bring about a comprehensive smoke-free lawthat will ban smoking in all workplaces including pubs, clubs, restaurants andhotels.(…) At the Cavern Club, my staff, customers and the bands which play here arenow all protected from the harm caused by tobacco smoke. Enforcement has beenstraightforward(…)Despite the many scare stories from opponents in advance of the smoke-freelegislation, the smoking ban was in no way detrimental to the Cavern Club’sbusiness performance. In fact, the Cavern Club is now busier and more successfulthan ever. The air is better, everyone is happier and profits are up! (…)” Bill Heckle
„A battle lost, a war to win” Dec 2009 – Parliament Health Committee vote for complete ban of smoking in almost all public places, including gastronomic venues (smoking rooms permitted in worksites) 10 February to 4 March 2010 – During first reading, the proposal is demolished by parliamentarians from ruling party (with part support by opposition!); new proposal of smoking ban becomes a Spanish-like. Civil society, medical organizations and media strongly protest against these changes and request Senate to improve the law March 2010 - senators decide to introduce many changes in the law and send their proposal to Sejm. April 2010 (Sejm accept Senate’s proposal) - Indoor and outdoor complete smoking ban in all health care settings, schools and other educational premises and children’s playgrounds, indoor ban in cultural, sport and recreation objects, public transport - Possibility but not obligation to establish designated smoking rooms in worksites and gastronomic venues (restrictive ventilation requirements). Venues without smoking rooms are smoke-free. - Possibility to restrict the Law by subnational authorities. 15 Nov 2010 – enforcement of the Law 2010-2012 - campaign and programs for remaining gastronomic venues and worksites smoke-free
Opinions of all adults and smokers on new legislation, 2011 Source: Nation-wide survey conducted in February 2011 on representative sample of 2,000 adult Poles 16 by the Homo Homini Research Institute for Polish Radio.
Percent of exposed to tobacco smoke in gastronomic venues and worksites before (Jul 2009) and after (Feb and Oct 2011)enforcement of new smoke-free policy in Poland (all respondents) 50 45 40 36 33 29 30 26 20 VII 2009 20 17 15 14 13 12 12 II 2011 10 8 6 10 X 2011 0 ite o b p nt sc ho pu ra ks di r/ es u r wo ba sta ffe re co
Impact of smoking ban on smoking behaviours (%), Poland, Oct 2011Response of 9,8 million of Polish smokers to smoking ban 11 monthsafter its enforcement (Nov 2010): gave up smoking 4,3 4,3 6,4 made attempt to quit 10,6 reduced smoking 6,4 better awared of smoking risk 68 no impact of smoking ban do not know In absolute numbers 420,000 of current smokers declared that they gave up smoking and 630,000 made attempt to quit
Conclusions Poland was another country where tobacco industry made attempt to enforce Spanish model of smoke-free policy. Fortunately, due to efforts of Polish civil society and medical organizations as well as of international health institutions and network of tobacco control advocates, this attempt was unsuccessful. Although enforced smoke-free law is still not comprehensive in gastronomic venues and some workplaces , media and public support campaigns for smoke-free Poland positively changed attitudes of smokers and employers toward smoke-free policy. SHS exposure is now much lower and most of managers decided not to establish smoking rooms or cabins in their workplaces. However, tobacco smoke was not eliminated from public places (surveys and compliance reports show tobacco smoke pollution in approx. 10-15% of gastronomic venues and worksites). There is urgent need to expand complete ban of smoking on all public places and worksites, including gastronomic venues (63% of Poles support such restrictive law), disclosure the industry conflict of interest and exclude industry representatives and lobbyists from parliamentary works on tobacco control and other public health legislative projects (FCTC article 5.3).