The document summarizes the contributions of public health administrations in Spain to changing the country's partial smoking ban law. It describes how public debate and media coverage increased support for stronger smoking regulations. Surveys showed higher approval ratings for the law among non-smokers. While the law achieved political consensus, weaknesses in implementation undermined it. This prompted the Ministry of Health to pursue a legislative change in 2010 implementing a total ban in bars and restaurants. Compliance has been very high due to clear regulations, leadership, and engagement with scientists and advocacy groups. Ongoing threats include weakening the social norm and discontinuity in leadership.

1. L’Hospitalet de Llobregat, Barcelona, 5th July , 2012
“Contributions of the public health
administrations to the change of the
partial smoking ban”
Esteve Saltó, MD, MPH, LSSP
Public Health Agency of Catalonia, Generalitat de Catalunya
81-95, Roc Boronat. 08005 Barcelona
esteve.salto@gencat.cat

2. The period before to enactment of Law
28/2005 (with partial bans) induced an
unprecedented public debate in Spain that
led to the crystallization of a strong feeling
for the protection against SHS.
The key role of the media:
Trends in the number of published articles on tobacco + 75%
Catalonia, 1997-2005

3. Average Evaluation (scale 1-10) of the Law 28/2005 by smoking status
Dec 2005-June 2006- March 2007- June 2008
CATALONIA, SPAIN
Never smokers
Ex smokers
Current smokers
Source: Eurobarometer 2005y 2008.
JHU -
Phone interview;
samples: 800 pers. Saltó E et al.. Rev Esp Salud, 2006

4. Average Evaluation (scale 1-10) of the Law 28/2005 by smoking status
Dec 2005-June 2006- March 2007- June 2008
CATALONIA, SPAIN
SPAIN, general population
Never smokers
Attitude towards
smoke-free
Ex smokers regulations (all in
favor)
Spain, 2005 & 2008
Current smokers
Source: Eurobarometer 2005y 2008.
JHU -
Phone interview;
samples: 800 pers. Saltó E et al.. Rev Esp Salud, 2006

5. Unfortunately, despite the overall political consensus
achieved, negative elements had soon appeared that
severely mortgaged the process:
 complexity/ambiguity of the legislative text which hindered its
implementation by the authorities, especially regarding to the
mixed model in the hospitality sector
 poor coordination between public administrations with a
territorial patchwork of enforcement “à la carte” and even
regional decrees that reduced the standards of the law
 progressive deterioration of the situation with a growing
distance between reality (very heterogeneous depending the
territories) and the social norm that demanded a good model.

6. Checklist

7. Checklist

8. SENTENCIA No 2321
TRIBUNAL SUPERIOR DE JUSTICIA DE MADRID
SALA DE LO CONTENCIOSO-ADMINISTRATIVO
SECCIÓN NOVENA
En la Villa de Madrid, a treinta de diciembre
de dos mil ocho (2008).
FALLAMOS
Que debemos estimar el recurso contencioso administrativo promovido por el
Abogado del Estado en defensa del Ministerio de Sanidad y Consumo; por la entidad
“Asociación NOFUMADORES.ORG” representada por la Procuradora Doña Paloma
Rabadán Chaves, y por la “Organización de Consumidores y Usuarios” (OCU)
representada por el Procurador D. José Luís Ferrer Recuero, contra el Decreto 93/2006,
de 2 de noviembre, del Consejo de Gobierno de la Comunidad de Madrid, de
desarrollo y ejecución de la Ley 28/2005, de 26 de diciembre, de medidas sanitarias
frente al tabaquismo y reguladora de la venta, el suministro, el consumo y la publicidad
de los productos del tabaco en la Comunidad de Madrid y, en consecuencia,
declaramos su nulidad de pleno derecho por haberse omitido en su elaboración el
informe preceptivo del Consejo de Consumo de la Comunidad de Madrid.

9. Law Enforcement
Complaints, inspections and sanctions imposed by
period 2006-2008 in five autonomous regions

10. Catalonia, March 2006
OCU-Spain, May 2007

11. Have difficulties to find a bar/cafeteria of their preferences
by smoking status
CATALONIA, March 2007
100
90,6
80
70
60 61,4 62,3
40 38,6 37,7
30
20
9,4
0
Smoker Exsmoker Non smoker Total
YES NO
E.Saltó et al. ECToH-Basel 2007

12. Initiatives led from professionals,
scientists and social agents and the
evidence of the inadequacy of the
2005 model, prompted the Ministry
of Health to promote in 2010 a
legislative change that would allow
getting smoke free environments.
Despite the reluctance - that still
exists - in some sectors, it was
possible to generalize the total ban
on bars and restaurants and finalizing
a model perversely exported.

13. Initiatives led from professionals,
scientists and social agents and the
evidence of the inadequacy of the
2005 model, prompted the Ministry
of Health to promote in 2010 a
legislative change that would allow
getting smoke free environments.
Despite the reluctance - that still
exists - in some sectors, it was
possible to generalize the total ban
on bars and restaurants and finalizing
a model perversely exported.

14. Complaints, inspections and sanctions
Catalonia 2011
Nombre Expedients
Servei Regional Denúncies Inspeccions Retolació Consum tabac Altres incoats Resolts
Incorrecta Correcta No Sí
Tarragona 23 1960 277 1683 1952 8 24 11 5
Terres de
l'Ebre 46 927 49 878 915 12 23 9 4
Barcelona
ciutat-ASPB 172 7582 490 7092 7575 7 1 0 0
Barcelona 65 2419 419 2000 2385 34 14 32 10
Catalunya
Central 24 708 92 616 706 2 9 5 4
Lleida-APIA 57 7040 178 6862 7027 13 0 18 13
Girona 78 4263 304 3959 4244 19 17 21 7
Total 465 24899 1809 23090 24804 95 88 96 43
7,27% 92,73% 99,62% 0,38% 0,35%

15. Complaints, inspections and sanctions
Catalonia 2011
Nombre Expedients
Servei Regional Denúncies Inspeccions Retolació Consum tabac Altres incoats Resolts
Incorrecta Correcta No Sí
Tarragona 23 1960 277 1683 1952 8 24 11 5
Terres de
l'Ebre 46 927 49 878 915 12 23 9 4
Barcelona
ciutat-ASPB 172 7582 490 7092 7575 7 1 0 0
Barcelona 65 2419 419 2000 2385 34 14 32 10
Catalunya
Central 24 708 92 616 706 2 9 5 4
Lleida-APIA 57 7040 178 6862 7027 13 0 18 13
Girona 78 4263 304 3959 4244 19 high compliance
Very 17 21 7
(96-100%)
Total 465 24899 1809 23090 24804 95 88 96
Catalonia, Andalucía, 43
Aragón , Basque Country…
7,27% 92,73% 99,62% 0,38% 0,35%

16. The process has been possible mainly due to:
• a legal text (Law 42/2010)
clear, with little margin for
biased interpretations
• the flexible leadership from
Public Health Directorate
(Ministry of Health), with
strong support from the
more active Autonomous
Communities

17. The process has been possible mainly due to:
• the positive interaction
with CNPT, scientists,
social groups, trade unions
…
• the addition of other key
measures (public
information and
structured aid to smokers,
in many territories).

18. Quitline
Informatives Línia d'ajuda per deixar de fumar-Quitline
73
58
47
45
43
36 37
33 34 34
30 31
27 28 27 27
25
22
16 17
14 13
10 11 10
9 9 9
7
3 4
3 4
3 3 4
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
8 times more than in the same period of the
previous year

22. Current threats
• the failure to keep the favourable social climate
• to implement other control measures (such as
taxation)
• the discontinuity at ministerial level
• and some potential "aggressions" encouraged
by severe economic crisis.

23. Aguirre reclama que se
pueda fumar en casinos
para mejorar la
recaudación
POLÉMICA | Tachan las palabras de la presidenta de
'ataque frontal' a la Ley
El Comité para la Prevención
del Tabaquismo rechaza la
medida de Aguirre
Europa Press | Madrid Mato, “dispuesta a estudiar
Actualizado miércoles 27/06/2012 argumentos” sobre el tabaco tras
Los epidemiólogos, frente a el reto de Aguirre
Eurovegas: no quieren tabaco en "Evidentemente, la prohibición de
los bingos fumar se cambiará", ha dicho la
EFE | 18/06/2012 presidenta madrileña

24. Aguirre reclama que se
pueda fumar en casinos
para mejorar la
recaudación
BOTELLA, A
POLÉMICA | Tachan las palabras de la presidenta de
FAVOR
'ataque frontal' a la Ley
El Comité para la Prevención
del Tabaquismo rechaza la
medida de Aguirre
Europa Press | Madrid Mato, “dispuesta a estudiar
Actualizado miércoles 27/06/2012 argumentos” sobre el tabaco tras
Los epidemiólogos, frente a el reto de Aguirre
Eurovegas: no quieren tabaco en "Evidentemente, la prohibición de
los bingos fumar se cambiará", ha dicho la
EFE | 18/06/2012 presidenta madrileña

25. Thank you
esteve.salto@gencat.cat
esteve.salto@ub.edu