The hidden dangers of the smoking ban
Could the ban on lighting-up in public in England and Wales lead to more dangerously polluted air in the home - and even to more house fires?
On 1 July, a ban on smoking in public was enforced in England and Wales. Restaurants, cafes, bus-stops, hospitals and other areas that can be defined as ‘places of work’ are now out of bounds for those puffing on a cigarette. Might the ban cause unintended harms? Here, health writers John Luik and Patrick Basham argue that the no-smoking policy might actually damage rather than improve public health, while below Rob Lyons says second-hand smoke in the home is not as scary as some people think.
In 1936, the American social scientist Robert Merton wrote an article in which he attempted to formalise what social scientists have long understood, but activists, policymakers and politicians have either ignored or denied. Merton argued that both individual and government actions have effects that are unforeseen, unintended and all too frequently unwelcome.
According to Merton, the most common unintended consequences result from ignorance and error. However, he also found that many perverse consequences flowed from what he called the ‘imperious immediacy of interest’ – where a group or government wants something so much that they deliberately ignore or deny the unintended negative effects.
Instances of unintended consequences are legion. Many economists, for example, have argued that government-provided old age pensions, while helping to reduce poverty amongst the aged, have also resulted in individuals saving much less for their retirement years precisely because they believe that the ‘government will take care of them’.
The recent North American experiment in extending summer time by three weeks in order to save energy is another instance of unintended consequences. According to energy analysts, the extra hour of evening daylight has increased the amount of driving – because of the longer evenings – and this in turn increased, rather than decreased, overall energy consumption.
With the public smoking ban that was enforced in England and Wales on 1 July, there are several signs that the smoke-free English pubs and restaurants that are supposed to be a boost for public health instead might increase the risks to non-smokers.
That is because smokers displaced from one of the last public places to allow smoking will likely increase their smoking at home. According to a study by Jerome Adda and Francesca Cornaglia of University College London (The Effect of Taxes and Bans on Passive Smoking, 2006), there are a number of unintended and perverse consequences associated with a countrywide public smoking ban.
Using information from the US National Health and Nutrition Examination Survey (NHANES III), which is a sample of over 50,000 individuals, Adda and Cornaglia found that smoking bans resulted in what they called a ‘perverse displacement of smoking’ from public places such as pubs and restaurants to residential settings, which were more likely to have children present.
Instead of reducing their smoking in a uniform manner, smokers confronted with workplace, pub, and restaurant smoking bans, smoke less in these places but in turn increase their smoking at home. According to Adda and Cornaglia, public smoking bans have in general ‘no effect on exposure’ for non-smokers.
As a result, children, one of the supposed major beneficiaries of public smoking bans, receive higher exposures to environmental tobacco smoke (ETS) under smoking bans than before such bans. As the authors note, ‘We find that bans in recreational public places can perversely increase tobacco exposure of non-smokers by displacing smokers to private places where they contaminate non-smokers. Children seem to be particularly affected by this displacement. The level of cotinine [a nicotine marker] in small children considerably increases as a result of bans in recreational public places.’
An increased level of smoking at home is not the only perverse consequence of a public smoking ban. Adda and Cornaglia also show that while such bans might reduce the second-hand smoke exposure of wealthier individuals, they in fact increase the exposure of poorer individuals – something that reinforces existing health disparities and works against the government’s policy of reducing health inequality.
Adda and Cornaglia suggest that the reason for this disparity is due to the ‘larger displacement effects for low-income individuals who are also more likely to live with smokers’, since the prevalence of smoking is higher in poorer families to begin with.
What this means, according to Adda and Cornaglia, is that complete public smoking bans are not smart tobacco control policy. Rather, they reflect the ‘simplistic’ and doctrinaire approach of the anti-tobacco lobby and its refusal to ‘take into account how public policies can generate perverse incentives and effects’. A much better policy, they suggest, would be one that allows for ‘alternative places to which smokers can turn to’ to avoid increased smoking at home.
Nor is greater exposure to second-hand smoke, particularly for the poor, the only unintended and perverse consequence of the upcoming smoking ban. A recent report by the insurer, Direct Line, notes that house fires will increase because of the public smoking ban. According to their calculations, almost 16million additional cigarettes will be smoked at home because of the smoking ban, placing about a million residences at increased risk from fires.
A similar increase in smoking at home, and in the consequent number of residential fires, took place in New York after the city’s public smoking ban in 2003. (Direct Line’s estimate is based on the fact that 70 per cent of the UK’s 10 million-plus smokers smoke at home. Of these seven million smokers, 15 per cent say that the smoking ban will force them to smoke more at home.) Currently, there are about 60 smoking-related house fires a week in the UK, with about 110 fatalities annually.
The anti-tobacco lobby has always argued that the precautionary principle of ‘better safe than sorry’ is the only way to deal with the supposed menace of public smoking. Blinded by Merton’s ‘imperious immediacy of interest’, it has failed to see that smoking bans are probably worse than the ill they attempt to prevent. In the end, the illusion of safety in preventing public smoking cannot protect us from being sorry.
by Rob Lyons
One of the key arguments that has been made against the smoking ban in England and Wales is that it will increase the risk to non-smokers at home. Forced out of bars and restaurants, smokers will light up at home more often, and blow their smoke around their children and non-smoking partners. There seems little doubt that there will be more home-based smoking, and that some homes will become smelly and smoggy as a result. But is there any hard evidence that ETS – environmental tobacco smoke, or ‘second-hand smoke’ – poses a health threat to those who live with smokers?
While a link between second-hand smoke and a slightly increased level of illness seems plausible on the surface, no link has ever been proven. Even where studies have found an increased risk of cancer, the increase has been so small as to be practically insignificant. The website of the anti-smoking group ASH suggests the risk of lung cancer for non-smokers is about 10 cases per 100,000 people (1 in 10,000). An ASH factsheet from 2002 claimed that: ‘Non-smokers who are exposed to passive smoking in the home have a 25 per cent increased risk of heart disease and lung cancer.’ In other words, 12.5 cases per 100,000 of the population, or 1 in 8,000.
Moreover, studies that show no link are often not published; there seems to be a bias in the medical-publishing world for studies that suggest a link between ETS and ill-health over those that do not. When studies that show no link were taken into account by researchers at the University of Warwick a few years ago, they found that the relative increase in risk of ill-health fell to about 15 per cent. An effect this small would usually be dismissed as potentially the product of other kinds of research bias. For this reason, researchers are usually advised to treat with extreme scepticism increases in risk of less than 100 per cent.
For anti-smoking campaigners, the passive smoking issue is a perfect stick with which to beat smokers. The suggestion is that, even if a smoker doesn’t care about his own health, he should at least be more respectful towards the health of others. And despite the lack of hard evidence for a link between ETS and serious ill-health, many of the recent bans in New York, Rome, London and elsewhere have been brought in on the back of fears about second-hand smoke damaging non-smokers.
Arguing against the smoking ban in England and Wales by focusing on the potential impact it will have on health in the home comes across as an attempt to beat the fearmongering of the government with an alternative form of fearmongering. Even worse, it could lead to someone in authority saying: ‘You’re right…so let’s ban smoking at home, too.’
Rob Lyons is deputy editor of spiked.