Some interesting and thought provoking thoughts from Catherine, a regular reader and contributor to this blog:
Image courtesy of Pixaby
The banning of smoking in the city’s public parks and on beaches is under active consideration at present in Brighton and Hove, where cigarette smoke is blamed for many premature deaths. Such bans are common in the US, in cities such as Seattle and Philadelphia, and are being debated in other countries, such as Ireland and Israel. In the UK generally, major public health experts, such as Lord Darzi, support such measures, and this has been much discussed in medical journals recently.
Lord Darzi of Derham, was one of Gordon Brown’s GOATS. He is an adviser to Boris Johnson, and in his moments of leisure is a highly-respected and expert surgeon at the Royal Marsden in the field of minimally invasive surgery. He has published extensively, is a recognised leader in his field, and a highly accomplished spokesman for the concepts of public and global health. When Lord Darzi speaks, medics tend to listen, even if they do not always fully agree with him. The Mayor of London made him the chair of the London Health Commission, and he has been much in the news recently for championing the idea that the capital, and by implication other cities, can be leaner, healthier and fitter. Among several recommendations, the Commission recommends that smoking should be banned in public parks. By using byelaws, they believe that 40% of London can be smoke free.
The report is called “Better health for London” and can be read here.
Interestingly, the New South Wales government in Australia banned smoking in national parks on 1/1/2015; the aims were to minimise the risks of bushfires and to attempt to reduce the seven billion cigarette butts which litter the country each year, in addition to improving the nation’s health. In 2011, the then-Mayor of New York, Michael Bloomberg, banned smoking in all 1700 of the city’s parks. In the UK, Glasgow will not allow smoking in children’s playgrounds, and in 2013 a “Tobacco Control strategy for Scotland” was launched. The British Medical Journal recently published a debate on outdoor smoking bans, with excellent references to supporting evidence. Here, Lord Darzi argues that this measure would promote behavioural change: if one does not see others lighting up, it becomes less of a behavioural norm.
The opposite view is presented by Professor Simon Chapman of the University of Sydney, who feels that the public health benefits of such restrictions would be negligible and unmeasurable, and that such measures in themselves are paternalistic and even totalitarian, fascist. “If it is fine to tell smokers that they cannot be seen to smoke anywhere in public, why not extend the same reasoning to drinkers or to people wolfing down supersized orders in fast food outlets??” he asks. Professor Chapman also voices objections to the “litter problem” which smoking creates being dressed up as a public health issue, although one could argue that smokers needlessly exacerbate opposition and revulsion by treating public spaces, such as parks, as an open ashtray in which they can throw down butts with abandon.
The tos and fros of the debate, and the discussion it has engendered, involve the extent to which it is legitimate for government to attempt to mitigate harm to the public health, and to what extent this should be left to the individual. Some say that a ban would be “the nanny state” and exhibit a slightly prurient Puritan disapproval; others reply that a public health emergency is imminent, justifying such measures. Is it reasonable to ban smoking in a park, whilst large vehicles spew out pollution on roads close by? Both sides cite technical scientific publications which are somewhat difficult for the average reader to evaluate.
A further point often raised in the debate is that any such law would be very onerous to enforce. Mayor Bloomberg and Lord Darzi tend to regard this measure as self enforcing: rather than it being a matter of a “de jure” law being imposed by government agencies, not smoking outside would become a moral and ethical norm, a “de facto” enforcement of a socially acceptable course of action, created by groups in society itself. It would become something that people in general simply don’t do. No law is completely enforceable in that people often don’t get caught breaking the law; but this is not, in itself, a justification for not having a particular law. The law on copyright is regularly ignored; people still use their mobile phones while driving. Should these laws be repealed, because they are regularly being flouted?
Having commissioned the above report, the Mayor of London has not rushed to implement all its recommendations; he has been known to smoke a cigar outdoors himself. However, the subject is unlikely to go away. Dedicated public health campaigners, libertarians and obsessive cacodoxians of all kinds sustain the debate: is a cigarette an inalienable human right or one of the deadliest decoctions in human history whose inhalation must be abolished? Is there a middle way? Smoking yields revenue and tax as well as cancers. Is it the most pressing public health concern, or are there other noxious forms of pollution which must also be tackled?
The use of the “totalitarian” or “health fascist” argument/nomenclature is interesting. Hitler memorably threw his fags into the Danube, and Nazi Germany promoted smoke-free public spaces. A certain amount of extremist imagery and rhetoric often creep into the debate, with phrases such “antismoking ayatollahs” or “health talibans” , which tend to denigrate by association. The German Nazis also enacted extensive animal protection laws, and Hitler may have been a vegetarian. What should we deduce from this?
There were several people smoking in the park at the weekend, seemingly oblivious to the impasse in evidence-based efforts to improve health by eliminating tobacco, and untroubled, too, by the more radical suggestions for a way forward, such as phasing out smoking by making cigarettes unobtainable to those born after a certain date, or the development of alternative measures “plain packaging”, or e-cigarettes. MPs may have time on their hands to debate this, but legislation looks unlikely. It’s unlikely too that Lord Darzi and his colleagues will cease to fight for public health.
There is an open access article on the case for abolition in the BMJ here. Opposing views can be found at http://www.forestonline.org/. The park is a public space, for the whole public, whether they are libertarians, fascists, dog walkers, joggers, footballers, mums with prams, …….. Should certain activities be banned there? What do readers think?