Gaining health : analysis of policy development in European ...

Ireland), and requiring the tobacco industry to make public
all information about the effects of its products. All forms
of tobacco advertising have been banned and regulations
put in place to exclude indirect advertising. Training is to be
provided for health care professionals and teachers.
Particularly aimed at reaching children, taxes were to be
continuously increased on tobacco products, the legal age
for buying tobacco was raised to 18, and tobacco was to
be sold only through registered premises. Health education
programmes were to be improved and specific remedial
programmes for child smokers developed.
At the local level, the then regional health boards were to
set up subcommittees for tobacco control and the legal
provisions were to be enforced by designated environmental
health officers and inspectors. These officers have the
authority to issue a warning or initiate proceedings against
those who contravene the law, sending the matter to the
relevant district court. The maximum fine is a hefty €3000
at the discretion of the judge. Despite the dismantling of the
old regional health board system, environmental health officers
and community services at the county level continue
much of this public health work.
The OTC commissioned an independent scientific working
group to investigate the health risks of passive smoking. It
concluded that second-hand smoke in the workplace increased
the risk of heart disease, cancer and respiratory diseases
and that pregnant women, bar staff and waiters were
at increased risk. In January 2003, the Minister announced
his intention to ban smoking in all enclosed public places.
A national debate occurred over the 15 months following
this announcement, with national and local media taking up
the issue on a weekly basis (29). One of the main concerns
was the possible loss of bar business and associated jobs,
and the process was nearly derailed a number of times.
Public support for the proposed measure was high, however
(59% of the population one month after the announcement),
support coming from health professionals, NGOs
and a wide range of trade unions.
The OTC and its collaborators concentrated on raising public
awareness of the adverse effects of smoke, counteracting
misleading claims by opponents and building confidence in
the enforceability of the legislation. Several key steps were
taken during the year prior to the workplace provisions
becoming law, including: consultations with representatives
of the hospitality industry, trade unions and enforcement
agencies to develop guidance for implementation; the production
and dissemination of information and guidance materials;
media advertising on the health effects of smoking;
the setting up of telephone lines to investigate complaints of
non-compliance; proactive visits to workplaces by environmental
health officers before and after the introduction of
the law; the establishment of fines for non-compliance; and
the prominent display of no-smoking signs plus the name of
the person to whom complaints could be made. The strong
focus on the plight of those working in bars and clubs struck
a cord with the public, as they related to the problem of
passive smoking in the workplace.
Smoking in the workplace was banned in 2004. With clear
messages, close collaboration with key stakeholders (particularly
the trade unions) and provisions for enforcement,
compliance has remained at over 90% and public support
is almost universal. Some 98% of people think that workplaces
are healthier as a result, including 94% of smokers.
In the first 12 months of the workplace smoking ban there
was a drop in national smoking levels, representing a 6%
decrease in the number of people smoking. An evaluation
carried out on the National Smokers Quitline in March
2005, showed that the workplace smoking ban was a very
important factor in helping them quit the habit of smoking.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases