Tobacco and Public Health - TCSC Indonesia

RON BORLAND AND CLAIRE DAVEY 711
What drives the introduction of, and compliance with, bans?
Under what conditions will there be action to reduce passive smoking? The answer to
this question can best be answered by attempting to understand the diversity of
responses to the problem both within and between jurisdictions. First of all, a necessary
condition for action is awareness of the evidence of harm at levels that warrant
action. The awareness could be at the level of the informed public or the general public,
and may or may not include institutional acceptance of the risk. There is no doubt
that authoritative government sponsored reviews can play a major role. For example,
the Australian NHMRC (1987) led to immediate government administrative action to
control smoking in government offices, but not to legislative moves to restrict smoking
in other workplaces.
The likelihood of government action (where it has jurisdiction) will be a function of
the nature of the proposed action and of the views of key stakeholders. In particular, it
will be more difficult to enact rules where there is an expectation that it will compel
behaviour change than where the rules are more symbolic.
Cultural expectations surrounding laws or policies appears to be a major factor influencing
compliance. In some countries rules are put in place to announce a new
aspiration or goal of policy makers. Any public education and/or moves to enforce compliance
follows formal implementation. A major role for activists is to encourage
compliance. By contrast other countries only impose laws when they believe that there is
public support for high compliance, and in these cases public education precedes implementation
and there are strong expectations about high compliance at the point of
implementation and typically enforcement mechanisms to ensure this happens. French
tobacco-control expert Gerard Dubois has observed that countries influenced by anglosaxon
legal traditions tend to follow the latter path, while much of the rest of the world,
most notably those influenced by southern European traditions, favour the former. Thus
in a country like France, a law restricting smoking in enclosed places was passed with
a minimum of fuss because there was no real expectation that it would be enforced
(at least in the short term), while in countries like the US, new laws are often strongly
opposed by vested interests, because the expectation is that they will be enforced.
Compliance with smoke-free legislation and bans can likewise vary substantially
between countries. In countries such as North America, Australasia, and northern
Europe, changes to smoking regulations that have used a combination of legislation and
efforts to modify public attitudes have generally decreased exposure to environment
tobacco smoke. However, the existence of legislation in some countries has not had the
same impact and this may reflect the variety of cultural and sociological factors alluded
to above (Serra et al. 2000). Serra et al. concluded that the most effective interventions
for preventing smoking in public places were those where the institutions concerned
developed, resourced and supported comprehensive programmes to achieve compliance
with their policy decisions to ban smoking.