The Smoking Ban was introduced in England in July 2007 (with similar bans being introduced in Scotland in March 2006, Wales in April 2007 and Northern Ireland in April 2007). This was introduced as a result of the Health Act 2006. The British government passed this Health Act which brought with it the prohibition of smoking in an enclosed public place and within the workplace, with fines and other legal punishments applicable for non-compliance. The aim of this ban was to ensure that people in restaurants, at train stations, or in shops, who chose not to smoke, did not feel the adverse effects of second-hand smoke. The ban was the result of a long campaign against the effects of smoking and passive smoking, dating back to the 1950s when studies were published demonstrating the link between smoking and lung cancer. (The 1950 Wynder and Graham Study ) Before the Health Act of 2006 and the subsequent smoking ban, some businesses within the U.K. voluntarily decided to ban smoking as a result of public feedback and complaints. The first major chain to prohibit indoor smoking was the restaurant chain Pizza Hut, which brought into effect a prohibition of smoking in all of its restaurants across the UK in August 2003.
Before discussing the implementation of the smoking ban it is important to understand the current healthcare system within the UK. According to Tweddell (2008), the National Health Service (NHS) act was brought before parliament in 1946. The NHS Act aimed to provide comprehensive health care, funded by taxation, that would be available to all and free at the time of need. The National Health Service officially launched on 5th July 1948. The NHS was formed due to years of criticism from the general population because the lower-class citizens of Britain could not afford appropriate medical care; this resulted in citizens using workhouse infirmaries which were often poorly run and extremely unhygienic. According to the NHS website, the National Health Service was founded on three core principles: that it meets the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability.
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Since it was founded, the NHS has had a significant impact on the health of the general population of the UK, as the National Health Service has provided free health care for millions of people across the United Kingdom and has been instrumental in the implementation of a number of policies regarding public health for example, early intervention vaccination programs for infants.
The policy that resulted in the 2007 smoking ban was the Health Act 2006. This act made numerous changes to protect the public's health and improve the running of the NHS. The act placed a ban on smoking in NHS and government buildings, public places, and workplaces. Many people argued that the legal age for buying tobacco was too low and was enabling young people to access tobacco products too easily, therefore causing permanent damage and severe health problems later in life. Before the implementation of the smoking ban, the sale of tobacco products was permitted to persons aged 16 and above. However, the Health Act 2006, made it illegal to sell tobacco products to any person under the age of 18 throughout the U.K.
The smoking ban, which prohibited smoking in certain premises and increased the minimum age for the sale of tobacco products and which was implemented due to The Health Act 2006, falls under the category of preventative medicine as it aimed to: reduce the risk to health from exposure to second-hand smoke; recognize a person's right to be protected from harm and to enjoy smoke-free air; increase the benefits of smoke-free enclosed public places and workplaces for people trying to give up smoking so that they can succeed in an environment where social pressures to smoke are reduced; and save thousands of lives by reducing the number of smokers in the UK.
Before looking further at the impact that the smoking ban has had, and its general effectiveness, it is important to assess the argument for and against preventative medicine. This argument is based on three key models of health: the biomedical model, the social model, and the complementary model.
The biomedical health model is a scientific approach that focuses on the illnesses themselves and their causes. This model uses the analogy of the body as a machine and states that the root cause of illness lies within the body itself.
The biomedical model has been subjected to much criticism in the past 40 years, as historians have criticized the medical professions' narrow focus on corrective and scientific medicine. For example, Thomas McKeown (1976) argues that improvements in public health can be linked to rising living standards clean water efficiency and removal, and improved nutrition rather than the treatment of people with medicines.
Despite the increasing dominance of the biomedical model around the world, observers note that those who become ill are not equally distributed throughout society, instead illness and premature death occur more often in deprived areas. The social model of health focuses on diseases of poverty and deprivation and explains health inequalities in relation to the structural features of society such as poor housing and deprived environments.
The social model of health also looks at lifestyle and cultural choices. For example, Action on Smoking and Health, a pressure group against smoking, notes that smoking rates are markedly higher among poor people. In 2012 14% of adults in managerial and professional occupations smoked compared with 33% of those in manual occupations and in very deprived areas smoking rates can be as high as 75% of the population of the area, implying a correlation between the stresses of poverty and smoking.
Finally, we have the complementary model, which one could argue is the antithesis of the biomedical model. Those who adopt a holistic approach argue that the biomedical model is more concerned with illness than with health. By concentrating on specific parts or symptoms doctors fail to see the connections between illnesses and the need to restore balance and equilibrium. Therapists argue that the biomedical model encourages treatment that suppresses symptoms rather than treating the origins of people's illnesses.
If we put these health models into perspective when considering political views, we find that each opposing side of the political spectrum tends to identify strongly with opposing health models. For example, Left-wing political parties will gravitate towards the social and complementary models of health. Focusing on preventative medicine which aims to prevent illnesses from occurring in the first place, as communism and socialism are generally regarded as left-wing principles, it stands to reason that preventative medicine would align with these core values as the emphasis is placed on the health of the individual and promoting the health and well-being of the general public whilst reducing the incidence of disease and illness.
Whilst Right-wing political parties will tend to favour the biomedical model of health, that is curative medicine, as conservatism and reactionism are generally regarded as qualities associated with the right side of the political spectrum. This means that the capitalist ideals of right-wing politics would support the curative health model, specifically in cases where the health service could be privatized and therefore would be economically advantageous for the government.
Generally, those who promote the social model approach to health argue for early intervention to stop illness or injury from occurring in the first place, this can be facilitated through legal and social changes like the smoking ban of 2007 or the introduction of compulsory car seat belt usage in 1983. (gov website https:www.gov.ukgovernmentnewsthirty-years-of-seatbelt-safety)
While the curative model of medicine has its place, it can be argued that prevention is more important than a cure, if we prevent these diseases, illnesses, and injuries from taking place in the first place we can improve overall public health, reduce medical costs for the NHS and improve the quality of life of the general public. Preventative medicine aims to promote health and well-being and prevent disease, disability, and death, (https:www.acpm.orgabout-acpmwhat-is-preventive-medicine) which can only be seen as a positive when considering the health of the UK population.
However, there are benefits to curative medicine that must also be considered, for example in countries where free healthcare is not commonplace, for example, the United States, the high cost of healthcare and treatment can motivate people to maintain a healthier lifestyle, to avoid becoming sick and needing to avail of medical treatment, thus avoiding or at least mitigating the expense of medical care. Although medical insurance is readily available, many illnesses and conditions are not covered and so should be prevented from occurring if possible.
In the UK, although we have access to free medical care through the National Health Service, most dental treatment is not free unless certain circumstances apply, for example, age, pregnancy, and income status. In order to avoid the cost of expensive dental care many people are more inclined to maintain a good standard of oral hygiene to avoid costly trips to the dentist. Here we see that although curative medicine can be exclusionary in certain cases, with a potentially negative impact on those who are on lower incomes or struggling financially, it can also promote a healthy lifestyle as people are keen to avoid medical costs if possible.
Without curative medicine we would not be able to treat emergency medical situations, as accidents and injuries cannot always be prevented, you can take calcium supplements and practice weight-bearing exercises to improve your bone strength, but if sufficient force is applied to any bone in the human body, it will still break.
Therefore, we cannot say that one type of medicine is superior to the other, as they both have their place and are equally necessary.
We can see exactly how effective preventative medicine can be in relation to public health if we analyze the effects that the smoking ban has had on the general public. 'Directly after the legislation, more people were trying to quit smoking, and more people succeeded because it's much easier to avoid those situations (in which one would smoke),' says Hazel Cheeseman, Director of Policy at ASH (Action on Smoking and Health). Furthermore, research undertaken by the British Medical Journal estimated there were 1,200 fewer hospital admissions for heart attacks in the year following the ban citing improved air quality and lower numbers of smokers will have contributed to this.
Smoking causes a host of illnesses for example: cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). Smoking also increases the risk of tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year. Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.
U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2016 Dec 20].
https:www.cdc.govtobaccobasic_informationhealth_effectsindex.htm
Based on the overwhelmingly negative impacts of smoking it is clear to see why the Health Act of 2006 focused on smoking as one of the key areas which needed to be addressed. Following the smoking ban of 2007 there was a positive impact on the number of smokers across the UK. In 2006, 22 percent of adults in the UK smoked, whereas in 2015 we see this figure drop to 18 percent. This forms part of a gradual decline in UK smoking rates since 1974 when the government first began gathering this data. If we look at 2019 only 14.7% of the population of the U.K. reported being a cigarette smoker, this demonstrates a considerable and steady decline in popularity of smoking since the introduction of the smoking ban. (https:www.ons.gov.ukpeoplepopulationandcommunityhealthandsocialcarehealthandlifeexpectanciesbulletinsadultsmokinghabitsingreatbritain2018)
Before the smoking ban was introduced, the air pollution in UK bars, from cigarette smoke was much higher than the 'unhealthy' threshold for outdoor air quality (set by the US Environmental Protection Agency), a University of Bath study found. After the ban, air pollution in UK bars was reduced by as much as 93 percent.
(https:www.bhf.org.ukinformationsupportheart-matters-magazinenewssmoking-ban)
Toby Green, Tobacco Policy Lead at the Royal Society for Public Health (RSPH), says the ban was 'one of the biggest public health interventions we've seen in the last 15 years'.
Before the ban, there was a large body of research linking passive smoking to health problems. Studies showed breathing in second-hand smoke increased an adult non-smoker's risk of lung cancer and heart disease by a quarter, and of stroke by 30 percent.
Breathing in other people's smoke is particularly harmful to children because their lungs are still developing, resulting in a higher risk of respiratory infections, asthma, bacterial meningitis, and cot death. A Glasgow University study showed that, before the smoking ban, the number of hospital admissions of children with asthma was increasing on average by five percent each year in Scotland. In the three years after the ban, admissions decreased 18 percent per year.
In the three months after the ban there was a 6.3 percent drop in the volume of cigarettes sold in England. 'The smoking ban is one of a series of moves to discourage smoking. It is part of a trend towards policies that disapprove smoking,' Toby says. 'It helped create a shift in culture.' (all of this was from the BHF website)
Officially as per the government website, the legislation, that is the Health Act 2006 and subsequent smoking ban has proved effective, popular, and well complied with. Around three-quarters of people in England say they support the legislation and, after three years of the law being in place, the national compliance rate was over 98% (measured by the number of premises and vehicles required to be smoke-free that were properly complying with the law when inspected by enforcement authorities).
The latest smoke-free legislation compliance data for England is online at www.smokefreeengland.co.uk files83840-coi-smoke-free-compliance_ period_tagged-13.pdf
A report from the Better Regulation Executive (BRE) showed that there had been considerable benefits to business as a result of smoke-free legislation in workplaces and public places and the way in which it was implemented. The BRE report, (Better Regulation, Better Benefits: Getting the Balance Right,10 published in October 2009,) used the implementation of the smoke-free law in workplaces and public places throughout the United Kingdom as a case study to illustrate good practice. The BRE states: 'The reduction in exposure to second-hand smoke and the general improvement in public health, along with the reductions in losses to business in terms of sickness and other costs have made a favorable impact on the UK economy. It is clear that this is a beneficial regulation.'
Furthermore, as the age of sale of tobacco increased from 16 to 18 due to the 2007 smoking ban, there was a greater fall in the prevalence of smoking in 16-17-year-olds in England following the increase in the age of sale than in older age groups. This suggests that raising the age of sale can, at least in some circumstances, reduce smoking prevalence in younger age groups.
All of this demonstrates exactly how vital preventative medicine can be to the general health of the population, the reduction in the number of younger people smoking can only have a positive effect on the health of future generations. Reduced exposure to the harmful toxins in cigarette smoke, both directly and passively, will have health benefits for years to come.
https:www.legislation.gov.ukukpga200628pdfsukpga_20060028_en.pdf
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