Report to: Executive Date: 21st November 2005 Report by: Susie Waller, Head of Health Improvement SMOKE FREE CITY 1. Purpose The Executive are asked to consider the proposed Local Smoke Free Charter for Portsmouth (see example appendix 1). The signing of this charter represents the ‘in principle’ commitment from Portsmouth City Council to the development of a Smoke Free City. This would include commitment from each of the directorates towards ‘getting our own house in order’ through contributing to the Smoke Free Action Plan. 2. Recommended That the Executive support and agree the signing of the ‘Smoke Free Charter’ 3. Background Smoking is the single greatest cause of illness and premature death through heart disease, stroke, lung cancer and asthma. In the South East it is responsible for: • 1 in 4 deaths of people aged 35-64. • The admission to hospital of over 44,000 people with smoking related conditions in 2003/4 with an estimated cost to the health service of around £238million. • The loss of £370million a year to businesses through related sick days and an estimated cost of £1.2 billion a year from cigarette breaks. • The estimated economic cost of smoking related fires of almost £15.5million a year. Nationally • it kills an estimated 86,500 people per year. • It is responsible for 1 in 3 cancer deaths and one seventh of all cardio vascular disease. • Over 80% of deaths from lung cancer are the direct result of smoking. • In pregnancy smoking can cause low birth weight, which in turn increase the chances of infant mortality and morbidity. 1 Smoking disproportionately affects the least well off. • 26% of all adults smoke in England, but the figure is 31% in manual groups as compared with 20% among non-manual groups. In Portsmouth the lifestyle survey (1999) showed that 32% of Portsmouth residents smoked, however a survey done in January 2003 shows that Portsmouth has a smoking prevalence greater than 29% (adult population 18 and over) This puts Portsmouth in the top four (3) for smoking prevalence in the South East (the others are Hastings, Thanet and Brighton & Hove). This compares to the average smoking prevalence in the South East which is 21%, and starkly compares with the Local authorities with the lowest prevalence in the South East of less than 15%. (It is important to note here that if the survey included 16 –18 it is estimated that the prevalence would be higher) Smoking costs the NHS between £1.4 billion and £1.7 billion per year. Second hand smoke Tobacco smoke contains over 4000 chemicals in the form of particles and gases. Many potentially toxic gases are present in higher concentrations in second hand smoke than in mainstream smoke and nearly 85% of the smoke in a room results from second hand smoke. Short-term exposure to tobacco smoke has a measurable effect on the heart in non-smokers. Just 30 minutes exposure is enough to reduce coronary blood flow. In the longer term, passive smokers suffer an increased risk of a range of smoking-related diseases. A major review by the Government-appointed Scientific Committee on Tobacco and Health (SCOTH) concluded that passive smoking is a cause of lung cancer and ischaemic heart disease in adult non-smokers, and a cause of respiratory disease, cot death, middle ear disease and asthmatic attacks in children. Every year thousands of children have to go to hospital because of breathing other peoples smoke Whilst the relative health risks from passive smoking are small in comparison with those from active smoking, because the diseases are common, the overall health impact is large. The British Medical Association has conservatively estimated that second hand smoke causes at least 1,000 deaths a year in the UK. It is also important to note that 70% of smokers want to quit National Policy context The first comprehensive tobacco strategy was ‘Smoking Kills’ (1998) This paper set targets to reduce smoking in the general population, in 11-15 2 year olds and pregnant women. The ‘Cancer Plan’ set a further target for manual workers. * The Department of Health Action Plan (2003)asked for Regional Tobacco Control Strategies to be developed. Public Health White Paper “choosing health” The aims of this strategy are that: • by 2006 all government departments and the NHS will be smoke free; • By the end of 2007 all enclosed public spaces and workplaces other than licensed premises will be smoke free (these exemptions may change in the near future) • By the end of 2008 arrangements for licensed premises will be in place. ‘Choosing health’ also outlines plans to boost local stop smoking services and strengthen action to prevent underage tobacco sales. The Government Position now is that they are agreed that England should be working towards ‘Smoke Free’ however the extent to which this will be implemented is still under debate. Going Smoke Free To promote non-smoking and protect non-smokers from second hand smoke, in itself a danger to health, some cities in England have already started to campaign for smoke free cities. Although councils do not have the power to implement bans in all private and public settings some are now taking the lead: making the buildings they own smoke free and encouraging the local community and business sector support the scheme. Smoking restrictions have been introduced in other countries and is currently under consideration in both Scotland and Wales. This follows the lead of Italy and Ireland: • According to Euromonitor International, sales of cigarettes in Ireland fell 8.7% last year, when the ban was implemented, after declining 3.4% in 2003, and 1.2% in 2002. Gallaher Tobacco, the market leader in Ireland, has reported that Irish sales dropped 10.7% from January to October of last year. • Support for the law increased after its introduction. Irish Marketing Surveys (commissioned by the Department of Health) reported in Summer 2004 that 82% of the public backed the smoke free law, and 90% agreed it would benefit workers. 70% reported that it improved their experience in pubs, and 78% said it improved their experience in restaurants. 3 • Figures released in February 2005 by the Central Statistics Office of Ireland show that the value of bar sales in Ireland fell by 3.5% between April and December 2004, compared to the same period in 2003. The decrease of the value of sales is in line with the decrease of the volume of sales in the bars in Ireland, which began in 2001, well before the smoke free law was introduced. • The Irish Office of Tobacco Control reported in December 2004 that compliance levels with the new law are high. Compliance levels are reported at: - 94% in hotels; - 99% in restaurants; - 91% in licensed premises. • According to the Irish Examiner (March 21st 2005) fewer than 20 prosecutions have been required since the introduction of the smokefree law. 4. WHY LOCAL ACTION? The Integrated Health Development Strategy (IHDS) 2004-9 that was agreed by the council in 2004 sets local (proxy) targets for increasing the numbers of non-smokers (High level target being to ‘Increase Life expectancy’). This local document supports and reinforces the National Policies set out above. In light of the high levels of smoking in Portsmouth, documented above, and also the statistics regarding smoking related illness and deaths in the South East it is important that Portsmouth City Council is seen to be taking the lead on this issue. Portsmouth City Council is a ‘Pathfinder Authority on Tackling Health Inequalities’ as the greater numbers of smokers in Portsmouth are amongst manual workers, with those quitting smoking tending to be predominantly in the non manual group, the health status gap is widening. Signing up to go Smoke-free would be a further commitment to tackling health Inequalities in Portsmouth. In the presence of national guidance and data although with the absence of national legislation it falls to local partners to promote the benefits of reducing the number of smokers and achieving the targets set out in the strategy. It is also important that Portsmouth City Council accepts responsibility for protecting its staff against ‘second hand smoke’ and itself from possible resulting legal action. The council can take a lead and set an example by going smoke-free in the buildings that it owns, this will require a committed Portsmouth City Council (time limited and focused) project group to take this forward. It can also work in partnership with the local community and business community to reduce smoking in other public places. 4 A City wide Smoke Free Portsmouth Steering Group has been set up with representation from The Royal Navy, Portsmouth University, the Co op, Portsmouth Hospitals Trust and Portsmouth City Teaching PCT. Local action also needs to involve the local community, improving the understanding of the risks and providing support for those wishing to be involved. 5. WHAT DO WE MEAN BY SMOKE-FREE? The aim of the scheme is to promote non-smoking and protect non- smokers from second hand smoke by creating smoke free public places. This includes indoor areas that are used by the general public in both the private and public sector as workplaces or meeting places. These can include; public buildings e.g. libraries, sports centres, schools; restaurants and pubs; public transport; shopping centres etc. 6. THE “WORKING TOWARDS” PRINCIPLE The council alone does not have the power to deliver a totally smoke free city so the aim would be to work towards this by creating a series of steps to achieving a smoke free status. The attached charter is the first step towards this. Adopting the Local Smoke Free Charter will give a clear indication of the council’s commitment to ‘work towards’ increasing the number of smoking free areas in the city and towards achieving the objectives of the Integrated Health Development Strategy (2004-9). Once the Charter is adopted then the next stage would be to get ‘our own house in order’ (see example attached appendix 2) with responsibility resting with individual Directorates (with support from Health Improvement Service) to produce detailed action plans as to the measures they would introduce to promote a smoke free city. These proposals would, of course, be subject to council approval. Approval to the recommendations The recommendation set out above was approved/approved as amended/deferred/rejected by the Executive Member on 21 November 2005. Signed…………………………………………………………………………………… Leader of the Council 5 Appendix 1 CITY OF PORTSMOUTH SMOKEFREE CHARTER Proposed charter for adoption by Portsmouth City Council We, Portsmouth City Council recognise that smoking is the number one cause of preventable deaths in our area and across the United Kingdom. We recognise that most smokers begin to smoke before they become adults, and that many begin before their thirteenth birthdays. The future health of our children depends on ensuring that they do not become smokers. We also recognise that progress to end health inequalities and increase the life expectancy of poorer and more vulnerable people in our community depends on action to cut the number of smokers and reduce the harm that smoking causes to them and to others. We are therefore determined: • to reduce smoking prevalence in our City; • to educate and inform local people about the dangers of smoking and secondhand smoke; • to encourage and support smokers who want to give up, and to promote local stop smoking services; • to protect non-smokers from the damaging effects of secondhand smoke; • to enforce the law on advertising and sale of tobacco products to minors. We commit ourselves and our organisation to work towards becoming a smokefree City. We will use our existing powers to protect our citizens from the harm caused by smoking, and we will call on the Government to give organisations and partnerships the necessary further powers to make this protection fully effective. 6 We will work closely with our partners and all those involved in local health and regeneration partnerships to set clear targets for reducing smoking and exposure in public places to second hand smoke, and to protect public health, and we will agree an Action Plan to ensure that these targets are achieved. We will work with Customs and Excise and police to tackle counterfeiting and smuggling. We will conduct research, monitor and publish results so that the local public can see the progress we are making. We will start by taking action in buildings and services directly owned and run by ourselves. No workplace should permit smoking on the premises. All employees should have access to professional advice and support services for smokers who wish to quit. We will however, in certain residential locations acknowledge peoples right to choose within their own homes. We will then take action in buildings and services where we have direct influence, including through funding and participation in their management. All workplaces or enclosed public spaces in receipt of funding from the Portsmouth LSP should be smokefree. We will do all in our power to protect employees from the dangers of secondhand smoke. This applies equally as much to those of employees whose work is mainly outside city council premises as to those who work mainly in city council offices and facilities. We will encourage, and where possible and desirable require, other employers in our area to ensure that their workplaces are smokefree. We will ensure that action on smoking is a core part of the work of all relevant staff. We will review at least once a year all relevant policies and programmes to ensure that they include effective action to reduce smoking prevalence, and where necessary we will make changes to ensure that our targets are achieved. We will ensure that bids for Government and European funding, and the uses to which such funds are put, reflect public health priorities and in particular our determination to reduce smoking prevalence. We believe that protecting and improving the health and safety of local people is a top priority for Portsmouth City Council. That duty cannot be discharged without determined action to protect the public from the damage caused by smoking. We cannot tolerate the terrible toll of death, illness and misery that both smoking and second-hand smoke causes to the people we represent. We promise to do all we can to bring it to an end. 7