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    WHO Issues Policy Recommendations on Secondhand Smoke

    By Keith R | May 30, 2007

    Topics: Health Issues, Tobacco Control | No Comments »

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    The WHO Recommendations (click to download the PDF)The World Health Organization (WHO) has released a set of policy recommendations to governments on secondhand smoke (SHS) as part of the run-up to World No-Tobacco Day (31 May). The recommendations are intended as guidelines for national measures to protect the health of workers and non-smokers by making all indoor public places and workplaces 100% smoke-free.

    They also set the stage for the upcoming discussions on guidelines for protection against SHS exposure to be held in Bangkok during the second Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC). The FCTC commits all Contracting Parties to

    the adoption and implementation of effective legislative, executive, administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

    Most Latin American and Caribbean (LAC) nations have signed the Convention, but quite a few have yet to ratify. Many have adopted measures regarding public places and public transport, but not all have not all have acted on workplace smoking and even many of the measures on SHS adopted have had many exceptions and loopholes.

    The WHO press release accompanying the guidelines (copied below) makes the case for banning smoking from indoor public places and workplaces, so I will not repeat it all here. Instead let’s look at what WHO says are the “lessons learned” from jurisdictions that have adopted tough SHS measures and its four principal policy recommendations.

    Regarding the “lessons learned,” these are:

    The four principal policy recommendations are:

    1. Remove the pollutant – tobacco smoke – by implementing 100% smoke-free environments. This is the only effective strategy to reduce exposure to tobacco smoke to safe levels in indoor environments and to provide an acceptable level of protection from the dangers of SHS exposure. Ventilation and smoking areas, whether separately ventilated from non-smoking areas or not, do not reduce exposure to a safe level of risk and are not recommended;
    2. Enact legislation requiring all indoor workplaces and public places to be 100% smoke-free environments. Laws should ensure universal and equal protection for all. Voluntary policies are not an acceptable response to protection. Under some circumstances, the principle of universal, effective protection may require specific quasi-outdoor and outdoor workplaces to be smoke-free;
    3. Implement and enforce the law. Passing smoke-free legislation is not enough. Its proper implementation and adequate enforcement require relatively small but critical efforts and means.
    4. Implement educational strategies to reduce SHS exposure in the home, recognizing that smoke-free workplace legislation increases the likelihood that people (both smokers and non-smokers) will voluntarily make their homes smoke-free.

    These recommendations are likely to be as controversial in LAC nations are they still are in the US and some European nations, since they advocate (1) abandoning voluntary approaches and the use of separate, designated, specially-ventilated areas in places such as bars and restaurants; and (2) pressuring smokers to stop smoking within the privacy of their own homes. WHO, however, feels the measures are all justified in public health terms and fully justifiable by health research. I suspect, though, that unless WHO (or its surrogates) fully trains and provides sufficient supporting advice and materials, many LAC health officials will be unable to persuade their legislators or presidents/prime ministers to show the political courage needed to adopt such steps.

    The WHO Press Release:

    Only 100% smoke-free environments adequately protect from dangers of second-hand smoke

    New WHO policy recommendations point to extensive evidence

    The World Health Organization (WHO) signalled the urgent need for countries to make all indoor public places and workplaces 100% smoke-free with the release of its new policy recommendations on protection from exposure to second-hand tobacco smoke in advance of World No Tobacco Day (31 May), which focuses this year on this them

    “The evidence is clear, there is no safe level of exposure to second-hand tobacco smoke,” said the WHO Director-General Dr Margaret Chan. “Many countries have already taken action. I urge all countries that have not yet done so to take this immediate and important step to protect the health of all by passing laws requiring all indoor workplaces and public places to be 100% smoke-free.”

    There are about 4000 known chemicals in tobacco smoke; more than 50 of them are known to cause cancer. Exposure to second-hand smoke causes heart disease and many serious respiratory and cardiovascular diseases that can lead to premature death in adults. It also causes diseases and worsens existing conditions, such as asthma, in children. The new WHO policy recommendations are based on the evidence of three recent major reports, which all reached the same conclusion: Monograph 83 Tobacco Smoke and Involuntary Smoking by the International Agency for Research on Cancer (IARC), the United States Surgeon General’s Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke and the California Environmental Protection Agency’s Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant.

    Exposure to second-hand smoke occurs anywhere smoking is permitted: homes, workplaces and other public places. An estimated 200 000 workers die each year due to exposure to smoke at work. WHO estimates that around 700 million children, or almost half of the world’s children, breathe air polluted by tobacco smoke, particularly at home.

    The Global Youth Tobacco Survey, developed by WHO and the United States Centers for Disease Control and Prevention (CDC), interviewed students between 13 and 15 years old in 132 countries between 1999 and 2005. The results of the survey show that 43.9% of the students are exposed to second-hand tobacco smoke at home, while 55.8% are exposed to smoke in public places. Support for smoking bans in public places is global, with 76.1% of the students surveyed in favour.

    The costs of second-hand smoke are not limited to the burden of disease. Exposure also imposes economic costs on individuals, businesses and society as a whole. These include primarily direct and indirect medical costs, but also productivity losses. In addition, workplaces where smoking is permitted incur higher renovation and cleaning costs, and increased risk of fire, and may experience higher insurance premiums.

    Later this year, countries participating in the second Conference of the Parties to the WHO Framework Convention on Tobacco Control are expected to discuss guidelines for protection against exposure to second-hand tobacco smoke. The second Conference of the Parties, starts on June 30 in Bangkok, Thailand.

    “This topic should matter to everyone, because everyone benefits from smoke-free places,” said Dr Douglas Bettcher, Acting Director of the WHO Tobacco Free Initiative. “With this year’s theme, we hope that everyone, especially policy makers and employers, will be inspired to claim, create and enjoy spaces that are 100% free from tobacco smoke. By doing so, we keep the bodies inside those spaces smoke-free too, and greatly increase our effectiveness in preventing serious diseases and saving lives in future generations.”

    Organizations, institutions and communities around the world celebrate World No Tobacco Day with different activities, for example marches, educational meetings and smoking cessation workshops, to raise awareness of the lethal health consequences of tobacco use and exposure to second-hand smoke. The day is also used to mark the beginning of extended media and advocacy campaigns or to introduce lasting policy changes, such as making public and workplaces 100% smoke-free.

    Tobacco use is the leading preventable cause of death globally, causing more than five million deaths a year. Tobacco use continues to expand most rapidly in the developing world, where currently half of tobacco-related deaths occur. By 2030, if current trends continue, 8 out of every 10 tobacco-related deaths will be in the developing world.

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