Blanket bans on outdoor smoking no panacea for tobacco control

There’s little evidence to support a ban based on the health harms of cigarette smoke in wide, open spaces. AAP/April Fonti

Support for smoke-free laws is near universal in Australia. In the late 1980s and 90s, these laws were primarily advocated and adopted on the premise that employees shouldn’t be continuously exposed to a known carcinogen as they go about their work. It’s now commonplace to ban smoking outside around the doorways, windows and air conditioner intakes of workplaces.

Even among smokers you would be hard pressed to find a longing to return to the days when pubs and restaurants were choking with smoke. Clear air is good for business, good for employees and welcomed by the public.

It’s unsurprising then that a call for a total smoking ban in the City of Melbourne, including all outdoor areas, appears to have widespread support. Councillor Richard Foster’s proposal calls for a complete ban on smoking in any outdoor dining areas, footpaths, city squares - essentially any area that is not deemed to be private land. It’s unclear how or if such polices would be enforced.

But should this be the next frontier in tobacco control?

Existing outdoor smoking bans

Outdoor smoking bans are not a particularly new or novel idea. School, university and hospital grounds across Australia and internationally have adopted complete smoking bans based on the idea that these institutions should serve as role models to the rest of community when to comes to healthy living.

Playgrounds, parks, sports fields, beaches and other child-focused venues are also increasingly being made smoke free in recognition that adult behaviour strongly influences children. Cigarette butts are also potentially poisonous if swallowed by small children. There is little argument that these sorts of outdoor areas should be smoke free.

The potential for hospitality staff and diners to be exposed to secondhand smoke has led to smoking bans for al fresco dining areas in several Australian states including Queensland, the ACT, and Western Australia with New South Wales to follow in 2015.

No Australian state has completely banned smoking in outdoor drinking areas, but in Queensland, all outdoor smoking areas prohibit patrons from being served and no food or entertainment is permitted.

AAP/Sergio Dionisio

Assessing the evidence

There’s no doubt that exposure to secondhand smoke in enclosed places is harmful – the evidence base is rock solid. The evidence that secondhand smoke exposure in outdoor dining areas could occasionally exceed safe levels, particularly for wait staff, may also be sufficient to warrant an outdoor dining ban.

But when it comes to fleeting exposure in wide open outdoor spaces, there is little evidence to support that this type of second hand smoke exposure is a public health issue. Completely banning smoking in all outdoor areas cannot be justified on the grounds that the exposure to the resulting secondhand smoke is of significant harm.

Very few public health organisations have actively lobbied for a complete outdoor smoking ban. Contrary to what the tobacco industry lobby would have you believe, tobacco control advocates – myself being one of them – know where the evidence stops.

Next steps in tobacco reform

So does this mean that smoking in outdoor areas should not be banned? Communities ban all sorts of things that they dislike or that annoy them, but do not cause any real health issue. Running into a cloud of smoke on an attractive city square ruins the look of the place and annoys some people.

Essentially it is up to the community to decide if a total outdoor smoking ban is something it supports and feels is necessary to fully enjoy their public spaces.

As a tobacco control and public health advocate, it is my responsibility to ensure that good evidence guides policy implementation. And when it comes to reducing smoking rates and protecting health, nothing beats a tobacco tax increase.