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HA’ARETZ
Toward a smoke-free Israel
By Dr. Martin McKee
As a public health professional from London, I was recently celebrating. An overwhelming majority of parliamentarians had voted in favor of a total ban on smoking in public places, to be implemented in summer 2007.
A few days after the vote in London I flew to Israel. I knew about the partial ban enacted here in 1983, but also that it was widely ignored. Would it be different this time? After all, 75 percent of Israeli adults are nonsmokers and a recent opinion poll found that three-quarters of Israelis favored a total ban, rising to 90 percent among residents of Jerusalem, where I was staying. Sadly I was to be disappointed. A waft of smoke hit me the minute I walked into my hotel. The officially nonsmoking bar was full of people who had no fear of any sanction. Why should they? Even if the ban was enforced, which it isn't, the worst the smokers could expect was a NIS 320 fine, while the hotel manager who allowed smoking to take place had nothing to fear at all.
This is very different to the situation elsewhere, such as in Ireland, which soon achieved almost 100-percent compliance. How did it succeed? Simple. It made the penalty 3,000 euros (16,780 NIS). This is serious money. What's more, the owners of bars and restaurants became legally responsible for enforcing the ban and were warned that if they did not, they risked loosing their license to serve alcohol. Consequently the ban is self-enforcing. England has learned the lesson as bar owners who allow smoking will be fined up to 2,500 pounds sterling (20,400 NIS).
Why have successive Israeli governments failed to act effectively against tobacco? The only reason I can think of is that those who have the power to make a change, such as by demanding realistic penalties for those allowing smoking on their premises, have been fooled by the tobacco industry's deception.
The tobacco industry has been misleading the public for decades. In 1994 the chief executives of seven of the largest tobacco companies testified to the U.S. Congress that nicotine was not addictive, even though their internal documents clearly stated it was and that they had been manipulating the content of cigarettes to increase the nicotine kick for years, to speed up the onset of addiction among new smokers.
We know this because of lawsuits in the United States, where the industry had to release millions of pages of internal documents showing how it distorted the evidence. A key aim was to foster an impression that there was genuine scientific controversy about whether inhaling other people's smoke was harmful. For example, they ran a campaign saying that everything was risky and passive smoking was no different. But they also conducted research that was often misleading and occasionally fraudulent. They spared no expense. When an authoritative report was published on the dangers of passive smoking, they spent $4 million to undermine it.
So how dangerous is passive smoking? In 1981 a Japanese researcher showed that nonsmoking wives of male smokers had a higher risk of lung cancer than women living with nonsmokers. By the mid-1990s more than 30 other studies reported the same finding, with others also showing a link to heart disease. The best studies, in which exposure is measured directly, show that nonsmokers with the greatest exposure to other people's smoke are about 60 percent more likely to suffer a heart attack than those with no exposure.
What is more, we now know why this risk is so high. For two decades a major tobacco company operated a secret animal-testing plant near Cologne. Its experiments showed that "sidestream" smoke, such as that from smoldering cigarettes, is about four times more harmful than directly inhaled smoke. The reason? Smoldering cigarettes burn at a lower temperature than cigarettes through which people are sucking air. Think of what happens if you burn rubbish in your garden. The low temperature produces lots of harmful substances that are not produced in high-temperature incinerators through which air is being forced.
Although it won't admit to any danger, the industry argues that any "irritation" can be abolished by ventilation. Of course they use their own studies to support this argument. Yet independent studies show that you need fans blowing with the force of a wind tunnel to reduce exposure to safe levels. Just because the smell has gone, the danger has not, as many harmful components, such as carbon monoxide, are odorless.
Then the industry argues that a ban will lead to reduced takings in bars and restaurants. This is simply untrue. Most people don't smoke and many avoid bars because they are so smoky. In New York, after smoking was banned, sales-tax receipts on food and drink increased by 12 percent and the hospitality industry took on several thousand new employees. More people now visit Irish pubs than before the ban was introduced. Why do people think the opposite will happen? Quite simply because many industry-funded studies say so. Yet over 60 independent studies found either no effect or an increase in takings.
I am only a visitor here, but I am concerned about the rights of the overwhelming majority of Israelis who want the ban to be enforced. My reason for coming to Jerusalem was to work with colleagues developing the Ministry of Health's exciting new "Healthy Israel 2020" initiative, which aims to set national health targets with strategies to achieve them by the year 2020, a project directed by Dr. Boaz Lev, deputy director general of the Ministry of Health.
Yet the people involved in this initiative will be working with one hand tied behind their back if others fail to do something about smoking, especially among young people. Twelve-thousand Israeli citizens die prematurely from the consequences of tobacco every year, of whom 2,000 are poisoned by other people's smoke. For the sake of the next generation of Israelis, we must work for a smoke-free Israel.
Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine. |
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