Clear The Air News Tobacco Blog Rotating Header Image

November, 2008:

Should The Ban On Smoking In Bars Be Delayed?

Nov 29 2008 – SCMP

Bars and pubs represent one of Hong Kong’s major entertainment industries, creating numerous job opportunities and making a significant contribution to local economic viability.

However, the Hong Kong government has shown a disregard for the industry’s welfare. Indeed, it has often implemented policies that create difficulties for the industry and threaten the survival of some establishments.

Looking ahead to next year, the industry expects to suffer as a result of the economic downturn.

In fact, in the past few months, we have seen a reduction in profits. Completely banning smoking in bars next year will be an additional blow for such businesses and lead to more unemployment.

By implementing a blanket smoking ban the government would be neglecting the diversity of the bar culture in the city.

Many bars are upstairs in commercial buildings. A total smoking ban will put them at a disadvantage, so in terms of competition, there will no longer be a level playing field. Also, given the insufficient manpower in the Tobacco Control Office, I do not think enforcement of the ban will be effective.

It is clear that extending the smoking ban to bars will disrupt the operation of businesses and exacerbate the problems connected with outdoor smoking.

As a bar owner and chairman of an industry association, I strongly urge the government to review the necessity of banning smoking in bars. I urge officials to consider alternative smoking arrangements for adult-only entertainment venues. The administration should delay the ban to help the industry get through this difficult economic period.

It should also consider practical long-term solutions, for example, allowing people to light up in ventilated smoking rooms set up in bars.

This policy has been adopted in many places, including Singapore, Taiwan, France, Germany and Italy.

Alternatively, the government can allow smoking after a certain time of the day, for example, Taiwan allows smoking in adult-only venues after 9pm.

Jeffrey Tam Chun-kit, chairman of Hong Kong Bars and Karaoke Rights Advocacy

Should The Ban On Smoking In Bars Be Delayed?

Nov 28 2008 – SCMP

Besides bars, readers should not forget the three types of adult entertainment premises that were also given a 30-month deferment before the smoking ban takes effect in July next year.

The government’s intention behind granting such a deferment was to allow for sufficient time to study other solutions to a complete smoking ban in these outlets.

Two years have elapsed and finally the government tells us its feasibility study is ongoing and the results will not be ready until the first quarter of next year (“Smoking rooms being considered”, November 24). This will leave businesses virtually no time to turn around and adapt to the new legislation before the law takes effect in July.

In some countries, entertainment outlets enjoy exemptions from a smoking ban because of their unique business model and adult-only clientele.

We see no reason for the Hong Kong government to implement such a harsh regulation particularly at a time of economic turmoil and when firms will be hardest hit by the credit crunch in the coming 18 months.

The government must seriously consider possible solutions to a total ban, including exemptions and a further delay of the ban until 2012, or at least allow smoking rooms.

Lilian Chan, Entertainment Business Rights Concern Group

Should The Ban On Smoking In Bars Be Delayed?

Nov 27th 2008 – SCMP

To protect the health of all citizens, there should be no delay on the ban on smoking in bars.

As bar staff inhale passive smoke, they have a higher chance of suffering respiratory diseases. Bar staff are there to earn a living – this should not mean that they have to risk their health.

The government has already banned smoking in public places. It is therefore high time this ban was extended to bars, in the interests of the staff.

Some operators may argue it will affect business but protecting the health of bar staff should be a top priority. If a bar is popular and has a good reputation, then customers will frequent it, even if smoking is banned.

Tsui Mang-ting, Tsuen Wan

Judith Mackay’s Tireless Crusade Against Smoking

No ifs or butts

Judith Mackay’s tireless crusade against smoking has won her global accolades – and plenty of enemies – but her work is far from done

Judith Mackay

Ella Lee – Nov 26, 2008 – SCMP

It was 1960. A young medical student at the University of Edinburgh took out her first cigarette, lit up and puffed smoke into the cool Scottish air. Her throat was a bit dry but, at that moment, the 16- year-old finally felt like an adult, a very “cool” adult. Almost half a century later, when 65-year-old Judith Mackay recalls that episode at her tranquil countryside house in Sai Kung, she laughs it off, but her tone turns serious as she explains why it helped her understand a young person’s urge to smoke.

Such knowledge is particularly important to Yorkshire-born Dr Mackay, the world’s leading anti-tobacco lobbyist and advocate, and one of Hong Kong’s few public health experts to become a global name.

“I was away from home for the first time and I was very young,” she says of her first smoking episode. “I thought smoking was sophisticated and was a doorway to becoming an adult.”

She was “fortunate”, she says, that she quit after only three months because her asthmatic roommate couldn’t stand the smoke.

“I really understand how young people feel. They smoke to be an adult, to be rebellious, to look cool. This is why school programmes don’t work. They tell children if they smoke, they will get cancers or lung diseases at the age of 60 or 70; it is completely meaningless to them,” she says.

For the past 25 years, Dr Mackay has been pushing for changes in countries where smoking is regarded as a lifestyle choice rather than a health hazard. And in recognition of those efforts, she will be made an OBE by Queen Elizabeth in a ceremony at Buckingham Palace today.

In her official capacity, she is the senior policy adviser to the World Health Organisation and senior adviser to the World Lung Foundation (WLF). The latter is responsible for taking care of the multimillion-dollar grant from Bloomberg Philanthropies, a fund set up by New York Mayor Michael Bloomberg to encourage tobacco control in poor countries.

In short, she is one of the three “most dangerous” people as far as the tobacco industry is concerned (the others are American campaigner Mike Pertschuk and Canadian Garfield Mahood).

Dr Mackay came to Hong Kong in 1967 after finishing her medical studies and has lived here ever since. Her anti-tobacco efforts began in 1984, when she quit her job at United Christian Hospital after seeing too many patients dying from smoking-related diseases. She decided she could save more lives by helping cut tobacco use.

Her battle began in earnest when she joined the Hong Kong Council on Smoking and Health as its first executive director from 1987 to 1989. She then set up what she calls the “one-woman-band” Asian Consultancy on Tobacco Control in 1989 and started reaching out to help other Asian countries.

Since 1984, she has advised the WHO on lobbying governments to introduce tobacco control measures such as taxes and advertising bans. Her impact has been felt all over East and Southeast Asia.

In 2006, her role became even more prominent when she was hired as the WLF’s project co-ordinator.

There are always two sets of curriculum vitae for Dr Mackay. One is a 70-page document listing her public health appointments, awards and published papers.

The second, a two-page file, contains the names and terms of abuse levelled at her by smokers’ rights groups and the tobacco industry.

She has been called “psychotic human garbage”, a “gibbering satan” and “an insane psychotic like Hitler” among other things. In 1993, a smokers’ rights group in the United States threatened to “utterly destroy” her.

At one time, in the 1990s, Dr Mackay was offered protection by the government because of concerns for her welfare. She also packed her two children off to high school in Edinburgh for their safety.

But none of these insults or threats have diverted her from her goal. Indeed, they have only made her more determined.

At times, she has had to keep her work itinerary secret to avoid interference, such as when she went to Mongolia in 1990 as a WHO consultant to design a national tobacco plan for the country. She was heartened to see Mongolia introduce one of the best tobacco control laws in Asia in 1994

Dr Mackay says her most rewarding achievement is the WHO Framework Convention on Tobacco Control, a milestone in the field and only achieved after she lobbied then WHO director general Gro Harlem Brundtland to make it a priority.

A total of 168 countries have signed the convention, which came into force in February 2005 and commits them to reduce tobacco use through legislation, taxation and public education. So far, 160 have ratified it.

Dr Mackay gives the government an “A-minus” for its tobacco control performance.

“In the 1980s and 90s, Hong Kong passed some important legislation on smoke-free areas and advertising bans [and] it was also one of the 20 countries and cities that introduced pictorial health warnings on cigarette packs,” she says.

“But, in the past eight years, Hong Kong has been lagging behind others in terms of taxation. We have not raised the tobacco tax to a significant level.”

She intends to lobby for a “plain packaging” law for cigarettes, meaning that the pack can only carry the brand name and a health warning.

Dr Mackay says her success is due to three elements, being “determined, optimistic and realistic”.

“I understand politics, that sometimes governments have to compromise,” she says.

“For example, when the Hong Kong government tried to push through the smoking bill in Legco two years ago, some bars asked for various kinds of exemptions. In that political atmosphere, the government could not have passed the bill without making some exemptions.

“I can’t say I accept this compromise but I understand it. It is what I mean by being realistic.” Building trust is also a key to successful lobbying.

“I think governments trust me because I never shame or embarrass them. I encourage them and support them.”

Aside from professional satisfaction, her efforts have won her local and international recognition.

Dr Mackay is also the proud recipient of the WHO Commemorative Medal, Hong Kong’s Silver Bauhinia Star award, the MBE, the US Surgeon General’s Medallion award and an award from the King of Thailand.

In 2006, Time magazine selected her as one of the 60 Asian heroes from the previous 60 years. In 2007, the same magazine named her one of the world’s 100 most influential people.

With all these accomplishments, she was at professional crossroads two years ago and considering taking a backseat.

“I thought I had done my best and it was time for a new wave of advocate to take up my job,” she says.

But a telephone call changed everything. A representative for Mr Bloomberg called her and offered her the position as senior adviser for the WLF. The initial, two-year US$125 million donation from Mr Bloomberg had not been made public at the time. She was given 24 hours to decide.

“My elder son, who is a doctor, said that if I take the job there will be many times I will regret it because there will be many people asking for money or jobs from me. But he also said, if I don’t take it, I will always regret it.” She accepted and since then has been working “close to burnout” to lay down the infrastructure for the project.

In July, Mr Bloomberg and Microsoft founder Bill Gates committed a combined US$500 million to tobacco control. The targets are low- to middle-income countries where between 10 and 25 per cent of all male deaths over 35 are tobacco-related.

The WLF, which gets the biggest slice of the funding, works with other partners including the WHO, the Centers for Disease Control and Prevention, the Campaign for Tobacco-Free Kids and the Johns Hopkins Bloomberg School of Public Health.

Dr Mackay says the Bloomberg initiative is the “first big funding for non-communicable diseases that makes something happen”.

“Many governments have been talking about [tobacco control] but there is no money to support it.”

Dr Mackay says the Bloomberg initiative has a clear target – to reduce smoking prevalence in countries with big smoking populations. “A small change in a big population means a lot. If you get 1 per cent of smokers to stop smoking in China, it is far more than stopping 99 per cent of smokers in Mongolia.”

She said tobacco control should be top of the agenda for Beijing because mainland smokers consumed one in three of the world’s cigarettes.

Dr Mackay said another impact of the Bloomberg initiative is that it created a profession and a paid career path for tobacco control personnel.

Her position with the WLF is her first paid job since she left the Hong Kong Council on Smoking and Health. She claims only expenses from organisations that she helps.

“My husband is a private doctor, he had been supporting me, but now he has retired, it is my turn to support him.”

A hectic life means Dr Mackay usually spends a quarter of each year overseas attending about 20 conferences. During a trip to a conference in South Korea two months ago, she fell and broke her ankle and leg. She was in a wheelchair for two months.

“I have prepared a nice cane to use at the OBE award ceremony,” she says. “I will wear a Chinese-style jacket to show my link with Hong Kong.”

As for her future plans, there is no stopping her yet. “I am always a working person. I enjoy every day.”

Smoking Rooms Being Considered

Dan Kadison – Nov 24, 2008 – SCMP

With the second phase of a smoking ban coming into effect next summer, government-commissioned consultants are studying the feasibility of having smoking rooms in Hong Kong – and they have even built an experimental enclosure for testing.

“When the Smoking (Public Health) (Amendment) Bill 2006 was passed, the administration undertook to commission consultants with relevant expertise to study the technical feasibility of a smoking room,” a spokesman for the Food and Health Bureau said.

The study started last August, and experts were trying to determine whether a smoking room could provide “effective separation” and protect the health of non-smokers, the spokesman said.

As of now, “the administration has not reached any conclusions regarding smoking rooms, neither on its feasibility nor applicability”, the spokesman said.

Findings of the feasibility study are expected to be announced during the first quarter of next year.

The smoking room being considered is different from another opposed proposal, one where people could stay, smoke and enjoy themselves in a partitioned, ventilated area.

James Middleton, chairman of the anti-tobacco committee of Clear The Air, a Hong Kong environmental group, called the new smoking room study “a waste of taxpayers’ money”.

“It’s already been proven that it doesn’t work – that in any contiguous area, where the smoking room, with an opening door, is connected to a non-smoking area, the smoke will go through. Every time the door opens, smoke will pass to the other area. There are worldwide expert studies on it.”

Legislator Tommy Cheung Yu-yan, a proponent of smoking rooms, said he had spoken to Secretary for Food and Health York Chow Yat-ngok about them.

The secretary for health was “still studying it”, Mr Cheung said. “He’s built a smoking room and is looking at the feasibility of it.”

Under the next phase of the smoking ban, people will no longer be able to smoke in places once given a grace period, such as bars, nightclubs, and mahjong parlours. The first stage of the ban began last January.

Delay In Smoke Ban?

Delay in smoke ban would help us beat crisis, bars say

Dan Kadison – Nov 24, 2008 – SCMP

Bar owners say a delay in the next phase of a smoking ban would help business as they struggle to cope with the economic downturn, which they expect to start to bite early next year.

Smoking has been banned in most indoor places since last year. Bars and nightclubs, exempted from the ban, are expected to fall in line by July 1 next year.

But Chris Lenz, founder of Igor’s Group, a chain of restaurants and bars including The Cavern and Stormy Weather, is hoping the ban will come into effect a year later.

“It’s better for our business,” he said. “The fiscal crisis isn’t helping things. Certainly, next year is going to be a challenge, there’s no question about it. Anything that can be thrown into the pot that can help would be appreciated.”

Bar owners said sales could start decreasing by January.

“Half-a-dozen to a dozen regulars of mine have lost their jobs in the past two or weeks. They’re not going to be partying next year,” said a Wan Chai bar owner who asked to remain anonymous.

Agreeing something needs to be done, legislator Tommy Cheung Yu-yan sees an alternative to the ban – smoking rooms. “I think some bars might not even last until next year,” he said, adding that those that ride out the downturn will have to deal with the ban, and that could “wipe them out”.

“If the government doesn’t want to see a lot of closures in bars, entertainment [venues], massage parlours, mahjong parlours…and nightclubs, it should think about allowing smoking rooms,” he said.

Mr Cheung, chairman of the Hong Kong Catering Industry Association, believed last year’s smoking ban was implemented too quickly, but he had no plan to call for the law’s suspension.

“I’m going to see what’s happening with the smoking room,” he said. “I feel strongly that if there was a smoking room, it would be OK.”

Meanwhile, PolyU Technology and Consultancy has found in a survey that 41 per cent of restaurants and businesses suffered a drop in sales in the first half of last year, compared with the same period in 2006.

The three-part, 18-month study was commissioned by the Catering Industry Association.

Local environmental group Clear the Air last week called on PolyU Technology to issue another report using government data that shows restaurant receipts had mostly risen in the quarters before, during and after the ban.

For instance, receipts increased 11.6 per cent in the second quarter of last year, compared with the same period in 2006, according to data from the Census and Statistics Department.

“The usual tactic of the tobacco industry is to spread doom and gloom,” James Middleton, of Clear the Air, said.

“These figures [from the government] prove conclusively that the anti-smoking legislation in restaurants, which have been proven to work elsewhere in the world, in many countries, also work in Hong Kong,” he said.

Responding to the call by Clear the Air, Mr Cheung said: “I don’t want to be here arguing about what is right and what is wrong. Clearly, everybody by now knows that 2007 was a very good year – with or without the smoking ban. The question you need to ask [is] if we did not have a smoking ban … could [it] even be better?”

Crisis No Reason To Delay Smoking Ban

Nov 24, 2008 – Leader

Bars were against the smoking ban when times were good. Unsurprisingly, now that the city is facing a steep economic downturn, they are calling for an extension of their smoking-ban exemption, which will end in the summer. For them, there is never a good time to impose the ban because they are simply against it. They have been given more than two years to prepare for the ban; they have no more excuses not to abide by it when their exemption expires. The authorities should not listen to them this time. Our city deserves a universal ban on smoking in public areas.

Bar operators may appear to have a good argument in these troubled times; it may even sound persuasive to some officials. It is, rightly, the government’s stance to help small and medium-sized businesses wherever possible in this economic climate. The bars are right in saying that many will face tough economic times; some will go under. It is not clear, though, that allowing bars to extend their exemption will help them maintain or improve business. Many restaurateurs were in the same position as bar owners are now when the ban was imposed. Many initially complained about a drop in business from smoking customers. However, they soon saw business return to normal as their establishments attracted non-smoking customers who had previously avoided them. Since there are far more non-smokers than smokers in Hong Kong, bars will attract new patrons even as they lose some old ones.

And there are public health concerns. Doctors now believe there is no safe level of exposure to second-hand smoke. Authoritative studies, conducted locally and overseas, have shown sharp drops in heart attacks in places where a smoking ban has been imposed. By now, everyone knows the high costs of treating chronic diseases associated with long-term smoking.

Endangering lives for the sake of business is not a sound argument, especially when the business value of allowing customers to smoke is questionable. The city’s smoking ban has undoubtedly saved many lives. But it has only achieved a partial victory in public health because of the exemption. It is time to complete the ban.

A critical review of the literature on generic packaging for cigarettes

Download (PDF, 502KB)

Smoking Ban Tied To A Gain In Lives

Fatal heart attacks drop in Massachusetts

By Stephen Smith, Globe Staff | November 12, 2008

Nearly 600 fewer Massachusetts residents have died from heart attacks each year since legislators banned smoking in virtually all restaurants, bars, and other workplaces four years ago, according to a report to be released today that provides some of the strongest evidence yet that such laws save lives.

The study, conducted by the state Department of Public Health and the Harvard School of Public Health, shows that a steep decline in heart attack deaths started as Boston and most of its neighbors adopted bans. Enforcement of the statewide law beginning in mid-2004 coincided with a further reduction, the study found. From 2003 to 2006, heart attack deaths in Massachusetts plummeted 30 percent, significantly accelerating what had been a more modest long-term decline.

The report, obtained in advance by the Globe, found that the number of heart attacks began dropping in communities with strong antismoking laws years before the 2004 statewide law and that similar reductions were achieved in other cities and towns only after the state ban. By the end of 2006, the rate of decline in all cities and towns had nearly converged. The authors said this pattern showed that advances in treatment of heart attacks were not responsible for the smaller number of deaths.

“This is the strongest study yet done of the effect of smoking bans on heart attacks,” said Dr. Michael Siegel, a Boston University School of Public Health specialist in tobacco control who has been a critic of some antismoking laws and of previous research conducted by the state and Harvard. “You can no longer argue that these declines would have occurred simply due to medical treatment.”

The health benefits of smoking bans have long stirred controversy between advocates and opponents of workplace tobacco laws. While health officials including the US surgeon general have concluded that secondhand smoke is responsible for thousands of deaths annually from heart disease and lung cancer, the tobacco industry and some in the hospitality industry have suggested that the dangers of secondhand smoke are overstated and that there is little evidence that bans prevent deaths.

The study, scheduled to be presented this morning to the state Public Health Council, appears destined to bolster the case of Boston health authorities who have already given preliminary approval to a sweeping strengthening of their tobacco control laws. The toughened Boston regulations would quickly eliminate cigarette sales at drug stores and on college campuses and would shutter swank cigar salons and hookah bars within five years.

The Boston Public Health Commission was supposed to consider final approval of the measures tomorrow, but that vote has been postponed until December, because the board wants to review hundreds of comments that have flowed in, said Barbara Ferrer, executive director of the commission.

The state’s report should prove to critics that her agency is not acting capriciously, Ferrer said. “The Board of Health isn’t just acting because it likes to regulate. It’s acting because there’s so much evidence about the importance of reducing tobacco smoke.”

Brandon Salomon, an owner of the Back Bay stogie bar Cigar Masters, said he was unpersuaded by the state’s research, describing it as skewed science.

“The decrease in heart attacks could be the fact that people have stopped eating carbs so much and are exercising more,” Salomon said.

Much of the evidence about the damage wrought by smoking has focused on lung tumors, the leading cause of cancer deaths in the nation. But cancer takes years to develop, so smoking bans would not be expected to diminish cancer rates for a long time. An expanding body of scientific evidence shows, however, that even fleeting encounters with cigarette smoke can damage the cardiovascular system of nonsmokers.

In one California study published earlier this year, young adults who did not smoke were exposed to secondhand smoke for 30 minutes in amounts meant to mimic what happens in a restaurant or bar. The researchers discovered that even that amount of exposure damaged the lining of blood vessels and disarmed the body’s natural ability to repair such damage.

Cigarette smoke can also cause clots to form or spark a cascade of biological events that causes chunks of fat lining artery walls to shear off, which can result in a heart attack.

“You know all the press that this new study on statins got the other day?” said tobacco researcher Stanton Glantz of the University of California at San Francisco, referring to Boston researchers’ finding that anticholesterol drugs substantially reduce heart attacks and strokes even in patients with normal cholesterol levels. “This is a much bigger deal. And it’s free.”

A spokesman for the nation’s largest cigarette maker, Philip Morris USA, said the company’s website points out that public health officials have shown that secondhand smoke causes heart disease in nonsmokers.

“We agree that people should be able to avoid being around secondhand smoke, particularly in places where they must go,” said company spokesman Bill Phelps.

Led by Tom Land, director of surveillance and evaluation for the Massachusetts Tobacco Control Program, the researchers hunted for signs the reduction might be due to a factor other than tobacco laws.

They considered, for instance, whether there had been an improvement in how heart attack victims were transported to hospitals. They could find nothing that swayed them from their conclusion that there was an indisputable relationship between the smoking ban and fewer heart attack deaths.

That belief was strengthened when they looked at what happened in communities that had either no job-site smoking law before the state ban or a weak law. Heart attack deaths dropped nearly 20 percent in those cities and towns during the first 17 months of the law. In municipalities that had longstanding regulations – and, thus, had seen a steadier decline – the reduction was more modest.

By comparing communities that adopted early smoking bans with those that did not, the researchers were able to estimate that an average of 577 fewer people have died annually from heart attacks because of the law.

“People have assumed that the only benefit we will be able to measure of a smoking ban is long-term benefits,” said John Auerbach, the state public health commissioner. “This study demonstrates a real connection between smoking bans and short-term improvement in health outcomes.”

Professor’s Efforts To Help Smokers Quit

US academy honours professor for efforts to help smokers quit

Colleen Lee – Updated on Nov 10, 2008 – SCMP

Sophia Chan Siu-chee noticed in the early 1990s that while doctors were advising patients to quit smoking, there were no medical workers helping them to do so.

So she decided to train nurses to help smokers kick the habit – and yesterday, her efforts won her international recognition.

Professor Chan, head of the University of Hong Kong’s Department of Nursing Studies, became the first Hongkonger to be named an international fellow of the American Academy of Nursing.

“I feel very honoured and happy,” said Professor Chan, one of three international fellows chosen this year.

She said that in the early 1990s, no medical staff were dedicated to helping smokers quit.

“When a doctor saw a patient smoking, he might just advise him not to smoke. And that was it … no one would do any follow-up.”

From 1993 to 1999, she studied part-time for her doctorate in public health at the University of Hong Kong, devoting herself to studying the use of counselling to stop smoking. Once she graduated, she decided to help promote that idea in the community.

She said that since 2000, she had helped the Hospital Authority train about 200 nurses in such skills. These nurses later played a key role in the authority’s Smoking Counselling and Cessation Centres, founded in 2002. The centres now number 16.

Professor Chan said she hoped her fellowship would encourage nurses in Hong Kong, adding that their morale had recently been affected by a staff shortage.

“Many nurses here work very hard … I hope more and more local nurses will be awarded fellowships by the academy,” she said.

Professor Chan said she next planned to study women’s smoking rates globally to find out the possible reasons for differences in various places. She said, for example, that Hong Kong and Japan were both metropolitan, but smoking was less prevalent among local women than those in Japan.

Professor Chan and the other two international fellows named this year were inducted along with 89 Americans as fellows at a ceremony in Scottsdale, Arizona.

The academy, set up in 1973, aims to anticipate American and international trends in health care and to address relevant issues.

The fellowship recognises individuals’ contributions to nursing and health care.