Regarding the enforcement of the revised Health Promotion ActSeptember, 2019Dr. Manabu Sakuta, Chairperson
Background from the Japanese Journal of Tobacco Control
1． Before the passage of the law
The Kanagawa Prefecture administration of Governor Shigefumi
Matsuzawa first implemented passive smoking regulations in Japan in 2009.
But for the 10 years thereafter, almost no new legislation was created inJapan due to political resistance from organizations like JT (Japan Tobacco,Incorporated), the Smoking Research Foundation and Dentsu advertising
agency; politicians reliant on tobacco tax revenues; and the Ministry ofFinance, which also relies on tobacco tax revenues.
But with Tokyo’s invitation to host the 2020 Olympics, the Japan Society for
Tobacco Control has accelerated the push for further smoking restrictions inconjunction with 130 other health organizations.
In August 2014, prefectural Governor Yōichi Masuzoe (at that time) made a
constructive statement, as quoted in the following text from Bloomberg on
August 22:• “Promoting the health of all the people in the world is one of the majoraims of the Olympics and Paralympics,” Masuzoe told reporters today. “I
think it’s important to properly prevent passive smoking in the run-up to2020,” he added.
To make Japan’s tobacco regulations consistent with international
standards, we visited Geneva with Shigefumi Matsuzawa, now a member ofthe House of Councilors, to meet with the International Olympic Committee(IOC), the World Health Organization (WHO), and the Secretariat of theWHO’s Framework Convention Tobacco Control (FCTC). The IOC and WHO
wrote a formal letter to the Society and Governor Masuzoe stating that atobacco-free Olympics is already implemented as an international standardpractice. The letter was signed by Douglas Becher, the Director of the WHO
department of the prevention of lifestyle diseases; Bella da Costa Silva, FCTC

Convention Secretary General; the presidents of the World Medical
Association, the World Dental Association, the World Pharmacists
Association, the World Nursing Association, and the World Heart Foundation.
Due to a scandal from mixing public and private monies, Governor Masuzoe
has since resigned, but Yuriko Koike has became governor of Tokyo with thesupport of the Tomin (Tokyo Citizens) First party. And momentum to pass
new passive smoking regulations has since increased.
As part of this momentum, the Japan Society for Tobacco Control has led apetition to collect 100,000 signatures in support of new passive smoking
regulations. The Japan Medical Association and other associations havecollected an additional 2.64 million signatures, which were submitted to the
Minister of Health, Labor and Welfare, Yasuhisa Shiozaki. Although Minister
Shiozaki has been devoted to tobacco control, others in the Ministry ofFinance and legislative assemblies have been less enthusiastic, so that
demonstrating popular support for reform has been deemed necessary.
The Tokyo Medical Association (led by chairperson Ozaki Haruo) also led apetition to collect 200,000 signatures in support of reform. The Tokyo
Medical Association, with the Japan Medical Association, collected morethan two times the number of signatures in favor of stronger passive smoking
restrictions than those collected by the tobacco industry in favor of limited
restrictions. The higher numbers from the medical associations indicatethat stronger passive smoking restrictions have popular support.
Also indicating popular support for healthy behavior was the fact that many
people wrote statements in petition journals like “I thought that the medicalassociations were for-profit organizations, but I now see that they areinterested in promoting the health of citizens”.
Partly in response to the canvassing of citizens and partly in preparation forthe 2020 Olympics, the Prevention of Passive Smoking Act (the revisedHealth Promotion Act) was passed in 2017 with the support of Katsunobu
Katō, the Minister of Health, Labor and Welfare.

One month before the revision of the national law, the Tokyo government
also revised its metropolitan passive smoking regulations. These
prefectural and metropolitan regulations are similar to but sometimes
different from the revised Health Promotion Act at the national level. A
comparison of the national law and the metropolitan regulations is shown in
the table below.
2． Comparison of the revised Health Promotion Act with the revised Tokyo
passive smoking regulations
Regulations applied to: Revised Health Promotion Act

Kindergartens,

Tokyo passive smoking regulations(Enacted on 18 July 2018)(Enacted on 27 June 2018)

No smoking indoors on theNo smoking indoors on theelementary/middle/high premises (but outdoor smoking

premises (and kindergartens,schools, universities,

nursery schools, elementary/areas may be installed)

hospitals, government

middle/high schools also may notagencies

have outdoor smoking areas)

Large scale restaurants Restaurants with capital > 50

Restaurants with employees must(such as chain stores)

million yen, restaurants withbe generally non-smoking indoors
2customer seating area > 100 m , (but may install smoking rooms)
and newly opened restaurants
are generally non-smokingindoors (but may install smokingrooms)
Small scale restaurants Existing stores with capital ≤ 50 Only restaurants without paid
(such as individuallyoperated stores)

million yen and a customer

employees (sole proprietor stores

2seating area ≤ 100 m may have operated only by kin who live
smoking if signs are posted (this together) may have smoking
is a provisional regulation with a allowed if signs are posted
expiration date)

Heated tobacco andAs a transitional measure “for the present time (indefinite time

nicotine vapor inperiod)” heated tobacco and nicotine vapor may also be used insiderestaurants

of a designed smoking room while eating or drinking

Other facilities (such as Generally non-smoking indoors (but smoking rooms may beoffices, hotels, etinstalled)cetera)Provisions for theprotection of minors

Minors are prohibited from entering any smoking space
Site manager: Fine of 50,000 yen or

Penalties (authoritative Site manager: Fine of 500,000

lessmeasures)

yen or lessSmoker: Fine of 30,000 yen or lessSmoker: Fine of 300,000 yen or(Penalty does not apply for heatedlesstobacco and nicotine vapor)

The revised Health Promotion Act was enforced after 1 July 2019.
In particular, from 1 July 2019, all level 1 facilities such as schools,
hospitals, and government agencies have implemented these regulations.
The laws will also be applied at level 2 facilities (for example, elderly carefacilities, gymnasiums and other health facilities) from 1 April 2020.
https://notobacco.jp/pslaw/psjoreilawhikaku1812.pdf
3． Government officials who enacted the revised Health Promotion Act
At one time there was doubt about whether the national Health Promotion
Act would be revised, so we should not forget the persistent efforts of theofficials that eventually made its enactment possible. One of these
individuals is Mr. Tokuaki Shobayashi, who was the Director of Health
Division, Ministry of Health, Labor and Welfare until August 2018 and iscurrently the Deputy Director-General of Secretariat of the Ministry of theEnvironment. We at the Society shared his belief that if Japan could notrevise the passive smoking law by 2020, it would lose the momentum torevise the law. To pass the revised bill, he had to overcome opposition fromthe Liberal Democratic Party’s Health, Labor and Welfare Committee and its
Policy Affairs Research Council. By defining “large-scale” restaurants as
those with at least a 100m2 customer seating area, he could extend therevised passive smoking regulations to most restaurants and thus avoid
opposition from most opponents not familiar with the regulations precisedetails. In addition, exemptions to the revised regulations for “small-scale”
restaurants with less than a 100m2 customer seating area are granted only
for existing stores (new small-scale restaurants must follow the revised

passive smoking regulations), and any customers less than 20 years of age
are forbidden from entering smoking areas in such restaurants and otherplaces. Opposition often is generated from existing business interests, andfew adults oppose restrictions for the benefit of the health of minors.
4. Measures that the Society continues to advocate
Even though the Passive Smoking Prevention Act (revised HealthPromotion Act) could be enacted, there remain holes and flaws. We feel that
we have a duty to continue to improve regulations.
For example, we believe that designated smoking areas should not beallowed indoors or outdoors at public institutions at all. Moreover, there are
the issues of third hand smoke (contamination of objects, like clothing andupholstery, from tobacco smoke) and the fact that air purifiers can only
imperfectly purify the multitude of toxins in tobacco smoke. The WHO andthe US government have stated that “There is no safe level for passivesmoking. In addition, engineering measures like ventilation, air purifiers andlimited smoking areas (so-called segregated smoking) do not prevent passivesmoking."
Our position is shown in the following document:
http://www.jstc.or.jp/uploads/uploads/files/essay/20181222.pdf
We are close to people who suffer from passive smoking, and thus knowthat it needs to be eliminated.

We have publicly stated that “If you aretroubled with passive smoking, let us help”:
http://www.jstc.or.jp/uploads/uploads/files/information/JSTC2019717.pdf
As part of our drive to eliminate designated smoking areas in public spaces,
we have asked convenience store companies to remove ashtrays and not to
install smoking rooms in their stores.
http://www.jstc.or.jp/uploads/uploads/files/essay/conbini2019722.pdf
In addition, the Supreme Court has established a general policy no smoking
on premises accessed by the public, even at type 2 facilities, to prevent

passive smoking.

Accordingly, regional courts have ruled in favor of notconstructing indoor smoking areas. Likewise, legislatures in Tokyo, Oosaka,Aomori, Akita, Shiga, Fukushima and other prefectures have also bannedsmoking on their premises, and the Hokkaido parliament is planning to haveno smoking indoors. Thus, the no passive smoking movement is undoubtedly
gaining momentum throughout the country, albeit gradually.
5. About heated tobacco
Last year in Geneva, the FCTC 8th Conference of the Parties (COP8) passed
a statement to declare that heated tobacco should be regulated in the same
way as traditional tobacco.
WHO also issued a report on 26 July 2019 to state that “heated tobacco” isless harmful than traditional tobacco that is combusted, but that heated
tobacco still contains some of the same harmful substances as combusted
tobacco, and it is not necessarily risk-free for one’s health. It also pointed
out that the harm from passive smoking can not be negated, and thus itcalled for regulation similar to that of traditional tobacco.
https://www.who.int/tobacco/global_report/en/
6. Conclusion
Due petition drives, the harm of passive smoking is now known to many
citizens, and now it is time for citizens to join forces to avoid passivesmoking.