Green Paper - Towards a Europe free from tobacco smoke: policy options at EU level
Date: 2007-01-30
Institutions: European Commission
Subjects: EU law - national law, EU policy, consumer protection, health policy, public health, smoking, social problem

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 30.1.2007 
COM(2007) 27 final 

GREEN PAPER 

Towards a Europe free from tobacco smoke: policy options at EU level 

(presented by the Commission) 

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TABLE OF CONTENTS 

INTRODUCTION ....................................................................................................... 3 

JUSTIFICATION FOR ACTION................................................................................ 4 

Health considerations ................................................................................................... 4 

Health burden of ETS exposure ................................................................................... 4 

Levels of exposure ....................................................................................................... 5 

Impact of smoke-free initiative .................................................................................... 6 

Economic considerations ............................................................................................. 6 

Economic burden ......................................................................................................... 6 

Impact of smoke-free initiative .................................................................................... 7 

Risk of unintended consequences ................................................................................ 7 

Social considerations.................................................................................................... 7 

Public support for smoke-free laws ............................................................................. 7 

Impact on tobacco consumption .................................................................................. 8 

Impact on social equity ................................................................................................ 8 

Momentum for action................................................................................................... 8 

CURRENT REGULATORY ENVIRONMENT......................................................... 9 

National provisions ...................................................................................................... 9 

Existing Community provisions................................................................................. 10 

I. 

II. 

1. 

1.1. 

1.2. 

1.3. 

2. 

2.1. 

2.2. 

2.3. 

3. 

3.1. 

3.2. 

3.3. 

4. 

III. 

1. 

2. 

IV. 

SCOPE OF SMOKE-FREE INITIATIVE................................................................. 11 

1. 

2. 

2.1. 

2.2. 

2.3. 

V. 

1. 

2. 

3. 

4. 

5. 

Comprehensive smoke-free regulation ...................................................................... 12 

Smoke-free regulation with exemptions .................................................................... 13 

Exemption for the licensed hospitality sector ............................................................ 14 

Exemption for pubs and bars not serving food .......................................................... 14 

Enclosed, separately ventilated smoking rooms ........................................................ 14 

POLICY OPTIONS ................................................................................................... 15 

No change from the status quo................................................................................... 16 

Voluntary measures.................................................................................................... 17 

Open method of coordination .................................................................................... 18 

Commission or Council recommendation.................................................................. 18 

Binding legislation ..................................................................................................... 19 

VI. 

CONCLUDING REMARKS ..................................................................................... 20 

VII. ANNEXES........................................................................................................................ 22 

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I. 

INTRODUCTION 

Exposure to environmental tobacco smoke (ETS) – also called "second-hand smoke" 
and  "passive  smoking"  -  remains  a  widespread  source  of  excess  morbidity  and 
mortality in the European Union, imposing significant costs on society as a whole.  

A  coordinated  effort  towards  “smoke-free  Europe”  is  one  of  the  priorities  of  the 
Commission’s  public  health,  environment,  employment  and  research  policy.  In  its 
Environment and Health Action Plan (2004-2010), the Commission committed itself 
to "develop work on improving indoor air quality,  in  particular by encouraging the 
restriction  of  smoking  in  all  workplaces  by  exploring  both  legal  mechanisms  and 
health promotion initiatives at both European and Member State level”.  

Substantial steps have already been taken to promote smoke-free environments in the 
EU. In the early nineties a number of EU health and safety at work directives defined 
certain  restrictions  on  smoking  at  work.  These  were  complemented  by  the  Council 
Resolution  of  19891  and  the  Recommendation  on  smoking  prevention  of  20022, 
which  called  on  Member  States 
to 
environmental  tobacco  smoke  in  indoor  workplaces,  enclosed  public  places,  and 
public transport. In addition to legislative action, two anti-tobacco campaigns in the 
media – “Feel free to say no” (2001-2004) and “HELP: For a life without tobacco” 
(2005-2008)  –  have  aimed  at  highlighting  the  hazards  of  passive  smoking  and  at 
promoting tobacco-free lifestyles, particularly among young people. 

to  provide  protection  from  exposure 

National  legislation  differs  widely  across  the  Member  States.  The  Commission 
welcomes the excellent example set by Ireland, Italy, Malta, Sweden and parts of the 
UK,  and  encourages  all  Member  States  to  make  rapid  progress  in  introducing 
effective  measures  to  protect  their  citizens  from  the  harmful  effects  of  passive 
smoking. 

At international level, the WHO Framework Convention of Tobacco Control (WHO 
FCTC),  signed  by  168  and  ratified  by  141  Parties3,  including  the  Community, 
“recognizes  that  scientific  evidence  has  unequivocally  established  that  exposure  to 
tobacco  smoke  causes  death,  disease  and  disability”.  The  Convention  obliges  the 
Community  and  its  Member  States  to  tackle  exposure  to  tobacco  smoke  in  indoor 
workplaces, public transport and indoor public places.  

The aim of the present Green Paper is to launch a broad consultation process and an 
open  public  debate,  involving  the  EU  institutions,  Member  States  and  the  civil 
society, on the best way forward to tackle passive smoking in the EU.  

The Commission will analyse thoroughly the comments received in response to this 
Green  Paper  and  on  that  basis  decide  on  possible  further  action.  The  report 
summarising  the  consultation  outcomes  is  expected  for  the  first  half  of  2007.  In 
parallel, the broader work on indoor air quality will be continued as a follow up to 
the Health and Environment Action Plan.  

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II. 

JUSTIFICATION FOR ACTION 

1. 

HEALTH CONSIDERATIONS 

1.1. 

Health burden of ETS exposure  

ETS contains over 4 000 chemicals, including over 50 known carcinogens and many 
toxic  agents.  No  safe  level  of  ETS  exposure  has  been  established  nor  is  there  any 
expectation that further research will identify such a level. 

ETS  has  been classified as a known human  carcinogen by  the US Environmental 
Protection Agency in 1993, by the U.S. Department of Health and Human Services 
in  2000  and  by  WHO  International  Agency  for  Research  on  Cancer  in  2002.  In 
addition, it has been classified as a workplace carcinogen by the Finish (2000) and 
German  (2001)  governments.  Recently,  the  California  Environment  Protection 
Agency has classified tobacco smoke as a "toxic air contaminant". 

Several recent reviews have confirmed the serious risks to health and life associated 
with passive smoking.4 Chronic exposure to second-hand smoke has been established 
as  a  cause  of  many  of  the  same  diseases  caused  by  active  smoking,  including  lung 
cancer, cardiovascular disease, and childhood disease.  

A  review  by  the  WHO-IARC  found  that  non-smokers  living  with  a  smoker  have  a 
20-30% greater risk of developing lung cancer. The extra risk of workplace exposure 
has been estimated at 12-19%.5 The links between exposure to ETS and other types 
of cancer are less clear. 

Living with a smoker has been shown to increase the risk of coronary heart disease 
among  non-smokers  by  25-30%6  (a  recent  study  indicates  that  this  figure  may 
actually be higher)7. There is also growing evidence that passive smoking is causally 
linked to stroke in non-smokers, although further research is needed to estimate the 
risk.8 

Passive  smoking  is  associated  with  respiratory  disease9  and  is  a  major  source  of 
exacerbation  for  people  with  asthma,  allergies  and  chronic  obstructive  pulmonary 
disease, leading to social and work exclusion. A recent pan-European survey among 
people with symptoms of severe asthma found that one of their major wishes for the 
future was to be able to breathe healthy air.10 

Second-hand smoke is especially dangerous for young children and infants, being 
associated  with  sudden  infant  death,  pneumonia,  bronchitis,  asthma  and  respiratory 
symptoms  as  well  as  middle  ear  disease.  ETS  exposure  in  pregnant  women  can 
cause lower birth weight, foetal death and preterm delivery11.  

The  most  recent  research  suggests  that  ETS  exposure  almost  doubles  the  risk  of 
developing  age-related  macular  degeneration  -  the  main  cause  of  sight  loss  in  the 
EU.12  

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Most  of  the  adverse  health  outcomes  brought  about  by  ETS  show  a  linear  dose-
response  relationship  –  in  other  words  the  risk  increases  steadily  with  increasing 
exposure. The level of individual risk is lower compared to active smoking (e.g. 1.2 
and  20,  respectively,  for  lung  cancer).  Nevertheless,  the  fact  that  large  numbers  of 
people are exposed results in a substantial burden of disease.  

In addition, the dose-response relationship for heart disease is non-linear. Second-
hand smoking carries a risk of heart disease which is almost half that of smoking 20 
cigarettes  per  day.  Even  very  small  amounts  of  tobacco  smoke  can  have  an 
immediate impact on clotting and thrombus  formation, as well as long-term effects 
on the development of arteriosclerosis - all important factors in heart disease.13 This 
is a source of major impact: heart disease is the most common cause of death in the 
EU, among both smokers and non-smokers. 

According to the most recent – conservative - estimates by the partnership between 
the European Respiratory Society, Cancer Research UK and the Institut National du 
Cancer  in  France,  more  than  79,000  adults  die  each  year  as  a  result  of  passive 
smoking  in  the  25  countries  of  the  EU.  There  is  evidence  that  passive  smoking  at 
work accounted for over 7,000 deaths in the EU in 2002, while exposure at home 
was  responsible  for  a  further  72,000  deaths.  These  estimates  include  deaths  from 
heart  disease,  stroke,  lung  cancer  and  some  respiratory  diseases  caused  by  passive 
smoking. However they omit deaths in adults due to other conditions related to ETS 
exposure  (such  as  pneumonia),  deaths  in  childhood,  and  the  significant  serious 
morbidity, both acute and chronic, caused by passive smoking.14 

1.2. 

Levels of exposure 

The  main  places  for  chronic  and  intensive  ETS  exposure  are  the  home  and  the 
workplace.15 According to the 1998 report by Information System on Occupational 
Exposure  to  Carcinogens  (CAREX),  ETS  was  the  second  most  common  form  of 
exposure  to  carcinogens  (after  solar  radiation)  in  the  EU-15.  Some  7.5  million 
European workers were exposed to second-hand tobacco smoke during at least 75% 
of their working time in 1990-93.16  

A  study  carried  out  in  a  range  of  public  places  in  seven  European  cities  in  2001-
2002,  showed  that  tobacco  smoke  was  present  in  most  of  the  studied  public  places 
studied, including leisure and hospitality venues, transport, hospitals and educational 
settings. The highest ETS concentrations were found in bars and discotheques, with a 
four-hour exposure in a discotheque being similar to that from living with a smoker 
for a month.17 The finding that exposure levels are exceptionally high in hospitality 
venues  has  been  confirmed  by  other  studies,  which  found  the  average  exposure  of 
bar workers to be three or more times higher than the exposure sustained from living 
in a smoking household.18 

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Recently,  smoke-free  regulations  have  led  to  a  near-total  elimination  of  workplace 
exposure  in  some  Member  States  and  in  some  types  of  venues,  while  in  countries 
with  no  comprehensive  restrictions  the  exposure  remains  high,  particularly  in  the 
hospitality and leisure sector.19  

In  order  to  estimate  EU-wide  exposure  to  ETS,  the  EU  Expert  Group  on  Human 
Biomonitoring20  recommended  to  include  cotinine  (a  major  biomarker  of  ETS 
exposure)  in  the  list  of  candidates  for  the  future  EU  Pilot  Project  on  Human 
Biomonitoring.  Member  States  have  supported  this  Recommendation  on  several 
occasions.  

1.3. 

Impact of smoke-free initiative  

Action on smoke-free environments would not only protect people from the harm of 
ETS  exposure  but  also  contribute  to  the  reduction  of  tobacco  consumption  in  the 
whole  population.  The  health effects  of  reduced  passive  and  active  smoking  would 
include reduced illness and mortality from major disease types - in particular lung 
cancer,  coronary  heart  disease,  respiratory  disease  and  stroke  -  and  increased  life 
expectancy. Although the full health benefits may take up to 30 years to be realised, 
major  improvements,  particularly  in  respiratory  and  cardiovascular  health,  can  be 
expected to occur within 1-5 years.  

The CHOICE project managed by WHO identified smoke-free public places as the 
second  most effective form of intervention to  reduce the mortality and morbidity 
related to tobacco use, after tax increases (see Annex I).  

2. 

ECONOMIC CONSIDERATIONS 

2.1. 

Economic burden  

Data  from  Member  States  (UK,  Ireland)  and  from  outside  the  EU  suggest  that 
exposure to ETS imposes huge private and social costs although the overall burden 
on EU-27 has yet to be estimated. The burden to the economy as a whole includes 
the  direct  costs  relating  to  increased  healthcare  expenditure  on  tobacco-related 
diseases, and the indirect costs linked to productivity losses and lost income tax and 
social  security  contributions  among  smokers  and  second-hand  smoke  victims  who 
would otherwise be in paid employment.21  

The economic burden is particularly high for employers and includes lower workers' 
productivity  due  to  smoking  breaks  and  increased  sickness  absence;  fire  damage 
caused  by  smoking  materials  as  well  as  the  additional  cleaning  and  redecoration 
costs  related  to  smoking.22  In  Canada,  the  annual  cost  per  smoking  employee, 
compared  to  a  similar  non-smoking  employee,  was  estimated  at  $2,565  in  1995 
Canadian  dollars.  The  loss  to  Scottish  employers  due  to  decreased  productivity, 
higher  rates  of  absenteeism  and  fire  damage  caused  accidentally  by  smoking  has 
been  calculated  at  0.51%  to  0.77%  of  Scottish  Gross  Domestic  Product  (GDP)  in 
1997. In Ireland, the equivalent estimate was 1.1-1.7% of GDP in 2000.23 

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2.2. 

Impact of smoke-free initiative 

In  the  longer  term,  the  potential  health  improvement  resulting  from  smoke-free 
policy  could  have  a  major  economic  effect.  The  regulatory  impact  assessments 
carried  out  by  the  UK  Government  estimated  the  long  term  net  benefits  of 
comprehensive smoke-free legislation at £1714-2116 billion annually.24 In Scotland, 
Wales and Northern Ireland, the net benefits of smoking bans have been calculated, 
respectively,  at  £4.387  and  £2.096  billion  over  a  30  year  period  and  £1.101  billion 
over a 20 year period.25 

2.3. 

Risk of unintended consequences 

As smoke-free policies will motivate some smokers to give up smoking or to smoke 
less,  there  may  be  a  loss  of  profit  to  the  tobacco  industry  and,  consequently, 
reductions  in  tobacco-related  employment.  However,  jobs  related  to  the  tobacco 
industry  represent  a  relatively  small  percentage  of  total  EU  employment.  In  2000, 
employment  in  tobacco-related  occupations  (tobacco  growing,  processing  and 
manufacturing)  accounted  for  0.13%  of  total  EU15  employment.26  Moreover,  the 
money currently spent on tobacco is likely to be spent on other goods and services, 
generating employment in other sectors of the economy.  

A reduction in the levels of active smoking will also mean a loss of Member States 
revenue  from  taxes  (excise  duty  and  VAT)  on  cigarettes.  It  should  be  noted, 
however, that in most EU countries, although cigarette taxation generates significant 
revenues,  in  terms  of  overall  portion  of  the  state  budget  it  does  not  make  up  a 
significant  share  (1-5%).  The  exceptions  are  Czech  Republic,  Poland  and  Greece, 
where  cigarette  tax  accounted  for  6,  7  and  9  %  respectively  of  government  tax 
revenue  in  1999.27  In  addition  to  a  reduction  of  the  societal  costs  associated  with 
smokingthe  disposable  income  of  smoking  households  would  increase  if  smoking 
bans  were  introduced,  and  the  revenue  from  VAT  accruing  from  alternative 
investments  and  expenditure  by  such  households  would  partly  off-set  the  revenue 
lost. 

Some production losses can be expected from smokers who are currently allowed to 
smoke  at  work  and  will  continue  to  smoke,  taking  smoking  breaks  outside  the 
building.  

3. 

SOCIAL CONSIDERATIONS 

3.1. 

Public support for smoke-free laws 

Nearly 70% of EU citizens do not smoke28 and studies demonstrate that the majority 
of smokers want to stop smoking29.  

According  to  the  recent  Eurobarometer  Survey  on  the  “Attitudes  of  Europeans 
towards  Tobacco”30,  three  quarters  of  Europeans  are  aware  that  tobacco  smoke 
represents  a  health  risk  for  non-smokers,  while  95%  acknowledge  that  smoking  in 
the company of a pregnant woman can be very dangerous for the baby.  

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The  survey  results  demonstrate  that  smoke-free  policies  are  popular  among  EU 
citizens  (see  Annex  III).  More  than  four  out  of  five  respondents  are  in  favour  of  a 
ban on smoking in the workplace (86%) and any other indoor public place (84%). A 
majority  of  Europeans  are  also  in  favour  of  banning  smoking  in  bars  (61%)  and 
restaurants  (77%).  Support  for  smoke-free  pubs  (over  80%)  and  restaurants  (over 
90%)  is  highest  in  the  four  Member  States  which  have  already  banned  smoking  in 
hospitality venues. This is another indication that the support for smoke-free policies 
tends  to  increase  during  the  build-up  to  their  introduction,  and  grows  still  further 
after implementation.31 

3.2. 

Impact on tobacco consumption 

An  important  indirect  benefit  of  smoke-free  policies  is  that  they  increase  people's 
awareness  of  the  dangers  of  active  and  passive  smoking,  contributing  to  the  “de-
normalisation”  of  smoking  within  the  society.  The  change  in  perception  could  be 
expected to lead to a change in smoking behaviour, and in particular to: 

–  Make it easier for smokers to decide to give up or reduce smoking and support 

them in the cessation process.32  

– 

– 

Discourage  children  and  young  people  from  taking  up  smoking.33  Smoking 
bans in places of entertainment – where young people often “experiment” with 
cigarettes - could be expected to have the biggest impact. 

Deter  smokers  from  smoking  in  the  presence  of  non-smokers,  in  particular 
children and pregnant women, even when there are no regulatory restrictions in 
place (e.g. in homes and private cars).34 This is important given that the main 
harm  concerns  children  who  are  exposed  to  passive  smoking  in  the  home, 
which is an area that a regulation cannot address.  

3.3. 

Impact on social equity 

Smoke-free policies could also help to reduce socio-economic inequalities in health. 
Given  that  the  likelihood  of  being  a  smoker  and  being  exposed  to  second-hand 
smoke is significantly increased for those who have a lower level of education, lower 
income  and  lower  occupational  class,  an  action  on  smoke-free  environments  might 
be expected to bring the biggest benefits to the most deprived groups in society. 

4. 

MOMENTUM FOR ACTION 

As a Party to the WHO Framework Convention on Tobacco Control (FCTC), the 
Community  is  under  a  legal  obligation  to  take  action  on  smoke-free  environments. 
Under  Article  8  of  the  FCTC  each  Party  has  undertaken  to  “adopt  and  implement 
(…) 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.”  The  first 
Conference of the Parties to the FCTC in February 2006 agreed to develop guidelines 
on smoke-free environments to be presented to the second Conference of the Parties 
due in the first half of 2007. 

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The  Council  of  the  European  Union  in  its  Recommendation  of  2002  on  the 
prevention of smoking and on the initiatives to improve tobacco control invited the 
Commission  to  “consider  the  extent  to  which  the  measures  set  out  in  this 
recommendation are working effectively, and to consider the need for further action, 
particularly  if  internal  market  disparities  are  identified  in  the  areas  covered  by  this 
recommendation”.  In  addition,  at  a  meeting  of 
the  Tobacco  Regulatory 
Committee35 in September 2005, Member States agreed that a Commission initiative 
in  the  form  of  a  Green  Paper  or  Communication  would  help  disseminate  good 
practice and bolster national efforts towards smoke-free environments. 

The  European  Parliament  welcomed  “the  Commission’s  willingness  to  act  to  put 
an  end  to  smoking  in  enclosed  spaces”  and  encouraged  it  “to  designate 
environmental  tobacco  smoke  a  class  1  carcinogen”  in  its  resolution  on  the 
Commission’s Action Plan on Environment and Health in February 2005. 36  

The  added  value  of  EU  action  has  also  been  recognised  in  the  report  “Tobacco  or 
Health in the European Union” prepared for  the Commission by a  consortium of 
tobacco control experts.37 The desirability of intervention at European level has been 
further highlighted by two pan-European projects on indoor air pollution, supported 
under the Community Public Health Programme. The INDEX report published by 
the EU Joint Research Centre established a list of five high-priority chemicals (all of 
which  are  present  in  tobacco  smoke)  that  need  to  be  regulated  in  indoor 
environments and recommended to “ban tobacco smoking in all indoor spaces under 
public  jurisdiction,  and  working  places”.38  The  same  recommendation  has  been 
formulated  in  the  THADE  report39,  which  identified  ETS  as  the  single  largest 
contributor  to  indoor  particulate  concentration  in  buildings  where  tobacco  smoking 
occurs.  

III. 

CURRENT REGULATORY ENVIRONMENT 

1. 

NATIONAL PROVISIONS  

There  is  a  clear  trend  towards  smoke-free  environments  throughout  the  Member 
States, driven – among other factors – by legal requirements at EU and international 
level.  All  Member  States  currently  have  some  form  of  regulation  aimed  at  limiting 
exposure to ETS and its harmful effects on health. The scope and character of these 
regulations vary widely.  

Comprehensive bans on smoking in all enclosed public places and all workplaces, 
including bars and restaurants, have already been introduced in Ireland (March 2004) 
and  Scotland  (March  2006).  In  Northern  Ireland,  England  and  Wales,  complete 
smoke-free legislation is due to come into force by summer 2007.  

Smoke-free legislation with exemptions introduced in Italy (January 2005), Malta 
(April 2005) and Sweden (June 2005) permits employers to create special sealed-off 
smoking rooms with separate ventilation systems. Similar measures are set to come 
into effect in France in February 2007 (transition period for hospitality venues until 

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January  2008)  and  in  Finland  in  June  2007.  Lithuania  is  set  to  become  smoke-free 
(with the exception of specially equipped “cigar and pipe clubs”) as of January 2007.  

A number of other Member States have banned smoking in all enclosed public places 
and  all  workplaces,  with  the  exception  of  the  hospitality  sector  where  partial 
restrictions  apply.  These  countries  include  for  example  Belgium,  Cyprus,  Estonia, 
Finland, the Netherlands, Slovenia and Spain.  

Most  Member  States  have  regulations  banning  or  restricting  smoking  in  major 
public  places,  such  as  health  care,  educational  and  government  facilities,  theatres, 
cinemas  and  public  transport.  Restrictions  of  smoking  at  the  workplace  are  less 
common.  The  force  of  the  measures  may  range  from  a  resolution  or  a  voluntary 
agreement to a strict law with penalties for failure to comply. 

As  a  result  of  incomplete  regulations  or  the  lack  of  enforcement,  national 
governments  and  employers  have  often  faced  litigation  by  citizens  for  damage  to 
their health caused by passive smoking.40 

In  several  Member  States,  nation-wide  provisions  are  enhanced  by  more  stringent 
is  also 
regulations  at  regional  and/or 
complemented  by  self-regulatory  measures,  with  a  growing  number  of  workplaces, 
schools,  hospitals,  public  transport  facilities  etc.  going  smoke-free  on  a  voluntary 
basis. More and more is being done to support the staff in giving up smoking and to 
promote  the  concept  of  healthy  indoor  air  as  a  basic  right  of  every  citizen  and 
employee.  

legal  framework 

level.  The 

local 

2. 

EXISTING COMMUNITY PROVISIONS  

At  EU  level,  the  issue  of  smoke-free  environments  has  been  addressed  in  non-
binding resolutions and recommendations, which have encouraged Member States 
to  provide  adequate  protection  from  exposure  to  ETS.  In  particular,  the  1989 
Council  Resolution  89/C  189/0141  on  smoking  in  public  places  invited  Member 
States to adopt measures banning smoking in public places and on all forms of public 
transport.  Most  recently,  the  Council  Recommendation  2003/54/EC42  on  the 
prevention  of  smoking  and  on  initiatives  to  improve  tobacco  control  called  on 
Member  States  to  implement  effective  measures  that  provide  protection  from 
exposure  to  environmental  tobacco  smoke  in  indoor  workplaces,  enclosed  public 
places, and public transport. 

The  Framework  Directive  on  Health  and  Safety 
the  Workplace 
(89/391/EEC)43, while not explicitly referring to tobacco smoke, covers all risks to 
the  health  and  safety  of  workers44  It  requires  the  individual  employer  to  assess  the 
risks  in  the  workplace  and  to  introduce  appropriate  risk  prevention  and  protection 
measures.  

in 

In  addition,  a  number  of  individual  occupational  health  and  safety  directives  by 
setting  out  "minimum  requirements"  for  specific  risks  contain  certain  provisions 
which  ensure  protection  of  workers  from  ETS  (see  paragraph  below).  These 
directives  shall  be  transposed  by  Member  States  into  national  law  and  shall  be 

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properly  enforced.  According  to  the  Treaty,  the  Member  States  are  allowed  to 
introduce more stringent measures.  

The  Directive  on  minimum  safety  and  health  requirements  for  the  workplace 
(89/654/EEC)45 as well as the directives for temporary or mobile construction sites 
(92/57/EEC)46,  mineral-extracting  industries  through  drilling  (92/91/EEC)47  and 
mineral-extracting industries (92/104/EEC)48 require employers to ensure ventilation 
and  sufficient  fresh  air  in  enclosed  workplaces  and  to  protect  non-smokers  against 
discomfort caused by tobacco smoke in rest rooms and rest areas.  

(83/477/EEC)50  prohibit  smoking 

The  Carcinogens  and  Mutagens  Directive  (2004/37/EC)49  and  the  Asbestos 
Directive 
respectively, 
carcinogens/mutagens and  asbestos are handled. The Pregnant Workers  Directive 
(92/85/EEC) requires employers to take action to protect pregnant and breastfeeding 
women from exposure to carbon monoxide. 

in  areas  where, 

Certain components of ETS (such as arsenic, 1,3-butadiene, benzene and propylene 
oxide)  are  classified  as  carcinogenic  under  Annex  1  to  the  Dangerous  Substances 
Directive  (67/548/EEC)51.  Tobacco  smoke  as  such  falls  outside  the  scope  of  EU 
chemicals  legislation  since  that  legislation  applies  only  to  those  substances  and 
preparations that are placed on the market in the Member States.52 

IV. 

SCOPE OF SMOKE-FREE INITIATIVE 

A key issue in developing an EU smoke-free initiative is its scope. Given the wide 
variety  of  settings  where  exposure  to  ETS  occurs,  an  effective  smoke-free  policy 
should take a broad approach rather than relate only to certain types of businesses or 
premises. 

The  most  comprehensive  approach  would  consist  in  proposing  a  total  ban  on 
smoking in all enclosed or substantially enclosed workplaces and public places, 
including means of public transport. Restrictions could also be extended to outdoor 
areas  around  entrances  to  buildings  and  possibly  to  other  outdoor  public  places 
where  people  sit  or  stand  in  immediate  proximity  to  each  other,  such  as  open  air 
stadiums  and  entertainment  venues,  bus  shelters,  train  platforms  etc.  Very  limited 
exceptions  could  be  considered  for  places  where  people  live  on  a  day-to-day  basis 
(e.g.  designated  rooms  in  residential  premises,  such  as  long-stay  care  homes, 
psychiatric units, prisons etc.). 

A less stringent approach  would consist in proposing a total ban on smoking in  all 
enclosed  or  substantially  enclosed  workplaces  and  public  places  but  with 
exemptions  granted  to  selected  categories  of  venues.  Minimum  requirements  for 
enclosed  smoking  rooms,  including  ventilation  standards,  could  be  developed  for 
exempted venues. Possible exemptions could include: 

– 

– 

the licensed hospitality sector (restaurants, pubs and bars),  

hospitality establishments which do not serve food. 

Action on smoke-free environments would deliver the best results if complemented 
by supporting measures at EU and/or Member State level. Such “flanking policies” 

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could  include  awareness  raising  campaigns  highlighting  the  right  to  smoke-free  air 
and the dangers of passive smoking as well as increased access to cessation therapies 
(both behavioural and pharmacological) for persons who wish to stop smoking.  

1. 

COMPREHENSIVE SMOKE-FREE REGULATION 

Advantages 

Of all the options, this one would offer the highest reductions in ETS exposure and 
related  harm,  ensuring  the  equality  of  European  citizens  to  protect  their  right  to 
breathe healthy indoor air, as recognised by the WHO.53 

Studies  from  smoke-free  countries  demonstrate  that  indoor  air  quality  improved 
dramatically after the smoking bans went into effect. The drop in ETS exposure has 
been  particularly  spectacular  in  hospitality  and  leisure  venues.54  This  has  been 
mirrored  by  a  significant  improvement  in  the  respiratory  health  of  hospitality 
workers55 and a considerable reduction in the incidence of and mortality from heart 
attacks56 within months of policy implementation. 

Comprehensive  regulation  would  also  have  the  biggest  potential  to  de-normalise 
smoking in society, creating an environment that encourages smokers to cut back or 
give up smoking and discourages young people from taking up smoking.  

A  review  of  35  studies  on  the  effectiveness  of  smoke-free  policies  concluded  that 
comprehensive public clean air laws have the potential to reduce smoking prevalence 
of  the  whole  population  by  about  10%.57  A  review  of  26  workplace  studies  also 
suggested  that  totally  smoke-free  workplaces  are  associated  with  a  reduction  in 
smoking prevalence of 3.8% and 3.1 fewer cigarettes smoked per day per continuing 
smoker.58  

That comprehensive smoking bans are associated with reductions in active smoking 
has  been  confirmed  by  the  evidence  from  smoke-free  countries,  where  the  fall  in 
tobacco  sales  (e.g.  by  8%  in  Italy  and  14%  in  Norway)  has  been  coupled  with  a 
significant increase in attempts to give up smoking shortly after the introduction of 
the  new  regulations.59  In  Ireland,  80%  of  ex-smokers  cited  new  legislation  as  the 
motivation to quit smoking while 88% declared that the law had helped them not to 
start  again.  60  Despite  concerns  to  the  contrary,  the  bans  on  smoking  in  all  public 
venues appear to have reduced the levels of smoking in the home, especially around 
young  children.61  In  Ireland,  the  proportion  of  smoke-free  households  increased  by 
8% after the ban came into effect.62  

In terms of social impact, the benefits of this option would be concentrated on people 
in lower socio-economic groups, who are more likely to smoke and to be employed 
in the hospitality sector.  

As  regards  enforcement,  a  comprehensive  smoking  ban  would  be  easier  to 
implement  than  partial  restrictions.  Over  90%  compliance  in  Italy  and  Ireland 
demonstrates  that  a  total  smoking  ban  is  almost  entirely  self-enforcing  as  social 
pressure becomes  a  powerful curb on smoking and drastically reduces  the need  for 
enforcement by formal authorities.  

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Disadvantages 

A total ban on smoking in all public places and workplaces would be likely to arouse 
opposition in some Member States, and may therefore be more difficult to adopt and 
enforce.  This  option  is  also  the  one  that  the  tobacco  and  the  majority  of  the 
hospitality industry have made clear they favour least. 

There  have  been  concerns  about  possible  harm  to  the  hospitality  industry  from 
bans  on  smoking  in  pubs  and  restaurants.  However,  evidence  from  smoke-free 
jurisdictions demonstrates no overall negative impact on employment or revenue in 
the  sector.63  In  Ireland,  the  volume  of  sales  in  pubs  and  bars  increased  slightly  (by 
0.1%) in 2005, thus reversing a declining trend which had started before smoke-free 
legislation came into force.64 It could be worth recalling some statistics even if they 
concern  States  not  belonging  to  the  EU.  For  instance,  in  Norway,  there  has  been  a 
slight fall of 0.8% in sales in eating and drinking establishments but this is likely to 
be due to a number of other factors, including the weather.65 In New York City and 
California,  most  hospitality  industries  appear  to  have  benefited  from  smoke-free 
regulations.66  This  is  consistent  with  an  international  review  of  97  studies,  which 
failed to find any negative economic impact in studies based on objective data such 
as sales tax and employment figures.67  

2. 

SMOKE-FREE REGULATION WITH EXEMPTIONS  

Advantages 

The reduction in both active and passive smoking as well as the de-normalisation of 
tobacco  use  under  this  option  could  be  expected  to  be  greater  than  if  no  measures 
were taken.  

Legislation  with  exemptions  could  be  more  acceptable  in  some  Member  States, 
especially to the industry, and therefore a compromise could be more feasible. At the 
same  time,  individual  Member  States  would  be  free  to  adopt,  or  to  continue,  more 
stringent national legislation where exemptions do not apply. 

Exemptions  could  be  complemented  by  minimum  requirements  for  enclosed 
smoking rooms, including ventilation standards. 

Disadvantages 

In  terms  of  health  and  social  benefits,  this  measure  would  be  less  effective  than 
comprehensive smoke-free regulation.  

Some  of  the  most  vulnerable  groups  would  continue  to  be  exposed  to  ETS. 
Incomplete  regulation  could  pose  the  risk  of  the  Member  States  and/or  employers 
being  subject  to  litigation  by  citizens  for  damage  to  their  health  caused  by  passive 
smoking.  

Exemptions  would  reduce  the  effect  of  de-normalising  smoking  which  could  be 
achieved by a total ban. International evidence suggests that regulations which allow 
smoking  in  some  areas  have  about  half  the  effect  on  smoking  behaviour  in 
comparison with totally smoke-free policies.68  

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Different  provisions  for  different  establishments  would  also  be  more  complicated 
and expensive to enforce than a comprehensive ban, necessitating increased signage 
requirements and inspections.  

2.1. 

Exemption for the licensed hospitality sector 

Owing  to  heavy  ETS  exposure,  hospitality  employees  are  at  particular  risk  from 
passive smoking, with a 50% greater risk of lung cancer69. This occupational group 
would  continue  to  be  exposed  to  second-hand  smoke.  The  same  health  risk  would 
apply to customers of drinking and eating venues.  

According  to  the  Labour  Force  Survey  figures  for  2004,  almost  4.3  million 
individuals  were  employed  in  the  bars,  restaurants  and  the  catering  sector 
(HORECA)  in  15  Member  States  of  the  EU,  which  accounted  for  3%  of  the  total 
employment  in  these  countries  (no  data  for  the  remaining  10  MS).  Significant 
proportions of young people and women are employed in the hospitality sector.70 

The regulatory impact assessment conducted by the Scottish Executive estimated the 
drop  in  deaths  due  to  reduced  active  and  passive  smoking  under  this  option  to  be, 
respectively, one half and one quarter of the drop in deaths due to a totally smoke-
free option.71  

2.2. 

Exemption for pubs and bars not serving food 

This  option  would  fail  to  protect  the  most  vulnerable  occupational  groups  from 
exposure  to  second-hand  smoke.  The  customers  of  pubs  and  bars  would  not  be 
protected  either.  It  would  also  create  a  risk  of  pubs  giving  up  serving  food  to 
circumvent the smoking ban. 

In  addition,  there  would  be  a  risk  of  widening  existing  health  inequalities:  recent 
studies from the UK show that the levels of ETS exposure are significantly higher in 
pubs  in  deprived  communities  than in pubs in more affluent areas.72 Moreover, the 
majority of licensed premises not serving food are located in deprived areas and pubs 
in these areas will have stronger incentives to switch to serving only alcohol.73  

The regulatory impact assessment carried out by the UK Government estimated the 
health benefits of this option at 40 per cent of the benefits of a total ban (based on an 
assumption that 10-30% of the pubs do not currently serve food).74 

2.3. 

Enclosed, separately ventilated smoking rooms 

The  evidence  demonstrates  that  currently  used  technologies  (based  on  mixing  and 
dilution)  have  a  limited  impact  on  the  levels  of  ETS  pollutants  in  the  hospitality 
industry  and  other  indoor  environments.75  In  addition,  studies  conducted  in 
controlled environments, such  as  the EU INDOORTRON  ‘environmental chamber’ 
found  that  increasing  the  air  exchange  rate  would  not  lead  to  a  meaningful 
improvement  of  indoor  air  quality.76  While  displacement  ventilation  has  been 
reported  to  be  more  effective  in  some  recent  case-studies  funded  by  the  tobacco 
industry77,  complete  elimination  of  tobacco  smoke  using  ventilation  is  not 
possible.78  

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The  first  Conference  of  the  Parties  to  the  Framework  Convention  for  Tobacco 
Control has (unanimously) agreed that “there is conclusive evidence that engineering 
approaches  do  not  protect  against  exposure  to  tobacco  smoke.”79  Likewise,  the 
American  Society  of  Heating,  Refrigerating,  and  Air  Conditioning  Engineers 
(ASHRAE)  –  an  international  standard-setting  body  for  indoor  air  quality  and 
ventilation  –  adopted  a  position  document  in  2005  on  approaches  to  controlling 
second-hand  smoke,  which  concluded  that  the  only  effective  way  of  eliminating 
health  risks  associated  with  ETS  exposure 
indoor 
environments.80 

to  ban  smoking 

in 

is 

Physical separation of smokers and non-smokers in the form of an enclosed smoking 
room  can  increase  the  effectiveness  of  ventilation  systems  in  the  non-smoking 
section of the premises.81 However, this approach does not protect the occupants of 
the smoking room and the staff (e.g. waiters or cleaners) that must enter the room as 
part of their job. 

A further concern relating to smoking rooms is the significant financial cost, which 
could  create  an  uneven  playing  field  for  the  smaller  operators82  In  addition,  the 
operating  and  maintenance  of  ventilated  smoking  rooms  require  an  extensive 
inspection  and  monitoring  infrastructure.  Evidence  shows  that,  where  ventilation 
systems are used, they often fail to meet the standards set by the law.83 

If  ventilated  smoking  rooms  were  to  be  considered  as  a  viable  option  for  the 
exempted venues, they would have to fulfil the following requirements:  

– 

– 

– 

– 

be completely enclosed and isolated from non-smoking areas, 

be equipped with a separate ventilation system from non-smoking areas, 

have negative air pressure to prevent the diffusion of tobacco smoke into other 
areas,  

no activity other than smoking should be allowed there in order to minimise the 
need for employees to perform work-related activities in those areas. 84  

In  Malta,  Italy  and  Sweden,  which  allow  for  the  creation  of  separately  ventilated 
smoking rooms, most of the operators have chosen not to make use of this option. 

V. 

POLICY OPTIONS 

Several different policy options are available to achieve the smoke-free objectives. 
The  aim  should  be  to  find  an  option  that  best  achieves  the  objectives  while 
minimising costs and burdens. The regulatory options described below are listed in 
an order reflecting an increasing level of possible EU intervention (from continuing 
the  current  level  of  activity  to  developing  a  new  binding  framework  based  on  EU 
legislation).  

These policy options are not mutually exclusive and might complement each other. 
For  example,  a  Commission  recommendation  could  be  an  incentive  for  self-
regulatory  initiatives  among  stakeholders  and  Member  States.  Self-regulatory 
instruments,  on  the  other  hand,  could  serve  as  groundwork  and/or  supplement  to 

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binding  legal  regime  (e.g.  covering  the  venues  where  the  legislation  is  not  yet  in 
force or those exempted from the smoking ban). 

It  should  be  noted  that  the  scope  of  the  various  policy  instruments  would  differ. 
Thus, while EU worker protection legislation would apply to public places in so far 
as they are workplaces given the limits provided by the Treaty, a comprehensive ban 
on smoking in all public places could be encouraged through non binding measures 
(such as Commission or Council Recommendation), legislative measures adopted by 
Member States and/or by voluntary measures adopted by stakeholders.  

In  order  to  be  effective,  any  regulatory  instrument  should  also  be  equipped  with  a 
viable means of enforcement and a transparent monitoring regime. The introduction 
of regulatory measures, either at EU or at national/sub-national level, should also be 
accompanied by prior  public consultation and information campaigns as well as 
an impact assessment. 

1. 

NO CHANGE FROM THE STATUS QUO 

This option would mean no new activity on the part of the EU, while continuing the 
current  work  on  second-hand  smoke  under  the  different  Community  programmes 
(Public health, Research, Employment). Regulatory developments in this area would 
be left to the Member States and the FCTC process.  

The  resources  saved  from  developing  and  implementing  any  new  policy  initiative 
could  be  used  to  ensure  proper  enforcement  of  existing  EU  recommendations  and 
occupational  health  and  safety  directives.  In  particular,  guidance  for  employers, 
employees and Member States' competent authorities could be developed in order to 
ensure a better application of the Framework Directive (89/391/EEC) which – while 
not explicitly referring to ETS - already covers all risks to workers' health and safety, 
including tobacco smoke. 

Efforts could also be devoted to promoting smoke-free environments through means 
other  than  legislation,  such  as  information  and  education  campaigns,  networking 
initiatives  etc.  The  current  anti-tobacco  "HELP"  campaign  will  run  until  2008  and 
might be followed by another awareness raising initiative thereafter.  

In addition, work on indoor air quality, including ETS, will continue as a follow-up 
to  Action  12  of  the  Environment  and  Health  Action  Plan.  The  necessary  resources 
for  the  various  projects  in  this  area  will  come  the  from  the  Life+  multi-annual 
strategic  programme  2007-201085,  the  Seventh  Framework  Programme  of  the 
European Community for research86 and the Public Health Programme87.  

Member States would retain the right to decide whether and how to introduce smoke-
free  measures  depending  on  national  circumstances  and  cultural  differences.  The 
trend towards smoke-free environments would most probably continue, reinforced by 
the  drafting  and  publication  of  the  FCTC  guidelines.  A  number  of  national 
governments, including those of Denmark, Germany, Latvia, Portugal and Slovenia, 
have  already  announced 
to  strengthen  national  smoke-free 
regulations in the near future. 

intentions 

their 

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However,  of  all  the  options  this  one  could  be  expected  to  be  the  least  effective  in 
reducing ETS exposure and related harm. The progress in different Member States is 
likely  to  be  patchy.  As  a  result  of  incomplete  regulations,  many  vulnerable  groups 
would remain exposed to ETS in indoor environments under public jurisdiction. This 
could present the risk of litigation by citizens for damage to their health caused by 
passive smoking. 

Given  the  widespread  expectations  for  EU  smoke-free  initiative,  there  would  be  a 
risk of disappointing the public. Continuing with the status quo would also be a lost 
opportunity to build on the current political momentum towards smoke-free areas in 
the EU.  

2. 

VOLUNTARY MEASURES 

This  option  would  consist  in  encouraging  stakeholders  to  adopt  common  voluntary 
guidelines  at  European  level  to  make  more  places  smoke-free.  Sectoral  approaches 
(e.g.  in  the  leisure  and  catering  industry)  could  be  promoted.  Corporate  social 
responsibility could be used as a basis for development in this area.  

In order to facilitate discussions, a wide platform process could be set up, bringing 
together the civil society and economic operators as well as the representatives of EU 
Institutions, Member States and international organisations. Such platform has been 
established last year in the area of diet and physical activity. A similar process has 
recently been proposed for the development of an EU-wide strategy on alcohol. 

Another option would be to encourage the European social partners (employers and 
trade  union  organisations)  to  negotiate  an  autonomous  agreement  on  workplace 
smoking based on Article 138 of the Treaty. Self-regulation through European social 
dialogue  has  resulted  in  a  variety  of  outcomes,  including  the  adoption  of  over  300 
joint texts by the European social partners.  

Ideally, self-regulation might be quicker and more flexible than traditional legislative 
channels,  and  provide  for  the  sectors  and  businesses  concerned  an  opportunity  to 
have more direct influence on the policies adopted. It also has the potential to create 
a sense of responsibility and ownership among stakeholders. However, the progress 
achieved  depends  on  the  stakeholders’  willingness  to  comply  with  the  agreed 
commitment  and  the  effectiveness  of  enforcement  mechanisms.  Evidence  from  the 
Member  States  suggests,  unfortunately,  that  voluntary  agreements  have  not  been 
effective  in  the  area  of  tobacco  control.  Specifically  in  the  leisure  and  hospitality 
sector, voluntary measures have not met the key target of significantly reducing ETS 
exposure.  

For  instance,  in  the  UK,  after  five  years  of  a  voluntary  agreement  between  the 
Department  of  Health  and  the  key  hospitality  associations,  fewer  than  1%  of  bars 
were  found  to  be  smoke-free.88  In  Spain,  the  2006  legislation  gave  bars  and 
restaurants below 100 m² the option to become smoke-free on a voluntary basis. The 
early  evidence  suggests  that  only  around  10%  of  eligible  establishments  have 
decided to do so.89 In Paris a voluntary scheme aimed at encouraging city's 12,452 
cafes,  bistros  and  brasseries  to  declare  themselves  smoke-free  zones  had  been 
adopted by barely 30 establishments90.  

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3. 

OPEN METHOD OF COORDINATION 

This  option  would  involve  coordinating  Member  States'  efforts  on  smoke-free 
environments  using  the  so-called  "open  method  of  co-ordination".  Member  States 
would  thus  be  encouraged  to  make  their smoke-free laws  more convergent without 
there  being  a  need  for  direct  harmonisation  (although  this  would  remain  a 
possibility). 

This could include the following elements: 

Sharing experiences and best practices of establishing effective smoke-free policies 
at national, sub-national and local level,  

– 

– 

– 

Agreeing common EU targets and guidelines based on successful experiences 
both within Member States and outside the EU. These could be accompanied 
by  relevant  deadlines,  together  with  the  conditions  for  monitoring  and 
enforcement, 

Translating these guidelines into national action plans to reduce ETS exposure 
with specific timetables for achieving the goals in the short, medium and long 
terms, 

Periodic  monitoring,  evaluation  and  peer  review,  for  example  in  the  form  of 
annual reports from the Member States.  

A number of jurisdictions have already gone smoke-free and a number of others have 
declared their intention to do so. Member States also face common challenges, such 
as  opposition  from  industry,  public  scepticism,  and  non-compliance  with  existing 
requirements. EU coordination might be instrumental in bringing about a process of 
mutual learning and sharing of best practices between Member States.  

However,  the  commitment  to  smoke-free  objectives  would  remain  voluntary  and 
there  would  be  no  sanctions  for  non-compliance  with  the  agreed  targets.  The 
effectiveness of the scheme would depend on the strength of multilateral surveillance 
and peer pressure.  

4. 

COMMISSION OR COUNCIL RECOMMENDATION  

legislation 

steered  by 

This  option  would  consist  in  encouraging  Member  States  to  adopt  national  smoke-
free 
comprehensive  Commission  or  Council 
Recommendation  on  smoke-free  environments  based  on  Article  152  EC,  which 
would set out suggested courses of action. It could be used independently or as part 
of  the  self-regulatory  schemes  among  Member  States  (option  3)  and/or  industry 
(option 2).  

a 

While  it  would  not  have  binding  force,  such  a  recommendation  would  be  a  clear 
statement  on  the  part  of  the  Commission  or  Council  that  action  should  be  taken  to 
eliminate  passive  smoking  in  Europe.  It  would  bring  the  issue  onto  the  political 
agenda at a high priority level in all EU Member States and thus provide support for 
Member States' actions.  

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The effectiveness of this option would depend to a large degree on the clarity of EU 
guidelines  and  the  reporting  requirements.  Clear  targets  accompanied  by  specific 
timelines  and  indicators  (e.g.  a  recommendation  that  a  specific  percentage  of 
workplaces be made smoke-free by a given year and sector) would certainly have a 
greater  impact  than  recommendations  of  a  more  general  nature.  Likewise,  the 
requirement  to  implement  a  monitoring  regime  and  make  the  results  publicly 
available would create public pressure for stronger enforcement and the development 
of more stringent policy.  

While this option would offer flexibility to Member States, the main risk would be 
that some Member States might chose not to act at all. 

5. 

BINDING LEGISLATION  

A  Community  action  in  this  field  could  include  the  adoption  of  binding  legislative 
measures.  Binding  legislation  would  impose  a  comparable,  transparent  and 
enforceable basic level of protection from  the  risk  of  ETS  exposure  throughout  the 
Member States. 

On  the  one  hand  a  legislative  process  ensures  formal  consultations  and  thorough 
negotiations involving all parties, which can make the resulting policy more robust. 
On the other hand, the legislative route is likely to be relatively lengthy and the end 
result could be difficult to predict.  

The  exact  legal  basis  of  the  legislation  could  only  be  determined  once  the  exact 
nature and scope of the instrument will be defined and this choice will have to take 
into account the results of this public consultation. 

A  few  options  can  already  at  this  stage  be  mentioned,  without  prejudice  to  the 
outcome of the public consultation. 

– 

– 

– 

Revision  of  the  existing  directives  based  on  the  Framework  Directive  on 
workplace  safety  and  health  89/391/EEC.  This  option  could  include,  in 
particular,  extending  the  scope  of  the  Carcinogens  and  Mutagens  Directive 
2004/37  (to  cover  ETS)  and/or  strengthening  the  requirements  for  the 
protection  of  workers  from  tobacco  smoke  in  Directive  89/654/EEC  on 
minimum health and safety requirements.  

Another option would be to enact a separate directive on workplace smoking. 

Although  not  directly  related  to  the  protection  form  second-hand  smoke,  a 
possible option to consider would be the amendment of Dangerous Substances 
Directive  (67/548/EEC)91  to  classify  ETS  as  a  carcinogen.  This  would 
automatically  bring  ETS  under  the  scope  of  the  Carcinogens  and  Mutagens 
Directive. 

The first two options would be restricted in scope to workplace environment. They 
could apply either to all workplaces or to certain categories of workplaces and would 
have  to  ensure  that  workers  who  are  exposed  to  dangerous  levels  of  ETS  are 
adequately covered.  

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Finally the adoption of a legislative instrument within the remits of the Treaty would 
not preclude the Community to adopt flanking measures whose nature would be non 
binding and that could contribute to ensure the overall aim of protection from ETS 
across all sectors.  

VI. 

CONCLUDING REMARKS 

Taking  into  account  the  unequivocal  scientific  evidence  of  the  harm  caused  by 
second-hand  smoke  and  the  impact  of  clean  indoor  air  policies  on  the  overall 
reduction  in  tobacco  use,  the  Commission  considers  that  the  policy  of  the  widest 
scope would bring the biggest benefit to the public health of the population. It would 
also  create  a  level  playing  field  for  all  operators.  Several  successful  examples  of 
comprehensive  smoke-free  policy  now  in  force  around  the  world  have  proved  that 
this option is viable and enforceable,  

The  desirable  level  of  EU  involvement  in  promoting  smoke-free  legislation  is  an 
open question, and is also linked to the current evolutions in Member States, some of 
them having recently decided to take action to ban smoking in public spaces.  

The  Commission  calls  on  all  the  EU  institutions,  the  Member  States  and  all 
interested citizens, parties and organisations to submit responses to the issues raised 
in this Green Paper. The Commission is particularly interested in stakeholders' views 
on the following questions: 

Questions  

(1) 

(2) 

(3) 

Which  of  the  two  approaches  suggested  in  Section  IV  would  be  more  desirable  in 
terms  of  its  scope  for  smoke-free  initiative:  a  total  ban  on  smoking  in  all  enclosed 
public  spaces  and  workplaces  or  a  ban  with  exemptions  granted  to  selected 
categories of venues? Please indicate the reason(s) for your choice. 

Which of the policy options described in Section V would be the most desirable and 
appropriate for promoting smoke-free environments? What form of EU intervention 
do you consider necessary to achieve the smoke-free objectives? 

Are  there  any  further  quantitative  or  qualitative  data  on  the  health,  social  or 
economic impact of smoke-free policies which should be taken into account?  

(4) 

Do you have any other comments or suggestions on the Green Paper? 

The  replies  to  these  questions  should  be  sent  by  1  May  2007,  to  the  following  address 
(preferably by e-mail): 

European Commission 

Directorate-General Health and Consumer Protection 

Unit C6 – Health Measures 

E-mail: sanco-smoke-free-consultation@ec.europa.eu 

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Postal address: B-1040 Brussels 

Fax: (+32) 2 298 42 04 

All  responses  to  this  Green  Paper  will  be  published  on  the  Commission’s  website  unless 
respondents make a declaration to the contrary.  

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Annex I: Cost effectiveness of various tobacco-control measures in European Region A* 

VII. ANNEXES 

Interventions:  
Codes_and  
Descriptions 

TOB-2: Excise tax on tobacco 
products: 80% of supply price 
(global average) 
TOB-3: Excise tax on tobacco 
products: 300% of supply price 
(highest regional rate) 
TOB-4: Excise tax on tobacco 
products: 600% of supply price 
(double the highest regional rate) 
TOB-5: Clean indoor air law 
enforcement 

TOB-6: Comprehensive ban on 
tobacco advertising 

TOB-7: Information dissemination 

TOB-8: Nicotine replacement 
therapy 

TOB-9: Combination (TOB4 + 
TOB7) 

TOB-10: Combination (TOB4 + 
TOB5 + TOB7) 

TOB-11: Combination (TOB4 + 
TOB6 + TOB7) 

TOB-12: Combination (TOB4 + 
TOB6) 

TOB-13: Combination (TOB4 + 
TOB5 + TOB6) 

TOB-14: Combination (TOB4 + 
TOB5 + TOB6 + TOB7) 

TOB-15: Combination (ALL) 

Source:  

Cost per year (I$, 
millions) per one 
million_population 
[i.e. cost per capita] 

DALYs** 
averted per year 
per one million  
population 

Average 
Cost per 
DALY 
averted 

0,22 

0,22 

0,22 

0,67 

0,27 

0,55 

2,35 

0,76 

1,43 

1,03 

0,48 

1,15 

1,70 

4,05 

1 939 

4 641 

6 723 

742 

561 

670 

670 

7 093 

7 467 

7 372 

7 032 

7 415 

7 725 

7 981 

111 

46 

32 

908 

473 

816 

3 511 

107 

192 

139 

68 

156 

220 

508 

WHO-CHOICE webpage: http://www.who.int/choice/results/tob_eura/en/index.html 

* 

** 

European Region A: Andorra, Austria, Belgium, Croatia, Cyprus, Czech Republic, 
Denmark,  Finland,  France,  Germany,  Greece,  Iceland,  Ireland,  Israel,  Italy, 
Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Slovenia, 
Spain, Sweden, Switzerland 

DALYs = Disability Adjusted Life Years (the sum of years of potential life lost due 
to premature mortality and the years of productive life lost due to disability. 

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Annex II: Global burden of ill-health 

Source: WHO's Global Burden of Disease Study 2004 

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Annex III: Support for smoke-free policies 

Q8. Are you in favour of smoking bans in the following places?

(EU25)  

Totally in favour

Somewhat in favour

Somewhat opposed

Totally opposed

DK

Offices, and other indoor
workplaces

Any indoor public space
(metro, airports, shops,
etc.)

66%

20%

7%

5%

63%

21%

9%

6%

Restaurants

56%

21%

13%

9%

Bars or Pubs

40%

21%

20%

16%

0%

100%

Source:  

“Attitudes  of  Europeans  towards  tobacco”,  Special  Eurobarometer  239,  January  2006, 
http://ec.europa.eu/health/ph_information/documents/ebs_239_en.pdf 

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