Personal View: What if the government refuses to ban smoking in public places?
Authors: Jammi N Rao
Journal: BMJ (2004)

I came across a new TLA (that's “three letter acronym”) the other day: KDM. It stands for key decision maker. It was in a great big document that was in my post on how to go about persuading the great and the good to do something to reduce people's exposure to secondhand smoke in public places.​places.




Figure 1



In Ireland smokers are now left out in the cold

Credit :FRAN VEALE/GETTY IMAGES




According to this framework for action a large number of public health professionals should devote a great deal of energy to winning the hearts and minds of city councillors, business leaders, trade unions, company bosses, and community leaders to act to limit or ban smoking in public places and in places of work. These people and organisations are the KDMs that we should be influencing.

That's all very well—but the thought occurred to me that there's one KDM that matters more than any other, so much so that if we have this one KDM on board then all the others don't matter at all. And if this one KDM refuses to do the right thing then all the others might as well not bother. I refer, of course, to the government. The government also has the perfect opportunity now, in the public health white paper that is expected to be published by the end of the year, to take what may well be the most important key decision for achieving better public health for the people of this country.

All the medical and public health authorities have called for a ban. The chief medical officer, the government's own top adviser, has set out the case for a ban. Survey after survey has shown that the public and even businesses would support a ban; and other cities and countries around the world have shown that a smoking ban can be easily introduced.

In Ireland the benefits of a ban are already visible: cigarettes sales are down 7.5% according to Gallaher, a company with a 50% share of the Irish market. In New York business in restaurants and hotels and employment have all risen after the smoking ban. Norway has now followed suit, having banned smoking in public places in June.

It seems therefore to be inevitable that the white paper will propose similar action. Surely a government that took us into an unpopular war because it believed that was the right thing to do to protect us from a dire (if unproved) threat would have the courage to ban smoking in public places? Especially given that it would be a measure with popular support and backing from experts and would deal effectively with a present and real threat to our health?

However, rumour has it that the decision on whether or not to announce official government support for a ban on smoking in public places is being left to the very last minute before the white paper is finalised. One news report suggests that Tony Blair favours giving powers to local authorities to introduce any bans. Such a Pontius Pilate approach would hardly do.

What if the ministers decide that a smoking ban would smack too much of the nanny state and leave it out of the white paper? How should the public health community and the health service respond?

I suggest that if the government misses the present opportunity then all of us in the health service should jointly write to ministers to say that we will



withdraw from all further activity to control tobacco


disown all targets on reducing the prevalence of smoking and refuse to carry out or fund surveys of smoking prevalence, and


refuse to supply data on smoking cessation services.






After all, in another era and in another context, when John Snow had identified the source of the cholera outbreak in Broad Street in London's Soho in 1854, the parish guardians agreed for the handle to be removed from the offending water pump. In the context of smoking, only the government is big enough to be able to do something similar. If ministers don't act to do the single most effective thing, why should we in the NHS be complicit by taking part in ineffective activity that allows our leaders to pretend that they are dealing with the problem? Indeed, by scurrying around pretending to influence KDMs that don't matter and providing an excuse for government inaction, we would be doing public health a disservice.