Global momentum for smoke-free society

In a perspective article in the April 12 issue of The New England Journal of Medicine (NEJM), researchers from the Harvard School of Public Health (HSPH) and the Association of European Cancer Leagues describe the growing momentum for indoor smoking bans in countries across the globe. They identify Ireland’s pioneering 2004 comprehensive indoor smoking ban as a likely tipping point for fundamental change in social norms and public health worldwide.

Since 2004, in only a few years, more than a dozen other countries have also adopted national indoor smoke-free policies that are being implemented or will be implemented in the near future.

Lead author Howard Koh, professor and associate dean of public health practice at HSPH, said: “The 21st century is witnessing a paradigm shift, once considered impossible, whereby entire countries are declaring themselves smoke-free in indoor public places. Such mounting progress across the globe is making smoking history worldwide.”

Co-authors are Gregory Connolly, professor of the practice of public health at HSPH, and Luk Joossens of the Association of European Cancer Leagues.

The article is accompanied by a world map showing countries, states, and provinces that have passed smoke-free policies applying broadly to indoor workplaces and other indoor public places. Among the countries are Ireland, New Zealand, Bermuda (territory), Scotland and England, Lithuania, Uruguay, Iran, the British Virgin Islands (territory), Bhutan, Norway, Italy, Malta, Sweden, Iceland, Uganda, South Africa, France, Hong Kong (region), and Finland. While the United States lacks a federal policy, 17 states are currently recognized as smoke-free, with the number increasing steadily. California enacted the first state ban on smoking in bars and restaurants in 1998. In addition, most of Australia and Canada are currently covered by smoke-free laws in indoor public places.

While a number of these new policies currently allow exceptions, such as the possibility of designated, enclosed, ventilated smoking rooms, all have advanced the international public health goal of protecting people from involuntary exposure to secondhand smoke.

“In short, the world has begun to reclaim clean air as the social norm,” the authors write. “For too long, the tobacco industry has spent billions to normalize, market, and glamorize a behavior that is now recognized as a tragic drug addiction.” They point out that changing the social norm will be critical to reversing the burden of tobacco-related illness that led to 100 million deaths in the 20th century and is projected to cause a billion deaths in the century ahead.

The authors also note that the 2003 World Health Organization Framework Convention on Tobacco Control, the first international public health treaty, helped galvanize global commitment. The treaty, which calls for countries to adopt clean-air policies as well as other initiatives to promote tobacco control and decrease consumption, has been ratified by 145 countries.