Ban on smoking in France: a new step forward

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

At the beginning of 2007, smoking set to be illegal in public areas, work places and schools. This ban has been extended successfully to cafés and restaurants since January 2008. Despite the initial fears, the smoking ban in cafés seemed to be supported largely by general public. The incidence rates of several cardiovascular diseases seemed to decline compared to last year although the law had no effect on tobacco sales and consumption of nicotine-replacement drugs.

Neue Entwicklungen

In November 2006, the French Government enacted a law designed to forbid smoking in public places. The implementation has been gradual.

• First, smoking has been banned in workplaces, schools, public transports since January 1, 2007.
• Second, the ban was extended  to cafés, restaurants and nightclubs a year later.

Monetary penalties have been introduced for individuals who smoke in workplaces or cafés/restaurants (68€) and for employers/owners who do not respect the law (135€).

The primary objective was to prevent passive smoking by reducing smoke exposure in public areas, workplaces, cafés and restaurants.

Secondary objectives are to reduce the number of smokers and especially to limit smoking initiation at adolescence. Therefore, the ban was combined with a set of supportive measures to help or advice smokers to quit: a dedicated help website and phone line have been set up; employers and/or health insurance fund have been supporting people willing to give up smoking and take a nicotine-replacement therapy via financial incentives; there was also a mass-media campaign on the dangers of smoking and diseases caused by tobacco. 

Ultimately, the reform aimed to lower the number of illnesses and deaths directly or indirectly attributable to smoking (cancers, cardiovascular diseases).

The first step of this reform, the ban on smoking in public places took effect successfully in workplaces and schools at the beginning of 2007.

The extension of this ban to cafés and restaurants was due at the beginning of 2008 and was considered to be a bigger challenge. The authorities feared resistance both from the owners and the customers of cafés.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

This reform is both traditional (since several countries have enacted the same law a few years ago) and rather consensual.

This law has neither structural nor systemic impact and it is totally system-neutral.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

• Parlament

• Bürgergesellschaft

• Wissenschaft

• Privatwirtschaft, privater Sektor

Stakeholder positions

Elections in May 2007 led to a new Government (still right wing though) but this did not effect the policy of the smoking ban: the new government decided to extend the ban in 2008 as it had been inititally planned.

The position of all actors and stakeholders remained the same as when the smoking ban was introduced in public places last year.

 Public health organizations, anti-smoking associations and some customers unions strongly supported this measure while this total ban proved - surprisingly for many observers - to remain highly popular in public opinion. According to opinion surveys, people did agree with the law in a large majority, even smokers: 82% of non-smokers and 73% of smokers were (quite or totally) favourable to the ban on smoking in cafés and restaurants (INPES, December 2007).

Nevertheless, there has been a noticeable opposition to the law from tobacco sellers and tobacco industry, intensified since January 2008. The owners of cafés and restaurants also claim that smoking ban hurt the business in their sector.

As a consequence, in the context of local elections in March 2008, and under pressure from local unions of tobacco sellers or cafés/restaurants owners, some members of the Parliament (from the second right-wing party in opposition) challenged the law. They proposed to modify the ban to allow the owners of cafés & restaurants to decide if they want to be a "totally smoking" or "totally non smoking" one.

However, there is very little chance that the Parliament will vote for this proposal.

Actors and positions

Regierung
Ministry of Health	sehr unterstützend		stark dagegen
Parlament
Parliament	sehr unterstützend		stark dagegen
Bürgergesellschaft
General public	sehr unterstützend		stark dagegen
Wissenschaft
Anti-smoking and public health organizations	sehr unterstützend		stark dagegen
Privatwirtschaft, privater Sektor
Tobacco industry	sehr unterstützend		stark dagegen
Tobacco-sellers interest groups	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

The smoking ban has been extended to café/bars, restaurants, nightclubs, casinos, etc. without any exception since the January 1, 2008.

Legislative outcome

Enactment

Actors and influence

Regierung
Ministry of Health	sehr groß		kein
Parlament
Parliament	sehr groß		kein
Bürgergesellschaft
General public	sehr groß		kein
Wissenschaft
Anti-smoking and public health organizations	sehr groß		kein
Privatwirtschaft, privater Sektor
Tobacco industry	sehr groß		kein
Tobacco-sellers interest groups	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

While this extension of the ban had been planned and announced in the initial law (November 2006) it was not clear if the new government would have the political will to pursue the reform. 

Monitoring and evaluation

The law process has not foreseen any monitoring or evaluation procedure.

Nevertheless, we can state that implementation of the ban has been fully successful for both stages.It seems that there is hardly any contravention to the law neither in workplaces nor in cafés/restaurants.

As a consequence, for many observers, and especially for public health organizations, the ban is expected to bring direct and indirect health benefits and to lower consumption of tobacco.

Expected outcome

Direct/indirect impact on health

First, tobacco exposure has decreased in workplaces, bars and restaurants: ban on smoking in such places has substantially improved the air quality.

This implies significant indirect health benefits since a large body of research provides evidence that passive smoking can cause the same health problems as direct smoking (including lung cancer, cardiovascular disease, bronchitis, etc.)

While there is no direct evidence of a real benefit, in terms of incidence of smoking-related illnesses, from the ban in public places, it seems that the extension to cafés, restaurants and nightclubs had a immediate impact on such illnesses and especially on serious cardiovascular diseases. According to a recent study conducted by a French lung specialist, the number of emergency hospitalizations for myocardial infarction for non smokers decreased by 15% in January-February 2008, compared with the same period in 2007 (Pr B Dautzenberg, OFT).

 Although it is difficult to establish a direct causality between the reduction of tobacco exposure in cafés and restaurants and a sudden decrease in the number of hearth attacks, this result is totally consistent with the findings in other countries (such as Ireland, Italy, the UK and USA) which have implemented total prohibition of smoking before France.

Some American studies suggest that the decline in the number of heart attack hospitalizations within the first year after the smoking ban, which was observed in most studies, could be explained by a decrease in the effect of second-hand smoke as a triggering factor for heart attacks . 

Impact on smoking

Surprisingly, however, the smoking ban so far seems to have only small impact on smoking habits and tobacco consumption.

Monitoring of several indicators of "propensity to quit" show no evidence that the ban policy drives smokers to stop smoking:

• There has been no decrease in tobacco consumption. Cigarette sales have remained roughly constant in the past two years; the last drop in tobacco sales was observed in 2004 as a result of the rise in price and taxes of cigarettes in 2003.

• Sales of nicotine-replacement drugs increased strongly (30% higher in 2007 compared with 2006) at the beginning of 2007 but have been decreasing slightly since then. Sales reached a high peak in January-February 2007. There are two possible explanations of this: first, the public ban came into force and second, the compulsory health insurance announced it would reimburse partially acquisitions of nicotine-replacement therapies from February 2007 (50€ per year). Moreover, a new (innovative) therapy entered into the market (Champix ®) virtually at the same time, which could also explain this peak in sales. 

• Since February 2007, there has been a constant decrease in sales of replacement-therapy, and the extension of smoking ban did not change this trend. And this is despite the partial reimbursement of such therapies by compulsory health insurance since February 2007 (50€ per year).

• Physician consultations for tobacco-addiction did not increase either in 2007-2008.

• Finally, a decreasing number of people have been using the free phone-line set-up to support smokers who wish to give up. The number of phone calls  fell from 6000 per month in January 2007 down to 1800 in February 2008.

These results contrast with studies and reports in other countries which state that cigarette sales decreased after the ban's introduction, even in the very first months: in Ireland, cigarette sales fell by 16% in the six months following the ban and in the UK sales fell by 11% during the first month (compared with the same month a year before).

Effects on business

The major union of "hospitality sector" (owners of bars, cafés, restaurants, hotels, nightclubs) claims that the number of customers in cafés and nightclubs has decreased about 15% in last February-March compared with the same period last year (Le Monde, April 2008).

References

Sources of Information

OFDT (French monitoring centre for drugs and drug addiction) report. Monthly statistics of tobacco and nicotine-replacement drugs consumption. www.ofdt.fr/ofdtdev/live/donneesnat/tabtabac.html

OFT (French office for prevention of smoking) website providing information about the implementation of the ban and its health benefits (results of the study from Pr B. Dautzenberg) : www.oft-asso.fr

"Les fumeurs boudent les cafés et les discothèques", Le Monde, March 19, 2008.

Reform formerly reported in

Smoking ban in public areas Process Stages: Umsetzung, Gesetzgebung, Veränderung/Richtungswechsel

Author/s and/or contributors to this survey

Renaud, Thomas

Empfohlene Zitierweise für diesen Online-Artikel:

Renaud, Thomas. "Ban on smoking in France: a new step forward". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/fr/a11/3