Smoking ban in public areas

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The French Government has enacted a law making smoking illegal in public areas and in workplaces since January 2007. The ban will be extended to restaurants and cafés in 2008. This law, aiming to reduce the number of smokers and passive smoking appears to gain a surprising support in public opinion. While it is too early to make an assessment of its effectiveness, we already note a significant increase in sales of nicotine-replacement drugs and in physician consultations to quit smoking.

Purpose of health policy or idea

In November 2006, the French Government banned smoking in all public areas by enacting and improving a former law on that issue (Loi Evin, 1991) which has been applied only partially. This law had effectively banned smoking in some public places (in public transports and in some parts of schools, hospitals, etc.) but the major requirements of this law, such as creating non smoking areas in restaurants and cafés, were never applied appropriately.

The new law aimed to fight passive smoking and to prevent especially adolescents from starting to smoke.

Workplaces and schools have been particularly targeted by this policy.

The law considerably reinforced the existing health and safety legislation of smoking at work. Firms are obliged to forbid smoking in all workplaces, to close the existing smoking rooms in the buildings or, at least, to fit out a smoking room in accordance with a strict sanitary scheme (rooms with smoke fume extractors). It is worth noting that the application of the law at the workplace is not always straightforward and changes the work habits of employees. Workers unions are also quite sensitive about a potential  discrimination between smokers and non smokers in the same company. 

In schools, the government reinforced the fight against children's and teenagers' smoking by extending the ban to schoolyards and all outdoor parts of schools.

This measure is in line with previous policies that strictly regulated tobacco packaging and selling in order to reduce smoking habits of young people. Tobacco selling to teenagers under 16 is no longer allowed since 2003; and in 2001 the small packs of ten cigarettes were withdrawn from the market as they were particularity attractive for young people.

In parallel with these regulations, a number of policies are developed to provide support to smoking cessation initiatives:

• The major compulsory health insurance funds decided to partly reimburse nicotine-replacement therapies; some employers also provide assistance to their employees who are trying to give up smoking.

• The Ministry of Health provided public health authorities with financial support  to create a website and a phone line giving information and advice to the general public, especially for those who want to give up smoking.

The second big step of this policy will be the extension of the ban  to restaurants, cafés and nightclubs in January 2008.

Main points

Main objectives

The ultimate objective is to prevent passive smoking, especially for children, and to reduce the prevalence of smoking as a common behaviour. A total ban on smoking is introduced/reinforced in all types of public places, with a particular emphasis on workplaces, schools and public transports.

Type of incentives

There are monetary penalties for smokers who do not respect the rules in public places (68 €) and for the employers if they allow employees to smoke in workplace (135 €).

Groups affected

Smokers, employers, tobacco-sellers, pharmacies and general practitioners by now., Owners and customers of restaurants and cafés next year.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

French and European context

In France, there are about 15 million regular smokers; one young adult (18-30 years) in two smokes every day. Smoking causes, directly or indirectly, almost 67 000 deaths each year, 1/3 of which are from lung cancer.

Some European countries have already implemented a ban of smoking in public areas, including restaurants and pubs: Ireland in 2004, Italy in 2005, etc.

The case of Italy, where the ban on smoking was a success, has been an inspiring example for French authorities because this is a neighbour country, where the prevalence of smoking used to be quite high and where the prices of cigarettes were not prohibitive.

 

Former attempts to reduce smoking

The idea of a total prohibition of smoking entered in the public debate about 15 years ago, with Loi Evin (1991). This law aimed to forbid smoking in public areas, but has never been effectively applied since there were no real incentives or penalties to underpin this policy. While this law initiated a process and banned smoking in some public places, many exceptions remained and smokers did continue to bend the rules.

In fact, previous French Governments were not very supportive of public health policies aiming to ban smoking because it was not a popular measure. The preferred policy was to increase prices: tobacco taxes revenue rose up to 10 billions € in the last years.

Increasing tobacco prices over the past 15 years led to a constant, but quite small, decrease of regular smokers. It seems that high cost of cigarettes is a disincentive, especially for teenagers, to start smoking. However, only a few regular smokers quit smoking because of the price increase.

The economic studies looking into the efficiency of different anti-smoking policies suggest that the most efficient strategy would be to subsidise quitting programmes and to help smokers to reduce their consumption by partial prohibition.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

Clearly this policy is a result of  a growing concern for the health hazards of tobacco and a following general trend to reduce smoking in most developed countries.

The WHO supports this concern trough the Tobbaco Free Initiative (TFI) established in July 1998 to focus international attention, resources and action on the global tobacco epidemic.

Initiators of idea/main actors

• Government

• Civil Society

• Private Sector or Industry

Approach of idea

The approach of the idea is described as:
renewed: the first attempt to reduce smoking in France was the law Loi Veil in 1976.
amended: amendment of former law Loi Evin (1991).

Stakeholder positions

The Ministry of Health initiated this law and was joined by several other ministries (labour, transports, education…); anti-smoking associations and public health authorities were very supportive.

At the beginning, it was not clear what the public opinion on the issue would be. It was feared that general public would be against to a total ban but, surprisingly, people were increasingly supportive over the months.

Tobacco sellers interest groups were strongly opposed to this law but do not have strong influence in decision making. And there is low pressure from tobacco industry since the Government has withdrawn in 2000 from SEITA, the former state tobacco manufacturer in France. Some members of Parliament admitted that there was some pressure from international tobacco companies which turned out to be unsuccessful.

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Other ministries (education, labour, transports)	very supportive		strongly opposed
Civil Society
General public	very supportive		strongly opposed
Anti-smoking and public health associations	very supportive		strongly opposed
Private Sector or Industry
Tobacco industry	very supportive		strongly opposed
Tobacco sellers interest groups	very supportive		strongly opposed

Actors and influence

Government
Ministry of Health	very strong		none
Other ministries (education, labour, transports)	very strong		none
Civil Society
General public	very strong		none
Anti-smoking and public health associations	very strong		none
Private Sector or Industry
Tobacco industry	very strong		none
Tobacco sellers interest groups	very strong		none

Positions and Influences at a glance

Adoption and implementation

The idea of reinforcing the law Loi Evin and introducing a general ban of smoking in public places has been of growing importance in the French public debate of the last couple of years:

• A long term media campaign about the health hazards of smoking has been organised and subsidised by the INPES (National Institute for Prevention and Health Education). This campaign highlighted the danger of passive smoking, especially for children, and the risks of smoking during the pregnancy.
• State authorities organised a large social consultation with different associations and unions. From February to May 2006, they met 30 different organisations: public health organisations (against cancer and cardiovascular diseases), anti-smoking associations, non-smokers unions, customers associations, labour unions and interest groups representing owners of restaurants, cafés, hotels or nightclubs.
• In this way, the Government ensured that a total ban in public areas would not be ill received. 
• The bill was submitted in October 2006 and enacted by the Government in November. This decision has been made by the Government only, without vote in Parliament: such a decision process, settled by the executive power, is called in the French code a "décret" (as opposed to a "loi" which requires the ratification of Parliament).
• Just afterwards, during the last quarter of 2006, the law has been promoted trough a wide media-campaign in order to explain the reasons of the ban and the importance of applying it correctly.

Application of the law is supported by a set of measures to help smokers to quit. For example, the Ministry of Health and the INPES subsidise a dedicated website (www.tabac.gouv.fr) and a free phone line designed to provide information about the new law, the dangers of tobacco or advice on how to give advice to give up tobacco.

In line with this policy:

• Most of compulsory health insurance funds have started to partially reimburse nicotine-replacement drugs (up to a ceiling) since the beginning of 2007.
• Employers are being encouraged to subsidise, partially or totally, smoking cessation programs for their employees; big companies even offer quitting programs or seminaries at the workplace to employees.

Finally, the idea of the ban proved to be popular during the media-campaign and three months later, when the law came into effect. At end of 2006, about 76% of the population were in favour of a ban on smoking in public areas according to opinion surveys; most of them agreed with the arguments of the campaign, even those who smoked regularly. The proportion of people who were in favour of the law rose to 83% two months after the ban had come into force.

Monitoring and evaluation

There is no evaluation, but it seems that the rules have been applied strictly in the last three months. A follow-up on the impact of the law on smoking habits and tobacco consumption would be interesting: it could be based on monthly statistics from OFDT (French Observatory of Drug Addictions).

Dimensions of evaluation

Process, Outcome

Expected outcome

The effect of this policy on the general consumption of tobacco cannot be assessed yet. In the first two months of 2007, cigarette sales have remained constant.

Nevertheless, the anti-smoking campaign and the law seem to have had a first impact as nicotine-replacement therapies and consultations for tobacco-addiction have been increasing since the beginning of 2007. According to OFDT, sales of nicotine-replacement drugs increased by 70% during the first two months of 2007 (in comparison with the same period one year ago). In the meantime, the number of consultations with physicians specialised in tobacco-addiction have increased by 25%.

 Also the law seems to significantly  change the way people think. Public opinion suddenly became less tolerant towards smokers and there is less and less tolerance for smoke exposure.

However, the big step is still to come in 2008, with a total ban of smoking in cafés and restaurants. This would be the real challenge for authorities as the previous attempts to even partly ban smoking in cafés/restaurants has not been successful. There is strong reluctance from customers and restaurant owners. If the Government succeeds in banning smoking in these places, the policy can be considered successful and tobacco consumption could decrease significantly afterwards.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

References

Sources of Information

Full text of the law (November 2006) in french: http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SANX0609703D

Monthly statistics of tobacco and nicotine-replacement drugs consumption: http://www.ofdt.fr/ofdtdev/live/donneesnat/tabtabac.html

Grignon M., Pierrard B., (2002), Modèles économiques et politiques de lutte contre le tabagisme, Questions d'économie de la santé n° 51, IRDES.

Saffer H., Chaloupka F.-J., (2000), The effect of tobacco advertising bans on tobacco consumption, Journal of Health Economics, vol 19, pp. 1117-1137.

Author/s and/or contributors to this survey

Thomas Renaud

Suggested citation for this online article

Thomas Renaud. "Smoking ban in public areas". Health Policy Monitor, April 2007. Available at http://www.hpm.org/survey/fr/a9/2