2 Public health need and practice

2 Public health need and practice

Smoking is the main cause of preventable illness and premature death in England. It led to an estimated annual average of 86,500 deaths between 1998 and 2002 (Twigg et al. 2004). It is also a major factor contributing to health inequalities.

A wide range of diseases and conditions are caused by smoking including: cancers, respiratory disease, coronary heart and other circulatory diseases, stomach/duodenal ulcer, impotence and infertility, complications in pregnancy and low birthweight. Following surgery, it contributes to lower survival rates, post-operative respiratory complications and poor healing.

Breathing secondhand smoke ('passive smoking') can affect the health of non-smokers. For example, it can exacerbate respiratory problems and trigger asthma attacks. Longer term, it increases the risk of lung cancer, respiratory illnesses (especially asthma), heart disease and stroke (International Agency for Research on Cancer 2002; Scientific Committee on Tobacco and Health 2004; US Environmental Protection Agency 1993).

The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke (US Surgeon General 2006). Exposure in the workplace is estimated to be responsible for the deaths of 617 employees per year in the UK (about two employed people per working day) (Jamrozik 2005).

Smoking is estimated to cost the NHS in England up to £1.5 billion a year (Parrott et al. 1998). Extrapolating from a study in Scotland (Parrott et al. 2000) it costs industry a further £5 billion in terms of lost productivity, higher rates of absenteeism among people who smoke and fire damage.

Reducing levels of smoking among employees will help reduce some illnesses and conditions (such as cardiovascular disease and respiratory diseases) that are important causes of sickness absence. This will result in improved productivity and less costs for employers.

The workplace has several advantages as a setting for smoking cessation interventions:

  • large numbers of people can be reached (including groups who may not normally consult health professionals, such as young men)

  • there is the potential to provide peer group support

  • a no smoking working environment encourages people who smoke to quit.

Policy background

The Government's independent Scientific Committee on Tobacco and Health (SCOTH) first summarised the health evidence on secondhand smoke and recommended smokefree workplaces in 1998 (SCOTH 1998). The tobacco white paper 'Smoking kills'(DH 1998) reinforced the message that people should not have to be exposed to cigarette smoke. But in 2004, about half of British workplaces still allowed some degree of smoking on the premises (Lader 2005).

Shifting the balance towards smokefree workplaces and public places has become a key aspect of the government's health strategy, as highlighted in the public health white paper 'Choosing health' (DH 2004). Virtually all workplaces in England will become smokefree when the regulations resulting from the 2006 Health Act come into force on 1 July 2007.