Tobacco Control Playbook

KEY MESSAGE: Smokefree legislation has a positive impact on the hospitality industry. Damage to the industry is a myth: rigorous studies have shown that these measures have a positive or neutral effect, discounting industry claims that are mostly based on poorly designed studies.

Smokefree legislation in public places such as hotels, bars and restaurants can benefit the hospitality industry in a number of ways. One way is by reducing exposure to second-hand smoke, which can have serious health consequences. A global study of the effects of second-hand smoke found that 1% of deaths and 0.7% of disability-adjusted life years were attributable to second-hand smoke. Of these, 25% were children and 47% women, and the deaths per capita in the WHO European Region were more than double compared to other regions ^[1]. Second-hand smoke is therefore a significant health hazard in the European Region, and therefore implementing comprehensive smokefree legislation in order to protect the health of others is essential (see “Comprehensive smokefree legislation is essential in protecting the health of others”).

Comprehensive smokefree legislation improves the health of workers who are subjected to significant health risks from second-hand smoke. A Scottish study found that health symptoms associated with smoking, including reported quality of life, among bar workers improved within four months of smokefree legislation taking effect in March 2006 ^[2]. Smokefree policies introduced in 2005 in Italy caused nicotine concentrates in the air to drop significantly, which was associated with decreasing long-term lung cancer risks. The decrease in nicotine was 10–20 times higher in bars and discos compared to restaurants ^[3]. These measures, in turn, improve worker productivity and contribute to economic benefits. A study of Swedish workers between 1988 and 1991, for example, found that non-smokers used 8–11 fewer sick days per year than smokers ^[4].

Net revenue in hospitality venues can also increase because most people are non-smokers. Additionally, smokers’ support for smokefree restaurants was found to increase after the implementation of such policies in France, Germany, the Netherlands, and Norway ^[5][6].

Studies, including a recent meta-analysis ^[7], using objective measures such as changes in sales, employment and the number of establishments have shown no adverse impact as a result of implementing completely smokefree bars, restaurants and tourist areas in most developed countries. In many countries, the overall economic impacts have been positive ^[8] (see “Case study: Hungary”). Although earlier studies came to mixed conclusions, a 2003 review which examined 97 studies explained these differences. The studies were divided based on their methodological rigour. The 21 that were considered to be well designed all found that full smoking bans had either neutral or positive impacts on sales or employment in bars and restaurants. Of the studies that reported a negative economic impact, 94% were funded by the tobacco industry or its allies ^[9]. A United Kingdom study found a net increase of 155000 jobs in the leisure and entertainment industries, since smokers who quit are then more likely to spend a larger proportion of their income on recreation and entertainment ^[10]. A number of recent studies of individual European countries including Belgium, Cyprus, Italy, Norway, and Spain have shown no negative effects on revenues, profitability or employment ^{[6][11][12][13][14]}.

Smoking bans should be complete, since partial smoking bans or air filtering solutions do not provide adequate protection from second-hand smoke (see “Comprehensive smokefree legislation is essential in protecting the health of others”). Nevertheless, the tobacco industry, along with some in the hospitality industry, has often tried to resist the implementation of complete smoking bans by arguing that they would have a negative economic impact on the industry. The proposed so-called solution is often a partial smoking ban or an expensive air filtering system, neither of which offers adequate health protection (see “Case study: Hungary”). Although many of these arguments seem to come from hospitality industry representatives, it is now known that the tobacco industry has been involved in manipulating the hospitality industry, primarily via financial contributions to hospitality associations or the formation of its own front groups, often – and misleadingly – positioned as grassroots movements independent of the tobacco industry ^[15].

Smokefree legislation in hospitality venues protects the health of workers and customers, brings financial benefits to the venues, and is an important component of a comprehensive approach to tobacco control as recommended by WHO ^[16].

KEY ARGUMENTS

• Guidelines for implementation of Article 8 of the WHO Framework Convention on Tobacco Control on protection from exposure to tobacco smoke ^[17] state that all indoor public places should be completely smokefree. The Guidelines also state that industry-proposed so-called solutions such as partial smoking bans and ventilation systems have repeatedly proven to be ineffective ^[16].

• Article 5.3 of the WHO Framework Convention on Tobacco Control ^[18] states that the development of public health policy should be protected from the commercial and vested interests of the tobacco industry. This includes the industry’s manipulation of the hospitality sector and use of front groups to delay, dilute or avoid comprehensive smokefree legislation.

Case study: Hungary

Hungary passed an amendment in April 2011 that called for a total smoking ban in all hospitality venues (and other public places), with a three-month grace period. It was enforced by fines: a fine of US$90–225 for smoking in a prohibited area, US$450–1120 for an individual’s failure to enforce, and US$4500–11200 for an institution’s failure to enforce the legislation.

Two months before the amendment passed, the hospitality and tobacco industries applied significant pressure, through media campaigns, to permit smoking in indoor areas with air filtering systems. Soon after the Hungarian National Tax and Customs Administration published an impact assessment which predicted a national loss of US$248000 as the direct result of a complete smoking ban. This assessment was based on literature selected by the tobacco industry, but its conclusions were featured in the media. A few days before the parliamentary vote, hospitality industry representatives held a widely publicized press conference in which they argued that hospitality sectors in other European countries had deteriorated as a consequence of smoking bans. A “Smoke and Talk” cabin was also presented, and it was – misleadingly – argued that air strained by the cabin’s filter system was cleaner than normal air. WHO issued a press release the following day, correcting these unscientific claims. On the basis of the WHO release, the amendment passed with 82% approval.

A 2012–2013 impact assessment reported good enforcement and compliance. Between 2011 and 2013, income had increased by US$ 142 million as had the number of hospitality venues. Guest flows in accommodation establishments had also increased. The health of Hungarians and the revenues of the country's hospitality industry both benefitted from the smoking ban. ^[19].