The smoking ban may have led to a decrease in the heart disease death rate and hospital admissions in every country where it was introduced, but it has had absolutely no impact in Malta, a medical study has revealed.

We suspect places of entertainment are not ensuring the law is enforced for fear of losing out on business

From Italy, where heart attacks dropped by 11 per cent after it banned smoking in public places, to Montana where the decline was a whopping 40 per cent, every country registered an improvement.

“We were shocked and disappointed with Malta’s results, especially since the island was the second country in Europe to introduce the smoking ban,”cardiologist Robert Xuereb told The Sunday Times.

“Seeing that international studies all showed a reduction in heart attacks and smoking-related deaths, we assumed we’d find a drop in Malta too – to our surprise there was absolutely no change in the figures,” he added.

The findings were recently presented to the European Society of Cardiology Congress, which was held in Paris and attended by a record 32,946 participants from across the globe.

The paper, titled ‘The Smoking Ban: The Malta Paradox’, looked at figures for cardiovascular deaths and hospital admissions due to a heart attack five years beforeMalta introduced the ban in April 2004, and compared these with five years later – there was no change in either the admission or mortality rates.

Dr Xuereb pointed out that, unfortunately, it was public knowledge that the smoking ban in Malta was not properly enforced.

Figures show police have been attempting to crack down on smoking in public places – the number of people charged was just 19 in 2004, but this soared to 2,567 in 2009. However, it is clear not enough is being done and the €233 fine that is slapped on a first offender does not seem to deter smokers from lighting up.

“We suspect owners of nightclubs, band clubs and places of entertainment are not ensuring the law is enforced for fear oflosing out on their business,”Dr Xuereb said.

His argument is backed by an exercise carried out by The Sunday Times in February 2010 when 14 bars in Paceville were visited over two evenings to witness how smoking restrictions were being enforced – revellers were smoking with impunity and on one occasion included a bartender and a police officer in uniform.

This raises the question whether the government’s decision to extend the ban to all public places from 2013 – it will be illegal to smoke anywhere inside a public place, including designated areas – will have any significance for Malta’s premier nightlife district.

Dr Xuereb believes the fear entrepreneurs keep bandying about that business will suffer as a consequence of banning smoking does not hold.

He referred to a study in Italy in 2009 that looked into the impact the smoking ban had on bars, cafes, and restaurants.

It showed 10 per cent of Italians were frequenting these places more often, compared with seven per cent who went less frequently.

This was a clear sign people preferred to be in a smoke-free environment and health authorities had to be made aware of this as businesses tended to pander for just a third of the population who were smokers.

The impact of second-hand smoke is often underestimated. Dr Xuereb referred to a 1992 study by the American Heart Association showing those exposed to environmental tobacco smoke at home had their risk of death due to heart disease increase by approximately 30 per cent.

“Maltese authorities were among the first to introduce the ban in Europe and they deserve a pat on the back for this, but unfortunately, we didn’t get the results,” Dr Xuereb said.

He is urging authorities to take bolder decisions that restrict smoking in places such as cars, in stadiums, public gardens and on beaches.

Were such measures not too drastic? And if there was so much environmental pollution, why was all the focus on smoking?

“True, pollution is a major health risk and action should be taken, but equally we need to reduce the impact of tobacco on non-smokers – smokers are a health hazard to non-smokers,” he said.

Malta will not be the pioneer if it adopts what Dr Xuereb is recommending, and other countries are now more ahead of the game. In May, New York introduced a smoking ban in Central Park, and last year Venice decided smokers could no longer light up at city beaches and parks.

Just last week, the British Medical Association called for all smoking to be banned in cars across the UK to protect people, especially the young whowere more vulnerable, fromsecond-hand smoke.

Dr Xuereb believes the situation in Malta is “very sad”, especially since cardiologists believe smoking-related “heart attacks can not only be prevented but eradicated”.

The team involved in this research include: Sandra Distefano, Neville Calleja, Victor Grech, Kathleen England, Miriam Gatt, Joseph Cacciottolo and Stephen Fava.

The facts

32% of men and 21% of women in Malta are smokers.

Of the smokers, 72% usually smoke 20 cigarettes a day; 20% smoke between 20 and 40; and 2.5% smoke more than 40cigarettes a day.

Passive smoking is highest in entertainment places (28%),followed by the workplace/school (24%) and at home (20%).

The proportion of 15-year-olds who smoke in Malta is higher than that of countries such as Italy and England – 10% of boys and 14% of girls.

Source: The 2008 European Health Interview Survey.

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