In April 2004 smoking was banned in all enclosed public spaces, including public transportation, clubs and restaurants to the combined applause of non-smokers and the grumbling of smokers.
The rationale for smoke-free laws is to protect people from the effects of second-hand smoke, which include an increased risk of heart disease, cancer, emphysema, and other diseases. This would lead to decreased health care costs, reducing government expenditure and increasing national productivity.
A loaded topic
Everyone has an opinion on the smoking ban. Throughout researching this topic anyone I spoke to wanted to steal a few moments (or more) of my time to let me know what they thought about the ban and how it has affected their lives.
This was highlighted to me when an otherwise helpful administrator working at the NSO snarled at me on the phone: “The smoking ban? I’ll tell you what effect the smoking ban has had: three flights of stairs every time I want to smoke a cigarette! And I’m not even a heavy smoker.”
When plans for the ban were announced, strong reactions were voiced throughout Malta from all sectors of society. The Health Promotion Department welcomed the move saying that health care costs would fall and in time the rate of smoking would decrease. Dr Mario Spiteri, director of the Health Promotion Department at the time stated: “Tobacco is known to cause cancer and heart problems apart from other diseases. The amount of money spent to cure these diseases is enormous. In the longer term the country will be saving money by controlling smoking.”
The GRTU and MHRA had reacted against the ban negatively, the GRTU even advocating its members to ignore the ban outright.
The shadow health minister had cried that by passing the ban Malta was effectively damaging tourism by telling potential tourists that they had to quit smoking before they visited Malta.
Non-smokers collectively jumped for joy and their holier-than-thou attitudes increased a notch.
Regardless of all the nay saying and prophecies of doom, after researching the matter the findings were eye-opening and not at all what I would have expected.
Smoking and leisure
Many restaurant, club, and bar owners were initially vehemently against the implementation of a “blanket” smoking ban and during the last five years most have not changed their initial opinions.
At the time the GRTU had argued that the introduction of smoking regulations in such a blanket manner was not “good social engineering”. They also warned of dire economic consequences on the leisure industry and the unfair disadvantage that smaller establishments without access to the outside would face since they would not be able to have a smoking area.
Philip Fenech, president of the hospitality and leisure division of the GRTU and a nightclub owner, reiterated that while the smoking ban has had some positive effects there was still much room for improvement.
“All over Europe measures to curtail smoking have caused rates of smokers to decrease and we are seeing fewer sales via cigarette vending machines now than pre-smoking ban.”
“However, enforcement of the ban is not equal. Enforcement in Paceville is strong during peak times, but enforcement in non-tourist districts is sporadic.”
This sentiment was echoed by Mark Grima, director of Grima Communications and owner of a popular nightclub in Paceville. “Enforcement needs to be done equally everywhere. It is very strict in some clubs, police visit multiple times a night but there are some other clubs which remain untouched. I can’t imagine the police going into band clubs, political party clubs and enforcing the law in there.”
George Schembri, MHRA CEO, carried out a survey among MHRA members to get their opinions on the ban. MHRA members also complained that enforcement of the ban was not equal: “Enforcement is not applied equally with some establishments being targeted more often than others while some other establishments, despite their visibility that they let customers smoke inside, are never brought to book. This creates unfair competition.”
When asked about how they would improve the ban Mr Fenech replied: “A bar/club should be able to choose whether it is a smoking or non-smoking establishment and then advertise the fact using large signage. The customer then decides where to go.”
Mr Grima suggested that the onus of the ban should shift from the club owner to the actual offender: “The government should change who the blame should be put on. They should concentrate only on the clients. No club owner would want to lose his licence for three months. You might as well close your club.”
The MHRA, on the other hand, reported that the effects of the smoking ban have varied depending on the type of business.
“Most hoteliers said that these regulations did not affect them negatively while others added that this has had a positive effect on business both in hotels and catering establishments. Customers have commented that the ban has improved the dining experience. However “stand alone” bars feel that they have been negatively affected and some have difficulty in refraining customers from smoking.”
“Restaurateurs were adversely affected. Following the introduction of the regulations a dramatic fall in orders of liquors and coffees was felt and also smokers sought to eat only in restaurants with outside seating.”
While the effects of the ban on leisure businesses have been mixed, no business figures or statistics are available so there is no way to accurately measure the amount of business generated pre and post the smoking ban.
Smoking and health
In October 2008 various news publications reported that the smoking ban was a success. A study conducted by the anti-smoking campaign HELP: For A Life Without Tobacco measured the difference in carbon monoxide levels since the ban was put in place.
The study found that since the introduction of the ban, tobacco pollution, through carbon monoxide, in non-smokers has halved. The study concluded that owing to the lack of cigarette smoke in public areas since the introduction of the ban, the presence of carbon monoxide in the lungs of non-smokers dropped significantly.
This is an encouraging sign but it is not the entire picture.
According to the Lifestyle Survey 2007, carried out by the NSO, 26.2 per cent of the population smoke compared to 25.7 per cent in 2002. Although that is only a 0.5 per cent increase we would expect to see a decrease due to all the anti-smoking campaigns and legislation that have come into force since 2002.
Mortality figures due to smoking-related illnesses also paint a grim picture. In 2002, 354 people passed away due to smoking-related illnesses while in 2007 the figure was 341. Since 2002 the rate of mortality due to smoking-related illnesses has remained constant.
However, various health registry officials were quick to point out that because of the disease process, a change in data might not show up until a few more years in the future. At this time there is no correlation between the smoking ban and mortality statistics.
The Health Promotion Unit, which offers counselling and runs a number of smoking cessation programmes, could not provide information on whether the number of people who have been trying to quit has increased since the smoking ban because no statistics were taken pre-2004. Anne Buttigieg, the Health Promotion Unit representative mentioned that the amount of smoking cessation classes has increased since 2006.
Smoking and children
With the smoking ban in place and a ban on tobacco advertising throughout the EU since July 2005 one would expect that smoking among children would halt in the coming years.
Happily, since 1999 the rate of smoking among schoolchildren under 16 has been on the decline. However, there was no sharp drop associated with the implementation of the smoking ban in 2004.
The 2007 ESPAD survey (European School Survey Project on Alcohol and Other Drugs) carried out in Maltese secondary schools showed that the percentage of Maltese schoolchildren smokers was below the average of the other countries participating in the survey, with 23 per cent of Maltese children smoking compared to 29 per cent. The survey also showed that the rate of male schoolchildren smokers has decreased since 2004 but the rate of female schoolchildren smokers has not changed.
The International HBSC (Health Behaviour in School-Aged Children) survey carried out in 2007 corroborated the findings in the ESPAD survey.
Malta placed 26th (with an average amount of school-aged smokers) among the 40 countries which took part in the survey for 15 year olds who reported that they began smoking at age 13 or younger. Estonia came in first (the most smokers) while Israel came in last place.
While the rate of smoking among Maltese schoolchildren is on the low side of the scale, the age of initiation to smoking, especially among female schoolchildren, is still one of the highest in the world.
Malta placed seventh for the number of 11-year-olds who smoke at least one cigarette a week. Even more shockingly, Malta placed fourth for the number of 13-year-olds who smoke at least one cigarette a week, with 11 percent of these regular smokers being female, compared to nine per cent being male. The global average for 13-year-old schoolchildren, both male and female, is six percent.
Up in smoke?
So to return to the original question, has the smoking ban had any effect? I can definitely answer that it has affected people on a personal level since everyone I spoke to was able to go on for hours explaining their opinion on the matter: government could do it better, establishments and smokers were still breaking the law, business is down, the smoking ban makes people want to smoke more, passive smoke doesn’t really harm anyone, etc.
To refine the questions then, has the smoking ban had the intended effect?
I would be inclined to say: no. Smoking rates have not decreased and mortality rates have not changed either. Smoking among schoolchildren is decreasing, but has been doing so since 1999, long before the ban was implemented.
On the other side of the fence, even though many club and bar owners have complained that the ban has affected them negatively without cold hard data to back up their claims they cannot be verified either. Hoteliers and some restaurants have seen increases in business. Personally, I have not seen one business go under due to the ban and according to the latest government figures tourism is still going strong.
The only certain conclusion is that the ban has not been the panacea or bankrupter it was portrayed to be and not enough time has passed for any long-term effects to take root.
First published in The Times Weekender April 11.