HOW SPANIARDS FORCED THE CHANGE OF THE PARTIAL SMOKING BAN
Joseba Zabala, Citizen’s initiative “Por qué nosotros no?”; Action Plan on Drugs, City of Vitoria-Gasteiz
The Spanish Smoke-free Law of 2005 was born with a great weakness: the lack of understanding by the public, which subsequently would lead to a lack of compliance. The so-called “Spanish Model” stimulated smoker bars and was only defended by the tobacco industry. From 2005 on, the tobacco control movement in Spain expected the great opportunity to fight politically for a definite change in the smoke-free law. The Spanish National Committee for Tobacco Prevention (CNPT) made up by over 40 health organizations led the movement towards a change of the partial ban. We knew that scientific evidence was not sufficient for the change of the law and was essential to create a citizen movement to reach this target—such a movement did not exist previously. The purpose of this movement was to achieve smoke-free environments in hospitality venues without exceptions.
The citizens’ initiative “Por qué nosotros no?” (“why not us?” In English) (www.porquenosotrosno.org) was born from this collaborative work between scientists and citizens, and promoted by the CNPT. Its slogan was “212 million Europeans living with smoke-free bars and restaurant. Applying new strategies based on social marketing, in December 2009, this citizen movement achieved a massive membership, over 260 civil organizations supported by more than two million citizens. During five years, “Por qué nosotros no?” collective work generated great social debate about public health in Spain. Spontaneously and naturally with the new tobacco law in 2010 we had experienced a great change in social life style in Spanish society. The social debate about the wrongly called “anti-tobacco law” has been permanently in the media facilitating the widespread acceptance and compliance of the law.
This public support is the greatest strength of the current tobacco law. The citizens’ initiative “Por qué nosotros no?” has become “Porque nosotros sí!” (“Because we can!”). Its new challenge is to defend and extend the new Spanish smoke-free model. The initiative has been awarded with the Queen Sofia Award for Drug Addiction for its social communication strategy. We are confident that this simultaneous strategy between science and citizenship for the defense of smoke-free areas without exception is a new suitable model for the implementation of new laws in new smoke-free countries across the world.
EVIDENCE-BASED FAILURED OF THE PARTIAL SMOKING BAN: CONTRIBUTIONS OF SCIENTISTS
Maria J. López, Public Health Agency of Barcelona
A partial smoking ban came into force in Spain in January 2006. Not surprisingly, this law was being promoted by the tobacco industry in other countries as a model of smoke-free legislation, citing arguments such as ‘tolerance for smokers’ or even the potential losses that the hospitality sector could suffer with a total ban. Different scientific projects were carried out in order to assess the real impact of this law in several outcomes such as secondhand smoke exposure or health effects. The objective of this communication is to review these studies and show some of the main results.
Most of the scientific projects carried out were “before-and-after” evaluation studies, using indicators based on secondhand smoke (SHS) markers or different kind of questionnaires. Concerning SHS exposure, some studies measured the changes in SHS levels after the Spanish law by means of environmental and biological markers, such as vapor-phase nicotine or saliva cotinine. These studies showed significant reductions on SHS levels in offices from the public and private sector. At the population level, the prevalence of SHS exposure significantly decreased in workplaces (more than 50% reduction), as shown by national and regional surveys. In hospitality venues, however, significant reductions of SHS levels were found only in those hospitality venues where smoking was totally banned (97% reduction), while in those where smoking was not banned the levels of SHS found were still very high. Consistently, a decrease in reported respiratory symptoms in non-smokers hospitality workers was found only in venues where smoking was totally banned.
In summary, the work of the scientific community has been essential in providing evidence and objective data proving that hospitality workers were still exposed to extremely high levels of SHS after the law. These data contributed to the modification of the 2006 law into the current 2011 law that bans smoking in all hospitality venues with no exceptions.
CONTRIBUTIONS OF THE PUBLIC HEALTH ADMINISTRATIONS TO THE CHANGE OF THE PARTIAL SMOKING BAN
Esteve Saltó, Public Health Agency of Catalonia.
The period before to the enactment of Law 28/2005 (with a partial ban) induced an unprecedented public debate in Spain that led to the crystallization of a strong feeling for the protection against secondhand smoke (SHS). Unfortunately, despite the overall political consensus achieved, a number of negative elements that severely mortgaged the process appeared soon: 1) complexity/ambiguity of the legislative text which hindered its implementation by the authorities, especially regarding to the mixed model in the hospitality sector 2) poor coordination between inter and intraterritorial public administrations with a patchwork of enforcement “à la carte” and even regional decrees that reduced the standards of law, and 3) progressive deterioration of the situation with a growing distance between reality (very heterogeneous depending the territories) and the social norm that demanded a good model.
Initiatives led from professionals, scientists and social agents and the evidence of the inadequacy of the 2005 model, prompted the Ministry of Health to promote in 2010 a legislative change that would allow getting smoke free environments. Despite the reluctance – that still exists – in some sectors, it was possible to generalize the total ban on bars and restaurants and finalizing a model perversely exported. From governmental point of view the process has been possible mainly due to: 1) a legal text (Law 42/2010) clear, with little margin for biased interpretations, 2) the flexible leadership from Public Health Directorate, with strong support from the more active Autonomous Communities, 3) the positive interaction with CNPT, scientists, social groups, trade unions … and 4) the addition of other key measures (public information and structured aid to smokers, in many territories).
Current threats: the failure to keep the favourable social climate, to implement other control measures (such as taxation), the discontinuity at ministerial level and some potential “aggressions” encouraged by severe economic crisis.