Protection from exposure to second-hand tobacco smoke. Policy recommendations

Scientific evidence has firmly established that there is no safe level of exposure to secondhand tobacco smoke (SHS), a pollutant that causes serious illnesses in adults and children. There is also indisputable evidence that implementing 100% smoke-free environments is the only effective way to protect the population from the harmful effects of exposure to SHS. Moreover, several countries and hundreds of subnational and local jurisdictions have successfully implemented laws requiring indoor workplaces and public places to be 100% smoke-free without encountering significant challenges in enforcement. The evidence from these jurisdictions consistently demonstrates not only that smoke-free environments are enforceable, but that they are popular and become more so following implementation. These laws have no negative impact – and often have a positive one – on businesses in the hospitality sector and elsewhere. Their outcomes – an immediate reduction in heart attacks and respiratory problems – also have a positive impact on health. These experiences offer numerous, consistent lessons learnt, which policy-makers should consider to ensure the successful implementation of public policies that effectively protect the population from SHS exposure. These lessons include the following: 1. Legislation that mandates smoke-free environments – not voluntary policies – is necessary to protect public health; 2. Legislation should be simple, clear and enforceable, and comprehensive; 3. Anticipating and responding to the tobacco industry’s opposition, often mobilized through third parties, is crucial; 4. Involving civil society is central to achieving effective legislation; 5. Education and consultation are necessary to ensure smooth implementation; 6. An implementation and enforcement plan as well as an infrastructure for enforcement are essential; 7. Implementation of smoke-free environments must be monitored and, ideally, their impact measured and experiences documented. In light of the above experience, the World Health Organization (WHO) makes the following recommendations to protect workers and the public from exposure to SHS: 1. Remove the pollutant – tobacco smoke – by implementing 100% smoke-free environments. This is the only effective strategy to reduce exposure to tobacco smoke to safe levels in indoor environments and to provide an acceptable level of protection from the dangers of SHS exposure. Ventilation and smoking areas, whether separately ventilated from non-smoking areas or not, do not reduce exposure to a safe level of risk and are not recommended; 2. Enact legislation requiring all indoor workplaces and public places to be 100% smokefree environments. Laws should ensure universal and equal protection for all. Voluntary policies are not an acceptable response to protection. Under some circumstances, the principle of universal, effective protection may require specific quasi-outdoor and outdoor workplaces to be smoke-free; 3. Implement and enforce the law. Passing smokefreelegislation is not enough. Its proper implementation and adequate enforcement require relatively small but critical efforts and means. 4. Implement educational strategies to reduce SHS exposure in the home, recognizing that smoke-free workplace legislation increases the likelihood that people (both smokers and non-smokers) will voluntarily make their homes smoke-free. WHO encourages Member States to follow these recommendations and apply lessons learnt to advance the goals of public health through legislated implementation of 100% smoke-free environments in workplaces and public places.