Aamchi Mumbai: Smoke Free Mumbai – The Rationale and Implementation

Dr Surendra S. ShastriProfessor and Head, Department of Preventive OncologyHead, WHO Collaborative Centre for Cancer Prevention, Screening and Early DetectionTata Memorial Hospital, MumbaiChairperson, Aamchii Mumbai: Smokefree Mumbai Campaign

U.S. Surgeon General's report on secondhand smoke (June 27, 2006)

• The scientific evidence is indisputable that secondhand smoke is not a mere annoyance but a serious health hazard that causes premature death and disease in children and nonsmoking adults.

• Secondhand smoke is a proven cause of lung cancer and heart disease in nonsmoking adults and of sudden infant death syndrome (SIDS), low birth weight, acute respiratory infections, ear infections and asthma attacks in infants and children.

• There is no risk-free level of exposure to secondhand smoke.

• Exposure to secondhand smoke has substantial and immediate adverse effects on the cardiovascular system.

• The only way to protect nonsmokers from secondhand smoke is to require smoke-free workplaces and public places.

• Other approaches, such as air ventilation systems and smoking and non-smoking sections, do not eliminate exposure to secondhand smoke.

• Smoke-free policies do not have an adverse economic impact on the hospitality industry.

• people around the world are speaking up for their right to breathe clean, smoke-free air. 

• a growing number of cities, states and countries are enacting laws that require all workplaces and public places to be smoke-free [Bermuda, Bhutan, France, Iceland, Ireland, Italy, Lithuania, New Zealand, Norway, Panama, Sweden, Thailand, Turkey, the United Kingdom and Uruguay. Most Canadian provinces/territories and Australian states/territories have also enacted such laws].

• Common arguments that are advanced against smoke-free restaurants, bars and hotels:

1. Laws to prevent smoking in bars will not be effective: Four years after the California ban on smoking in restaurants, bars and hotels, adherence with the law was 99%. Almost 100% adherence has been reported from Boston, Ireland, and New Zealand.

2. The general public will not accept smoke-free restaurants, bars and hotels: International studies show that most people support smoke-free bars and restaurants and Public opinion becomes increasingly positive following smoke-free legislation.

3. Smoke-free laws will cause economic losses to the restaurants: Using sales tax receipts and other objective financial data, studies now conclusively demonstrate that bars, restaurants, and hotels do not lose revenue after becoming smoke-free. In fact, some of these studies actually show a growth in income.

• In sum, smoke-free legislation is effective, accepted by the public, and has no negative economic impact.

• After 10 years of partial and voluntary controls on smoking in public and workplaces failed, on March 29, 2004, the Irish government introduced the world's first comprehensive national ban on smoking in public and workplaces.

• Effects of the Irish Smoking Ban on Respiratory Health of Bar Workers and Air Quality in Dublin Pubs: Patrick Goodman et all [American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 840-845, (2007)]

• Concentrations of particulate matter and Benzene were measured and compared before and after the ban in 42 pubs. 81 barmen had full pulmonary function studies, exhaled breath carbon monoxide, and salivary cotinine levels performed before the ban and repeated 1 year after the ban.

• There was an 83% reduction in PM and an 80.2% reduction in Benzene concentration in the bars. A 79% reduction in exhaled breath carbon monoxide and an 81% reduction in salivary cotinine along with significant improvements in measured pulmonary function tests and significant reductions in self-reported symptoms and exposure levels was recorded in nonsmoking barmen volunteers.

• The US State of California passed a law in 1998 that prohibited smoking in all public places and work places, including restaurants, bars and hotels.

• Analysis of responses of Long Beach, California residents to the Smoke-free Bars Law: R.H. Friis et al: Public Health Vol. 119, Issue 12, December 2005, Pages 1116-1121

• A survey was conducted in 1998 and 2000 in Long Beach, California, to determine the degree of community support for the smoking ban.

• Statistical analyses using univariate frequency distributions and logistic regression showed that the overall community approval for the 1998 state law increased from 65.2% in 1998 to 72.6% in 2000.

• Over this period, the rate of approval by smokers increased from 20.6% to 37.1%, and the rate of approval by non-smokers increased from 74.5% to 80.3%.

• On March 30, 2003, New York City implemented a comprehensive ban prohibiting smoking in all of the city’s restaurants and bars. In March 2004 a report issued by the New York City Department of Finance, Department of Health noted that:

• Business tax receipts for restaurants and bars increased 8.7 percent from April 1, 2003, to January 31, 2004 compared to the same period in 2002-2003.

• Employment in New York City restaurants and bars increased by 10,600 jobs.

• A survey of over 30,000 New York restaurant-goers found that 23 percent of respondents said they are eating out more often since the

city’s Smokefree laws, only four percent said they are eating out less.

• A 2002 survey of California restaurant owners, managers and bartenders found overwhelming support for the state’s smoke-free bar law, with 83 percent saying they think the smoke-free workplace law protects their health and the health of other bar employees, and 77 percent of bar managers and employees saying that complying with the law has been "very" or "fairly" easy.

Smoke-Free Mumbai: Stake Holders

• Maharashtra State Government: MOH, FDA, Home (Police), Education, Tourism, Factories Insp.

• Municipal Corporation of Greater Mumbai: Public Health, Medical Services, PRO

• BEST, Railways

• Hotels and Restaurant owners and Employees Associations

• Tata Memorial Centre (Hospital)

• NGOs (ACT-India, Healis, Salaam Bombay, Cons Org. and other Civil Society)

• Medical-Dental Associations

How do we do it?

• Human resource development

• Legislative interventions

• Educational interventions

• Workplace interventions

Legislative Interventions

• Advocacy for enforcement

• Enforcement of existing laws

• Fixing responsibility for enforcement

• Mechanisms for reporting violations

Advocacy for Enforcement of Exisiting Law

• Advocacy with elected representatives

• Advocacy through Media

• Advocacy at public level

• Education and awareness campaigns through schools, colleges, radio, television, print media,bill boards.

• Workplace awareness programmes

• Special programmes for unorganised employment sectors(Mathadi Workers)

• Zero tolerance policies in educational institutions,health care institutions,public places including restaurants and stadiums

• 11-Day Ganesh Festival• 9-Day Navratri Festival• Mumbai Festival• Kalaghoda Festival• Banganga Festival• Youth Festivals and College Social Events: Mood Indigo,

Malhar• School and University Sports Events • Mumbai Marathon

Awareness thro’ Religious and Social events

Educating all Stakeholders

Reducing Secondhand Smoke Exposure

• At Homes thro’ Education

• At Public Places and Workplaces thro’ Education and Legislation

Campaign Monitoring and Evaluation

• Baseline surveys

• Opinion polls through SMS, Radio, T.V surveys.

• Baseline and end point surveys will help determine the public demand for smoke free places during various phases of the project

• Time line: August 1, 2008 – May 2010

Human Resource Development

• Municipal Health Care Providers

• Municipal School teachers

• All Municipal employees

• Police force and other Enforcement agencies

• NGOs and Civil society Organisations

• Primary Care Physicians and Dentists

Work-Place Intervention

• Passing Tobacco-Free notification in workplaces

• Training of workers, managers in tobacco control awareness and education

• Training of factory Medical Officers and Social Workers for Counseling, Behavioral and Pharmacotherapy for Cessation

• Awareness and education programmes for owners and employees of hotels, restaurants, bars and sports stadiums

• Monitoring of implementation of the law in hotels and restaurants

Access to Cessation Counselling and Pharmacotherapy

What works in Ireland and New York should work in Mumbai tooThank You for Your Attention