CHAPTER TWO THE POLICY CONTEXT
This chapter looks at the policy context within which ASH Scotland's effectiveness was assessed in this review. Key points to note are:
- significant moves on tobacco control followed the 1997 UK General Election and the establishment of the Scottish Parliament in 1999
- ASH Scotland undertook significant work and published important policy documents on tobacco control throughout the period 1998-2007
- by 2004 a shift in public opinion on legislating to restrict smoking in public places had taken place
2.1 This chapter looks at the policy context within which ASH Scotland's effectiveness was assessed in this review.
2.2 As has been noted in paragraph 1.8, the focus of this review is the period 2004-07 and, therefore, a key part of the policy context is the lead up to the Smoking, Health and Social Care ( SHSC) (Scotland) Act 2005. Background UK and Scottish policy development since 1998 has been included here to set the wider external environment for ASH Scotland's work.
Key policy initiatives: UK and Scotland
2.3 One of the first significant breakthroughs in respect of tobacco control at UK level was the publication in 1998 of the first White Paper on Tobacco Control, "Smoking Kills" (Department of Health, 1998), by the UK Government. In it the Government set out three key objectives to be reached by 2010:
- to reduce smoking among children and young people
- to help adults - especially the most disadvantaged - to give up smoking
- to offer particular help to pregnant women who smoke
2.4 The White Paper announced a Government investment of £110 million in England (£50 million public education campaign; £60 million smoking cessation services) and £8 million in Scotland (£5 million public education campaign; £3 million smoking cessation services). The Paper set down actions which it deemed to be required on a range of issues, including:
- tobacco advertising, branding and marketing
- under age sales cigarette vending machines
- Nicotine Replacement Therapy ( NRT)
- public education
Towards a Healthier Scotland
2.5 In February 1999, the Scottish Office published its White Paper "Towards a Healthier Scotland" (The Scottish Office, 1999) 5 in which it set targets on a range of health issues, including smoking. The specific targets are contained in Table 2.1 below
Table 2-1 Smoking Targets for Scotland
Headline Targets for Scotland
Smoking among young people (12-15 year olds)
Reduce smoking among young people from 14% to 12% between 1995 and 2005 and to 11% by 2010.
Proportion of women who smoke during pregnancy
Reduce the proportion of women who smoke during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010.
Second Rank Targets
Rate of smoking among adults (aged 16-64) in all social classes
Reduce rate of smoking from an average of 35% to 33% between 1995 and 2005 and to an average of 31% by 2010.
2.6 By July 1999, the new Scottish Parliament had assumed its full powers. The Scottish Government endorsed the UK White Paper and agreed it should be implemented in a Scottish context. In response to a Parliamentary Question, Susan Deacon, then Minister for Health and Community Care, explained the approach of the Scottish Government to "Smoking Kills":
"The Scottish Executive will judge the impact of Smoking Kills in part by measuring Scotland's performance against the smoking targets set out in Annex A of the Public Health White Paper, Towards a Healthier Scotland, which was published in February 1999 (available in the Parliament's Reference Centre). The Executive will also be monitoring progress in a number of other areas to check how the measures are working. Health boards are expected to monitor and evaluate the success of their smoking cessation initiatives. An independent survey on smoking in public places is planned to monitor the impact of the Scottish Voluntary Charter on Smoking in Public Places.6"
2.7 The Scottish Government set up the Scottish Tobacco Control Strategy Group to guide the process.
The Smoking, Health and Social Care (Scotland) Act 2005
2.8 The Scottish Parliament's Health Committee was first asked to consider legislation to restrict smoking in public places in August 1999. One newspaper report on this reflects the context of the time. The Scotsman's report was headed "A controversial move to ban smoking in public places in Scotland is to be considered by MSPs, it emerged last night" (The Scotsman, 1999) 7.
2.9 One member of the Committee, Hugh Henry publicly called for a ban. A fellow member of the Health Committee, Mary Scanlon, responded predicting there would be bitter opposition to the idea. She said:
"This is a touch of the nanny state. The government cannot control every moment of your life. They cannot dictate everything you do. It is up to the individual and individual choice. Individuals have to take responsibility for the effect that smoking has on their health and the health of those around them."
2.10 A BBC Scotland survey of the Committee at the time showed 6 members backing the ban, four against and one member undecided 8.
2.11 The Tobacco Industry, the Scottish Licensed Trade Association ( SLTA) and the Freedom Organisation for the Right to Enjoy Smoking Tobacco( FOREST), the smokers' rights group, were active in their opposition to anything bar a voluntary approach to a smoking ban in public places. FOREST claimed there was no real evidence on the risks of passive smoking and was quoted in an article published in the Daily Mail saying it was "the greatest myth of 20 th Century"9; and wrote in a letter published in the Scotsman that "passive smoking is a hoax by the anti-smoking lobby"10.
Key additional influential publications in Scotland
2.12 Various additional publications (apart from those cited above) were influential in the external policy environment. These were:
- "Improving Health in Scotland - the Challenge" (Scottish Executive, 2003)
- "Reducing Smoking and Tobacco-Related Harm: a Key to Transforming Scotland's Health" ( ASH Scotland & NHS Health Scotland, 2004)
- "A Breath of Fresh Air for Scotland" (Scottish Executive, 2004)
- "Health in Scotland 2003" (Scottish Executive, 2004)
- "Secondhand Smoke: Review of the Evidence since 1998. Update of Evidence on the Health Effects of Secondhand Smoke" (Department of Health, 2004)
2.13 All these publications pointed to the dangers of both smoking and passive smoking; and the benefits to public health of reducing smoking levels and preventing exposure to secondhand smoke.
The Scottish Tobacco Control Action Plan "A Breath of Fresh Air for Scotland" (Scottish Executive, 2004)
2.14 The action plan also upgraded the Scottish Tobacco Control Strategy Group to the Scottish Ministerial Working Group to progress the plan's implementation and develop a future direction of tobacco control policy. The action plan had a number of key priorities, these being:
- Prevention and education
- Provision of smoking cessation services
- Second-hand smoke (passive smoking)
- Protection and controls
- Measuring progress
2.15 It is in the context of that action plan that ASH Scotland's contribution, effectiveness and impact is set for the purposes of the review.
ASH Scotland Contribution to policy development and initiatives
The Women, Low Income and Smoking Project
2.16 Prior to the publication of "Smoking Kills", in 1996, ASH Scotland was already working on issues around inequalities and smoking and had established the Women, Low Income and Smoking Project.
2.17 An important aspect of the Project was the dissemination of findings to policy makers. This dissemination of findings to policy makers in turn informed the development of tobacco control policies in Scotland.
A Smoking Cessation Policy for Scotland
2.18 A Smoking Cessation Policy for Scotland on evidence-based smoking cessation interventions was jointly published in 1998 by ASH Scotland and HEBS ( ASH Scotland & HEBS, 1998).
2.19 The policy was derived from the results of a seminar in November 1997, at which academics, policy makers and smoking cessation practitioners had met to discuss smoking cessation in Scotland. The participants considered evidence about nicotine addiction, the effectiveness and cost effectiveness of interventions, inequalities in tobacco use and the resource implications for Scotland 11.
2.20 ASH Scotland had welcomed "Smoking Kills" stating that it perceived it as "providing an excellent framework for future action. Effective implementation of the paper in Scotland is crucial to its success". In respect of clean air, however, it went on to say:
" ASH Scotland supports legislation to restrict smoking in public places. Studies have shown that workers on low income are most likely to have no protection from passive smoking in the workplace yet cannot afford to lose their jobs. At what stage will legislation be used if targets are not reached? ASH Scotland is disappointed with the emphasis on ventilation systems as they do not adequately protect against the health risks of passive smoking." ( ASH Scotland, 1998) 12
2.21 In addition, it said, in relation to the Approved Code of Practice in the workplace proposed in the White Paper, that " ASH Scotland is concerned that the government has not gone far enough and that the new Code will lack 'teeth'"13.
Smoking in public places paper
2.22 In March of 1999, ASH Scotland had published a policy paper "Smoking in Public Places" ( ASH Scotland, 1999) in which it outlined its position. This was:
"Since 1991 the voluntary code on smoking in public places has failed. A new voluntary approach - as outlined in the White Paper Smoking Kills - is unlikely to succeed.
- Restrictions on smoking in public places will lead to a reduction in smoking prevalence.
- Restrictions on smoking make a strong and symbolic statement about the government's stance on tobacco use.
- Legislative action is the only way to ensure minimum levels of protection for public health.
- The government should introduce legislation restricting smoking in public places."
2.23 After extensive campaigning by ASH Scotland and its partners and collaborators, and widespread consultation by the Scottish Government, both prior to the legislative process and during it, the SCHC (Scotland) Act 2005 received Royal Assent in August 2005. The Act was implemented on 26 March 2006 and a ban in smoking in enclosed public places was instituted.
The formation of alliances and campaigning
2.24 In October 1999, the Scottish Cancer Coalition on Tobacco ( SCCOT) was created by ASH Scotland as an alliance between itself and the leading Scottish Cancer Charities and Scottish branches of UK Charities.
2.25 In 2000, ASH Scotland received funds from the Scottish Government to undertake a consultation process to explore the need for a national tobacco control alliance and the role(s) that it might hold. It then went on to form the Scottish Tobacco Control Alliance ( STCA) with Scottish Government funding, bringing together a multi-disciplinary, multi-sectoral body of over 120 organisations concerned with the impact of tobacco on Scotland and its people.
2.26 ASH Scotland set up Scotland CAN! (Cleaner Air Now) in May 2000. This brought together a wider group than SCCOT and began campaigning for legislation to restrict smoking in public places. In November 2004, it was agreed that SCCOT would no longer exist as a separate coalition, and that it would instead reform under the wider coalition of SCOT (the Scottish Coalition on Tobacco). Scotland CAN! also came under this umbrella.
2.27 The principal period for policy development on tobacco control was from 1998 onwards. ASH Scotland made a significant contribution to the development of such policies both through its own policy development and dissemination of best practice and in collaboration with HEBS and the Scottish Government.