Politicians hesitate despite health hazards

Reuters/Christian Hartmann

Restrictions on smoking in public places are beneficial to the health of restaurant staff, according to new studies. Even though the health authorities acknowledge the findings, they are shying away from supporting tougher anti-smoking laws.

Both the cabinet and health office are calling on voters on September 23 to say no to a proposal from health organisations, which would ban waiter service in smoker’s lounges.

Currently, Switzerland resembles a patchwork rug when it comes to legislation on indoor smoking bans. The federal law introduced in 2010 bans smoking in public places in principle but allows exceptions.

Of the 26 cantons only eight have completely outlawed smoking in restaurants and cafés. In the others, separate smoker’s lounges and/or special bars for tobacco users are permitted. In these establishment, employees must give written consent to work in them.

The latest studies now show that the total bans make healthy sense. A survey carried out by the Tropical and Public Health Institute (TPH) in three cantons found evidence that the health of restaurant staff has improved in smoke-free places.

Led by Martin Röösli, professor for social and preventive medicine at Basel University, the study measured heart rate variability and pulse wave velocity in restaurant employees before and 12 months after implementation of a smoking ban.

“The reduction in environmental tobacco smoke at the work place led to a measurable improvement in cardiovascular health,” researchers said.

In other words, those employees no longer subjected to second-hand smoking have a markedly reduced risk of heart attacks and arteriosclerosis. For waiters in smoking venues, however, this improvement could not be observed, according to the TPH.

These findings appear to back up results from three additional studies carried out in different regions of the country.

Heart failure

In Ticino where smoking in restaurants was limited to special lounges with waiter’s service in 2007, researchers led by Marcello Di Valentino, examined the number of patients admitted to hospital for heart attacks.

Comparing data from before and after the introduction of measures against passive smoking, they found a marked decline in admissions: They were more than 22 per cent and nearly 21 per cent down in the first and second year respectively against a three-year average before the rules on smoking were tightened.

A similar study carried out in canton Graubünden appear to confirm the Ticino results. A team by cardiologist Piero O. Bonetti in Chur found a 21 per cent decrease in acute heart failures.

As part of the health study in Graubünden, scientist also likened their results with figures from Lucerne, a canton which had no restrictions before 2010. Here cases of heart failure were on the increase before nationwide minimum rules were passed by parliament.

Pneumonia

Finally a study of cases of pneumonia and acute exacerbation of chronic inflammation of the lung in canton Geneva showed a 19 per cent decline in hospital admissions after an outright smoking ban in restaurants and bars was introduced in 2009.

“This is the first time we have scientific evidence of this impact,” says study director Jean-Paul Humair.

Scientists also found a reduction in diseases of the heart or blood vessels. However, Humair says the statistical evidence was not sufficient to link the facts beyond reasonable doubt.

He adds that Geneva had gradually introduced smoking bans in public venues and work places at the start of the last decade. Therefore, cases of cardiovascular diseases may have started to decrease already at the turn of century, Humair adds, while the study only looked at the 2006-2012 period.

Contradiction?

The results are fully acknowledged by the Federal Health Office. Patrick Vuillème, biologist and expert on tobacco prevention, commends the studies for their “high quality” and describes their methodological approach as “rigorous”.

Interior Minister Alain Berset and the head of the Federal Health Office, Pascal Strupler, have both mentioned the results of the studies at a news conference in the run-up to the nationwide vote while stressing the serious health hazards of second-hand smoke.

And the government and the Health Office warn in their official documentation that exposure to tobacco smoke “is never harmless”.

But despite agreeing with the promoters on the aim of the initiative against passive smoking, they have recommended that voters reject the proposal. The current law has had a positive impact and a further tightening of rules is premature, they argue.

The statements might leave many a citizen wondering whether the authorities are contradicting themselves.

“Certainly not!” says Health Office biologist Vuillème.

The cabinet and the administration have to consider scientific as well as health aspects, while taking into account political viewpoints, Vuillème explains.

The minimum anti-smoking legislation passed by parliament two years ago followed tough discussions which resulted in a compromise.

“The government is bound by decisions of the parliament and the federal administration must not contradict the government. And ultimately voters have the final say,” says Vuillème.

Context

Parliament in 2010 agreed minimum rules to protect non-smokers against second-hand smoking at indoor workplaces, including restaurants.

The law allows exceptions, including special cafés or smoker’s lounges with waiter service.

Only eight out of the 26 cantons, particularly in western Switzerland, have introduced strict smoking bans in restaurants.

The Lung League collected enough signatures for a vote aimed at imposing an outright ban nationwide.

Under the Swiss constitution cantons have wide-ranging autonomy over public health and other issues.

Smoking in Europe

Smoke-free rules in restaurants and bars vary across Europe, according to a survey by the Federal Health Office. Implementation of the bans is not always consistent.

Britain, Ireland and Spain, Norway and Greece have imposed an outright ban.

In France, Italy, Sweden, Poland, Finland, Belgium as well as Estonia and Malta only smoker’s lounges without waiter service are tolerated.

All other European countries, including Switzerland, have patchy legislation, partly allowing special smoker’s lounges and bars.

(Adapted from Italian by Urs Geiser)