Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
THE ECONOMIC IMPACT OF
SMOKE-FREE WORKPLACES:
An Assessment for Nova Scotia
June, 2001
The Bad News
•30% of Nova Scotians smoke, the highest rate of
any province in the country (CTUMS 2000).
•38% of 20-44 year olds smoke.
•42% of children under 12 are regularly exposed to
environmental tobacco smoke (ETS) in the home.
•24% of Nova Scotians are exposed to ETS at work.
The Good News
– “My government is committed to reducing Nova Scotia’s
excessively high rate of smoking, as well as the huge costs
it imposes on our health care system.
– “As part of our initiatives to encourage healthy living, we
will introduce a Comprehensive Tobacco Control
Strategy, aimed at reducing consumption, limiting
exposure to second-hand smoke, and creating awareness
of the deadly and costly effects of smoking.”
– Speech from the Throne, Nova Scotia, March 22, 2001
“The Deadly and Costly Effects of
Smoking”
• Smoking kills 1650 Nova Scotians a year
• Smoking costs NS $168 million/year in health
costs
• Second-hand smoke kills 200 Nova Scotians a
year,(140 from heart disease, 60 from cancers).
• Second-hand smoke costs $21 million a year in
health costs and $57 million in productivity
losses
The Deadly Effects of ETS
• ETS causes heart disease, lung cancer,
nasal sinus cancer and respiratory
ailments in adults.
• ETS causes sudden infant death syndrome,
fetal growth impairment, bronchitis,
pneumonia, middle ear disease and
asthma exacerbation in infants and
children.
Health Hazards of ETS
Recognized by:
 World Health Organization (1986 and 1999),
 U.S. National Academy of Sciences/National Research Council (1986),
 Australian National Health and Medical Research Council (1987),
 U.K. Department of Health and Social Security (1988),
 U.S. Environmental Protection Agency (EPA) (1992),
 U.S. Public Health Service (1986),
 U.S. National Institute for Occupational Safety and Health (1991),
 American College of Occupational & Environmental Medicine (2000),
 California Environmental Protection Agency (1997),
 The Australian National Health and Medical Research Council (1997),
 United Kingdom Scientific Committee on Tobacco and Health (1998)
 U.S. National Toxicology Program (9th Annual Report on Carcinogens,
2000)
Recent Research Also Shows:
• ETS has been linked to cervical and breast
cancer, stroke, and miscarriages in adults;
and to asthma induction, decreased lung
function, cystic fibrosis, and cognition and
behaviour problems in children
Restaurant, Bar and
Casino Workers Most at
Risk
• In restaurants, second-hand smoke levels are twice as high
as in other workplaces without smoke bans. In bars and
casinos they are 3-6 times as high.
• Food service workers have a 50% higher rate of lung
cancer than the general population.
• Excess mortality for workers in smoking lounges, bars,
restaurants, casinos and bowling alleys is 15-26 times
higher than OSHA’s “significant risk” level.
• “Establishment of smoke-free bars and taverns was
associated with a rapid improvement of respiratory
health….” Eisner, 1998
Costs of Second-Hand Smoke,
NS, 1999
• Deaths
200
• Potential years of life lost 2,900
• Hospitalizations
• Hospital Days
1,400
15,000
Direct Health Care Costs of ETS
($1999 mill.)
• Hospitals
15.2
• Ambulance Services
0.3
• Physician fees
1.5
• Prescription Drugs
3.2
• Other Health Care Costs
0.3
• Total Direct Health Care Costs
20.5
Indirect Costs of ETS ($1999
millions)
• Productivity loss (sickness)
0.7
• Productivity loss (mortality) (6% discount
rate)
57.1
• TOTAL COST TO ECONOMY77.6
Sources: Costs based on Canadian Centre for Substance Abuse, The
Costs of Substance Abuse in Canada, Colman, The Cost of Tobacco
in Nova Scotia, pages 15-20, and mortality rates in Glantz and
Parmley, (1995), op. cit., and Steenland, (1992),op. cit..
Do “Non-Smoking” Areas
Provide Protection from ETS?
• “Simple separation of smokers and non-smokers
within the same air space ... does not eliminate
exposure of non-smokers to environmental tobacco
smoke.”
U.S. Surgeon-General and National
Research Council
• The ‘non-smoking’ (casino) tables, as currently
situated, did not measurably decrease employee
exposure to ETS.” U.S. National Institute for Occupational
Safety and Health
• “…Simple separation of smoking and non-smoking
indoor workers fails to prevent involuntary exposure
to ETS.” American College of Occupational and Environmental
Medicine (2000)
The “Courtesy of Choice”
Program
• “Courtesy of Choice makes it possible for smokers
and non-smokers to live in harmony. It is a
program of self-regulation that uses scientific
air-flow analysis to guarantee that non-smoking
areas are truly smoke-free....(It) involves
effective ventilation and filtration systems to
ensure that smoke and other contaminants in the
air are removed.”
Hotel Association of Canada
• The Canadian Tobacco Manufacturer’s Council
has given the Hotel Association of Canada $3.2
million to implement its “Courtesy of Choice”
program.
Does Ventilation Protect
from Second-hand
Smoke?
“Accommodation of tobacco smoke in the
workplace, the solution proposed by the tobacco
industry, was found to have no basis in science or
public health protection.... The ventilation system
capable of removing tobacco smoke from the air
does not exist…. ASHRAE no longer provides
ventilation standards for air with tobacco smoke
in it, only for air in smoke-free buildings....
Ventilation provides no solution to the
problem of exposure to second-hand
tobacco smoke.”
Ontario Tobacco Research
Unit, University of Toronto (2001)
Would restaurants build
ventilated smoking
areas?
A random survey of 401 Quebec
restaurants found that most
would not construct ventilated
smoking areas, even if they were
effective, for financial and
technical reasons.
Cremieux and Oulette, 2001
Therefore:
• “A limited policy offers no advantage over no policy at all….
(T)he only way to protect nonsmokers’ health is with a smokefree work site.”
Borland,
JAMA
• U.S. Surgeon-General recommends: “100 percent smoke-free
environments in all public areas and workplaces, including all
restaurants and bars.”
• “All involuntary exposure to tobacco smoke is harmful and
should be eliminated.”
Ontario Tobacco Research Unit, University
of Toronto (2001)
• Smoking bans remain the only viable control measure to
ensure that workers and patrons of the hospitality industry
are protected from exposure to the toxic wastes from tobacco
combustion.” Repace (2000)
Smoke-Free Workplaces Will Save
Lives and Money
• 80% of ETS exposure is in the workplace.
• Smoke-free workplaces cut cigarette
consumption among smokers by 20%.
• Smoke-free workplaces can save 400-500
lives a year, $50 million in avoided health
costs, and $150 million in avoided
productivity losses.
And savings to employers:
• It costs Canadian employers $2,280 more to
employ a smoker compared to a non-smoker.
Conference
Board of Canada
• Smoke-free workplaces can save NS employers
$25 million a year in avoided absenteeism and
smoking areas costs, and lower insurance
premiums.
• “Strong economic incentives exist for rapid
adoption of smoke-free workplaces.”
American College of Occupational and Environmental
Medicine
Occupational Health and Safety
Laws
“require employers to provide a safe working
environment”
• “Employees...should have the right to refuse to work
in environments with high levels of ETS….
Canadian OHS legislation that could apply
indirectly to ETS include the regulation of
substances found in tobacco smoke (possibly
through the national Workplace Hazardous
Materials Information System.”
Health Canada
• Smoke-free workplaces avoid potential
litigation based on unhealthy
workplaces.........
Nova Scotia’s 1996 Occupational
Health and Safety Act (chapter 7),
section 13 (1)
• requires every employer to “ensure the health
and safety of persons at or near the
workplace” and to ensure “that employees
are not exposed to health or safety hazards.”
Employers shall “render harmless all gases,
vapours, dust or other impurities that are
likely to endanger the health or safety of any
person therein.”
Are Smoke Bans Bad for
Business?
• Without exception, every objective study using actual
sales data finds that smoke-free legislation has no
adverse impact on restaurant, bar, hotel and tourism
receipts. (Studies conducted in California, Colorado,
Massachusetts, New York, Arizona, Texas, Utah, Vermont, North
Carolina, and British Columbia.)
• Two of the 16 studies found an initial decline in
receipts in the first 1-2 months following enactment,
but no overall or aggregate decline in the longer term.
• Several studies find smoke-free legislation is good for
business as non-smokers eat and drink out more
often.
The Researchers Conclude:
– “Legislators and government officials
can enact health and safety regulations
to protect patrons and employees in
restaurants and bars from the toxins in
secondhand tobacco smoke without fear
of adverse economic consequences....
these data further discredit tobacco
industry claims that smoke-free bar laws
are bad for the bar business. Quite the
contrary, these laws appear to be good
for business.”
Glantz 1997 and 2000 (California)
Conclusions from the 16
Studies
• “All models indicate that smoke-free
restaurant restrictions increased restaurant
receipts in towns adopting smoke-free
policies, by 5 to 9 percent.”
Pope & Bartosch, 1997 (Mass.)
• “Other cities can enact similar laws, which
protect restaurant patrons and food service
workers from tobacco smoke, without
concerns that restaurants will lose business.”
Sciacca & Ratcliffe (Az)
More Conclusions:
• “Smoke-free restaurant ordinances did
not hurt, and may have helped,
international tourism” From tourism/hotel
sales in 6 U.S. States
• “The statistical results strongly confirm
that there are no long-term impacts from
restrictive smoking regulations.”
CRD,
BC, 2000
• “Nine months after tough anti-smoking legislation
was imposed in B.C.’s capital, business remains
steady and liquor sales are up….”
Victoria, B.C. 1999
• “In one study after another, covering multiple states
within the US, analysts have found no adverse effect
of smoking restrictions, including complete bans, on
local restaurants’ business. Indeed, several of the
studies have found a tendency for smoking
restrictions to increase business. Similar findings
derive from analysis of the effects of smoking
restrictions on bars ...(and) tourism.”
Warner, 2000
Smoke Bans May Increase
Sales
“Our results indicate that these nonsmokers are more
than making up the revenues lost from
inconvenienced diners who smoke.... At the very
least restaurateurs should make business decisions
based on data, not opinion. Ultimately, smoke-free
legislation is likely to have a positive impact on
restaurant-industry revenues. Our advice to other
cities and municipalities is to consider similar
legislation. The restaurant industry collectively
may experience higher revenues through smokefree legislation.”
Cornell Hotel and Restaurant Administration Quarterly, 1996
Restaurateur Fears
Unfounded
A survey of Arizona restaurateurs before
smoke-free legislation found 44%
concerned that customers would be upset.
Afterwards, the same restaurateurs
reported that most customer reactions
were positive. Only 15% found negative
reactions. 88% said the law was positive or
neutral for staff, and 94% said it was easy
to enforce.
Sciacca 1996
The Politics of Smoke-Free
Legislation
• The tobacco industry resists smoke-free legislation
by:
• Denying the overwhelming scientific evidence on the
health hazards of ETS, finding fault with study
methodologies and funding scientists to publish
articles to that effect.
• Working through third parties, especially restaurant,
bar and hotel associations by spreading fears (never
empirically substantiated) that the legislation will
harm their business.
• Watering down legislation; delaying its
implementation; shifting the focus of debate from
public health to market choice and self-regulation; and
arguing that ventilation can remove ETS despite
In the Tobacco Industry’s Own
Words:
• “The immediate implication (of smoking bans)
for our business is clear: If our consumers
have fewer opportunities to enjoy our
products, they will use them less frequently
and the result will be an adverse impact on
our bottom line”
(Philip Morris)
• “Our objective is to contain and refine the
environmental smoke issue in order to
decrease the pressure for safety measures….”
(Tobacco Institute)
In the Tobacco Industry’s Own
Words:
• “TAC (Tobacco Advisory Council) hopes to
(1) create ‘marketable’ science, (2) to deflect
criticism of ETS, and (3) to place the
industry in the most favorable position
possible” (Philip Morris)
• “Obviously I am very much against
anything that tries to reduce consumption of
a legal product that is used by adults.”
(CEO, Imperial Tobacco)
Creating “Marketable
Science”
“Philip
Morris then expect the group of
scientists to operate within the confines of
decisions taken by PM scientists to
determine the general direction of research,
which apparently then be “filtered” by
lawyers to eliminate areas of sensitivity.”
(Philip Morris)
Creating “Marketable
Science”
To subvert the International Agency for Research
on Cancer study on ETS, Philip Morris
determined to:
“Delay the progress and/or release of the study; Affect
the wording of its conclusions and official statement
of results. Neutralize possible negative results of the
study, particularly as a regulatory tool. Counteract
the potential impact of the study on governmental
policy, public opinion, and actions by private
employers and proprietors”
(Philip Morris)
Who is Paying the Piper?
An analysis in the Journal of the American
Medical Association found 39 out of 106 review
articles that did not find passive smoking to be
harmful to health, and examined author funding
for these articles:
“Tobacco industry affiliation was the only
factor associated with concluding that
passive smoking is not harmful to health in
the multivariate analyses.…”
Who is Paying the Piper?
“These findings suggest that the tobacco
industry may be ... flooding the
scientific literature with large numbers
of review articles supporting its position
that passive smoking is not harmful to
health.... (T)he conclusions of a review
article may be suspect whenever the
author has a financial interest in the
outcome of the review.”
JAMA 1998
If No one Believes You, Use
Others
“…The economic arguments often used by the
industry to scare off smoking ban activity
were no longer working, if indeed they ever
did. These arguments simply had no
credibility with the public, which isn’t
surprising when you consider our dire
predictions in the past rarely came true”
(Philip Morris)
If No one Believes You, Use
Others
“Evidence from tobacco industry documents now
on the public record proves the existence of an
extensive industry campaign to undermine the
scientific consensus on the health risks of
second-hand smoke. A particular target of this
campaign has been the hospitality industry,
whose representatives have (often unwittingly)
repeated tobacco industry arguments against
second-hand smoke controls in their
establishments.”
Report to Ontario Minister of Health, 1999
Using “third party
sources” to gain
credibility:
“…We try to keep Philip Morris out of the
media on issues like taxation, smoking bans,
and marketing restrictions. Instead we try
to provide the media with statements in
support of our positions from third party
sources, which carry more credibility than
our company and have no apparent vested
interest….”
(Philip
Morris)
...and talk about anything
except public health:
We try to change the focus on the issues. Cigarette tax
become(s) an issue of fairness and effective tax
policy. Cigarette marketing is an issue of freedom of
commercial speech. Environmental tobacco smoke
becomes an issue of accommodation. Cigaretterelated fires become an issue of prudent fire safety
programs. And so on.” (Philip Morris)
“Portray the debate as one between the anti-tobacco
lobby and the smoker, instead of ‘pro-health public
citizens versus the tobacco industry.’”
(Philip
Morris)
What Enables Smoke-Free Legislation
to Succeed?
• Legislators must be well aware of the facts and evidence and
also of tobacco industry strategies to prevent smoke bans.
• An in-depth analysis of the politics of tobacco control in
California also concluded: “Despite the tobacco industry’s
superior financial resources, the outcome of proposed local
tobacco control legislation appears to depend on how seriously
the health advocates mobilize in support of the local
legislation. When the health community makes a serious
commitment of time and resources, it wins. When it fails to
make such a commitment, the tobacco industry prevails, more
by default than by its superior financial resources.” Samuels &
Glantz, 1991
Tourism and Hospitality
Industries Can Protect their
Employees and their
Business
• Smoke bans are popular (76% of Nova
Scotians), and protect hospitality industry
employees who are most at risk from ETS.
• 97.2% of visitors to NS are from other parts
of Canada and the US, where smoke-free
legislation is common.
Tourism and Hospitality
Industries Can Protect their
Employees and their
Business
• The California Restaurant Association fully
supported the smoke-free workplace law that
applies to all restaurants, bars and gaming
places.
• “Why not take the high road and promote
NS as a healthy, trend-setting, visionary,
smoke-free environment – a marketing
opportunity for the new century and new
generation of visitors?”
Response to a TIANS survey on smoke-free legislation
The Evidence Clearly Shows:
• Second-hand smoke causes heart disease, cancer and
respiratory illness. Smoke-free workplace legislation will
save the lives of hundreds of Nova Scotians, prevent
serious illnesses, and save $200 million in avoided health
costs and productivity losses.
• Restaurant, bar and casino workers are exposed to the
highest levels of ETS and have the greatest health risks.
• Designated non-smoking areas and ventilation do not
work. Only 100% smoke-free environments protect
employees/patrons.
• Smoke-free legislation will not harm restaurant, bar, hotel
and tourism sales, and may be good for business.