A smoking ban is coming to a restaurant and pub near you, but not everybody is cheering. Barry Nelson listens to the arguments further to restrict smoking in public places as outlined in yesterday's Public Health White Paper.
When Bill Kirkup returned to his native North-East in the late 1970s he was shocked at the contrast in health between people in the North and the South.
Born in Newcastle in 1949 - the year after the NHS was set up - he had vivid memories of ships on the Tyne, coal trains and pit-heaps everywhere.
One of his grandfathers worked at Smith's Dock in North Shields and the other was a signalman at South Shields.
While much has changed since his childhood and the North-East is a much more prosperous and cosmopolitan place these days, the legacy of those hard times lives on in the relatively poor health of the region.
One issue in particular gets Dr Kirkup's goat - smoking.
When he was a lad, about two-thirds of people living in the North-East smoked.
More recent figures show that is down to less than a third, but the region has still some of the highest smoking rates in the country and people die an average of two and a half years earlier than their counterparts in the healthier south west of England.
And this is after decades of health promotion information about the dangers of smoking.
Dr Kirkup knows only too well those dangers. Five members of his family died prematurely of heart disease and one of a stroke and he is convinced that all of those smoking-related deaths could have been prevented.
That's why he is enthusiastic about yesterday's Public Health White Paper, which promises radical action to increase the number of smoke-free workplaces.
Under the highly controversial proposals, all restaurants, plus pubs and bars serving food will have to be smoke-free by 2006.
WHILE the health establishment has warmly welcomed the new onslaught against smoking, the smokers' lobby group the Freedom Organisation for the Right to Enjoy Smoking Tobacco (Forest) has reacted angrily, predicting that smokers "will reach for their fags in defiance".
Dr Kirkup is convinced that this move will help to bring down North-East smoking rates and, in turn, reduce premature deaths from heart attacks, strokes, lung cancer, bronchitis and other smoking-related disease.
While some have criticised Health Secretary John Reid for not going far enough and banning smoking in all pubs, Dr Kirkup believes that such a move is only a matter of time and it is important to stay in line with popular feeling.
"This is in line with what the Chief Medical Officer recommended. We cannot afford to go faster than public opinion will let us," he says.
But while Dr Kirkup refuses to criticise Dr Reid's softly-softly strategy, there is no doubting his fervour about taking on the enemy.
Speaking at a special Press conference hosted by the Public Health Group North East in Newcastle, Dr Kirkup hailed the extension of smoking restrictions as a great step forward.
"Potentially, this move has the most far-reaching implication of any measure in the last 50 years, since the link between tobacco and smoking was proven," he says.
He singles out smoking as the single most dangerous factor for anyone's health.
"It is more lethal than Russian roulette. In fact, smoking is the equivalent of playing Russian roulette with three bullets in six chambers because it will kill one in every two smokers. If you smoke you will lose, on average, ten years of life."
While Dr Kirkup is also keen on reducing smoking levels, he is keen to try to protect the thousands of staff who work in smoky restaurants, pubs and bars and welcomes assurances that even in pubs that opt to remain smoker-friendly, measures will have to be put in place to protect bar staff from inhaling other people's smoke.
It is the emergence of the perception that passive smoking is not just an irritant but a positive menace that has probably changed public perceptions of smoking bans.
Recent opinion polls suggest there is an growing majority of people who favour restrictions on smoking.
This has been fuelled by publicity about smoking bans in New York, Ireland and supposedly easy-going California. The Scottish Executive last week agreed to bring forward a ban north of the border.
THE reality is that even macho Australian surfers are subject to restrictions on some of that continent's most famous beaches, as the tide turns, apparently inexorably, against smokers.
Ian Willmore, spokesman for the anti-smoking group Action on Smoking and Health (Ash) has been arguing that we should call time on smoking.
"Secondhand smoke is a killer. Whatever the tobacco industry and its allies may pretend, the science on this point is quite clear. Breathing in the smoke from other people's cigarettes is bad for your health," he says.
The British Medical Association estimates that secondhand smoke causes at least 1,000 premature deaths a year in the UK and many thousands of illnesses, asthma attacks and hospital visits. Secondhand smoke has been linked with heart disease, stroke and Sudden Infant Death Syndrome.
Mr Willmore argues that, with secondhand smoke containing poisonous chemicals such as benzene, arsenic, formaldehyde, DDT and ammonia, it is wrong to allow an estimated three million employees to be regularly exposed to secondhand smoke in the workplace.
Anyone who doubts that smoking is harmless should stick around when it's time to redecorate and watch "heavy yellow tar being scraped off the walls," he says.
The Health and Safety at Work Act is supposed to stop employers from exposing their employees to preventable risks, but huge numbers of staff are still working in a smoky atmosphere.
Mr Willmore believes it is only a matter of time before a bar or restaurant worker issues a writ.
Pro-smokers argue that a good ventilation system is probably all you need to take away unwanted smoke.
But Mr Willmore says that even the most expensive systems on the market cannot take all of the dangerous chemicals out of the atmosphere fast enough to prevent damage to health.
He is also dismissive of the smoking lobby's argument that it is every man or woman's right to smoke or not to smoke.
"This is a deliberate misrepresntation of the true liberal argument that any individual is free to do as they choose unless they do things which cause direct harm to others. Smoking does do harm to others; your freedom to smoke ends at my nose," he says.
Ash also shoots down arguments that a smoking ban would be disastrous for trade, citing the example of New York.
Earlier this year, the City Finance Commissioner in New York, Martha Stark, revealed that the Big Apple's bars and restaurants had paid the city 12 per cent more in business taxes in the months since the ban began than they did in the corresponding six month period in 2002.
NONE of these arguments cut anyice with Forest. Director Simon Clark says: "The Government has ignored public opinion and surrendered to the vociferous anti-smoking minority. Most people want more no-smoking areas and better ventilation in all pubs and bars. They do not want a complete ban on public smoking enforced by an army of tobacco control officers.
"We support further restrictions but we vehemently oppose this systematic attempt to demonise smokers and their perfectly legal habit."
He adds: "If the aim is to get smokers to quit it won't work. Despite increasing restrictions and numerous anti-smoking initiatives, smoking rates in the UK havefallen by just two per cent in 12 years. Far from giving up, smokers will reach for their fags in defiance."
But Dr Kirkup believes that with around 70 per cent of smokers wanting to g ive up the more extensive ban will give many people the incentive they need to quit. "The reality is that smoking is one of the major causes of health inequality in this country and this help us to close the gap," he says.
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