Stub it out: Smoking laws across the world
Tobacco smoking is one of the most dangerous – yet popular – addictions and vices of all time. The practice of smoking has altered throughout history but today it is a widely accepted habit across the globe.
Over the past few years there have been many attempts to regulate smoking to reduce the number of deaths it causes every year, through direct and passive smoking. Estimations suggest there are 1.1 billion smokers worldwide and according to the World Health Organisation (WHO), smoking is responsible for more deaths than any one single illness, disease or disability. The WHO also believes that by the year 2020, the number of smoking-related deaths will reach 10 million.
The current trend among government and health organisations across the world is to limit who can smoke and when and where they can smoke, measures which are part of the WHO’s Tobacco Free Initiative. Age restrictions have been in place in many countries for years, but recently these have been strengthened and extended. What we are also starting to see is the emergence of smoking ‘bans’. The introduction of these new laws prevents people from smoking in certain areas. For example, offices, work vehicles, public parks, bars and restaurants. Authorities are also trying to implement various restrictions regarding tobacco packaging rules about how tobacco products can be displayed in shops.
Here’s an example of some of the most notable tobacco laws in place in countries across the world:
Although there is no national smoking ban currently enacted in the US, it’s thought 50 percent of states have imposed regulations regarding smoking in workplaces, bars and restaurants. However, states in the South are thought to be tailing behind the rest with seven having not imposed such bans. In May 2011 New York even banned smoking in some outdoor spaces, most notably parks, beaches, promenades and in Times Square. Golf courses and sports centres are also affected by the law.
Major smoking laws came into play in the UK between 2006 and 2007. By 1 July 2007, all public spaces (workplaces, work vehicles, bars, clubs and eateries) were designated smoke free areas. Currently the only restrictions prohibiting smoking in outdoor areas in England is in railway stations, bus stations and phones boxes. Scotland was the first to introduce the ban in March 2006, in spaces that were enclosed by more than 50 percent. In Wales, public ‘No Smoking’ signs must be displayed in both English and Welsh languages. In September 2011 cigarette machines were banned from pubs and clubs too. In 2007 the legal age for buying tobacco products in the UK rose from 16 to 18-years-old.
Australia was the first country in the world to enact a law which required all cigarettes and other tobacco-related products to be sold in plain packaging as of December 2012. From then, packaging will be a dark matte brown as standard. Smoking bans vary according to state, but many enclosed public places are smoke-free and there are a number of restrictions in place regarding smoking in vehicles in an attempt to protect children from the effects of second-hand smoke.
New Zealand’s first smoking ban was put in place in 1876 when smoking was prohibited in the Old Government Building in Wellington, but this due to fire concerns as it was the world’s second largest wooden building. Laws preventing smoking in indoor workplaces and hospitality venues came into force in 2004 and studies have found compliance is relatively high. Some outdoor smoking laws are also in place, in school grounds and stadiums, outside some hospitals and on two university campuses.
Although smoking has been banned in all public places in France, designated ‘smoking rooms’ are allowed if they adhere to strict regulations. However, various media reports have suggested enforcement of the bans is fairly lax and French residents deliberately flout the restrictions. In early 2011 it was even reported regulations regarding the promotion of tobacco and smoking were loosened, over concerns the law was affecting the French culture after a number of iconic figures appeared on posters without their trademark cigarettes.
It was not until January 2011 that restrictive smoking laws were imposed in Spain but they are now thought to be some of the strictest in Europe. All inside public spaces are now smoke-free and smoking rooms in pubs and restaurants are not allowed. Smoking on TV programmes is also prohibited. In prisons, psychiatric hospitals and retirement homes smoking areas are available but employees are forbidden from entering them.
In October 2000, South Africa was among the first countries in the world to impose a ban on smoking in public places, including bars and restaurants. However, smoking in a small, well ventilated outside area at these locations is permitted. In 1995 a ban was enforced disallowing those aged under 16 to buy tobacco products, but the government is currently looking at extending this to the age of 18. Tobacco advertising and sponsorships have also been banned, as has the sale of single cigarettes and the distribution of free tobacco.
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NHS staff face severe impact on mental health due to COVID
The decision to drop COVID-19 restrictions in England this month alarmed doctors in the National Health Service (NHS) while hospitalisations are on the rise. At the same time, hospitals have started cancelling operations again adding to the existing backlog of operations, which estimates say could take a year to clear.
Dr James Gilleen of the University of Roehampton and his Covida Project team are warning of the ongoing risks to the mental health of NHS staff, many of whom are traumatised from the first wave of infections. “As the UK continues to see COVID-19 infection numbers rise at a similarly alarming rate as those seen during the country’s second wave, it’s combined with a renewed strain on the NHS and its staff" he said.
The Covida Project is a digital tool created to assess the psychological impact of the COVID-19 pandemic on frontline workers including NHS staff, the police and carers.
“Healthcare workers are already exhausted and burnt-out; they are traumatised from their experiences of working during the pandemic. During the first wave in May 2020, a study from the Covida Project found an unprecedented quadrupling of the number of NHS staff with high levels of anxiety, depression and post-traumatic stress disorder (PTSD) compared to before Covid-19" Gilleen said.
"Having the most severe levels of these symptoms was statistically linked to four key factors - insufficient access or pressure to reuse Personal Protective Equipment (PPE), insufficient workplace preparation, insufficient training and communications, and a higher workload. Staff aren’t just anxious, depressed and traumatised from being over-worked – it is from feeling unsafe and at risk."
The Covida Project found that almost a third of healthcare workers reported moderate to severe levels of anxiety and depression. The number reporting very high symptoms was four times higher than before the pandemic.
Gilleen adds, “With COVID-19 restrictions now fully removed in England, NHS staff face the daunting triple-threat of rising Covid-19 hospitalisations, huge backlogs of medical operations to clear, and the added expectation of large increases in winter flu, which is already being seen even now in summer.
"These difficulties are present at a time when the NHS is already under-resourced, impacted by sickness and/or staff being ‘pinged’ to self-isolate through the government’s track and trace app, and staff continuing to fear the daily risk of infecting family and friends.
"Together these are considerable psychological burdens and create a perfect storm for the mental health and well-being of NHS staff."
Gilleen says there may be worse to come, especially if new, more transmissible variants develop. "Previous research after other pandemics such as SARS has shown that residual mental health symptoms like PTSD can continue for years, so the impact of repeated waves over the long-term will be potentially catastrophic for the mental health of NHS staff.
He has some clear recommendations to protect the wellbeing of frontline healthcare workers. “To protect the mental health of NHS staff they must feel they are less at risk or in danger, have access to the required level of PPE, not be continuously over-worked, with better staffing, more opportunities for rest and space to share their stress.
"Despite this and similar findings from other studies, still not enough is being done to protect NHS staff mental health and wellbeing and we fear it will continue to suffer in the months to come. With this comes the real risk that large numbers of staff will burn out or even quit the NHS.”