Health

Smoking ban 20 years on: Against expectations, the ban worked. But doctors fear momentum has been lost

Smoke was banished from workplaces 20 years ago today, but as vaping introduces a new generation to nicotine, challenges remain

After 20 years the long-term legacy of the smoking ban is not certain. Photograph: PA
After 20 years the long-term legacy of the smoking ban is not certain. Photograph: PA
Paul Cullen's picture
Paul Cullen
Fri Mar 29 2024 - 05:00

“No smoke without ire” ran the headline on one article in The Irish Times as the workplace smoking ban came into effect, 20 years ago this Friday.

Along with much other commentary, it predicted the groundbreaking new prohibition on smoking in bars, cafes, offices, public buildings and taxis would prove unenforceable.

To the contrary, the new law proved hugely successful. More than 3,700 smoking-related deaths were averted in the first decade after the ban was introduced. For most of the population, smoking disappeared from their lives, while more than 70 countries followed Ireland’s lead by introducing their bans on smoking in public places.

Two decades on, however, the long-term legacy of the ban is more uncertain than ever. Progress in reducing smoking rates has bottomed out and the rise of e-cigarettes has posed challenges never dreamed of when then minister for health Micheál Martin oversaw the introduction of the smoking ban on March 29th, 2004.

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“It was a complete success and very popular too,” recalls respiratory consultant Prof Luke Clancy, who played a pivotal role as head of an advocacy coalition in convincing the government to introduce the ban.

“Thousands of lives were saved. Within a year, I had patients saying, ‘I was on holidays there in Spain and the smoke was terrible’. However, the follow-up wasn’t good. Martin moved on, and so did the excitement around the initiative. We took our foot off the pedal.”

[ Smoking engaged in by 800,000 fewer since ban introduced 20 years ago, HSE says ]

Over the years, the cost of cigarettes was pushed up incrementally through tax increases, and restrictions were placed on advertising, packaging and display of tobacco products. In 2019, though, smoking rates among children increased for the first time in 25 years.

The turnabout is usually attributed to e-cigarettes, first touted as an aid to quitting smoking and now regarded by health campaigners as a form of Trojan horse re-normalising smoking.

Ireland was one of the last countries in Europe to ban the sale of vapes to under-18s, says Chris Macey of the Irish Heart Foundation.

“The target was to reduce smoking rates to 5 per cent next year, but we’re going to miss the target by half a million smokers.”

“I thought when I took on the role that tobacco control would be a fairly easy gig,” according to HSE public health lead Dr Paul Kavanagh. “Suddenly, I was faced with a situation where people were asking whether e-cigarettes are part of the solution to smoking cessation,” he told a public meeting last week.

“We had been warning about e-cigarettes since 2021 but nothing was done until recently. We were just marking time. They are there to increase addiction and to get children to start on cigarettes, but for a long time the Department of Health was soft on them,” Clancy asserts.

According to last year’s census, 9 per cent of the population smoke daily, 4 per cent smoke occasionally and 19 per cent have given up smoking. Ireland recorded one of the largest falls in smoking rates over the past decade, according to an Organisation for Economic Co-operation and Development report last November, though the overall rate remains close to the international average.

The last tobacco manufacturing plant in the Republic closed in 2008, four years after the ban was introduced. Cigarettes are now universally imported products and the concern of the sector is on illegal or non-duty-paid tobacco, estimated to account for 30 per cent of the trade.

“This is a massive loss to our industry and to the exchequer, which is losing millions every year through this trade,” according to Itmac, representing the sector. “The recently established duty-free area with the UK has thrown fuel on the fire, but the issue has been growing for years.”

Revenue seizures of illegal tobacco amounted to €58 million last year, and €39 million already this year, it noted.

The lack of further progress on tobacco control has disappointed many anti-smoking advocates, but Macey says he has become more hopeful of late.

“There has been a perceptible change in political will over the last few months,” he says, noting plans to ban flavoured and disposable vapes and to require plain packaging, as well as a ban on disposable versions of the product.

“The next logical step is to increase the minimum age of sale of tobacco products from 18 to 21, followed by consideration of their phasing out over time.”