The Bad News

1. Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - AtlantiqueTHE ECONOMIC IMPACT OF SMOKE-FREE WORKPLACES:An Assessment for Prince Edward IslandMay 6-7, 2002

2. The Bad News 26% of Islanders smoke (CTUMS 2000). 21% of 15-19 year old Islanders smoke. In NS, 24% of workers are exposed to ETS at work, and more than one-third of children are exposed to second-hand smoke at home.

3. “The Deadly and Costly Effects of Smoking” • Smoking kills 200 Islanders a year • Smoking costs PEI $10 million/year in health costs and another $43 million in productivity losses • Second-hand smoke kills 25 Islanders a year, (18 from heart disease, 7 from cancers). • Second-hand smoke costs $1.24 million a year in health costs and $5.5 million in productivity losses

4. 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.

5. 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)

6. 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

7. 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

8. Costs of Second-Hand Smoke, PEI • Deaths 25 • Potential years of life lost 350 • Hospitalizations 140 • Hospital Days 1,500

9. Direct Health Care Costsof ETS • Hospitals $750,000 • Ambulance Services $10,000 • Physician fees $150,000 • Prescription Drugs $300,000 • Other Health Care Costs $30,000 • Total Direct Health Care Costs $1.24 million

10. Indirect Costs of ETS, PEI • Productivity loss (sickness) $44,000 • Productivity loss (mortality) (6% discount rate) $5.4 million • TOTAL COST TO ECONOMY $7 million 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..

11. 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)

12. 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.

13. 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)

14. 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

15. Therefore: • “A limited policy offers no advantage over no policy at all…. (T)he only way to protect nonsmokers’ health is with a smoke-free 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)

16. 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 60 lives a year, $3 million in avoided health costs, and $13 million in avoided productivity losses.

17. 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 PEI employers $2.5 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

18. 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.........

19. 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.”

20. 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.

21. 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.” Glantz1997 and 2000 (California)

22. 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)

23. 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

24. “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

25. 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 smoke-free legislation.” Cornell Hotel and Restaurant Administration Quarterly, 1996

26. 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

27. 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 scientific evidence to the contrary.

28. 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) • “Ourobjective is to contain and refine the environmental smoke issue in order to decrease the pressure for safety measures….”(Tobacco Institute)

29. 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)

30. 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)

31. 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)

32. 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.…”

33. 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

34. 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)

35. 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

36. 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)

37. ...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. Cigarette-related 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)

38. 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

39. 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.

40. 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

41. The Evidence Clearly Shows: • Second-hand smoke causes heart disease, cancer and respiratory illness. Smoke-free workplace legislation will save the lives of 60 Islanders each year, prevent serious illnesses, and save $16 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.