UK Initiatives

BMA response to the UK Department of the Environment, Transport and Roads consultation on smoking in taxis

7 December 1999

Mr John Hampton
Buses and Taxis Division
DETR
3/12 Great Minster House
76 Marsham Street
London SW1P 4DR

Dear Mr Hampton

Thank you for your correspondence requesting comments on the above Consultation Paper. The British Medical Association has pleasure in responding to the points raised.

We welcome the proposal to introduce measures to protect taxi drivers and their customers from the harmful effects of passive smoking. However, we feel that while the measures proposed have the potential to go some way towards protecting people from passive smoking, the options put forward in the document are not a wholly adequate response to the problem.

Protection from passive smoking is primarily a matter of health. For more than a decade, convincing scientific evidence has been available to demonstrate that exposure to second-hand cigarette smoke both harms health, and worsens existing health problems. A series of expert scientific reports has assessed and evaluated the studies available, and concluded that passive smoking harms health. The recent report of the UK Scientific Committee on Tobacco or Health again confirms these conclusions, recommending that:

'Smoking in public places should be restricted on the grounds of public health. The level of restriction should vary according to the different categories of public places, but smoking should not be allowed in public service buildings or on public transport, other than in designated and isolated areas. Wherever possible, smoking should not be allowed in the work place' [1].

BMA policy in this area reflects the harm caused to health by exposure to second-hand tobacco smoke. The policy of the Association is that in the interests of the health of the majority of the population, cigarette smoking should be banned in public places. The BMA considers as a public place 'any enclosed space to which the public has access'. This definition includes public conveyances, including taxi cabs and any other vehicle used for the transportation of the public. It also covers business premises used for any trade, business or profession, and open to members of the public.

The BMA supports the introduction of regulations or legislation to ban smoking in public places. Taxi cabs clearly fall under the definition of public conveyances. Moreover, while private hire vehicles may not for the Department's purposes be seen as public transportation, they meet the Association's definition of a public place in that they are a place where a business or trade is carried out.

No rational basis has been established for assuming that certain individuals may be immune to the harmful effects of second-hand smoke. In addition, exposure to levels of tobacco smoke that may result in minor health effects in one individual may precipitate more severe effects in another person - for example, an asthma attack. People with certain conditions are especially vulnerable to adverse effects, such as asthma sufferers, pregnant women [2] and people with existing cardiovascular [3] or cerebrovascular [4] disease.

In view of the proven health effects of passive smoking, we feel that measures must be aimed at protecting the health of all drivers and passengers. Neither option put forward in the consultation paper is entirely satisfactory, as neither can ensure that drivers or passengers will be protected during the journey from exposure to second-hand smoke.

The BMA is therefore in favour of measures to make all taxis and private hire vehicles smoke-free - acceptance of this status should be a condition of the license to operate as a hire cab. Failure to respect this restriction would result in a fine for passengers, and in loss of license for drivers. Measures should be backed by clear mechanisms of enforcement, an information campaign to explain their importance, and a system of monitoring their effectiveness.

Recently, the Government has initiated a scheme of voluntary measures aimed at protecting the public and workers from second-hand smoke: an Approved Code of Practice on passive smoking at work and a Public Places Charter for clean air. While the proposed measures fall far short of BMA recommendations in this area, the Association has welcomed them as going some way towards protecting the public health. The options proposed in this document are in line with these initiatives, and are also commended as a step in the right direction. At a minimum, drivers should have the right to declare their cab smoke-free, and effective measures should be put in place to enable them to enforce this choice. We emphasize, however, that the public health could best be served by making all taxis smoke-free.

The BMA is grateful for the opportunity to take part in this process and remains at your disposal for any further assistance.

Yours sincerely,

M J Lowe
Deputy Secretary

References

1. UK Department of Health. Report of the Scientific Committee on Tobacco and Health. London: Her Majesty's Stationery Office, 1998. p. 10.
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2. UK Department of Health. Report of the Scientific Committee on Tobacco and Health. London: Her Majesty's Stationery Office, 1998. p. 10.
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3. Law MR, Morris JK, Wald NJ. Environmental tobacco smoke and ischaemic heart disease: an evaluation of the evidence. BMJ 1997;315:973-79.
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4. Bonita R, Duncan J, Truelson T, Jackson RT, Beaglehole R. Passive smoking as well as active smoking increases the risk of acute stroke. Tobacco Control 1999;8(2):156-160.
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