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Reactions to Catalonia's proposal to ban smoking on bar terraces

In an interview on TV3's Els Matins, the Catalan government's health minister Josep Maria Argimon explained that they are preparing a regulation to ban smoking on bar terraces and make them "smoke-free spaces". They are also considering adding canopies and the entrances and exits of schools to the ban.

23/09/2022 - 12:00 CEST
Expert reactions

Ildefonso Hernández - prohibir fumar terrazas EN

Ildefonso Hernández

Professor of Preventive Medicine and Public Health at the Miguel Hernández University and director of the Global Health research group.

Science Media Centre Spain

I think the Generalitat's proposal is excellent. I am pleased that the city councils are also doing it, like the initiative of Barcelona City Council. The more examples of public health like this, the better for everyone.

The author has not responded to our request to declare conflicts of interest

Pedro Gullón - prohibición fumar terrazas EN

Pedro Gullón

Social epidemiologist and doctor specialising in preventive medicine and public health at the University of Alcalá

Science Media Centre Spain

This has been a demand of public health scientific societies for years. Several studies show that, in environments such as terraces, bus stops or around school entrances, there is greater exposure to environmental tobacco smoke, so the regulation of these spaces could be positive to protect the population from this smoke.

Although we will have to wait to see the specific regulations, these smoke-free spaces should include: terraces (many terraces are already in breach of current legislation with semi-closed spaces), public transport stops, around schools and university campuses. It is also important to work towards compliance with current smoke-free legislation.

The author has not responded to our request to declare conflicts of interest

Manuel Franco - prohibición fumar terrazas EN

Manuel Franco

Epidemiologist, professor and researcher at the Universities of Alcalá and Johns Hopkins. Spokesperson for the Spanish Society of Public Health and Health Administration SESPAS

Science Media Centre Spain

I think the measure is necessary and very well drafted and designed, because it is not only saying what measures can be taken in our society to help prevent smoking - both not to start smoking and to avoid second-hand tobacco or environmental tobacco smoke - but it is also saying 'we are going to help people stop smoking'.  

We know that tobacco has been designed for decades to be a highly addictive substance and that it is also big business for many. That is the tremendous thing about tobacco: we have known since the 1960s that it is a danger to our individual health and to the health of the population, and that there is big business behind it. Therefore, preventing people from starting to smoke and also helping those of us who are already hooked to quit smoking is fundamental. These two legs are one of the most important public health and disease prevention measures.  

It also has a health equity component. We do not all smoke equally in our society, there are people who smoke more and others who smoke less. Those who smoke the most now are the people with the lowest socio-economic status, which is even more terrible because it means that the people who get sick the most are those who have the least money and the least access to treatment. Therefore, the equity dimension of this measure in Catalonia is very welcome. 

And finally, it is very important to say that the situation of the terraces is very serious. Some time ago we demonstrated in an investigation that the limits for exposure to tobacco smoke were exceeded in the vast majority of terraces in Madrid. And that, in addition, terraces that are closed in winter are illegal. 

Therefore, the example of Catalonia, where the city council of Barcelona has already succeeded in making beaches smoke-free, seems to me to be the way forward. Always helping people who are hooked [to tobacco] to give up this addiction from the point of view of primary care and the treatments that exist. 

The author has not responded to our request to declare conflicts of interest

Carlos Rábade - prohibir fumar terrazas EN

Carlos Rábade

Coordinator of the Smoking Area of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR)

Science Media Centre Spain

SEPAR is in favour of the five measures we have called for and one of them is a ban on smoking in open public spaces. Banning smoking on terraces, in outdoor areas or in any open public space is one of the measures that we have been calling for for a long time. It seems to me to be a good initiative and I hope that the other autonomous regions will join in and that this will be the beginning of the new anti-smoking law that we are demanding, which includes a ban on smoking on terraces and in other open public spaces.  

This type of measure, on the one hand, will protect non-smokers, and on the other hand, it will also encourage smokers who were not thinking of giving up smoking to make a serious attempt to quit. On the other hand, it serves to discourage or prevent new smokers from taking up smoking and to denormalise smoking. Therefore, these types of measures are very important. 

SEPAR has also been insisting for a long time on the importance of financing all pharmacological treatments for smoking. Right now we only have one treatment funded, which is Bupropion. The Minister has spoken of nicotine replacement therapy, which should also be funded, but we believe in the need to fund another, which is one of the most effective treatments for smoking cessation, which is cytisine.  

Each drug is adapted to a specific patient profile and therefore, although any funding initiative is positive, we believe that all drugs should be funded. We have been insisting for some time now to the Ministry of Health on the need to finance these smoking cessation treatments because they are efficient, effective, cost-effective, that is, they represent a very significant economic saving for the national health system and, most importantly, they produce great health benefits in terms of morbidity, mortality, quality of life and a reduction in health resources. 

The author has not responded to our request to declare conflicts of interest

Esteve Fernández - prohibir fumar terrazas EN

Esteve Fernández

Director of Epidemiology, Prevention and Cancer Control at the Catalan Institute of Oncology and Director of the WHO Collaborating Centre for Tobacco Control at the Catalan Institute of Oncology

Science Media Centre Spain

The measure to make terraces and other outdoor spaces smoke-free is necessary to protect health and promote public health. We have conducted several studies showing that in these outdoor areas where smokers congregate there is significant exposure to environmental tobacco smoke. We have demonstrated this in studies in Barcelona and Madrid, where PM2.5 and ambient nicotine concentrations in terraces (usually in breach of current legislation and virtually closed) were similar to the concentrations we had inside bars and restaurants before the 2010 tobacco law.  

In addition to protecting the health of customers and, importantly, workers, these measures have a very important public health and de-normalisation of smoking in society component. The risk of lung cancer or myocardial infarction among non-smokers who are exposed to environmental tobacco smoke is 20-25% higher than in non-smokers who are not exposed to tobacco smoke.  

Therefore, these measures should be extended to other public places currently not covered by the law, such as school environments and building entrances (smoke spreads indoors), outdoor bus and train shelters and bus stops. In addition, given the huge environmental impact of tobacco, especially the highly polluting cigarette butts, beaches and swimming pools, parks and gardens of any kind. 

The author has not responded to our request to declare conflicts of interest

José Luis Díaz-Maroto - prohibir fumar terrazas EN

José Luis Díaz-Maroto

Family doctor and head of communication of the working group on smoking of the Spanish Society of Primary Care Physicians (SEMERGEN)

Science Media Centre Spain

From SEMERGEN we make a very good assessment. We have been waiting for this news for a long time, but it had to be at national level, although if it starts with an autonomous region, it is welcome. It is very important that it is put into effect. First of all, because the terraces of cafés and restaurants that are open in summer, in winter or autumn, when it is cold, often do not comply with the legislation in force ten years ago, which said that only smoking or smoking terraces that were open were allowed. Now the bar, where smoking is not allowed, has often been moved to the pavements, but the terraces are completely closed, even with doors and plastic sheeting.

Therefore, it is all very well to ban it at last, but it should be totally banned on the terraces and they should be open. And, by extension, on canopies, entrances to buildings or near schools and institutes. Current legislation should also be complied with in health centres, where smoking is prohibited in the premises, even if it is outside and in the open air, but this is not complied with either. We would make a lot of progress.

On the other hand, the fact of doing a lucrative activity or meeting with friends in cafés or restaurants that are open to the outdoors and that this leisure time is associated with smoking is not normalised. This is very good for young people: to denormalise consumption, even if it is in open spaces. And by extension, it would be very good if it were also enforced on beaches and other open spaces such as concerts. We have to go further, even if they are completely open spaces.

The author has not responded to our request to declare conflicts of interest

Regina Dalmau - prohibir fumar terrazas EN

Regina Dalmau

Cardiologist at the Hospital Universitario La Paz, representative of the Spanish Society of Cardiology in the National Committee for the Prevention of Smoking and member of the Tobacco Expert Group of the World Heart Federation

Science Media Centre Spain

I think it is a very good and necessary measure and I believe that the prevention and control of smoking involves extending smoke-free spaces. Although at first these measures generate a little rejection among hotel and catering staff and customers themselves, later, as happened with the tobacco law, they are well received. This is in everyone's interest because we are talking about terraces, which are spaces where there is often a lot of proximity between users and it is inevitable that there will be exposure to environmental smoke. In addition, there are many false terraces, with pavements or even roofs, which should not be considered open spaces, but with the excuse that they are not totally enclosed spaces, they do not comply with the law. 

My opinion is that these are necessary measures and that it is important for the autonomous communities to take their own initiatives because the Ministry of Health, which is responsible for revising the tobacco law and extending it, seems to have, sadly, backed down, and tobacco continues to be a very important public health problem.  

Another issue is that we have gone through a pandemic in which we have experienced very stressful situations for people who have suffered from the disease, in their environment or in their own flesh, and there is a new perception of the importance of preserving respiratory health and cardiovascular health. It is a good time to promote initiatives to reduce tobacco consumption and perhaps it has been a little bit missed. I think this opens that window of opportunity to make progress in tobacco control in our country, even if it is an initiative of an autonomous community. It should be a model initiative that other communities can then join, regardless of their political profile, because this has nothing to do with politics. It is a measure that is in favour of public health, the health of the population.

The author has not responded to our request to declare conflicts of interest

Xisca Sureda - prohibir fumar terrazas EN

Xisca Sureda

Epidemiologist and researcher in public health at the University of Alcalá

Science Media Centre Spain

I believe that it is essential and necessary to advance in measures for the prevention and control of smoking, and one of the necessary measures is to extend smoke-free spaces, as it has been seen that they not only serve to protect the population from exposure to environmental tobacco smoke, but also to encourage the denormalisation of its consumption. School environments are very sensitive points, both because of the exposure to tobacco smoke of a more vulnerable population such as children, and because of the negative impact that the visibility of tobacco consumption has on them, as it favours the normalisation of this unhealthy behaviour.  

On the other hand, studies carried out in Spain show that in certain terraces (those partially or totally closed) the levels of environmental tobacco smoke concentration are comparable to those found inside bars when smoking was allowed. And even in fully open terraces, these levels of exposure to tobacco are high in certain circumstances. This leaves a sector of the population such as hospitality workers unprotected, as well as exposing vulnerable populations such as children, the elderly and pregnant women to tobacco smoke. The initiative is great, but it should be a necessity at the state level. There is a Comprehensive Plan to reform the Tobacco Law that we hope will not be forgotten because Catalonia's initiative should be a reality in the whole of Spain. 

The author has not responded to our request to declare conflicts of interest
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