Health Bill

My Lords, I will confine my remarks to Chapter 1 of Part 1 of the Bill, which legislates to ban smoking from public buildings and workplaces. This of course was not the Government’s original intention but, since the Cabinet was divided, the matter was left to a free vote of the Commons. My opposition to Chapter 1 of the Bill is based on a single point. It is grossly disproportionate and off target relative to the harm, such as it is, caused by passive smoking. I thought that I would be in a minority of one after listening to the debate, but as it is I am glad to follow the powerful interventions of the noble Lords, Lord Naseby and Lord Geddes. If there is a rational basis to the Bill, it seems to be this: the Government are determined to stamp out smoking or at least heavily reduce it from its present level of 25 per cent of the adult population. I am told that the Department of Health has a target for reducing smoking to 21 per cent by 2010. I do not know whether that is true, but it seems plausible. Since banning smoking outright would seem to be too gross an interference with liberty—there are still too many smokers around—the idea is to reduce it by claiming that it harms others. If there are fewer places in which people are allowed to smoke, it seems to follow that fewer cigarettes will be smoked. That seems to be the rational basis for this Bill. What is wrong with that basis? If the attack on passive smoking helps to rid society of tobacco, is that not a good aim? The answer is that it is corrupt. The quality of information that the public receive is vital to the proper functioning of a democracy. I fear that we have got into the absolutely appalling state where it is widely accepted that the end justifies the means. We saw it with Iraq: it did not matter whether Saddam Hussein had weapons of mass destruction, we got rid of him, and wasn’t that a good thing? The same attitude seems to be prevailing here. It does not matter whether passive smoking actually does do that much damage provided that the end result is a reduction in smoking. There is also the not insignificant matter of the assault on freedom. An office with two persons is designated a smoke-free zone even if both occupants want to smoke. A group of smokers will not be able to form a private club. As far as I can make out, even private dwellings and private motor cars may at some time in the future be designated smoke-free zones on the order of the Secretary of State. So this Bill is not the end of a process; it is part of a process which may result in a much greater interference with liberty than is at present contemplated, grave though that is. I refer noble Lords to the Explanatory Notes on Part 1 of the Bill, which state:"““The Bill will also give the Secretary of State for Health the power to make regulations specifying places or specified areas within them that do not have to be smoke-free. These will include premises where a person has his home””." The Englishman’s home will for the time being remain his castle by permission of the Secretary of State. I do not deny for a moment that smoking is dangerous to one’s health. How could one? Some 100,000 people a year are said to die of smoking-related diseases, 30,000 of them from lung cancer. But even here we must be careful. What does it mean to say that smoking kills? Everyone dies. What the statement must mean is that it causes premature death. What the statement that 100,000 people a year die from smoking-related diseases actually means is that 100,000 smokers die on average somewhat earlier—up to five year earlier, it is said—than non-smokers. The question then is: how dangerous is passive smoking? Before trying to answer that, I have a health warning of my own. The interpretation of smoking statistics is fiendishly difficult. That is why they tend to give way in legislative assemblies to anecdote or general statements. And I do not blame politicians for not understanding statistics; very few people understand statistics. What I blame them for is being too careless of liberty. So the question is: how dangerous is passive smoking? There have been more than 50 studies of passive smoking over 25 years. The firmest conclusion is that non-smokers exposed to environmental tobacco smoke at work and at home show an increased risk of lung cancer of about 20 per cent—it may be a bit more or a bit less. How many extra premature deaths is that? If we assume a 20 per cent risk, the answer is about 650 extra deaths a year. Earlier this year, the House of Commons Select Committee on Health said:"““It is currently estimated that SHS””—" inhalation of second-hand smoke—"““causes at least 12,000 deaths each year in the United Kingdom””." That is deaths from all smoking-related diseases, not just cancer. However, I have to emphasise that 12,000 is not a robust figure. The US Environmental Protection Agency estimates that there are 3,000 environmental tobacco smoke-related deaths in the United States, which has five times the population of the United Kingdom. Even in Britain the estimates range from several hundred to 12,000. If you assume that passive smoking causes a 20 per cent increase in the risk of lung cancer and that there are as many deaths from other causes relating to passive smoking as from lung cancer, which is not unreasonable, the rough estimate of premature extra deaths on the basis of available data is about 1,300 a year. That is roughly consistent with the British Medical Association’s estimate, which is 1,000. So that is the sort of order of magnitude of the premature deaths caused by passive inhalation of tobacco smoke. Another approach to the question—a more intriguing one, I think—would be to ask by how much life is shortened by exposure to environmental tobacco smoke. Obviously it is less than by the five years’ shortening suffered by the active smokers. The US Center for Environmental Health has estimated that the mean cotinine level of non-smokers exposed to ETS—that is, the level of toxic substances in tobacco smoke—is 1/500th that of active smokers. If we assume that the increased risk of premature deaths from environmental tobacco smoke relative to smokers is reduced in proportion, then 1/500th of five years works out at about four days. So whether the number of premature deaths caused by passive smoking is 12,000 or 100,000 or 1,000, if we assume that on average smoking reduces life expectancy by five years, then passive smoking reduces average life expectancy by four days per person. As the House of Commons Select Committee recognises, most deaths from passive smoking are caused by domestic exposure to second-hand smoke; that is, living with a smoker. Various studies, including one by Professor Konrad Jamrozik of Imperial College London, imply that only about 15 per cent of deaths from passive smoking are caused by exposure to environmental tobacco smoke in public places—the places which the Bill proposes to make smoke-free zones. Thus we are talking about between 150 and 200 premature deaths a year from passive smoking. That means that the maximum decrease in average life expectancy from exposure to ETS in public places is about 15 hours per person. Now, I am just trying to lead you on to what statistical manipulations can achieve if you want to follow the logic of these matters. And, after all, we should not entirely dispense with logic in framing our legislation. These numbers are impossible to prove statistically. This is because the increased risk from passive smoking is too small to determine given the quality of the data. To say that passive smoking would lead to an increase in the incidence of lung cancer from 10 per 100,000 non-smokers to 12 per 100,000 is statistically meaningless. The cautious experts refuse to commit themselves to a number."““I think that passive smoking has to be causing some risk””," one expert recently told the House of Lords Select Committee on Economic Affairs, of which I am a member, but he refused to name a number when pressed several times. He said that it must have some effect. So what conclusion does one draw? The part of the Bill dealing with passive smoking seems to me to be based on a false prospectus. It relies on a manipulation or lack of understanding of the statistics. At best, it is using a sledgehammer to crack a nut and it is grossly careless of liberty. It does not deal with the main risks from passive smoking, which arise from the home, and whose biggest, non-lethal impact is on young children. Indeed, the smallness of the risk of dying from passive smoking has caused the argument to shift to the non-lethal damage done by passive smoking rather than the lethal damage. I am deeply sympathetic with the plight that the noble Viscount, Lord Simon, movingly described in his speech. I would simply say that the legislative response must be proportional to the damage. Not only do we have very little data on non-lethal effects, but the response must be much more nuanced than it is in the Bill. If the Government honestly want to reduce smoking, they have two legitimate weapons—education and taxes. Both have already had a big effect, not a negligible effect. Only a minority of adults now smoke. Pressure from the majority of non-smokers has led to most working places and many hotels and restaurants becoming non-smoking zones. Public opinion is already achieving what the Government aim to do by legislation, without trampling on the liberty of smokers to choose where they want to work and relax. I am saying this as an ex-smoker. If governments want to accelerate that movement, there is no reason why they should not continue to raise taxes on tobacco to the point at which smoking becomes the vice of the rich rather than the habit of the many. It will be claimed that that approach would disproportionately hurt the poorer sections of the population who smoke more. But those groups will also gain disproportionately from the improvement in their health. Rather than using the price mechanism, or ““sin taxes””, which is the natural thing to do if you want to reduce the quantity demanded, the Government prefer that all smokers should suffer an equal loss of liberty. Equality of deprivation has always been more attractive to some people than freedom of choice. We are faced with a demand to legislate which, although I believe it to be unnecessary, is almost certainly unstoppable. Therefore, I will be looking to introduce or support amendments in Committee that exempt private clubs from this legislation, and in other ways to modify the blanket prohibition of smoking in public places.