Vivienne Nathanson is not depressed

The government has received clear advice from health experts, including from Sir Liam Donaldson, its Chief Medical Officer. 

That advice says that the evidence of health harms from direct and indirect or passive smoking is overwhelming and compelling.  There is no safe level of exposure to tobacco smoke. If we wish to protect the health of the nation we must protect from exposure to smoke. Further evidence makes a compelling case for the inadequacy of ventilation systems in offsetting this health harm.

Pledge
Why was this advice ignored?  The answer appears to be about the contents of the election manifesto and about power plays within the cabinet.  John Reid was secretary of state at the time of the white paper and made it clear that he was against restrictive legislation.  That commitment became government policy and was included in the manifesto; he appears to have persuaded his cabinet colleagues that this is one manifesto pledge that should be kept.

Why did John Reid ignore at least part of the advice he was given?  Is it related to his own relatively recent recruitment to non-smoking?  Could he still hanker after the weed?  Does he really still see smoking as enjoyable – “the last pleasure of the poor living on sink estates”?  If he does, then his resistance to a total ban was inevitable.  But he did move a long way from early suggestions of voluntary guidance.

Huge advance
So what does this mean?  The reality is that we should not be too depressed.  Although the draft legislation snatches defeat from the jaws of victors, it is still a huge advance on where we thought we might be.  A clearly reluctant Secretary of State (John Reid) was persuaded against his own clear preferences to include a moderately extensive ban within the legislation, and other ministers have since indicated that a total ban is inevitable in the near future.

The decision to allow a free vote must also be a reflection on the consistency of advice to parliamentarians. Advice has had an impact.    The weakness of the health lobby was to underestimate John Reid’s addiction to the idea of smoking.  Next time, we will not make that mistake.

Professor Vivienne Nathanson is Director of Professional Activities at the British Medical Association