Smoke-free streets and lanes: a growing headache for big tobacco?

Smoke-free Melbourne?

One of Melbourne’s quintessential experiences is to stroll its laneways, many lined with restaurants.  Smoking here would spoil things for everyone.

In 2014, Causeway Lane, a small restaurant strip running between Bourke Street Mall and Little Collins Street, went smokefree.

You can read reactions to this smoke-free pilot here.

Three more laneways were added in 2015.

Victoria’s Local Government Act 1989 permits local governments, including the City of Melbourne, to make and enforce “local laws” (see ss 3E, 111) that relate to its functions or powers, provided they are not inconsistent with Victorian Acts or regulations.

The City of Melbourne’s Activities Local Law 2019, one of three local City laws, empowers Council to prescribe smoke-free (local) areas (see Part 3A). Click here for more information on City of Melbourne smoke-free places, and click here for a map of these places.

The City of Melbourne is currently reviewing community feedback about a proposal to make Bourke Street mall smoke-free.  See here, and here.

 

Smoke-free North Sydney

North Sydney Council has gone even further, voting in July 2019 to completely ban smoking in its CBD.

Community consultation showed 80% support in favour of the ban.

The traditional justification for second-hand smoke laws – in bars and restaurants, offices, trains and airplanes, is that smokers should not be permitted to harm the health of non-smokers.

With growing demand for fresh air, however, these laws have taken on a life of their own.

Area-wide smoking bans in public places are a logical follow-on from the decade-old smoking bans on Sydney beaches.

Manly beach went smoke-free in 2004, and all harbour and ocean beaches in Sydney’s northern beaches area are now smoke-free.

Bondi Beach also went smoke-free in 2004, and Waverley Council has since extended smoking bans to the Oxford Street Mall.

 

Conceptualising innovations in tobacco control

Second hand smoke controls reduce butt litter and harm to non-smokers, including asthmatics and others with lung and heart conditions.

It seems clear, however, that bans are expanding into areas where the risk of harm to non-smokers is substantially reduced.

It’s a process I call transformation: when the justification for existing legal controls changes over time as a result of norm change, facilitating further expansion.

These days, what functions do smoking bans serve?  Beyond causing harm to non-smokers, are they laws that relate to amenity – the desire of the majority not to have their enjoyment of public places spoiled by even transitory encounters with nasty tobacco smoke?

Or are they about reducing the potential for smoking to function as a socially communicable disease by reducing the visibility of nicotine-seeking behaviour?

Or are they about litter and protection of our waterways?  (I once saw a smoker put their butt in the bin.  Honest, cross my heart).

Or are they simply an exercise in “making tobacco use difficult” (to use Brawley’s term)?

Whatever the reasons, the nanny state theorists aren’t having a bar of it.

Residents’ demand for fresh air, and smokers’ recalcitrance on butt litter went down like “sick in a cup” with radio man Steve Price, who has blasted the ban as a “nanny state solution”.

Other ways in which tobacco controls can expand include through extension (where the purpose of the law remains the same, but the reach or intensity of legal controls becomes more extensive over time (as with prohibitions on tobacco advertising), and through creation (where law imposes distinctively new kinds of controls to help reduce initiation, encourage quitting, discourage relapse, and reduce exposure to second-hand smoke).

[a designated smoking area on Orchard Road, Singapore]

 

Smoke-free districts in asia

A similar trend towards smoke-free streets and precincts looks to be under way in parts of asia.

From 1 January 2019, the Orchard Road precinct in Singapore became a smoke-free zone.

Smoking has not been eliminated entirely along Singapore’s famous shopping strip.  But smokers are required to smoke in designated places, reducing litter, and further reducing non-smokers’ exposure to tobacco smoke in outdoor areas.

It’s a similar picture in Penang, Malaysia.  This wonderful world heritage city has gone smoke-free.

In the United States, Disney World and Disneyland are going smoke-free, and there are no designated smoking areas within these parks.

Not all tobacco control advocates are comfortable with the trend towards smoke-free public spaces.

Simon Chapman has argued that “banning smoking in wide-open public spaces goes beyond the evidence and is unethical”.

One interesting possibility is whether the failure to accommodate smokers’ nicotine addiction constitutes discrimination on the grounds of “disability” or “impairment” under NSW, Victorian and other anti-discrimination or equal opportunity statutes.

While opioid addiction has been considered a disability under the Disability Discrimination Act 1992 (Cth) [see commentary here], nicotine dependence has not yet been regarded as a “disability” or an “impairment” for the purposes of State anti-discrimination laws (see here, and here).

I’m not sure tobacco companies want all their addicted customers categorised as disabled, but you never know.

In the meantime, enjoy the fresh air!

[No smoking in George Town, Penang’s World Heritage site]

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Breastfeeding rooms in US federal buildings: who would have thought?!

Last year the US watered down a resolution of the World Health Assembly that would have called on States to “protect, promote and support breast-feeding”, and to provide technical support to “halt inappropriate promotion of foods for infants and young children”.

A step too far, apparently, given the economic interests of US-domiciled formula companies.

See here for a previous post.

In June 2019, however, Congress passed a Bill requiring federal agencies to provide lactation rooms for lactating women in buildings that are open to the public.  Think federal courts, US Social Security Administration buildings, and indeed, within the US Capitol building itself.

The Bill requires the agency to provide a lactation room that is “shielded from view”, “free from intrusion”, and contains a chair, a working surface and electrical outlet.

This ensures a place for women both to breast-feed, and/or to express breast milk.  Importantly, it encourages breast-feeding, and expressing breast milk as a new normal for women with infants who are interacting or indeed working for the federal government.

The bill provides for exceptions: where it is impossible at reasonable cost to re-purpose a space as a lactation room using portable materials, or where new construction would be required to create a lactation room at a cost that is unfeasible.

The Bill is a nice example of a public health intervention that changes the environment to support a behaviour that benefits the health of both the infant, and the nursing mother.  President Trump signed it.  Who would have guessed?

And now for the hard question: Can you imagine anything similar happening in Australia, the clever country?

Click here for a quick summary of the benefits of breastfeeding: you might be surprised how significant and extensive they are.

It’s the kind of stuff the manufacturers of “toddler milk” (Nestle and all the rest) tend not to emphasise.

(By the way, for those interested in tracking US Congressional legislation that impacts global health, click here).

 

Why the media gets it wrong on obesity

“I’m not overweight”, writes columnist Katrina Grace Kelly in The Australian.  “I’m just the helpless pawn of a vicious corporate conspiracy”.

Amusing read, but it also illustrates why public health researchers are failing to cut-through with governments and the broader community on obesity.

“The ‘obesogenic environment’ is the culprit here, apparently”, Kelly writes, referring to a recently-released report from the Obesity Collective, and to recommendations from the Senate Select Committee into the Obesity Epidemic in Australia.

“The creators of the obesogenic environment are government, society in general and the harbingers of all evil – corporations, specifically, companies in the food and beverage sector, now being referred to as Big Food.”

She adds: “We are fortunate to have researchers on the public payroll, so they can conduct studies to arrive at such previously unimaginable conclusions”.

 

It’s all personal responsibility, stupid

Kelly’s beliefs about obesity illustrate why the problem is so hard to tackle at a population level.

The dominant framing of obesity as purely a matter of personal responsibility seems obvious, intuitive.  No one is force feeding us, right?

But it has a downside: if you’re fat, look in the mirror, you only have yourself to blame.

According to the Australian Bureau of Statistics, the proportion of adults who are overweight or obese has increased from 56% in 1995, to 67% in 2017-18, with an additional 900,000 adults becoming overweight in the 3 years since the previous survey in 2014-15.

There is a troubling trend here, but for many people, it’s difficult to accept that the causes of the trend might be different from the causes of an individual’s obesity.

 

Personal policy, and public policy

If you are obese, having greater personal responsibility is an excellent suggestion – it’s an excellent “personal policy”.

But it turns out to be a rather silly and unproductive explanation for the trend towards population weight gain.

For one thing, personal responsibility is not a new idea; in fact, it’s a strategic failure, so urging people to have more of it is unlikely to reduce obesity rates in future.

Viewing obesity in terms of the failure of personal responsibility also means that the dramatic trend towards weight gain over the past couple of generations – affecting many millions of people in most countries of the world – is best explained in terms of an unprecedented, mass deterioration in self-control.

Who could have guessed?!

Framing obesity in terms of individual responsibility probably does little to help those who are obese, although it might make the rest of us feel smug.  It also deflects attention from both the causes of, and the solutions to, the problem at a population level.  And that’s what healthy public policy needs to be directed towards.

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Beyond the “hot tub”: Australia’s runaway obesity epidemic

How sure are you that you won’t lose your feet or toes to diabetes?

According to a new report by the Obesity Collective, based at the Charles Perkins Centre at the University of Sydney, obesity in Australia is getting much, much worse.

Between 2014-15 and 2017-18, the obesity rate in Australian adults rose from 27.9% to 31.3%.

In other words, over the past 3 years, an additional 900,000 Australians became obese.

Sixty-seven percent of Australian adults are now either overweight or obese (2017-18), an increase from 63.4% in 2014-15.

That’s astonishing.

Astonishingly bad news.

Australia now ranks 5th out of 44 OECD countries in the obesity stakes – it’s a race we shouldn’t be trying to win.

If this trend persists, how will we look in 2027-28?

By that time, nearly nine million Australians will be obese.

Think of the cost – not only costs to our taxpayer-funded health care system, but premature deaths from cardiovascular disease, obesity-related cancers, limbs, feet and toes amputated due to our runaway diabetes epidemic.

According to Diabetes Australia, 4,400 diabetes-related amputations already occur each year in Australia.

That’s set to get worse.

 

Australia’s runaway obesity epidemic needs to become an election issue

How long till we see concerted national action that is not choreographed by the big food lobby?

Did you know that the Australian Food & Grocery Council seeks a “constructive and collaborative response to obesity”?

They’ve been saying stuff like that for years.

I call it the “hot tub approach”.  Let’s all jump into the hot tub together and soap each other’s backs, and see what we can achieve…together.

This “constructive and collaborative approach” – characterised by voluntarism, and weak accountability structures – has been official policy in Canberra for years.

It would be great if it actually worked.

But if it was going to work, wouldn’t we be seeing positive results by now?

 

Life outside of the “hot tub”

There is life beyond the hot tub.

Feasible policy options to halt Australia’s obesity epidemic have been identified.  We know what we could and should do.

The “Australian Obesity Prevention Consensus” sets out an evidence-based policy agenda for the federal government.

Implementing the (surprisingly strong and certainly welcome) recommendations of the Senate Select Committee into the Obesity Epidemic in Australia would also be a good place to start.

The INFORMAS Network monitors the actions of state and federal governments and has issued scorecards on the performance of Australian governments, with priority recommendations.  (Watch out for the 2019 Food Policy Index Progress report, to be launched on 2 April 2019).

These reports include recommendations for legal and regulatory changes that the processed food industry will resist.

Like implementing credible – as distinct from voluntary, weak and loophole-ridden – standards to protect children from exposure to unhealthy food and drink marketing.

Like setting ambitious, time-sensitive and independently-monitored targets for reformulation to be met by food manufacturers, retailers and caterers.

Like a health levy on sugary drinks.  (Remember folks, at the end of the day, it’s only sugar water, not holy water).

Like making the Health Star Rating system mandatory.

No one likes sharing hot, soapy water with the folks from “big food” more than me, but the statistics speak for themselves.

Over the last 10 years, the number of Australians with obesity has more than doubled, from 2.7 million (2007-08) to 5.8 million in 2017-18.

It’s time to get out of the hot tub, and to implement long-recommended, evidence-based policies to create healthier food environments.

Put another Winfield on the Barbie

Having actor Paul Hogan headline Cure Cancer’s “Barbecure” makes no sense to me.

Put another shrimp on the barbie, I get it.  But so what?

Hogan may regret the staggeringly successful “Anyhow, have a Winfield” advertising campaign he headed in the 1970s, but his presence in a cure cancer campaign is inept.  It muddies the message.

Winfield is a brand of cigarettes now owned by British American Tobacco Australia.

Of his former campaign for Winfield, Hogan has said “Yeah, we were encouraging people to smoke.

“Young ones were taking up smoking and all going for Winfield. It was a staggering success but I was a drug dealer. But who knew then?”

This is not to suggest that Hogan is not sincere in wanting to help.  I’m sure he is.

But why does an organisation raising funds to support cancer research ask one of the most effective promoters of tobacco in Australian history, someone who is still, apparently, a smoker – to front the campaign?

Curing cancer…a tale of two strategies

Cure Cancer’s Barbeque concept seems to be about raising money for what we might call “techy” solutions to treating cancer – funding research towards a new drug or therapy.

(Must say, though, I love the idea about hosting a barbie, telling the guest list they’re not invited and hitting them for hard cold cash instead).

Cancer research is, of course, worthy and deserving of funding.  Who knows, many of us may one day benefit from such research and the therapies that result.

But there’s another way to cure cancer as well…it’s called reducing the risk that Australians will get cancer in future.

Using smart public policies, we can prevent the risk that Australians will get heart disease, and diabetes too.

Unfortunately, preventive health enjoys a fraction of the profile – and almost none of the money – that techy solutions like research towards new drugs or therapies attract.

This could be because one important dimension of prevention at the population level is regulation, and that makes prevention a political matter.

Australia has a pretty shabby record in using law and regulation to reduce modifiable risk factors for the non-communicable diseases that are responsible for the overwhelming share of death and disability in this country.

When it comes to food and diet-related risk factors, for example, see the scorecard and priority recommendations for Australian governments issued by the Global Obesity Centre, a WHO Collaborating Centre for Obesity Prevention, at Deakin University.

How many lifetimes till these are implemented, I wonder?

A decade ago, the National Preventative Health Taskforce released a blueprint for improving the health of Australians.

I can no longer find that report on the Australian Government’s website.

Although the government has raised the excise on tobacco and implemented plain tobacco packaging, no formal targets have been set for reductions in obesity or dietary risk factors, and prevention policy has been described as “flapping in the wind” (Swannell 2016).

Preventing cancer is “curing” cancer too

The Australian Preventive Health Agency, which was established to spearhead preventive efforts, and to fund preventive research, was de-funded and is extinct.

This move damaged momentum on preventive health in Australia, as Leeder, Wutzke, and many others have pointed out.

Which is a shame, because preventing cancer is “curing” cancer too.

Are you interested in health law?  Sydney Law School offers a Master of Health Law with mid-year entry.  See here and here for more information.

Update and summary guide to the WHO report: Advancing the right to health: the vital role of law

In September 2018 the World Health Organisation published an Update and Summary Guide to the report Advancing the Right to Health: the Vital Role of Law.

[See here for a previous post on the full report].

The summary Guide, like the full report, was a collaboration between the World Health Organisation, International Development Law Organisation, Sydney Law School, and the O’Neill Institute for National and Global Health Law at Georgetown University, Washington DC.

The aim of the original report, published in January 2017, was to raise awareness about the role that the reform of public health law can play in advancing the right to health and creating the conditions in which people can live healthy lives.

The Update and Summary Guide keeps the same focus: providing an introduction to the role of law in health development, with links to the full report, while also drawing attention to topics that were beyond the scope of the original report, and to links between law and the health-related Sustainable Development Goals.

The Update and Summary Guide integrates new health data and refers to new developments, including a list of highly cost–effective legal measures for reducing risk factors for non-communicable diseases (“NCDs”), drawn from the updated Appendix 3 of the WHO Global Action Plan for Prevention and Control of NCDs. It also references selected new decisions, such as the unsuccessful claim by a tobacco company against Uruguay’s tobacco control laws, and the decision of the Constitutional Court of Colombia confirming the right to receive information about the health effects of sugary drinks.

Public health law in the USA: What can Australia learn?

SEMINAR ANNOUNCEMENT: 

Public Health Law and Health Leadership in the United States: What can Australia learn?

Thursday 19 July, 6.00-7.30pm, Sydney Law School

In 2016, life expectancy at birth in the United States fell for the second year in a row.  Since his inauguration in 2017, President Trump and his administration have taken a number of actions that arguably weaken America’s public health infrastructure.

At the same time, the Unites States remains one of the world’s great innovators. With 52 States and more than 89,000 local and city governments, the United States frequently functions as a social laboratory for social policies, and public health laws and practices. While constrained in some areas by its constitutional design, the United States remains a leader: its influence and innovations in public health law cannot be ignored.

What can Australia learn from recent American experience with public health law and regulation?  What are the good ideas?  What should be avoided?  How can Australian jurisdictions adapt the best American innovations and create an enabling legal and political environment for public health and wellbeing?

This seminar features presentations reviewing public health law and leadership in the United States, with particular reference to: communicable diseases and pandemic preparedness, non-communicable diseases, health care, injuries and global health leadership.

This seminar is co-hosted by the United States Studies Centre at the University of Sydney, and Sydney Law School.

This event features a keynote presentation by Professor Lawrence Gostin, who is the Linda and Timothy O’Neill Professor of Global Health Law, Georgetown University Law School, Washington DC, and Faculty Director of the O’Neill Institute for National and Global Health Law. Prof. Gostin is also the Director of the WHO Collaborating Center on National and Global Health Law.

For further information on this event, further speaker details, and to register for this event, click here.