COMMENT - PUBLIC HEALTH

Published: 03/11/2005 Volume 115 No. 5980 Page 3

The British Medical Association wanted one.

The National Institute for Health and Clinical Excellence wanted one. The Royal College of Physicians wanted one. Even the pub industry wanted one. But former health secretary John Reid, along with the scientists at Imperial Tobacco, didn't want one. So the promise of a complete ban on smoking in pubs and members' clubs evaporated.

Whatever the speculation about Cabinet squabbles, the result is a blow for the fight against health inequalities that has dismayed public health managers (news, page 9). There is clear evidence, set out by the BMA and NICE, that a partial ban of this kind would concentrate smoking in poorer areas, in direct contradiction of the 2010 target to cut smoking at a faster rate among non-professionals.

So why the distinction for pubs serving food? Obviously no-one argues that secondhand smoke is more deadly when you are eating scampi and chips - it is arguably more annoying, but surely government policy on smoking should be based on health outcomes rather than etiquette.

It seems obvious that the issue is class and the fear that too many Labour voters will be annoyed if they are not given places in which they can drink and smoke simultaneously. It is true that opinion polls do not show majority support for a complete ban on pub smoking, hence the nervousness. But history suggests that public support for the policy grows after full smoking bans are introduced.

A major survey of directors of public health, to be launched in HSJ on 17 November, shows a high level of confidence among primary care trusts on meeting their smoking-cessation targets this year. But confidence falls sharply on the overall target to cut smoking rates to 26 per cent for manual workers by 2010.

They must be thinking of all those poor people whose 'one pleasure' Mr Reid is so committed to retaining - no wonder the smoking lobby want to give him a medal. It will add to his villain status, but critics might better wonder why a current health secretary couldn't swing more power behind her argument than a former one.