Once again my girlfriend returned depressed after an attempt to enjoy one of Tel
Aviv’s excellent music venues with friends. This time she was out only 30
minutes. I leaned to kiss her hello but hesitated. Her beautiful, dark hair and
warm skin smelled of tobacco smoke.
Tears in her eyes, she said she had
had enough. She had even called the police but was told her complaint would be
passed on to another agency which would deal with it “in due course.” She railed
at me about the anti-public-smoking laws that had been passed in March 2001 and
were deemed to be “among the toughest in the world,” according to a report in
the British Medical Journal. The laws have been stiffened over the years, but to
little effect other than a reported reduction in smoking in
My girlfriend does not smoke and never has, which makes her
all the more attractive to me, not least because, unlike her smoking friends, I
know her skin will not deteriorate in the years to come. She told me
sardonically that the venue she had visited had no-smoking signs right in front
of those lighting up. It simply seems impossible to have an evening out or
attend any form of dance without having other people’s smoke inflicted upon
It is, sadly, very clear nowadays that Israelis blatantly ignore,
deny and trample on the anti-smoking legislation, and the authorities simply
ignore it – to the future cost of their citizens’ health. The issues were
reviewed in The Jerusalem Post
(March 2) in an interview with Prof. Gregory
Connolly of the Harvard School of Public Health. In it a study by public health
expert Dr. Leah Rosen of Tel Aviv University was cited. Rosen’s study showed
that owners of Tel Aviv pubs consistently fail to enforce laws, and inform one
another that municipal inspectors are on the prowl for violators I remember
similar attitudes being prevalent in Britain until, in the 1990s, the government
realized the real costs of treating smokers and non-smoking adults and
In the 1990s, the estimated cost to American society of smoking
was $52 billion in health expenses or time lost from work – about $221 per
person each year, according to federal officials. The current cost of passive
smoking in the UK to children’s health alone was estimated at £23.3 million per
The British government in 2002 estimated that the net benefits
(after calculating loss of revenue and other costs as well as benefits) of just
making all workplaces smoke free would be between £2.3 and £2.7 billion per
year. This is equivalent to treating 1.3-1.5 million hospital waiting list
patients. In Scotland, the net benefit of making all public places smoke free
was calculated at around £124 million per year.
Other, similar, figures
worldwide convinced politicians that preventing passive smoking would be of
significant benefit to society.
Health promotion then kicked in
successfully, reinforced by bans on tobacco advertising, an increase in tax on
cigarettes, presentation of the nonsmoking message on popular television, and
various social marketing strategies. In addition, free stop-smoking clinics were
provided along with subsidized nicotine treatments such as anti-craving drugs,
nicotine patches, gum and inhalers. Not only the health of smokers was
considered, but also the risks of passive smoking.
A miracle ensued.
Britain, Ireland and many European countries now have dance bars, raves and rock
concerts which anyone can enjoy and come away with cleansmelling clothes and
clear lungs. The streets no longer have cigarette butts strewn across them, and
the air generally smells and feels cleaner. Britons actually seem to be taking
pride in their environment.
The tobacco companies hated it but bowed to
the inevitable and took their poison trade to developing places like Asia,
Africa and the Far East.
A KEY part of the change was the willingness by
politicians to take health-related research seriously and use strategies such as
social marketing to really tackle the issue. This occurred once politicians
began to realize the huge negative impact of smoking on public health and the
A highly influential report based on leading international
research was produced by Britain’s Royal College of Physicians in 2005. Entitled
“Going Smoke Free,” it presents the medical case for smoke-free areas at home,
work and in public places. Its main conclusion is that for the safety of all, it
is better to legislate for completely smoke-free public places and work places
and to advise people to make their homes smoke free.
The risks of passive
smoking that it highlights include all the risks faced by smokers, plus things
like sudden infant death syndrome and increased risk of asthma. The risk of
bronchitis and pneumonia in infants during the first two to three years is 57
percent greater for children whose parents smoke. Ear disease is another issue,
as is meningitis, and second-hand smoke may damage a child’s ability to
Other data indicate there is also the chance that passive smoking
may have a negative effect on a child’s ability to read or use reasoning skills.
A key message is “do not smoke around children.”
Skin problems such as
premature aging and wrinkling, have been shown to develop much more quickly in
smokers, and those who are regularly around smokers are also at risk. Other
research found that passive smoking kills 12,000 people in the UK each
IN ISRAEL, there have been a number of studies about smoking and
According to a May study by the Health Ministry, 22.8
percent of the adult population smokes. The study found 31.3% of men smoke,
while for women the figure is 14.8%. A study of eighth-grade students found that
5% smoke occasionally. Jewish children whose parents smoke were 2.8 times more
likely to smoke themselves. Arab children whose parents smoke were 5.8 times
more likely to do so. According to a 2009 report in the European Journal of
Public Health, 8,664 deaths in Israel were attributable to smoking in 2003. The
number attributed to passive smoking is unclear.
Smoking is also
associated with low IQ, according to a study of 20,000 IDF soldiers by Dr. Mark
Weiser from the Sheba Medical Center in Tel Hashomer. Published in the journal
Addiction in March, Weiser’s research found a direct correlation between the
number of cigarettes used and low IQ.
And what exactly is in tobacco
smoke? According to data available freely on the Internet, tobacco smoke
contains more than 4,000 chemical compounds, including at least 40
Tobacco smoke also contains carbon monoxide, a
poisonous gas which inhibits the transportation of oxygen to the body’s vital
organs via the blood. The smoke emitted from the tip of a cigarette has about
double the concentration of nicotine and tar as smoke directly inhaled. It also
contains about three times the amount of the carcinogen benzo(a)pyrene, five
times the level of carbon monoxide and about 50 times the ammonia. Add to these
the other chemicals like arsenic, formaldehyde, vinyl chloride, and hydrogen
cyanide, and it becomes a pretty toxic gas cocktail.
challenge to tackling smoking is in attitudes.
Smokers often have a “live
now, pay later” approach. I have heard a smoker say things like: “So what? I
could be run over by a bus tomorrow, so I might as well enjoy my cigarette
This lasts until they or a relative’s health becomes severely
impaired. I remember being put off smoking for life when my grandmother, then
61, had to have the iliac arteries in her legs replaced due to secondary damage
She was never able to walk without discomfort
The other common argument presented by smokers is “it’s my right
to smoke if I want.”
They conveniently forget the effect of their smoke
on others and the reality of smoking being a purely selfish act.
calculation of the personal cost of smoking and the benefits of stopping helped
many give up.
A key approach to tackling smoking and passive smoking in
Israel will be social marketing. This involves systematically applying the
principles of marketing alongside other concepts and techniques to achieve
changes in behavior.
Commercial marketing is different in that its aims
are primarily financial, measured in terms of profits or shareholder value.
Social marketing aims specifically to achieve improvement in the lives of
people. It works by focusing on specific groups in context and delivering
messages to help create lasting change.
This would have to be backed up
with support to quit, and easy access to nicotine replacement
For my girlfriend, even removing the risks of passive smoking
from dance bars and clubs in Tel Aviv would be a significant milestone.
her sisters and friends, music is their interest and priority, but
not something they can simply ignore. “If people want to smoke, then
not to exhale,” she says. This option is not so far from being
new technology like nicotine gums, patches and inhalators. A smoke-free
is not impossible.
The writer is a therapist and former UK National
Health Service manager. He has an MSc in clinical and public health
addiction and a special interest in social marketing in health. He
of his time in Tel Aviv when he is not working in London.