*Yearning to breathe free*

The amendment that barred tobacco use in workplaces is now 20 years old. While it has reduced smoking, there is still a long way to go, especially with regard to enforcement.

By JUDY SIEGEL-ITZKOVICH
Smoking (photo credit: INGIMAGE / ASAP)
Smoking
(photo credit: INGIMAGE / ASAP)
Until October 1994, it was a different world – one where bosses and employees smoking cigarettes, pipes and cigars were on the offensive and had the power to set down the rules; non-smokers who yearned to breathe free at their workplaces were dependent on their colleagues’ good will and usually lost.
The amendment to the 1983 law that prohibited smoking in public places from taxis and buses to elevators did reduce the country’s smoking rate, but it was still as high as 32 percent two decades ago. Approval by only the Knesset Labor and Social Affairs Committee was needed to approve the amendment, not a majority vote of the whole plenum.
The amendment was backed in the summer of 1994 by then-health minister and Labor MK Haim Ramon, the Israel Cancer Association (ICA), tobacco-control advocate Amos Hausner, the ministry’s smoking-cessation expert Dr. Tuvia Lehrer and public health head Dr. Alma Avni, and Labor MK Amir Peretz, who headed the Knesset committee.
The need to take a break and leave the premises (risking pneumonia in the winter) for a smoke has since discouraged many employees from lighting up and is partly responsible for the current smoking rate of less than 20%. Weizmann Institute of Science senior cancer researcher Prof. Natan Trainin told me then that if the amendment were passed, “it will have more of an effect than all the cancer research I have done in 38 years.”
According to Prof. Ben-Ami Sela, head of the chemical pathology lab at Sheba Medical Center and anti-smoking activities (who runs his own non-profit, Hebrew-language website on tobacco’s dangers at www.tevalife.com), the health damage caused by secondhand smoking has been proved beyond doubt.
Beyond the fact that half of all smokers die of tobacco-related diseases, “studies have shown that passive smoking increases heart attack risk by 30%. Non-smokers’ blood vessels are sensitive to even small amounts of cigarette smoke, leading to atherosclerosis [clogged coronary arteries] and increased inflammation in the body, as reflected in levels of C-reactive protein. There are numerous victims of lung cancer and chronic obstructive pulmonary disorder caused by tobacco smoke even though they never themselves smoked.”
The 1994 amendment was strongly opposed by the Histadrut’s senior trade union official Shaul Ben-Simhon and former justice minister Haim Zadok, who was hired by the Dubek tobacco company to represent it and was at the same time president of the Israel Press Council. The amendment was publicly ridiculed on Channel 1’s Popolitica show by journalist Yisrael Segal, who died some years later from a disease connected to his smoking habit.
The road to its approval was not smooth. Only four MKs – Peretz, Tamar Gozansky (Hadash), Yoram Lass (Labor) and Benny Temkin (Meretz) – voted for the amendment.
None of the others who had previously voiced their support or opposition turned up at the crucial meeting.
Early in 1994, Ramon resigned his post to run for the post of secretary- general of the Histadrut, the General Labor Federation, which due to union objections had long opposed a law prohibiting smoking in the workplace. Until a new minister was appointed, prime minister Yitzhak Rabin had responsibility for signing into law the bill finally approved by the committee.
Rabin unnerved smoke-free activists when he lit a cigarette during an interview on Army Radio and said: “I am health minister. I can decide not to sign the amendment if I don’t want to. Does it mean that a truck driver won’t be able to light up in his cabin?” he said. (Only offices were covered by the amendment, not vehicles.) “MKs must be careful about what legislation they pass.”
Health Ministry sources insisted the premier was “only joking” and would sign it in the end. Although the change would prevent Rabin and others from smoking in the meeting room where the cabinet meets, it would not have affected their ability to light up in their private offices), this was prohibited in a 2012 amendment. After approval of the 1994 change, Civil Service Commissioner Shmuel Hollander personally informed Rabin that he and other ministers would not be permitted to light up where the cabinet met, and to his credit, the prime minister observed it.
Rabin didn’t, however, sign the bill; he waited until he named Labor MK and physician Dr. Ephraim Sneh health minister. When I asked Sneh on his first day in office in June 1994 when he would sign the amendment, he replied angrily: “I have no time for that! I have a nurses’ strike to deal with.” But Sneh finally inked his signature a month later, and it came into effect on October 19. The fine per violation was only NIS 170 (and is NIS 1,000 today) but enforcement was expected to be mostly through pressure from the public rather than fines from municipal inspectors.
About a year before the bill went into force, The Jerusalem Post’s management decided voluntarily to prohibit smoking in the building, bringing relief to journalists such as myself who had been passive smokers against their will, couldn’t stand the dirty habit and knew its human, medical and financial toll.
Eight years before approval, I had my own unpleasant and unforgettable public experience with passive smoking. Eight months pregnant, I was assigned to cover an important and packed Knesset Labor and Social Affairs Committee session that lasted two hours. The one empty seat was immediately behind Labor MK Binyamin Ben-Eliezer, who puffed away incessantly (and a few years ago almost died from tobacco-related causes). Feeling unwell from his smoke 15 minutes into the session, I asked him politely if he would put out the cigarette, pointing to my pregnant belly.
“No!” he said emphatically.
Half an hour later, when I felt I was going to vomit on him, I quietly repeated my plea. Ben-Eliezer (who this year planned to run for presidency of Israel but was instead bogged down in corruption charges) stood up and demanded that committee chairman MK Ora Namir have me ejected from the session.
Two burly Knesset guards were called in and escorted me out the door.
But an Israel Radio reporter who knew me and witnessed the incident reported it in a live broadcast, noting that “Ben-Eliezer banished from the committee session the Post’s pregnant health reporter after she asked him if he would put out his cigarette.”
Today, there is a small, glass-enclosed smoking room adjacent to the Knesset’s public cafeteria, with the cigarette puffers an enclosed minority behind the see-through walls. In 2005, the Histadrut (under different leadership) offered legal assistance to non-smoking employees who were afraid of the consequences of complaining about bosses and colleagues who violated the law.
SUBSEQUENT LEGISLATION in 2007, initiated by then MK (and now minister) Gilad Erdan placed responsibility for enforcing the 1994 law in the laps of the owners of the premises in question, such as offices, restaurants, bars and clubs.
Today, few employees are seen smoking in hospitals, clinics, schools, restaurants and other public establishments, but since many bars and clubs are still smoke filled, waiters and kitchen staff are constantly exposed to toxins in the air.
Guards posted at entrances press a buzzer to alert smokers when a municipal inspector arrives to see if the law is being enforced, and since the rules require that the inspector actually catch the violator in the act, he can’t hand out fines if there is only telltale smoke in the room.
In 2012, the Knesset passed a Health Ministry bill to bar smoking not only at indoor bus stations but also those outdoors that have a roof over them, as well as all train stations – including Jerusalem’s Light Rail system. Israel Railways stations are usually, but not always, smoke free. But in the capital, where the Light Rail has 140,000 passengers daily – more than all Israel Railway line passengers combined – marathon-runner Mayor Nir Barkat has done nothing to ensure that city inspectors fine customers who light up. The no-smoking-on-the-platform signs are totally ignored. Not a single NIS 1,000 fine has been handed out along the route since it opened in the summer of 2011, and cigarette butts on the sidewalk abound.
IN ITS original form, Hausner recalled last week, the 1994 bill was supposed to have been in force for only a year, but he managed to persuade the then-chairman of the Knesset committee, Labor MK Yossi Katz, to make it permanent, and history was made.
“I had actually suggested smoking prohibition in the workplace in 1983, but MK Mordechai Gur, who was health minister between 1984 and 1986, and Orna Namir, were against it,” the lawyer recalled. “I was very proud of the law prohibiting smoking in the workplace. Except for the US and Norway, which had done it before, we were the first country in the world to have such legislation. But while we were pioneers and very advanced then, we have sadly fallen way behind in tobacco legislation and enforcement since then. The ministry has failed to abolish smoking rooms, which are almost unknown around the world.”
In addition, other countries have prohibited smoking in private vehicles if children are present due to the resulting high levels of toxic particulate matter. And now Paris has instituted a one-year trial ban on smoking in the playgrounds of the Parc de Montsouris as part of a larger French campaign to reduce the country’s high death toll from smoking, some 73,000 lives annually. After a year, Paris officials will determine whether the measure should be made permanent and extended to other Paris parks.
While the Health Ministry in Jerusalem has implemented a law proposed by then-MK (and now minister) Uri Ariel barring cigarette vending machines in all public places, it has not managed to halt duty-free sales of tobacco in the airports, require that cigarette packs show graphics of tobacco damage and be uniform and generic so as not to attract youngters or bar tobacco advertising in the print media.
RAMON, WHO left the Knesset and politics and is now a businessman, told the Post that he still follows the subject of tobacco legislation.
“Smoking is more dangerous to public health than hard drugs, because it affects and kills people around the user and not only the smoker himself. Drugs affect only those who abuse them. As health minister, I understood the dangers of secondhand smoking. But I knew then that enforcement is very difficult. Even though they would bring to city coffers large sums, municipalities don’t like to anger their residents, and fines for illegal smoking get violators angry,” he said, even though the vast majority of residents are nonsmokers who would appreciate proper enforcement.
“City inspectors prefer to hand out parking fines, as the drivers are not there to argue,” said Ramon, who said he has never smoked.
Hearing the Post’s idea that the best way to eliminate illegal smoking would be privatization of enforcement, in which a company with young IDF veterans on motorcycles and armed with cameras could be dispatched to act on phoned-in complaints, patrol public areas and fine violators, Ramon said that if he were health minister today, “I would indeed privatize the job. It would create a real incentive to catch violators.
If this is not done, violations will not end until there is a health minister who is aware of the public health problem and really cares. The treatment of tobacco-related diseases is so expensive and has such a huge human toll.”
Former New York mayor Michael Bloomberg spent millions of dollars of his own money promoting smoking cessation and put in place tough laws to reduce tobacco use – and city residents’ health quickly improved as morbidity and mortality from smoking-related diseases significantly dropped.
PROF. ITAMAR Grotto, the ministry’s current head of public health and a one-time smoker – now a confirmed opponent of tobacco – concedes that there is a severe lack of enforcement of the laws by municipal inspectors around the country. “Before coming to the ministry, I was in charge of public health of the IDF, and there it’s easier to give orders and promote observance of the rules. In civilian life, it is much harder.”
The 1994 amendment, he told the Post, was a very important law, but it has to be updated. We need to add places not covered by the law, but most important, we must promote enforcement. The ministry doesn’t have the means to do it by itself.
We have to meet with mayors go get them to do it better,” he said, noting that the mayors have much to gain, because the local authorities pocket the fines for their own use.
He concedes that the ministry has not followed through on its own 2012 legislation to bar smoking at covered bus stations around the country.
(There isn’t a single sign noting the prohibition.) “Maybe there is a better way,” he said.
ICA director-general Miri Ziv noted that her organization was very active in promoting legislation to fight tobacco. “It is the number-one cause of preventable death. We were among the top 10 countries in early smoke-free laws, but since then we have fallen behind.”
Some 8,500 Israelis still die annually from smoking, about 1,500 of them passive smokers who never put a cigarette to their lips, she said, adding that while the 1994 law was important, much more has to be done in enforcement and education. “If public enforcement does not become serious, I am in favor of considering privatization,” she concluded.