Let’s clear the smoke: Making bars and restaurants accountable for a smoke free Lusaka

N Chizuni1

  1. Zambia Center for Applied Health Research and Development, Lusaka, Zambia

Correspondence: Nellisiwe Chizuni (luyandochizuni@gmail.com)
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Citation style for this article: Savory T, Mwanza M, Lumpa M, Chitala M. Keep our future generation alive: Reinforcing routine HIV testing & treatment among children in Zambia. Health Press Zambia Bull. 2017;1(2), [Inclusive page numbers].

Smoke-free laws protect non-smokers from unwanted second-hand smoke and resulting health effects.
The Zambia smoke-free law was passed in 2008, but no enforcement was done.
55% of bars and restaurants have cigarette smoke levels way above the suggested guidelines.
Making restaurants and bars accountable for ensuring their in-door premises are smoke free is one of the most effective way of enforcing the law.
Providing an incentive and re-training of the enforcers will make them carry out their duties more attentively.
The Problem
Second-hand smoke (SHS) is one of the most important and most widespread exposures in the indoor environment. It has been linked to several health outcomes such as respiratory infections, ischemic heart disease, lung cancer and asthma [1]. Globally about a third of the population is exposed to the harmful effects of smoking, and responsible for over 600,000 deaths every year, of which 53,000 were in Africa. These deaths were mostly caused by ischemic heart disease for adults and lower respiratory infections (LRIs) for children [2]. There are no risk-free levels of second-hand smoking and even just a small amount of exposure can cause immediate harm [3].
Smoke-free law protects the non-smokers from involuntary exposure to second-hand smoking and this in turn reduces the number of health outcomes from second-hand smoking. In Scotland, where the smoke-free law was implemented fully there was a reduction in smoking related diseases like asthma from 79.2% to 53.2% [4]. In Spain, the number of hospital admission from acute respiratory infection reduced by 16% after the smoke-free law was passed in 5 years [5].
The Zambian government in 2008, through the Ministry of Local Government passed the smoke-free law, banning smoking in public places. This law was passed but no enforcement was done. It has been shown that only in hospitals and public transport are the public places complying with the law [6]. In 2014, 6 years after the law was passed 55% of the public places visited still had visible patrons smoking and the air pollution levels for cigarette was 69% over the suggested guidelines. Even the 45% of the public places visited and the immediate outdoor surroundings still had cigarette butts on the floor and the air pollution was still higher than the guidelines [7]. This is due to the lack of enforcement from the appropriate authority and not making public places owners accountable.
Policy options
In order to reduce smoking in public places, the smoke-free law that was passed in 2008 should be enforced. Policy options that can enforce the smoke-free law include, increase the fine paid by public places, training of the enforcers on the importance of the smoke-free law and public awareness.
Introduce Fines for Bars and Restaurants Owners in the Law
WHAT: Introduce fines of thirty thousand, three hundred and forty penalty units to be paid by public place owners who fail to comply with the smoke-free law.
WHY: Currently public place owners are not fined if they are caught allowing someone to smoke in a non-smoking area.
FEASIBILITY: High. The Law is already there and has to be amended by the Ministry of Local Government.
Training and Incentivizing Health Inspectors
WHAT: Re-educating the enforcers on the importance of enforcing the smoke-free law and offering an incentive for all non-compliance of the smoke-free law booked.
WHY: Passing the law on its own will not produce the desired effects of reducing smoking in public places. It requires people to ensure that the law is being followed and if anyone fails to comply, the consequences should follow through.
FEASIBILITY: Medium. The government can use the human resource department to organize an in-house training for the enforcers and using money generated from fines collected by the department.
Public Awareness
WHAT: Carry out a public campaign on the dangers of second-hand smoking and how they can report if anyone fails to follow the law.
WHY: The public need to be aware of the dangers of second-hand smoking and that it is their right to protection from exposure to tobacco smoke.
FEASIBILTY: Medium. The government needs money to be able to have a meaningful campaign as campaigns will have to be translated to the various local languages.
Making bar and restaurant owners accountable for ensuring that their in-door premises are smoke free and the enforcers have an incentive and re-training to enforce the law. This is both cost-effective and feasible.
For this strategy to be implemented, the Ministry of Local Government and Ministry of Health needs to review the implementation plan and organize money needed to pay for the incentives.
The Ministry of Local Government needs to amend the smoke-free law so that bars and restaurants owners are accountable of enforcing the law in their premises. A public awareness program on the amended law needs to be done by the Ministry of Health and Local Government. The Lusaka City Council will have to get some of the money from the fines collected and use that to pay the incentives.
Having bars and restaurants owners accountable for ensuring no smoking is done in-doors and ensuring the enforcers carry out their duties has been noted to be highly effective way of making sure there is compliance and is less costly to the government
Available literature

  1. Global Health Observatory Data – Second Hand Smoking: WHO;
  2. Commission CfSAAU. The Impact of Tobacco Use on Health and Socio-Economic Development in Africa. 2013.
  3. Services USDoHaH. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
  4. Daniel Menzies. AN, Peter A. Williamson., Stuart Schembri., Mudher Z. H. Al-Khairalla., Martyn Barnes., Tom C. Fardon., Lesley McFarlane., Gareth J. Magee., Brian J. Lipworth. Respiratory Symptoms, Pulmonary Function, and Markers of Inflammation Among Bar Workers Before and After a Legislative Ban on Smoking in Public Places. Journal of American Medicial Association. 2006;296(14).
  5. Iñaki Galán. LS, Víctor Flores., Cristina Ortiz., Rafael Fernández-Cuenca., Cristina Linares., Elena Boldo., María José Medrano., Roberto Pastor-Barriuso. Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues. British Medical Journal. 2015.
  6. Project I. ITC Zambia National Report. Findings from the Wave 1 and 2 Surveys (2012-2014). Waterloo: University of Waterloo; 2015.
  7. F. M. PMM. Ambient Air Pollution by Second Hand Tobacco Smoke in Public Entertainment Places In Selected Areas of Lusaka, Zambia. Medical Journal of Zambia. 2014;41(2):59-64.