Smoke-free cities

A huge body of evidence shows that second-hand exposure to tobacco is a major risk factor for many chronic diseases, including cancer, lung diseases, and cardiovascular diseases. Therefore, any regulation that leads to a reduction of exposure to tobacco smoke will have a positive impact on public health.  To assist efforts, the WHO Framework Convention on Tobacco Control establishes guidelines for policy development and implementation. Furthermore, with the MPOWER package WHO identifies six effective tobacco control policies whose enforcement will greatly contribute to preventing the lethal effects of tobacco. One is protecting people from second-hand smoke. However, while many countries have legislation restricting use and exposure to tobacco products, only 5% of the world’s population live in countries that fully protect their population using with any one of the key measures that reduce smoking rates.

            Meanwhile regulation of tobacco use in public spaces have became an important issue in the local agenda. In fact, several cities have been successful in enforcing smoke free environments through local interventions. Often, local regulations have anticipated national interventions or addressed the issue with measures beyond the legal or political scope of national governments. The implementation of such local regulations are clear examples of action for urban health, and the importance of urban governance for health. This study documents experiences and systematizes evidence for interventions at the city or sub-city level that have led to public spaces free of exposure to second-hand smoke. Lessons for policy-makers at the local level promoting smoke free cities are presented. Examples of interventions that can be implemented in cities include regulation of public spaces, buildings, commerce and pathways. The paper also gives recommendations on the process of promoting these interventions such as community involvement and advocacy actions among health workers, city officials, and other policy-makers.