SMOKING bans in public places are spreading across the world far more rapidly than most people realise.

What California started is now about to become the norm in several European countries, and has already been enforced in Thailand, Singapore, South Australia, parts of Canada, Cape Town, Tokyo and in “hundreds of towns where there are local ordinances” says Action against Smoking and Health (Ash).

The Irish Republic is set to introduce a ban early next year on smoking in workplaces, which will include restaurants and bars. Greece introduced tougher rules on public smoking more than a year ago, but they stop well short of a complete ban in a nation where 45 per cent of adults are smokers.

Norway plans a total ban on smoking inside all public places, to be introduced at the beginning of next year. The Netherlands also plans to introduce a ban next year.

Other European countries have been more reluctant, prompting David Byrne, the EU’s Health Commissioner, to suggest a European Directive on the issue. Legislation to ban public smoking is “simply a matter of time,” he said in September.

In London a public study is being held by the London Health Commission, a body set up by the Mayor, Ken Livingstone. Its report is expected in January.

Different places have approached the introduction of bans in different ways, Amanda Sandford of Ash says. “In California they started in offices, then moved to restaurants and, finally, bars, to get people used to the idea gradually. California is virtually a smoke-free state these days, with very little protest.”

Those in favour of such a ban in Britain include the British Medical Association, Sir Liam Donaldson, the Chief Medical Officer, and now the royal colleges. Sir Liam believes that a ban would cut deaths from cancer and heart disease by reducing exposure to others’ smoke, and encourage more smokers to quit.

The Office of National Statistics published a survey this year which showed that 87 per cent support such bans.

The Government has so far declined to adopt its Chief Medical Officer’s advice, fearing that bans will be seen as infringeing freedom. The economic effects remain controversial. Three US studies showed that bans in restaurants do not damage trade. In New York, 10,000 bar and restaurant jobs were created in the first six months, according to the US Department of Labor.

Proof positive eludes scientists

Virtually every public body that has looked at passive smoking has concluded that it does harm. But behind the apparent unanimity there are still some question marks.

Other people’s smoke has been blamed for heart disease, lung cancer and other respiratory conditions, especially among children. A report this year by the TUC, the anti-smoking group Ash, and the Chartered Institute of Public Health said that, every year, passive smoking at work killed three times as many people — 900 office workers, 165 bar staff and 145 factory workers — as workplace accidents.

But measuring these effects in a way everybody will accept is difficult. Taken together, various studies suggest an elevated risk for lung cancer of about 20 per cent, but critics say that this could easily be accounted for by the failings of the studies themselves.

Critics also argue that the conclusions are based on pooling data from a lot of studies, a technique vulnerable to publication bias. Scientists are more likely to publish studies that show positive results, ignoring the ones that show no effect.

Saying so, though, makes one unpopular. Two scientists who published a study in the British Medical Journal this year which followed 120,000 adults over 40 years and showed no evidence of increased risks of lung cancer or heart disease were vilified as the tools of a manipulative tobacco industry.

Yet, if tobacco smoke is dangerous — and everybody accepts that it is — then it is unfair to expose non-smokers to even small doses of it, whether the evidence of actual harm is wholly convincing or not. An employer would not be permitted to expose employees to a known carcinogen — so why should fellow employees be allowed to? That is the basis for the calls for workplace smoking bans, and it has proved more than adequate for the many places that have already implemented them.

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