Prohibiting smoking outside hospital buildings: consultation analysis

Section 5: Equalities

Question 8: Do you consider there to be any positive or negative impacts on equality as a result of the proposals in this consultation?

Context

The basic perimeter size of 15 metres for a no-smoking area outside certain hospital buildings will potentially impact more on some people than others. For that reason the Scottish Government sought views on how the proposals may impact on people with respect to age, gender, sex, sexual orientation and identity, ethnicity, religion or belief, disability, pregnancy and maternity or socioeconomic disadvantage (i.e. potential positive and negative impacts, and, if applicable, advise on any mitigating actions that could be taken).

Overview

Over one-third of respondents considered there to be positive or negative impacts on equality as a result of the proposals in this consultation (37%), Table A8. Organisations were far more likely to note positive and/or negative impacts on equality than individuals.

In terms of protected characteristics, the main groups identified by respondents that noted a negative impact(s) on equality as a result of the proposals were disability (as defined in the Equality Act 2010) and age (i.e. older people). These respondents typically highlighted the difficulties people with mobility issues (e.g. older people, infirm) might face in walking (safely) from the exterior of a hospital building to smoke, and "which may include negotiating a hazard such as a road".

"…we predict there will be a largely negative impact on anyone who is infirm or largely immobile without third party support. Patients who may be mobile but are attached to a drip (for example) will also be among the hardest hit. Forcing such patients away from hospital buildings and even off site will discriminate against those who have disabilities or may be recuperating in hospital following an operation and are unable to move unaided to an area where smoking is permitted".
Freedom Organisation for the Right to Enjoy Smoking Tobacco (FOREST)

"The overall impact of this policy is likely to be positive in terms of reduction in exposure to second hand smoke and also environments which are supportive for people trying to be smoke-free. However, there may be some groups for whom a negative impact could be experienced: people with long-term conditions or mobility issues who may find it difficult to move to external areas could be negatively affected; and people with learning disability or for whom English is a second language may inadvertently commit an offence due to potential confusion relating to signage and understanding of policy/legislation".
NHS Borders

People with mental health issues were frequently viewed as a group who could be negatively affected, and in particular those patients detained under the Mental Health (Care & Treatment) (Scotland) Act 2003.

"We are concerned that some patients will resist hospital treatment based upon these restrictions, and witnessed patients state this. Within the context of psychiatric care, engagement with some patients is already problematic, this may provide an additional disincentive to engage. It is well evidenced that many patients, especially those who receive psychiatric care, are less likely to be in employment, financial penalties for smoking will effectively penalise those least able to pay. We would suggest a full equality impact assessment should be carried out on all hospital sites in Scotland in relation to this policy".
Mental Health Network Greater Glasgow

Other groups identified who could be negatively affected were people with long-term limiting illnesses, and those from disadvantaged socioeconomic backgrounds.

"It should also be noted that smoking rates are highest in deprived areas which means that statistically it is more likely that smokers affected by the prohibition, or indeed by enforcement action, will be from deprived areas".
Glasgow City Council

Some respondents noted the negative impact that the proposals could have on smokers (i.e. addictive nature of nicotine), while others noted that smokers would be unfairly discriminated against (i.e. legal product and freedom of choice arguments).

"…smokers rights and freedom of choice are not being given fair treatment".
Individual

"I believe there to be a negative impact in equality because nicotine is an addiction. I understand that it is detrimental to the health of others and believe that there should be designated areas that are weather proof".
Individual

The main mitigation actions identified were accessible designated smoking shelters and access to smoking cessation support services. There were also some references to nicotine patches and NVPs.Where positive impacts were noted, these typically centred on the following:

• Reducing health inequalities.
• Equal protection of patients, staff and visitors to the health harms of ETS.
• Encouraging positive change to harmful behaviour.
• Reducing the visibility of smoking for children and young people.
• Reducing adult smoking rates across all demographics and income groups (although to various degrees).
• Supporting people across social groups to stop smoking by increased promotion of, and access to, smoking cessation services.

There was some specific reference to the benefits that the proposals could have on individuals from all protected characteristic groups (in particular pregnancy and maternity).

"There will be positive impacts in that people within specific protected characteristic groups will have added protection, through the reduced risk of exposure to second hand smoke, which is evidentially known to affect health".
Royal Environmental Health Institute of Scotland

"The proposals have the capacity to support and promote equality and diversity. They will provide further protection for staff, patients and visitors from second hand smoke/environmental tobacco smoke and this includes pregnant women and children. Existing primary studies and systematic reviews of smokefree policies show that they can benefit all groups and have the capacity to support smoking cessation".
SPECTRUM - Shaping Public hEalth poliCies To pRevent ineqUalities and harM

"These positive impacts relate to ensuring patients, staff and visitors to psychiatric hospitals are protected from the hazards of ETS, as well as ensuring pregnant women in, working at or visiting NHS Scotland hospitals are also fully protected from these hazards. Smoke-free areas have also been shown to impact adult smoking rates among all demographics and income groups (though to varying degrees)".
The Scottish Coalition on Tobacco (SCOT)

Over half of respondents did not consider there to be any positive or negative impacts on equality as a result of the proposals (53%).

Common themes from across the responses emphasised that:

• While people have the freedom of choice to smoke, this should not be to the detriment or harm of others.
• The Scottish Government has a duty to put in place measures to help de-normalise smoking and reduce the use of tobacco across the population.
• The importance of improving and protecting public health.

"As long as appropriate, accessible and safe smoking areas are made available, and not positioned in such a way that non-smokers need to walk through or close to them, there should be no equality issue. Equality is smokers smoking, and non-smokers not breathing in their smoke".
Individual

"Equalities are about making reasonable adjustments, so moving a permissable smoking area… away from a building is protecting non-smokers, whilst maintaining an open area for smokers. This, I would say, is a more than reasonable adjustment".
Individual

"I can appreciate that it is harder for physically disabled people to go further off the site to smoke than others would, but smoking in itself is a choice (there is support to stop if wanted) rather than something related to their disability. The health impact on others of their choice needs to be considered, especially when they are attending a place where other people with disabilities may be adversely affected by their choice, such as in the case of people with respiratory conditions or vulnerable children".
Individual

"All people are treated equally. It's a personal choice to smoke, one that is made and reinforced each time a person chooses to smoke. They should respect other peoples' rights to clean quality air to breathe, and not have it contaminated".
Individual