Elsevier

Health Policy

Volume 102, Issue 1, September 2011, Pages 49-55
Health Policy

Street smoking bans in Japan: A hope for smoke-free cities?

https://doi.org/10.1016/j.healthpol.2011.05.013Get rights and content

Abstract

Objectives

This study analysed 112 municipalities enforcing municipal smoking restrictions on streets in Japan to examine anti-smoking measures implemented in urban settings from a health perspective and derive lessons for future tobacco control.

Methods

Municipal governments implementing ordinances which restrict smoking on streets were identified through grey literature review. Implementation period, characteristics, scope, and department responsible were examined.

Results

Since the first municipal regulation was introduced in 1997, many other municipalities have followed. Enforcement of fines started in 2002, which is now a common practice nationwide. Nevertheless, the health impact of exposure to secondhand smoke is not clearly articulated in the ordinances. Street smoking bans have been developed in connection with “beautification” and littering prevention for environmental purposes, and local health departments do not have responsibility for these ordinances.

Conclusions

There is potential to further prevent secondhand smoke exposure if such measures are expanded to indoor environments and integrated into broader policies. For policy-makers and advocates, the Japanese experience provides information on an additional tobacco control intervention as well as clues in the process of design, implementation and enforcement of such municipal measures. A more comprehensive and health-driven approach is required to effectively address the harm of secondhand smoke in Japan.

Highlights

► A case study on ordinances against street smoking in 112 Japanese municipalities. ► Smoking restrictions were justified not on health but on environmental grounds. ► Stronger subnational tobacco control is increasingly feasible in Japan. ► This study provides lessons for cities worldwide considering similar policies. ► Impact seems limited and the need for national comprehensive control remains.

Introduction

The negative effects of secondhand smoke (SHS) on health are supported by abundant evidence and its prevention remains an important public health challenge [1], [2], [3], [4], [5], [6], [7], [8], [9]. Given that 100% smoke-free environments are the only proven way to adequately protect the health of all people from SHS, World Health Organization (WHO) strongly recommends smoke-free legislation through the MPOWER package of six tobacco control policies to counter the tobacco epidemic [10]. Furthermore, Article 8 in the WHO Framework Convention on Tobacco Control (WHO FCTC) mandates its signatory and accession countries to enforce smoke-free public places by legislative, executive, or administrative measures [11]. However, only 5% of the world's population benefits from national legislation covering a wide range of public places [12]. The Japanese government signed the WHO FCTC in March 2004 and ratified it in June of that year. Although smoke-free policies that include legislative and other relevant measures to prevent harmful exposure to SHS are an integral part of the WHO FCTC, progress in this area has been insufficient worldwide; Japan is no exception [11], [13].

Yet, amid a lack of effective national tobacco control, a subnational government can become an active player in promoting smoke-free environments through local legislation. Twenty-two of the 100 biggest cities in the world in terms of population are smoke-free, including 15 cities which have implemented local smoke-free laws. In fact, 53% of the world's population is not currently protected from SHS by any law, even though they live in countries where subnational jurisdictions have the legal power to restrict smoking in public places [12]. This indicates that there is increasing need for local government involvement in tobacco control.

Japan is a country with a high rate of tobacco use, thus tobacco control is an important public health concern. Smoking prevalence in Japan was 21.8% overall (36.8% for men and 9.1% for women) in 2008. The male smoking rate has been gradually falling while prevalence among women has remained more or less static [14].

The first law regulating smoking was introduced in 1900 – the Law of Prohibition of Smoking by Minors, and it was the only national law concerning smoking until the national government introduced a new law in 2003 [15]. The Ministry of Health, Labour and Welfare (MHLW) introduced a National Health Promotion Plan as part of its efforts to improve national health, which includes the launch of Healthy Japan 21 campaign for 2000–2010, taking these issues into account with a well-defined set of goals. Healthy Japan 21 aims to achieve a society where “all people can live a healthy and happy life” [16]. The campaign, intended to enable people to take positive steps toward improving their health, is promoted with the help of a wide variety of groups. Alongside these programmes, the Health Promotion Act went into effect on 1st May 2003, establishing targets to prevent lifestyle-related diseases. Prevention of SHS exposure was one aim, and Article 25 in this law suggested that persons in charge of public places such as schools, gymnasiums, hospitals, and theatres take measures against SHS [15], [17].

Past studies have reported that Japan has been half-heartedly promoting public smoking restrictions due to, among other reasons, conflicting interests among concerned ministries, and economic policies [18], [19], [20], [21], [22]. Indeed, the Japanese Ministry of Finance, one of the most influential governmental agents, is the major shareholder of Japan Tobacco (JT), owning around half its stock [23], [24]. JT is the third largest tobacco companies in the world and, in Japan, its business interests include food and pharmaceuticals [25]. JT often gives both financial and technical assistance to local governments dealing with tobacco-related issues, for example, setting up public smoking areas and campaigns for cleaner streets [26]. Furthermore, tobacco companies were a major financial contributor to the MHLW to maintain social welfare programmes [24]. The relationship between the government and JT has been affecting national tobacco control policy [24], [27]. Advertising, promotion and sponsorship by the tobacco industry is not well regulated, and smoke-free environments are not common [13], [28].

Many municipalities in the world are capable of implementing or have introduced their own smoke-free policies even in the absence of strong national tobacco control measures [12]. Local governments have demonstrated potential as contributors to tobacco control in Japan. The country comprises 47 Prefectures, each further divided into municipalities, including cities, towns and villages. All three types of municipality possess the same political authority and have a legislative branch capable of establishing ordinances under the national law. Such ordinances may include penalties such as imprisonment and fines for violators. Taking advantage of this system, local governments have implemented ordinances banning smoking on certain streets. Although these are generally not motivated by public health concerns, such municipal regulations can help to reduce injuries and health risks. This is particularly the case in the street environments commonly found in the centre of Japanese cities. Many streets are converted to shopping arcades that are not only bustling with shoppers, they provide a roof for shelter, making them hybrid indoor-outdoor spaces where smoke is hard to disperse and where brush-by burns can be hard to avoid.

This paper presents insights into how street smoking bans were developed by investigating three characteristics of current legislation: the “background” which informs the purpose of the ban, “scope,” and “enforcement and implementation”. Details are also provided about governmental approaches and trends along with potential complementary measures for dealing with SHS. We describe the Japanese experience of municipal ordinances restricting street smoking; explore the motivation behind the introduction of the ordinances and the relationship to health; and derive lessons for tobacco control from such measures.

Section snippets

Methods

We conducted a case study of municipal street smoking bans based on grey literature sources including news databases, local government publications and websites. Keywords used to search these sources were “aruki tabako (smoking while walking)” and “rojo kitsuen (smoking on the street)” at the initial stage. The category of regulation could include ordinances, guidelines, visions, edifications or favours but for the purpose of simpler information-gathering, the search was limited to ordinances.

Results

There are 1727 municipalities or equivalent local governments in Japan: 786 cities, 757 towns, and 184 villages [29]. We identified 112 municipalities, around 6% of the total, implementing street no-smoking ordinances by the end of 2009. The total population of those 112 municipalities is approximately 49 million, or some 38% of the population of Japan. The largest municipality with an ordinance in terms of population is Yokohama (approximately 3,669,000) and the smallest is Ribetsu (around

Discussion

The ordinances identified cover municipalities with nearly 40% of the total population in Japan. However, most of the regulations only partially cover the geographical area of each settlement. Yet, the ordinances apply to anyone in the no-smoking area, meaning that the ordinances touch more than the municipal residents. For instance, the daytime population in Chiyoda is approximately 20 times higher than its night-time population. This also explains why for some municipalities like Chiyoda, a

Conclusions

While the most common objective of the anti-street-smoking ordinances in Japan is to reduce cigarette butt litter in streets and to prevent brush-by burns, there is no clear evidence of the impact of anti-street-smoking regulations on exposure to SHS, nor on the prevalence of tobacco use, nor on knowledge and attitudes to SHS, which we found as rather severe limitations of the ordinances implemented in Japan. Additional research and surveys on Japanese cases could reveal the impact of the

Acknowledgements

We thank Dr Kenji Hayashi (National Institute of Public Health, Japan) and all the panelists in the Symposium on “Healthy Urbanization and smoke-free policies”, February 2009, Yokohama, Japan for providing us with useful information for this paper. We also thank WHO Tobacco Free Initiative team in Geneva and the journal's anonymous reviewers for comments and Mr Richard Bradford (WKC) for editing.

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