1 Passive Smoking from a Human Rights Perspectives Panagiotis K. Behrakis, MD, PhD, FCCP Pulmonologist-Intensivist Adjunct Professor, Harvard University President, European Network for Smoking and Tobacco Prevention Consultant,Athens Medical Center Investigator, Biomedical Research Foundation, Athens Academy
2 Definitions Involuntary smoking (passive or environmental tobacco smoke) is the exposure to second-hand tobacco smoke (SHS) which is a mixture of exhaled mainstream smoke and side stream smoke released from a smouldering cigarette or other smoking device (cigar, pipe, water pipe, etc.) and diluted with ambient air. "Third-hand smoke is tobacco smoke contamination that remains after the cigarette has been extinguished. WHO, 2012.
3 Dangerous chemical substances in ETS 4000 known chemicals in tobacco smoke; 250 of them are known to be harmful and More than 50 are known to cause cancer in humans. Tobacco smoke in enclosed spaces is breathed in by everyone, exposing smokers and nonsmokers alike to its harmful effects. There is no risk-free level of secondhand smoke exposure; even brief exposure can be harmful to health. WHO, 2012
4 Where does passive smoking exposure take place? Home Smoking parent to nonsmoking child. Smoking spouse to nonsmoking spouse. Public places Offices, Bars, restaurants. Vehicles Cars, public transportation.
5 Extent of exposure Worldwide, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004.
6 Exposure to tobacco smoke in Bar-Restaurants Hospitality Venues, EU.
7 Exposure to tobacco smoke in Hospitality Venues, EU Countries
8 Exposure to tobacco smoke in workplaces, EU. The socio-demographic analysis shows that: Males are more likely than females to be exposed to tobacco smoke at work. The younger the respondents, the more likely they are to be exposed. 33% of respondents aged report they are exposed to tobacco smoke at work. Among respondents that are currently working, manual workers are the most likely to report that they are exposed to tobacco smoke at work.
9 Extent of exposure to tobacco smoke Children-worldwide The World Health Organization has estimated that nearly 700 million, or almost half of the world s children, are exposed to tobacco smoke by the 1.2 billion adults who smoke. ASH Research Report: Secondhand Smoke: the impact on children Planned review date June 2013
12 Health Effects of Passive Smoking worldwide premature deaths attributable to second-hand smoke worldwide. This exposure was estimated to have caused: 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, 21,400 from lung cancer.
13 Health Effects of Passive Smoking EU According to conservative estimates, over adults, ( non-smokers), died in 2002 due to exposure to tobacco smoke at home (72000) and in their workplace (7300).
14 Health Effects of Passive Smoking-USA More than 20 million Americans have died as a result of smoking since the first Surgeon General s report on smoking and health was released in 1964 (Table 1) Most were adults with a history of smoking, but nearly 2.5 million were nonsmokers who died from heart disease or lung cancer caused by exposure to secondhand smoke. Another 100,000 were babies who died of sudden infant death syndrome (SIDS) or complications from prematurity, low birth weight, or other conditions caused by parental smoking, particularly smoking by the mother. Surgeon General, U.S. Public Health Service, 2014.
15 Health Effects of Passive Smoking in Children-USA In U.S. children aged 18 months or younger, secondhand smoke exposure is responsible for: An estimated 150, ,000 new cases of bronchitis and pneumonia annually. Approximately 7,500 15,000 hospitalizations annually. CDC,2014.
19 WHO: Health Definition Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
20 The Universal Declaration on Human Rights (UDHR) (1948) Article 3 of the UDHR recognizes the right to life as fundamental and non-derogable. Article 22 of the UDHR a right to a standard of living adequate for the health and well being of the individual s family. It also puts States under the obligation to avoid serious environmental hazards or risks to life and to set in motion monitoring and early warning systems to detect serious threats.
21 The Universal Declaration on Human Rights (UDHR) (1948) Articles 2 and 7 entitle all people to equal protection under the law without discrimination. Article 23 (1) guarantees the right to safe and healthy working conditions. Article 5 says that all have a right to human treatment.
22 Lisbon Treaty (2009) On 1 December 2009, the Treaty of Lisbon entered into force, thus ending several years of negotiation about institutional issues. The Treaty of Lisbon provides the Union with the legal framework and tools necessary to meet future challenges and to respond to citizens' demands.
23 Lisbon Treaty (2009) Article 2. Right to life. Everyone has the right to life. Article 24. The rights of the child. Children shall have the right to such protection and care as is necessary for their well-being. In all actions relating to children, whether taken by public authorities or private institutions, the child s best interests must be a primary consideration. Article 26. Integration of persons with disabilities. The Union recognizes and respects the right of persons with disabilities to benefit from measures designed to ensure their independence, social and occupational integration and participation in the life of the community.
24 Lisboa Treaty (2009) Article 31. Fair and just working conditions Every worker has the right to working conditions with respect his or her health, safety and dignity. Article 35. Health care Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all the Union s policies and activities. Article 37. Environmental Protection A high level of environmental protection and the improvement of the quality of the environment must be integrated into the policies of the Union and ensured in accordance with the principle of sustainable development.
25 World Health Organization, Framework Convention on Tobacco Control (2007) Article 8. Protection from exposure to tobacco smoke 1. Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability. 2. Each Party shall adopt and implement in areas of existing national jurisdiction as determined by national law and actively promote at other jurisdictional levels the adoption and implementation of effective legislative, executive, administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.
26 The International Convention on Economic Social and Cultural Rights (1966) Article 12 of the ICESCR elaborates the right to health. Article 12.1 of the ICESCR includes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Article 12.2 of the ICESC recommends affirmative steps including the following: a) The improvement of all aspects of environmental and industrial hygiene b)the prevention, treatment and control of epidemic, endemic, occupational and other diseases. Article 10 provides the rights of the child Article 2 guarantees that the rights will be exercised without discrimination of any kind
27 The International Convention on Economic Social and Cultural Rights (1966) Article 7 acknowledges the right of everyone to enjoyment of just and favorable conditions of work which ensure, in particular, safe and healthy working conditions. Article 15 recognizes the right to everyone to take part in cultural life and to enjoy the benefits of scientific progress and its applications.
28 The convention on the Elimination of Discrimination against Women (CEDAW) (1979) Article 12: Guarantees that States parties shall take all appropriate measures to eliminate the discrimination against women in the field of health care in order to ensure on the basis of equality of men and women, access to health care services
29 International Convention on Civil and Political Rights (ICCPR)(1996) Article 6 states that everyone has the right to life and that right shall be protected by law. Articles 2 and 26 ensues the right to non0discrimination and equal protection. Article 6 of the ICCPR: Imposes a duty on the State to : ensure the right to life including steps to protect the environment. Article 7 states that no one shall be subjected to inhumane treatment.
30 The convention on the Rights of the Child (CRC)(1989) Article 6: Guarantees the maximum possible survival and development of the child. Article 24: affirms the child s right to the enjoyment of the highest attainable standard of health. Article 24 (2) (d) recommends appropriate pre-natal and post natal health care for expectant mothers and guarantees the highest attainable standard of health to the maximum extend of available resources.
31 The Inter-American System American Convention of Human Rights (1969). Additional Protocol to the American Convention on Human Rights in the area of Economic, Social and Cultural Rights (1988). Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women (1994). American Declaration of the Rights and Duties of Man (1948). PAHO Directing Council Resolution (2001).
32 Petition Greek Students Demand Passive Smoking to be Treated as a Human Rights Issue 6 June 2013 Passive smoking in closed public spaces is a widespread form of violence, oriented mainly against small children and weak population groups, such as those suffering from lung or heart problems. The problem is particularly acute for pregnant women and employees in those premises, who without defenses are subject to inadvertent smoking and suffer heavy consequences on a personal, family, and societal level. The situation in Greece appears to be out of control, as the laws of our country (Law 3730/08 and 3868/10) are not enforced, and the international agreements (World Health Organization, Framework Convention on Tobacco Control, Article 8, Guidelines on Protection from Exposure to Tobacco Smoke) are violated in order to accommodate specific economic interests.
33 Greek Students Demand Passive Smoking to be Treated as a Human Rights Issue We, as academic citizens of this country, take a decisive stand and ask from the European Commission and the European Network for Smoking and Tobacco Prevention (ENSP) to act in all directions in order to highlight and to recognize officially that passive smoking is a major international issue, which violates the human rights of health, work and the protection of women and children.
36 Conclusions Passive smoking is a worldwide spread form of violence. There is a strong legislative framework relating passive smoking with human rights issues. Implementation of the existing legislation is globally inadequate. It is a real challenge to put an end to passive smoking through a human rights global network.
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