E-cigarettes – balancing the risks and benefits for public health in Wales

2 September 2015

Article by Philippa Watkins, National Assembly for Wales Research Service

Image by Mike Mozart via flickr, licensed under Creative Commons.

Image by Mike Mozart via flickr, licensed under Creative Commons.

The Assembly’s Health and Social Care Committee will continue its scrutiny of the Public Health (Wales) Bill in the autumn term. It is the proposals to restrict the use of e-cigarettes in public places that are attracting the most attention and controversy.

Evidence sessions to date have covered all elements of the Bill – proposals relating to provision of toilets, pharmaceutical services, special procedures (tattooing, piercing etc.), and tobacco and nicotine products. In the autumn, the Committee will be seeking further evidence on the e-cigarette proposals from a wide range of stakeholders.

The Committee has already taken evidence from public and environmental health experts and representatives of local government. So far, there’s been strong support for the proposals to bring the use of e-cigarettes in line with the smoking ban. Whilst acknowledging that e-cigarettes may have a role in smoking harm-reduction, witnesses have argued that allowing the widespread use of e-cigarettes in public places risks undermining progress made so far in reducing the uptake and prevalence of smoking, and poses a significant challenge to enforcement of the smoking ban.

The Committee is likely to hear contrasting views in upcoming evidence sessions; even within the medical community, experts are divided on the issue.

A key point that’s expected to be discussed is the extent to which e-cigarettes actually represent a potential public health gain. If e-cigarettes helped large numbers of smokers to quit tobacco, this could have a significant impact on reducing smoking-related deaths and disease. It’s important to be clear that the Bill’s proposals do not prevent people from buying or using e-cigarettes, but there are concerns that smokers may be discouraged from switching to e-cigarettes if they are not able to use them freely.

In earlier evidence sessions, public health witnesses described how e-cigarettes themselves are not safe or without risk. This is also likely to be the subject of further discussion, particularly given the recent publication of an independent review commissioned by Public Health England, which found that e-cigarettes are around 95% less harmful than tobacco. The Minister for Health and Social Services has been clear that this isn’t really the point however, and that the basis for bringing forward the legislation are the risks of normalising smoking behaviour, the possibility of e-cigarettes acting as a gateway to tobacco use, and the enforcement issue.

The independent review found no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers, nor that e-cigarette use was having the effect of normalising smoking:

Since EC [electronic cigarettes] were introduced to the market, smoking prevalence among adults and youth has declined. Hence there is no evidence to date that EC are renormalising smoking, instead it’s possible that their presence has contributed to further declines in smoking, or denormalisation of smoking.

However, it’s widely recognised (including in the above report) that e-cigarettes are a relatively new product and further research is needed. The Chartered Institute of Environmental Health told the Committee:

it’s a cliché to say it but absence of evidence is not evidence of absence. I think we need to wait and see if e-cigarettes normalise smoking.

Waiting, according to the Minister, is too risky a strategy:

We won’t have definitive evidence for many years to come. What I don’t think we ought to be prepared to do as a committee or as a National Assembly is to take the risk that, in 10 years’ time, we will look back and say how much we wished we had acted then, before the harm had occurred.

It will be for the Committee to consider, based on the evidence it receives, whether the Government’s precautionary approach is a proportionate one.

Note:

As part of its evidence gathering, the Committee has invited individuals and organisations to submit their views on the proposals via a survey and written consultation, which have been running over the summer.

Oral evidence sessions will continue in September and October, and the Committee is expected to report on the general principles of the Public Health (Wales) Bill in November 2015.