1
Japan has three levels of government (below). In this study, we focused on subnational, i.e. prefectural and municipal ordinances. Levels of government bodies in Japan (A: Legislative authority, L: Law) A: Prefectural Assembly L: Prefectural ordinance A: Municipal council L: Municipal ordinance A: National Diet of Japan L: National law/act National government 47 prefectural governments 1,727 municipal governments (cities, towns, villages) 2010: Ministry of Health Labour and Welfare of Japan reaffirmed through an official announcement that public places should be smoke-free The first ordinance to restrict smoking in indoor public places was adopted by Kanagawa Prefecture, originating from the then governor’s manifesto during the 2007 election. Unlike street smoking bans, the ordinance was under the responsibility of the prefectural health department and has clear mention on negative health impacts of SHS. 9 Different levels of ban for two categories of public places were employed (see Table I); however, it has significant, health-affecting exemptions: • Separation of smoking and non-smoking areas (e.g. separated seating areas in restaurants) • Designated smoking areas can be established in any type of facility 2000: Japan launched Healthy Japan 21 campaign 2011: Nagareyama City introduced the first municipal smoke-free bill to the city council 2010: Chiba Prefecture established a consultation committee for SHS measures 2003: Japan adopted the Health Promotion Act 2005: The WHO FCTC entered into force (worldwide) 2010: Hyogo Prefecture established a consultation committee for SHS measures 2002: Chiyoda City (Tokyo) introduced penalties against violations of street smoking bans 2011: Penalty provisions of the Kanagawa ordinance came into force 2010: Kanagawa ordinance came into force (except provisions on penalties) 2004: Japan signed and accepted the WHO FCTC 2009: Kanagawa Prefecture adopted Kanagawa prefectural ordinance on prevention of exposure to secondhand smoke in public facilities 1997: The first street smoking ban ordinances were implemented in four cities in the Greater Tokyo Area: Nerima, Kashiwa, Ichikawa and Toshima The evolution of tobacco control in Japan: Local governments move to target indoor areas Kashiwabara M 1 , Armada F 2 and Yoshimi I 3 1 Consultant, Kobe, Japan; 2 World Health Organization Centre of Health Development, Kobe, Japan; 3 Tokyo Metropolitan Government, Tokyo, Japan RESULTS CONTACT INFORMATION World Health Organization Centre for Health Development (WHO Kobe Centre) Address: 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe 651-0073, Japan Tel: (+81) 78-230-3100 Fax: (+81) 78-230-3178 Email: [email protected] URL: http://www.who.or.jp/ REFERENCES 1. World Health Organization. (2011) WHO report on the global tobacco epidemic, 2011 - Warning about the dangers of tobacco. Geneva, Switzerland. 2. The Japan Times (2010) Passive smoking kills 6,800 annually. 29 September 2010. 3. Ueda, H., Armada, F., Kashiwabara, M., Yoshimi, I. Street smoking bans in Japan: A hope for smoke-free cities? Health Policy 102(1):49-55. 4. Yin, R.K. (2009) Case study research : design and methods. 4th ed. Los Angeles, CA, USA: Sage Publications. 5. Ministry of Health Labour and Welfare, Japan. (2000) [Healthy Japan 21 – Japanese National Health Promotion in the 21st Century]. Tokyo, Japan. 6. Ministry of Health Labour and Welfare, Japan. (2003) [Health Promotion Act], 103. 7. World Health Organization. (2003) WHO Framework Convention on Tobacco Control - Adopted by the Conference of the Parties to the WHO FCTC. Geneva, Switzerland. 8. World Health Organization. (2011) WHO Framework Convention on Tobacco Control: guidelines for implementation Article 5.3; Article 8; Articles 9 and 10; Article 11; Article 12; Article 13; Article 14 - 2011 edition. Geneva, Switzerland. 9. Kanagawa Prefectural Government. (2009) [Kanagawa prefectural ordinance on prevention of exposure to secondhand smoke in public facilities], 27. DISCLAIMER The views presented herein are those of the authors and do not necessarily reflect the decisions, policies or views of the World Health Organization. The use of particular designations of countries or territories does not imply any judgement as to the legal status of such countries. CONCLUSIONS Although no evidence is yet available in terms of the health impact of these ordinances implemented by the subnational governments, SHS is becoming less socially acceptable in Japan as smoke-free ordinances are becoming popular. The legislation demonstrates that local governments in a country with weak tobacco control can take the initiative to restrict smoking and that local action facilitates tobacco control activities in other jurisdictions. Stronger health-based tobacco control policy such as 100% smoking ban is necessary to provide universal protection to people in Japan, and the past initiatives proved that implementation of such policy is politically feasible. For more information about our research on smoke-free cities: http://www.who.or.jp/smokefree.html METHODS A descriptive case study to illustrate different types of Japanese ordinances that restrict smoking in public places. 4 Grey literature including government records and media reports was reviewed. BACKGROUND Japan has national laws such as the Health Promotion Act that include tobacco control provisions and signed the WHO Framework Convention on Tobacco Control (FCTC) in 2004. However, it falls far short of achieving smoke-free environments for which effective implementation is required in the WHO FCTC. 1 As a result, nearly 7,000 adults (est.) die annually of lung cancer and heart diseases due to secondhand smoke (SHS) in Japan. 2 Meanwhile, subnational ordinances with potential tobacco control impacts are becoming common – an increasing number of municipalities/prefectures are implementing ordinances on smoking in public places, especially in streets. 3 This study examines legislation at Japanese subnational level and its relationship to SHS in order to derive evidence on the role of local governments in promoting smoke-free environments and to guide others considering similar measures. ACKNOWLEDGEMENTS: We would like to thank Dr Hiroshi Ueda (Osaka University) and the National Institute of Public Health of Japan for their support in carrying out this study. Street smoking bans Street smoking bans (implementedafter2010) Indoor smoking bans Indoor smoking bans (discussionon-going) World Health Organization F ramework Convention on Tobacco Control (WHO FCTC) was introduced to counter tobacco epidemic in the world by providing a set of provisions both on the tobacco production and consumption sides. With its Article 8, parties are required to implement effective measures to protect people from SHS for which harmful impacts on health has been proven by abundant evidence. 7 Since Japan is one of the parties, it is bound to implement measures against SHS in line with the WHO FCTC and its guidelines, i.e. 100% smoke-free environments in public places. 8 Article 25 of the Health Promotion Act exhorted managers of public places such as schools, halls, hospitals, department stores, public service offices, and restaurants to implement measures to prevent SHS exposure to visitors of the premises. 6 Since it is an exhortation, it has no legal penalty against those who do not abide by the provisions, and the regulations practically rely on voluntary bans. Although it goes against the WHO FCTC, recommended measures include physically separated smoking and non- smoking areas. Healthy Japan 21 is a national health promotion campaign whose main purpose is to prevent lifestyle diseases. 5 The campaign includes four smoking-related goals to be achieved by 2010: • Awareness raising on health impacts of smoking • Elimination of tobacco use among minors • Promotion of separation of smoking and non-smoking areas in public places and workplaces • Promotion of smoking cessation support programmes Street smoking bans are the common measures implemented by municipal governments in Japan. 3 A wave of ordinances started in 2002 when Chiyoda introduced a ban with fines, and 112 municipalities had introduced restrictions on outdoor smoking by the end of 2009. Most of the ordinances were not motivated by protection from SHS, but for environmental or aesthetic reasons, e.g. prevention of littering and brush- by burns. Complete bans are rare even in designated “no-smoking streets”, and exhortation to refrain from smoking in streets is the most common approach. Other prefectures and municipalities are now moving to enact their own indoor smoking restrictions. Hyogo Prefecture, Chiba Prefecture, and Nagareyama City (in Chiba Prefecture) have launched local initiatives for smoke-free legislation (Figure I). Figure I. Ordinances on street and indoor smoking bans in Japan Hyogo Prefecture: A final report of discussions at the special committee was shared with the Governor in July 2011. A bill for an indoor smoke-free ordinance is expected to be introduced by the end of 2011. Nagareyama City: The first municipal-level bill on indoor public smoking bans was submitted to the council in September 2011. Chiba Prefecture: A committee was established in 2010 and the local initiatives in Hyogo and Nagareyama on indoor smoking have been discussed. A signage on a pavement “No smoking in streets” in Toshima City, Tokyo No-street-smoking zone in Chiyoda City, Tokyo Type I public facilities Type II public facilities Type of buildings Schools, hospitals, sports facilities, halls, malls, banks, amusement parks, government offices Restaurants, bars, night clubs, hotels, leisure facilities (dance halls, karaoke etc.), any other hospitality facilities Provision Prohibition Prohibition or smoking separation Table I. Categories of public places in Kanagawa prefectural ordinance on prevention of exposure to secondhand smoke in public facilities WHO FCTC and the Guidelines for implementation A sign in front of a coffee shop indicating separate smoking and non-smoking seating areas
