Authors: Shuhei Nomura and Haruka Sakamoto with Yusuke Tsugawa, Naoko Iwanaga, Seiichiro Kuchiki, Ichiro Kawachi, Kenji Shibuya
Despite its outstanding health record in other areas, Japan is a global laggard in tobacco control, and does not meet standards set by the World Health Organization Framework Convention on Tobacco Control (FCTC), particularly for smoke-free public spaces. The widespread public exposure to second-hand smoke in Japan will come into sharp focus during July and August 2020, when the eyes of the world turn to Tokyo as the host city of the next Olympic and Paralympic Games.
In 2010, the International Olympic Committee (IOC) agreed with WHO to promote a smoke-free Olympics and Paralympics (IOC’s standards). From 2008, every Olympic and Paralympic host site has had smoke-free regulations. In anticipation of the 2020 games, there has been a nationwide push in Japan for smoke-free policy. The former Minister for Health, Labour and Welfare of Japan, Yasuhisa Shiozaki, expressed his support for a smoke-free policy by proposing new legislation in 2016 to prohibit indoor smoking in all public spaces, including restaurants and bars. The policy was strongly supported by the general public, patient groups, academia, and practicing health professionals. However, Shiozaki and other smoke-free policy supporters faced fierce opposition from pro-smoking politicians. As a result, the legislation was not submitted to the Diet (Japanese parliament) in 2017.
In March 2018, the Cabinet endorsed an alternative, watered-down smoke-free bill, which was passed in the Upper House on July 2018 and will be implemented in April 2020. This permits small restaurants and bars with floor space up to 100m2 to allow indoor smoking. Nearly 55% of restaurants/bars in Tokyo are below this threshold and will be exempt from being completely smoke-free. The legislation is much less effective than the original plan presented by Shiozaki in 2016. It had a 30m2 threshold, which would have applied to more than 70% of restaurants and bars in Tokyo. The weakened bill also allows restaurants and bars to have special smoking rooms in which customers are allowed to smoke electronic tobacco products while eating and drinking.
In order to ascertain Diet members’ perspectives regarding the smoke-free bill, we conducted a survey of Japanese parliament members. All 707 Diet members were sent questionnaires in February 2018. A total of 125 responded; a response rate of less than 18%. The response rate varied significantly by party: only 7.9% (32 of 407) of the members of the ruling Liberal Democratic Party (LDP) returned the questionnaire, compared to 34% (70 of 206) opposition party members.
Among respondents, there was high awareness about the risks of secondhand smoke. Ninety six percent were aware of the association between secondhand smoke and lung cancer and cardiovascular diseases. Similarly, 97% were aware that segregated smoking and non-smoking areas are ineffective in preventing exposure to second-hand smoke.
Despite this awareness, support for appropriate policies regarding smoke-free areas was sharply divided. About 55% suggested that new policies should make restaurants and bars completely smoke-free, regardless of size. On the other hand, nearly 25% answered that no restriction or smoke segregation policy should be applied, depending on the size. While 73% of opposition parties’ respondents (51 of 70) supported the smoke-free policy, only 31% (10 of 32) of LDP respondents agreed.
The questionnaire also addressed the perspectives of Diet members on what kind of second-hand smoke measures should be applied to meet the IOC’s standards on the premises of public facilities and other places that many people may visit during the Tokyo games. Slightly more than 34% agreed with smoke-free policies either on-site or indoors, but 48% indicated support for an option permitting an installation of smoking rooms.
In Japan, Diet members are obligated to vote along party lines. However, this does not apply to certain situations for issues considered sufficiently controversial to vote according to one’s individual conscience. Nearly half (47%) of the respondents supported a conscience vote on the smoke-free bill. Respondents who supported entirely smoke-free policies in restaurants and bars were more likely to support a conscience vote than those supporting smoke segregation policies.
Given the low response rate to the survey, at 17.7% overall, and 7.9% for the ruling LDP, it is unlikely that those who did respond represented the wider population of Diet members. For example, three of the 125 (2.4%) of the respondents are known to receive donations from the tobacco and relevant industries. However, among all Diet members, studies have found that at least 140 of 707 (nearly 20%) of Diet members received tobacco industry donations between 2010 and 2015 (see here and here, both in Japanese).
Most respondents from the opposition parties were against the smoke-free bill approved in July 2018 and preferred stronger protections from second-hand smoke, but opinions from LDP opinions were not unanimous. According to the Japan Society for Tobacco Control, the LDP as a whole has historically stronger ties with the tobacco industry (led by JT) than the other parties,and may have tried to weaken the smoke-free bill because of industry pressure. It is worth noting that tobacco industry contributions to political campaigns are neither prohibited nor transparent in Japan.
Strong protection from second-hand smoke would likely have a significant positive impact on population health in Japan, given that approximately 18,000 deaths were attributable to second-hand smoking in Japan in 2017. As demonstrated by the UK’s recent passage of smoke-free policy, political commitments to legislate smoking control policies based on scientific evidence are a key determinant of improvements in tobacco control and thus of public health success. Diet members, including Prime Minister Abe and the Minister for Health, Labour and Welfare, Takumi Nemoto, are expected to show their leadership and commit to the health of the Japanese people.
Promoting an open debate on the smoke-free bill, and allowing a free vote would be an important step forward. Implementing a comprehensive and effective smoke-free bill would signal a new commitment from the Japanese government to protect its own citizens. It is past time to cast aside Japan’s dismal tobacco control record and fully implement its obligations under the WHO FCTC. Apart from the urgent need to protect Japanese citizens, the forthcoming Olympic and Paralympic Games would be an opportunity to showcase fully smoke-free, impeccable Japanese hospitality as it hosts athletes and visitors from around the world.
Shuhei Nomura is an assistant professor and Haruka Sakamoto a doctoral student, both with the Department of Global Health Policy at The University of Tokyo. Yusuke Tsugawa is assistant professor of medicine at the University of California, Los Angeles. Naoko Iwanaga is the news editor and Seiichiro Kuchiki a news reporter, both with Buzzfeed Japan. Ichiro Kawachi is a professor of social epidemiology at Harvard TH Chan School of Public Health. Kenji Shibuya is a professor with the Department of Global Health Policy at The University of Tokyo.