Smoking has been under attack for decades as a major public health problem. Its impact on overall health costs is less clear, because smokers tend to die earlier and thus incur less total lifetime health spending. But smoking obviously contributes to significant disease prevalence not just among smokers but among non-smokers as well. A Wall Street Journal article describes the results of recent research studies in this area. (WSJ Article) (The studies are available on a paid basis online at the journals cited in the article.)
The research demonstrates that communities which ban public place smoking have drops in the rate of heart attacks, 17% lower in one year, 26% lower after three years. That is a lot of heart attacks. While bans on smoking related activity do raise questions about personal freedoms and may have an impact on economic activity, the research strongly suggests that exposure to second-hand smoke is detrimental to the health of the general public, most members of which don’t smoke themselves. It seems unfair to subject non-smokers to heart attacks and other health problems which may not be caused by their own behavior. And second-hand smoke exposure appears to play a role in creating significant incremental health expense.
The most interesting study reported in the article was one examining a sort of natural experiment in Helena, Montana in 2002. The town implemented a smoking ban in bars, restaurants and casinos in June. The ban was repealed in December. Physicians noticed a decline in heart attacks while the ban was in place and collected data to conduct an analysis. They found a 40% reduction in heart attacks during the ban, but the rate returned to the original level after repeal. (Helena Study)
Smoking bans are an example of community wellness and prevention problems. As a matter of public health, it is hard to imagine stronger evidence than these studies supporting smoking bans in public places.