That Law that Changed the Health of Italians| Tabaccologia

The clash between the smoking and non-smoking lobbies

Smokers and tobacco lobbyists dreamed, schemed, shouted, demanded, and threatened to obtain a postponement, until the last moment, which did not happen. Officially a deadline postponement, three to six months. Secretly sine die.

The pro-tobacco lobby did its best, gathering its best forces. Minister Sirchia had to face the backlash from smoking politicians and ministers, supported, with thousand distinctions, by a fertile undergrowth of former and non-smokers, slyly wavering between guaranteeism and healthism, as well as by the Italian Federation of Public Establishments (FIPE) and Confcommercio, with the ineffable president Billè at the time, “genuinely” concerned about an apocalyptic and improbable economic collapse of public establishments!

This was no coincidence, given that the Confcommercio/FIPE had become a minority shareholder in British American Tobacco Italia (BAT), which had purchased the former State Monopolies from the Ministry of Finance and the Treasury [2].

Frightened by the idea of losing customers, in those days, restaurateurs’ associations challenged the law in administrative courts, while groups of smokers started a referendum campaign to repeal the law, which the Constitutional Court quickly rejected, as the right to health comes first, as enshrined in Article 32 of the Constitution of the Italian Republic [3].

Impact on Public Opinion and Commerce

Despite all this, the impact on public opinion was surprising. Against all odds, the majority of Italians welcomed the new regulation to the point that the “ban on blondes” was respected with extremely high compliance rates from the very first years. Smoking indoors stopped immediately.

In the first months following the enforcement of the Sirchia Law, the journalist Piero Ottone, in his column “Vizi & Virtù” (Vices & Virtues) in Venerdì - La Repubblica, curiously wondered what Garibaldi would have done in those tumultuous and agitated months for smokers. Would his rebellious nature have emerged forcefully, leading him to ignore the prohibitions, instead of fighting them, as some hardcore smokers were now planning to do?

The journalist, however, preferred to think of another side of the hero of two worlds, not the rebel, but the good citizen, which, in famous circumstances, led him to respond with a single word, destined to go down in history: “Obbedisco” (I obey).

Since the law banning smoking in public places was enacted in 2005, survey results have shown that most restaurants and bars have actually increased their customer base, and despite initial threats from business owners to ignore the 2005 law, compliance with the implemented legislation has been remarkably high [4,5].

“It seems that Italians have wisely embraced the protection of public health.” said former Minister of Health Girolamo Sirchia, the architect of the law. The fact that the new regulations have been so well respected makes it inevitable to reconsider some stereotypes about Italians. “Have we suddenly become respectful and disciplined? No, it’s just that we’re not stupid.” wrote Beppe Severgnini in Corriere della Sera “When a law makes sense and is properly enforced, even with fines, we follow it.”

The success of the law is also attributed to the increasingly widespread awareness of the risks of tobacco smoke on health, even among non-smokers. Many surveys have shown that the law is strongly supported by both non-smokers and smokers.

“When the law was introduced, there was a lot of skepticism about its actual implementation” wrote Stefano Zecchi in Gente. “Instead, Italians have shown respect for a law they are well aware of.” Severgnini also added that the government’s ability to “flex its muscles” to make the law work had been a key factor [6].

The Tobacco Lobby

All of this happened despite the strong and prolonged opposition from the tobacco industry (Big Tobacco) and its allies in Parliament and the media.

The Italian “anti-smoking” law banned smoking in all public and private leisure and workplace environments, such as offices, bars, and restaurants.

The attempts to block the enactment of national anti-smoking legislation in Italy were part of a broader global strategy by Big Tobacco aimed at influencing public health policies also on secondhand smoke issues.

Among the strategies adopted, the tobacco industry exerted pressure on hospitality organizations, created front organizations using journalists, media outlets, and scientists, as well as directly lobbied political circles, as can be seen from the internal documents of the tobacco industry, which were made public after a US court ruling, which reveal the industry’s efforts over the past 50 years of the last century [7].

The strategies adopted by Big Tobacco to fight smoke-free legislation in Italy later served to inform other countries, while the Italian experience acted as a catalyst, encouraging them to be bolder in implementing laws to protect non-smokers in workplaces and leisure environments [8,9].

The domino effect, we recall, began with Jeff Wigand’s dramatic declaration against the tobacco industry before the Mississippi State Court (US), which helped open Pandora’s box on the confidential and top-secret documents of the US tobacco companies.

“Ope legis” millions of documents were declassified, and tobacco companies were required to publish them online on their respective websites until the end of 2010. Thanks to this, we have finally come to know deceptions, lies, and conspiracies that had been kept hidden for 50 years. The infiltration into the vital systems of nations did not spare our country either, and for the first time, it became evident to us why a clear and uninterpretable anti-smoking law had not been in place for 50 years [7,10].

Thus, thanks to the courage and determination of Professor Sirchia, Italy became the second European Union (EU) member state and the third European country to introduce anti-smoking legislation in public places, following Ireland and Norway, which is not an EU member [8].

The Italian anti-smoking legislation was approved and successfully implemented, despite a history of more than 40 years of opposition from the tobacco industry and its allies, whose global efforts aimed at manipulating and denying scientific evidence on the harmful health effects, particularly respiratory and cardiovascular, of both active and passive smoking [9,11-15].

Impact on Health

Surprising as hoped was the impact on the health of Italians, a long wave that continues to give us its beneficial effects.

One year after the anti-smoking law came into effect, 90% of Italians supported the legislation, and cigarette sales had dropped by over 5.7% [16].

A 2008 survey found that about 84% of Italians believed that the law was moderately respected, a slight decrease from the 90.5% recorded in 2005 [17].

The 2005 anti-smoking law also had an immediate impact on the retail sales of tobacco products in Italy. A comparison of surveys conducted before, during, and after the anti-smoking law showed an 8% decrease in tobacco consumption in the first year [18].

The purpose of legislation banning smoking in public places is a moral one: to reduce involuntary exposure to smoke. By comparing atmospheric particulate matter before and after the smoking ban in Italy, Valenti demonstrated a significant reduction in particulate matter originating from passive smoking [19].

A systematic review conducted by Callinan concluded that public health, particularly regarding heart disease, improved following the introduction of smoking bans in public places, in addition to reducing smoking prevalence by 3.8% [20].

These effects of smoking reduction were also experienced in Italy. Before the anti-smoking law (2004), there were 14 million smokers. The law triggered a long-term decline, with 500,000 fewer smokers six months after the Sirchia law came into effect. By 2013, the number had dropped by 3.5 million, marking the lowest historical point.

This trend has continued to the present day with fluctuations, stabilizing at around 12 million smokers. Unfortunately, a persistent core remains, fluctuating between 10.5 million in 2013 (a figure confirmed in 2023) [21], 11.3 million in 2021 [22], and a concerning peak of 13 million smokers (25.4%) in 2024 (see Possenti et al. contribution published in this issue).

Given this trend, a crucial reflection arises: if to date this hard-core has not been scratched, despite approximately 80,000 smoking-related deaths per year from smoking-related diseases and nearly 10,000 smokers quitting annually [23], it is evident that there is a primary prevention issue among young people, where tobacco industries secure their future business.

Regarding health benefits, in Italy, an estimated 545 deaths from lung cancer and 2,131 deaths from ischemic heart disease are attributed to secondhand smoke each year [24]. Passive smoking increases the risk of vascular and heart diseases [25,26], lung cancer [27], respiratory illnesses [28-30], and chronic infections [31]. Comparisons of acute coronary events in Italy before (2000-2004) and after (2005) the implementation of the anti-smoking law show a reduction in incidence by 7.9% and 11.2% among individuals aged 65-74 years and 35-64 years, respectively [25].

Conclusion

The Sirchia Law, in short, initially led to a reduction in cigarette consumption and encouraged a certain proportion of smokers to quit, either independently or with support from Anti-Smoking Centers, but above all it had the effect of informing and raising the public awareness of the harm caused by active and passive smoking, and of educating smokers to respect non-smokers, making the latter aware and courageous enough to claim the moral and constitutional right not to be harmed by secondhand smoke.

Finally, let us recall that the relative recent emergence of new tobacco and nicotine-based products requires us to call for an update to the Sirchia Law, with the inclusion of these new products and the equalization of their excise duties with those of traditional cigarettes... in short, let us not give Big Tobacco a discount.

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