This week the Government got the go-ahead to ban smoking in cars where children are passengers.

The move follows a campaign by 700 health experts who called for legislation to protect child health.

Critics of the ban, which has yet to take place, say it will be largely unenforceable and is an infringement of personal freedom.

But the British Lung Foundation, which estimates that more than 430,000 children aged 11 to 15 are exposed to second-hand smoke in cars every week in England, welcomed the “great leap forward for the health of our nation’s children.”

Shadow Public Health Minister Luciana Berger has argued that there is no freedom of choice for youngsters forced to breathe in a cocktail of more than 4,000 chemicals from smoke – many of which are toxic or known to cause cancer.

However, it could be argued that the ban won’t go far enough. If exposure to smoke in childhood is deemed to be a serious health hazard then surely a woman who smokes during pregnancy is harming her unborn child? Should we legislate against this too?

NHS statistics on smoking show it to be a destructive habit in every way. While latest available figures show that smoking has declined in Kirklees since 2008, one in five residents over the age of 18 still smoke, rising to one in four in Dewsbury. Smoking is said to contribute to 18% of all deaths in adults aged over 35 and causes 28% of all deaths from cancer. Perhaps, most worrying of all, one in eight pregnant women smoke. The habit has been found to increase the risk of having a low birth-weight baby by as much as three-and-a-half times.

Second hand smoke is also a risk factor for sudden infant death, lower respiratory tract infections, middle ear problems and asthma.

According to the National Childbirth Trust, whose mission is to promote informed choice, smoking also increases the risk of stillbirth and premature delivery.

However, Anna Dawson-Jones, an NCT ante-natal teacher and local project manager working with families with asylum or refugee status, says legislation may not be the best way to tackle the problem.

She explained: “The evidence is overwhelming that smoking is not good for your baby or child but the NCT is always about informed choices. What parents do is their own business, you can only give them the information.

“My personal view is that education empowers people but legislation is like hitting people with sticks and there will be a backlash. People stop listening. You need to work with parents, not alienate them.”

While agreeing that smoking during pregnancy is undesirable, Anna believes that it would be wrong to legislate against it.

 “Where do you stop,” she said. “You would be going down a slippery slope of deciding what everybody should do all the time.”

Having taught ante-natal classes for many years, the mother-of-three from Holmfirth says smoking in pregnancy is something women smokers are concerned about but may conceal from health professionals.

“People know that it’s not a healthy thing to do, therefore it’s something that they don’t advertise,” she said.

Because smoking rates are linked to socio-economic status – with lower earners smoking more than higher earners – it is the most disadvantaged children who tend to suffer the most as a result of their parents’ and carers’ smoking habit.

Not only do they run increased health risks but the cost of smoking (between £6 and £8 for a pack of 20) has a negative impact on family finances.

In Kirklees, smoking is less common in older people (one in 10 aged over 65) than it is in younger people (1 in 4 between aged of 18 and 44).

Dewsbury has the highest rate of smoking while Denby Dale and Kirkburton have the lowest – just 10% compared to 24%. Statistics gathered for Kirklees Council show that more than half of smokers want to give up.

Alarmingly, research by the council, the NHS and West Yorkshire Police found that the mean age at which a young person starts smoking is just 12 – and one in five began before they were 10.

By the age of 14 one third of girls and nearly half of all boys have tried smoking.

And all this is despite expensive and frequent public health campaigns to highlight the dangers of the habit.

There are those who argue the tax on tobacco is an important source of revenue, balanced against an estimate by the Public Health Department at Oxford University that the NHS spends more than £5bn treating people with smoking-related conditions.

That figure, says the pressure group Action on Smoking and Health, is just the tip of the iceberg and doesn’t take into account lost working days due to smoking-related ill health, cleaning public areas of cigarette butts and the cost of fires caused by cigarettes.

However, Simon Clark, director of Forest, the campaigning group set up to protect the rights of smokers, says its members have been driven out of pubs and clubs and now face another guilt trip: “The accusation is that it costs the NHS huge sums of money treating ‘smoking-related diseases’.”

He added: “Leaving aside the fact that most ‘smoking-related diseases’ are multifactorial, consumers contribute a whopping £10b a year in tobacco duty and VAT.

This figure far exceeds the alleged cost of treating ‘smoking-related diseases’, which was estimated a few years ago to be £1.5b but has risen dramatically in recent years to £2.5b and now £5.5b.”

In fact, latest figures from HM Revenue & Customs show that £12.3b was raised from excise duty and VAT on tobacco in 2012-13.

As the Government deliberates over whether to introduce the ban on smoking in cars where children are present, figures such as these may come into play – and alienating smokers may not seem to be such a good idea after all.

A survey of smokers, aged 20 to 40, in Kirklees found that the habit is considered by women to be an opportunity to take ‘me time’ and leave their worries behind. Men, however, described drinking and smoking with friends as a ‘working class right’ and group-based relaxation.

A ban on motorists smoking while children are present may not be easily enforceable but it sends out an important message.

Nicky Hoyle, consultant in public health for Kirklees Council, says even if legislation is difficult to enforce it can make behaviour unacceptable. She cited restrictions on mobile phone use while driving, which the AA says has reduced the number of drivers making calls, as an example.

“The smoking ban in cars is not just about making it illegal for health reasons,” she explained, “it’s about trying to change attitudes and norms. Children witnessing smoking in cars see it as the normal thing to do.”

Nicky Hoyle
Nicky Hoyle

And she points out that it’s not just campaigners who want a smoking ban in cars. According to a YouGov survey, as many as 78% of children questioned said they didn’t want to sit in a smoke-filled vehicle and a whopping 98% wished their parents would give up the habit.

According to Nicky, Kirklees’ Stop Smoking Service, run by Locala, targets sections of the community in which smoking rates are particularly high. For example, it is known that one in three people with depression are smokers and one in four people with lung diseases. Pregnant women are also offered help to quit.

She says legislation such as the current raft of amendments to the Children and Families Bill, which will make it illegal to sell e-cigarettes to the under 18s; enforce plain packaging for cigarettes; and ban smoking in vehicles where children are present, are all effective ways to tackle the smoking problem.

“The really important thing is to prevent children taking up smoking in the first place and make it less attractive to them, but we know that children of smokers are more likely to smoke than the children of non-smoker,” said Vicky.

“Smoking is one of the biggest public health issues because it is still the biggest cause of preventable death and one of the biggest causes of inequality in health.”