It has been almost a year since smoking was banned from bars and restaurants in the Netherlands. During that time a lot of unrest was created by the lingering uncertainty over the interpretation of the law. Rumours that enforcement would be lax pending further legislation, and comments by some opposition parties that the law should be scrapped altogether only added to the confusion.

Bar and restaurant owners who abided by the smoking ban now worry that it might be reversed. While a majority of the population is quite happy with the smoking ban and doesn't want to go back.

How did it come to this?

A comparative study by us shows that the Netherlands is the only country where a smoking ban has led to less rather than greater acceptance among the public. When we present these results to colleagues from other countries, we do our best to explain them within the Dutch context.

A man in a cigarette costume

Our colleagues shake their heads with pity when we tell them that our health minister, upon the introduction of the smoking ban, reassured bar and restaurant owners that they shouldn't worry about it being enforced in the early stages. Disbelief shows on their faces when we tell them that the main campaign tool was a TV ad showing a man in a cigarette costume being turned away at a series of cafes.

When Ireland adopted a smoking ban in 2004 the government launched an awareness campaign a year in advance. The health minister used every opportunity to explain that his main concern was to protect the health of the population. Partly as a result of this, the smoking ban went over smoothly. There was no insurrection and no negative economic impact on the bar and restaurant industry. The owners were happy, and the customers were happy. The smoking ban was chosen as the most popular government measure of the year.

The Dutch authorities failed to realise how difficult it would be to get the smoking ban accepted, especially here. The Dutch have a long and proud tradition of tolerance. They get upset when acquired rights are taken away from them. Whereas most people see a cafe as a public place, there are some who consider it a sanctuary. In other words: some resistance was to be expected - all the more reason why it was so important to explain why the smoking ban was necessary.

Support is waning

The first reason is of course to protect people from the health effects of secondary tobacco smoke. Regular exposure to tobacco smoke can cause cancer and heart and lung diseases. Surprisingly, this simple message was remarkably absent from the debate in the Netherlands. Another element is that the risk increases with higher exposure to tobacco smoke. This is a problem for employees working in cafes and the government is right to step in. But a smoking ban is important for the general population too. A small increase in the risk can have considerable results for the public health because it touches a large segment of the population.

During the parliamentary debate about the smoking ban, minister Ab Klink said the health of cafe and restaurant workers was the priority, but that customers, especially asthma patients, would also benefit. One would have expected more from a minister who is responsible for public health.

Our opinion polls show that popular support for the smoking ban is waning; it is at an all-time low among smokers. This is a result of the ongoing discussion about whether we should keep the smoking ban or not, and the large media attention for smokers and cafe owners who are defying the ban.

The unfortunate awareness campaign cannot be undone. But it would help if the health minister took a firm stand in favour of the ban, and offered a clear explanation why it is necessary in the interest of public health.