(Written for Prof. Casamayou’s Public Policy Cycles/Public Health [GOVT490] seminar class at George Mason University.)
Recently, there have been moves in several jurisdictions to ban or limit smoking in public. There is no question that smoking is dangerous to the smoker, but the smoker has made the choice to pick up the cigarette. Smoking bans represent a recognition of the dangers cigarette smoke poses to nonsmokers nearby, including those who are exposed to smoke in their workplace.
The Kingdon Policy Window Model
According to John W. Kingdon’s policy window model, three ‘streams’ must be aligned for a matter to be dealt with in the public policy arena: the problem stream (is the condition considered a problem?), the policy stream (are there are policy alternatives that can be implemented?), and the political stream (are politicians willing and able to make a policy change?) . When these three streams come together, a window of opportunity is open and action can be taken on the subject at hand.
Public Smoking Bans
The model seems to fit well with the issue of smoking bans, generally and in specific cases. This paper will explore, in depth, how the Kingdon model applies specifically to the public smoking ban implemented in New York City and later statewide throughout New York.
Public smoking bans are generally framed as a positive step to improve environmental safety for workers and patrons of establishments that would otherwise permit smoking on their premisses. This paper will examine through the New York ban how the condition—smoking being allowed in some business establishments—is framed by policy entrepreneurs as a public health risk, how policy alternatives are debated and selected, and how political climate allows these bans to pass in some areas.
While it is tempting to explore this issue on a national scale, the limited scope of this paper prevents it from rambling on for what could be hundreds of pages of study. The New York public smoking ban has been a recent, high profile, major policy change and roughly parallels the development of earlier smoking bans in other states and newer bans, including one currently up for debate in Washington, DC.
Reliance on News Sources
Because the New York public smoking ban is so new, there is very little written on the subject outside of major news sources (newspapers, wire services, etc.). Because of this, reference material for this paper comes primarily from these media outlets. While there is a reasonable amount of material on smoking and secondhand smoke in general, this information is limited to the section on “The Problem Stream.”
The Problem Stream
Recognition of public smoking as a problem did not happen overnight. People have been smoking for centuries, and it was not until the last few decades that it was even recognized as a real health risk to the individual with the cigarette in his or her mouth.
The potential dangers of secondhand smoke did not begin to become apparent until after this initial realization that cigarettes were not good for you. Scientists curious about the effects of smoke discovered that nonsmokers who were exposed to the substance were also more likely to be adversely effected by it.
How Many People Smoke?
According to the 1998 National Health Interview Survey (NHIS) by the Centers for Disease Control and Prevention, about 26 million men and 22.7 million women smoke in the United States. This accounts for 25.7 percent of men and 21 percent of women.
At its peak in the 1950s, about 50 percent of the US population smoked. Recent data indicate that smoking today is significantly less popular than it once was, and it can be inferred that this change in public opinion toward smoking is at least partially resulting from knowledge of related health risks.
Demographically, percentages of smokers do not differ significantly on the basis of race (with the notable exception that nearly 40 percent of ‘American Indians/Alaska Natives’ smoke). Smoking is more prevalent among those living below the poverty line (33.3 percent), and among those with less than 11 years of education.
Secondhand smoke is smoke inhaled by nonsmokers due to proximity to one who is smoking. Smoke exhaled by somebody using a cigarette contains over 4,000 separate chemicals, and at least 40 of those substances are known or suspected carcinogens.
The Environmental Protection Agency (EPA) estimates that secondhand smoke is a “Class-A (known human) carcinogen” and is responsible for thousands of deaths every year. A study conducted by scientists at the Stanford University School of Medicine determined that secondhand smoke contributes to the growth of tumors and their blood vessels in mice.
Aside from cancer, secondhand smoke has been associated with a myriad of other health problems. Pregnant women exposed to cigarette smoke are more likely to have miscarriages, prematurely, stillbirth, or infant death than women not exposed to the substance. Children exposed to smoke are more likely to have respiratory infections, ear infections, and chronic cough. Secondhand smoke is believed to be a factor in development of asthma and other respiratory problems.
Other studies indicate that children and adolescents exposed to cigarette smoke have 20 percent lower vitamin C levels than other children, exposure to secondhand smoke might increase the risk for problems related to osteoporosis, and exposure may also trigger or exasperate menstrual cramps.
Framing the Issue
Antismoking groups and politicians in favor of a public smoking ban did not have to do much to frame the issue of secondhand smoke. Studies such as those referenced in previous sections made it into the media regularly, and nonsmokers—often already annoyed when confronted with lit cigarettes in public places—were ever more conscious of the potential health risks of being around smokers.
With as much scientific evidence available (I’ve only scratched the surface), exposure to secondhand smoke was considered a problem by the vast majority of citizens (remember, only about 20 percent of which are smokers) and politicians. Nobody argued that secondhand smoke was a good thing, even opponents of the public smoking ban focused instead of economic and “right to smoke” issues.
The public smoking ban was made out to be an issue of public health by those in favor of it, with Republicans in the New York state senate estimating that secondhand smoke cost the state health care system over 6 billion dollars every year.11 Because of these and other arguments, by 2003, the New York’s problem stream was well organized, in-place, and waiting for the other two streams to converge.
The Policy Stream
Several policy entrepreneurs managed to help coalesce the New York public smoking ban into a cohesive policy. The primary catalyst toward the statewide policy was a more limited ban which only effected New York City that went into effect in early 2003.
The primary policy entrepreneur with regard to New York’s smoking ban was Mayor Michael R. Bloomberg of New York City, who managed to get this earlier ban enacted. After observing the relative ease with which the New York City ban was implemented, state officials were emboldened to attempt a similar ban statewide.
The New York City Ban
The ban on most forms of public smoking in New York City was pushed and hyped by Mayor Bloomberg and health-related parts of the New York City government. The New York City Department of Health and Mental Hygiene published a series of four fact sheets, highlighting the potential negative health effects of secondhand smoke.
The city health department’s four fact sheets each included a “warning” at the top, “WARNING: You don’t have to smoke to die from it. Secondhand smoke kills.” While the New York City health department is a mayoral agency and falls directly under Bloomberg’s control, it has the appearance of being a neutral public health agency. Because of this appearance, the department was able to establish itself as a major policy advocate in favor of the ban, though it was truly just a surrogate for the mayor.
The New York City ban allowed smoking restaurants and businesses that provided an area with separate ventilation from the nonsmoking section of the establishment.
The Statewide Ban
After the policy success of the New York City ban, state officials—led by Governor George E. Pataki and several prominent state legislators—wished to enact an even stronger ban statewide. The governor and these legislators were the policy entrepreneurs who brought forth the statewide ban.
The state policy sets a minimum standard, while localities are free to enact even stricter policies if they wish. Under the law, smoking is prohibited in all establishments except private residences, personal cars, “cigar bars” in New York City registered before the end of 2002, and Indian casinos. Even establishments with separate smoking rooms—permitted under the New York City ban—would now be prohibited from allowing customers to light up. Fines are set at up to $1,000 per violation.
While many had reservations about the stringent policy enacted by the state legislature—including Governor Pataki, who pushed for the ban in the first place—it sent a clear message about New York’s feeling on smoking, and rallied interest group and political support.
The Political Stream
Because the issue of public smoking had been so clearly established as a public health issue—and, to a certain extent, an occupational safety issue (for those working in bars and restaurants)—the political stream was strongly in line with action in New York.
One of the concerns put forth by opponents of the public smoking ban was that it would have a negative economic impact on bars and restaurants that catered to smokers. The New York City Department of Health and Mental Hygiene specifically countered this argument in their fourth “fact sheet,” titled “Smoke-free workplace laws don’t hurt business.”
In this fact sheet, the department argued that under an earlier, more-limited ban on certain establishments, those establishments actually grew significantly, California’s similar ban has not had negative economic impact, tourism is unaffected, and employers are able to cut business costs in smoke-free workplaces (less absenteeism, etc.).
In fact, some of these fears may have been realized. After the ban went into effect, some bars in neighboring states saw a significant increase in business.
The strongest influence on the political stream was public opinion. Mayor Bloomberg in New York City and Governor Pataki both openly supported public smoking bans in their campaigns, and according to a 2002 study 7 out of 10 New York City voters supported the elimination of smoking in all offices and restaurants.
With ban supporters in the small (but vocal) minority, the statewide ban passed handily and with strong, bipartisan support in the New York legislature. The Republican controlled state Senate passed the bill 57-4, the Democratically controlled Assembly passed it 96-44, and the Republican governor signed it into law with only minor reservations.
Politicians were generally willing to risk angering smokers because they were such a small percentage of the population—only about 20 percent—and for every smoker vote a politician may have lost, they likely gained several nonsmokers who felt passionately about the ban.
Despite such strong support, however, supports were almost surprised to find how popular their view was. One article in a New York newspaper proclaimed, “Enjoying no smoke: Not everyone is joining the chorus of complaints about the state’s new smoking ban. Many are grateful for it,” as if this were unexpected.
But the reality of strong public support truly prodded the politicians to action, and in the face of what appeared to be a potentially grave health risk, arguments about negative economic impact seemed to fall flat. This convergence of public opinion is what prodded the political stream into action.
With the convergence of the three streams, the New York smoking ban made its way into the public policy agenda and ended up becoming policy. With secondhand smoke firmly established as a serious health risk, strong policy entrepreneurs in elected and non-elected positions in government, and the smoking issue becoming politically expedient due to overwhelming public opinion, there was no keeping it off the table.
It is still too early to see, in depth, what effect the smoking ban will have either on the New York economy or on secondhand smoke’s estimated 6 billion dollars yearly public health price tag. But with the issue so clearly framed as an issue of public health in populous states like California and New York, this view has entered the national consciousness.
It is likely, then, that as public opinion becomes stronger on this subject, more public smoking bans will be enacted nationwide. The problem stream is in place in almost every locality and state, it’s just a matter of solidifying the policy (what exactly would new bans entail?) and political (is public opinion strongly in favor of a ban?) streams to get the issue on the agenda elsewhere.
In some areas, this is already possible. Washington, DC, will soon be considering a public smoking ban similar to that in New York, and other local and state jurisdictions around the United States are considering these types of bans.
The Kingdon policy window model seems to apply properly to the issue of public smoking bans. In New York, the streams came together and the issue made it onto the policy agenda. In other jurisdictions, however, the window of opportunity has not necessarily opened.
John Kingdon, Agendas, Alternatives, and Public Politics, 2nd ed. (New York: Harper Collins, 1995). p. 19.
“Cigarette Smoking Statistics,” American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4559
“Passive Smoke,” National Jewish Medical & Research Center MedFacts. http://www.nationaljewish.org/medfacts/passive.html
“Second hand smoke fuels the growth of tumors and their blood vessels,” Cancer Weekly (Nov. 18, 2003) p. 18.
“Secondhand Smoke may lower Vitamin C Levels in Children,” Alcoholism & Drug Abuse Weekly Vol. 13 i. 15 (April 9, 2001), p. 8.
“Other people’s cigarette habit and your osteoporosis,” Tufts University Health & Nutrition Letter Vol. 18 i. 12 (Feb. 2001), p. S6.
“Smoking out a source of painful menses,” Science News Vol. 158 i. 17 (Oct. 21, 2000), p. 269.
Joel Stashenko, “Smoking ban bill approved by legislature,” The Associated Press (March 26, 2003).
“New York City Department of Health and Mental Hygiene,” NYC.gov. http://www.nyc.gov/html/doh/home.html
Judy Lin, “New York’s smoking ban is boon for bordering bars, restaurants,” The Associated Press. (August 2., 2003).
Gene Warner, “Enjoying no smoke: Not everyone is joining the chorus of complaints about the state’s new smoking ban. Many are grateful for it,” Buffalo News. (November 25, 2003).