Japan must host smoke-free Olympic Games

By Tadao Kakizoe / Special to The Yomiuri ShimbunTokyo will host the Summer Olympic and Paralympic Games in 2020 for the second time, 56 years after the quadrennial sports festival exalting human diversity was first held in the Japanese capital. The forthcoming Games will be completely different from the previous undertaking in that strong interest is now being shown in the Paralympics, whereas the public did not necessarily pay much attention to the event for athletes with disabilities in 1964.

The Paralympic Games are an occasion for athletes with a range of disabilities to challenge their physical limits, partly through the use of new technology. The increased prominence of the Paralympic Games clearly reflects people’s growing awareness of such events as an important means of respecting the diversity of each human being and realizing an inclusive society.

Also, there has been a sea change in Japan’s demographics between 1964 and 2020. This nation is now experiencing an era with a declining birth rate and an aging population, a situation that requires us to have a fundamentally new mind-set about the nature of society. It is of course desirable to transform our society into one in which older people can stay healthy and active, and continue working and contributing to society.

Health is the common factor between the Olympic and Paralympic Games, and the desirable society mentioned above. So I would like to think about the 2020 Games from the standpoint of health.

In November 2017, the online edition of an international medical journal cited a new study as showing that nearly 6 percent of new cancer cases diagnosed worldwide in 2012 had been caused by diabetes and obesity. This fact has been widely recognized by medical experts.

The Japan Diabetes Society and the Japanese Cancer Association set up a joint committee in 2013 to assess in detail the link between diabetes and cancer. They listed an unbalanced diet, insufficient physical exercise, smoking and excessive alcohol consumption as common risk factors for diabetes and cancer. Based on such findings, the two entities have been campaigning to raise society’s awareness of those risks.

Cancer and diabetes are two of the most damaging and prevalent diseases, not only in Japan but around the world. Given that lack of physical exercise is a common risk factor for them, the upcoming Tokyo Games can be a timely opportunity for the nation to tackle the issue.

If regular physical exercise can help lower the risk of developing cancer and diabetes, that should be tremendously effective in mitigating the burden caused by the development of such diseases on health-care services and society.

I hope that the 2020 Games, which mainly young, healthy athletes will participate in, will prompt Japanese people to become more aware of their own health.

‘Behind global standard’

As preparations are under way for the Tokyo Games, we should think of another health issue. What will Japanese society do regarding tobacco use, especially nonsmokers’ exposure to secondhand smoke? More than 30 years have passed since it became known that tobacco is harmful not only to smokers but also the people around them who inhale the smoke secondhand.

The International Olympic Committee adopted a smoke-free policy for Olympic Games in 1988, and signed an agreement with the World Health Organization in 2010 to promote “tobacco-free Olympic Games.” It has therefore become imperative for countries hosting Olympic and Paralympic Games to prepare smoke-free indoor spaces for athletes and spectators.

Holding tobacco-free Olympic and Paralympic Games is the global standard. The host countries of recent Games — Canada, Britain, Russia and Brazil — complied with the global norm as a matter of course. Moreover, 55 countries have already imposed a total ban on indoor smoking in public places. In the United States, there is no federal ban on tobacco use, but 27 of the 50 states had completely banned smoking in public spaces, including restaurants and bars, as of 2017.

Douglas Bettcher, WHO’s director for the prevention of noncommunicable diseases, commonly known as lifestyle-related diseases, visited Japan in April 2017 to learn firsthand about tobacco use and smoke-free measures. He commented afterward during a press conference that the government’s proposed “partial” anti-smoking approach, including the use of ventilation, air filtration and designated smoking areas in public places, was ineffective. He strongly criticized Japan for being “completely behind the international standard.”

Prohibiting smoking in indoor public spaces is a definite and effective way — and the international standard — to protect people from secondhand smoke. Tobacco smoke is a main source of indoor airborne fine particulate matter, known as PM2.5, which is now classified as a carcinogen or cancer-causing substance. It is increasingly recognized worldwide that a total ban on indoor smoking is the only way to get rid of PM2.5 air pollution indoors.

The National Cancer Center of Japan estimates about 15,000 people die from secondhand smoke in this country every year. In the summer of 2016, a team of experts commissioned by the Health, Labor and Welfare Ministry studied a total of about 1,600 medical articles about health and tobacco smoke published at home and abroad, concluding that it is “definite” that secondhand smoke causes seven kinds of ailments and symptoms, including lung cancer, stroke and heart diseases.

It is well known that infant sudden death syndrome is connected to maternal smoking during pregnancy and parental smoking.

Influence of tobacco industry

The most effective solution for secondhand smoke prevention is to completely prohibit smoking at restaurants, bars and similar establishments where many people gather. Proprietors would swiftly oppose a total ban, saying they would suffer a decrease in revenue. The tobacco industry undoubtedly supports such opponents.

Certain researchers overseas have already found that when smoking is prohibited, sales at restaurants and bars hardly decline, and that some even post greater sales because a total ban on indoor smoking leads to an increase in new customers, such as nonsmokers and families with children. These findings suggest that they can acquire a completely new cohort of customers.

A 2009 study by the International Agency for Research on Cancer (IARC), a WHO affiliate, showed there was a stark discrepancy between the results of research projects that were conducted independently and those using subsidies from tobacco companies. In the group free from the tobacco industry’s influence, 63 (95 percent) of 66 research theses concluded that indoor smoking prohibition did not cause any sales decreases. In the group supported by tobacco companies, 14 (93 percent) of the 15 theses said sales shrank due to the smoking ban.

The IARC study indicates that the opinion that prohibiting indoor smoking can reduce sales can be regarded as an argument presented on the basis of biased research by researchers strongly influenced by the tobacco industry.

Flawed law

The Japanese government has recently submitted to the Diet a bill to revise the Health Promotion Law, including a plan to prevent secondhand smoke, with a view to implementing the act in April 2020, just ahead of the Tokyo Games. The bill envisages prohibiting indoor smoking at facilities such as restaurants in principle, but it exempts establishments that have “customer space” of 100 square meters or less provided that they are operated by individuals or small- and mid-size companies capitalized at ¥50 million or less. Such facilities will be required to display signage at the front telling customers they have “smoking” or “separate smoking” areas.

These measures are tantamount to making indoor smoking lawful at many facilities without any regulations.

The proposed bill will never be effective enough in protecting the health of nonsmoking customers and people working at those places. If indoor smoking is prohibited at restaurants and similar places, young people who are sensitive to secondhand smoke will be willing to work there. This will also help the country overcome workforce shortages.

Why is it impossible for Japan to do what the host countries of the recent Olympic and Paralympic Games were all able to do?

If nothing is done to rectify the situation, Japan will risk not only failing to protect the health of Japanese people, but also annoying foreign tourists and athletes coming to Japan for the 2020 Games — and even losing their trust in our country.

In closing, I raise two serious questions. Does a country that is not vigorously tackling passive smoking have a promising future? Is Japan fundamentally worthy to host the next Olympic and Paralympic Games?

Special to The Yomiuri Shimbun

Kakizoe is president of the Japan Cancer Society and a past president of the National Cancer Center.Speech

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