66 Percent of Israeli Adults Inhaling Second-hand Smoke, Health Ministry Says

Ministry reports serious lack of enforcement in smoking restrictions, with vast majority of local authorities failing to enforce them at all

File photo: A man smokes a cigarette in Jerusalem's Old City.
Emil Salman

Despite more regulations limiting or banning smoking in public places, a majority of Israelis continue to be exposed to second-hand smoke. The just-released 2018 Health Ministry report on smoking and its effects found that 59 percent of Israeli children and 63 percent of adult nonsmokers had signs of cotinine (a metabolic byproduct of nicotine) in urine testing.

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The report paints a disappointing picture of the progress of the anti-smoking effort in Israel, even after a series of stricter health ministry regulations on smoking were introduced.

According to the report, in 2018, about a fifth of Israel’s adult population – 19.8 percent, or more than a million and a half Israelis -- smokes (25 percent of men and 15 percent of women). This figures has declined slightly over the last few years, down from 23.1 percent in 2014 and 21.6 percent in 2016. The Health Ministry has set a goal of reducing the smoking rate in Israel to 15.5 percent within five years. “We believe that the newest legislation, education, programs for quitting smoking and the support of civilian organizations will lead us to this goal,” the ministry says. But these efforts have yet to prove themselves.

Since 2012, various regulations have been enacted to restrict smoking in public places. In May 2018, these restrictions were significantly expanded. The new restrictions include a ban on smoking at open-air events with more than 50 people; anywhere on the grounds of a hospital or clinic, including outside the building; in government offices, courthouses, the offices of the public authorities and the religious councils; places where physical activity is taking place, including outdoor locations, such as a basketball court and swimming pool; by the entrance to preschools, at playgrounds, in a covered or underground parking lot; at zoos. The administrators of hospitals, clinics, government offices, parking complexes, zoos and catering halls are allowed to designate smoking areas more than 10 meters from the exit or entrance, if they do not pose a hazard to other sections of the location and are not in close proximity to a residential area. Local authorities are authorized to enforce the bans and the money collected from fines goes into their coffers.

Feeble enforcement

But the law is one thing and enforcement is another matter. The report cites a serious lack of enforcement that is hindering the effort to reduce smoking in public spaces. “The ministry’s department of enforcement and inspection is working hard to promote enforcement together with the local authorities. However, the local authorities must put more effort into enforcing the smoking bans in public places to ensure that people can breathe clear air without the toxins of cigarettes, for the sake of everyone’s health, particularly our children’s health,” the report says.

Although enforcement of the smoking restrictions is a vital health and quality-of-life matter, required by law, as well as an additional revenue source for local authorities – it is being almost completely ignored. The report finds that the vast majority of local authorities in Israel do not enforce the regulations at all. Only 31 percent even reported enforcement figures for 2018, as they are required to do by law. Of those that did report, 14 said that not a single fine was issued for violating the smoking laws.

In all of 2018, 6,545 fines were issued in Israel for violating smoking bans. Of the 17 local authorities that did issue fines in 2018, Tel Aviv (1,791), Jerusalem (1,498), Haifa (1,288) and Netanya (656), reported the highest numbers. Most of the fines were issued in restaurants, hospitals and train stations.

Fewer people trying to quit

In addition to efforts to keep teens from becoming smokers, and many programs in the IDF to reduce smoking among soldiers, the past decade has also brought a greater effort to help people quit smoking. Since 2010, the basket of health services has included workshops to quit smoking and prescription medications for that purpose too. But the report indicates that these efforts are falling short.

Getting a nicotine-addicted smoker to quit is extremely difficult, so the emphasis in reducing smoking rates has shifted to prevention efforts. A 2017 survey by the Central Bureau of Statistics found that 23 percent of smokers began smoking before age 16, 23 percent began at age 16-17, 24 percent began at 18-19 and 30 percent at age 20 and over. The survey also found that 20 percent of smokers are currently trying to quit, 37 percent tried in the past to quit and 42 percent have never tried to quit.

The latest figures show that in 2018, only 24,865 Israelis (just 2 percent of all smokers) sought help from the programs at their HMO. This figures was nine percent lower than in 2017. Though the report also notes that most people try to quit independently.

Meanwhile, the tobacco companies continue to spend tens of millions of shekels to promote smoking in Israel. The report says that in 2017, the tobacco industry spent 80 million shekels on sponsorships, promotional ads and direct mail campaigns.