Symposium Smoke-free legislation: Global reach, impact and remaining challenges 5 L. Gruer a, *, E. Tursan d’Espaignet b , S. Haw c , E. Ferna ´ ndez d , J. Mackay e a Public Health Science, NHS Health Scotland, Glasgow, UK b Tobacco-free Initiative, WHO, Geneva, Switzerland c Public Health and Population Health, University of Stirling, Scotland, UK d Tobacco Control Unit, Instutut Catala ` d’Oncologia, Barcelona, Spain e World Lung Foundation, Hong Kong, China article info Article history: Accepted 9 December 2011 Available online 15 February 2012 Keywords: Tobacco Smoking Second-hand smoke Smoke-free legislation summary Article 8 of the World Health Organization Framework Convention on Tobacco Control (2005) requires all signatory countries to adopt measures to protect people from tobacco smoke in indoor workplaces, indoor public places, public transport and other public places as appropriate. The aims of this symposium were to review progress across the world, to assess the evidence for the impact of legislation on health, and to identify the continuing challenges in making universal protection a reality. There was agreement that even in countries where strict legislation is enforced, many children continue to be dangerously exposed to parental second-hand smoke in the womb, the home and private cars. The importance of using accurate estimates of the burden of disease caused by second-hand smoke was agreed, in order to present an unassailable case for legislation and enforcement ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. The harm to health from breathing second-hand smoke is now recognized as a major contributor to the global burden of disease caused by smoking tobacco. Article 8 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires all signatory countries to adopt measures to protect people from tobacco smoke in indoor workplaces, indoor public places, public transport and other public places as appropriate. 1 All signatories are urged to provide ‘universal protection’ within 5 years of ratifying the Convention. Voluntary agreements or partial bans to restrict smoking in public places and workplaces have been found to provide inadequate protection. Consequently, most countries have now passed some form of protective legislation of varying comprehensiveness. The aims of this symposium were to review progress across the world, to assess the evidence for the impact of legislation on health, and to identify the continuing challenges in making universal protection a reality. Edouard Tursan d’Espaignet, Tobacco-free Initiative, WHO, said that in order to assess the strength of smoke-free legis- lation, WHO had categorized eight public places of interest for smoke-free legislation: healthcare facilities; educational facilities other than universities; universities; government facilities; indoor offices and workplaces; restaurants; pubs and bars; and public transport. Countries are assessed on how many of these eight public places are covered by legislation. By December 2010, 31 countries had covered all eight, 16 had covered six to seven, 51 had covered three to five, and 91 had covered one to two. Thus, virtually every country in the world 5 World Epidemiology Congress Symposium, 10 August 2011, Edinburgh, UK. * Corresponding author. Tel.: þ44 (0) 141 354 2960. E-mail address: Laurence.Gruer@nhs.net (L. Gruer). Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe public health 126 (2012) 227 e229 0033-3506/$ e see front matter ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2011.12.005