WHO smoke-free city case study

Advancing the enforcement of the smoking ban in public places – Davao City, Philippines

© World Health Organization 2011
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WHO smoke-free city case study: Davao, Philippines

Abbreviations
FCAP NGO PhP US$ WHO WHO FCTC Framework Convention on Tobacco Control Alliance Non-governmental organization Philippine peso United States dollar World Health Organization WHO Framework Convention on Tobacco Control

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WHO smoke-free city case study: Davao, Philippines

Contents
Acknowledgements.................................................................................................................... 3 Foreword .................................................................................................................................... 4 1. 2. Introduction ........................................................................................................................ 6 The Context......................................................................................................................... 6 2.1 2.2 2.3 2.4 3. 4. City Background .......................................................................................................... 6 Tobacco Use and Smoking Behaviour ......................................................................... 6 The Health Costs of Tobacco ....................................................................................... 7 The Smoke-Free Policy and Legal Context: ................................................................. 7

The Davao City Smoke-Free Ordinance .............................................................................. 8 Key Stages in the Development of the Ordinance ........................................................... 11 4.1 4.2 4.3 The Political and Legislative Process ......................................................................... 11 Campaigns and Compliance Building ........................................................................ 12 Issues, Debate Topics and Arguments ...................................................................... 14

5. 6. 7.

Compliance and Enforcement .......................................................................................... 15 Impact of Davao City’s Smoke-Free Actions ..................................................................... 16 Conclusions and Lessons .................................................................................................. 17

References ............................................................................................................................... 18

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WHO smoke-free city case study: Davao, Philippines

Acknowledgements
The WHO smoke-free city case study Advancing the enforcement of the smoking ban in public places – Davao City, Philippines was developed for the WHO Centre for Health Development in Kobe, Japan, WHO Tobacco Free Initiative in Geneva, Switzerland and the Regional Office for the Western Pacific in Manila, Philippines. It was written by Domilyn Villarreiz, Davao Anti-Smoking Task Force in Davao, Philippines and edited by Jon Dawson Associates in Chester, United Kingdom.

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WHO smoke-free city case study: Davao, Philippines

Foreword
All people have a fundamental right to breathe clean air. There is no safe level of exposure to second-hand smoke (SHS), which causes heart disease, cancer and many other diseases. Even brief exposure can cause serious damage. Only a total ban on smoking in all indoor public places, including workplaces, protects people from the harms of SHS exposure, helps smokers quit and reduces youth smoking. Guidelines to Article 8 of the WHO Framework Convention on Tobacco Control (WHO FCTC) help countries know exactly what to do to protect their people from SHS. An increasing number of countries have adopted legislation to accomplish smoke-free environments. Smoke-free legislation is popular wherever it is enacted, and these laws do not harm business. Any country can implement effective smokefree legislation. However, only a small proportion of the world’s population currently has meaningful protection from SHS. While a national law protecting all the people in a country is ideal, cities can often pass legislation sooner than countries. In many cases public sub-national legislation or local regulations can be effective ways to address the issue with measures beyond the legal or political scope of national governments, and even to anticipate or promote national interventions. A growing number of cities and counties across the globe have already taken action. Many cities have every authority to pass comprehensive smoke-free laws to eliminate SHS exposure. If comprehensive smoke-free legislation does not exist at another jurisdictional level, these cities should use their authority to adopt laws or other available legal instruments to prohibit tobacco smoke in these places. Some cities may not have adequate authority to pass strong, comprehensive legislation. However, this does not mean that they should not take action. Most cities will at least have the authority to prohibit tobacco smoke in certain types of workplaces, for example, local public transportation and municipal public buildings. They can adopt legislation prohibiting smoking indoors in whatever categories of establishments they have authority to regulate. In addition, all cities can advocate for action at other governmental levels. Mayors and other city leaders can directly advocate for national comprehensive smoke-free laws. In a joint project, WHO Centre for Health Development, Kobe (WKC) and the WHO Tobacco Free Initiative (TFI) aimed to facilitate local action by documenting the experiences of nine selected cities in becoming smoke-free. Their interventions and processes were examined by local experts, based on evidence from a wide range of local sources. These included documentation, archival records, direct observation, interviews and participant-observation. A case study database was created and the most relevant documents kept on file, including statements from key-informants. Some cities have banned smoking in enclosed public places including workplaces, educational facilities, transportation, shopping malls, restaurants, and bars. Other cities have implemented smoking bans as part of
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WHO smoke-free city case study: Davao, Philippines

comprehensive tobacco control regulations, while imposing other restrictions, for example on tobacco sales and advertisements. Cities use different mechanisms to introduce such regulations and their impact goes beyond the cities adopting the smoke-free policies. The present case is one in a series of nine case studies of cities that have engaged in the process of becoming smoke-free. Although not all of the cities have yet accomplished the goal of becoming a "smoke-free city", they provide lessons learnt in relation to political commitment for local action towards smoke-free air for their citizens and the role of civil society in urging city governments to take action, helping them to build effective partnerships and to conduct awareness campaigns that benefit enforcement and maximize compliance. We hope that these lessons can be used by municipalities to succeed with local smoke-free legislation or tobacco control programmes. Municipal success may trigger action in other cities and countries, and thus contribute to worldwide protection from exposure to SHS.

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WHO smoke-free city case study: Davao, Philippines

1.
1.1

Introduction
Davao City is a leading example for taking forward smoke-free agendas in the Philippines. In advance of the 2003 National Tobacco Control Law, the city council passed its Comprehensive Anti-Smoking Ordinance in 2002 and has actively promoted and enforced it. This case study examines Davao’s smokefree agenda and how it has been implemented. It discusses the impact of the law and lessons learned.

2.
2.1
2.1.1

The Context
City Background
Davao City is a sprawling metropolis located in the Southern part of the Philippines. Covering 2,444 square kilometres, it is one of the largest cities by area in the world. It has a population of about 1.4 million - 71% of which live in urban areas.1 With a predominantly migrant population, the city has a diversity of cultures that includes many migrants from Luzon (Tagalogs) and Visayas (Cebuanos and Ilonggos) and at least 10 Indigenous Peoples (tribal groups). Economically, the city has grown steadily over the last two decades with high levels of inward investment in the last 10 years. With the presence of the country’s top 200 companies in the city, Davao City has a mixed economy incorporating agricultural, service and industrial sectors.2

2.2
2.2.1

Tobacco Use and Smoking Behaviour
Smoking prevalence in the Philippines is far higher for men than for women. According to the 2009/10 Global Adult Tobacco Survey, overall smoking prevalence is 28%. However, 42% of men smoke compared to 9% of women. Amongst youth aged 13-15 years old, smoking prevalence reaches 23%.3 Estimates also indicate that the prevalence of daily smoking in Davao is at least 20%.4 There is also evidence that, nationally, poorer households spend proportionately more of their incomes on tobacco than do other households in the country 5. In this context, the affordability of tobacco – cigarettes can be bought for PhP0.75 (US$0.016) per cigarette – combined with the influence of cigarette advertising, reinforces poorer people’s access to tobacco.

2.2.2

).

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2.3
2.3.1

The Health Costs of Tobacco
In the Philippines, the major tobacco-related diseases, namely cerebrovascular disease and coronary artery disease, caused the majority of deaths, based on projected deaths for 2003 and using cause-specific mortality rates from 20025. In 1996, 144,931 men and 103,311 women older than 35 years of age were reported to have died from smoking-related diseases such as trachea, lung, and bronchial cancer, ischemic heart disease, respiratory disease and stroke.6 Within Davao City, smoking is one of the most significant threats to public health. According to data compiled by the Davao City Health Office, between 2001 and 2007, there were 892 recorded deaths caused by lung cancer. The number of yearly deaths from lung cancer peaked in 2004 when about 139 people died from the disease.

2.3.2

2.4
2.4.1

The Smoke-Free Policy and Legal Context:
National Tobacco Control Legislation The Philippines ratified the WHO FCTC on 6 June 2005. Two years before, the Tobacco Regulation Act of 2003 (Republic Act 9211) was approved. Section two of the Act stated that “the government shall institute a balanced policy whereby the use, sale and advertisement of tobacco products shall be regulated to promote a healthy environment and at the same time ensure that the interests of tobacco farmers, growers and stakeholders are not adversely compromised”. 7 It consisted of three components:  a smoking ban in public places (see section 2.4.3);  restricting minors’ access to cigarettes - under 18’s are not allowed to sell, buy or smoke cigarettes and cigarettes cannot be sold within 100 metres of a learning or recreational facility for minors;  a focus on tobacco advertising and promotion that bans tobacco advertising on television, cable television, radio, cinema, outdoor billboards and in mass media. Point-of-sale advertising is exempted. The Inter-Agency Committee - Tobacco is charged with administering and implementing the 2003 Act. The Secretary of the Department of Trade and Industry and the Secretary of the Department of Health co-chair the Committee. Its members include the Secretaries of a range of departments: Agriculture, Environment and Natural Resources, Justice, Finance, Science and Technology, and Education. Other Committee members are the administrator of the National Tobacco Administration, a representative from FCAP (a nongovernmental organization involved with public health promotion) and a representative from the tobacco industry (the Philippine Tobacco Institute – which represents the five major tobacco companies in the country).8

2.4.2

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2.4.3

2.4.4

National Smoke-Free Legislation The 2003 Tobacco Regulation Act prohibits smoking in all centres of youth activity, elevators and stairwells, locations where fire hazards are present, health facilities, public conveyances, public facilities, and food preparation areas. However, the Act requires the designation of smoking and non-smoking areas for enclosed places that are open to the public. Moreover, owners can determine the size and specifications of the smoking and non-smoking areas on their premises. Enclosed areas are tightly defined. The Act states that, “the mere presence of a roof or ceiling over the structure but without walls or partitions... does not constitute an enclosed area” It also states that, “the walls or partitions must be continuous interrupted only by doors and windows”. Although far from comprehensive, earlier legislation provided some protection against exposure to second-hand smoke. Section 24 of the Clean Air Act of 1999 (Republic Act 8749) addressed “pollution from smoking”. It prohibited smoking inside a public building or an enclosed public place including public vehicles and other means of transport or in any enclosed area outside of one’s private residence, private place of work or any duly designated smoking area. It gave the responsibility to local government units to implement the law. The Previous Legal Framework for Smoke-Free Public Places in Davao City Prior to its recent efforts to implement an effective smoke-free agenda, Davao City had three pre-existing ordinances, from 1964, 1987 and 1996, that addressed smoking in public places.9 The 1964 ordinance prohibited smoking in cinemas and the second expanded its scope to government offices and public utility vehicles. The 1996 ordinance banned smoking in restaurants and accommodation establishments such as hotels, motels, lodges, inns and similar places. However, these ordinances, which partially banned smoking in public places, were not implemented and were regarded as “sleeping ordinances”. Nevertheless, they were later amended to conform to the Philippine Clean Air Act of 1999. Article 5, section 24 of the Clean Air Act focused on “pollution from smoking”. It prohibited smoking in enclosed public places and public vehicles but, in addition to private homes, exempted private places of work or “any duly designated smoking area.”

2.4.5

3.
3.1

The Davao City Smoke-Free Ordinance
The Comprehensive Anti-Smoking Ordinance of Davao City (City Ordinance 04302 series of 2002) bans smoking in all public places and enclosed places but has an option for designating a smoking area - provided establishments pass through a series of rigid inspections by the Anti-Smoking Task Force. It sets out specific
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definitions of “enclosed areas”, “prohibited acts”, “persons liable”, penalties, and inspection and monitoring by government agencies. Subsequent Executive orders, culminating in Executive Order no. 06, in 2009, set out specific regulations relating to the ordinance including for signage, smoking rooms and enforcement roles. 10 Extent of Smoke-Free Spaces The ordinance states that it is unlawful for any person to smoke or allow smoking in vehicles, whether government-owned or for public transport for passengers, accommodation and entertainment establishments, public buildings, public places, enclosed public places, or in any enclosed area outside of one’s private residence, and private places of work within the jurisdiction of Davao City. “Private places of work” were not explicitly defined in the legislation but, in practice, have been interpreted as a place to which the public does not have access. The ordinance defines enclosed areas where smoking is prohibited as “areas which are totally or partially closed at the sides and are roofed or make use of the floor above as ceilings, or even areas open on all sides but covered by a roof that is permanent or temporary in nature”. This definition effectively makes smoke-free places more extensive than does the definition of enclosed spaces set out in the national law. The ordinance also explicitly prohibits smoking in specific public places such as gasoline stations, banks, malls, town squares, terminals, shopping/business arcades, schools, churches, hospitals, cinema houses, gymnasiums, funeral parlours and barbershops. Moreover, it extends smoke-free places to some public outdoor spaces where people congregate to be together or listen to or attend concerts, rallies and other events. These include, but are not limited to, four parks in the city – Rizal Park, Freedom Park, Magsaysay Park, and Osmeña Park. Exemptions The Anti-Smoking Ordinance contains some explicit exemptions that permit smoking indoors. It allows for designated smoking rooms within accommodation and entertainment establishments. These include restaurants, fast food outlets and other eateries, hotels, motels, lodges, inns and boarding houses, bars, cinemas and other recreation venues. However, the ordinance is stricter than the 2003 Tobacco Regulation Act, where establishments are free to determine the size and specifications of smoking areas. Unlike the national law, the city ordinance lays down specific criteria that smoking rooms must satisfy. Specifically, the smoking room should be totally enclosed and:

3.2

3.3

3.4

3.5

3.6

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

3.7

3.8

3.9

must not be more than one-quarter of the total accommodation area of the establishment;  must be separate from the smoke-free part of the premises. There are also specific requirements depending on whether the premises have or do not have air-conditioning. For premises with air-conditioning, the designated smoking room should have an exhaust fan and be completely enclosed on all sides. For premises without air-conditioning, the designated smoking room should be fully ventilated and include a separate ventilation/air re-circulation system where the air is directly extracted to the outside. Executive Order No. 06 further states that for designated smoking rooms:  they should be located away from entrances or common pathways;  food and drink are not allowed within them;  minors are not allowed to enter;  they cannot be converted into a room for meetings, gaming areas or other private functions;  only tables and ashtrays are allowed in the room. All designated smoking rooms need to be approved by the Anti-Smoking Task Force before smoking is permitted. The ordinance assigns responsibility for inspection and certification of smoking rooms to the City Health Officer and the City Engineer. Signage The 2009 Executive Order sets out the minimum size and required content of no smoking signs. It also states that they should be placed in “strategic areas of the establishment”. Penalties Smoking where it is not permitted, including in public utility or government-owned buildings, can lead to fines of between PhP300 (US$6) and PhP1000 (US$22) - or imprisonment of between one and four months. Managers or owners of establishments who knowingly allow, abet or tolerate and/or fail to warn, advise or report violators of the smoking ordinance to any policeman or police station within three hours of violation are liable to being penalised. Establishments found violating the ordinance also face the possibility of being closed for noncompliance following notice of violation. The fines contained in the city ordinance are lower than those in the national law. Fines for smoking violations of the 2003 Tobacco Regulation Act, range from PhP500 (US$11) to PhP10,000 (US$220). Business permits and licences to operate can also be revoked.

3.10

3.11

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4.
4.1
4.1.1

Key Stages in the Development of the Ordinance
The Political and Legislative Process
In 2002, Mayor Rodrigo Duterte initiated a review of the city’s ordinances relating to smoking in public places. As the ordinances did not offer protection to second-hand smoke in most public places, he asked the City Council through the author of the 1996 Ordinance 3816, Councillor Bonifacio Militar, to conduct hearings to amend the Ordinance and to draft a Comprehensive Anti-Smoking Ordinance that would extend its scope to all public places. The Smoke-Free Davao Co-ordinator, who was appointed by the Mayor, assisted in building the case for the ordinance by gathering information on the effects of smoking including statistics on tobacco-related morbidity and mortality. The data was presented during public hearings and utilised in mass media campaigns. In accordance with the City Council’s legislative process, a draft ordinance was prepared and a series of public hearings were held to obtain reactions from various stakeholders. These included representatives of the business and tourism sectors who had initially opposed the ordinance, citing their perception that it could have a negative commercial impact. At a committee hearing on 29 May 2002, Councillor Militar stressed that the Comprehensive Anti-smoking Ordinance consolidated and amended previous anti-smoking ordinances. The hearing also helped to generate support and commitment for the ordinance from different sectors and it provided an opportunity to clarify concerns. A follow-up hearing on 10 June 2002, also chaired by Councillor Militar, focused on discussing “grey areas” in the proposed Comprehensive Anti-Smoking Ordinance. This hearing was attended by the Members of the Committee on Rules, Privileges, Laws and Ordinances. These included an array of representatives from the public and private sectors. In attendance were the Davao City Chamber of Commerce, Davao Association of Tourist Attraction (DATA), City Health Office, City Legal Office, the Davao City Police Office, owners and managers of various hotels, malls, department stores, restaurants, bars, drivers association, and other establishments in Davao City. Community leaders also participated. In addition to focussing on the smoke-free provisions in the ordinance, the June hearing also discussed a resolution calling for the passage of an ordinance prohibiting all minors from buying or smoking cigarettes and other tobacco products in the City. The imposition of fines and penalties for any violation was also considered. During the period when the ordinance was being discussed by the Council, one councillor suggested that smoking be allowed in small restaurants, since he
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4.1.2

4.1.3

4.1.4

4.1.5

4.1.6

WHO smoke-free city case study: Davao, Philippines

4.1.7

4.1.8

4.1.9

believed it would be financially challenging for small restaurants to set up smoking areas. However, Councillor Militar, opposed this idea on the grounds that the ordinance was intended to protect the people's health and so it was important for the many small restaurants in the city to be smoke-free. Militar's appeal to the council later led to the inclusion of all restaurants in the final ordinance. The City Council, through a unanimous vote by all its members, approved and adopted the Comprehensive Anti-Smoking Ordinance on 30 July 2002. Following its approval by the City Mayor on 14 August 2002, the ordinance took effect on 9 November of the same year. A workshop focusing on drawing up Implementing Guidelines of the Comprehensive Anti-Smoking Ordinance of Davao City was also held prior to the ordinance coming into effect. It resulted in Executive Order No. 25 that established the Anti-Smoking Task Force to monitor compliance and implementation of the comprehensive anti-smoking ordinance, conduct advocacy and campaigns and support the Police in filing charges for violation. It was provided with an annual budget of PhP700,000 (US$15,220). Davao’s smoke-free legislation was approved and came into effect in advance of the national tobacco control law. It is also more protective against exposure to second-hand smoke. For instance, “enclosed places” in the Davao ordinance include places that have permanent or temporary roofing but are open on all sides, while the national law restricts an enclosed place to one which is both walled and roofed. However, local ordinances in conflict with the provisions of the law are superseded, so it was necessary to bring the national law in line with the local ordinance. In 2009, Executive Order no.26 harmonised the national law and the Davao ordinance. However, the City Legal Office found ways to ensure that the ordinance would not be totally affected and, in practice, Davao has maintained its protective approach.

4.2
4.2.1

Campaigns and Compliance Building
The mayor appointed a Smoke-Free Davao Coordinator to take charge of all the campaign initiatives and the Smoke-Free Davao Programme launched an advocacy campaign on 31 May 2002 to raise public awareness about the provisions of the smoke-free ordinance and to prepare the citizens of Davao for its enforcement and implementation. The campaign also aimed to raise awareness of the health risks associated with smoking and hence prevent smoking initiation and increase smoking cessation. Led by the City Health Office, health professionals were trained to deliver lectures and meetings in workplace, school and community settings.

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4.2.2

4.2.3

4.2.4

4.2.5

Information dissemination intensified following the publication of the ordinance in local newspapers. A week before the ordinance came into effect, the city government, in partnership with the NGO Kiwanis Club of Davao, conducted an information campaign. It too focused on the dangers of smoking and making people aware of the implementation of the ordinance. It included a "No Smoking" sticker campaign with stickers posted on public utility vehicles and billboards located at seaports and airport. Over time, an extensive Information, Education and Communication campaign was developed and delivered. It has incorporated social marketing, advocacy and counter-marketing tactics. It has included:  a media campaign involving four local television stations, 28 radio stations and five local newspapers;  lectures in schools, workplaces and communities;  education about the ordinance for managers and owners of eating places, gas stations, nightspots and the business sector generally, national government offices, transportation groups, civic society organisations and NGOs;  advocacy with government bodies, private companies and civil society to generate support in placing billboards and reproducing stickers, handouts and posters;  a sticker campaign for public utility vehicles and transport terminals;  the provision of “certified smoke-free establishment” signs at the entrance to all public places and “I support” stickers awarded by the Anti-Smoking Task Force;  an advocacy meeting with the managers and owners of airlines, shipping and bus companies - this led to an agreement that, on arrival in the city passengers would be informed that a smoking ban in public places is strictly implemented in Davao City;  training of health educators on the effects of smoking so they could assist in the conduct of lectures. A “Smoke-free Prison” campaign for Davao City Jail inmates was also launched. It led to the prison warden discouraging the selling of cigarettes inside the jail and to implement a “no smoking policy” within the prison cells. Moreover, law enforcers were not exempted from the orientation and training. Police were ordered not to smoke while on duty or wearing uniforms. Initially, the campaign was handled solely by members of the task force. On the third anniversary of the campaign on 31 May 2005, activities began to boost significantly the scale of the campaign. In response to the 2005 World Health Organization’s theme “Health Professionals against Tobacco”, health professionals became more extensively involved in the campaign and especially in conducting lectures in schools, workplaces and communities.
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4.2.6

After several meetings and orientations with health professional groups, civil society organizations and other smoke-free advocates, the task force was expanded in 2005 to meet the demands of conducting lectures and monitoring in all areas in Davao. The Association of Smoke-Free Davao Advocates - with more than 1000 members to date - was organized by the Smoke-Free Davao Coordinator. It comprises church leaders, community leaders, Muslim leaders and health professionals. Responding to the need to have more people to monitor the enforcement of the ordinance in different communities, these advocates are inter alia required to inform the public on the ill effects of smoking, and are encouraged to report violators to the Task Force and the law enforcers.

4.3
4.3.1

Issues, Debate Topics and Arguments
Smoke-free agendas often encounter opposition from a range of organisations and individuals. In Davao City, the ordinance was not, at first, welcomed by some economic sectors that feared it would have a negative impact on business. For instance tourism-related organisations feared that it would discourage tourists from visiting the city. In response, Councillor Peter Lavina, chairperson of the committee on Trade, Commerce and Industry suggested that the smoking ban would “hit tourism but only momentarily”.11 However, in practice, people continued to frequent restaurants, shopping malls and similar establishments despite the smoking ban. Anecdotally, this experience of the smoke-free ordinance, led to a shift in opinions with the business and tourism community becoming supportive of the smoke-free law. Joaquin (2003), a columnist who shared fears, at the start of the campaign, that the smoke free ordinance would have a negative effect during holidays, commented that people “still had fun even without cigarettes”. He concluded that the fears of the establishment owners may have been unfounded. 12 Some parts of the business community supported the smoke-free agenda from the outset. For instance, the chairperson of the Mindanao Business Council, said that the emergence of a “health conscious market” would help the industry grow despite the smoking ban.13 Equally, the President of the Integrated Bar of the Philippines Davao Chapter, supported the campaign and considered it a welcome move towards a healthy environment. The lawyer, countering “right to smoke” arguments, informed the public that arguing that the ordinance curtailed individual freedom was “mere conjecture and speculation since the ordinance shows the city’s police power is aimed at promoting public health and welfare. Limiting one’s right as to when and where to smoke is hardly an abridgement of one’s liberty but simply putting smokers in the right place at the right time”.14

4.3.2

4.3.3

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4.3.4

4.3.5

The tobacco industry also attempted to undermine directly the city’s smoke-free agenda. On 18 December 2002, the Corporate Affairs Manager of Philip Morris wrote a letter to the Mayor, urging the local government to permit the business and hospitality sectors to provide smokers with a comfortable place in which to smoke. Philip Morris released a statement that tobacco regulations should be based on four “fundamental principles”. Phillip Morris argued that  smoking-related decisions should be made on the basis of a consistent public health message;  effective measures should be taken to prevent minors from smoking;  the right of adults to choose to smoke should be preserved;  all tobacco manufacturers should compete on a level playing field. However, neither the Mayor nor the city government gave an opportunity to Philip Morris to discuss any of their proposed regulations or programmes.15

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5.1

Compliance and Enforcement
Enforcement responsibilities are shared amongst key partners. The Anti-Smoking Task Force is responsible for monitoring compliance with the law. The Davao City Police Office is in charge of apprehending and filing charges against any person or establishment that violates the ordinance. The City Legal Office provides legal assistance and prepares formal notices while the roles of the City Engineer’s Office include inspecting establishments and putting up anti-smoking billboards. The Business Bureau - also one of the members of the Task Force - is tasked with issuing violation or closure orders to non-compliant establishments while the City Tourism Office monitors all tourism-accredited establishments. In the immediate aftermath of the ordinance’s smoke-free provisions coming into effect, many business establishments violated the ordinance. Anecdotally, a major reason for the low level of compliance was “financial insufficiency”. Less than 10% of businesses set up designated smoking rooms.16 Some entertainment establishments, including hotels and restaurants, violated the ordinance by converting large spaces, like dance floors, into smoking areas - in contravention of the ordinance which specified that smoking spaces should be solely for the use of smoking. The media reported the impact on business as being the prime motivation for those opposing the ordinance. 513 violators were arrested in the first two months after the ordinance came into effect - 494 were males. Over the seven years from 2002 to 2009, a report by Davao Police indicates that there have been over 9000 violations for smoking.17

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6.
6.1

Impact of Davao City’s Smoke-Free Actions
This section considers the impact of the smoke-free provisions of the ordinance in terms of:  exposure to second-hand smoke;  the incidence of smoking;  wider influence of the Davao City smoke-free agenda. Exposure to second-hand smoke Prior to 2002, people in Davao were regularly exposed to cigarette smoke in public places. Among those affected were children with parents who smoked in their presence, food servers exposed to cigarette smoke from customers, employees exposed to cigarette smoke inside workplaces, and commuters exposed to smoking inside public utility vehicles.18 Despite the possibility of incorporating designated smoking rooms, the majority of public places are completely smoke-free. In this context, Davao’s casino is the only one in the Philippines with a smoke free main playing hall. Incidence of smoking There is some evidence that the intensity of smoking reduced in the city. Traders in the city estimated that cigarette consumption dropped by 60%, a loss of at least at least PhP 1 million in sales. It was claimed that many sidewalk vendors lost their jobs. However, they also reported that local demand for tobacco products recovered later on.19 A focus group discussion with government employees who smoked revealed that they had reduced the number of cigarettes they smoke following the implementation of the ordinance. Moreover, they reported that the inaccessibility of smoking areas and cigarette outlets reduced their cigarette consumption and eventually led to some stopping smoking.20 Wider influence Davao City’s smoke-free experience has been recognized by cities and other countries in the region. The Southeast Asia Tobacco Control Alliance and the Thailand Ministry of Public Health in 2008 commended the city for its commitment to implementing a Comprehensive Local Government Tobacco Control Initiative. It has since become a popular destination for smoke-free study tours by local and international advocates. Local government officials from nine cities in Metropolitan Manila participated in a smoke-free workshop conducted in Davao, and cities and municipalities from around Mindanao and the Visayas visited the city for a study tour. In 2008, delegates from Hanoi’s Peoples Committee and Health Bridge and, in 2009, Action on Smoking and
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Health Thailand, together with representatives of Thailand’s Ministry of Health, visited the city to learn about the strategies for enforcement and to observe the implementation in establishments.

7.
7.1

Conclusions and Lessons
Lessons learnt The Davao Smoke-Free City experience highlights a series of factors that have contributed to Davao’s achievements. These provide important lessons for taking forward smoke-free agendas. Key amongst these are: Political will and leadership. Mayor Duterte’s leadership underlines the vital role that consistent political will from city leaders plays in initiating and seeing through smoke-free legislation. Combined with public statements, his unwavering stance has bolstered the implementation of the law. Effective guidance and supervision. The Smoke-Free Davao Co-ordinator, who was also co-chair of the Task Force, had an influential role in providing leadership and guidance - in terms of both strategic direction and implementation – for different members of the Task Force. A motivated team to drive agendas forward. The leadership and intent of a wide range of advocates has supported the effectiveness of Davao’s AntiSmoking Ordinance. In particular, the role of the Anti-Smoking Task Force - even where it meant adding to members’ personal workloads - played a key role in motivating establishment owners and managers to support campaigns and to ensure regular inspection and monitoring of premises. Building a wide partnership. Initially, the Davao Anti-Smoking Task Force consisted only of representatives from local government offices. In time, it came to include a wider partnership of health professionals, religious leaders and other advocates tasked to conduct awareness programmes and lectures in schools, workplaces and communities. This valuable resource, formalised by the creation of the Association of Smoke-Free Davao Advocates, enabled the reach and effectiveness of awareness raising and inspection to be enhanced significantly. Intensive education and mass media campaigns. The Davao experience highlights the importance of initiating intensive mass-media campaigns and information drives in advance of legislation coming into effect. It also emphasises the value of targeting different sectors of society to raise awareness of the rationale for legislation and the provisions contained within it. The Davao model shows how advocates can be deployed to raise awareness and demonstrates how regular publicity of key messages can serve as constant reminders to the wider population. In this context, securing support from the
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7.2

7.3

7.4

7.5

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WHO smoke-free city case study: Davao, Philippines

private sector and NGOs in providing information materials enhanced the impact of campaigns. Final remarks Davao’s smoke-free legislation was approved and came into effect in advance of the national tobacco control law. It is also more protective against exposure to second-hand smoke. Although, in 2009, Executive Order no.6 harmonised the national law and local ordinance, in practice, it has maintained its protective approach. Nevertheless, an amendment to the national law to bring it in line with the WHO FCTC would provide greater support to the Davao smoke-free city programme and prevent it being undermined by continuing legal challenges. In this context, however, the continued involvement, at the national level, by the tobacco industry, as one of the members of the government’s Inter-Agency Committee-Tobacco, is an impediment to a more protective smoke-free national law. Notwithstanding these challenges, Davao city provides a leading example of a city in the Philippines that has effectively implemented smoke-free legislation and significantly reduced the extent that its citizens and those visiting the city are exposed to second-hand smoke. Crucially, it has demonstrated that smokefree laws can work in the Philippines and it is being held up as a model for other parts of Asia. Notable for its strong political leadership, good co-ordination and, in particular, the development of an extensive network of committed smokefree advocates, large-scale information dissemination and a willingness to enforce smoke-free status, the city has remained committed to protecting the health of its people. As a result, for the most part, smokers in Davao have “learnt to become responsible citizens”, leading them to form the habit of smoking only in places were it is allowed. Dayanghirang, the majority floor leader of the city council, observed that the smoking ban resulted in major changes in behaviour to the point that it is hard to see anyone smoking in public places anymore.21

7.6

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References
1 2

2009 National Statistics Office (NSO) Philippines in Figures Source: Davao City website: www.davaocity.gov.ph 3 WHO Statistical Information System [database on the Internet]. World Health Organization. [cited July 6, 2009]. Available from: http://www.who.int/whosis 4 Francisco CQ. Davao businesses hit law banning smoking. Business World. 2003 December 18, 2003.

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5

Tobacco and Poverty Study in the Philippines, WHO Publication, 2008 ISBN 978 92 4 159656. 6 Shafey O, Dolwick S, Guindon GE (eds). Tobacco Control Country Profiles 2003, American Cancer Society, Atlanta, GA, 2003. 7 Tobacco is cultivated in the Philippines on over 40,000 hectares and in 27 provinces. Source: http://www.nta.da.gov.ph/moretobacco.html 8 Republic Act 9211, “Tobacco Regulation Act of 2003” 9 Ordinance No. 217 series of 1964, Ordinance No. 08 series of 1987, and Ordinance No. 3816 series of 1996. 10 Executive Order No.25 series of 2002 “An Order setting the Implementing Guidelines of Ordinance No. 043-02 series of 2002” amended by Executive Order No. 26 “An Order Revising Executive Order No.25 series of 2002” 11 Interview with Councillor Peter Lavina 12 Dimayuga A. “Straight Forward”. Mindanao Times, 4 June 2002. 13 Enobio OC. “Smoking Ban Offers Opportunities”. Sun Star Davao, 3 June 2002. 14 Maxey CR.”City Lawyers Support Anti-Smoking Drive”. Sun Star Davao, 6 June 2002. 15 [Anonymous].“Philip Morris breaks Silence on Smoking Ban”. The Mindanao Daily Mirror, 4 February 2003. 16 WEEKENDER - ENVIRONMENT - Going strong on anti-smoking. Business World. 2003 January 10, 2003. 17 Davao City Police Office Report 18 Interview with Mayor Rodrigo Duterte 19 Francisco CQ. “Davao businesses hit law banning smoking”. Business World. 2003 December 18, 2003 and “Davao's anti-smoking measure”. Business World. 2003 November 12, 2003. 20 Smokers’ Focus Group Discussion 21 Interview with Councillor Danilo Dayanghirang, 2008

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