Reducing the harm of shisha and the need for better regulation

Shisha smoking is a legal activity enjoyed by people in the UK, and involves smoking a heated, specially prepared tobacco through a pipe. Its popularity has increased in recent years, and it is now seen as a mainstream activity, albeit it is more closely linked with Middle Eastern, North African, and South Asian communities.  

The UK shisha industry is considerable and diverse, with many facets covering a wide range of services such as shisha delivery, click-and-collect shisha, electronic shisha and shisha for smoking in a wide variety of settings – cafes, restaurants, licensable entertainment venues and family orientated venues. The sole purpose of the industry is to provide smoking services and materials for its customers.  

There is no available national strategy, policy or guidance for businesses or regulators alike on this increasing shisha economy. Councils are concerned about the health impacts shisha smoking can have. They are also finding that such businesses can have a significant impact on local communities and have been known to breach existing legislation and contribute to anti-social behaviour in local areas.  

Shisha smoking is a complex issue about which our learning continues, but the mounting evidence for greater regulation and guidance can no longer be ignored. Current legislation does not provide councils with the tools they require to regulate shisha premises, and challenges associated with badly run premises can negatively impact local communities. There is also evidence of the disproportionate harm these venues can have on minority and deprived communities who already suffer from health inequalities. Action is now needed to address this. 

This paper sets out the various health and community issues caused by shisha smoking, including case studies from councils across England. It proposes steps that central government can take to strengthen and reform national legislation through introducing a shisha licensing regime either through the Local Government Miscellaneous Provisions Act 1982 or the Licensing Act 2003.  

Although tobacco generally is not licensed, there are not smoking lounges for other types of tobacco, and we believe it is reasonable to licence shisha because it is a venue specifically designed for consumption of a high risk product which can impact on health which merits close oversight. It does not seem right that a venue requires a licence to serve a hot drink after 11pm but does not require one for smoking shisha. Moreover, licensing shisha would send a stronger health message in itself. 

Local authorities have been attempting to manage and regulate shisha premises within existing powers, but these are not sufficient.  A cohesive, national approach to shisha smoking would save on resources for local and central government, make businesses aware of their responsibilities, as well as helping our communities to make better informed choices about smoking shisha. 

This paper has been supported by councils up and down the country, and we are particularly grateful to Birmingham City Council, Ealing London Borough Council, Newham London Borough Council, Brent London Borough Council and Luton Borough Council who have inputted into this paper alongside the LGA and firmly support calls for better regulation of shisha premises.  

Cllr Heather Kidd, Chair, LGA Safer and Stronger Communities Board  

Cllr David Fothergill, Chair, LGA Community Wellbeing Board  

This local government policy paper is solely concentrating on those aspects of the shisha industry that cause adverse health, safety and environmental impacts on local communities. These are impacts which councils and partners are unable to resolve through current legislative or other means available to them.  

Why is shisha smoking a problem? 

First and foremost, shisha smoking is harmful to health but the risks associated with shisha are not widely known or publicised. Whilst there is limited research on the impact of shisha smoking, emerging evidence suggests it has a range of adverse health impacts, including heart and circulatory diseases, cancers, nicotine addiction, carbon monoxide poisoning, bacterial infections and high blood pressure. Despite this, shisha is seen as a ‘safe’ alternative to cigarette smoking and continually falls outside of tobacco control harm reduction strategies and campaigns. This means there is a lack of trusted health information available for shisha smokers. 

In addition to the health impacts of the activity itself, councils report that, in some instances, shisha bars negatively affect the local community, for example noise nuisance from amplified music or late-night disturbance. Regulatory officers report frequent breaches of planning regulations, as well as fire risk and anti-social behaviour, leading to enforcement issues for councils, fire authorities and police services. There are also concerns about illicit tobacco (non-duty paid) being found at shisha premises. 

What are councils doing? 

Councils have statutory duties to safeguard communities from harms. With responsibility for public health having transferred to councils on 1 April 2013, councils have greater scope to take account of health in our service provision and decision making.  

However, there is no sole legislative provision or specific regulator which covers shisha activities. Councils enforce good management of shisha bars as best they can through the range of different legislative provisions, for instance environmental health and fire safety inspections, enforcement action on shisha premises in breach of smoke free regulations or planning permission, and serving community protection notices for anti-social behaviour. These measures often require a multi-agency approach which relies on resources being available from each regulatory authority to react and coordinate a response. This can mean that such preventative work is limited. Moreover, clarity of ownership and management of a business is not often forthcoming, which frustrates procedures to remedy issues. 

Why is the current regulatory framework insufficient? 

There are several pieces of legislation relevant to shisha smoking, but these currently fail to provide councils with the necessary tools to deal with shisha premises. These issues are detailed later in the report, but cover applications of the Health Act, Tobacco and Related Products Regulations, Health and Safety at Work, and Trading Standards. Shisha falls through the gaps in each of these areas, either because penalties and prosecutions are not acting as enough of a deterrent, or because regulations which apply to cigarettes and hand-rolling tobacco are not equally applied to shisha, despite the parallel risks of shisha smoking.  

There are particularly concerning loopholes, for example, around the lack of application of flavoured tobacco legislation to shisha, which makes it seem more appealing and less dangerous. Labelling regulations, including health warnings which are now mandatory on cigarette packaging, are also aimed at retail rather than shisha served in cafes, where pipes, mouthpieces and menus do not warn consumers of shisha’s serious health impacts.  

What is needed from central government? 

We have two asks of government. Firstly, we believe that shisha should be brought within the scope of the UK Tobacco Control Strategy. This would be a crucial addition to the strategy owing to the serious health consequences and community impacts of shisha detailed in this paper. It is welcome that ‘The Khan Review: Making smoking obsolete’ makes some reference to shisha. However, a greater focus on the harms caused by shisha in the UK Tobacco Control Strategy would demonstrate government’s commitment to protecting public health and promoting responsible management of shisha premises. Moreover, there has been welcome action taken by Government recently to deliver a smokefree 2030, including legislating to raise the age of sale one year every year from 2027 onwards, doubling the funding for local authority Stop Smoking Services from 2024, increasing funding for awareness raising campaigns and for enforcement on illicit tobacco and e-cigarettes. The lack of specific provisions on shisha are a notable omission, and it is important that Government considers shisha within this work, as well as commissions additional research on the health risks of shisha. This will also help to ensure that the health impacts of shisha are more widely understood by society. 

Secondly, we believe that the Government should introduce a licensing regime to better regulate shisha premises. This could be achieved by amending the Local Government (Miscellaneous Provisions) Act 1982 or the Licensing Act 2003. This would give councils the powers to grant or refuse licences for new shisha premises, to add conditions to licences to improve safety or mitigate potential community impacts (such as noise nuisance), and the power to revoke or suspend licences in the event of non-compliance.  

Although tobacco generally is not licensed, we believe it is reasonable to licence shisha premises because it is a venue specifically designed for consumption of a risky product which merits close oversight.  

What is shisha? 

Smoking shisha (or hookah) involves burning wood, coal or charcoal to heat tobacco (or flavoured tobacco, ‘maassel’). This produces smoke, which bubbles through a bowl of water or other liquid, into a tube or pipe, and is inhaled through a mouthpiece.  

How prevalent is shisha smoking? 

Shisha smoking is a popular activity in Middle Eastern, North African and South Asian communities. It is increasingly common in England, especially in young people from all ethnic minority backgrounds. 

Shisha is offered commercially at a number of ‘shisha premises’ across the country, often smoked in dedicated shisha lounges or bars, or in restaurants after a meal. These premises are increasingly visible, with smoking often taking place outside premises on the street, sometimes late into the night. We recognise that some communities go to shisha premises because they are social spaces, often free from the presence of alcohol. Whilst we are deeply concerned about the health impacts of smoking, we do not want to ban these premises, but rather see them better regulated.  

In recent years there has been a sharp increase in the number of people shisha smoking and in the number of shisha bars. Between 2007-2012, shisha smoking rose by 210 per cent and there was a 510 per cent increase in shisha cafes between 2010-2018. Studies from different parts of London show 40 per cent of secondary aged children have smoked shisha, more than twice the number who have tried cigarettes (19 per cent). 

Health impacts 

There is a misconception that because shisha smoke is inhaled through a waterpipe, it is ‘safer’ than traditional cigarette smoking. This is not the case, and evidence shows shisha is not a safe alternative to cigarette smoking. Shisha smokers are at risk of the same kind of diseases caused by cigarette smoking, including cancer, heart disease and respiratory disease, as well as adverse effects during pregnancy. Some users do not see the activity as smoking at all and therefore make no correlation with any tobacco smoking harm reduction messages available, or as most messages surrounding smoking are related to cigarettes then the connection is not made. 

These harmful impacts are recognised by organisations such as NHS England, Action on Smoking and Health (ASH), and the British Heart Foundation. The Khan review also raised concerns about the harmful impact of shisha and recommended that additional data and research is collected to inform future interventions. 

In addition to its direct health impacts, shisha smoking and shisha premises can contribute to a number of amenity and quality of life issues, in turn impacting on the health and wellbeing of our communities. Key issues include: 

Fire safety is a significant concern with regard to shisha premises, and in recent years there has been some serious fires associated with shisha premises. Moreover, inspections and enforcement against premises can sometimes reveal numerous hazards– including a lack of smoke and carbon monoxide detectors, obstructions caused by shisha pipes and seating, and unsafe indoor/ partially covered premises. In addition to this, an estimated 12,288 tonnes of carbon dioxide are emitted from shisha bars each year, contributing to poor air quality, particularly in already polluted urban centres. 

Noise pollution is also significant problem in cities where shisha premises are increasing in number, such as London, Manchester and Birmingham. There were 597 noise complaints registered against shisha bars between 2010-2018. Excessive noise can have serious impacts on the health of the residents, impact wellbeing and reduce quality of life.  

The premises first came to the attention of Newham in 2011, when a visit was made by officers and a shelter (more than 50 per cent indoors) was under construction. Advice was given to the owner about the requirements of smoke-free legislation. Despite this advice, the structure was completed and the business operated illegally throughout early 2012. The owner was prosecuted.  

The premises changed hands in October 2012 and continued to operate illegally. The new owner was prosecuted in September 2013 under the same offences. Despite stating his willingness to work with the council to ensure compliance, he continued to operate illegally throughout 2013 and 2014.   

In October 2014, Newham carried out works under planning legislation to physically remove the smoking shelter at the rear of the premises; despite this, the council received further reports of smoking at the premises in 2015 and 2016. With the assistance of the police and a locksmith, another inspection was carried out. This revealed that the owner had rebuilt the smoking shelter to the same dimensions and specification as the shelter demolished by the council. 

This continuous, resource-intensive process demonstrates the limitations of enforcement under both smoke free and planning legislation. Fines are so low that they are no deterrent to shisha operators, who absorb them as a business cost. 

Since January 2014, all herbal smoking products such as those used for shisha smoking are liable for excise duty. Previously only tobacco products were liable.  

An All Party Parliamentary Group (APPG) on Smoking and Health held an inquiry into the illicit trade in tobacco products in 2013, recognising that a significant proportion of shisha in the UK appears to be illicit: imported illegally, with no duties paid. It is estimated that in the UK, illicit tobacco costs the taxpayer £2 billion a year and has links with low-level and large-scale organised crime. 

Aside from illicit shisha, there have been some incidences of violence and exploitation linked to poorly run or illegal shisha premises. This is by no means indicative of those shisha premises operating lawfully but, like any venue breaching regulations in one way, the lack of local authority powers to deal with unsafe, problematic venues means a comorbidity of issues are more likely to arise.     

The Public Safety Team (PST) at Leicester City Council has noted regular non-compliance over the last decade within this growing business sector within Leicester. This reflects a national trend of shisha cafes becoming more mainstream. In Leicester, formal action has resulted in ten prosecutions since 2008, with fines imposed by Magistrates generally having increased over the years to £3450, as well as £1500 in costs. 

Operation Falcon 2019 

During February and April 2019, the Public Safety Team visited shisha cafes in Leicester as part of a joint project called ‘Operation Falcon’ with Her Majesty’s Revenue and Customs (HMRC) Officers and Leicestershire Police. The national HMRC Officers were visiting to ensure that the shisha tobacco being sold had UK duty paid. The local HMRC Officers were examining whether fraud was taking place in the businesses. The police were present to prevent any breaches of the peace. 

Shisha tobacco was being sold without UK Duty paid in nine of the thirteen premises. As a result, the HMRC officers seized approximately 170kg, equating to approximately £21,250 pounds of duty not being paid. 

Enforcement

Existing legislation is not currently strong enough to effectively tackle issues with poorly managed shisha premises. To properly tackle the growing public health issue of shisha smoking, and ensure premises are run in a safe, fair, compliant way, action is required from central government to reform and strengthen several pieces of legislation. These are summarised in the below. 

Even if all of the amendments suggested above are made to existing legislative frameworks, many councils with significant numbers of shisha premises do not believe that will be sufficient. We are therefore calling for a licensing regime to be established to better regulate shisha premises. The aims of a licensing regime for shisha would be: 

The Public Sector Equality Duty (Section 149 of the Equality Act) requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people carrying out their activities. 

The Equality Duty supports good decision making – it encourages public bodies to be more efficient and effective by understanding how different people will be affected by their activities, so that their policies and services are appropriate and accessible to all and meet different people’s needs.   

Potential Impact