Seanad Éireann - Volume 169 - 07 March, 2002
Public Health (Tobacco) Bill, 2001: Second Stage.
Question proposed: “That the Bill be now read a Second Time.”
Question put and agreed to.
Ms Hanafin Ms Hanafin
Minister of State at the Department of Health and Children (Ms Hanafin): The battle against tobacco is one of the most important public health challenges facing us in the new millennium and is one of the main priorities of the Minister for Health and Children. The Government at its meeting on 27 February 2001 approved the drafting of the Public Health (Tobacco) Bill, 2001, and agreed to give the Bill priority in the Government's legislative programme. The text of the Bill was approved for publication by Government on 31 July 2001 and published on 1 August 2001. This Bill is the most comprehensive anti-tobacco legislation ever published in this country and confirms the Government's commitment to the battle against the tobacco epidemic.
This Bill will bring together a number of legal instruments and will replace two existing Acts, the Tobacco Products (Control of Advertising, Sponsorship and Sales Promotion) Act, 1978, and the Tobacco (Health Promotion and Protection) Act, 1988, and incorporate certain provisions of the Government's policy, Towards a Tobacco Free Society. Strong legislative measures are an important public health instrument in countering the tobacco threat.
Public attitudes to tobacco use and, in particular, cigarette smoking remain the leading cause of preventable illness in the country. A survey I commissioned by the Office of Tobacco Control on attitudes to smoking and smoking prohibitions has shown there is considerable support among the public for measures to control tobacco consumption, to make smoking less attractive to young people and to help current smokers stop smoking. This support is broadly based, coming from non-smokers and smokers alike. The public mostly welcome restrictions on tobacco retailing and promotion of tobacco products.
Most smokers recognise the dangers of smoking, the increasing social unacceptability of smoking and wish to break their smoking addiction. The survey shows that the public generally and smokers specifically are looking to Government to take further action on smoking on all fronts.
We also need to provide greater protection for people against inhalation of toxic environmental tobacco smoke. Studies in the USA have shown that restricting smoking in public settings increases the likelihood that smokers in these settings smoke less or quit smoking entirely. The introduction of smoke free areas supports those who wish to quit and protects non-smokers.
In the early years of the last century when tobacco use, largely through smoking cigarettes, was  becoming widespread the product was seen as benign and recreational. Today, tobacco smoking represents the most extensively documented cause of disease ever investigated in the history of biomedical research. In the early 1950s major scientific studies first began to associate ill health and disease with the use of tobacco products. In 1964 the US surgeon general released a report, Smoking and Health, which concluded that cigarette smoking is causally related to lung cancer in men and to a lesser extent in women.
The dangers of smoking and its detrimental effect on human health have been clearly established in numerous scientific studies carried out by reputable medical and scientific bodies, including the World Health Organisation, particularly over the last 30 years. Evidence has accumulated year on year of the enormous worldwide threat to human health from consumption of tobacco products. Studies carried out internationally in recent years have also confirmed that there is a significant risk to the health of the non-smoker from inhaling environmental tobacco smoke referred to as passive smoking.
The adverse impact of tobacco consumption on public health is enormous. Smoking related illnesses account for about 7,000 deaths each year in Ireland and 500,000 deaths each year in the European Union. Tobacco can kill in many ways, including lung cancer and other forms of cancer, heart disease, strokes, emphysema, chronic bronchitis and other respiratory diseases. Smoking tobacco products is one of the most unhealthy things a human can do.
Life expectancy is lower in Ireland than the EU average and the diseases which contribute primarily to this are heart disease and cancer. Tobacco use is the leading preventable cause of these diseases. Smoking is a major causative factor in about 90% of the 2,000 deaths from lung cancer each year and increases the risk of other cancers such as of the mouth and throat. Smoking is also a primary cause of cardiovascular disease, the greatest single cause of mortality in Ireland. Tobacco is a significant burden to individuals, families and society through death, illness and medical costs. Reduction in tobacco use will increase life expectancy in Ireland and result in happier, healthier and better quality lives for many Irish people.
About 30% of the adult population are severely addicted to nicotine in tobacco products and the vast majority of smokers become addicted in their childhood and teenage years. Smokers who begin smoking in adolescence and continue to smoke regularly have a 50% chance of dying from a tobacco related illness. The death rate among smokers in middle age is three times that of non-smokers. These are appalling statistics.
The increasing levels of smoking among children and access by under age persons to cigarettes are a cause for concern. Children are easier to addict to tobacco products than adults and damage to children's health can be genetic and lifelong. Advertising of tobacco products and sponsorship of events by tobacco companies play  a significant role in inducing young persons to smoke and continue smoking. Children smoke the most heavily advertised brands of cigarettes.
The smoking of tobacco products also poses a real and significant threat to the health of the non-smoker. Almost 70% of the adult population are non-smokers, yet many are unwillingly exposed on a daily basis to toxic environmental tobacco smoke. Environmental tobacco smoke is causally associated with acute and chronic diseases in non-smokers. Being able to breathe clean air, free from harmful irritating tobacco smoke, is a serious issue for everyone.
Many public areas and facilities and some workplaces are subject to prohibitions and restrictions on smoking and there is a growing demand for increased protection from tobacco smoke. Optimal protection for non-smokers and smokers is best provided by smoke free areas. The Minister will use enabling powers under section 46 of the Bill to extend environmental controls on smoking to a range of public areas and facilities not already covered by existing legislation and regulation, including the workplace and pubs. An amendment was made to the Bill on Report Stage to include specific reference to licensed premises and the workplace.
Children are particularly at risk from passive smoking. As children grow, exposure to environmental tobacco smoke significantly reduces their lung capacity and exercise tolerance. Involuntary exposure of children to tobacco smoke has been identified as a cause of respiratory disease, middle ear disease and asthma attacks, and is a significant factor in sudden infant death syndrome, SIDS. Children are powerless to control their exposure to tobacco smoke, yet, because of their age, are most adversely affected by exposure to this toxic combination. We must ensure the children and young people of today, whether through being induced to smoke tobacco products or exposure to and inhalation of environmental tobacco smoke, do not become future victims of the tobacco industry.
The global tobacco industry, through its own extensive scientific research, knew for many decades of the dangerous and addictive nature of the product it manufactures, promotes and sells, yet it denied for decades that nicotine is addictive, that smoking and second-hand smoke cause disease and that tobacco advertising recruits children and keeps adults smoking. The tobacco industry used a wall of words to protect itself at the expense of public health. The public was not informed by the industry of the real facts about the dangers to health from tobacco consumption. It is only in recent years that public health authorities have come to fully understand the dreadful nature of nicotine addiction and the powerful marketing skills of the tobacco industry to induce people, particularly young persons, to smoke. Once young people become hooked the industry works hard to maintain that addiction.
Much information has come to light in the last decade about the unscrupulous behaviour of tob acco companies with regard to targeting young people with their products. Documentation disclosed from within the tobacco industry during litigation proceedings in the United States shows an industry doing everything it can to encourage smoking and establish and maintain tobacco brand loyalties, particularly with young smokers. The industry continued to market its products worldwide without regard to their harmful effect on human health. This same industry, while claiming publicly to want to work constructively with Governments in introducing tighter regulation of tobacco, has consistently striven to frustrate and undermine all such efforts. It seeks to thwart, not only national efforts to effectively address the tobacco problem, but also those pursued at regional and global level.
The cynical attitude of the tobacco industry to human life was revealed in an economic report on healthcare costs and smoking commissioned by Philip Morris in the Czech Republic and published in June 2001. The report concluded that as smokers die prematurely, this is beneficial by saving the state substantial amounts of money that would otherwise have been spent on healthcare and pensions. This spurious economic argument shows a complete disregard for basic human values. It is reprehensible that premature death, human suffering and ill health caused by smoking tobacco products should be discounted against long-term economic gains.
The Irish tobacco industry, with thousands of its Irish customers dying each year from consumption of its products, is reliant on recruiting new consumers to remain a viable industry. Young people are sensitive to perceived signals that smoking is the norm. These signals include visible public smoking, the availability of cigarettes to minors and widespread promotion and advertising of tobacco products. Logically, the industry needs access to young people to gain new smokers. We must deny it that access. The aims of the industry are contrary to public health policy.
Tobacco advertising and sponsorship are a powerful means of increasing tobacco consumption and attracting young smokers. Ireland was one of the first countries to introduce restrictions on tobacco advertising and sponsorship by the tobacco industry. Both the World Health Organisation and the World Bank recommend that countries prohibit all forms of tobacco advertising and sponsorship. A number of very positive steps have already been taken in this area.
Tobacco companies were spending up to £10 million annually in Ireland on advertising and sponsorship. The tobacco industry consistently used sponsorship of events to promote a harmful and socially destructive product. In July 2000, this expenditure was terminated by the Minister despite fierce opposition by the industry and we make absolutely no apologies for this. Banning advertising leads to a reduction in tobacco consumption and prevents new smokers from start ing. Bans on advertising have an impact on youth attitudes to smoking and directly further the Government's commitment to prevent young persons from taking up smoking.
Furthermore, the Minister approved the replacement of tobacco sponsorship of the Irish Masters snooker tournament with health sponsorship. This assured the continuance of this popular international event and replaced tobacco promotion with a healthy anti-smoking message. International research has shown that anti-smoking sponsorship of sports events is effective in sending a particular message to the public. The Minister will continue to ensure a clear, sustained, positive health message is sent to the population, particularly our young people.
The Minister has already taken a number of anti-tobacco initiatives in the area of health promotion using broad based public awareness campaigns with a special focus on young people. The following are some specific examples. The Break the Habit for Good campaign was launched in association with the Irish Cancer Society and the health boards. This campaign emphasises the positive effects which quitting smoking can have on the individual. The campaign, which involves national and local initiatives, offers support for those wishing to give up smoking. An advice kit was developed as a support for those who wanted to quit.
NICO was developed last year to target the growing number of young teenage girls who are smoking or starting to smoke. This anti-smoking campaign emphasises the negative effects smoking can have on physical appearance, that is, stained teeth and wrinkled skin. The storyline is there is nothing sexy about smoking. The media used are television, radio, outdoor and newspaper advertising. Television is a proven useful resource in accessing young people. Strategically located outdoor sites such as those adjacent to schools and colleges complement television and radio advertisements.
The best prospect for reducing the number of people, especially young people, smoking or preventing them from starting is a targeted approach. In this regard, initiatives such as the social, personal and health education programme are particularly important. Since September 2000 a SPHE programme has been offered at junior cycle level to post-primary schools nationwide through a partnership between my Department, regional health boards and the Department of Education and Science. The Minister is committed to ensuring this process is a success.
The out-of-school setting for delivering health messages to young people is important. The Department of Health and Children has also teamed with the Department of Education and Science and the National Youth Council of Ireland to provide a wide range of health promotion training for the youth sector, which will ensure the message is received by young people and that the message is the same as that mirrored elsewhere.
 Most smokers wish to break their addiction to nicotine based tobacco products. Additional help has also been made available to smokers to help them quit. Since 1 April 2001 the full range of nicotine replacement therapies, including patches, gum, sprays and tablets, is available free of charge to medical card holders on prescription by their general practitioner.
The tobacco epidemic can only be beaten with the commitment of society as a whole. Concerted and sustained effort is necessary to make progress. The Bill provides for strong legislative measures to tackle the tobacco epidemic on a number of fronts.
A comprehensive ban on tobacco advertising, including in-store advertising and displays, and all forms of sponsorship by the tobacco industry is provided for. Tobacco advertising is intended to increase consumption as well as brand share and has a powerful effect on young people. Advertising and related activities are major influences on children taking up smoking. The industry has known of this for many years and exploited rather than compensated for this childhood vulnerability.
Accordingly, the Bill proposes further restrictions on tobacco advertising, many of which are already in place under a statutory instrument with effect from 14 July 2000. However, the existing controls do not prohibit in-store or retail advertising, which will be prohibited under the Bill. This rebalancing of the rights of the public and the tobacco industry is necessary because the status quo ensures children will continue to take up smoking in increasing numbers and become addicted before reaching adulthood. The evidence is that the total prohibition of advertising is very effective, but that partial prohibitions do not give a pro rata return. The Bill will prohibit practices which we have witnessed since July 2000 whereby advertising of tobacco products was done in a manner to try to get around these statutory instruments rather than complying with them.
Registration of tobacco retailers and tougher penalties for those convicted of under age sales is provided for in the Bill. The approach to enforcement has been piecemeal. Compliance with existing laws, especially in respect of sales to minors, has been poor. Surveys have shown that many under age young people can purchase tobacco products over the counter from retailers without being asked for evidence of age. The evidence from other campaigns, for example, the drink driving campaign, is that strong enforcement combined with positive public messages is necessary to effect real change in public behaviour.
The Bill will provide for comprehensive powers of enforcement and introduce a range of penalties commensurate with the offences. The age limit for the sale of tobacco products to young persons was raised from 16 years to 18 years last year and the maximum fine for persons convicted of selling tobacco products to under age persons has been raised substantially on foot of the Health (Miscellaneous Provisions) Act, 2001. These measures are incorporated into the Bill and will  act as a further deterrent to retailers. The Bill also provides for the use of age cards, as defined under the Intoxicating Liquor Act, 1988, by purchasers of tobacco products to better enable retailers to establish the bona fides of purchasers.
The Department has already begun the process of increasing the number of health board environmental health officers who will enforce the tougher tobacco controls. An additional €1 million has been made available to health boards for this purpose. The Bill requires retail outlets that sell tobacco products to be registered. Such registration is recommended in the Government's policy document, Towards a Tobacco Free Society, and justified on public health grounds as it will facilitate inspection and compliance, as provided for in the proposed Bill.
There is provision for a ban on retail sales of packs of cigarettes of less than 20. Price is the single most effective means of protecting children against experimenting with cigarettes and becoming addicted. Increasing the minimum pack size that may be sold raises the price barrier for children. It is proposed to ban the sale of packets of cigarettes containing less than 20.
There will be tighter controls on the sale of tobacco products from vending machines, many of which are located in areas of licensed premises, often out of sight of staff, where there is no form of supervision, giving unrestricted access to cigarettes to under age persons. The Bill provides for much tighter control on all aspects of tobacco retailing, including vending machines. They will have to be located beside, on or behind the bar counter under the direct supervision of staff. Regulations will provide that the machine, which will have a locking device, will be activated for sale by a unique coin or token available only from staff on the premises. The need for much tighter controls on these machines has been made clear to the cigarette machine operators.
Provision is made for a ban on the sale of confectioneries, normally intended for children, which resemble a tobacco product. The sale of this type of confectionery is a particularly odious practice and helps builds an unhealthy relationship and familiarity between children and tobacco products. Children who use candy cigarettes are more likely to become smokers. This type of candy will be prohibited, as well as similar types of confectionery products.
Public disclosure of all aspects of tobacco, including toxicity and addiction, is provided for in the Bill. The Bill provides the proposed Tobacco Control Agency with powers to obtain information from manufacturers relating to the composition or properties of tobacco products and to test tobacco products. The agency may, subject to certain requirements, publish this information. Tobacco contains many chemicals which are cancer causing and gases such as carbon monoxide which cause heart disease. As and from now, there will be public disclosure on all aspects of tobacco.
Improved protection against passive smoking is provided for in the Bill. Tobacco smoke is the  biggest single source of indoor air pollution. As I stated, it is a real and substantial health hazard to infants, children and persons with heart or lung disease. Tobacco smoke contains as many as 4,000 chemicals, many of which are harmful to health and at least 60 of which cause cancer in humans.
It is well known that there is a risk to health from exposure to environmental tobacco smoke. We know this from the WHO air quality guidelines for Europe. Over the past two decades we have acquired sufficient international scientific evidence to show that this is the case. As I stated, the Minister will use his enabling powers to extend environmental controls on smoking to a range of public areas and facilities.
The Bill allows for the establishment of the Office of Tobacco Control which will monitor, co-ordinate and, in certain circumstances, enforce and report on the new tobacco policy initiative. The office will drive the implementation of many of the Bill's provisions and also co-operate with all relevant agencies in working towards a tobacco free society. The office has already been established on an administrative basis and is located on a temporary basis in Clane, County Kildare. Its work will be complemented by the Tobacco Free Council, to be serviced by the office, which will have a much broader representation than the board of the office and representatives will be drawn from a wide range of necessary disciplines.
Public health authorities in many countries have grappled with the problem of how to prevent people from taking up smoking and how to get smokers to break their addiction once established. There is no single solution to dealing with the tobacco epidemic. In the early 1970s the incidence of smoking here was about 43%. Successive Administrations, by a combination of measures, including legislation, regulation and health promotion, were able to reduce this to today's level of just over 30%. Our success in improving the health status of the nation is linked to reducing further the level of tobacco usage and, in particular, preventing young persons from starting to smoke. If the incidence of tobacco use by young persons can be reduced, we can make considerable progress towards a tobacco free society.
Legislation alone, no matter how comprehensive, cannot create and sustain the environment necessary to prevent people from starting to smoke and assist those who have already started to stop. Our anti-tobacco strategy will be multifaceted, containing strong legislative controls, effective enforcement powers and resources. However, it will also have a well-resourced health promotion dimension, a fiscal element and the supports required by smokers to kick the habit. The implementation of this comprehensive strategy will, in time, effect the necessary attitudinal changes in society to tobacco consumption and, then, the necessary behavioural changes. We owe it to ourselves, the younger and future generations to  ensure the war against tobacco is won. It gives me great pleasure to commend the Public Health (Tobacco) Bill, 2001, to the House.
Seanad Éireann 169 Public Health (Tobacco) Bill, 2001: Second Stage.