Dáil Éireann debate -
Tuesday, 7 Mar 2000

Vol. 515 No. 6

Private Members' Business. - Tobacco (Health Promotion and Protection) (Amendment) Bill, 1999: Second Stage.

Mr. Shatter

I move: "That the Bill be now read a Second Time."

I wish to share my time with Deputies Neville, Ahearn and Ring. Tomorrow, 8 March, is not only Ash Wednesday but is also national "no smoking" day. It is, accordingly, appropriate that legislation published by me together with my colleague Deputy Stanton, on behalf of Fine Gael – the Tobacco (Health Promotion and Protection) (Amendment) Bill, 1999 – comes before this House this evening and will be voted on tomorrow night. I hope this Bill will be supported unanimously by all sides in the House and that it will not be opposed by the Government or the Independent Deputies on whom the Government's survival depends.

It is estimated that 20% of all deaths annually in the Republic are attributable to tobacco-related illnesses. That means tobacco kills between 6,000 and 7,000 people each year. Six times more people die prematurely each year as a result of smoking cigarettes than from car and other accidents, alcohol abuse, abuse of illegal drugs, murders, suicides, fires, hepatitis C and AIDS combined. In addition, many thousands more suffer from chronic debilitating diseases as a result of smoking.

Smoking is the single biggest cause of preventable death in Ireland. It is a major cause of cancer, cardiovascular disease, strokes, respiratory illness, peptic ulcer disease, emphysema and accelerated bone density loss in women. Some 1,500 people die here annually from lung cancer. Smoking is a major causative factor in 95% of lung cancer deaths.

Smoking during pregnancy can impact on foetal growth and is associated with adverse pregnancy outcomes, including increased incidences of low birth weight. Higher infant mortality occurs in mothers who smoke compared with those who do not. The incidences of asthma is higher among children whose parents smoke. It is estimated that a child ingests the equivalent of a 100 to 150 cigarettes a year just by being with a parent who smokes.

Research has established that the mean survival of smokers is ten years shorter than non smokers. The earlier a person starts smoking, due to the addictive nature of nicotine, the more likely it is he or she will become a heavy smoker and will suffer a greater risk of diseases caused by smoking. Approximately one out of every three young people who become regular smokers die prematurely as a result of smoking.

Research has established that 80% of adult smokers who are addicted to nicotine commenced smoking under 18 years of age. The Department of Health's strategy for effective health care in the 1990s, Shaping a Healthier Future, published in 1994, set a target to reduce the percentage of those who smoke to less than 20% of the overall population by the year 2000. In the course of work undertaken by me as rapporteur to the Oireachtas Joint Committee on Health and Children, in preparing A Report on Health and Smoking: A National Anti-Smoking Strategy, it became clear there was no possibility whatsoever of the State achieving this objective.

While during the 1980s the number of smokers in the State reduced to the extent that 28% of people aged 15 and over smoked cigarettes, two baseline surveys of health related behaviour among adults and school children carried out in 1998 established that the decrease in the overall number of cigarette smokers had been reversed and that there had been a substantial acceleration in the growth of female smokers.

The SLAN survey reported that 31% of the adult population smoke, with slightly more males – 32% – than females – 31% – being reported as smokers. More alarmingly, in the 18 to 34 age group, 39% of the respondents in the survey smoked; 38% being men and 40% women. The HBSC survey of children between the ages of 9 to 17 years established that in 1998 21% of all children across that age group were smokers and that overall 34% of children in the 15 to 17 age group are current smokers. In that age group just under 31% of boys are smoking compared to 36% of girls. It is clear that if the present trend in youth smoking continues, the number of overall smokers in the population will continue to increase and within a relatively short period, the number of adult female smokers will substantially exceed male smokers.

The report of the Oireachtas Joint Committee on Health and Children prepared by me as rapporteur, was unanimously endorsed by all members of the committee last November. This report concluded that the number of smokers in the State is escalating due to the substantial increase in youth smoking. The report labelled cigarette smoking as a paediatric disease. It is interesting to note that at his press conference today the Minister for Health and Children referred to smoking as a childhood addiction.

The November 1999 report proposed that a national anti-smoking strategy be adopted by Government, stating that:

It should be a central objective of health policy not merely to effect a global targeted reduction in the prevalence of smoking and tobacco consumption in the State, but also to entirely eliminate cigarette smoking and the use of other tobacco products by minors – persons under 18 years of age. Most people who suffer the adverse health consequences of using cigarettes begin their use before attaining 18 years of age. Only by preventing children and adolescents from starting to smoke can we succeed in substantially reducing the overall numbers of smokers in the State within a reasonable time frame.

The committee proposed a new national health objective:

That smoking by all persons under 18 years be entirely eliminated by 2005 and that by that date adult smokers be reduced to below 15% of those aged 18 years and over.

It should be a central objective of our national health policy to eliminate youth smoking. Elimination of youth smoking cannot be achieved by one single initiative. As the November 1999 report states:

A comprehensive multi-faceted approach with a mixture of strategies is required to put in place an effective tobacco control and elimination programme.

While it is an important measure, this Bill is merely one of the many initiatives required if we are to truly and properly confront the problem of youth smoking. I will now to turn to the provisions of the Bill and will then refer briefly to a variety of other initiatives required to eliminate youth smoking. I also want to put the Bill's proposals in context.

As part of its recommendations for a new legislative framework relating to cigarettes and tobacco, the November 1999 report proposed that the current prohibition on the sale of cigarettes to under 16s should be replaced by a prohibition on the sale of cigarettes and other tobacco products to persons under 18 years of age. It also stated that it should be an offence to have cigarette vending machines in any premises into which any person under 18 years of age is permitted to enter or be present.

The report recommended a number of other related changes in our law, of direct relevance to youth smoking, all of which are contained in the Bill before the House. Section 2 renders it an offence to sell cigarettes or other tobacco products to any person under the age of 18 years "whether for his or her own use or otherwise" or "to sell cigarettes to any person acting on behalf of a person under the age of 18 years". This section also renders it an offence to keep a cigarette vending machine "in any premises frequented by a person or persons under the age of 18 years".

As a consequence of these provisions, the age bar on the sale of cigarettes to children would be increased from 16 to 18 years. Moreover, the current fine of £500 which can be imposed for under-age sales of cigarettes is increased to £2,500. A person convicted of a second or further offence of the under-age sale of cigarettes is, under the terms of Bill, liable to a fine of up to £5,000 and/or a term of imprisonment not exceeding six months or, as an alternative, can be directed by the courts to undertake community service.

Surveys undertaken in recent years have established that a substantial number of retailers are ignoring the current prohibition on the sale of cigarettes to children under 16. The increased penalties which can be imposed on under-age sales by virtue of this Bill should ensure proper compliance with the law, provided of course that application of the law is properly supervised and enforced.

As recommended in the November 1999 report, the Bill contains new provisions relating to age verification. The shopkeeper prosecuted for selling cigarettes to a person under age may establish in his or her defence that "the person to whom the tobacco products were sold had upon request furnished to him or her" a specified age verification document, confirming the purchaser to be 18 years of age or older. For such a defence to work, the court must be satisfied that it was "reasonable to regard the documentation concerned as authentic and as applicable to the person to whom the tobacco products were sold". Similar provisions are in force in a number of states in the United States which have been effective in substantially reducing under age sales and ensuring that cigarette retailers are conscious of their legal obligation not to sell cigarettes to under age purchasers.

Section 3 requires retail outlets which sell cigarettes, at the point of sale, to exhibit in a prominent position notices warning of, "(a) the addictive and health dangers posed by cigarettes" and "(b) the age restriction on sale and the vendors obligation to ask for age verification". This provision also implements recommendations contained in the November 1999 report. It also replicates measures implemented in other countries seeking to confront the problems posed by youth smoking. By giving notice of the retailer's obligation to seek age verification, cigarette purchasers are warned that such verification may be sought and, when seeking it, retailers can point to the obligation the law imposes on them.

In accordance with the recommendation contained in the November 1999 report, a retailer who fails to exhibit the required notices is liable to criminal prosecution and to the imposition of the same penalties as can be imposed on a retailer who engages in under age sales. The Bill provides for regulations to enable the Minister for Health to specify the documentation that a shop retailer may rely upon for age verification and the nature of the notices which are to be exhibited in cigarette retail outlets. Under section 5 of the Bill, every regulation made under it must be laid in the usual way before each House of the Oireachtas.

Section 6 of the Bill provides for summary proceedings to be taken in relation to any offences committed under it. Provision is also made for prosecutions to be brought by either the Garda or a health board officer, such as an environmental health officer. Section 7 provides for the repeal of section 3 of the 1988 Act, which renders it unlawful to sell cigarettes to persons under 16 years. Section 8 provides for the Bill to come into force one calendar month after its passing and section 9 contains the usual provisions concerning the short title and collective citation.

The Minister for Health today launched a report commissioned by his predecessor, Towards a Tobacco Free Society. Many of the proposals relating to youth smoking contained in this report are similar to those contained in the November 1999 report. The measures contained in the Bill which is tonight before this House, if enacted, would effectively put in place the prohibition on the sale of cigarettes to under 18s and the controls on cigarette vending machines proposed in the report launched by the Minister today.

I emphasise that this Bill will not of itself solve the problems of youth smoking. It is merely one of the many initiatives required if we are truly to tackle the enormous health problems created by smoking within our society. If we are not merely to reduce but eventually to eliminate youth smoking a broad range of other initiatives is required. These are detailed in the November 1999 report which I also would include in the context of young people: targeted child smoking prevention and cessation programmes; the empowerment of and activation of a national anti-smoking, anti-tobacco youth organisation such as the one currently in existence in Florida State in the United States; explicit anti-smoking television, cinema and press advertising campaigns; a ban on all tobacco advertising, sponsorship and patronage; the free provision of nicotine replacement products to those who require them; provision for the imposition of a levy on tobacco companies whose cigarette brand or brands increase under age market share; the elimination of smoking in public places such as pubs and restaurants to protect children and adults from the health risks of passive smoking; annual increases in tobacco taxes in excess of cost of living increases; and active enforcement of smoking prohibitions and controls.

It is welcome that in response to the provisions contained in the November 1999 report the Minister for Finance increased cigarette taxes by 50p for a packet of 20. It has been established that young people are price sensitive and that the more expensive cigarettes become the lesser the number of young people who commence smoking. This was also acknowledged by the Minister today. It is, however, disappointing that the Minister did not today commit the Government to an increase in tobacco taxes annually of 5% in excess of the rate of inflation as proposed in the November 1999 report and as called for today by the National Youth Council.

It is a disgrace that during the tenure of the present Government there has been no effective multi-media anti-smoking campaign to discourage children and adolescents from taking up the habit. The Government will this year receive £1 billion in tobacco taxes, £130 million of which alone derive from the 50p on a pack of 20 increase announced in the last budget. In 1999 the tobacco companies in Ireland alone spent in excess of £7 million on tobacco advertising and sponsorship. In 1999, a mere £250,000 was given to the health promotion unit of the Department of Health for its anti-smoking campaign. I am calling on the Government to allocate immediately the funds required to launch, in the first half of this year, an effective anti-smoking television and cinema campaign similar to the campaign so successfully launched in Florida State in 1998. It is disappointing that the Minister has today made no commitment to such a campaign.

Many millions of pounds are spent internationally by tobacco companies on cigarette promotion. Such international expenditure also substantially influences young people in Ireland. For example, tobacco sponsorship of Grand Prix racing is designed to glamorise cigarettes and the cigarette smoker and to disguise the fact that cigarettes are the only consumable product sold by manufacturers in the knowledge that they will ultimately kill many of their customers. I am calling on the Government to require RTE when broadcasting Grand Prix racing and other sporting events sponsored by cigarette companies to carry, for free, appropriate anti-smoking advertising targeted at young people. It is disappointing that the Minister failed to announce today that the Government intends to impose any such obligation on RTE, despite the fact that the Joint Oireachtas Committee on Health and Children called for one.

I welcome the fact that the work of the joint Oireachtas committee stimulated the Government into finally attempting to formulate an anti-smoking strategy. I welcome the fact that the report I spent six months compiling for that committee has finally galvanised the Government at least to consider what action should be taken by it. While I welcome publication of today's report in so far as it reflects recommendations contained in the November 1999 report, it is regrettable that the Minister has totally failed to bite the bullet on a number of crucial issues which must be addressed if we are to have a truly tobacco free society. The November 1999 report recommended that smoking be banned in restaurants and public houses. The Minister's report published today acknowledges that there is now "irrefutable evidence that environmental tobacco smoke is a real and substantial threat to health". In advocating a change of attitude to smoking the Minister's report laments that "the efficacy of our existing measures is compromised by social ambivalence towards tobacco use". Regrettably, the Minister appears today to have continued to endorse such ambivalence. Much of today's youth culture is centred around public houses and the joint committee acknowledge the reality that children between the ages of 15-18 frequently socialise in public houses, as do a large number of young people between the ages of 18-34, 39% of whom we know smoke.

The joint committee also expressed concern about the health impact of environmental tobacco smoke, or passive smoking, not only on children but also on adults in both public houses and restaurants. It categorically stated that smoking should be banned in both public houses and res taurants. The Minister should explain to the House why he has failed to implement this important recommendation endorsed unanimously by the Joint Committee on Health and Children. Is he afraid to take on the political interests which need to be taken on to ensure such a ban can be imposed and properly implemented, as has occurred in other parts of the world?

The November 1999 report set an identifiable objective of eliminating youth smoking by 2005 and reducing adult smoking to less than 15% of the population. It is also disappointing that the Minister's report published today sets no such clear objective nor does it expressly endorse the proposal of the joint committee to provide integrated, comprehensive primary and secondary school anti-smoking programmes that go well beyond the current programmes in existence. While the Minister promises the nicotine replacement therapy will be made available free of charge it is not clear when this will occur, when it will be made available or to whom. It seems from today's report it will be made available only to a limited number of people participating in smoking cessation programmes and will be subject to unspecified conditions. The Minister should immediately make tobacco replacement therapy products available freely to all of those entitled to free medical care under the general medical scheme and extend the drug payment scheme to such products.

The Minister in response to our bringing forward this Bill announced at a press conference today various plans the Government proposes to implement to confront the enormous health problems posed by smoking. The Bill before the House is a litmus test of the Government's true commitment to take genuine action to tackle this problem. I believe the Government should this afternoon have gone further in the commitments made by it, but many will still welcome the fact that after almost three years in office it at last appears to have a policy framework which it proposes to implement. If the Government tomorrow night votes down this Bill, its credibility on this major issue will be seriously damaged and the press conference held by the Minister today will be seen to be nothing more than a crass political public relations exercise.

I hope when the Minister responds he will indicate to the House that the Government will not oppose this measure, that it will be supportive of it, and that the completion of Second Stage of the Bill this week will facilitate the measure speedily going to Committee Stage to facilitate its enactment into law before the Easter vacation.

Mr. Neville

I commend Deputy Shatter for bringing the Bill before the House. It is timely, as the Minister recognised in choosing today to announce his policy in this area. I also commend Deputy Shatter, as should the House, for the work he has done in the Joint Committee on Health and Children on bringing forward the report and in doing pioneering work in an Irish context in looking at this important health problem. The National Youth Council's report on cigarette smoking among young people has policy proposals for action and is an excellent document. Much of the information to which I will refer is drawn from it.

After countless campaigns over the years and the expenditure of millions of pounds by the State, proportionately more young people smoke, than adults. We all know that smoking kills and causes cancer and that smokers die younger. We have been listening to that for decades and those statements are on cigarette packets; they could not be much clearer. However, in spite of health warnings and the awareness that cigarettes are bad for people, young people continue to take up smoking. I welcome Deputy Shatter's work in this area.

One third, or 33%, of those between the ages of 15 and 17 smoke regularly, in comparison with 31% of adults who are regular smokers, so more young people between the ages of 15 and 17 smoke than adults. Also, 80% of all smokers become addicted between the ages of 14 and 16 years, while more than 80% of those under 16 who attempted to buy cigarettes were successful in doing so, according to research, though it is illegal to sell cigarettes to people under 16. In addition, 50% of today's young smokers will die prematurely from smoking-related disease. It is estimated that a child ingests the equivalent of 100 to 150 cigarettes per year from a parent who smokes. Regular smoking by young people can result in chronic low grade respiratory symptoms such as coughs, bronchitis and asthma. This can result in absenteeism from school and can affect performance in sport. The Department of Health strategy, "Shaping a Healthy Future", which was published in 1994 targeted reducing the numbers smoking by at least one percentage point per year. That target has not been reached.

It is not by chance that tobacco is one of the most accepted and popular drugs in Ireland. The normalisation and social sanctioning of tobacco has allowed it to become a common part of the daily lives of young people. Despite its normality and prevalence, there are health implications associated with the use of tobacco that are only now being addressed on an individual and societal basis. Given that health in its broadest sense encompasses social, economic, mental and spiritual aspects as well as physical wellbeing, these implications are far-reaching. Smoking among young people is particularly worrying given that it is at that age that lifetime habits are set. Last year Deputy Shatter said the early initiation age of smokers, the addictive nature of smoking and the health risks of nicotine resulted in the FDA concluding that smoking is a paediatric disease.

Tobacco is the only legal product in the world which, when consumed as intended, will kill half of those who use it. Given that scenario, it is no surprise that smoking is the single biggest cause of preventable death in Ireland; 80% of all smokers become addicted between the ages of 14 and 16 and the earlier a person starts smoking, due to the addictive nature of nicotine, the more likely he or she will become a smoker and suffer a greater risk of disease from smoking. Half of today's young smokers will die prematurely. Eight types of cancer are recognised as being caused by smoking, with lung cancer almost entirely caused by smoking. The other forms are cancer are those of the upper respiratory system, bladder, oesophagus, pancreas, stomach, kidney and leukaemia. Other potentially fatal diseases that are judged as being caused by smoking are respiratory diseases, chronic obstructive airways disease, pneumonia, stroke and heart disease, the most common cause of death in economically developed countries. In Ireland, smoking is a causative factor in 95% of lung cancer deaths, 25% of deaths from heart disease and approximately 75% of deaths from bronchitis and emphysema. Smoking is also a risk factor in non-fatal diseases such as peripheral vascular disease, cataracts, hip fractures, periodical disease and accelerated rates of post-menopausal bone density loss in women. These diseases cause appreciable disability, cost and inconvenience to the sufferers. As Deputy Shatter said, smoking during pregnancy can impact on foetal growth and is associated with adverse pregnancy outcomes such as spontaneous abortion, limb reduction defects, stillbirths and increased incidence of low birth rate Approximately one hospital bed in ten in Ireland is taken by a patient with a smoking-related disease. Surveys of GP practices show that cigarette smokers attend more frequently than non-smokers. Smokers also have more acute and chronic illnesses, more restricted activity and more absenteeism from work. Research has established that the mean survival of smokers is ten years shorter than non-smokers. Involuntary inhalation of others' smoke is also a deadly risk, as it exposes the non-smoker to the same detrimental health impacts as are suffered by smokers. Non-smokers exposed over long periods to passive smoking have at least a 35% increase in lung cancer rates and are at increased risk of cardio-respiratory symptoms.

Children are particularly affected by passive smoking. Recent research shows that parental smoking increases the risk of sudden infant death syndrome. Every day young people are forced to breath environmental tobacco smoke, most often at home, with their childminder or in a car. It is estimated, as I have said, that a child ingests the equivalent of 100 to 150 cigarettes by being with a parent who smokes. Some of the results of children being exposed to environmental tobacco smoke are increased risk of lower respiratory tract illness, acute and chronic middle ear disease and possible hearing loss, upper respiratory tract symptoms such as coughing, wheezing and phlegm, decreased lung function and asthma. For the majority of young people these symptoms will not materialise until later in life and are less likely to occur if they cease their habit. However, young people are still physically developing and can be greatly affected on a daily basis by the health hazards of smoking. Regular smoking can result in chronic low grade respiratory symptoms such as coughing, bronchitis and asthma, which can result in absenteeism from work and school.

Nicotine is highly addictive for its stimulant and mood enhancing qualities. Many people use it on a daily basis as a psychological boost without which they feel they cannot function. There has been increasing recognition in Ireland that young people decide to smoke within a broad social context made up of individual factors and ranging to peer, family, community and media influences as well as legislative factors. The challenge of any initiative aimed at reducing the numbers of young people taking up smoking and drinking is to address all those components. Research shows that the most significant factors affecting whether or not young people take up smoking are advertising, sponsorship and promotion, education, availability of the product – which is being dealt with tonight – and the price of the product.

The availability of tobacco is a key factor influencing consumption. The current law makes it illegal for tobacco to be sold to someone under 16 years of age, but Deputy Shatter proposes increasing this to 18. The present situation is out of line with other countries' provisions as well as our Child Care Act. However, the effectiveness of any law is determined by the certainty of detection and punishment as perceived by the general public. For legislation to be effective it requires frequent, widespread and publicly visible checks that the law is being kept. That is not always the case with tobacco laws in Ireland and there is strong evidence that the law in this area is being routinely flouted. Research shows that 80% of children under 16 can buy cigarettes. As law enforcers, environmental health officers have no right of entry to those premises selling tobacco and are not permitted to request offenders' details and these anomalies bring the law into disrepute. The legislation must be modified as a matter of urgency.

The Minister for Justice, Equality and Law Reform introduced a voluntary ID card scheme as part of the provisions of the Intoxicating Liquor Act, 1998. Young people who want this official card confirming their correct age must apply to the Garda and the scheme should be extended to include the sale of tobacco products.

Mrs. T. Ahearn

I am pleased to have an opportunity to support this important Private Members' Bill introduced by my colleague, Deputy Shatter. This is the seventeenth Private Members' Bill introduced in this House by the Deputy. Four of his previous Private Members' Bills have already been enacted and there is no reason this Bill should not be the fifth.

The genesis of the Bill is the 12 months of hearings by the Oireachtas Joint Committee on Health and Children on the subject of smoking and health, and six months intense research and drafting of the most comprehensive report by Deputy Shatter. The Shatter report entitled the National Anti-Smoking Strategy was launched in November 1999. The recommendations in the report were unanimously endorsed by the all-party committee and adopted without amendment. These included new health warnings on cigarette packets, new provisions requiring tobacco companies to disclose fully the ingredients in cigarettes, a ban on all tobacco advertising, sponsorship and patronage, new and increased penalties for violation of tobacco legislation, explicit anti-smoking television, cinema and press advertising campaigns and a prohibition on the sale of cigarettes to persons under 18 years of age. The Bill was introduced last November following the publication of the Shatter report on smoking and health. It seeks to give effect in law to one of the prime targets of the anti-smoking strategy, that is, preventing young people from becoming addicted to cigarettes.

The new Minister for Health and Children has in his report, coincidentally published today, the day on which the Second Stage debate on this Bill is taking place, reiterated many of the Shatter recommendations, which I welcome. Having given several interviews on radio and television today and in interviews with newspaper journalists over the week-end, the Minister is sending a clear message that the sale of cigarettes to children under 18 years of age should be outlawed, as recommended by Deputy Shatter last November. It would be totally incomprehensible if, having stated repeatedly that legislation must be introduced to outlaw the sale of cigarettes to minors, he opposed Second Stage of the Bill. If so, he will be acting in a purely partisan and party-political manner and such an approach would be totally unworthy of the Minister. I hope he will not act in such a hypocritical manner. I am sure he will agree that this is far too important an issue to be turned into a party-political football. What matters to all of us is safeguarding the health of children and young people. Any delay in enacting this legislation would be totally unforgivable.

We must all be fully committed to reducing the numbers of people who smoke. We must be prepared to take radical steps, no matter how unpopular, to influence and educate people on the dangers of smoking. We will have to develop almost a sense of fear, particularly among young people, of cigarette smoking. Deputy Shatter has shown this courage in initiating this debate and introducing this Bill in the House. I hope all of us as public representatives will follow his courage in this House tonight. It is our duty and obligation to convince smokers of the risks they are taking and the long-term damage to their health and to those around them who are under threat from passive smoking.

No matter what efforts the Minister made today to upstage Deputy Shatter's Bill and to pre- empt tonight's debate, a decision to oppose the Bill would confirm that otherwise a Bill seeking to prevent the sale of cigarettes to people under 18 years of age would not have been introduced in this House. Nevertheless, I am confident the Minister will have the courage to show true leadership qualities by supporting the Bill tomorrow night.

Mr. Ring

I am pleased to be able to speak on the Second Stage of the Bill. I take this opportunity to congratulate Deputy Shatter. As the previous speaker said, this is the seventeenth Bill introduced by the Deputy, four of which have already been enacted by the Dáil. No Minister for Health, Government or political party could say this legislation is not correct for this country at this time. I heard a rumour throughout the House today that the Government will not accept this Bill. I am sure the Minister will confirm or deny the rumour in the next few moments when he will get an opportunity to address the House.

It will be an outrage if the Minister and the Government opposes this legislation tomorrow night. Deputy Shatter and the Oireachtas Joint Committee spent many days and months and put a great deal of effort and commitment into drawing up this report. All members of the committee and their political parties supported the report. When the report was launched on behalf of the Oireachtas Joint Committee all members were associated with it. It would be very wrong if the Minister, the Government, the Independent Members or anyone else opposed this sensible legislation. People are outraged when they see young people being sold cigarettes in shops, supermarkets or on the streets. This legislation will outlaw that practice. Tomorrow is Ash Wednesday and we will listen to the Minister and everyone involved in health care on every local radio station and RTE encouraging people to give up smoking. They will do so because smoking is bad for people's health. If young children of ten, 11 or 12 years of age see their fathers, mothers, brothers, sisters, cousins or aunts smoking cigarettes, naturally they will think this is the correct thing to do.

If the Minister opposes the Bill tomorrow night, the message he will be sending is that the Government supports young children smoking. There has been a great deal of talk in the past about this issue but legislation has not been introduced. Deputy Shatter has now put legislation on the table and I ask the Minister to indicate that he will accept it. The Deputy has thought long and hard about any legislation he has introduced in this House. He has worked hard on this and people recognise he is a man who thinks quality, shows quality and introduces quality legislation. If amendments are needed, they can be dealt with on Committee Stage. The Minister should indicate that he and the Government have the commitment, the will and the courage to support this legislation, that there will not be division on the issue tomorrow night and that all Members of the House will support what Deputy Shatter proposes. This will prevent thousands of people, including young children, from taking the deadly weed, cigarettes. I agree with the Deputy about the national media, including RTE, TV 3, TG 4 or so on. When covering sporting events, particularly motor car racing, if cars carry advertisements or if participants carry advertisements on their vests, television stations should give a warning that smoking endangers health and kills people. I say to all sporting organisations that they should not use money from tobacco companies to promote sport because sport, smoking and bad health do not sit well together. Sport is supposed to help young people to keep fit and to become involved in their communities. Statistics show that if people smoke 20, 30 or 40 cigarettes a day they will not live as long as those who do not smoke. The Minister should be brave. He is a new Minister, a new face and when he speaks in a few moments he should say that he will accept Deputy Shatter's Bill. If so, I will be the first to congratulate him.

Minister for Health and Children (Mr. Martin)

I wish to share my time with Deputy Mary Hanafin. I commend Deputy Shatter on his Bill and his determination to keep the tobacco issue at the top of the national agenda. I thank and pay tribute to Deputy Batt O'Keeffe, Chairman of the Oireachtas Joint Committee on Health and Children, who has also been very active on this issue. Both are absolutely right in being so.

Ireland has thousands of children, addicted to a substance that will kill half of those who cannot get free of the addiction. That is a national scandal. We are becoming very good at examining the conscience of the past: good at condemning those who either abused children in the past or failed to intervene when abuse was going on.

Fifty years from now, when they examine how we took care of our children, I do not want people to say we stood back and let them get hooked on a killer substance. I want them to say that Ireland accepted the World Health Organisation's definition of tobacco use as a global epidemic, that Ireland commissioned a set of guidelines to help us become a tobacco free society and that we acted on those guidelines.

Consequently, this morning, I published the Report of the Tobacco Free Policy Review Group, which was established by my predecessor. I was asked by those concerned to make sure that the initiatives were published in time for Ash Wednesday. That group was asked to carry out a fundamental review of health and tobacco and to make recommendations to the Minister for Health. What emerged this morning, was an extensive action programme to further a policy for a tobacco free society. The timing is important. Ash Wednesday has, for many years, been the day when anti-smoking campaigns were launched because Lent was traditionally the time when smokers tried to give up, at least for a few months. Today is the day when the smoking issue is top of the agenda for many people.

The report of the Tobacco Free Policy Review Group is substantial and detailed, as might have been expected. It does not deserve the kind of carping criticism it received this evening. We should work together on the implementation of the contents of that report. It is also blunt, clear, accessible and interesting. It looks, not just at tobacco use in Ireland, but breaks down that use into important issues including smoking by gender and current smoking prevalence among children. It also takes a blunt look at the industry and at responsibility and accountability for tobacco related illness. The report offers us a blueprint for immediate, sustained and tough action against the use of tobacco. We need that because we are not making a big enough dent on this massive problem.

Smoking is a childhood addiction. In the past, campaigns set out to prevent teenagers smoking. The majority of smokers are already addicted by the time they reach their teens. Huge numbers of 11 and 12 year olds are getting hooked on something that will kill half of them. As many Deputies know, tobacco related illnesses kill half of those who use tobacco.

The report gives us guidelines on which to base action, but its recommendations are not a general shopping list, but a much more realistic set of actions. The report says, for instance, that there is no point in banning cigarettes: what would result from a ban would be a flourishing black market. Instead, it says, four linked actions need to be taken and sustained. Number one, we have to change attitudes towards smoking. At all levels, we have to make smoking unpopular and uncool, not by attacking smokers, but by changing the way we all think about smoking as an activity.

The second set of actions in this report recommends supporting people trying to quit smoking. Eight out of every ten smokers want to kick the habit. Many of them try and fail, but they try again and we need to put specific supports in place to help them get away from the addiction. The third set of actions relates to the environment. We need to strengthen environmental controls on smoking. Last but definitely not least, we need to rescue the children. We need to prevent them from starting, and help them if they have already started.

I will move on the recommendations of this report immediately. Later, I will present to the House the outlines of what I plan, in promotional and legislative terms. However, I will first put those plans in context. For many years, Ireland has been a leading advocate for the worldwide control and ultimate elimination of tobacco use. We were one of the first countries to introduce restrictions on tobacco advertising and sponsorship by the industry. These measures were later adapted for the whole of the European Union and are now the gold standard, internationally. Ireland was also one of the first countries to recognise the impact of environmental tobacco smoke and to prohibit smoking in public places. That is leadership of which we can be proud and which we need to continue.

In aiming for a tobacco-free Ireland, it's important to be unequivocal. Tobacco kills in many different ways, none of which are easy. Not only does tobacco kill, but it has no benefit for smokers. Occasionally a flurry of stories appear suggesting that nicotine might have some protective function relating to some disease. Smoking tobacco in pursuit of any of these alleged health benefits carries a risk of other diseases outweighing any perceived benefits.

As a lifelong non-smoker, I am reluctant to appear too biased against tobacco, so I will concede that it is a useful pesticide and can be quite a decorative plant but that is all. There are no other benefits. There are no benefits to smokers. Tobacco use holds nothing for human beings other than addiction, financial cost and devastating disease.

If we look at the alternative, a tobacco free society would offer us freedom from addiction, more money in our pockets, and avoidance of some of the grimmest self-induced illnesses known to the medical profession. That is why it is worth aiming for a tobacco-free society. It has been put to me on the air that this is an unrealistic ambition, that it would not and could not happen, but the history of public health is full of inspiring stories of impossible dreams coming true by hard work, and through the dedication and commitment of many people.

Some of our older Deputies remember a time when polio was a dreaded disease, shadowing every child's summer holidays. Now within one generation we are within reach of completely eradicating this disease. Nobody could have imagined that success story at the time, just as nobody could have imagined that we would beat back TB, diphtheria or tetanus. We did because we did not focus on the difficulties, but on the results we wanted and we did not fool ourselves that leaving ourselves open to getting diphtheria was an aspect of our personal freedom.

For too long, we have allowed the promotion of death and disease under the guise of personal freedom. There is something infinitely sad about citizens cherishing the right to slowly kill themselves. That kind of talk and the suggestion that a tobacco-free society is an unrealistic objective is music to the ears of the tobacco industry. For that reason, I want to nail the popular myth that Government is prepared to collude with the tobacco industry because of the contribution cigarette taxes make to the economy. The reality is precisely the reverse. I do not care what impact on the Exchequer aiming for a tobacco-free society would have. It is the only moral objective we can have, as a Department, as a Government and as a society.

Another myth is that if the facts are presented, smokers will instantly stop smoking. Any smoker knows that will not work. Not only is nicotine a powerful addictive chemical, but the tobacco industry for generations has pumped so much money into the promotion of their products that a few facts – no matter how shocking those facts may be – will not roll back the power of that spend. The tobacco industry has not only spent money like water, but has also used psychology in a sure-footed and cynical way. According to a confidential marketing document generated by the world's leading tobacco company: "A cigarette for the beginner is a symbolic act. I am no longer my mother's child. I'm tough. I'm not square. As the force from the psychological symbolism subsides, the pharmacological effects take over to sustain the habit."

This is what we are fighting – the most malignant marketing force in history, with a death toll in millions and the tobacco industry has known for a long time that its products were killing people. If one reads the history of tobacco, the first warnings were sounded loud and clear, not years or decades ago, but centuries ago. Scientific evidence took longer to arrive. This is where the "Big Lie" came in. The industry looked at the evidence that cigarettes could kill, and said that there was no scientific support for it and it was all coincidence. For the first half of the last century, the industry kept the jury out.

That changed mid-century, and one feature in a popular magazine, Reader's Digest, convinced people to become concerned about smoking, and doctors began to cut back and to stop smoking themselves. The tobacco industry responded with speed and sensitivity – sensitivity to markets rather than to the truth. Sophisticated public relations campaigns were put into action. Vague assurances about good intentions were circulated. Filter cigarettes were introduced and the industry skilfully marketed them as “safe” cigarettes.

There is evidence that the industry deliberately frustrated independent scientific research into tobacco. Where they could not frustrate the researchers, they confused the people who read the published research. The industry outspent and out manoeuvred the public health community to win public support for its deadly products.

Recent revelations from the United States of America have renewed public concern about tobacco and exposed some of the sleazy behaviour of the industry. We now know the industry suppressed scientific data it did not like. Having done so, it took another step and embarked on worldwide marketing to children. I quoted one of the documents which shows precisely how the industry set out to snare little children. It is brutal, cynical and offensive but, tragically, it has been successful. It is mind boggling that any adult would willingly set out to addict children to something he or she knew would cause them disease, distress and death. It is frightening that the industry did so systematically and successfully.

Past performance is the best indicator of future behaviour. It will take more than ingratiating words to persuade me that the tobacco industry has changed. It is an industry that must be subject to the closest regulation and scrutiny in the future. The insidious approach the industry has traditionally taken is to cast the tobacco issue as a human rights concern. The tobacco industry says the public health community is attempting to interfere with personal freedom when they oppose a free market in this product. It argues that it is an adult choice. This is nonsense.

More than 80% of smokers start and become addicted long before they reach the legal age. In relation to the current legal age of 16, Deputy Shatter and I are at one in regarding the current legislation as too lax in this area. All the evidence is that smokers begin smoking at a much earlier age, so it is not an adult choice. Once addiction is established, the individual cannot be regarded as exercising free choice when he or she continues to smoke and they know it because over 85% of smokers would like to quit but find it too agonising and impossible to do.

The industry is falsifying the position. Smokers have rights, and these are the right to know what is in a tobacco product; the right to know the harm smoking can do to them; the right to know that smoking is one of the most difficult addictions to break; the right to be protected from this product when they are children; the right to know about the harm environmental tobacco smoke causes to those around them, especially their children; and the right to have their addiction recognised as an illness and to be treated. Their final right is infinitely sad; if smokers are unable to break their addiction, they have the right to continue to smoke. The evidence now emerging suggests that these rights have been habitually and deliberately violated by the tobacco industry. It is time to cut through the smoke rings of spin.

Deputy Shatter and the members of the Oireachtas committee, chaired by Deputy Batt O'Keeffe, have kept this issue to the forefront of our attention. The Bill is being opposed not because the Government opposes some of its contents, but because I have already instructed my officials that a new miscellaneous health provisions Bill is to be published in two weeks. The age at which a person may be sold cigarettes is a distinct priority in this Bill. The age limit will be raised to 18 years and the fines will be increased to £1,500. We have been advised that this is the upper limit in relation to the fines that can be levied in this area.

The office of tobacco control, which is being established, and the Department have been instructed to prepare a comprehensive tobacco Bill which takes on board all the issues relating to tobacco such as vending machines. These machines may be prohibited under the new Bill, but I want to consider the matter in greater detail. The Bill before the House mentions restrictions with regard to vending machines but it may be necessary to go further.

The comprehensive tobacco Bill will deal fundamentally with the issue of full disclosure of the contents of cigarettes in terms of additives, etc. There are no regulations in that regard at present in Ireland or elsewhere in the European Union. In terms of environmental controls, there is a need for additional legislative powers to increase the number of public places where smoking is prohibited in the future. There is also a need to consider the issue of enforcement and compliance with existing legislation.

The report published today is the result of comprehensive work undertaken over two years. This work creates a template for comprehensive legislation to deal with issues raised in the report and other reports that have been produced. The Government has committed itself to banning packets containing less than 20 cigarettes. This issue was also identified in the report.

Our collective responsibility is to the children who are being sold an addictive poison as a way of proving their coolness. I want to work with all parties in the House in trying to develop the agenda and move it forward. Regarding indirect advertising, which some tobacco companies have utilised to avoid the ban on more direct advertising, the report recommends that the Minister for Arts, Heritage, Gaeltacht and the Islands review the code of ethics for broadcasters. This will be followed up with the Minister and the national broadcasters.

Regarding the education programme, the report signifies a significant change in terms of the financial resources that will be made available for a public relations campaign on tobacco. Last year the Department of Education and Science produced the comprehensive Walk Tall programme on substance abuse. This very good programme is being run in almost all schools at this stage and it will be supplemented with campaigns by the health promotion unit. It was important to publish the report. One cannot criticise the Government for inaction and then criticise it for publishing a comprehensive report.

The report outlines a management framework for sustaining the initiative. There have been too many stop-start campaigns and the office of public control will be a vital element in terms of delivering the programme. The tobacco free council will be particularly important and the Department's health promotion unit will have an enhanced role in terms of the public campaigns. A satisfactory template is in place to progress the agenda.

It is not envisaged that there will be any signage of any sort in relation to tobacco in any retail outlet. The report contains many recommendations on how retailers market cigarettes next to confectionery at the counter. I assure the House of my bona fides in relation to the contents of today's report. There is a need for a comprehensive tobacco Bill. Deputy Shatter acknowledged that the Bill before the House deals with only two or three issues. A Health (Amendment) Bill will be published in two weeks and there are logistical issues in terms of whether there should be two Bills before the committee at the same time. That is not necessary but I assure the House that the Government supports the idea of raising the age limit from 16 to 18 years. The Bill before the House does not deal with the full gamut of issues but I thank the Deputies for the opportunity to discuss this matter.

Minister of State at the Department of Health and Children (Ms Hanafin)

In dealing with young people and teenagers, when there is a conflict between what is healthy and fashionable, fashion will always win. If there is a battle between power pressure and peer pressure, the peers will always win. In the debate about smoking and not smoking, when one is dealing with young people, smoking will always win. Unfortunately, over recent years, society has allowed this to happen. We as legislators, the tobacco companies, advertisers, parents and particularly young people have allowed a situation to develop where smoking is not only a fashion but a cult and an addiction. We are all responsible for this position.

Having spent many years teaching, I witnessed at first hand the extent of smoking among young people and particularly among young girls. It was no surprise to me to read in the report of the tobacco free policy review group that 31% of all women smoke, but that 40% of the 18 to 34 age group smoke. The report highlighted the point that the problem is acute among the 15 to 17 age group, a group with which I dealt for many years. It is frightening to read a report which mentions addiction from the age of 11 years. If we were talking about an addiction to any other substance, we would have dealt with the problem many years ago. What is more relevant by way of statistics, is a report by the Eastern Health Board of health behaviour of school pupils which showed that 51% of 12 to 14 year olds and 70% of 15 to 18 year olds in schools in the area had smoked and that the younger the boys and the older the girls the more likely they were to start.

Let us look at the influences on those young people who smoke. Undoubtedly peer pressure is the number one influence in the case of young girls. The aim of teenage girls to have a shoe size which is bigger than their dress size means they are constantly watching their figures and diet. Smoking is one way, which they see, of keeping the weight down and is one of the reasons teenage girls smoke.

In a society where it is important to succeed it is in vogue among young people to indicate that they are under pressure, even in those students where there is no pressure from themselves, their friends or their families in relation to their junior or leaving certificates. Smoking shows a person is trying to calm his nerves and is under pressure responding to the demands of society which demands success. To be daring, a student will go on to the fire escape, down behind the convent graveyard or on to the football pitch to smoke during break time and lunch time. To be sophisticated at the disco or club one has a cigarette in one hand and a glass in the other. It is unfortunate that cigarettes are the cheapest status symbol available. Money is no object for many young people. It is not just a question of charging more – and I would welcome that – it is a whole culture among the young people which has to change.

That culture must also change among parents. Parents who smoke cannot say to their young people, "Do not do as I do, do as I say", because that does not work. Parents are role models for young people. It has been proven and is stated in the various reports that children of smokers are twice as likely to smoke. Parents become very tolerant of smoking because they convince themselves that the child could do worse, that it could be an addiction to something else. They accept smoking as the lesser of a number of evils. This culture and attitude has to change.

The attitude of all those leaders of society must also change. Schools talk about the education courses, health education, on my own two feet, walk tall and all the available courses and yet ignore the students who smoke on school premises although they are not in the building. Those same schools will take students away for weekends and on school tours abroad and will turn a blind eye to the fact that they all smoke in the hostels or wherever they happen to be on the tour.

Smoking is not tolerated on buses. Yet young people still smoke on the top of buses because there is no conductor to go up and find them and the driver cannot leave his seat to find them. The smoking habit is creeping in on our public transport.

One is almost encouraged to smoke in pubs where no differentiation is made between smoking and non-smoking areas. At least that distinction exists to some degree in restaurants, although I discovered last night that the non-smoking area was beside the door and that most of the people in the smoking area did not smoke.

Mr. Shatter

Usually it is beside the toilets.

Ms Hanafin

At least a differentiation is made whereas in pubs there is none. People who smoke lose their sense of taste and smell. When they leave the pub they and their clothes have the lingering smell of smoke on them. Advertising has become so sophisticated that one no longer needs to mention names. The advertisement in the magazine does not mention the name of the brand, it just shows the cut through the silk; that says it all. The advertisement mentioned here, Formula 1 racing, the vending machines and the newspapers, is highly sophisticated, well targeted and influential. What was frightening on a recent visit to China was that the tobacco companies, recognising that the markets may be in danger in Europe or in the United States, have targeted the Chinese young people and show advertisements which seem to suggest that smoking stands for freedom, independence and America. That type of influence was used by them to ensure they could not only encourage young people to smoke but lead them on to addiction. That addiction means that in all schools there is an increase in the use of inhalers because young people have more asthma and respiratory problems than heretofore. It is affecting their sense of smell and taste and the figures for the rates of mortality in Ireland, the smoking related diseases, are evident.

I am convinced that if death certificates made it clear the cause of death was a disease related to smoking more accurate figures would be available. Each of the groups mentioned needs to be targeted to ensure we can wipe out this addiction. The report published today focuses on those groups and on those people. I would like to see more being done at primary school level not only in the case of the courses being provided but in the overall culture and attitude in a school. Many schools offer a range of extra curricular activities. Why is it that in fashion shows in which I participated with my students, all the girls who were more than half my age were less than half my width and proud of it? Their aim is to fit into a size six or size eight dress. Why do not the selectors of the models focus more on poise, walk and presence rather than have them try to look anorexic?

We will have to focus on parents to ensure they do not tolerate smoking as the lesser of two evils. Smoking is not comparable to drugs in the sense of a heroin addiction but it is an addiction and needs to be targeted. I look forward to the Minister's legislation targeting the sale of cigarettes, the amount that can be sold, the price at which they can be sold and the advertising of same. Unless we focus on the young people and make them realise it is a drug and an addiction we cannot help them to change their attitudes. The battle against tobacco is one of the most important battles we will face as a Government and as a department of health. Tobacco consumption is a burden to individuals, to young people though they do not realise it, to families and society through death, illness and medical costs.

The report published today, Towards a Tobacco Free Society, will set out the strategy and will help to change attitudes and support those smokers who want to quit. It will also protect society against passive smoking and smoking and, more particularly, it will focus on children. Though it does not come within my remit as Minister of State with special responsibility for children I hope to assist the plan in some way in dealing with young people to wipe out this addiction at an early stage.

Ms McManus

I wish to share time with Deputies Stagg and O'Shea. I compliment the Minister for Health and Children. One difference which is evident over his predecessor is that he has got a new speech writer. Nobody would disagree with what he and the Minister of State have said. He deserves high marks for colour. I like the phrase "smoke rings of spin". However, only a small number of specific measures are outlined at the core of the Minister's speech.

I am perplexed by the speeches of the Minister and the Minister of State. Both speakers are in Government and are in a position to deal with this very serious problem yet they are unable to accept the basic and practical measure which is presented by the Opposition. We have heard much about the problem of smoking. We all know the problem and we share the views expressed by the Minister and the Minister of State. However, the Opposition has presented a practical measure which could be adopted by the Government, if only as a gesture of goodwill. The acceptance of this Bill would show that this question is not to be treated as a political football. The Bill is a modest one but it is to the credit of Deputy Shatter that a valuable body of work has been presented to the Oireachtas Joint Committee on Health and Children.

Efforts to tackle the problem of smoking have had limited impact. While there has been a reduction in the number of people smoking since the 1970s the number of young people, and particularly young women, who smoke is now increasing. The slight decline in the number of older smokers is very welcome but the number of women smokers between the ages of 18 and 24 is now greater than the number of male smokers of the same age.

It is wrong to concentrate solely on young people and children. We must examine the issues of addiction and of class. Medical card holders are more likely to be smokers than those who are not. The class basis of good health practice is evident in the SLAN report and we should not dismiss it. It is good to emphasise the issue regarding young people and that issue must be addressed. Legislation may not be the answer to the question of young people smoking. Banning an activity may often make it more attractive to young people.

While the document produced by the Oireachtas Joint Committee on Health and Children is a very important one, an aspect of the problem was not given sufficient prominence. We must address the needs of the 20% to 30% of our population who have been smoking for many years and who are now suffering the consequences of that. Most of these people suffer an addiction which can be stronger than the addiction to heroin. We all know colleagues, family members and friends whose health is breaking down as a result of this addiction. The only treatment for chronic obstructive pulmonary disease is to give up smoking cigarettes.

Deputy Martin is responsible for health as well as for children. He has mentioned the 85% of smokers who wish to give up smoking but he has not said how he intends to deal with this aspect of the problem. There has been an over-emphasis on legislation and not enough on a programme to deal with the medical conditions which result from smoking. Previous Governments have also failed to face up to the nature of this addiction. There has been an over-reliance on lecturing people who know only too well that they should not smoke.

We have made considerable progress in dealing with heroin addiction. It is greatly to the credit of the previous Government that good practice was established and alternative therapies provided, without judgmental strings attached and free of charge, for heroin addicts. If smokers were harming people besides themselves, would more effective Government action have been taken? The relationship between heroin addiction and crime was undoubtedly a factor in persuading society to deal with that problem. Why has a similar effort not been made to deal with addiction to tobacco which is doing so much damage to so many people?

Twice as many people could become non-smokers by using nicotine replacement therapy yet this is not available through the GMS or on the drugs refund scheme. Why can we not do something practical to enable people to give up smoking? Nicotine patches can have a beneficial impact on many people. Why do we not incorporate these therapies into the national anti-smoking strategy?

Cigarette smoking is the single biggest cause of cardiac disease and lung cancer. If lung cancer is detected early enough it can be treated but there is no screening programme for this condition which targets smokers. Some members of the medical profession are of the opinion that the diseases of smoking are self-inflicted and that sufferers from them are less entitled to treatment than others. Would we tolerate any other group of citizens being poisoned in this way? Change is required in the way we view this high-risk group of people who require screening, treatment and help to overcome their addiction. We need to adopt a different strategy; we need to adopt a humane and people centred approach to ascertain what will work rather than ban advertising. We need to ensure children under the age of 18 are unable to access cigarettes. We all know someone who is addicted and who may in every breath they take, be conscious of the fact that they are seriously addicted and have no way of dealing with it.

It is worth noting that tomorrow is Ash Wednesday and the Minister availed of the opportunity to highlight his approach to combating smoking. It is also International Women's Day. It has to be noted that women are particularly vulnerable, not just in the ways rightly indicated by the Minister of State. I suspect that it would be much more effective to ask Weight Watchers to conduct a mass campaign in schools than try to convince women that they should not have a cigarette in their hand to keep their weight down.

A study conducted in Norway in 1997 clearly showed that women tend to have a genetic predisposition – we always seem to get the rough end of the stick – to lung cancer, even when they smoke less. Studies in the United States indicate that by 2002 lung cancer will kill twice as many females as breast cancer. There is a major breast cancer problem here. This indicates a trend. We are not just talking about children and the chronic addict therefore, we are also talking about the risk factors relating to women.

There is a need for commonsense on the question of increasing the price of a pack of cigarettes. There is a huge range in the cost of cigarettes across the European Union. I understand the Greeks pay least and smoke the most. That is to be expected but the second heaviest smokers are the Danes who pay most. We have to be careful therefore that we are not just depending on cost or dealing with advertising; much more has to be done to ensure the factor of addiction is also addressed in terms of medical practice.

The February 2000 report of the Royal College of Physicians in London states that cigarette smoking should be seen first and foremost as a manifestation of nicotine addiction and every bit as addictive as hard drugs such as heroin; that all actions aimed at curbing smoking should flow from this recognition of nicotine's central role in the compulsion to smoke, and that if smoking is primarily a nicotine addiction nicotine replacement therapy must be a central plank in treating smokers.

We must ensure treating the addiction of smoking is recognised as part of medical practice and that the resources provided for health boards are directed not just at encouraging the creation of tobacco free environments or controlling the sale of cigarettes but also at the training of nurses, general practitioners and local communities to ensure that when an addict decides to give up smoking the resources, in terms of replacement therapy, and personnel with the necessary skills are in place to ensure he or she moves forward in the same way that a heroin addict works through the stages. I know of heroin addicts in my community who are moving through methadone to real life, to the point where they will have a job, settle down and have a family, and kick the habit once and for all. That is what we need to concentrate on in terms of tobacco addiction. I ask the Minister to recognise the needs of these sick people in terms of their addiction and its likely outcome.

Mr. Stagg

As a cigarette addict, I warmly welcome the opportunity to contribute to this debate. I do not enjoy or wish to be a cigarette addict. I am among the 85% who would like to kick the habit. At long last we are in a position to devise a comprehensive national anti-smoking strategy. I strongly support the comments of my party colleague, Deputy McManus, on this subject. Unlike her, however, I can speak from personal experience.

The tobacco industry is one of the most destructive and insidious in the world. It has lied, concealed the truth and destroyed the health of hundreds of thousands in the pursuit of avaricious and more avaricious profit. It has exploited Third World countries for their raw material while poisoning the populations of countries, rich and poor. The international political economy of the tobacco industry is disgusting, exploitative and deserves condemnation at every hand's turn.

In trying to reduce the incidence of smoking here and across the European Union we should not forget that the tobacco industry will not hesitate to move on to pastures greener in its efforts to generate profits. As Deputy McManus stated we have to realise that reducing smoking in the rich western world will lead to an increased assault by tobacco companies on poorer countries which may have less legislative and public health resources available to them to take on the tobacco companies in the way I hope we will in coming years. We should recognise this fact and immediately exchange our strategies for combating smoking with poorer countries. The globalisation of international capital is one of the most powerful forces in the world today. It is a force which drives the tobacco industry and we have a duty to reinforce this point at both bilateral and EU level.

I take the opportunity to challenge the Minister on one aspect of the Government's anti-smoking policy, that is, the withdrawal of a cigarette allocation from patients in psychiatric hospitals. Why did the Government decide to launch an attack on some of the most vulnerable in society in an effort to flex its get tough policy on smoking, which I welcome?

Mr. Martin

That is not true.

Mr. Stagg

I have smoked all my adult life and made numerous attempts to kick the habit but failed. I have used hypnosis, patches, ear studs and acupuncture without success. I know the real pain and sacrifice involved in kicking the habit and the real strain it places on a person, even in good health. I cannot understand for the life of me why the Government decided to withdraw the cigarette allocation to a group of citizens, many of whom are at their lowest ebb and least able to cope with cutting down or giving up cigarettes.

I know what the effects of this policy will be. In many cases patients' behavioural controlling medication will be increased. A sudden and drastic cut in cigarette consumption will increase irritability and anxiousness. Increased medication will be used to treat this. It is a short-sighted policy which attacks the most vulnerable in the community. It should be dropped and a proper anti-smoking campaign instituted in psychiatric hospitals rather than the blunt instrument introduced at the stroke of a pen by the Government.

Cigarette smokers are addicts. Instant withdrawal without preparation and an individual making the conscious and voluntary decision to try to quit the habit will not and cannot work. Yet, that is what the Government has tried to force on the residents of psychiatric institutions. It fails to understand the nature of addiction and the vulnerability of many psychiatric patients. It was a shallow, cruel and vindictive move. I urge the Minister to reverse this decision immediately or to make a cash allocation to patients who wish to purchase cigarettes. Because of the price of cigarettes the minimum extra allocation required in this regard will be £25. I ask the Minister to seriously consider this.

Debate adjourned.