I move: "That the Bill be now read a Second Time."
I regard the battle against tobacco as one of the most important public health challenges facing us in the new millennium. I have made this area one of my main priorities as 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. The 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. Tobacco use and, in particular, cigarette smoking remains the leading cause of pre ventable illness in the country. A survey 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 welcomes 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 entitled "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. Furthermore, 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 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. Smokers have three times the death rate in middle age of nonsmokers. These are appalling statistics.
I am particularly concerned about the increasing levels of smoking among children and access by under-age persons to cigarettes. 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 to 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 people 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. I 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.
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, asthma attacks and is a significant factor in sudden infant death syndrome, SIDS. Children are powerless to control their exposure to tobacco smoke and yet, because of their age, are most adversely affected by exposure to this toxic combination. We must ensure that 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 the dangerous and addictive nature of the product it manufactures, promotes and sells. Yet the industry for decades denied that nicotine is addictive, that smoking and secondhand 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 were 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, and particularly young persons, to smoke. Once young people become hooked, the tobacco industry works hard to maintain that addiction.
Much information has come to light in the last decade about the unscrupulous behaviour of tobacco 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 to 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 wanting to work constructively with Governments in introducing tighter regulation of tobacco, has consistently striven to frustrate and undermine all such efforts. They not only seek to thwart national efforts to effectively address the tobacco problem but also those pursued at regional and global levels.
The cynical attitude of the tobacco industry to human life was revealed in an economic report on health care costs and smoking commissioned by Philip Morris in the Czech Republic and published in June this year. 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 health care and pensions. This spurious economic argument shows a complete disregard for basic human values. That premature death, human suffering and ill health caused by smoking tobacco products should be discounted against long-term economic gains is reprehensible.
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, and we must deny it that access. The aims of the tobacco industry are totally 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. I have already taken a number of very positive steps in this area with Ireland last year being one of the few EU countries to prohibit the advertising of cigarettes in newspapers, magazines and other publications.
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, I terminated this expenditure despite fierce opposition from the tobacco industry and I make no apologies for this. Banning advertising leads to a reduction in tobacco consumption and in preventing new smokers from starting. 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. I 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. I will continue to ensure that a clear, sustained and positive health message is sent to the population, particularly our young people.
I have 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 involves national and local initiatives, which offer support for those people wishing to give up smoking. An advice kit was developed as a support for those who want to quit.
NICO was developed last year to target the growing number of young teenage girls who are smoking or who are starting to smoke. This anti-smoking campaign emphasises the negative effects smoking can have on physical appearance, for example, stained teeth and wrinkled skin. The storyline is that there is nothing sexy about smok ing and 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 the TV and radio ads.
The best prospect of reducing the number of people, especially young people, smoking or not 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 social, personal and health education programme is 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. Social, personal and health education is a broad based health education programme which aims to enhance the self-esteem and decision making skills of young people using experiential learning methodologies. Implementation of this programme will ensure there is a co-ordinated approach between health boards and the Department of Education and Science at regional level in a way that has never formally existed before. I am committed to ensuring that this process is a success and that a secure place will be established for health education within the school system to complement the work that has already taken place in many health boards.
I recognise the importance of the out of school setting for delivering health messages to young people. My Department has again teamed up with the Department of Education and Science and also with the National Youth Council of Ireland to provide a wide range of health promotion training for the youth sector through the national youth health programme. This programme promotes the notion of a health promotion youth service thereby ensuring that the messages young people receive in school are mirrored elsewhere, and the Office of Tobacco Control has also been involved with a group of young people acting as advocates and peer leaders in terms of the anti-tobacco issue.
Most smokers wish to break their addiction to nicotine based tobacco products. Additional help has been made available to smokers to help them quit. Since 1 April 2001, I have made the full range of nicotine replacement therapies including patches, gum, sprays and tablets available free of charge to medical card holders on prescription by their GP. Since I have introduced that measure, about 16,000 people have taken it up.
The tobacco epidemic can only be beaten with the commitment of society as a whole. A concerted and sustained effort is necessary to make progress. This 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 on all forms of sponsorship by the tobacco industry is proposed. 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 has exploited rather than compensated for this childhood vulnerability.
Accordingly, the Bill proposes further restrictions on tobacco advertising. Many of these provisions are 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 this Bill. This re-balancing of the rights of the public, especially children, and the rights of the tobacco industry is necessary because the status quo ensures that children will continue to take up smoking in increasing numbers and become addicted before reaching adulthood. The evidence is that the total prohibition on advertising is very effective but that partial prohibitions do not give a pro rata return.
Since July 2000, advertising of tobacco products and sponsorship by tobacco companies is prohibited, other than limited in-store and trade advertising. This was done under existing legislation and regulations restricting the amount of money that tobacco companies are allowed spend on promoting their products. While in the past Ireland has severely restricted sponsorship which provided advertising for tobacco products, the tobacco industry has identified a number of ways around this restriction, for example, sponsorship to promote the company name rather than a tobacco product. The full extent of this practice is not known but the Bill will prohibit such practices.
The approach to enforcement in the past has been piecemeal. Compliance with existing laws especially in relation to sales to minors has been poor. Surveys have shown that many underage young people can purchase tobacco products over the counter from retailers without being asked for evidence of age. The evidence from other campaigns, such as drink driving campaigns, is that strong enforcement combined with positive public messages are necessary to effect real change in public behaviour.
The Bill will provide for comprehensive powers of enforcement and will introduce a range of penalties which are commensurate with the offences. The age limit for sale of tobacco products to young persons was raised from 16 to 18 years earlier this year and the maximum fine for persons convicted of selling tobacco products to underage persons has been raised substantially on foot of the Health (Miscellaneous Provisions) Act, 2001. These measures are incorporated in the Bill and will act as a further deterrent to retailers. My Department has already begun the process of increasing the number of health board environmental health officers who will enforce the tougher tobacco controls. I made available this year an additional £1 million for this specific purpose. The Bill requires retail outlets which sell tobacco products to be registered. Such regis tration is recommended in the Government's policy document "Towards a Tobacco Free Society," and is justified on public health grounds as it will facilitate inspection and compliance, as provided for in the proposed Bill.
A ban on retail sales of packs of cigarettes of less than 20 is also proposed. Price is the single most effective means of protecting children against experimenting with cigarettes and becoming addicted. Increasing the minimum pack size which may be sold raises the price barrier for children. This measure was also recommended in the Government's policy document "Towards a Tobacco Free Society." The results of a survey commissioned by the Office of Tobacco Control and published in October this year concluded that the sale of cigarettes in larger packs will significantly reduce consumption. Ten-packs of cigarettes are bought mainly by young smokers. Accordingly, it is proposed to ban the sale of packs of cigarettes containing less than 20 cigarettes.
There will be tighter controls on the sale of tobacco products from vending machines. Many cigarette vending machines are located in areas of licensed premises, often out of sight of staff, where there is no form of supervision, giving unrestricted access by underage persons to cigarettes. The Bill provides for much tighter control on all aspects of tobacco retailing including vending machines. Machines will have to be located beside, on or behind the bar counter and under the direct supervision of staff. Regulations will provide that the machines, which will have a locking device, will be activated for each 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.
A ban is proposed on the sale of confectioneries, normally intended for children, which resemble a tobacco product. Selling confectioneries to children in the form of tobacco products is a particularly odious practice and helps to build an unhealthy relationship and familiarity between children and tobacco products. Children who use candy cigarettes are more likely to become smokers. Some of the candy cigarette packets on sale in shops are difficult to distinguish from packets of cigarettes. Our legislation and regulations at present relate only to controls on the sale of tobacco products. The new Bill prohibits the sale of these types of confectionery products.
Public disclosure of all aspects of tobacco including toxicity and addiction will also be provided for. 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. The pharmaceutically active ingredient in tobacco smoke is nicotine. Nicotine is a highly addictive substance and breaking that addiction is difficult for most smokers. There is international evidence that the industry manipulates this addictive characteristic through the use of certain chemical technologies such as ammonia, and by using genetically modified tobacco plants with high nicotine content. Accordingly, certain technical standards relating to the composition of tobacco products need to be set. Compliance with these standards needs to be independently monitored. In addition, health warnings and batch numbering will be mandatory on all packs. The industry will have to meet a very high threshold of disclosure about the toxicity and addiction of its products and the public will be truthfully and fully informed about the composition and toxicity of tobacco products. False or misleading claims will be prohibited. An EU directive on these measures was adopted earlier this year.
There will be improved protection for people against passive smoking. Tobacco smoke is the biggest single source of indoor air pollution. Environmental tobacco smoke is a real and substantial health hazard especially to infants, children and persons with heart or lung disease. Tobacco smoke contains as many as 4,000 chemicals. Many of these are harmful to health and at least 60 are known to cause cancer in humans. The International Agency for Research on Cancer, a specialist agency of the World Health Organisation, classified tobacco smoke as a human carcinogen in 1986. A human carcinogen is a cancer causing substance for which a cause-effect relationship has been established.
The risk to health related to exposure to environmental tobacco smoke, ETS, is well known. The WHO air quality guidelines for Europe concludes that ETS has been found to produce a substantial amount of morbidity and mortality from other serious health effects. Environmental tobacco smoke is the single most important source of harmful indoor air pollution. That has been supported by two decades of evidence and the scientific community now agrees there is no safe level of exposure to second hand smoke. Three of the main components of tobacco smoke are nicotine, an addictive drug, tar, which is a cancer-causing substance, and carbon monoxide, which interferes with the oxygen supply to the heart and blood vessels. Carbon monoxide is the same lethal gas which is released by motor vehicle exhausts. Other toxic components include hydrogen cyanide, formaldehyde and benzene.
There is an international scientific consensus that environmental tobacco smoke kills. Passive smoking is a cause of disease in otherwise healthy non-smokers. Tobacco smoke contributes to a noxious environment, causes eye irritation, sore throat, cough, and headache.
It is a reasonable expectation on the part of the public that they should not be exposed to such a toxic combination, whether in their work place or in public areas and facilities. A European Commission research study found that more than 80% of Europeans over 15 years of age are exposed to ETS and inhale the equivalent of one or more actively smoked cigarettes per day.
Existing legislation has been shown to be robust in facilitating the extension of controls in this area and these relevant provisions are being incorporated into the proposed Bill. The Bill accordingly will provide significant protection for people against environmental tobacco smoke. However, I will use enabling powers under section 46 to extend environmental controls on smoking to a range of public areas and facilities not already covered by existing legislation and regulation. That includes the work place, pubs and other areas.
The tobacco control agency will be established on a statutory basis. It will monitor, co-ordinate and, in certain circumstances, enforce the new tobacco policy initiative. The agency will drive the implementation of many of the Bill's provisions and will co-operate with all relevant agencies in working towards a tobacco free society. It has already been established on an administrative basis and is located on a temporary basis in Clane, County Kildare. The work of the agency will be complemented by a Tobacco Free Council to be serviced by the agency and which will have a much broader representation than the board of the agency and will be drawn from a wide range of disciplines necessary to promote a tobacco free society. The council will be a consultative forum.
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.
I am not suggesting that legislation alone, no matter how comprehensive, can create and sustain the environment necessary to prevent people from starting to smoke and to assist those who have already started a programme to stop. Our anti-tobacco strategy will be multi-faceted, containing, as it will, strong legislative controls, effective enforcement powers and resources. However, the strategy 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, to the younger generation, and to future generations to ensure that the war against tobacco is won. It gives me great pleasure to commend the Public Health (Tobacco) Bill, 2001, to the House. I look forward to the debate and will be open to taking amendments on Committee and Report Stages.
