Public Health (Tobacco) Bill, 2001: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

I apologise for my late arrival, but I did not realise that I would be called to speak so soon. I spoke last night about the clear evidence that the cost of cigarettes is a factor in reducing the level of cigarette smoking in this country, a point that was recently reinforced by Dr. Luke Clancy. I referred to the World Bank Group's report, the Economics of Tobacco Control, which states:

Scores of studies have shown that increased taxes reduce the number of smokers and the number of smoking-related deaths. Price increases induce some smokers to quit and prevent others from becoming regular or persistent smokers. They also reduce the number of ex-smokers returning to cigarettes and reduce consumption among continuing smokers. Children and adolescents are more responsive to changes in the price of consumer goods than adults, that is, if the price goes up, they are more likely to reduce their consumption. This intervention would therefore have a big impact on them. Similarly, people on low incomes are more price-responsive than those on high incomes, so there is likely to be a bigger impact in developing countries where tobacco consumption is still increasing.

One of the arguments made against an increase in the price of cigarettes is that it would lead to an increase in cigarette smuggling. However, the World Bank report refutes this:

Smuggling is a serious concern, but even in the face of smuggling, the evidence from a number of countries shows that tax increases still increase revenues and reduce cigarette consumption. Furthermore, Governments can adopt effective policies to control smuggling. Such policies include prominent tax stamps and local language warnings on cigarette packs, as well as the aggressive enforcement and consistent application of tough penalties to deter smugglers.

It is clear that there is already a large and lucrative illegal trade in cigarettes, notwithstanding the fact that price increases have not been prohibitive. An international cigarette smuggling route was uncovered this week when 80 million smuggled cigarettes were found at Dundalk port. It appears that criminal traders have used Ireland as a back door route to the United Kingdom. Recent discoveries have shown that terrorist organisations are benefiting from cigarette smuggling and this is borne out by the involvement of the Provisional IRA in a major cigarette theft at Belfast docks. I congratulate those responsible for bringing some of the criminals to justice and this House encourages the authorities to persist in their work. Since we know that smuggling is an ever-present danger which has to be overcome, we should not accept it as a false argument in favour of keeping the price of cigarettes low.

Nobody is more familiar with my arguments than the Minister for Health and Children as I suspect he has made similar arguments on a number of occasions. The Government chose to ignore the case for substantial increases in the prices of tobacco products and increased prices moderately in the recent budget. I have been struck by the fact that many people, including smokers, see the Government's failure to make the hard decision as a negative feature of the budget. It an interesting phenomenon that one would not have encountered in the past. Smokers used to give a sigh of relief and happily continue to smoke if the price of cigarettes did not alter to any great extent. There has been a cultural change and smokers are feeling the pressure, although they still find it difficult to kick the habit. It is worth asking why this change has come about. Research on Irish attitudes to smoking and smoking prohibition, carried out by the Office of Tobacco Control, shows that smokers are critical of the lack of Government action to make smoking less attractive to young people and to help smokers to stop. The office concludes that smokers are frustrated by their efforts to kick the habit; 72% of them would like to give up and 68% have tried. Smokers recognise the dangers and social unacceptability of their addiction all too well.

The Minister for Health and Children must be greatly disappointed by the failure of his campaign to exclude tobacco prices from the consumer price index. There is broad agreement that increases in the cost of tobacco products assist those who wish to stop smoking and, more importantly, prevent younger people from starting to smoke. Raising tobacco prices helps people to overcome the addiction. By creating a CPI which excludes tobacco, the Government would remove a definite impediment to ongoing increases. The Irish CPI is compiled by the Central Statistics Office, which publishes a CPI sub-index for tobacco, thereby making it feasible to publish and use a national CPI without tobacco. Despite the protests of the Minister for Health and Children, the Government feels that the exclusion of tobacco from the CPI is unfeasible as it would cause problems within the European Union. I find it hard to believe this difficulty would not be overcome if the Minister for Finance was sufficiently enthusiastic and campaigned on the issue with his European counterparts.

It is obvious that uniformity is needed when comparing price indices across Europe, but surely the Governments of other European countries see the merit of increasing the price of cigarettes. It is one of the few deterrents that is effective and leads to fewer young people beginning to smoke. Prevention is much better than cure in this case as addiction to tobacco is severe. It is regrettable that the Minister for Finance yet again has shown himself to be unsympathetic to arguments made with good public health in mind.

The problems with the European Union highlight an anomaly that has existed for some time. While Health Ministers and the European Parliament are increasingly promoting measures to reduce smoking, the European Union is subventing tobacco growers, especially in the poor Mediterranean regions. I know the subvention will cease within a few years, but its existence underlines the fact that employment in the tobacco industry is an issue of concern in many countries, including Ireland. Manufacturers, including cigarette companies, enjoy beneficial rates of corporation tax. Almost 1,000 people are employed in the tobacco industry in Ireland in Gallahers, PJ Carrolls and smaller companies such as Villagers of Ballaghaderreen. Quite apart from the powerful, unrelenting pressure from the tobacco industry, there is also the argument which is not enunciated clearly, but which is part of the subtext when it comes to challenging the tobacco companies, that people's livelihoods depend on this industry.

It was extraordinary that a spokesperson for the Irish Tobacco Manufacturing Advisory Committee pointed out that 95% of the cigarettes sold in Ireland are manufactured here. He suggested that it is better that cigarettes sold here are manufactured here, rather than abroad. It is not an advantage that cigarettes are manufactured in Ireland. This is part of the problem which must be addressed in terms of finding ways, creating alternatives or setting targets to reduce the level of cigarette manufacturing, along with the other measures which have been discussed.

The Minister tried to convince us that he was somehow getting the message across by sponsoring the snooker championship. Young women are the growth cohort among smokers, but I am not sure if many of them are involved in snooker.

The Deputy would be surprised.

I think I would be surprised. I am not suggesting that young women do not get involved in snooker, but that they do not figure largely in it. If one is to sponsor anti-smoking campaigns, it might be better to find a more effective means of targeting those at risk.

ASH Ireland is doing a remarkable job in promoting the arguments against smoking and in acting as a watchdog on decisions made by the Oireachtas and by the Minister for Health and Children in particular. The organisation has made the point that Ireland is losing the battle against the scourge of nicotine addiction given that about 7,000 smokers die each year. ASH has pointed out that, after some success in the past, a recent survey shows a 2% increase in smoking levels. It also notes that the number of young women who smoke is on the increase which is directly linked to identifying and targeting a key market by the tobacco industry.

It is important to note what happens as changes are made in terms of restrictions on advertising and sponsorship. It is like dealing with a multi-headed hydra. If one deals with sponsorship and advertising, as sure as eggs are eggs one will have to start combating the same pressure in terms of promotion, propaganda and targeting in some other area. We have seen evidence of this and it is clear that we are dealing with a powerful, lucrative industry which will resist any restriction on its activities in every way possible. It is disappointing that no Irish cigarette company has ended up in court and that the Minister has not taken any case in terms of standing up to these powerful interests who are ruining lives, and, in particular, shortening young lives in a manner which must be combated like for like.

The Bill provides that the new agency may take various courses of action. The agency may require companies to do certain things and provide certain information. What the agency will insist on, and how effective the regulations, measures and penalties for non-compliance will be, will have to be carefully thought out in light of the kind of targeting and ways and means which the tobacco industry is using.

I read some time ago in a British newspaper that, as with alco-pops, tobacco companies have been adding various tastes to cigarettes to tempt children to become addicted. They use sweet tasting additives to disguise the taste of alcoholic drinks. They are also now using cocoa, coffee and vanilla. Approved cigarette ingredients now include honey, maple syrup, molasses, liquorice and any number of fruit extracts from pineapple and cherry to apricot and banana. The article went on to point out that there is no obligation on manufacturers to list such additives on the cigarette packaging.

The article further highlights that cigarette manufacturers have an acute need to recruit new smokers. The problem for the cigarette industry is that smokers keep dying, thus affecting sales. There is an imperative on cigarette companies to keep recruiting more smokers. Each year in Britain about 120,000 of the industry's customers die from smoking related diseases. Research shows that people who do not start smoking before the age of 20 are unlikely to start at all. This means the industry must hook new smokers in their childhood or teen years. This is the purpose behind the targeting which is going on. The success of the industry in such tactics is shown by recent surveys which highlight that 5% of 11 year olds are addicted to tobacco, rising to 43% of 15 year olds.

The figures for Ireland are probably equivalent to those in Britain. Our figures are certainly disturbing in terms of the high percentage of the population which smokes. The Minister seemed to take comfort in the fact that the figure used to be 40%, but is now down to 30% or 31% which is still extraordinarily high. It has to be continually stressed that the figure is growing among young people, particularly among young women and women generally.

The Minister referred to his decision, which I welcome, to make nicotine patches available on the medical card. However, we must recognise that not everyone is aware of this. I recently advised a woman to go back to her doctor who told her, prior to the Minister's decision, that the patches were not available on the medical card. Dr. Luke Clancy has pointed out that only 18% of smokers were availing of this measure. There is an information deficit. It is relatively easy for GPs to contact people who should be targeted, but not enough of this kind of work is done at general practice level. As part of an anti-smoking strategy, doctors should be encouraged to target those patients who may be able to avail of the nicotine patches.

The Minister frequently refers to the cardio-vascular strategy which has been in operation for some time. There is a need for this strategy because of our high rate of heart disease which is about twice the EU average. As a result of this high rate we have a lower life expectancy than most EU citizens. As part of the strategy, GPs are urged, particularly when treating medical card holders, to play a greater role in treatment and in areas such as blood pressure checks, the use of aspirin and supports to help people stop smoking. This is all very well if a patient has a medical card but it highlights the practical damage done by the Minister's decision not to increase the number of people in the general medical services scheme. When people assess the Government's achievement in health they will see that despite spending additional money, the number of people with medical cards went down during the lifetime of the Government. That is a terrible indictment. The value for money audit by Deloitte & Touche showed that medical cards are good value and we know they are the means whereby doctors can carry out preventive medicine, encourage patients to come back to them without fear of having to pay, and carry out good practice in a way which is impossible when paying the doctor is a block for patients. When people with weekly incomes of £100 are obliged to pay doctors' bills, blood pressure checks and other procedures to encourage people to stop smoking simply cannot be done. How can a doctor call in a patient who would have great financial difficulty in coming to the surgery?

The Minister's decision with regard to medical cards makes the health strategy, and the cardiovascular strategy in particular, suspect because its effectiveness in application cannot be measured. Many of the points in both strategies are extremely important and very valuable but if people are prevented by their income from availing of these good and practical measures, then the Minister must admit he has got it wrong. Because of the Minister's decision many measures will not reach those most in need. It was a bad decision.

The decision underpins the issue of inequality in the health service. Earlier, when speaking about Deputy Liam Lawlor, Members spoke of a two-tier justice system. We know we have a two tier health system. Inequality is evident at every level. Apart from the accident and emergency unit, inequality is the norm. Yet it is an aberrant feature when compared with other European health services. Measures to encourage a reduction in smoking and good health care for patients who suffer from smoking related illnesses are distorted as a consequence of the inherent inequality in the provision of health care.

The issue of banning smoking in pubs is not dealt with in the Bill, although I am sure the Minister will say it is dealt with in general terms. This may be true in theory. However, there are only a few months left to the Government and if one is to deal with this issue it must be done now. I do not believe the Minister will confront this difficult issue. He will have the support of the opposition if he proceeds down that route but I do not believe he will do the painful thing in the days before an election. I have been lobbied on this issue by retailers and vending machine suppliers but not to a great extent by publicans. I have received the usual amount of briefing but publicans do not feel they are under pressure on this issue. This is an indicator. If publicans are not uncomfortable in the way one might expect if the Minister was going to deal with the issue, we can presume they know what will be done.

We often laugh at the zeal with which smoking is discouraged in the United States, but the results achieved in that country are tremendous. There has been an enormous and accelerating reduction both in smoking and in smoking related diseases. We must keep this message at the forefront of our minds. It is not just a matter of going through the motions and saying the right things. If we are vigorous enough, focused enough and brave enough, it is possible to deal with this addiction in an effective way but it requires enormous energy and commitment. This Bill does not contain an expression of that commitment. However, I will support the Bill and try to add a little vim and vigour to it. I look forward to committee stage.

This Bill has attracted much attention inside and outside the House. We often deal with legislation which people outside the House feel has little or no bearing on their lives. However, this Bill will have an effect on almost every citizen and it is important that it contains measures which are for the benefit of the people, while recognising the traditions which have survived for many years.

The main purpose of the Public Health (Tobacco) Bill, 2001, is to give greater legislative powers for regulating and controlling the sale, marketing and smoking of tobacco. As a schoolboy I bought cigarettes. Most young people go through a phase of smoking out of the sight of adults. Smoking is something which most young people try at some stage but for most this is merely a phase to be gone through while growing up. Unfortunately, for many young people smoking becomes an addiction which marks their lives and which they find very difficult to shake off.

People who become addicted to smoking pay a huge price, in terms of money and health. Deputy McManus has complained that cigarettes are too cheap but the majority of smokers would not agree with her. Because it is an addiction, people are compelled to buy cigarettes. They spend a considerable amount of their disposable incomes on them.

There is no comparison between the monetary side of the issue and the health aspect. A lifetime of smoking has to have a serious effect on anyone's health. In most cases people suffer as their health deteriorates, starting off with breathing problems. Some unfortunately will develop cancer. As a number of speakers have pointed out, from the research available it can be estimated that up to 7,000 people die each year from tobacco-related diseases. Not all smokers die from tobacco-related diseases but if 7,000 are dying each year, and one can imagine the number of people hospitalised because of similar illnesses, some idea can be obtained of the number of beds that are taken up as a result of tobacco use. It causes enormous problems everywhere and brings with it a large expense in terms of the demand on the health services.

The Bill provides for a comprehensive ban on tobacco advertising, with limited exceptions, and on all forms of sponsorship by the tobacco industry. I am pleased this ban will be introduced. The tobacco industry is extremely wealthy. It has had no difficulty over the years spending much that money on advertising campaigns which are, by and large, sexy campaigns aimed particularly at young people. They have to be aimed at young people because the customers are dying and new ones must be recruited. Research shows that the younger the customer, the more likely he or she is to remain a smoker for the rest of his or her life. That is why so much money has been spent on advertising campaigns, not just in Ireland but throughout the world. It is obvious that these advertising campaigns are successful, otherwise the industry would not be wasting its money on encouraging young people to start smoking.

In the lead-up to the budget, ASH made a submission to the Minister for Finance in which it sought an increase of 2 per packet of 20 cigarettes and a number of speakers here were very supportive of that. It is one area with which I have a certain difficulty, although I support the Minister on any initiative which aims to reduce the number of smokers. From an early stage he has shown great interest in the problem and is very keen to try to reduce the numbers of people dying from tobacco-related illnesses. The submission from ASH stated that price is a very important factor and that a significant price increase would be the most cost-effective way of dissuading young people from starting to smoke. It would also be an important trigger to make current smokers contemplate quitting and would help dissuade ex-smokers from returning to the habit.

While it may be difficult to argue with that, we must be conscious of the fact that smokers are addicted to a substance and have to have 20, 30, 40 or 100 cigarettes per day. There are all types of smokers. They are not all young or rich people; there are many old and poor smokers, male and female. It is unfortunate that in many cases, these people spend a substantial amount of their disposable incomes on cigarettes. Had the Minister decided last Wednesday to increase the price of a packet of 20 cigarettes by 2, enormous hardship would have been created for many people, particularly the elderly. We cannot ignore this. We must be realistic in the measures we take in this House and we need to look at bigger picture. I acknowledge the interest and tremendous contribution of ASH and the lead it has given in seeking action on smoking and promoting a healthier lifestyle.

The Minister, in this Bill, is trying to make it as difficult as possible for young people to get their hands on tobacco products. Many of our secondary schools have an ambivalent approach to smoking. There is probably not one school in Ireland which allows smoking inside the gates of its buildings, but if one drives by a school youngsters can be seen lighting cigarettes as soon as they come out the gate. School principals should take a much stronger line than they do. At present the out of sight, out of mind approach is prevalent – once they do not see the students smoking they do not mind. Many secondary students feel under pressure to smoke. In many cases it can be the in thing to do. We must target secondary school pupils and encourage them to take a different route. The damage, the difficulties and the hardship that lie ahead, if they decide to smoke full time, must be explained.

It is equally important, from the Minister's point of view and that of the tobacco industry, that we do not take measures that may drive the whole thing underground. In that case the results achieved would be the opposite of those we want. The measures we introduce should be realistic. We are anxious to change people's habits but nevertheless we must acknowledge that people have been smoking cigarettes for years. Old habits die hard and people will not give them up easily. We must make it as difficult as possible for young people to obtain tobacco products, whether we target shopkeepers, school teachers or parents. That is the message we must send out and any measures we take must endeavour to achieve this.

ASH has called for a ban on the use of vending machines to sell tobacco products. I disagree with that for a number of reasons. The Minister indicated in the Bill that he will allow vending machines to be used in licensed premises. That is only right as people are given a licence to sell intoxicating liquor and we put our trust in them to carry out that duty. As we are showing faith in them in that regard, surely it is not too much to ask that we show the same faith in them not to sell tobacco products to people under the age of 18. Most public houses do not welcome children after 7 p.m. or 7.30 p.m. anyway.

From the point of view of security in licensed establishments, it is preferable for publicans to use vending machines in their premises. The drinks trade is very much aware of the Minister's intentions and it is grateful for his change of heart regarding the banning of cigarette machines in public houses. It is intended that vending machines are in close proximity to the counter where they will be under the watchful eye of staff. It is important that they take their responsibilities seriously in this regard.

Ireland is not ready for a ban on smoking in pubs, but it is important that the health authorities insist on proper ventilation in pubs. Some publicans were afraid that the Minister would impose a ban on smoking in pubs. Many people only smoke when they go for a drink. These are habits that we should try to encourage people to change but an overnight ban would not be a nice way to treat people. It may be something we should contemplate in future but at the moment a ban on smoking in pubs would be a non-runner as far as I am concerned.

Deputy McManus referred earlier to the Minister's decision to sponsor a snooker event earlier this year. I confess that most people in Kildare were very sorry to see the Benson & Hedges snooker tournament leaving Goffs. It was a very welcome sporting event in the calendar and was supported by local people throughout Kildare. However, this is the price we will have to pay if we are serious about implementing the new legislation and placing a ban on cigarette advertising. There is bound to be some pain and any group suffering that pain will react and put pressure on Members to change the rules a little. It is vital that the House promotes a healthy lifestyle, particularly among young people.

This was the first year that the snooker moved from Goffs and it only moved up the road to Citywest. The Minister agreed to sponsor it and while it is important to support events, particularly in the first year, it is questionable whether that was a proper use of resources – I would say it was not. While the event receives an amount of television coverage, other anti-smoking campaigns would be much more productive. I encourage the Minister to look at other ways of spending money on encouraging people not to smoke.

We see cigarette butts strewn about on every street. In recent years a number of people were fined for throwing butts out their car window and people have to be made aware of their responsibilities. Smokers do not have a right to throw the butt anywhere once they finish a cigarette. It is important that we continue the anti-smoking campaign but, from a litter point of view, it is imperative to tell smokers what to do with their butts. I congratulate the Minister on his health strategy. It is obvious that much consultation went into it and while we are not expecting overnight success, it is the way forward in the long-term.

I wish to share my time with Deputy Lowry. We will have ten minutes each. We have all heard the question about whether people who died from cancer smoked. The next question asked usually refers to drinking habits. Relatives of people on their death bed say that their loved one is paying the penalty for smoking by having a hard death. There are two eminent doctors in the Chamber and I am sure they have experienced such scenes over the years.

The attitude to smoking has changed in recent years. I applaud people who no longer allow others to contravene the no-smoking regulations on buses, in restaurants and so on. The message is getting through. Ten or 15 years ago people smoked everywhere and nobody said anything. It was acceptable on soap operas on television and I am sure cigarette companies played a part in that by sponsoring programmes. I see a resurgence of smoking on television again and this needs to be addressed.

Debate adjourned.
Sitting suspended at 6.30 p.m. and resumed at 7.00 p.m.