Dáil Éireann debate -
Friday, 15 Jul 2011

Vol. 739 No. 1

Public Health (Tobacco) (Amendment) Bill 2011 [Seanad]: Second and Subsequent Stages

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

Minister of State at the Department of Health (Deputy Róisín Shortall)

At the outset, I wish to acknowledge the welcome given to this important legislation during its passage through the Seanad earlier this week and, in particular, the all-party and across-the-board nature of the support that was accorded to the Bill in that House.

Tobacco packaging serves as a critical link to consumers. It must be acknowledged that the brand imagery of the tobacco package is the foundation upon which all other marketing is built and plays an even greater role in jurisdictions such as Ireland where traditional forms of advertising, promotion and sponsorship are restricted. It is, therefore, critical that health warnings on tobacco packages counteract the promotion of these products.

The first guiding principle of the World Health Organisation's Convention on Tobacco Control is that every person should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke. Tobacco packages are an excellent medium for communicating health information, particularly in light of their reach and frequency of exposure. Tobacco health warnings are also unique among tobacco control initiatives in that they are delivered at the time of smoking and at the point of purchase. As a result, the vast majority of smokers report a general awareness of package health warnings and those who smoke a pack a day are potentially exposed to these warnings some 7,300 times per year. Such health warnings on tobacco packages are among the most prominent sources of health information.

The 2010 global progress report on the implementation of the WHO's Framework Convention on Tobacco Control reported that 44 parties require health warnings to take the form of or include pictures. A total of six EU member states have introduced combined text and photo warnings and a further four are in the process of doing so. Health warnings on the packaging of all tobacco products are guaranteed to reach all users and increase smokers' awareness of the risk they are taking. The use of pictures which contain graphic depictions of disease and other health-related and cessation images has greater impact than words alone and is critical in reinforcing the warnings.

The WHO's recently published Report on the Global Tobacco Epidemic confirms that effective health warning labels increase smoker awareness of health risks and increase the likelihood that they will think about cessation and reduce tobacco consumption. The report also considers that such warning labels shift the nature and value of packaging away from marketing and towards public health messaging. The WHO report also points out that in Australia the introduction of graphic health warning labels in Australia led more than half of smokers to believe they had an increased risk of dying from smoking-related illness. Some 38% of these individuals felt motivated to quit. Other countries with pictorial warning labels, including Brazil, Singapore and Thailand, report similar effects on smoking-related behaviour. Findings from Canada, Thailand and elsewhere indicate that considerable proportions of non-smokers also report awareness and knowledge of package health warnings. As a result, health warnings are an extremely cost-effective public health intervention and have a tremendous reach.

Full-colour, picture-based health warnings on tobacco products are far more effective than text-only warnings. Pictorial health warnings on tobacco products make them less attractive and target smokers by providing them with information on tobacco-related health risks. They are an essential component of a comprehensive tobacco control programme.

In introducing this Bill, it is appropriate to reflect on the comprehensive range of tobacco control legislation that has been introduced in Ireland since 2002. I refer, in particular, to the successful implementation of the smoke-free initiative in 2004, the ban on the sale of packs containing fewer than 20 cigarettes in 2007 and the ban on in-store display and advertising and the introduction of the retail register in 2009. This comprehensive range of tobacco control legislation places Ireland in the top rank of countries internationally.

Despite the significant tobacco control measures that have been put in place to date and the widespread knowledge of the harm caused by tobacco consumption, smoking prevalence in Ireland remains unacceptably high. The most recent SLÁN survey estimates that 29% of the population smoke. This prevalence rate has remained stubbornly high for a number of years and was a cause of particular concern to Members of the Seanad when the Bill was debated there earlier this week. This prevalence rate is despite the comprehensive nature of our tobacco control legislation. We cannot, therefore, become complacent and must continue to build on the work that has already been done. This legislation is a further step in that regard.

Combined text and photo warnings, also known as pictorial or graphic warnings, on tobacco products were developed by the European Commission for member states that wished to adopt them. The Commission proposed a library of these warnings, but as their introduction is not mandatory, the legislation before the Dáil today is required prior to their introduction on the Irish market.

We should not lose sight either of the health consequences of smoking. It must be remembered that smoking is the greatest single cause of preventable illness and premature death in Ireland, killing over 5,700 people a year. Half of all those people who continue to smoke for most of their lives will die of their habit, half of these before the age of 69. Every year, premature deaths caused by tobacco use in Ireland are far greater than the combined death toll from car accidents, fires, heroin, cocaine, murder and suicide. It is worth reflecting on that.

Tobacco use is also a major cause of increased morbidity. Smoking is the main cause of chronic obstructive pulmonary disease, COPD, and causes nearly 90% of all cases of emphysema. There is also a causal relationship between smoking and acute respiratory infection, including pneumonia and tuberculosis. Smoking increases the risk of cardiovascular disease, with the risk of mortality from cardiovascular disease in cigarette smokers being 1.6 times that of those who never smoked. The impact of smoking on health care costs, in terms of treatment services for cancer, cardiovascular disease and respiratory diseases, is significant. If we do not make progress on reducing the impact of tobacco within the next ten years, it is estimated this will cost our health service in excess of €23 billion. This would pay the entire cost of running our health services for almost two years. Smoking costs the Irish economy at least €l million per day in lost productivity.

It could be a concern that the use of shocking images is not the best way to inform smokers. However, qualitative research in the UK has shown that images tend to be most effective when they convey shock, immediacy and empathy. Smokers tend to be affected by shock images that are disturbing or unpleasant to look at. Research in Belgium has demonstrated similar results. Warnings shown to have the most impact were those that were felt to be the most graphic and most disturbing. In Ireland, pre-testing of the 42 images in the EU library was carried out by TNS MRBI on behalf of the then Office of Tobacco Control and the 14 warnings to be used on the Irish market were identified. The research found that images impacted differently depending on age group and sex. For example, the apple image particularly impacted on a very important target group, namely, younger female smokers in the 18 to 35 age group. They could readily see that smoking causes damage to the skin, predominantly around the eyes and the lips. At the same time, impotency was found to have a particular impact on younger male smokers.

International research indicates that smokers are more likely to remember a health consequence of smoking, when smoking, if they have seen a picture. In Canada, more than 50% of Canadian smokers say the warnings compelled them to smoke less around other people. Canadian smokers who discussed the combined text and photo warnings were significantly more likely to quit, attempt to quit or reduce their smoking, and 31% of Canadian ex-smokers participating in a study reported that combined text and photo warnings had motivated them to quit in the first place.

In bringing this legislation before the House, I have taken particular note of general concerns raised with regard to children and smoking. Three-quarters of all smokers in Ireland started smoking before the age of 18 and half of all smokers before the age of 16. While research on school aged children shows that smoking rates for those aged 15 to 17 decreased between 2002 and 2006 for both girls and boys, the decrease was much smaller among girls in that age group. The fact remains that the earlier children start to smoke, the more likely they are to remain smokers for life.

The ban on the sale of packs of cigarettes of less than 20 since 2007 was introduced with young people, in particular, in mind. The 2009 legislation removing point of sale display and advertising in retail outlets ended the placement of tobacco products in close proximity to every day consumer goods such as sweets and newspapers and is a comprehensive and far reaching body of legislation that will, over time, considerably assist ongoing efforts to denormalise tobacco use in Ireland. Already, by 2010, the proportion of children who recalled seeing retail tobacco displays had dropped by 60%. It is no coincidence that one of the world's largest tobacco manufacturers has now initiated legal proceedings in the High Court challenging key provisions in our 2009 legislation, including the point of sale advertising and display ban.

The Bill before the House today is a further important intervention in our ongoing efforts to reduce smoking, particularly by young people. The recent WHO report highlights that graphic warning labels are more likely to prevent adolescents from initiating smoking or, if they are already smokers, to think about cutting down or quitting. While an enabling provision allowing the Minister to make regulations was included in the 2009 Public Health (Tobacco) (Amendment) Act, which was enacted in July 2009, the Department was advised by the Office of the Attorney General that this provision in the 2009 Act does not adequately empower the Minister to make the necessary regulations. The Office of the Attorney General advises that an amendment of the 2009 provision is, therefore, required to give the Minister the necessary authority to make the required regulations.

This Bill will allow for the introduction of regulations which will provide that all tobacco products sold in Ireland will carry a combined text and photo warning. This will, in turn, help to reduce the numbers of people smoking and, more particularly, encourage children and young adults not to start smoking. I would again like to confirm this Government's commitment to health promotion and tobacco control measures that support the aim of denormalising tobacco. We will work constructively with all stakeholders to achieve this goal. I commend this Bill to the House.

Deputy Billy Kelleher

I welcome this legislative provision. We have spoken on this issue on numerous occasions in the context of broader health debates, but this provision is critical and central to any Government policy aimed at promoting health in the population.

We must acknowledge that smoking, and nicotine in particular, is addictive and must look at the issue in that context. The statistics show clearly that a large number of people who smoke would like to be able to give them up and that they continually make an effort to give up cigarettes. I have tried once or twice to give them up myself. We must be very conscious of the addictive nature of smoking when discussing health promotion and reducing tobacco consumption in Ireland. Sometimes we forget to look at tobacco as an addictive substance. Therefore, any policies we bring forward to discourage people, young people in particular, from starting smoking or to encourage smokers to quit smoking are welcome.

The proposal to use these graphic photographs is positive. All the research shows clearly that graphic images make people more aware of the negative health impacts of smoking. We do not have to look far to see the power exerted by the tobacco industry. Philip Morris International and others are flexing their muscles in threatening to bring states to court if they seek to introduce generic packaging of tobacco products. The company is initiating such an action in Australia, for example. We should not be surprised by these tactics given that tobacco companies have lied on many occasions over the years when making presentations to the United States Houses of Congress and various committees on Capitol Hill and have consistently denied putting any chemicals or products in cigarettes to make them more addictive. We all know that is patently untrue. If they were concerned in any way for people's health, they would try to make cigarettes less damaging and addictive. Instead, the policy is to ensure that smokers maintain the habit for as long as possible. We should not be bullied or browbeaten in any way by companies whose sole objective is to enslave people to nicotine addiction.

As a society and as a Parliament, we must get to grips with the importance of health promotion. At present, it is done in a piecemeal way, with the Department of Health having overall responsibility, the Department of Education and Skills making noises about increasing the allocation for physical education in the educational curriculum, and the Department of Children and Youth Affairs and the Department of Transport, Tourism and Sport also having a remit. There should be a concerted and co-ordinated effort across all Departments to ensure health promotion and physical activity are at the centre of the educational curriculum. I am not talking about physical education for one hour a week rather an effort to educate children to see physical activity, healthy eating and good nutrition as a vital part of life. In a broader sense, we must encourage people to reduce consumption of alcohol and cigarettes and to be aware of nutritional and physical activity guidelines.

I do not mean to take a puritanical approach, but there is extensive evidence to suggest that while we are becoming more aware of health issues in general, we are, as a nation, struggling in certain areas, as evidenced, for instance, by the increase in the incidence of obesity in young people. It is a problem any Government and society should seek to address at an early stage, rather than having to deal with the serious medical issues arising in later life from unhealthy living. The cost to the Exchequer, and hence to the taxpayer, in dealing with smoking-related illnesses in the years ahead is alarming, with a potential contingent liability on the State of some €29 billion. We can encourage people to give up smoking, improve labelling and packaging, introduce strong advertising campaigns and so on, but we must also, because tobacco is an addictive product, facilitate people who are making efforts to give up smoking, perhaps via the provision of nicotine replacement patches, tablets and so on. I am not suggesting that people should be able to avail of these products free of cost whenever they like, but a system might be put in place whereby smokers are allocated a quota of nicotine replacement therapy products free of charge. We must look to more practical support solutions other than helplines and advertising campaigns. The research shows that nicotine replacement therapy can help people to quit smoking.

Within the cohort of the 29% of the population who smoke, the most alarming statistic is the number of young girls taking up the habit. We must look at advertising in this context, where there is a bombardment of subliminal messages that smoking will make a girl look like Kate Moss or some other supermodel. There is a view among teenage girls that smoking acts as a diet suppressant and will enable them to attain a model figure. These subliminal messages put huge pressure on young girls in terms of diet and the attraction of smoking. Of all the cohorts we should be targeting, young people, particularly young girls, are the most important.

I speak more as a father than a politician in observing that while many male role models are healthy individuals — rugby players, soccer players, hurlers and so on — some of the role models presented to young girls are not so positive. The physical ideal of tall and thin puts great pressure on girls from an early age. Advertising can feed on this insecurity with messages that if girls smoke they will eat less and end up looking like Kate Moss. It is an insidious and subliminal message that is being encouraged by tobacco companies throughout the world. Of that there is no doubt. In taking on the tobacco companies, we must highlight this aspect of their advertising.

The Health Service Executive has an obligation to promote the benefits of quitting smoking. The stark reality is that one in two smokers will die of tobacco-related illnesses. In other words, up to 6,000 people per year are dying as a consequence of nicotine addiction. As the Minister for State observed, it is alarming that despite all the efforts in this area in recent years, smokers continue to make up 29% of the population. This stubbornly high rate suggests we can only go so far in terms of the control of tobacco, restrictions of sale on age grounds, restrictions on the presentation of sale and this latest measure regarding tobacco packaging. What is required is a change of mindset in our society. That is happening to some extent, but we are behind other countries such as Australia. The latter is an extremely health-conscious nation where the importance of healthy living is promoted in schools, workplaces and so on. The messages regarding healthy living are part and parcel of people's everyday lifestyle. That is the most effective way of driving down the smoking rate in Ireland.

One could argue that our climate does not lend itself to encouraging people to do press-ups on beaches. However, we must devise more effective methods to encourage people to look after their health and live more active lives. In Cork, as elsewhere in the State, one sees slí na sláinte signs about the place. Walking groups are springing up throughout the country which encourage people of all ages — but mostly those in middle age and beyond — to be active. These organised walks and group support systems should be rolled out in communities throughout the State with the support of local authorities and in conjunction with the HSE. There must be active encouragement and support for people seeking to pursue a healthier lifestyle. That will involve a co-ordinated approach between local authorities, in devising walking routes, and the HSE in promoting the schemes. Schools also have a clear role to play. I hope we will see in the coming years a stronger emphasis on ensuring health promotion is at the centre of learning in primary schools, with all the benefits which flow from that.

As a small country, we have a very high success rate in various sports, boasting many national and international sports stars. There are soccer, rugby and GAA clubs in every town, village and parish yet teenagers continue to take up smoking at a very early age. I began smoking when I went to boarding school at 12 and half years of age. I am aware of how difficult it is to give up. For many smokers, their greatest regret in life is starting to smoke. If we can prevent teenagers from taking up the habit, it will have a positive effect in driving down the stubbornly high smoking rate. As a person who struggles with and occasionally succumbs to nicotine addiction, I find nicotine replacement therapies useful. Perhaps it is merely psychological, but they certainly help me in times of stress.

In this old life, one experiences lots of stress. I hope the Minister could consider arrangements through the medical card service for people to access nicotine replacement aids for a certain number of days to help them stop smoking. It is expensive, but I believe such a service is available through the National Health Service in England. I am not making political points, but ask the Government to consider this as a public health measure.

As 29% of the population smoke, it is quite clear that public policy is not driving down that figure. I think this Bill is a very welcome measure. I would nearly welcome tobacco companies such as Philip Morris flexing their muscle because it might expose the tobacco industry for what it is. The tobacco industry is powerful with significant resources behind it. Consider the Tobacco Master Settlement Agreement which was the basis for legislation in the United States where, without admitting liability, tobacco companies coughed up significant sums to various US states that took actions against Philip Morris and others to mitigate against the contingent liability of costs relating to smoking illness in the years to date and in the future. The tobacco companies argue that smoking is not bad for the person, but indirectly they are funding some of the fallout in health spending.

While the measures in the Bill will help, we need a stronger, deeper and more focused aggressive campaign at all levels to promote a healthy lifestyle and encourage people not to take up smoking. I believe there is a strong role for sports people and others to whom young people look up in strategies to tackle smoking. Sports people can promote a healthy lifestyle and encourage younger people not to start smoking. There is peer pressure on youngsters to buy the packet of cigarettes and head out to the back of the school and start smoking. It can spiral from there. The statistics show that those who start young are enslaved for much longer. Some 5,500 people die each year from smoking-related illnesses. There is a major drain on health service resources for the provision of care to those suffering from smoking related illnesses. Nobody wants to single out a group of people and stigmatise them for smoking, but at all stages we must encourage and convince them that what they are doing is harmful to themselves. I think helplines and campaigns to quit smoking, followed up by assistance to deal with the addiction of nicotine and wean a person off it may be measures that should be considered in a stronger way.

The Minister said that a tobacco company is taking the Government to court. The tobacco companies have flexed their muscle all over the world, but at the end of the day there should be no sympathy for tobacco companies. I do not think the chief executive of Philip Morris or any other tobacco company will go to a hospice to express sympathy to those families of people who died from smoking or pick up the bill at the end of the day. They are unscrupulous in the way they aggressively target people and market their products, in the full knowledge that they are harmful and damaging to the health of the population. When one visits countries where the control of tobacco is not heavily regulated, it is quite clear that the tobacco companies target the youngest, children who are aged from only six to eight years. That is indicative of how low these companies will stoop to further enslave more people to their products for one motive, profit and greed at any cost. I support the Minister in aggressively combating those actions by the tobacco companies and I hope many other countries will bring forward strong tobacco control legislation and resist any pressure from these bully boy companies. Australia has taken the lead and we should examine this with a view to learning from the health promotion measures it has put in place.

It is proposed to place graphic photographs on cigarette packaging and this will make people become more aware of the dangers of smoking and its consequences for their health. The Minister suggested that it also raises awareness among non-smokers of the damage that smoking can cause to the health of an individual and the broader society.

The introduction of the ban on smoking in the workplace in 2004 was a very positive step. There was considerable resistance to it, more from the fear of change in the way we socialise. It has, however, been embraced by people and inspections by the control of tobacco unit, now subsumed into the HSE, show there is strong compliance in public houses and the broader workplace. It is the people who really police the ban, individuals acting collectively in society. It would be frowned upon if a person decided to light up a cigarette in a hotel foyer or in a bar. That is now completely unacceptable behaviour. If we can change the mindset of those who smoke when they are out socialising, at a time when they are most open to temptations, we should be able to change the mindset of how people view health promotion and the consequences of smoking, obesity and other behaviours. Health promotion should be taken across all areas.

What the smoking ban shows is that if there is a strong legislative framework, with implementation supported by enforcement and a consistent coherent campaign of education, advertising and promotion, people will begin to listen.

I could enumerate the damaging effects on human health, but the pictures are worth a thousand words. I hope this measure will discourage people from starting to smoke and encourage others to stop smoking. I welcome the Bill and I hope not only Ireland but the countries of the European Union will embrace it fully. I commend it to the House.

Deputy Sandra McLellan

I welcome the opportunity to speak on this technical Bill which allows the Minister to introduce combined text and photographic health warning on tobacco products. We have no difficulty with these amendments to the Public Health (Tobacco) Act 2002. The Bill provides an opportunity to address some of the issues around smoking. Progress has been made in recent years especially through the smoking ban. Studies have already shown the benefit of this ban both for workers in the indoor areas where it operates and for the general public. However, smoking is all too prevalent. Young people continue to take up smoking in large numbers. A study by Dr. Alan Moran in Drogheda looked at the issues of peer-parent-sibling pressure on smoking and the reasons teenagers stop smoking. He surveyed pupils from three main secondary schools in the north east and found that if a sibling smoked, the adolescent was three and a half times more likely to smoke. If a best friend smoked, they were 11.5 times more likely to smoke. Of the boys surveyed, 79% reported enjoying smoking, 80% reported having tried to stop smoking and 70% wanted to stop. The reasons they started smoking were stress, 34%; to feel cool, 15%; to feel confident, 11%; enjoyment, 10%; addiction, 9%; and because friends smoked, 3.3%. Only 9% thought they smoked because they were addicted but 34% because they were stressed. Also of interest in this study is that, in spite of legislation banning the sale of cigarettes to those under 16 years, all the adolescent smokers stated they were able to buy cigarettes when asked where they got them from.

Many older people who have smoked are experiencing all the hugely damaging health consequences. The cost in terms of population health and the drain on the scarce resources of our public health services is very substantial. The campaign to reduce smoking and to work towards a smoke-free society is very important and needs to be maintained and expanded.

Action on Smoking on Health, ASH Ireland, has expressed disappointment that Ministers for Finance did not increase the price of tobacco sufficiently in their budgets. The organisation has pointed out that price is recognised by the World Health Organisation and others as the most important way of encouraging smokers to quit and discouraging young people from experimenting with tobacco. The Government response is to express the view that such price increases might encourage tobacco smuggling. That is not an adequate response.

Tobacco smuggling is a huge problem and needs to be tackled in its own right. It is huge business for criminal empires internationally with a big market in Ireland. The cigarettes being illegally imported in billions are very often even more dangerous and more toxic than those legally imported and sold here. Anyone involved at any level in this deplorable trade, whether criminal bosses or people selling cigarettes from their homes to children, is to be condemned and should be made accountable to the law. We should continue to co-operate to make progress in reducing smoking in our society. Sinn Féin supports the Bill.

Deputy Catherine Murphy

I propose to share time with Deputy Mick Wallace. This Bill is welcome. Anyone who has seen a member of the family suffer and die from lung cancer will know that seeing someone trying to survive on an eggcup of air in the lungs is enough to put one off smoking for life. Professor Clancy in St. James's Hospital articulates in graphic detail the job he has in dealing with people with lung cancer. The Bill is a step in the right direction and the photographic warnings are quite graphic. The evidence appears to be that they work. They must be targeted at the group most likely to commence smoking. I started smoking when I was a teenager and into my early 20s. It was so difficult to give up that I promised myself I would never do it myself again. When people embark upon it, they do not realise how addictive it is. The younger age group must be targeted. This can be done with photographic warnings and with health promotion and prevention campaigns.

This is considered international best practice and the World Health Organisation convention on tobacco control recommends full-colour pictures are included on the packaging and the label. This Bill brings Ireland into line with the international consensus on a critical public health issue. Evidence from countries that have introduced the warnings show a greater impact from graphics than from text alone. Text had an impact when it was first introduced but people have stopped noticing it. We can learn the lesson that images on packages must change over time so that they continue to have an impact. This is a cheap and effective strategy in reducing tobacco consumption and it saves lives. It makes cigarette smoking less attractive to those who are most likely to take up smoking and to smokers. The imagery has a nagging effect that will be helpful. The Eurobarometer survey showed that nearly 50% of smokers in Belgium between the ages of 15 and 17 years thought pictorial images on the packaging made smoking less attractive.

Smoking is the largest cause of preventable death and disease in Ireland, killing half of all lifetime users. It should be the single highest priority in health promotion policy. It is shocking to think that 30% of people in Ireland smoke. I did not think it was that high and I thought it had dropped considerably. I remember sitting in council chambers with some of the people who are Members of the Dáil. I remember Deputy Bernard Durkan with his pipe and Deputy Stagg smoking one cigarette after another. That was acceptable practice in the council chamber.

Deputy Finian McGrath

The good old days.

Deputy Catherine Murphy

We sat in a fog and it was outrageous.

Deputy Finian McGrath

Bring it back.

Deputy Catherine Murphy

Now, it would be completely frowned upon.

Deputy Finian McGrath

They would be shot at dawn.

Deputy Catherine Murphy

There were also other smokers. Going to other countries, one arrives at the airport and sees people smoking, which is shocking when one is used to the smoking ban here. I do not think it has modified the behaviour of one of my constituency colleagues but at least this takes place outside.

Some 79% of smokers want to quit, which suggests the shock campaigns will be effective. I would like to see the campaigns extended to television. This would work very well in respect of health promotion. The impact of the staining of people's skin will have an impact on those who are smoking because they think it will change their weight. It costs the State an estimated €1 billion every year to provide services for smokers. Putting €1 billion towards job creation would make a phenomenal difference. We must consider what we can spend that money on as well as extending the life of people who will not smoke. We will not tackle cancer if we do not tackle smoking. On Newstalk this morning, I heard that over half of the waste on the streets is cigarette butts. One cannot but notice it and it is unsightly and costs money to clean up. It may be a small thing but it is very unattractive. The former Minister of State, Mary Wallace, said in 2009 that if we do not make progress reducing the impact of tobacco in the next ten years, it is estimated that the cost to our health service will be in excess of €23 billion. This would pay for running the health services for two years. The argument is profound when one considers these figures.

I would like to see cigarette companies being obliged to put the telephone number of the National Smokers' Quitline on the packets. That amendment would be useful because people need assistance. Anyone who has given up smoking cigarettes will give themselves 150 reasons they should not give up. We need to give people a reason and the means to give up cigarettes.

The embargo on public service recruitment to the Garda Síochána and the Customs and Excise service is counter-productive in respect of cigarette smuggling. There are all sorts of concoctions of dangerous content beyond tobacco. We must make an all-out assault in dealing with that because not only are we losing revenue for the State, but the least well-off communities will be targeted for selling those cigarettes. Those black market activities are ongoing and we must tackle that problem. The campaign for increasing the cost of cigarettes was an important factor in discouraging people from starting to smoke and encouraging others to give up, but it is being seriously interfered with by virtue of the fact that we have a thriving black economy in the area of illegal cigarette selling. I would like that specific area to be targeted. If the customs service wants the embargo to be lifted for those areas, there is an unanswerable case for doing that because there are returns in terms of money going back to the Exchequer but also health benefits.

An Ceann Comhairle

There are 21 minutes left in this slot. Deputies Shane Ross, Finian McGrath and Luke ‘Ming' Flanagan are on the list.

Deputy Mick Wallace

I would like a few minutes to contribute. Deputy Flanagan is not here.

An Ceann Comhairle

I will replace Deputy Flanagan with Deputy Wallace.

Deputy Shane Ross

I welcome this Bill and the spirit in which it is introduced. The motivation behind it is undoubtedly something we should applaud. The only problem I have with it is that I am doubtful about the effectiveness of these measures. In her contribution the Minister of State highlighted an interesting statistic, namely, that 29% of the population — nearly one in three — still smoke despite past legislation of this sort, including the legislation introduced by Deputy Micheál Martin when he was Minister for Health and Children and massive educational campaigns to stop people smoking. One wonders what will deter people from smoking if this sort of campaign will not do so.

The introduction of pictures of this sort is welcome in the sense that it is an attempt to give people an opportunity to make an informed decision. It is difficult to get that message across to people who do not want to hear it, namely, smokers. People who started smoking do not like to hear that what they are doing is bad for them because they enjoy smoking so much, but it is important to get that message across to children and younger people and I welcome the campaign in that sense.

I sometimes worry, and I would be interested to hear the Minister of State's comments on this, about the value and virtue of shock therapy of this sort. Some of these pictures are commendable but there are some horrific images also. One sees the same type of images in the television advertisements highlighting car accidents and the dangers of drinking and driving. There is a tendency to introduce shock therapy to discourage people from doing something but I often wonder about the effect of that on people who already have got cancerous effects, and one of these pictures is of a cancerous lung. It is somewhat unfair to those who already have that disease to be told the state of their lungs and how horrific it is for them to see that.

I wonder if the message could be got across without it being quite so stark and crude. I do not know what the research shows on the effect of these messages and whether it prevents people from taking up smoking but I imagine it might be just as effective if the message could be got across in terms of statistics and the damage that could be done. Some of these photographs are deliberately vile in appearance and I imagine extremely hurtful to those already suffering from these diseases and for their families. That also applies to those advertisements depicting car crashes because the families of people killed must be very upset by them. It is a consideration which should be taken into account. It might be better to accentuate the positive benefits of not smoking or giving up smoking rather than the horrors of what one may do to oneself or maybe have already done to oneself if one continues to smoke heavily.

I say that as one who many years ago smoked at least 100 cigarettes a day for many years. That was utterly destructive in terms of my bank balance, although one does not notice it because it is gradual in that it is only so much per day, but also in terms of my health. I was lucky in that I was too young at the time for my health to have suffered but it was unhygienic, undoubtedly unhealthy, unpleasant for people who were with me, and it caused offence to the many people who had to put up with it. It also affected my own life in that I found it difficult to go to places where I was not encouraged or allowed to smoke. I smoked between courses. I smoked when I got up and I smoked before I went to bed. I smoked in bed. I was certainly an addict, although I gave it up without any help, but it is the kind of addiction which must be discouraged and is something which is insoluble unless we go to the extreme of banning smoking, which is unrealistic at this stage.

The statistics are utterly convincing. There is enough in the Minister's contribution statistically to convince one that smoking is deeply damaging to one's health. The number of people who have got cancer or heart disease as a result of smoking is very convincing but there are still what I call the flat earth smokers around who say that if somebody eats enough fat or does such and such they will damage their heart. However, smoking is a massive contributory factor. Ask any general practitioner what are the contributors to heart disease and they will say stress, high cholesterol levels and smoking. If one does not smoke they will take one off the list and say one is in less danger. It is pointless to contest the fact that smoking is bad for people. It is extremely bad for them, and it may cause their death. They may be lucky, and many smokers hope to be lucky, although they are playing Russian roulette with their lungs, but statistically they are unlikely to be that lucky.

The other issue is the freedom of the individual to do what they wish. There is the nanny state argument that if people want to drink, smoke, smoke cannabis, take heroin or whatever, they are adults and they should be allowed to do it. I am not sure I agree with that argument because what they do not have is the ability to make that informed choice. An informed choice will be helped by putting these photographs and more text on cigarette packets but whatever we do it must be State policy to discourage people from doing things which, in the view of the Government and the State, are categorically and almost undeniably bad for their health. That is a duty for an adult state to take. It should not be compulsion but encouragement.

I welcome the Bill. I congratulate the Minister on introducing it. I hope it will be effective but I hope also that she might consider examining the crude nature of the advertisements used because they may be extraordinarily upsetting to people already suffering from diseases connected with smoking.

Deputy Finian McGrath

I thank the Ceann Comhairle for the opportunity to speak on the Public Health (Tobacco) (Amendment) Bill 2011, the object of which is to enable the Minister to make regulations and introduce combined text and photo warnings on tobacco products. Before I discuss the details of the Bill, I must declare an interest in this debate. I am one of those very bad people despised by many sections of society, particularly in modern Ireland, because I smoke.

Deputy Shane Ross

Shame.

Deputy Finian McGrath

While I support the Bill, I have major concerns over the way smokers are treated. While I totally respect the rights of non-smokers, listened very carefully to other contributions and support many comments on the health effects of smoking, I believe throwing smokers out onto the wet and windy streets in the cold and rain shows a complete lack of tolerance for 29% of the population. This is a legitimate point. The closing down by the HSE hit squads of smoking areas in pubs that install a cover or roof for smokers is completely over the top. I have direct experience of this. Where publicans put up a little canopy or a little extra cover for smokers, the HSE closes down their designated smoking areas within 24 hours.

I raise this point because many people get sick and tired of these petty occurrences. Consider, for example, the case in Galway yesterday. Where were the HSE hit squads when they were needed to move in and help the poor children in question who suffered for years? We should ask ourselves questions in this regard. Sometimes people get distracted by trivial issues. The HSE's lack of common sense is appalling and its lack of respect for the 29% of the population who smoke is undemocratic in so far as it impinges on the rights of minorities. This is a legitimate point.

The elephant in the room, which is known to all political parties, is the loss of jobs in the past five or six years, or since the smoking ban was introduced. It is as if we are not allowed to talk about this issue. In the current economic climate, we should consider all the factors associated with job creation and retention. I make this point because publicans have told me their revenue has dropped by 15% to 20%. Many young people are now drinking cans of beer at home because they can smoke at home. There is a cultural change. One should not believe smokers have gone away.

Deputy Ross referred to the effectiveness of anti-smoking campaigns. One must look at the matter honestly. Although the Government has a legitimate concern and is correct about the health issue, it should examine the effectiveness of anti-smoking campaigns. Some 29% of the population still smoke despite all the hype and throwing smokers out in the rain and cold. The Government has not examined the deeper causes.

People smoke for different reasons, including when they are young. We need to consider these. It is very easy to issue soundbites and little pictures and hammer smokers. The latest is that smokers are being blamed for the problems in the health service and the economy. If the Government does not bear in mind the amount of tax smokers pay to the Exchequer, it should get off the stage and listen to what is happening in the real world.

My position has always been that designated smoking areas in all pubs comprise a sensible and fair solution. This solution would respect the rights of non-smokers and give smokers a break from the high-moral-ground brigade. Accommodating difference and enjoying diversity should be at the heart of any democratic society. I make this point genuinely because it is very important.

Section 1 of the Bill provides for the Minister to make regulations to introduce combined text and photographic warnings on tobacco products. I do not know whether campaigns designed to shock and horrify work. When I see the television footage showing a young couple being knocked down in a car crash, I immediately change the channel. I have talked to friends and my supporters about this and most told me they do not want to take such campaigning on board. I do not know whether showing photographs of people with cancer will be effective. The correct approach is through education and targeting people at a younger age.

I started smoking when I was 12. I started at the back of the schoolyard with a gang of lads because I was an insecure, shy young teenager. These are all the issues with which one must deal. Every day, I see young girls in secondary school having a smoke during their lunch break. One must consider the reasons. Some believe they smoke to control weight or because of low self-esteem. We should consider these issues and have an honest debate. Let us is not spend more millions of euro on campaigns that may not work.

I have concerns about the direction our country is going and am very worried about the creation of a nanny state. With regard to job creation, I meet many tourists from different countries who tell me our stance on smoking is putting them off. They travel to a beautiful pub in Connemara and must stand out in the rain to have a little cigarette and enjoy the odd pleasure in life. I had a general practitioner who lived to be 90 who always said one should do everything in moderation, that there is nothing wrong with having a smoke, drink and a chat and that this is good for one. I am in that camp.

When I heard Deputy Ross talk about smoking 100 cigarettes per day, I was blown away. I am one of the reasonable smokers and smoke 15 to 20 cigarettes per day. When I heard about the smoking of 100 cigarettes per day, I said to myself I am not at the races at all.

The Minister of State, Deputy Shortall, referred to the SLÁN survey that suggested 29% of the population smoke. She said the percentage has remained stubbornly high for a number of years. This is very true and links into the debate on where campaigns are going wrong. One reason they are going wrong is the lecturing tone of some of them. This does my head in as a smoker.

Let me consider international research. Smoking is damaging to one's health but so is eating too many burgers or drinking too many pints in a week. For some reason, Irish society is ganging up on smokers. There is a lack of balance in the debate.

With regard to research on health issues, many people who did not smoke died of cancer. Therefore, we must ask whether the research is accurate. Should it be more detailed? We must have a balanced, non-emotional debate, consider the facts and proceed on that basis.

Deputy Mick Wallace

Deputy McGrath's contribution was very interesting. I would not agree with much of it but we are allowed to disagree in the Technical Group.

Deputy Robert Dowds

We are even allowed to disagree in the Labour Party.

Deputy Mick Wallace

We are looking forward to that. I have many vices but thankfully smoking is not one of them. I have never smoked and thank goodness for that.

I have a daughter of 18, who is doing the leaving certificate this year, and a son of 17. This morning I asked my daughter the percentage of her class who smoked. Given that 29% of the population are believed to be smokers, it is horrific to note how many young people are smoking. My daughter says 80% of the approximately 60 pupils in the two classes in her year smoke. Eighty per cent is an unbelievable figure.

I believe campaigns work. Approximately 30 years ago, the number of young people smoking dropped significantly because of a campaign at the time. Over the past ten years, similar emphasis is not being placed on anti-smoking campaigns aimed at young people. Although my two younger children do not smoke — the two older ones do — the fact that so many of their friends smoke indicates it has become trendy again. This is a big problem. We must work on it and make smoking untrendy. While Deputy Finian McGrath may question the figures, the harm the tobacco industry is causing is devastating.

The advertising industry is going through a tough time. The State-owned broadcaster is not finding it as easy to obtain advertising revenue as it once did and it is probably having to cut its rates. Therefore, there has probably never been a better time for the Government to obtain advertising slots from RTE, the taxpayers' property, to launch a campaign.

People underestimate the value of sport. I currently train approximately 22 under-18s for the new season, and approximately 18 under-19s. Not one of these 40 players smokes, which is unbelievable. This is because it does not help in sport. Granted this is the higher end of it because it is the Wexford Youths League of Ireland club, but guys who are very serious about their sport will not smoke and we should take advantage of this. By promoting sport we will eat into tobacco use.

In the class of my daughter Gráinne, a total of 80% smokes. She stated most of them do not pay the full price because they cannot afford to do so. The price is draconian for them and rightly so. I agree with the Government collecting as much tax as it does from tobacco. However, the idea of haranguing the girls on Moore Street for selling cigarettes is a waste of time; once illegal cigarettes enter the State they will be sold. If it is possible to seize the cigarettes that is different, but more work must be done on seizure at the point of entry. We must stop the container loads entering the State, whether they roll off ships and we catch some but not all or they arrive on small boats. More work can be done to seize cigarettes at point of entry. I am not so much in favour of chasing the individuals on the streets because once the cigarettes enter the State they will be sold. Somebody will sell them.

Deputy Patrick O’Donovan

I wish to share time with Deputies Dowds, Donohoe and McFadden.

An Ceann Comhairle

Is that agreed? Agreed.

Deputy Patrick O’Donovan

I acknowledge the presence of the Minister of State in the House and I appreciate the opportunity to speak on this matter. I come from a family where the after-effects of smoking are all too clear to see. I welcome the comments of Deputies Catherine Murphy and Mick Wallace. I watched most of their speeches in my office. However I take issue with other comments that have been made. It is not that long ago when some people believed the world was flat and that when one arrived at a certain point one fell off. Some people are of the opinion that it is all right to have one or two cigarettes. Smoking kills and that is the end of it as far as I am concerned.

Smoking causes cancer. Cigarettes contain known carcinogens which cause cancerous tumours, whether in the throat, lungs or elsewhere. We can dress it up whatever way we want but smoking kills. It is one thing to be in denial but it is another to support smokers. It would be easy to almost criminalise smokers and put them in a box and cast them out of the community. However, we must be reasonable. It is an addiction which many people find difficult to deal with. If Sir Walter Raleigh stepped off a boat from Virginia today with a new crop called "tobacco" it would be made an illegal substance and treated as such by the State and all its authorities. However, tobacco is freely available in Ireland and we must deal with it.

Deputy Wallace is correct to state it is most important to deal with young people. The fact that 80% of one class smokes is unacceptable and shows the system is failing. It also slows that society is failing. Everybody knows that for the tobacco companies to be successful their customers must be young. There is no point in getting somebody in their thirties to take up smoking; it is too late. The companies get them when they are young and keep them because the addiction is far more pronounced in people who started young. The companies get their claws into young people by investing in targeting them by making smoking look sexy and attractive and something one would want to do because one's peers do it. This has been very successful. Some of the tobacco companies are among the largest in the world.

This is also about being responsible. The legislation proposes the use of pictures and in other countries, particularly Australia and New Zealand, this is effective. Deputy Finian McGrath stated he turns off the television when he sees the car crash campaigns. This shows the campaign works because it has shocked him to a point where he turns it off. He knows what is coming next and he does not like the look of it. The Road Safety Authority has invested in encouraging people to act more responsibly. The number of lives lost on the roads has reduced because of three factors, namely, enforcement, education and engineering. Such education also needs to happen with regard to smoking.

It is a pity this is coming so late in many respects. Many people have gone to early graves because of smoking. I am not a smoker. In a sense I am lucky because I cannot be a smoker due to being asthmatic. Deputy Catherine Murphy recalled being in council chambers and at meetings of the old Eastern Health Board with Deputy Durkan where there was a fog of smoke. A person such as me would not be able to sit in such a room. Prior to the smoking ban I used to feel like choking in an atmosphere where people smoked. I had to ensure I had my inhaler in my pocket because I would not want to leave the company I was with as I would not want to be rude but I could feel myself physically choking.

Most smokers who want to quit find it difficult and I have seen this in my family. People do not want to hear lectures or be told they are being criminalised. They need to be supported. Deputy Finian McGrath referred to the manner in which this can be done as being akin to the nanny state. I liked the comments made by Deputy Catherine Murphy on Irish people going abroad and seeing people smoking in airports or restaurants nudging each other and remarking how it is totally unacceptable and not politically correct. This is an element of our maturity. We in Ireland have come to accept it is not something we can take any more.

Deputy Ross stated we must be careful that we do not make the message cruel. The message is cruel and stark: smoking kills and causes cancer. The younger one starts the more likely one is to die from cancer as a result of smoking.

Last year 178 million illegal cigarettes were confiscated in Ireland. My major concern is not about the cigarettes that were confiscated but about the ones that were not. God only knows what type of filth and rubbish they contain, which people inhale into their lungs. It is the worst form of dirt that people inhale.

I support the Bill, which is a good idea. We should do anything we can to minimise the number of people who take up smoking and to encourage those who smoke to drop it. Shock value works on obesity and road safety. If it works on smoking it will be welcome. I agree with Deputy Catherine Murphy that it needs to be refreshed on an ongoing basis with the advertisements and pictures changing and campaigns being modernised.

Deputy Robert Dowds

In supporting the Bill I recall the remarks of the mother of a friend of mine who had another son who was a sales representative for a tobacco company. She referred to him as "the drug pusher". In a way it was a joke but it was also a serious point because her husband had died from the effects on his lungs of smoking. We should see tobacco companies as drug pushers because that is what they are. I will not recount all the statistics, some of which I was going to include in my speech, because they have already been mentioned by the Minister of State and other speakers. The House should send a clear message that tobacco producers are drug pushers.

I will refer to some statistics I dug up. The tobacco industry argues that the annual tax take from tobacco is approximately €1.2 billion. However, the Chief Medical Officer, Dr. Tony Holohan, estimates that the cost of treating tobacco related illnesses is €2 billion per annum. Tax revenue from tobacco is, therefore, not sufficient to cover the cost of trying to undo the damage caused by tobacco products.

I ask the Minister to monitor carefully whether the legislation is effective. The single great achievement of Deputy Martin when he was Minister for Health and Children was the introduction of a smoking ban in pubs and other public places. Despite the ban and other tobacco related campaigns, 29% of the population continues to smoke. Deputy Wallace, for example, referred to the number of smokers among his daughter's classmates. Figures from 2007 show that 56% of women and 44% of men in the 18 to 29 age group were smokers. If these shocking statistics are still valid, they would highlight a burgeoning and devastating problem among young people, especially young women.

If the legislation does not have a significant impact, I urge the Minister for Health to go further on four different fronts. As a number of speakers have argued, the tax take on tobacco should be increased. Careful consideration should be given to how to tackle the serious problem of tobacco smuggling. Apart from pushing tobacco products, smuggling results in a loss in revenue.

We must also help people who want to quit smoking. Ireland's expenditure on encouraging people to stop smoking is only half the level of that in Britain. We should try to match our expenditure levels with those of Britain.

I am fortunate in that I have never smoked. My father's decision to give up smoking when I was about 13 years old was a tremendous lesson for me. We should consult smokers who wish to give up their habit to ascertain their views on how best to achieve that outcome. Smoking illustrates that education is not always the solution because every smoker knows the harm the habit causes. Smokers may have a useful contribution to make on how to promote smoking cessation.

There may be a case for following the example of Australia by legislating for the introduction of plain tobacco cartons with tobacco warnings and the producer's name printed in plain font at the bottom of the packet.

In this age of austerity tackling smoking successfully is a win-win scenario for the State and its citizens. More lives will be saved and fewer people will suffer the debilitating effects of strokes, heart disease and cancer. It should be noted that if €1.2 billion is taken in tobacco taxes and €2 billion is the annual cost of treating tobacco related illnesses. There is, therefore, significant scope for achieving savings, not to speak of the thousands of lives that could be saved.

Deputy Paschal Donohoe

I support the Bill and note the progress made in tackling the problem of smoking. One of my favourite television programmes is "Mad Men", a series about the birth of the advertising industry in the United States in the late 1950s and early 1960s. One of the striking aspects of the programme is that virtually all the characters smoke and do so at all times and in all settings, whether at meetings, at home or socialising. Friends who are a little older than me and also watch the programme say this was normal at that time in the types of businesses featured.

Deputy Finian McGrath asked why people who smoke should be lectured when those who eat lots of burgers do not tend to receive lectures. There is a tremendous difference between eating lots of burgers and smoking, namely, the presence of what are known as externalities. If Deputy McGrath eats 20 burgers each day, the impact is confined to him, whereas if he smokes 20 cigarettes beside me each day, his habit impacts on my health. This is one of the reasons we must take a different approach to tackling smoking and its effects from the approach we would to someone who eats lots of burgers.

On the issue of demand for tobacco products, there is much to be said for the broad approach being taken, for example, the use of certain imagery in advertising. We must also adopt strategies at a micro-level, which means identifying what action can be taken to help specific groups of smokers. It never ceases to amaze me when I see, as I often do, pregnant women smoking outside a maternity hospital. We should develop a specific plan to make mothers-to-be aware of the consequences of smoking for their unborn children. It would be especially beneficial to target this group.

Several speakers noted that 29% of the population smokes. I have examined statistics which provide a breakdown of the various categories of smokers. They show, for example, that 49% of people who are unemployed smoke and 44% of persons with a disability smoke. Can anything be done for these two groups, particularly the unemployed who must already cope with great stress and difficulty in their lives? We must make clear to them what are the effects of smoking on their health, ability to cope with stress and personal financial circumstances, which is an issue to which Deputy Ross alluded.

On the issue of supply, I have been struck by statistics from 2009 which indicate that 40% of retailers are willing to sell cigarettes to minors. While I understand the figure has declined from 49% or 47%, which indicates some improvement, it is unacceptable that two in every five retailers appear to be in breach of the law governing the sale of tobacco products. Legislation was introduced which established a tobacco register from which retailers found to be in breach of the law would be disqualified. This approach works well with regard to people who supply alcohol to minors. Progress in this area would contribute significantly to reducing supply to people who are too young to smoke and do not understand the health consequences of smoking.

On the issue of requiring people purchasing cigarettes to provide identification, research was done to show that when minors attempting to buy cigarettes were asked to provide identification, 96% were refused cigarettes. We still have a long way to go in regulating the supply of cigarettes by retailers. Progress in this area would have a beneficial impact on health.

I strongly agree with Deputy Dowds's point on introducing generic cigarette packaging. For too many people, particularly the young, using cigarettes is still considered cool. As Deputy Dowds said, if generic packaging was to be brought in, combined with the use of images that this legislation allows for, we could raise public awareness of the consequences of smoking. It would also make clear that doing something that could cause cancer in future is not cool.

An Leas-Cheann Comhairle

I call Deputy Eoghan Murphy who is sharing time with Deputies Griffin and Mathews. Is that agreed? Agreed.

Deputy Eoghan Murphy

I should preface my remarks by stating that I am a smoker, so I have a particular interest in this important debate. I quit when the smoking ban came in. However, I then got a job abroad where it was permitted to smoke indoors and I started smoking again. I now smoke when taking a drink, as a lot of my peers do. If we could do something to break the link between alcohol and cigarettes it would go a long way towards solving the problems arising from the effects of smoking.

I very much welcome the Bill and thank the Minister of State for circulating the pictures. They are graphic and disturbing, and they will work. About eight years ago, when I was a student in Canada for the summer, they already had such images on cigarette packets. It was quite graphic and drove the message home. I always wondered why we did not have that system here, so it is great that we are finally starting to catch up with some of our international friends in this regard.

We should examine a number of other areas in this respect — not just what we are doing to discourage people from starting to smoke but also to help smokers to move away from the habit. Some good things are happening with new technological developments, including substitute cigarettes. I recently met with a group that had developed a battery-powered mechanical cigarette which provided a substitute effect without any of the harmful elements of smoking. If we can spend more time promoting such alternatives, including nicotine patches and substitute cigarettes, it would go a long way towards improving the situation. In addition, we should destigmatise such alternatives to smoking by making them more commonly available and more acceptable to use. We must also do what we can to aid research into the addictive nature of cigarettes.

Deputy Donohoe mentioned the dangers of smoking for pregnant women. I pass a hospital on my way home and it is shocking to see pregnant women smoking there. Surely we are not doing enough to educate people if such women think it is acceptable to smoke while pregnant. At the same time, one sees young mothers smoking. I understand that when one has such an addiction one will smoke, but there will be a negative effect on young children at home in their formative years who are subject to passive smoking. We should target particular groups, including young mothers, to help them stop smoking. The impact on people's health and lives goes beyond the individual smoker.

I stopped smoking when the ban was introduced because one had to go outside and stand in the rain to have a cigarette. It was miserable. I started smoking again when I was abroad, but when I came back to Ireland I saw that there had been a proliferation of smoking areas in bars and restaurants. I understand the idea of erecting a canopy with a heater to help smokers but some of these smoking rooms are not outside. There seems to be no difference from being inside when one goes to the smoking areas. That needs to be examined and, although I understand that such businesses are suffering perhaps the law is being interpreted too loosely. They are able to build these rooms that might as well be inside, yet because there is a small hole in the wall for ventilation it is deemed appropriate to smoke there.

It used to be just the smokers who would go outside to have a cigarette and then come back inside but now everyone is going out to these smoking rooms and staying there for the evening. They are thus subject to the secondary effects of passive smoking, which is completely undermining the smoking ban. I urge the Minister of State and her officials to revisit the legislation to see if it is too liberal and whether we are allowing too many variations of the smoking section, which are undermining the purpose of the ban itself.

I welcome the Bill, which is a great initiative. I hope we can get the pictures on to cigarette packets as soon as possible.

Deputy Brendan Griffin

I thank the Minister of State for bringing this Bill before the House. I welcome its provisions. These images are shocking and will have an impact, which is a welcome development. I quit cigarettes seven years ago but could not have done it without the introduction of the smoking ban. We may often be critical of the former Minister for Health and Children, Deputy Martin, who is not present today, but that was one of the most progressive steps ever taken by an Irish Government to tackle smoking. It has had positive ramifications.

At the time, I felt there should have been a stepping-stone approach, with provision for special designated smoking areas in bars. In hindsight, however, I believe it was a very good and progressive step to take. I remember working in bars when I was at college and being completely blocked up from having worked in such a smoky environment. Later, I became a publican for some years and that decision was made because of the smoking ban. I would never had run my own bar for three years without the ban being in place because it was a desperate environment to work in before its introduction.

I know many former publicans who now have serious health problems. They put it down to having worked in smoking environments for years. I have family members who have respiratory problems due to having working in such environments for decades. There is no doubt that there is a big link between exposure to smoking environments and health problems.

Deputy Eoghan Murphy made a very valid point concerning provisions being made by certain establishments to accommodate smokers. We need to examine that situation and ensure that we are ahead of the game. We cannot allow any complacency in this area.

This Bill is a step in the right direction. It is never too late for any smoker to give up cigarettes. I hope the message does not go out from here that there is a witch-hunt going on because that is not what is happening. The Government is hoping to co-operate with smokers throughout the land to try to help them quit cigarettes. This legislation will hopefully assist in that regard.

Ten years ago, when I was in NUI Galway, I was part of a college committee. At the time, I proposed that we should introduce a poster campaign on campus, including images such as those it is proposed to include on cigarette packets, in an effort to help people stop smoking. Unfortunately, my colleagues on that committee did not agree with me, so the campaign did not happen. Since then, however, a person who smokes ten cigarettes a day, will have smoked 36,500 cigarettes in the past ten years. Therefore, if some people had quit cigarettes as a result of that poster campaign, which never happened, I am sure there would have been positive health ramifications for them.

While it could be argued that it is overdue, this Bill is the right thing to do. Hopefully it will help people to stop smoking. The message needs to go out that it is never too late to quit. Ten years from now, if someone has smoked 36,500 fewer cigarettes as a result of this legislation it will be a very good thing.

We should also focus on counterfeit cigarettes in circulation because God only knows what they contain. It is one thing focusing on cigarettes that are regulated on the mainstream market but the number of counterfeit cigarettes entering the market from abroad is a major problem and there are many harmful and dangerous chemicals and ingredients in them, the true danger of which might not be recognised for many years. As a society and as a Government, we need to tackle that issue. People need to be aware of what they are putting in their systems when they smoke these cigarettes. This again comes down to education and informing the public.

Deputy Donohoe mentioned junk food. It does not present as an external problem similar to cigarettes but, at the same time, it is worth considering a similar provision to deal with junk food. Calorie counts and other nutritional information are available on packaging for most food products but this area could be examined to ascertain whether it can be taken further because obesity and coronary disease are major problems in this country.

Perhaps the Minister could also address the problems caused by excess alcohol intake. A shocking report published earlier this week highlighted huge numbers of people dying every year as a result of alcohol poisoning in this State. More information needs to be given to people about the dangers of excess alcohol intake and the long-term damage that can be caused through alcohol abuse such as liver disease. The link between depression and alcohol is important and many people are not aware of this. However, we have a spiralling suicide problem, yet the only information I have seen regarding the dangers of alcohol are advertisements warning people to drink sensibly, which is a step in the right direction but it is not enough. As a former publican, I am not anti-alcohol. I enjoy a drink and I have drunk too much at times like most people but, at the same time, we need to give people as much information as possible to allow them to make informed decisions. That means laying all the facts on the table. I am not trying to be a party pooper or to take away from people's enjoyment but we need to put the information out there. There is general ignorance regarding the link between depression and alcohol and this needs to be highlighted.

Health warnings also need to be carried on advertisements for motor vehicles. Thankfully, steps have been taken in the right direction in recent years to reduce the number of road deaths but every road fatality is one too many. As a small measure, a warning should be placed in motor industry advertisements to highlight that a car is a lethal weapon and every time a driver sits behind the wheel of a car, he or she and the public are in danger. A subtle warning needs to be given to drivers in such advertising. Perhaps that could be considered. I do not take away from the important role the motor industry plays in the economy and the important role owning a car has for many people, particularly in rural areas where they have no other way to get around.

I thank the Minister of State for introducing the legislation. It is a step in the right direction and it is good to have heard the many positive comments on all sides of the House. Hopefully, this is another step in the right direction and further measures will be taken as a result.

Deputy Peter Mathews

I welcome the opportunity to contribute to the debate, which has reflected an excellent interest and encouragement of our younger people because cigarette manufacturers and the advertisers of cigarette consumption target them not only in Europe, but all over the world. I recall watching a documentary on BBC2 about British American Tobacco corporation, which showed how the company cynically got around advertising laws in Nigeria and other countries with huge populations and presented corner shops in villages and towns in the shape and colour of a cigarette box such as a Benson & Hedges corner shop. Little boys aged ten distributed cigarettes and promotional lottery-type tickets and if people bought a pack or part of a pack, they would be entered in a draw for a fridge or a television. It was disappointing to find out at that time that a former chairman of the Bank of Ireland was appointed chairman of British American Tobacco, which engaged in such activities to promote its sales.

I am a reformed smoker and perhaps people should not listen to me. I stopped smoking on 19 August 1980 and I estimate I smoked 87,912 cigarettes in the previous ten years but when I stopped, my head and my lungs cleared.

Deputy Billy Kelleher

Did the Deputy buy them all or did he bum some?

Deputy Peter Mathews

As Deputy Wallace pointed out, it is a shame that 80% of the girls doing the leaving certificate smoke because it is considered trendy and cool and because young people think in pictures, not words or figures. They do not read spiral bounds or Bills but they read pictures, hence they use their telephones to take pictures and send pictures to one and other. They look at movies, DVDs, television and so on. With regard to the consumption of cigarettes, it would be timely to remind them of what it looks like to develop a cancerous growth as a result of smoking.

One of the landmark moments in a student's experience is when the school organises a tour to visit a jail. Students then realise how sad it is that lives have gone off the tracks and people have to spend time in prison for their offences. The physical visit to a jail tells more about the slide into wrongdoing or keeping the wrong company. People dream and think in pictures. Nobody has dreams about columns of figures or paragraphs of words, although I may be contradicted by Deputy Wallace.

I just want to touch anecdotally on these issues in support of the Bill. Do people realise that thousands of other ingredients are added in the manufacture of cigarettes and not only nicotine, which is addictive? This is also done in the manufacture of ice cream. Let us take orange juice as an example of a generic product, without going into brands. If people discovered it was carcinogenic, every carton of orange juice would be whipped off the shop shelves. However, because smoking has become embedded and is part of the fabric of generations of people, nobody is prepared to give it a shock. A consumer ECT is needed.

Deputy Wallace also referred to sports and smoke free zones, especially at competitive levels. I also experienced this because my four children swam competitively. None of them smoked but when they stopped and because it was cool and people were outside bars on the street or under verandas and so on, it was looked on as cool. Why not be different socially? It takes a huge decision when one is a smoker to stop. One cannot do it and think, "I will just have the one because I am at a wedding or a christening". That does not work; one has to make a clean cut because of the additional addictive substances.

What cigarette manufacturers do is wrong. It would be like selling people fast cars for the momentary and immediate thrill of driving a turbo-charged car, knowing that there are no brakes to stop them. It is wrong.

In the 1960s in the United States the connection between cancer and smoking cigarettes or tobacco was first being discussed and there were denials by the industry, which was big. The most powerful, successful and richly rewarded lobbyist at the US Government level suddenly did a volte-face because he developed cancer himself. He knew that being a smoker was the cause of his illness. He went against the tobacco lobby. He said that those in the advertising industry knew cigarettes and tobacco were carcinogenic and that smoking caused emphysema and death.

It is tragic to see someone of perhaps 60 years of age wheeling around an oxygen trolley so that he or she can breathe. The trendy youngsters do not see the end product — the emphysema wards. They do need to see the picture on the pack. At the point of entry where the containers come in to the country we need to get to not just the people who unload them. We should also speak to the carriers who are very careful about what goes into them. Deputy Dowds said his mother called them drug pushers, and they are. Let us face it. Tobacco is addictive. I am sorry that my mobile telephone is ringing.

Deputy Bernard J. Durkan

Another addiction.

Deputy Peter Mathews

I apologise, a Leas-Cheann Comhairle.

Deputy Bernard J. Durkan

Perhaps it is a smoker telephoning.

An Leas-Cheann Comhairle

We will excuse the Deputy as it is Friday.

Deputy Peter Mathews

Perhaps it could be an ASH day.

Deputy Bernard J. Durkan

That was me telephoning.

Deputy Peter Mathews

If alcohol and cigarettes are not handled the right way for young people to see cause and effect, they act as gateways to other slippages. I am not a holy Joe. I am in favour of people enjoying themselves and celebrating but with alcohol there are no extra additions. We know it is alcohol. It is controlled in its production. There are no extra addictive ingredients added. It is bad luck if someone has a genetic predisposition to be alcoholic in the same way as someone who cannot take the sun but they at least know where they stand.

This is good legislation. It is pointing in the right direction. I am pleased to hear so many Members contribute so well and so relevantly to the support of the Bill.

Deputy Bernard J. Durkan

I am a lost cause because I am a smoker, unfortunately for a long time. I have not learned the lesson just yet. Oddly enough, I enjoy smoking. I do not smoke when I am under pressure. I smoke when I am relaxing and want to enjoy myself. I am well and truly a lost cause.

I also spent time in prison. The smoking regime in prison is different, although it is many years since I was there.

Deputy Jerry Buttimer

Was it as a member of a visiting committee?

Deputy Bernard J. Durkan

The psychology that is being applied to disincentivise smoking is all wrong. The shock treatment is wrong. I agree with Deputy Ross in that regard. It tends to affect those who have already been tragically affected. It makes them relive the tragedy and brings it up close and personal once again. It does not do anything for anyone else other than to revolt them and turn them off. I do not think that works. I have seen statistics which attempt to prove such an approach works but it does not, it has the opposite effect. Technical evidence will do most. I refer to specific evidence that can prove beyond a shadow of a doubt on medical grounds that if one follows a particular path such a thing will happen. That works more than anything else.

I have to laugh when I hear my male colleagues question why pregnant women might want to smoke in the vicinity of a maternity hospital. It would be interesting to ask them. When I was party spokesman on health I heard a prominent former Member of this House indicate at a public meeting in UCG a number of reasons that might happen. It was interesting. The purpose was not to justify it but a case was put forward as to the reason for it and how it might be combated. There may be reasons for such behaviour. When one speaks to pregnant women who are smokers they refer to the pressures and reasons they continue to smoke.

Deputy Jerry Buttimer

From what Deputy Flanagan is wearing it seems the dress code has been introduced.

Deputy Luke ‘Ming’ Flanagan

Respect.

Deputy Bernard J. Durkan

The other thing that annoys me is the creation of the perception of smokers as guilty, unclean and as outcasts in society. I have been in smoking rooms abroad where the air extraction systems work extremely well. The only people who bother going in them are those who want to smoke. I have only gone out of a room once in my life to smoke outside in the open air. It is an appalling thing to do. It is appalling to single out people who have a particular addiction especially when we live in a country with many people with other addictions that are equally life threatening. We do not seem to ostracise them to the same extent. There is a good case to be made for the creation of smoking areas that are medically cleared as being suitable for people and that the air extraction system is sufficient to ensure there is no smoke.

Reference was made to doing everything in moderation. When I was party spokesperson on health I felt there was a certain incompatibility with my role and the fact that I smoked. I mentioned it to the late Maurice Neligan. He said that one should do everything in moderation. There was no need to go overboard. He probably knew more than anyone else about that subject.

My colleague, Deputy Catherine Murphy, referred to the smoke-filled rooms of the Eastern Health Board and county council meetings in the 1980s. We were there and the rooms were full of smoke. I am sure it was not good for us. However, many of the decisions made during that time had a much greater impact than decisions made on health in the meantime.

Deputy Catherine Murphy

Deputy Durkan must be joking.

Deputy Bernard J. Durkan

For whatever reason, many of the decisions made had a positive and long-lasting impact and were taken in the best interests of the provision of a health service to society at the time.

Deputy Mick Wallace

The smoke has affected Deputy Durkan's memory.

Deputy Bernard J. Durkan

Political correctness is a thing that bugs me intensely.

Deputy Luke ‘Ming’ Flanagan

Hear, hear.

Deputy Mick Wallace

Hear, hear.

Deputy Bernard J. Durkan

It is an appalling thing. Some people wear pink coats, others wear yellow coats and others still wear white coats. Wearing a tie is a help as well, as one can wear another colour. There is nothing wrong with that.

Political correctness drives us all in a particular direction. When our children were small the thinking was just beginning to emerge that one could not buy a cowboy suit for a young boy because it was pandering to gratuitous violence, shooting and killing and that it was the wrong image to create. Generally speaking, one does not see children with cowboy suits very often. The presumption is that there would be less violence as a result but the reverse is the case. One sees gratuitous violence on television in particular but also in films in the cinema and in the media in general. Once upon a time, John Wayne would give a fellow a clip round the ear and he would fall down in the corridor and there would be nothing else from him; he never said another word. Now, the guy is beaten over the head with iron bars for an hour from all angles. I wonder how he can withstand the pressure. Of course, he is not smoking at all, that would not be PC. There is gratuitous violence and with all the political correctness we have, we have no problem or aversion to that sort of thing. It is appalling. We then worry when kids beat up other kids, or older people, attacking them in the streets and kicking them half to death. We say they are awful and they are but they have been fed a diet of that.

I do not want to promote smoking. I hold my hands up, I am not perfect and I never claimed I was. The society that claims it is perfect must look at itself again because I do not think our society is perfect. There was a certain lady in Paris who died a few years ago. She was 121 when she died, she was very long-lived, I admit. She had an astute solicitor and when she was 75 years of age she smoked, like Deputy Shane Ross, over 100 cigarettes a day, which was not a good thing. Her solicitor decided he would take equity in her house for a certain sum of money. He did this on the presumption that she would not live too long, and she should not have but she lived to be 121. Her poor, unfortunate legal adviser had passed away some ten to 15 years previously.

I do not suggest that to promote smoking but smoking is an addiction and a habit. In my case it is not; I can stop if I want to but I enjoy it. I smoke a pipe at night or when I am driving a long journey. I certainly do not step into anyone's house to smoke and I do not step out into anyone's garden to smoke. I smoke when it suits me and when I am relaxed. I do not wish to be depicted as a social outcast. I have not done anything to deserve that, and I am sure many other people feel like that. There are many people who ingest other things that are bad for them at all levels in society, not just in one area or among the lower orders but across society. One would be surprised at the amount of addiction throughout society on an ongoing basis and we do not seem to be worried about it at all.

I agree the example is not good so why do young people smoke? Young parents of teenagers must make a decision. They might suspect their children will take drugs or be in the company of people who will take drugs. They might be on the horns of a dilemma and figure out the least damaging drug. I do not know the answer to that question but it is a question young parents have to answer on a regular basis.

Everyone will tell us about the smoke filled room and the damage it does to everyone else, and I am sure it does. I do not inhale smoke so presumably I inhale in a secondary way. Perhaps I do and perhaps I do not. Has anyone ever thought about the damage done to a person's health by sitting in a room where there are no smokers but one or two people with a particular infection that is contagious? A person could get a most appalling infection such as the flu or a chest infection. I assure the House the only difference between the two is that we can see the breath that has been exhaled in a smoke filled room but we cannot see it in the other room. I am not suggesting everyone should get up tomorrow morning and say they will have a good smoke, that they will smoke regularly and often and it will be good for their health. It is not but there is a need for a change in the psychology applied to deter people. Shock treatment does not work and the attitude of political correctness we have adopted in this society is not helpful at all. To ostracise people and suggest they are layabouts, drop-outs and ne'er-do-wells is wrong.

Deputy Jerry Buttimer

I welcome the Minister of State to the House and thank her for bringing this legislation before us. Before Deputy Durkan leaves, I would say to him that it is never too late to stop smoking. I hope he will quit today. I grew up in a house where all the adults smoked and all of them gave them up for a variety of reasons, predominantly health reasons. This legislation is long overdue.

This is a public health Bill; it is in the interests of the public and their health. It is also important that we acknowledge the role of the Department, the different agencies and stakeholders and the work done since 2002. Despite him calling me a Jack Russell last week, I commend Deputy Martin on the smoking ban. It was a good initiative and I supported it.

I am a non-smoker but many of my friends smoke. I suppose the smoking ban has created a new form of clientele in pubs. There are smokers, non-smokers and those who sit with smokers in the smoking area. The important thing is that we do not just say the smoking ban is the end of our efforts. It is important that we combine text and photo warnings on tobacco products.

I remember ard-fheiseanna when there would be smoking at the top table in the auditorium and when tobacco companies sponsored sports such as golf and show-jumping. There was the great image of the Marlboro Man adorning our magazines and newspapers to make smoking look clean and cool but we know that is not the case. It is critical to acknowledge that we are failing to communicate the message to young people. As a schoolteacher, I saw many young people start smoking. A former principal in the school would suspend students for smoking, saying they were suspended for being in the company of smokers. He was a hard act on smoking but it did not work; the measure was too severe. We must communicate a message that resonates with young people.

I listened to Deputy Griffin talking about obesity and other issues. We are failing on obesity, tobacco and alcohol. This week's report on alcohol consumption shows the numbers dying from alcohol-related disease are increasing. Now, 50% of smokers die from tobacco-related disease, with 7,000 people dying in this country every year from the effects of smoking. Deputy Finian McGrath claimed this legislation is part of the nanny state. This is, however, about public health. I am not in favour of prohibition and accept people have the freedom to make a choice.

Deputy Luke ‘Ming’ Flanagan

I will quote the Deputy on that.

Deputy Jerry Buttimer

However, if a certain action, such as smoking, has a serious health effect on people it should not be condoned or tolerated. We live in a democracy and cannot bring in the prohibition of cigarette sales. Yet, smoking kills.

The Minister of State distributed the images that will be used on cigarette packets which graphically show the effects of smoking. Young schoolgirls have turned to smoking as an appetite suppressant and to help them not gain weight. They, however, just see the body beautiful image but not the long-term effects. The placement of images on packets will do much to dissuade young women from taking up smoking.

A friend of mine smokes up the chimney of his house believing the smoke will not affect the rest of us in the room. Second-hand smoke poses serious health risks. Children exposed to second-hand smoke are twice as likely to develop a neural or behavioural disorder, such as hypertension. The Tobacco Free Research Institute, Dublin, recently published a report which showed children in smoke-free homes tend to be in better health.

This Bill is about enhancing public health. I commend the Minister of State, Deputy Shortall, for living up to her responsibilities in promoting better health. As well as putting the graphic images on cigarette boxes, will she consider putting the quit helpline number on them too? The cost of smoking to the health system runs into billions of euro. We must target young people to tackle the alarming rise in youth smoking. Will the Minister set up a campaign, using say town halls, to inform young people about the dangers of smoking?

Last year in Spain I was nearly nauseous from the smoke-filled restaurants and public places. I do not want to see Ireland return to those old ways. Unlike Deputy Durkan, I much prefer to go to a smoke-free bar. Last week at a match in Páirc Uí Chaoimh I noticed people smoking in the stands. Will sports organisations ban smoking at events? The campus at Cork University Hospital in Wilton is entirely smoke-free. However, some staff and visitors smoke at the hospital entrances, one of which is in a residential area and affects people's homes. I have already written to the hospital manager about this problem and I hope the Minister of State will take it up with the Health Service Executive.

I am concerned about the illegal smuggling of cigarettes. No one knows what these cigarettes contain and it is becoming a serious issue. A recent article in The Sunday Business Post cited Europol’s claim that Ireland has the worst cigarette smuggling problem in the EU. Will the Department and the Revenue Commissioners develop a new strategy to target the illicit tobacco trade? This article also had a claim that the price of legitimate tobacco products was the most important factor affecting consumption.

This Bill is not part of a nanny-state approach but about public health. It will ensure we do what is best and right for our citizens and their health. We must remember we live in a democracy which gives us responsibilities as well as rights.

Deputy David Stanton

I welcome any initiative that discourages smoking, especially among young people. However, will images of the effects of smoking on cigarette boxes be effective in dissuading young people from smoking, particularly with so many illegal cigarettes in circulation which may not have these images?

Many young people value physical fitness. This can be a huge deterrent to smoking, excessive drinking and substance abuse. Sports and out-of-school youth activities, such as those of Foróige, Youth Work Ireland and the Scout Movement, could be used to dissuade young people from smoking. These organisations should be given funding and encouragement to engage with young people because the rewards for society can be huge. Formal programmes on lifestyle issues in schools have a limited effect because it is a captive audience. It is much better to engage with young people.

Recently, I met with Retailers Against Smuggling which gives some startling figures about tobacco smuggling. Up to 23% of all tobacco consumed in Ireland has not had duty paid on it, for example. Illegal tobacco cost retailers €575 million in 2010 alone.

Retailers Against Smuggling also maintains that the State lost €460 million as a result of the avoidance of tobacco duty in 2010. The organisation states that the black market is the third biggest tobacco supplier in Ireland. Some 31% of people over the age of 15 smoke. However, shop sales of cigarettes are down as much as 30%. People are, therefore, smoking but they are either purchasing their cigarettes from illegal outlets or in other countries.

Placing images on packets of cigarettes will have an impact in respect of the sale of legal tobacco products. However, we should tackle the sale of illegal cigarettes in a much stronger way than has been the case heretofore. Retailers Against Smuggling claims that large-scale criminal gangs are smuggling illegal cigarettes into Ireland and selling them here in order to fund their criminal operations. That is another matter about which we should be concerned.

Retailers Against Smuggling also makes an interesting point regarding the sale of illegal cigarettes giving rise to a precedent of increased acceptability among citizens with regard to duty avoidance. If people purchase illegal products, they will not pay the relevant duties in respect of them. The organisation further makes the claim that the sale of illegal cigarettes undermines health policy and regulations as well as a host of different laws.

Many local shops depend on cigarette sales, particularly as they bring customers onto a premises. I accept that we do not agree with this and would prefer if people did not go into shops to purchase tobacco products. When people do seek to purchase cigarettes or whatever in their local shop, however, they often buy other products as well. That is the point being made by retailers.

Illegal cigarettes are being sold at street markets, in pubs and on a door-to-door basis. There does not appear to be a policy to deal with those who engage in this trade. We must take a much stronger line in respect of this matter. The Finance Acts of 2001 and 2005, the Trade Marks Act 1996, the Casual Trading Act 2005 and the Public Health (Tobacco) Act 2002 and the Public Health (Tobacco) (Amendment) Act 2004 are being flouted by those who sell illegal tobacco products.

Retailers Against Smuggling makes another interesting point regarding the law and states that retailers can face fines of up to €1,900 and a potential prison term if they display tobacco products on their premises. According to the information provided to me by Retailers Against Smuggling, the fine for illegal street sellers is €63. In the context of retail registration, retailers can also be liable for fines of up to €1,900, they can be struck off the register and they can potentially face prison. Last year, the average fine in respect of criminals who defrauded the State of excise duties was €527 and any prison sentences handed down were suspended.

Retailers Against Smuggling maintains that there is a need for a smuggling strategy and that a Garda task force must be established to implement such a strategy. It also is of the view that the fines handed down should fit the crime, that street markets should be regulated, that additional resources be provided to the Garda Síochána and Customs and Excise in order that they might deploy additional officers and that there should be a freeze on excise increases.

This is a serious issue. As previous speakers stated, we do not know what many illegal tobacco products contain because there are no controls in place in respect of them. There is a double whammy for those who smoke illegal tobacco products because not only is their health being damaged as a result of their smoking them, it can also be damaged by the other substances these products contain. The Government and the Minister should take action on this issue as a matter of urgency.

I welcome what is being done in the Bill, which represents a first step. However, the matter to which I refer cannot be ignored. I urge the Government to place a great deal of emphasis on positive things such as the promotion of physical fitness, sporting organisations, etc. We must encourage younger people in particular to look after their physical fitness. If people become involved in sport, look after themselves and are health conscious, in many instances they will not smoke.

Deputy Michelle Mulherin

I wish to make a number of brief points. I understand what the Minister of State is trying to achieve with regard to encouraging people, for the sake of their health, to stop smoking. This is generally perceived to be in the public interest. Ireland has been extremely successful in leading the way in banning tobacco smoking in public spaces. In effect, this has ensured that the health of those who do not smoke or who choose not to do so has been protected. It has also had an impact on social attitudes to smoking. Even though the smoking ban was not universally well received, it has proven to be of great benefit. Ireland is a leader in this area.

In the context of further progress, we must engage in a reality check and consider the contradictions that exist. It is possible to describe, in gruesome detail, the effects tobacco smoking can have on people. However, the reality is that it is legal to smoke in this country. As a result, a tension and a contradiction arise because something which we state is so dangerous is deemed to be legal. The Government collects large tax revenues in respect of tobacco products and many people are employed in the tobacco industry. When it was possible to advertise tobacco products, there was a great deal of money to be made. As a result, tobacco companies were prepared to spend millions on advertising. If such advertising was still allowed, the position would be the same.

A question arises in the context of personal responsibility. We are targeting two sectors. The first of these is adults and there is not an adult in the country who does not know that smoking is bad for them. I accept the results of the studies and research that have been carried out but I am not sure about the inclusion of photographs on cigarette packets. I do not smoke so I would not see such photographs. When I see television advertisements relating to road traffic accidents, however, I tend to change the channel. The young people who are most likely to benefit from seeing such advertisements tend not to watch them. On a personal level, I find the advertisements to which I refer somewhat offensive and not nice to watch and I always change channel when they come on. I am of the view that something similar may happen in respect of smokers.

We are demonising those who smoke rather than making clear to them that there comes a point where they must realise that smoking is a personal choice. We must enable people to seek help. It is clear from their contributions that some Members are not at all interested in smoking and I am sure that will continue to be the case.

I am most concerned with regard to young people. We must consider this matter from a psychoanalytical point of view. It is the nature of youth to rebel. Regardless of what type of laws we introduced, young people will want to go against them. They will also seek to experiment and do things which may not necessarily be good for them. Members of the current generation of young people do not like being told what to do. Instead, one must persuade them through a process of dialogue. Deputy Stanton referred to this matter. Young people can be engaged, appealed to and reasoned with in schools, in youth groups and by Foróige. That is the approach which must be taken. Young people sometimes perceive certain things as being cool and on other occasions such things will not be deemed cool. How does one legislate in respect of what is cool? The answer is that one cannot do so.

There is only so much action that can be taken in respect of this matter. As already stated, it is legal to sell tobacco in this country. However, our policy leans to the other extreme and encourages people not to smoke. There are contradictions in this regard which we must accept. Until we shut down the tobacco factories or inform people that they cannot buy cigarettes, those contradictions will remain in place and people will still have a certain freedom of choice. Notwithstanding all their good intentions, those in Government will tear their hair out if they try to intervene in this matter beyond a certain point.

My main point is that we must consider what represents real progress and examine what should be our response to suggestions that action must be taken in respect of this complex matter. I understand what is intended by including photographs on cigarette packets. However, I hope that other initiatives involving dialogue and aimed at young people in particular will be pursued. I also hope that the money the Government takes in through taxes and duties on tobacco products will be spent on such initiatives. Ultimately, this matter relates to personal choice. A person will not give up his or her addiction without reaching a decision to change his or her lifestyle. I do not know whether tormenting people with photographs on packets is the way to proceed in this regard.

Minister of State at the Department of Health (Deputy Róisín Shortall)

I thank Members who contributed to the debate and who put forward many interesting and worthwhile ideas. I welcome the cross-party support afforded to the legislation. I appreciate Members facilitating the taking of all Stages today.

The Bill is a technical measure, the purpose of which is to amend the 2009 Act in order to allow us to proceed to make the regulations to permit the use of graphic images on cigarette packets. It is no more and no less than that. It does not pretend to do anything other than that which I have already outlined.

This is an important element of the approach being taken to discourage people from smoking. We do not suggest it is a kind of panacea, nonetheless it is an important element in the battle against smoking.

I would like to respond to a number of points raised in the debate. A question was raised about nicotine replacement therapy and I would like to clarify that it is available free of charge to medical card holders. Unfortunately, the evidence is that lower socioeconomic groups are much more likely to smoke. We must examine the reasons for that. Other agencies must also take responsibility for contributing to the conditions which make people more inclined to smoke or to abuse alcohol or drugs. Along with the support available for people on medical cards, the HSE is doing considerable work in the area of smoking cessation programmes. It has also employed a number of smoking cessation counsellors to help people quit smoking. It is also involved in various social marketing campaigns to discourage smoking. Recently, a new billboard campaign was launched displaying the clear message that one out of every two smokers will die of a smoking related disease. Members may have seen some of those advertisements, which make a significant impact. There is a lot of work going on in this area.

A number of Members referred to the legal challenges being taken against the 2009 Act and other legislation. Given the scale of the profit that can be made from people smoking, such challenges are always a problem and the industry makes a huge effort to combat attempts made by governments to discourage smoking. The 2009 legislation restricted the display of cigarettes and advertising in retail outlets and those provisions are being challenged by Philip Morris International. I assure Members that the Department is preparing rigorously to defend the action in much the same way as was done with the P.J. Carroll litigation. The Department is liaising with the Office of the Chief State Solicitor and with the Attorney General in that regard.

Members also referred to the issue of the price of cigarettes. There is no doubt that, as with alcohol, the price of cigarettes is a key factor. Cigarette prices in Ireland are the highest in the world. It is €8.65 for a packet of 20 cigarettes, which is €1.50 more expensive than cigarettes in the UK, for example. The tax take from a packet of cigarettes is €6.71. We have made moves on the price of cigarettes and the Minister for Health has indicated that he intends to seek a further increase in the price of tobacco in the forthcoming budget. We have been active on that front. Related to the question of price is the illegal trade in cigarettes smuggled into this country. In many cases, this trade is a significant part of the activity of criminal gangs. Much work has been done by the Revenue Commissioners and customs officers in this regard. For example, in the period 2008-10, the Irish customs service seized a total of 532 million cigarettes, with an estimated retail value of €222 million, in just under 30,000 individual seizures.

It is estimated that at least 20% — retailers would say more — of all cigarettes smoked in this country are brought in illegally. This poses a huge challenge. While significant work is being done in this area, we need to go further. In that regard, I take on board the point made by Deputy Stanton with regard to the penalties and undertake to examine that issue. In addition to the cigarettes brought in illegally, significant numbers of cigarettes are brought in legally because of the high limit on the number of cigarettes that can be brought in personally. Unfortunately, people who have decided to profit from this area travel a lot back and forth, to eastern Europe in particular, to bring in bagloads of cigarettes which they then distribute in local housing estates and so on. This is a matter of concern and is an area I intend to examine.

I take the point made by Members with regard to the publication of the Quitline number on cigarette packets. The legislation we are dealing with today is just enabling legislation and the detail of what goes on a packet is not covered by it. That is a matter for the regulations. One of the selected 14 images includes the Quitline number. We will give that suggestion further consideration. There is a balance to be struck in what goes on the packet as only a limited portion of the packet can be devoted to these images. We want the image to be as stark and clear as possible. We are also required to include bilingual text. We must strike the balance between the text and how much of an image can be put on the package, but I will consider the points made with regard to the Quitline number.

With regard to young people who smoke, it is well known that the younger people are when they start smoking, the longer and more heavily they are likely to smoke. The majority of smokers become addicted in their childhood and teenage years and we need to break that cycle. This area has been the focus of much of the activity around discouraging smoking and discouraging young people from ever starting to smoke.

On the sale of cigarettes to minors, the tobacco legislation is enforced by the environmental health service of the HSE. As part of the enforcement of the legislation, the environmental health officers carry out test purchasing of tobacco products to minors. Last year, for example, the HSE carried out 402 test purchases to monitor compliance with the legislation. As a result, 12 prosecutions were taken for breaches, resulting in eight convictions, three dismissals and the application of the Probation Act in one case. There were six suspensions from the national register of tobacco retailers, varying in duration from one to 14 days.

Some Members suggested plain packaging on cigarettes. My immediate priority is to introduce this legislation so that we can go ahead with the regulations on the graphic images. The introduction of plain packaging will be considered by the tobacco policy review group, which is expected to report shortly. In Australia, the proposal to introduce legislation in this regard is being challenged by the tobacco industry. We await the outcome of that challenge with an open mind. If the evidence suggests that plain packaging is effective, we will give it consideration.

Deputy Finian McGrath spoke about smoke-free workplaces. Workers in pubs, restaurants, hotels and the catering industry generally have rights and we must be mindful of those rights. These workers have the right to have their health protected, which was a key factor in the case of the legislation introduced by Deputy Martin as Minister, and we must ensure their rights are protected. The evidence is, that since the smoking ban came into effect, there has been a considerable improvement in the health status of people working in this area. Compliance with the legislation has been consistently over 96%, indicating the success of this important measure. I understand it is not easy for smokers, but part of the approach taken is to discommode smokers and to make it difficult for them. For far too long, it was too easy to smoke anywhere, but now the notion of smoking on a plane or in the cinema is unthinkable. The more unacceptable and unimaginable we make smoking, the better. We cannot do that without restricting people and limiting the number of places where they can smoke. It is part of the strategy to do that and to make it less easy for people to smoke. We should not make any apologies for that.

Several Members, including Deputy Shane Ross, wondered whether the use of graphic images are effective. As I said in my opening comments, research from the United Kingdom and Belgium shows that shocking, stark images are indeed effective. In reference to road safety campaigns, several Members made the point that viewers tend to change channel when confronted with shocking images, thus potentially reducing their impact. However, the whole point of such images is to make us uncomfortable.

We are confident, in line with the view across Europe, that including graphic images on cigarette packaging will be effective in discouraging smoking. Smokers cannot switch off the image, as one can do with a television advertisement. Every time a smoker buys a packet of cigarettes or takes one from the pack, the graphic is unavoidable. We hope the images will have an impact over time in convincing people that the activity in which they are engaged will likely lead to ill health in later life. We must keep reinforcing that message, including by way of this measure. The inclusion of graphic images on cigarette packaging will make that message unavoidable.

I take on board the points made by Deputies in regard to the tone of the campaign. It is important that the anti-smoking message is not delivered in a lecturing and judgmental way. Our approach is, first, to put out the facts in a stark and clear way and, second, to ensure supports are in place, including easily accessible advice and counselling, as well as various products to assist in quitting the habit. It is very much a two-handed strategy.

I am heartened that so many Members emphasised the importance of placing a greater focus on health promotion within the health service. I hope to move in that direction in the coming months. We must face up to the large numbers of deaths in this State from smoking-related illness, alcohol abuse and poor diet. The reality is that some 80% of all illness is preventable. In other words, it is in people's own hands to maintain a healthy lifestyle and give themselves the best possible chance of avoiding serious illness. That message can be put across through effective information campaigns and the provision of effective supports and advice on how to adopt a healthier lifestyle.

I fully concur with Members who referred to the importance of positive role models for young people and of encouraging children to be involved in sport and to make positive choices. In regard to alcohol, I hope to take an initiative in the coming months and to bring proposals to the House in that regard. The time is right for such efforts; people realise we need to move towards a more health-conscious society and that it is imperative to take responsibility for improving one's own health status. It makes sense for people personally because it will offer them the potential for a much better quality of life. It also makes sense from the point of view of the health service, with a greater focus on health promotion potentially reducing the burden of disease on the system. That is the direction in which we are moving.

I thank Members for their worthwhile contributions on Second Stage and their cross-party support for the Bill.

Question put and agreed to.

Bill reported without amendment, received for final consideration and passed.

The Dáil adjourned at 1.15 p.m. until 2.30 p.m. on Tuesday, 19 July 2011.