Joint Committee on Health and Children debate

Public Health (Standardised Packaging of Tobacco) Bill 2013: Discussion (Resumed)

Chairman

As members are aware, the general scheme of the public health (standardised packaging of tobacco) Bill 2013 was referred to the joint committee for consideration before Christmas. Before the Christmas recess, the Minister, Deputy Reilly, and the Chief Medical Officer made a presentation to the joint committee by way of introduction to this important legislation. Last week, we heard from representatives of the Revenue Commissioners, the Garda Síochána and the Health Service Executive concerning issues surrounding counterfeiting, smuggling and enforcement. Following on from that, today's meeting is the third in our series of meetings that will convene in the coming weeks to consider the heads of the Bill. We will hear today about the potential effects of legislation on public health policy. In that regard we will have before us representatives of a number of non-governmental organisations and also people affected by smoking. I will not name all the witnesses now but I will welcome them individually when they are invited to speak. I thank them for their participation in this morning's meeting.

Witnesses are protected by absolute privilege in respect of the evidence they give to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person or an entity by name or in such a way as to make him, her or it identifiable. I remind members of the long-standing rule of the Chair that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.

I should have apologised at the outset for Deputy Ó Caoláin, who cannot be here, and for Senator van Turnhout and Deputies Mary Mitchell O'Connor and Ciara Conway, who are attending the launch this morning of the Child Family Support Agency. Deputies Eamonn Maloney and Catherine Byrne and Senator Imelda Henry send apologies also. I call former Senator Kathleen O'Meara who is head of advocacy and communications for the Irish Cancer Society. I ask Ms O'Meara to make her opening statement.

Ms Kathleen O'Meara

I thank the Chairman and members of the committee. I am delighted to be here today on behalf of the Irish Cancer Society to present to them the evidence already available, which demonstrates that the plain packaging of cigarettes does, and will, work.

Our vision and ambition in the Irish Cancer Society is nothing less than a future without cancer. That is the why we fight tobacco with everything we have got. Smoking is the single biggest preventable cause of cancer in Ireland. Almost one in five deaths is attributable to smoking. If we tackle smoking, as a country we will have delivered the single biggest blow possible to cancer. We fully support the efforts of the Minister for Health in his ambitious target to make Ireland tobacco free by 2025. It can be done, and the key is the next generation. It is possible to have a generation that does not start smoking. In terms of how we do that, to successfully protect them from the tactics of the tobacco industry, which needs to recruit 50 new smokers a day in Ireland to replace those who quit and those who die, the answer is the plain packaging of cigarettes.

Plain packaging has four impacts. First, and crucially, it reduces the appeal of tobacco to young people; second, it stops smokers believing that some brands are less harmful than others; third, it encourages current smokers to quit; and fourth, it increases negative feelings around tobacco. I want to focus today on that first point, namely, reducing the appeal of tobacco to young people. We wanted to show members a short video – two minutes long – in which the children of Scoil Aonghusa in Tallaght demonstrate their response to branded cigarettes and plain packs. We made the video in the Irish Cancer Society. Unfortunately, it was not possible to show it in this room but yesterday evening we sent members a link to the video. We would ask them to view it because the message in the video is very clear: plain packs significantly reduce the appeal of cigarettes to children.

In terms of young people and teenagers who are also the target of the tobacco industry, 78% of smokers start before they are 18 and even though the rate of those starting to smoke is falling among young people, it is clear we have more to do to protect this particular group. The Irish Cancer Society together with our collaborators, the Irish Heart Foundation, commissioned research into the impact on young people of tobacco branding and standardised packaging. Focus group research was conducted last summer among a group of 15 and 16 year olds, both smokers and non-smokers, who were first shown branded packs. These sleek, expertly designed, coloured packs influenced everything from the teenagers' perception of the quality of the cigarette to the likely users of the brand and, ultimately, their likelihood to try them.

They were then shown examples of standardised packaging. These packs, with their dull colour and graphic health warnings, are immediately rejected by teens. The images showing the health effects of smoking strip away any glamour or fun attributes imbued by branded packs. We can make that report available to the committee.

For those teens who have tried smoking, most reported that the introduction of plain packaging would be enough to prevent them from trying cigarettes again. For those who smoked on a daily basis, plain packaging would encourage them to give up sooner.

The findings of our research mirrors similar research carried out in different parts of the world. Time does not allow me to name them all but I would like to refer to a study published in September 2013 by the Centre for Tobacco Control Research in the University of Stirling, in the United Kingdom, which sets out a comprehensive overview of 17 studies carried out between August 2011 and September 2013 across the UK, New Zealand and Australia. The findings of these 17 studies confirm that the plain packaging of cigarettes would reduce their appeal, enhance the effectiveness of health warnings, and ensure that smokers are not misled about the level of harm done by cigarettes.

Australia was the first country to introduce plain packs just over one year ago. Interestingly, very soon after the introduction of plain packs smokers began to complain about the taste of their cigarettes, convinced that they had changed for the worse but the recipe had not changed. It was the effect on the smokers of the removal of colour and branding, and the impact of stark pictorial warnings that were now enhanced.

A recent study published in the British Medical Journal showed that those smoking from standardised packs perceived their cigarettes to be lower in quality; perceived them to be less satisfying than the previous year; were more likely to have thought about quitting at least once a day; rated quitting as a higher priority; and tended to support the policy on standardised packaging. A more recent study published two weeks ago by the Cancer Council of Victoria into the impact of plain packs on the behaviour of smokers in cafés showed that pack display on café tables declined by 15% after the introduction of plain packaging. That was due mostly to a 23% decline in the percentage of patrons who were observed smoking.

All these studies show that the inclusion of a Quitline number on packs in Australia is essential. The Medical Journal of Australia recorded a massive 78% jump in the number of calls to the Quitline since plain packaging was introduced. On that basis, the Irish Cancer Society would strongly recommend the inclusion of a Quitline number in the legislation being brought forward by the Government, in other words, that the packs would have the Quitline number on them.

It is still too early to analyse some of the long-term effects on smokers in Australia but these early studies confirm the findings of our own research and the research conducted in the UK.

I am pleased to have had the opportunity to share with the Chairman and the members this evidence demonstrating that plain packs work. No one wants to see his or her child smoking. As legislators, the members have the power to ensure that children and young people are protected from the tactics of the tobacco industry, which does target them. We urge them to take this opportunity to protect the lives of the next generation, and to make smoking history in Ireland.

Chairman

I thank Ms O'Meara. I call Mr. Chris Macey, head of advocacy, Irish Heart Foundation.

Mr. Chris Macey

I thank the Chairman for the opportunity to address the committee on legislation we believe will save the lives and enhance the quality of life of untold numbers of people in Ireland in the years and decades ahead.

We commend the Government and the Minister for Health, Deputy Reilly, in particular for standing up against the might of the global tobacco industry to protect the nation, particularly our children, from the lethal effects of tobacco.

The committee has heard the evidence on the need for plain packaging. I will address the bogus arguments used by the tobacco industry and its funded groups to oppose the proposed legislation to protect a business model which, given that 80% of smokers start before they are 18, relies on replacing dead smokers with children and young people. In addressing their claims, it is useful to first look at Big Tobacco's broader strategy to maintain profit levels by subverting national and international health policy.

Given that the industry has been so discredited, not least by years of lying about the health impact of smoking, it needs others to make arguments on its behalf. For many years it has provided funding to a diverse range of hidden persuaders to achieve its aims, including retailers' groups, business and trade organisations, fake grass roots organisations, assorted lobbyists and others.

It is virtually certain, in our opinion, that every organisation opposing plain packaging at these hearings will have a funding link, direct or indirect, to the tobacco industry, even if some do have genuine, if misplaced, concerns. While its coffers are empty in terms of credibility, the industry has no shortage of cash to pay for support. The five biggest tobacco companies alone make profits of over $37 billion a year, making them bigger than Coca Cola, Microsoft and McDonalds combined.

The model of who the industry funds to make its case is strikingly similar from country to country. Likewise, the arguments it makes against policies to protect the public from smoking tend to be recycled for repeated use regardless of the specific policy intervention. For example, on issues ranging from increasing taxation, legislation banning shop displays and now plain packaging, the industry claimed that each would increase smuggling and hit retail jobs without reducing smoking, but these initiatives have spearheaded a decline in smoking rates, from 29% six years ago to 22% last year, a reduction of 200,000 smokers, without any of the industry's dire predictions coming true.

As regards smuggling, plain packs will still carry current security markings, health warnings and other labels. Consequently, the Garda and Revenue told this committee categorically there was no evidence plain packaging would increase smuggling. Clearly, it is not in their interest to make such a clear assertion if there is room for doubt.

The truth has not deterred the industry. Even since then, tobacco companies, at least one of which has a plain packaging campaign co-ordinator, have visited retailers claiming plain packaging will reduce their sales by 20% due to increased illicit trade.

One constant industry claim is that plain packaging will be a "counterfeiter's charter". Anyone making this argument, particularly in the Irish context, either has no idea what he or she is talking about or is not telling the truth. Research by Revenue and the HSE, which is the only measure of tobacco smuggling not produced for the industry in this country, shows that our smuggling rate is 13% - slightly above the EU average. Of this, 1% is counterfeit and virtually all the rest is the product of the legal industry. Counterfeit tobacco in an Irish context is virtually irrelevant and, therefore, provides no valid argument on plain packaging here.

Even aside from the absence of any difference in the level of difficulty between counterfeit in current or plain packs, the fact is that while the industry has cited concerns about smuggling to prevent budget tax increases and then hiked up its own prices in each of the past ten years, there is growing suspicion that the legal industry is again involved in smuggling. This was echoed in the Dáil in November last when the Finance Minister, Deputy Noonan, said he suspected that the legitimate trade is involved in the production of illicit cigarettes. Stronger concerns have been voiced in the UK Parliament's Committee of Public Accounts and just this week in Europe, MEPs met international experts to discuss smuggling and the role still being played by the big tobacco manufacturers. Consequently, any organisation coming before this committee expressing fears about smuggling that takes tobacco industry funding should be asked if it understands what it is doing.

There is also no evidence the proposed legislation will negatively affect the retail trade. Plain packaging is primarily intended to discourage young people from starting to smoke and is not likely to have as much impact on current smokers. Therefore, sales reductions resulting from the policy will be gradual, giving retailers considerable time to diversify their business.

In addition, tobacco sales only account for a small proportion of small retailers' profits. While tobacco may account for up to one third of a small retailer's turnover, profit is minimal as, according to one representative organisation, retailers receive an average of 8.7% of the price of tobacco products. The size of this income stream is reflected in assertions by retailers' representatives that it will not be worth their members' while selling cigarettes when the licence fee increases to €500.

Another industry claim is that introducing plain packaging is tantamount to the Government appropriating their trademarks. Apart from the grotesque notion that intellectual property rights for tobacco firms are more important than our children's health, this is legally without foundation. The Australian courts ruled plain packaging did not represent an acquisition of property by government from which it could benefit. Here, a legal challenge cannot succeed once the State shows plain packaging is rationally connected to improving public health and is a proportionate response.

Finally, when all else fails, the industry and its supporters complain that tobacco control legislation is an attack on individual freedom and interference from the nanny state. This is their most ludicrous argument of all. Tobacco is quite possibly the greatest usurper of individual freedom in the history of the planet. Not only is it among the most addictive substances known to man, it kills half its regular users. What more conclusive denial of freedom is there than your premature death? Similarly, if we really had a nanny state, would 5,200 people be allowed to die each year from smoking?

By measuring the strong evidence supporting plain packaging against the industry's lists of baseless claims recycled from other lost battles, a simple choice emerges between protecting our children's health or industry profits regardless of the human cost.

Chairman

I thank Mr. Macey. The next speaker is Ms Sharon Cosgrove, the CEO of the Asthma Society of Ireland. I also welcome Ms Niamh Kelly and thank her for her assistance to the clerk to the committee over the past couple of weeks.

Ms Sharon Cosgrove

I wish the Chairman and members of the committee good morning and thank them for inviting us to this hearing. We representing the hundreds of thousands of people living with asthma in Ireland and we welcome the opportunity to share our views.

As many members will be aware, asthma is the most common chronic disease in the country and affects one-in-ten adults and one-in-five children. Tobacco smoke is one of the most common and dangerous asthma triggers. As others have said, tobacco is a unique product in that it causes the death of half of its users and is more addictive than any other product available legally in this country.

We are members of the Irish Lung Health Alliance, a coalition of 14 organisations working to improve lung health in Ireland. Ireland has one of the highest rates of respiratory illness in Europe, at almost double the EU average. One-in-five deaths in Ireland is from lung disease and smoking is the leading cause of respiratory death. The Irish Lung Health Alliance also fully supports this proposed legislation.

Tobacco not only adversely affects the user but also those around him or her. Passive smoking is particularly problematic for those with chronic respiratory conditions such as asthma. The 2004 workplace smoking ban allowed people with asthma to work, study and socialise without fear of an attack, and yet those with asthma are still exposed to tobacco smoke every day and our members tell us smoking poses a problem day to day, even when going to their hospital appointments. Most worrying is that children with asthma are often exposed to tobacco smoke in the home and in cars.

Breathing tobacco smoke increases the risk of asthma. For every 1% increase in smoking prevalence, asthma admissions rise by 1%. Babies born to mothers who smoke while pregnant are more likely to develop asthma. Tobacco also worsens asthma control and lung function, reduces the effectiveness of medication, and increases the risk of virus and infection. Smoking with asthma greatly increases the chance of developing irreparable life-threatening conditions such as COPD.

One quarter of Asthma Society of Ireland service users, both on our advice line and at our clinics, in 2013 were smokers and despite the risks, those with asthma still smoke.

As to why one should introduce standardised tobacco packaging, it is that branding works. Those with asthma feel the adverse affects that tobacco has on their health the minute they smoke their first cigarette, and yet they smoke. This is because branding works. Parents of children with asthma smoke in their homes and in their cars, despite the risk to their children's health. This is because branding works. The tobacco industry is fighting to defeat this proposed legislation in order to maintain its profits and its power to recruit new smokers.

Branding sells products and is so powerful that it can even sell a 50:50 chance of death. Addiction keeps people smoking and branding entices them to start. Countless research studies throughout the globe show that standardised tobacco packaging reduces smoking prevalence by reducing the appeal of smoking and increasing awareness of the health risks. Furthermore, plain tobacco packaging is found to be even more effective on young people than the rest of the population.

The tobacco industry and other interests may argue that this legislation will cost the economy and reduce the approximately €1 billion in State revenue from the sale of tobacco products. Yet the costs of maintaining the status quo are much greater. Lost work days due to asthma alone costs the economy €262 million each year. The total cost to the State of respiratory illness is estimated at €1.036 billion, with asthma accounting for €501 million of this. It is estimated that the overall cost of smoking-related illness to the State is in excess of €4 billion.

The example set by Australia is inspiring countries throughout the world to take action against tobacco. Public opinion is also in favour of plain packaging. A recent survey carried out by an alliance of health and children’s charities found that the majority of Irish people support this legislation. Ireland was the first European country to introduce a workplace ban on smoking. It is now time for Ireland to again take the lead in protecting the lives and lungs of future generations. We in the Asthma Society of Ireland fully support this legislation and urge its speedy implementation.

Chairman

I thank Ms Cosgrove. I now welcome from ASH Ireland, Dr. Ross Morgan, chairperson and Ms Norma Cronin, board member.

Dr. Ross Morgan

I thank the Chairman and members of this committee for affording ASH Ireland the opportunity to make this presentation on what I believe is ground-breaking public health legislation. This legislation will contribute to saving thousands of lives in future decades and protecting further thousands of young people from the scourge of tobacco and related nicotine addiction.

The only agenda of ASH Ireland is health. We are the only single-issue anti-smoking advocacy group in this jurisdiction. We have been deeply involved in supporting this and previous governments in the introduction of anti-smoking legislation which contributes to saving lives and protecting people from the harmful effects of environmental tobacco smoke. My colleague Norma Cronin has worked in smoking cessation and advocacy for tobacco-related legislative change for many decades. She has a deep knowledge of the effects of smoking and the industry which promotes it. I am a respiratory physician by profession and on a daily basis I treat many people who are suffering ill health for one reason only - they smoke. This week, 100 people will die from smoking-related lung disease. We must help these people with every avenue open to us. In my view effective legislation is perhaps the most powerful tool in tackling the smoking dilemma. Almost every one of my patients who smoke wants to quit and virtually all wish they had never started. The vast majority started smoking in their teenage years and continue to smoke because nicotine addiction quickly takes hold. It is specifically in this area that we believe the proposed legislation would have most impact.

This legislation is essentially about restricting a specific industry in marketing a unique product which costs this State well in excess of €1 billion annually in treating a raft of related diseases and which kills 50% of those who use it. New users must be recruited and it is young people who are the primary target of tobacco industry marketing. In this context, I wish to offer the committee a number of quotations from tobacco industry representatives. From RJ Reynolds Tobacco we have the following: "Brands which fail to attract their fair share of younger adult smokers face an uphill battle". The quote continues, "if younger adults turn away from smoking, the industry must decline just as a population which does not give birth will eventually dwindle". I offer the committee another quote from this company dating back to 1974. When talking about young people, RJ Reynolds said, "They represent tomorrow’s cigarette business. As this 14-24 age group matures, they will account for a key share of the total cigarette volume for at least the next 25 years". Market research conducted by Philip Morris in 1981 states the following:

It is important to know as much as possible about teenage smoking patterns and attitudes. The smoking patterns of teenagers are particularly important to Philip Morris. The share index is highest in the youngest group for all Marlboro and Virginia Slims packings. At least part of the success of Marlboro Red was because it became the brand of choice among teenagers who then stuck with it as they grew older.

I have another quote from a marketing and design executive representing Lorrilard, another large tobacco firm:

We have been asked by our client to come up with a package design, a design that is attractive to kids. While this cigarette is geared to the youth market, no attempt (obvious) can be made to encourage persons under twenty-one to smoke. The package design should be geared to attract the youthful eye, not the ever-watchful eye of the Federal Government.

The committee should note the number of times that brand, marketing and worryingly, young people and teenagers are mentioned by an industry which tries to convince us that it does not market to and target young people. This is untrue. For every smoker that dies, the tobacco industry is determined to replace that smoker with a young person who will quickly become addicted and thereby continue to smoke for the remainder of their lives. When we consider the current challenges facing our health services, both here in Ireland and elsewhere, the committee will find it interesting to note that in 2006 alone, the five largest tobacco manufacturers in the United States spent $12.49 billion on marketing their products. This marketing is entirely centred and focused on brand promotion and awareness. It goes without saying that if the tobacco industry is spending $12.5 billion dollars on supporting brand awareness and promotion, it is fully aware of the vital importance of branding in enticing young people to smoke and encouraging brand loyalty and continuance of the practice among smokers.

It is clear that the legislation which is now before the committee is running directly contrary to the highly expensive and focused marketing campaigns of an industry which supplies a product which is highly addictive and which is the leading cause of premature death and disability in our country. I expect that in the later stages of the committee's hearings the Irish tobacco industry will enter this room and try to convince the committee that it has a right to market its product and will probably try to say that this important legislation will have no impact. In my view, no industry has the right to market in a normal fashion a product that is known to kill 50% of those who use it. Tobacco is a unique product in terms of addiction, which is often referenced as being similar to the addiction to heroin. It is not a food or beverage that can be life sustaining. It is not a product that has a threshold of effect, a safe level of use or a product that can be used safely in moderation. It is unique in regard to related mortality. No other product on sale worldwide costs the health services such massive amounts of money in treating its related diseases.

I have no doubt whatsoever but that the introduction of plain packaging will make it more difficult for the industry to market its products to young and old. The committee has already heard the evidence in favour of plain packaging from the Australian experience, which I will not repeat. I urge the committee to proceed with this legislation. In our written submission we have put forward a number of proposed amendments under heads Nos. 3, 4, and 14, and we ask that the committee looks positively at these proposals.

The workplace smoking ban was introduced ten years ago, despite the resistance of many interests that decried the legislation and predicted it would fail. Nobody could speak now against the success of that legislation. Ireland can once again take the lead in Europe by putting the health of the nation ahead of the profits of any single industry. The leadership of our legislators is a key element in this. I thank the committee again for the opportunity to address it today.

Chairman

I thank Dr. Morgan. I now call on Mr. Damien Peelo, the executive director of COPD Support Ireland to make his opening remarks.

Mr. Damien Peelo

Good morning Chairman and members of the committee. I thank the committee for inviting us here today. COPD Support Ireland is a national network of local groups led by people living with COPD. Our focus is to raise awareness of COPD and the profound link between smoking and the development of this disease. COPD is probably not as well known as other illnesses but it is estimated that 440,000 people are living with the disease in Ireland today. Smoking is the lead cause of COPD. There are approximately 1,500 deaths per year from this disease and over 90% of all sufferers are smoking or are ex-smokers. COPD is the collective name for lung conditions that make it hard for sufferers to breathe due to obstruction in the air passages of their lungs.

It is a progressive, disabling disease with a significant extra-pulmonory effect and it has a major impact on the lives of patients, families and carers, in addition to the health care system. COPD cannot be cured. Even when a person quits smoking, the damage to the lungs is not reversible. The consequences of smoking are lifelong. One sufferer has said the condition is such that it is like trying to take a breath with an elephant sitting on one's chest.

There are approximately 11,000 admissions to hospitals each year of COPD patients, representing approximately 120,000 bed days utilised. There are huge costs associated with that. An uncomplicated admission of a COPD patient costs over €4,000, and a complicated admission can cost €7,700. The average length of stay is nine days. Therefore, one can see how the costs build up.

Although smoking is the leading cause of COPD, 77% of Irish people do not know this. This indicates that the health warnings are currently not effective enough in deterring people from taking up smoking. More needs to be done. Smoking is a factor in 90% of cases of COPD. Most of those affected have smoked over 20 cigarettes per day for up to 20 years. Up to 50% of lifelong smokers will develop COPD. An individual who is highly exposed to passive smoking is 48% more likely to present with COPD than an unexposed individual. Given the adverse effects of cigarettes in terms of COPD, the disease can have a lag period of up to 15 to 20 years. These rates have significant health implications for the medium and longer term.

We have heard a little about passive smoking already. What was said applies to those with COPD. While the workplace ban has limited the number of places in which people can smoke, passive smoking has a huge impact on people with COPD. Our members tell us that smoking poses a problem daily as people must walk past smokers on the street or gathered outside public buildings, such as hospitals, pubs or cafés. Even being in a vehicle where smoking has recently occurred can induce a coughing fit and immobilise a person with COPD. It is very important to reduce the number taking up smoking rather than just restrict the number of places where people can smoke.

COPD is adversely associated with socioeconomic status. The effects are reflected in the risk factors for the disease. The smoking rate in Ireland among those in the most deprived social groups is high compared with the national rate. Among homeless men in Dublin, the smoking rate is 78%. These social and economic gradients are reflected not only in the prevalence of smoking but also in the prevalence of COPD and the outcome for those with COPD in terms of morbidity and mortality.

COPD Support Ireland fully supports the Bill to standardise the packaging of tobacco. Smoking is a dominant cause of COPD. Discouraging young people from taking up smoking is a key preventive measure in tackling the disease. On seeing a mock-up version of a potential plainly packaged box of cigarettes, a 50-year-old woman commented: "I wish I had never started smoking. I would not have taken up smoking if those images were on the packs. You would be mortified to take that out". The statement was made by Paula, who smoked ten cigarettes per day from the age of 16. She is present today in the Visitors Gallery because she is determined to prevent and passionate about preventing others from taking up smoking. She believes plain packaging will have an impact.

COPD has a considerable impact on the quality of life of all patients. It involves long-term medical care and, for many, frequent hospital admissions for the treatment of exasperations, which often result in premature death. As with many chronic conditions, COPD not only affects the patient but also has a significant impact on the family, carers, health services and wider society. Given that 90% of cases are caused by smoking, it is imperative that we act now to minimise the potential of future generations from taking up the addictive habit. The Bill represents an important step towards protecting young people and future generations from addiction to tobacco products. The swift introduction of the legislation will ensure that the health of Irish citizens is prioritised over the efforts of the tobacco industry to weaken and delay a significant public health protection.

Chairman

I thank all the delegates for their very informative and sobering presentations. Deputy Kelleher apologised as he has had to leave. He hopes to return.

Deputy Sandra McLellan

I welcome the delegates and thank them for their presentations. I apologise on behalf of Deputy Caoimhghín Ó Caoláin as unfortunately he cannot be here today.

Sinn Féin supports the planned legislation. My colleague Martina Anderson has done a lot of work with regard to the tobacco directive at EU level. What do the delegates think about the discussion on the current tobacco products directive at EU level? Should menthol cigarettes be included in the legislation? What is the age profile of those taking up smoking? With regard to the plain packaging in Australia, has the number of people quitting smoking levelled off? Have those who have quit smoking stayed off tobacco?

A comment was made in one of the presentations to the effect that the University of Cambridge estimated in 2013 that two years after the introduction of plain packaging, the number of adult smokers would be reduced by one percentage point, and that the percentage of children experimenting with tobacco would be reduced by three percentage points. How would these statistics translate into figures in this State? What would the long-term effect be on smoking and tobacco addiction?

How could the legislation be improved? It was stated that addiction keeps people smoking and that branding entices them to start. Is it a case of branding or addiction? There is no branding of illegal drugs but people still use them because of socioeconomic factors. Could the same thinking not be applied to cigarettes?

Deputy Seamus Healy

I welcome the delegates. We have heard this morning a series of absolutely shocking facts. One in every two smokers will die of a smoking-related illness. The ASH presentation stated 100 people will die this week of smoking-related illnesses. The tobacco industry is an industry of death. While we obviously welcome the reduction in recent years in the prevalence of smoking, which is now down to 22%, much more needs to be done. Plain packaging is required to prevent 50 people taking up smoking per day, which number is required to maintain the overall number of smokers. It is predominantly young people who take up smoking.

It was suggested that the Australian experience shows that it is not only plain packaging but also the size of the packaging that has an influence. Do the representatives believe the size of packaging should be covered in the legislation? The Australians have reduced the size of packaging in addition to introducing plain packaging. The introduction of a quitline is a helpful suggestion.

I said on the last occasion that what we really need from the representatives appearing before us is a very clear indication that they are absolutely satisfied that plain packaging will reduce the attractiveness of cigarette smoking among younger people. The representatives who were present last week were very clear on that and were happy to make the case. Are the representatives present today fully satisfied that plain packaging will reduce the number of people taking up smoking?

There is a suggestion that plain packaging will make it easier for criminal elements to sell cigarettes illegally. I do not believe that myself but I would like confirmation of it. I want to hear the position of the various organisations on that.

Senator John Crown

I welcome my various colleagues in the anti-smoking struggle here today. This is a slam dunk and everybody who cares about health will support this Bill. We need to get it shepherded through as quickly as we can. All the arguments about smuggling and illegality are entirely bogus. I believe in my heart, and I believe the evidence is clear, that the tobacco industry directly and indirectly profits from the sale of illegally smuggled cigarettes, which are their own products. They also indirectly profit from the sale of illegally produced counterfeit cigarettes because anything which provides cheap cigarettes to impressionable young people who may have limited financial resources, which hooks them and addicts them to nicotine from tobacco smoking at an early age is in their long-term interests. The industry therefore does not really care about that; all it cares about is selling cigarettes. Anybody from the tobacco industry who espouses any position other than one which honestly says, "We want to increase sales of tobacco products" is lying. It is that simple.

We also need to foster the notion of ethical business. As the committee may know, I have put out an idea that we should pick some future date and say that after that time it will be illegal to do for-profit commerce in carcinogenic tobacco. In the short term we equally need to think of ways to incentivise individual businesses to get out of the tobacco supply chain. I do not mean to moralise about mom and pop corner shops. As I have pointed out at this committee before, my own father, Lord rest him, used to run a shop called "Jack's cigar store". He used to sell tobacco in Brooklyn, New York, many years ago. The culture is different now, however, and people understand that smoking causes cancer.

People in any shop, be it a local retail shop or garage, who are selling cigarettes are part of the problem and they need to understand that. The Government needs to think of clever ways of incentivising people to get out of that business, perhaps by having differential VAT rates on all products for shops that declare themselves to be tobacco-free zones. One would therefore pay a little less VAT if one went to a shop that committed itself to not having tobacco.

What about those nice pictures we have on the tobacco boxes now? Why not have a life-size poster of that mandatorily put up in every shop that sells tobacco, saying: "The proprietor of this shop sells these products"? A nice big picture of somebody with an advanced tumour, a gangrenous leg or an oxygen mask could be put in every shop. Let people know exactly what they are doing.

I also hope this Bill passes for another reason. Those who heard the news this morning will realise that the House of Lords - that second great upper Chamber of these islands - passed an amendment last night to the Child Welfare Act which would make it illegal to smoke in cars where children are present. That comes two years after that legislation was introduced here. For the past two years, it has been interminably glued up in the bureaucracy, so it needs to pass. As of today, 30 January 2014, this Government has passed one piece of smoking legislation, which is to make it easier to sell cheap cigarettes, although I know that is not the intent of the Minister or the Government. That legislation was forced on them by commercial courts and international precedence, but that is the scorecard as of today. It could be fixed quickly with the rapid passage of several pieces of legislation.

Chairman

To be fair to the Minister, he explained the reasoning and rationale behind the delay in the Bill which he co-sponsored. I think the Senator is being unfair to the Minister in that regard. In the interests of balance we should hear from the Minister about that. We are on the same page concerning today's debate.

Senator John Crown

It could be fixed with about three hours of legal time.

Chairman

Okay. I thank Senator Crown and call on Senator Burke.

Senator Colm Burke

I thank all the witnesses for their comprehensive presentations and the work they are doing. I am concerned that it is 50 years since the first major report was published in the United States setting out the real risks of smoking and the health difficulties is was causing. While we have moved on somewhat in 50 years, we have not really got the message across to a large percentage of the population around the world. In most countries, well in excess of 20% of the population are smoking. I hope that whatever progress has been made in the last 50 years, we can at least treble it in the next ten years. Are we doing enough to get the message across even on simple issues? Despite the economic downturn during the past five to six years, it is costing a person who is smoking 20 cigarettes per day well over €3,500 per year in real terms. We have highlighted the health issues but I am not sure we have highlighted the financial costs. Should we not also examine that aspect of campaigns?

The real financial cost of cigarettes should be highlighted as well as the cost healthwise. For instance, if a person decided not to smoke 20 cigarettes a day, they would save €3,500 per year, which is the price of two holidays. We have not been that subtle in the way we are providing such information. It is something we should examine. It is right to highlight the health risks but we should also focus on the financial benefits of giving up smoking. Perhaps the witnesses could give us their own views on that. In addition, how can we fast-track reducing the numbers further? In fairness, all the witnesses are doing their own job in selling that message but I wonder what their plans are for the coming three to four years.

Deputy Peter Fitzpatrick took the Chair.

Deputy Dan Neville

I also welcome the contributions and thank the witnesses for attending the committee. It is almost 20 years since a committee like this one first produced a document on the dangers of tobacco consumption. Deputy Alan Shatter was allocated the task of producing the report. I remember the strong lobbying by the tobacco industry at that time which brought a lot of pressure to bear. In addition, international pressure was put on the committee at the time to persuade it against the approach that was being taken. The report played a role in what has been done so far as regards banning smoking in the workplace. That was one of the issues raised in the report at that time.

This is a further development and I hope it will be one of a series of such developments to protect public health, including the future health of our children.

Deputy Jerry Buttimer resumed the Chair.

Chairman

We will return to our witnesses next.

Ms Kathleen O'Meara

I thank the Chairman and other members of the committee. Deputy McLellan asked about the tobacco products directive. An incredible amount of lobbying was done around that directive by the tobacco industry. A lot of this took place during the Irish EU Presidency and an Irish civil servant remarked that he had never seen that extent of lobbying and the sheer volume of lobbyists there. Despite that, the tobacco products directive has been passed and will do a number of things, including introducing important regulations concerning e-cigarettes. Menthol cigarettes are also covered by the directive.

A question was also asked about the number of smokers who were quitting in Australia but it is only a year since plain packaging was brought in there. The research I referred to shows, for instance, the high rate of people who are telephoning the quitline, which is a good indicator of intention to quit, although the number who will quit will not be as high. My former colleague, Ms Norma Cronin, who is on the board of ASH, will say it is very important that in the first instance, a person has an intention to quit.

Many members referred to branding.

It was one of the issues considered in the report commissioned by the Irish Heart Foundation and the Irish Cancer Society. People who have contact with teenagers know that branding is of significant importance to them. It is part of the sense of belonging to the group. It creates a sense of status and belonging. It is the hook that brings in the young person.

I was asked how the legislation could be improved. Deputy Seamus Healy asked whether the size of the packet had an influence. We have suggested in our submission to the joint committee that standardising the size of the packet of cigarettes is important - this is backed up by evidence from Australia - in other words, that tobacco companies should not be allowed to change the size of the packet, in particular to produce smaller neater packets because size can be relevant. We want the legislation to ensure there is a standardised size of a packet of cigarettes. Much has been done. Senator Colm Burke referred to the US Surgeon General's report of 50 years ago, but as Deputy Dan Neville said, the report of this committee was very relevant in setting the tone for the workplace smoking ban. A great deal has been done, therefore, in a relatively short period. In that time we have succeeded in de-normalising smoking, in other words, smoking is not considered generally to be a normal activity. For many who are addicted, this is too late. We have to ensure, however, that there are sufficient supports in place for those who are heavily addicted to cease smoking.

Senator Colm Burke asked me to outline the Irish Cancer Society's plans. We have a specific programme with a number of women in two disadvantaged communities in Dublin designing a model which will support them specifically in giving up smoking. The normal advertising messages to quit smoking are not sufficient for particular groups in society. Their smoking habit is linked with other factors such as poverty and dependence. We are designing a particular model and when we have it later this year, we will be very happy to talk about and share it with members of the committee. This is one of a series of developments which, as Dr. Ross Morgan said, represent ground-breaking legislation.

Mr. Chris Macey

Let me respond to Deputy Sandra McLellan's questions. Ms Martina Anderson, has been fantastic and stood up to what Ms O'Meara identified as the massive industry lobbing in the European Union. Her work has had a deep impact, but having said that, the Irish Heart Foundation would have been quite disappointed with the voting on the tobacco products directive. On a positive note, the graphic warnings on plain packets will make them much stronger, but on the issue of slim cigarettes which are aimed at young girls, MEPs from other countries turned. One tobacco company alone had 161 lobbyists working on this issue, whereas it was registered in the EU register of lobbyists as having only seven. It was the fourth largest supplier of cigarettes in this country. Let us think of how many people are working on co-ordinating the anti-plain packaging campaign.

Some 78% of smokers start to smoke before the age of 18 years, which is the reason the tobacco industry knows it must get new customers. Tobacco products kill their customers and the industry must replace them. As somebody mentioned, it needs 50 new smokers a day, most of whom will be children and young people because they account for the majority who start to smoke. It was mentioned in the context of addiction to illegal drugs that they were not branded, but people still use them. We must remember that the main purpose of the legislation is to stop young people from starting to smoke. For people who are already addicted, it is another issue. It has been shown in Australia that there has been a 23% reduction in the numbers smoking outdoors; therefore, the packaging used is having an impact on current smokers. We also know that cigarettes are addictive. There is evidence that the tobacco industry is making them more addictive by increasing the nicotine content to hook people and frustrate tobacco control efforts.

Deputy Seamus Healy asked if the use of plain packaging would reduce smoking rates. As my colleague, Ms O'Meara said, we carried out research with focus groups of young people that showed that in 100% of cases those who had not started to smoke were less likely to start; that those who had started but were not addicted would stop immediately and that those who were addicted were going to try to stop. That was the message across 100% of the people to whom we spoke. When they spoke about the packaging currently used, they talked about how it made them feel more sophisticated, richer, more glamorous and cooler, whereas the plain package would actually turn that concept of peer pressure on its head by making them fear judgment and shame from their peers and saying they would quit immediately. As far as we are concerned, what more conclusive evidence could young people give us?

Let me deal with the question of smuggling and counterfeiting. The tobacco industry and the groups it funds bang away at the argument that plain packets will increase the number of counterfeit cigarettes, but the Garda Síochána and Revenue are absolutely categorical that there is no evidence that plain packaging fuels smuggling in any way. Counterfeiting is not an issue because only a very small amount of illicit tobacco coming into the country is counterfeit, the vast majority comes from the legal industry. Let me give an example. Exports of cigarettes to Andorra increased from 13 million cigarettes in 1993 to 1.52 billion in 1997, the equivalent of 130 cigarettes a day for every Andorran man, woman and child. Most of these cigarettes ended up back in the United Kingdom on the illicit market. As Senator John Crown asked: "Who makes the profit from that?" The legal tobacco industry makes the profit. The Minister for Finance said in November 2013 that he was concerned about the legitimate tobacco industry being involved in illicit trade. There are repeated remarks about this, in particular, in the United Kingdom. The Chairman of the UK Public Accounts Committee, Margaret Hodge, MP stated:

The Department [HMRC] has failed to challenge properly those UK tobacco manufacturers who turn a blind eye to the avoidance of UK tax by supplying more of their products to European countries than the legitimate market in those countries could possibly require. The tobacco then finds its way back into the UK market without tax being paid.

The supply of brands of hand rolling tobacco to some countries in 2011 exceeded legitimate demand by 240%. That highlights where the fuelling of this illicit trade is taking place. The tobacco companies state the smuggling rate is around the 30% mark at a time when it has been reduced from 16% in 2009 to 13% now. That is not to say we do not have a problem because the average rate of smuggling in EU countries is 11%, whereas it is 13% in Ireland, but it is nothing like what the tobacco industry states it is.

Ms Niamh Kelly

I will try not to repeat what has been said. In response to Deputy Sandra McLellan who asked if we were supportive of the tobacco products directive, we are.

Banning flavoured cigarettes is a significant measure in terms of stopping young people smoking. They are very appealing to teenagers. We were disappointed that the warning size was reduced to 65%. We would have liked to have seen the maximum warning size adopted.

Mr. Macey has already touched on the age profile. A total of 50% first-time smokers are under 15 years of age and 78% are under 18 so it highlights the fact that this is a child protection measure. Branding has been stopped in public places and advertising has been stopped but a packet of cigarettes at home where there are young people and where their parents smoke is a key branding tool for the industry.

Deputy Healy spoke about the numbers in Australia, which was touched upon earlier in terms of the quitline number being on the packs. We would fully support the quitline being included on the packaging. There has been a 78% increase in calls to the quitline in Australia so it demonstrates that this is a measure that will, hopefully, stop existing smokers smoking.

I will address the questions from Deputy McLellan and Senator Burke regarding the risk of smoking, getting the message across and branding. Branding is aspirational. It sells something that somebody wants to be and it is really important that tobacco packaging demonstrates that the only things you are aspiring to if you use this product are ill health and death. It has to send the message that if you smoke, you have a 50% chance of dying. At the moment, allowing the tobacco industry to use coloured packaging in the same way as every other product says "try me" and "buy me" to young people. It needs to be treated like the individual unique product it is and the packaging needs to be unique.

Senator Burke asked about the financial implications of smoking. The personal financial implications are a strong message to put forward. Ms Cosgrove outlined in our opening statement the cost of smoking. People with asthma miss 12 days of work and ten days of school each year. One can add to that people with other respiratory problems. These are not just smokers. Passive smoking is a huge issue for people with asthma and other respiratory diseases. One of our patient advocates spoke recently about needing emergency care after being at a hurling match where someone was smoking. Even in outdoor areas, someone smoking nearby can stop you going to work, which has an add-on effect for the State. More worryingly, one in five children in the State has asthma and 22% of adults smoke. Therefore, the children of smokers are in the home and in the car with people with smoking. This all adds up to a huge burden on the State in respect of health care so the financial implications are not just personal. There are implications for the State. A recent Philip Morris report stated that the loss in revenue from standardised packaging would be €125 million. When one compares that with the cost of treating smoking-related illness, which is estimated to be about €4 billion each year, it is minuscule.

Senator Burke also asked about how we can further reduce smoking prevalence. The measures contained in the Tobacco Free Ireland policy document are very ambitious and will go a long way but it is imperative they be implemented as speedily as possible. Measures like banning smoking at bus stops, around schools and in public places can help. Deputy Healy asked us to confirm that we are absolutely satisfied that this Bill will reduce smoking prevalence. I can confirm that the Asthma Society of Ireland fully supports this Bill and believes it will go a long way towards reducing smoking prevalence in this country.

Chairman

Does Dr. Morgan or Ms Cronin wish to speak?

Dr. Ross Morgan

There is unity here. This legislation is primarily about discouraging young people from starting to smoke cigarettes. It is part of a suite of things that can be done to get the prevalence down further. The success of the last decade has seen smoking rates fall from about 30% to 22% and a reduction of about 50% in 12 to 15 year olds starting to smoke. I thank the members for their questions. I will pass over to Ms Cronin for some specific answers.

Ms Norma Cronin

I will respond to Deputy McLellan's question about whether it is addiction or packaging that keeps people smoking and legal drugs not having branding. I have a lot of experience of dealing with people with the addiction and helping smokers to quit. The Deputy is probably right in that the branding and glamorisation of the packs, along with peer influence and whether their parents smoke, start them smoking. However, the addiction takes hold very quickly. We know nicotine reaches the brain in seven seconds. It is a very fast delivery system. Most smokers are not smoking out of choice. We have heard from previous speakers that almost 80% of smokers want to quit. I do not think the branding is crucially important.

We know from other research that people underestimate the health effects of smoking. They might all know about lung cancer but research conducted by the Irish Cancer Society and the HSE has shown that people do not know that it causes age-related macular degeneration - blindness in common language. They know about gangrene but when they see the image, they do not know about its effects on oral health. They do not know about mouth, head and neck cancer or that 30% of all cancers are caused by smoking. It is crucially important that this measure comes into effect.

The other question related to whether we are doing enough to get the message across. Senator Burke is not here but I think that was in respect of-----

Chairman

Senator Burke had to go to another meeting.

Ms Norma Cronin

I might refer to that question because of the sum of €3,500 spent by the smoker. From research and from my experience of running the national smokers' quitline, we know that health is the main reason for people wanting to quit. That is the first thing everybody says. We ask everyone what their reason for quitting is. It is health but the second reason is the cost. It does have an impact which is why it is so important that we continue to advocate for price increases in tobacco. Despite us thinking we have one of the highest prices for cigarettes, we know from the World Health Organization that it is a very effective method.

In respect of whether we are doing enough with regard to the quitline number, Ms O'Meara highlighted in her presentation the fact that having the quitline number on the pack does a number of things. It is crucially important. We know about the increasing calls to the quitline from the Australian research. We know from our national smokers' quitline that when we have an ad campaign, we get a huge increase in the volume of calls. The quitline number will do two things. It will prompt these smokers to pick up the phone and possibly make their first attempt or get the information about quitting. Second, it is a very cost-effective measure when one considers what we must spend on advertising the quitline number or advertising campaigns so it will do what it says on the pack. It is crucially important that this is included. ASH Ireland fully supports the legislation. I think all the other questions have been dealt with.

Chairman

Does Mr. Peelo have any remarks to make?

Mr. Damien Peelo

In respect of Deputy McLellan's questions, we support the call for the standardised size of a pack of cigarettes so that it cannot be used as a branding form, for example, slim or long cigarettes, and you cannot distinguish between the different brands. We know that branding works. It will not stop people being addicted but it could be a key shock factor that helps people want to come off cigarettes. Branding works because marketing companies exist and make a lot of money out of branding.

Having something in plain packaging will certainly go a long way. Deputy Healy asked us to confirm whether we think it will result in a reduction in the number of those who start smoking. COPD Support Ireland expects that it will be a major step forward in preventing people from taking up smoking but other cross-departmental strategies will also be required to address the link between social deprivation and smoking.

Senator Colm Burke asked about the cost. It is a key strategy for saving money that could be spent in other areas, such as improving health and well being. The savings to the State alone would be considerable through, for example, reducing the cost of hospital stays for COPD patients. For these reasons, we fully support this legislation.

Deputy Peter Fitzpatrick

It is important that we listen to the views expressed by the organisations that appear before this committee. A number of serious facts were presented this morning and I learned a lot. The Irish Cancer Society stated that 5,200 people die prematurely per year, that 25% of the Irish population smoke, that one in two long-term smokers will die from smoking-related diseases and that smoking is an addiction. Harm from smoking begins immediately and ranges from addiction to serious damage to the heart and lungs. The earlier children become regular smokers, the greater the risk of developing heart or lung disease, or cancer.

ASH Ireland stated that our health services spend more than €1 billion annually on tobacco-related diseases, that the evidence indicates standardised packaging is less attractive to young people, that tobacco is directly linked to serious diseases, such as cancer, cardiovascular disease and asthma, and that the tobacco industry now accepts that nicotine is highly addictive.

The Irish Asthma Society stated that tobacco smoke is one of the most common and dangerous triggers of asthma attacks, that 470,000 people in Ireland have asthma, that Ireland has the fourth largest prevalence of asthma worldwide and that 60% of people in Ireland have uncontrolled asthma, which means they are at risk of asthma attacks. One in every ten adults and one in every five children has asthma. The Irish Heart Foundation noted that socialising remains a key driver for smoking and that the biggest barrier to giving up smoking is a night out. Smoking is seen as equating to more fun, a way to fit in and an opportunity to interact with others.

COPD Support Ireland stated that approximately 11,000 admissions to hospitals per year are COPD related and that approximately 120,000 beds are utilised by COPD patients. It costs €4,086 for an uncomplicated admission and €7,749 for a complicated one. The average length of stay is nine days.

The witnesses agreed that packaging offers tobacco companies a powerful opportunity to recruit new smokers, particularly among young people. They suggested that reducing the appeal of tobacco products can play a vital role in reducing the impact of tobacco on health among Irish adults and children. As a non-smoker, I am especially concerned about the risk of passive smoking to people with chronic respiratory conditions. If this legislation is passed, what level of reduction would the witnesses expect in the number of smokers in Ireland?

Deputy Catherine Byrne

I recently learned that politics is to be included on the leaving certificate curriculum. I wonder why health matters are not also being included on the curriculum. Education is central to health awareness, whether that education begins at home, in school or at work. Over Christmas I spent some time in the company of 15 young people, ten of whom were smokers. I asked the smokers their opinion of the packaging of their cigarette packages. Two of them said they would continue to smoke regardless of the packaging but the rest thought the picture on the package looked awful. However, the picture on the package is the size of a postage stamp. If we are to promote good health through standardised packaging, we need to put more thought into the image on the box. In my opinion as a non-smoker, the image is too small. I got the sense that the aforementioned young smokers did not understand the health risks, and this is why education is important. It is time that the Minister for Education and Skills examined the way in which health matters are taught, including drug and alcohol addiction.

I agree with Senator Crown that advertising plays an important role. What are the witnesses' organisations doing to disseminate graphic images of the diseases caused by smoking? A massive poster campaign should be developed to reach hospitals, schools, community centres, sports halls and bus stops. The one thing that lives on in our minds is the image. The way a baby learns that an apple is an apple is by looking at a picture. I spent much of the past week in the respiratory unit of St. James's Hospital because my brother is a patient there. I was shocked that some of the patients with COPD and other respiratory illnesses continued to smoke. We need an organised effort to disseminate the graphic images of the effects of smoking.

Two of the aforementioned young people had close relatives who had died of lung cancer. I was appalled that they continued to smoke despite this impact on their families. Education begins at home and extends into our classrooms. All organisations that campaign against smoking need to examine how it can disseminate the message graphically. I did not see one poster with information on smoking in St. James's Hospital.

Deputy Regina Doherty

I thank the witnesses for their presentations. The more I hear about the benefits of plain packaging, the more the proposal becomes a slam dunk. The suggestion that a quitline telephone number should be included on packages is a no-brainer and the committee should recommend to the Department of Health that it be included in the Bill.

I acknowledge that Deputy Crown's passion arises from his professional experience but it is not our role as policy makers to demonise manufacturers and, especially, Irish retailers. I have 20 years of experience in marketing. Companies would not spend money on marketing if it did not work. We should take the opportunity to find positive outcomes because they are equally as important as negative outcomes for those who continue to smoke. Those who want to quit smoking should have a positive image to strive towards. When my mother was giving up smoking she set a goal of spending the money she saved on clothes for me. As a teenager, that was an attractive goal.

Retail Ireland needs to engage with the Department of Health to provide for a positive campaign for a healthy Ireland and healthy alternatives for retailers around the country. We have already discussed this issue. They do not want to sell tobacco. They know full well that they would earn much more profit from selling something else, but at the end of the day they are providing jobs and a living for themselves. It is incumbent on us and the Department to try to provide some alternative for them. Perhaps nicotine replacement therapies should be freely available in all retail outlets, as opposed to customers trying to find a chemist that is open at 6 p.m. on a Sunday. We need to be part of the solution in providing equivalent incomes for retail businesses in Ireland, as well as providing positive messages for people who want to quit smoking. As Senator Colm Burke said, we could provide the image of that holiday for the price of a person's ten or 20 cigarettes a day if they gave up smoking, as well as for the improvements to one's lifestyle and overall health. I congratulate the delegates and urge them to keep going. We are nearly there and they have the full support of the committee.

I have a question for Dr. Morgan. On the website of the manufacturers there is all this wishy-washy stuff about how they are involved in ensuring young people do not start smoking and all this wonderful executive language about giving money to buy scouts' equipment. What is the source of the quotes Dr. Morgan read? Where did he get them? That is the kind of stuff we need to refute and promote in the coming weeks when the industry starts to wag its tail and tell us how good it is at ensuring under 18 year olds do not smoke. I would appreciate that information.

Chairman

Some of the quotes were from the 1980s. Do we have any more modern, up-to-date quote or references? It would be important in the context of our debate.

Ms Norma Cronin

We will give them to the committee.

Mr. Damien Peelo

Particularly on Deputy Catherine Byrne's comments, all organisations are key to part of the education on smoking and the damage it can cause. I agree that we need to look at visual, graphic images to help in that task. Education starts in the home and there has been a cultural change. My parents were smokers. Smoking seemed to be a very normal thing to do and I am not talking about all that long ago. It is still in our psyche that smoking is not going to cause that much damage and that it happens to somebody else, but there is a need to personalise the effects of smoking. We will be trying our best to promote this approach.

Because ours is a national network, people with COPD go into schools and publicise the effects smoking has had on their lives. It is often a very big shock factor for young people to see people with oxygen and learn that this could happen to them as they get older, although with the age gap, people often think it is a lifetime away. Education is key in that regard. On Deputy Fitzpatrick's comments, all those facts are very clear, that COPD is a huge burden on Ireland's health service, both financially and in the personal lives of sufferers and their families. This burden can be reduced by preventing people from getting COPD in the future. One way to do this is through providing for the plain packaging of cigarettes.

Dr. Ross Morgan

On Deputy Regina Doherty's point, a very small proportion of the budget is spent on the marketing side on what the industry terms awareness campaigns, which we believe do not work. We talked a little about education, while Deputy Catherine Byrne talked about where it started. Education clearly is important, but legislation must support it, too. Senator Colm Burke alluded to Luther Terry, the US surgeon general, when, finally, the evidence was out that smoking caused lung cancer. It is 50 years since that happened and in the first 30 or 40 years after that event the industry put up a smokescreen of doubt, controversy, jobs and all of the arguments we now hear when we talk about introducing new legislation.

The quotations referenced in the submission are in the public domain and would have got into it during the course of the tobacco master settlement in the United States in 1999. That was the year in which the Marlborough man was retired. He died this week of COPD, the condition suffered by many of the people Mr. Peelo supports. It is a very common and increasing condition of chronic lung disease and disability. He died of that condition. He was a promoter of cigarettes in his early days as an actor. More recent quotations may be available. One would imagine the industry is a little tighter with these quotations now. Some lip-service is paid to awareness campaigns in some countries, for example, the oft-quoted ones in Germany. They have done nothing to impact on childhood smoking.

Chairman

The German model is espoused by the pro-tobacco lobby. I am curious to hear Dr. Morgan's remarks on it.

Dr. Ross Morgan

That is correct. Some of my colleagues may want to join in on this subject. The German model which is supported by the industry is around awareness, rather than legislation. The approach is: let there be cigarettes, but we will spend some money or time in telling people what they are like. That model does not appear to work or be associated significantly with any impact on smoking. The types of legislation introduced in the past decade have been effective, but we need to go further. The current rate of 12 to 15 year olds smoking or experimenting with tobacco is around 12%. As Deputy Catherine Byrne rightly said, smoking is the biggest cause of health inequality in this country now and will be in the next few decades.

Ms Norma Cronin

I spoke at a conference in Germany recently and the German Cancer Research Centre in Heidelberg is looking to Ireland for guidance. Germany still permits advertising and is very much in the hands of the tobacco industry. We can look at WHO figures. Others might be from the tobacco industry or other research conducted, but Germany is not doing as well as we might think and it is looking to Ireland for support and encouragement. Deputy Catherine Byrne talked about having real posters and graphic images. We know that might work for some, but for young people, some of the research shows that perhaps scare tactics alone will not work. We need to have what is in the schools, the social personnel and health education, SPHE, programme further developed. More needs to be done in school programmes. It is a choice for teachers whether to include it. It must start with education. The images and health effects information will have more impact if there is a broader approach to understanding addiction and empowering young people with refusal skills. That is crucially important for young people, in particular.

Ms Niamh Kelly

On Deputy Fitzpatrick's question on the reduction in prevalence, initial findings from Australia are positive, but they are still fairly new. However, something that points to a reduction in prevalence is the tobacco industry's assertion of the loss in revenue that standardised packaging will cause. If the industry did not believe this was going to cut the amount of people smoking, the figures would be much lower.

Deputy Catherine Byrne spoke about the size of the picture. In Australia the health warning covers 75% to 90% of the packet. We are in favour of having the health warnings as large as possible, provided it allows for the quit line number to be carried also.

Deputy Catherine Byrne asked what we were doing about the lack of understanding of health risks. Smoking, as Deputy Fitzpatrick mentioned, is the most common and worst trigger for asthma symptoms. Smoking is part of everything. Smoking cessation is mentioned in our clinic advice. We have clinics to which people go throughout the country and it is included in all of our health information on asthma. Every piece of information we give includes a smoking cessation message.

Further to this, smoking cessation is first on the list of priorities in the HSE's national asthma programme as a measure to help people with asthma. Deputy Byrne spoke about educating young people and Ms Cosgrove will speak about this.

Ms Sharon Cosgrove

To add to what Ms Kelly stated and to return to Deputy Byrne's question on education and young people, it is something the Asthma Society has been involved over the years. Last year, we developed and piloted a transition year e-learning programme, which was an interactive module with videos. We know young people are attracted by branding and engage in risk-taking behaviour, and those with asthma often do not carry their inhalers or might try cigarettes. We have developed a particular approach which examines education regarding asthma but also, as Ms Kelly stated, includes a component about health and the impact of addiction and smoking on asthma and what to do if smoking or passive smoking triggers an asthma attack. We are very conscious of this. We also provide a service whereby asthma nurse specialists go to schools and meet groups of parents, children and teachers to educate them on asthma. Part of this includes speaking about the impact of smoking on asthma and what to do.

A question was asked as to whether the Asthma Society should use harder hitting campaigns. Over the past year we have tried to use harder hitting campaigns, but we must get the balance right between scaring people and educating or empowering them to quit smoking and control their asthma. We are conscious our messages need to be very clear and need to be harder hitting with regard to the prevalence of deaths and the link with smoking.

Deputy Doherty suggested the use of positive images and this is something we try to do. We are very conscious of it, particularly the use of asthma ambassadors such as young people who are involved in sport and have very healthy lifestyles. We try to ensure we have swimmers and kickboxers in our campaigns because positive images of healthy lifestyles for young people and throughout life are very important and we are building this into our awareness raising and campaign work.

Mr. Chris Macey

To answer the Chairman's point, we examined the situation in Germany because it is something the tobacco industry tends to raise. Specifically we examined it after a number of retail organisations whose interest is supposed to be in smuggling raised it on radio programmes. We found Germany does not have a mandatory school-based education programme on smoking. An analysis of the existing school-based programme found it was not effective. Germany has the same smoking rate for 12 to 17 year olds as Ireland does, which is 12%.

To address Deputy Fitzpatrick's point on what reduction we seek, I stress the crucial element of this legislation is to stop young people starting to smoke. The percentage of people who had ever smoked in Ireland in 2002 was 41% and in 2010 it was 27%. This is the figure we seek to reduce. It is almost certain to have reduced further from 27% since 2010, but I do not know the figure. It is a matter of maintaining this reduction. The youth smoking rate had fallen from 21% to 12% in 2010, and we can be reasonably confident it is lower than this now. It is a matter of maintaining the reduction of this figure.

To answer Deputy Byrne, there is no doubt that education is very important. We cannot have enough education and it is vital. We also need to take other steps, one of which is to block attempts by the industry to reel in young people. It has done so successfully for many years. We know it has incredible amounts of money and that it is ruthless and will stop at nothing. It does not care about our children's health and it is up to us to protect them with all the measures we need to do so.

Deputy Byrne mentioned she was surprised to hear people continue to smoke knowing the risks. A recent survey showed more than 50% of stroke survivors are back smoking within six months. We also know people who have had amputations because of smoking are often back smoking very quickly. This shows the hugely addictive nature of cigarettes. The most important thing we and legislators can do is to stop people starting. Once people have started they must be helped to quit and we do not do enough in this country in this regard. The quit programmes in some places throughout the country are good but in many places they are not. We need to do more. We cannot let down smokers. We have a duty of care to them.

To respond to Deputy Doherty's point, we do not wish to demonise retailers although we have serious issues about some of the representative bodies. We know most retailers are decent hard-working people who are making a living. In our opinion they have been duped for many years by the industry, particularly in terms of the bogus smuggling argument. We would reach out to ordinary retailers throughout the country and do anything to work with them to protect their businesses but also to reduce this element of it. Likewise we are not out to demonise smokers. A total of four out of five smokers want to quit and we want to help them do so. We wish the best of luck to those who decide they want to continue smoking and we hope no harm comes to them, although we know it is very likely to do so. The four out of five smokers who want to quit deserve our help and we should be doing everything we can to give it to them.

Ms Kathleen O'Meara

Deputy Fitzpatrick referred to the smoking rate as being 25% but in fact it is 21.7%. I am glad to say it is lower than 25%. With regard to the type of reduction we want, we want a tobacco-free Ireland. The Minister speaks about a smoking rate in Ireland of 4% in 2025. It is a very ambitious target but we have been making considerable progress, particularly in recent years. If we continue to do all we are doing and more and stay focused on the target we think it is possible. Education is the key as Deputy Byrne stated. The committee will hear from a youth group which has taken part in the exhale programme started by the Irish Cancer Society a few years ago, which is about empowering school groups and youth groups to take on a project themselves. It has been very popular.

I wish to quote very briefly from some of the comments from young people we surveyed. A female teenager stated superslim cigarettes looked really cool and would look really classy on the table. When the participants were shown the plain packs they stated they would stop smoking when they came out because they turn them off completely, that the pictures look awful and disgusting and one would be embarrassed to be seen with them in one's hand. This is what we want and expect. We believe it will work.

We also favour mass media campaigns and more investment in cessation programmes and quit programmes. The quit.ie programme is very good but we would like to see many more television advertisements. Some of them are very powerful. I thank Deputy Doherty for her major support and for the inclusion of the quit line number. I agree with the point on positive messages. I also agree with my colleague, Mr. Macey, with regard to retailers. We know they are trying to earn a living like everybody else. On behalf of the Irish Cancer Society, I emphasise we fully believe the legislation will reduce smoking prevalence in Ireland, in particular combined with other measures the Government is taking and intergovernmental measures on the illicit side.

We need more investment in cessation programmes. We need to ensure that illicit tobacco is tackled and we need more public education programmes. I thank the Chairman for the opportunity to be present today and all the members for their support.

Chairman

I thank Ms O’Meara and also Mr. Owen Bradley for his assistance in organising today’s meeting. I sincerely thank all witnesses who attended the meeting and for their presentations and very informative participation in the debate. Today’s meeting is one of a series of meetings culminating in a report being presented to the Minister on the heads of the Bill. Following the suspension, we will have our second session with the youth group, the Children’s Rights Alliance and the ISPCC.

Sitting suspended at 11.30 a.m. and resumed at 11.45 a.m.

Chairman

I welcome witnesses to our second session this morning on plain packaging for tobacco. We have the Children's Rights Alliance, the Tipperary Regional Youth Service and the ISPPC. They are all very welcome. I am sure the other witnesses do not mind if I welcome in particular the three girls, Cliona, Danielle and Amy. I thank them for being present. I also welcome Mr. Paul Gilligan and Ms Caroline O’Sullivan. It is not the case that they are not welcome but it is nice to have the young people.

Ms Caroline O'Sullivan

Of course.

Chairman

They travelled from Tipperary. It is a big journey for Tipperary people to come to Dublin because they do not get here too often for all-Irelands any more. The girls are very welcome. I hope they will enjoy the presentation and their time with the committee this morning.

Deputy Robert Dowds

We dissociate ourselves from that sectarian remark.

Chairman

Okay. Thank you. Everyone is welcome. We will move to more serious matters. A very important element of our legislative programme is the public health (standardised packaging of tobacco) Bill. The Minister for Health has asked us to hold public hearings on it. This morning we heard from the Irish Cancer Society, the Irish Heart Foundation, the Asthma Society of Ireland, COPD Ireland and ASH Ireland. We have also heard from the Minister for Health and the Chief Medical Officer. A series of meetings is being held, including during the month of February, to discuss standardised, plain packaging.

I remind all present that mobile telephones should be turned off or put on airplane mode as they interfere with the broadcasting of the proceedings and they interfere with staff members. By now, people in the Visitors Gallery will have texted their friends to say the girls are now live on UPC channel 207 and on the Oireachtas channel.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to this committee. If they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not comment on, criticise or make charges against any persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice and ruling of the Chair to the effect that Members should not comment on, criticise or make charges against a person outside the House, or any official by name in such a way as to make him or her identifiable.

I welcome all witnesses and remind people that there is also an Oireachtas app which can be downloaded. We are in committee room No. 2.

I welcome everyone who is watching and listening via media, including social media.

I invite Ms O'Neill, Ms Gayson and Ms Maher to make their presentations, although I am unsure as to who will start.

Ms Cliona O'Neill

I will. My name is Cliona O'Neill. With me are Ms Danielle Gayson and Ms Amy Maher. We are from the Tipperary Regional Youth Service. I will provide the committee with some background information on our organisation.

The Tipperary Regional Youth Service, which is affiliated to Youth Work Ireland, is an integrated youth service that works with young people aged between eight and 25 years of age. The mission of the youth service is to provide a range of quality and professional services to young people in a safe and inclusive environment, contributing to a changing society for the benefit of young people. Geographically, there are three regions under the remit of the Tipperary Regional Youth Service, those being, Tipperary south, Tipperary north and east Limerick, with four youth centres in Cashel, Templemore, Thurles and Tipperary. We deliver youth projects and services funded in the main through the Department of Children and Youth Affairs, the HSE and the Departments of Justice and Equality and Social Protection. Our services include working with disadvantaged young people, providing targeted interventions in the areas of justice, substance misuse and family support and supporting volunteer-led clubs and community initiatives.

The Tipperary Regional Youth Service has a voluntary board of directors holding overall responsibility for the organisation, working through the chief executive officer, staff and volunteers. This board is made up of local club and community representatives with an interest in youth participation.

One of our centres is the Cashel neighbourhood youth project, which has been in existence since the mid-1990s and has a high level of youth participation. There are a number of youth-led initiatives that members of the project participate in and this is the project of which we are members.

I will hand over to Ms Gayson, who is going to tell the committee a little bit about what we have been doing to help prevent young people from smoking.

Chairman

I thank Ms O'Neill.

Ms Danielle Gayson

In 2012, we received funding from the Irish Cancer Society through the X-HALE Youth Awards for a group of 22 young people aged between 14 and 17 years in the Cashel neighbourhood youth project to develop a peer-led anti-smoking programme for sixth class students, entitled "Lungs on the Run". We worked hard throughout the summer of 2012 creating an animation, a programme and a workbook that highlighted the dangers of smoking.

In September of that year, four members of the group went to our local primary school, facilitated our programme, showed the animation and asked the class of 30 students to make a pledge not to smoke. Each student received a workbook and a wrist band to remind him or her of that pledge not to smoke. According to one teacher, the students took on board the information provided because it came from their peers.

In October, we attended a showcase hosted by the Irish Cancer Society to highlight the X-Hale projects and received an award for the creation of our animation. Due to the positive feedback from our work, we have gone on to secure further funding through the X-HALE Youth Awards to develop our programme further into a training resource pack and to train young people in other projects to roll out an anti-smoking workshop to their peers. Also in 2013 we contributed some of the activities from our workshops to a resource pack that the Irish Cancer Society is developing for schools and youth projects throughout Ireland.

As part of our workshop in the schools, we asked the students what information impacted on them the most and 25 of the 30 young people identified the images they saw and the fact that they did not like being a target of the tobacco industry as having the most effect. We felt as a group that it was important to work from a preventative approach to smoking and that giving young people the right information from people they looked up to as role models would empower them to make positive choices in their future.

One of the main factors that we highlight to primary school students when we run our workshop is that the tobacco industry must attract 50 new smokers per day to replace those who have either died or quit. Given that most smokers start smoking before they are 18 years of age, the majority of these new recruits are young people. Highlighting this to young people has been shown to affect their thinking about smoking.

Ms Maher will now tell the committee why we as a group of young people believe that the introduction of plain packaging is so important.

Chairman

I thank Ms Gayson.

Ms Amy Maher

As a group that focuses much of its work on prevention, we feel that the introduction of plain packaging is an important step towards preventing young people from ever starting to smoke. By introducing this legislation, we are protecting future generations by changing young people's attitudes to smoking so that it will no longer be what I may term "the norm".

When we started to consider making a submission, we organised focus group discussions with young people who were both smokers and non-smokers. We wanted to find out what young people felt about the idea of plain packaging, whether it would impact on their decision to smoke and whether they placed much importance on smoking as an image factor. They discussed how "purple skins" or "flavoured skins" were "class" and mentioned a friend who, while not a smoker, had brought home pink-coloured cigarettes from holidays abroad because she wanted to have them at a disco to offer to people. This highlighted to us the importance young people place on how things look and that the appearance of cigarettes plays a huge role in young people smoking.

Young people discussed the health implications for them from smoking. Some experienced difficulties with their teeth and lungs and their ability to engage in physical activities and sports. They expressed that they would not like to see their younger siblings smoking and felt that plain packaging would have a significant impact on preventing young people from ever starting to smoke.

We feel that young people should have a right to be protected from the marketing of a highly addictive and seriously harmful product. Plain packaging is one way we can do this. By making smoking less appealing and health warnings more effective, the misguided opinion young people have that smoking is "cool" or "class" will be changed, stopping them from smoking in future.

We recommend that the public health (standardised packaging of tobacco) Bill be introduced as a matter of urgency; that members of the committee appreciate that plain packaging seeks to stop young people from taking up smoking and that branding cigarettes undermines the work of our group; that the Bill take account of the EU product directive on flavoured and coloured cigarettes; that the legislation seek to de-normalise smoking further and be considered a public health measure; and that the Bill take into account the effect of branding on young people and the desire of young people to be seen with a "cool" product such as cigarettes.

We thank the committee for the opportunity to attend and share our group's views today. We hope that members take into consideration our recommendations and we welcome whatever questions they have for us.

Chairman

I thank Ms Maher. Deputy Healy must attend Leaders' Questions. Does he wish to make a remark now or wait until after Mr. Gilligan and Ms O'Sullivan have contributed?

Deputy Seamus Healy

As the Chairman stated, I am due to take Leaders' Questions after 12 noon. I welcome the organisations to this meeting, particularly the Tipperary Regional Youth Service and the girls from Cashel community college. I thank them for their work and their presentation. I was especially happy to see young people making that presentation and that they have been involved with the Irish Cancer Society in this project. As they mentioned, the future of the tobacco industry depends on its ability to get 50 additional smokers per day to replace those who have died or quit smoking.

The facts of smoking are shocking. One in every two smokers, some 100 this week alone, will die of a smoking-related illness. This amounts to approximately 5,200 each year. I welcome the fact that the prevalence of smoking has reduced to 21.7-22%. The target is 4% by 2020. That is achievable, with this legislation playing a major role. Much more needs to be done, but the type of work being done by the Tipperary Regional Youth Service and the girls from Cashel indicates that plain packaging will prove a major element in reducing smoking prevalence and ensuring that fewer people are affected by smoking-related illnesses.

This morning and last week, we addressed the question of packaging.

Chairman

Just to let the Deputy know, Leaders' Questions is about to begin.

Deputy Seamus Healy

Plain packaging must show the Quitline telephone number. We must also ensure that the packaging's size be regulated under the legislation. These two elements have been raised.

I thank the Chairman for the opportunity to contribute. I also thank the girls from Cashel and the other speakers. I will try to return if possible.

Chairman

I invite Mr. Paul Gilligan of the Children's Right Alliance to make his opening statement.

Mr. Paul Gilligan

The Children's Rights Alliance welcomes the opportunity to present its views on this issue. The alliance is a network organisation with more than 100 member organisations. We want an Ireland where children are valued and where it is the one of the best places in the world in which to be a child. We have been involved in a number of campaigns down through the years, the most important, perhaps, being the constitutional referendum campaign.

We support the public health (standardised packaging of tobacco) Bill 2013 and commend the Minister on driving it forward. We believe this is a core children's rights issue. Other witnesses have articulated very well the type of on the ground issues confronting young people who do not want to smoke. Article 24 of the United Nations Convention on the Rights of the Child holds that State parties shall recognise the right of the child to the enjoyment of the highest attainable standard of health. This extends beyond the provision of appropriate prevention or treatment and includes the implementation of programmes that address the underlying determinants of health. There is no doubting the research in this area, which states that smoking has a detrimental affect on people's health.

One of the starkest statistics from the recently published Government report, Tobacco Free Ireland, highlights that 78% of smokers commence smoking regularly before the age of 18. The indication is that this statistic is even higher for the UK. This is a children and young person's issue. There may be arguments against this initiative, but the Children's Rights Alliance finds it hard to understand any of them. The concept that packaging is nothing other than marketing or branding cannot be disputed. Cigarette companies would not spend millions on marketing and development of these types of fancy packaging if they did not believe it encouraged people to buy cigarettes. We believe a standard plain package which contains a strong health warning, perhaps similar to the one being introduced in Australia, would be the best way forward.

Research on the effects of plain packaging of cigarettes is still at an early stage. However, research from Australia indicates that this type of packaging would result in a reduction in the number of children who try smoking, a reduction in the number of children who become regular smokers, an increase in the number of adult smokers giving up smoking and an increase in awareness among children of the dangers of smoking. We strongly support this legislation, as we believe this is a core children's rights issue.

Chairman

I thank Mr. Gilligan. I invite Ms Caroline O'Sullivan to make her opening statement.

Ms Caroline O'Sullivan

The Irish Society for the Prevention of Cruelty to Children, ISPCC, is a child protection and welfare organisation. Our vision is of an Ireland wherein all children are heard and valued. Our mission is to advocate on behalf of all children and to provide a range of independent and unique services that are preventative and empowering in nature. The ISPCC welcomes this opportunity to address this committee on this issue. We welcome the proposed legislation and the developments contained therein.

The ISPCC sees smoking and the targeted marketing of such a fatal product to children and young people as a serious child protection issue. As an organisation dedicated to the protection of children, we believe children should be protected from the preying marketing of tobacco companies. We believe this legislation is a hugely important step in improving the protection and welfare of children and reducing the potential for children to begin smoking. As outlined by Mr. Gilligan and Ms Gayson, 78% of people who smoke began smoking while under the age of 18 years.

In our submission, we referred to head 3 which outlines the purpose of the Bill. The tobacco industry requires the continuous recruitment of new consumers, namely, children, in order to maintain it. New customers are needed to replace those who have quit or died from a tobacco related disease. The ISPCC works directly with children on a daily basis and has approximately 2,000 contacts per day with young people. As such, we can readily attest to what is happening with children every day. We know that children and young people are pressurised by peers to fit in, which is hugely important to them. If a product is targeted as a fun or stylish product or something that makes a person look and feel better about himself or herself, then clearly it is something in which young people will be interested. Bad as this is if the product is the latest shoes, clothing and so on, a lot worse it is if it is something that can seriously damage a young child's health.

The concept of standardised packaging as a means of reducing the likelihood of smoking or making children more aware of the risks involved in taking up the habit of smoking can only be a positive step forward. Advertising and the normalisation of any form of drug usage can be heavily influential to impressionable young minds. Recently conducted research by Ignite Research involved direct contact with young people and includes direct quotes from them, some of which stood out for me and my colleagues. One such quote is: "It’s not even just the cigarettes, it’s the packaging. It’s all the swirls on the pack, the colours, they look fashionable. You kind of want them sitting on the table to be able to say, 'Yeah they’re mine'." This would indicate a level of pride being associated with the fancy box sitting on the table. If that packaging was changed and in future displayed the horrors of what smoking can do to a young person, that level of pride would be taken away and young people would not want it. Some of those surveyed said that if such were displayed on every box, they would stop smoking because they would be too embarrassed to take out the box. This is a clear indication of what can be achieved through this legislation. By changing the branding and packaging, children will not be interested in being seen with this product.

The ISPCC believes that legislation needs to reflect the influential nature of marketing and advertising on children. In this regard, there is a duty of care between the Government and its citizens, and in particular a duty for the protection of children. We believe the legislation should highlight that this is a protection issue. This is not about packaging or cigarettes or a drug. It is about protecting current and future generations of children in Ireland. We believe the legislation should acknowledge this in the context of tobacco products.

Chairman

I thank Ms O'Sullivan. Apologies have been received from Deputy Billy Kelleher, who must be in the Dáil today for Leaders' Questions, Deputy Caoimhghín Ó Caoláin and Senator Colm Burke who had to attend another meeting. Another reason for the sparse attendance at today's meeting is the launch today of the Child and Family Agency. I welcome Senator van Turnhout. I call Deputy McLellan.

Deputy Sandra McLellan

I welcome all of the witnesses and apologise on behalf of Deputy Ó Caoláin who, unfortunately, cannot be here. I thank all of them for their presentations and congratulate them on the positive work they have been doing. It is important young people are being listened to and that we know where they are coming from.

Sinn Féin supports the proposed legislation. I have a few questions and ask that the witness to whom each is relevant would respond. How are young people affected by passive smoking and are they concerned about it? Why do young people start smoking? Ms O'Sullivan referred to the following quotation: "It’s not even just the cigarettes, it’s the packaging. It’s all the swirls on the pack, the colours, they look fashionable. You kind of want them sitting on the table to be able to say 'Yeah they’re mine'." That says an awful lot. Do the witnesses believe we need to target young people with anti-smoking campaigns and do they believe such campaigns are good or relevant? What more can be done? Could the legislation be improved? If so, how?

I refer to the statement made earlier that addiction keeps people smoking and branding entices them to start. Given there is no branding on illegal drugs but people still use them - perhaps for socioeconomic reasons - is the problem one of branding or addiction? Could the same be applied to cigarettes?

Senator Jillian van Turnhout

I join in welcoming the witnesses. I fully support the proposed legislation and we are just working to see how we can strengthen it and ensure the tobacco industry cannot hinder us in our important work. Mr. Gilligan has commented on the UN Convention on the Rights of the Child, which is very important, as this is a children's rights issue and should be framed as such. Ms O'Sullivan mentioned the duty of care of the Government to citizens, which is very important.

My questions are mainly directed at the representatives of the Tipperary Regional Youth Service. They have provided a compelling case and I thank them for that and their work. They noted that peer education is very important and we must learn more from that. There is a difference between me going into a classroom and saying smoking is bad and them going into the same classroom, and that work is excellent. I have no doubt that in a few weeks we will have representatives of the tobacco industry before us saying that they do not market to children as cigarettes are sold behind the counter and they are not allowed to advertise. I have no doubt they will have charts and so on to illustrate this. I will feel like telling them to butt out and leave our kids alone. Is there anything the witnesses would like to ask those people? I may be putting them on the spot but they can follow up with me afterwards if they so wish. What should the committee say or ask?

The delegation spoke about a reality in their submission and they are the experts. I believe people of their age are being targeted but I should not put words in their mouth. It would be useful for the committee to have primary expert evidence when we have these people in front of us. Plain packaging is a very strong step in the right direction for Ireland. Deputy Healy spoke about the size of packages and we must consider having quitline numbers on them. I welcome the views of the witnesses because of their expert opinion.

Deputy Robert Dowds

I have a couple of pointed questions which the witnesses may ignore if they so wish. Have any of them smoked and how did they manage to kick the habit if they have given up?

Chairman

That is not relevant to the legislation.

Deputy Robert Dowds

It is relevant to the issue.

Chairman

I am just joking.

Deputy Robert Dowds

There is a related point. The witnesses are predominantly girls so where are the fellows? Are they not involved with the issue? Smoking goes across gender lines, although it may be more dangerous for women if they are expecting a baby. Why has the running been left mainly to women?

I very much appreciate the delegations being here and I agree with the comments and questions from the two previous speakers. This legislation will be enacted because it has cross-party support, but will there be a greater temptation for young people in particular to smoke cigarettes that people may bring back from holidays because the packaging will be much more attractive than what will be available in Ireland? Will there be a temptation to use illegal tobacco products and how would we stop that behaviour? I have one or two ideas but perhaps the witnesses can add to them. When people go on holidays they are allowed to import approximately 800 cigarettes per head, but many people bring in numbers way in excess of that, which has a definite impact on the market, in addition to illegal stock. Will the witnesses comment on that? I thank them for their input in that regard. To what extent does education work in trying to stop people smoking or drinking to excess?

Deputy Peter Fitzpatrick

I am a father of three children and I have a grandchild. I am sorry I missed the contributions earlier but I attended the last session. Everybody is saying the tobacco industry is targeting young people, and it has been argued that young people smoke because of reasons like fashion or style. A year ago another group was here telling us that young girls smoke to keep down weight because of pressure. Will plain packaging help young people to stop smoking? Is there anything else we can do to help? I am concerned about the health issue, which is similar to the problem of alcohol consumption. I am concerned about the damage that can be done by smoking. We heard statistics this morning about how many people die because of smoking, so is there anything else we can do to help the young people of Ireland in health matters, including smoking and alcohol consumption?

Chairman

Ms Gayson looks like she is poised to respond.

Ms Danielle Gayson

Deputy McLellan asked about passive smoking and whether it affects young people. While doing research for the Lungs on the Run project, we came across a statistic indicating that 25% of lung cancer is caused by passive smoking, which is quite a high figure.

Ms Amy Maher

Deputy Fitzpatrick asked if the plain packaging will decrease the number of people who smoke. Colourful packaging definitely has an impact on people, and they attract young people to smoking. Changing the packaging would be prevention rather than intervention. The colourful packaging has an effect on young people's decision to smoke because it affects how they perceive their looks. Therefore, plain packaging would not attract as many young people.

Chairman

Are young people influenced by advertising or marketing?

Ms Danielle Gayson

Many young people are influenced by who they know who already smokes. If somebody pulls out a packet of cigarettes with bright colours, others may perceive it as cool and think they should do the same. The influence comes from many factors but packaging is one.

Chairman

I compliment your workbook, which is graphic and visual. It certainly would intimidate somebody against smoking. As a former schoolteacher, I wonder if young people are aware of the damage to health caused by smoking. They may not ever think they will get to 70 but Mr. Peelo this morning spoke of people he knew who felt like they had an elephant on their chest when they tried to breathe. Are young people aware of the profound effect that smoking could have on quality of life and future health? If not, how can we make them aware?

Ms Danielle Gayson

Young people have heard the facts and what smoking can do but the information comes from adults, and they would never really believe that this can happen. Peer-led programmes, with young people telling other young people what can happen, could be effective. If people know somebody who is troubled by smoking, there is more potential to believe the facts than if a teacher or somebody older conveys those facts.

Chairman

That is why your work is so important.

Deputy Sandra McLellan

Young people may think they will never get that old, as it seems so far into the future.

Chairman

It is a case of something occurring in the far distance.

Deputy Sandra McLellan

Unfortunately, this can come around very quickly.

Mr. Paul Gilligan

I will pick up on a couple of points. All the work we know of that takes in drugs, alcohol and smoking indicates that the longer we can delay somebody starting, the better chance that person will never start and will never develop an addiction.

That is an important point to make about smoking. The longer we can delay a person having a first cigarette, the better chance we have of ensuring they never do it.

Second, one must remember that children are vulnerable by virtue of their developmental capability. The reason they begin smoking is that they do not fully comprehend the impact. No child or teenager thinks he or she can die. It is not something young people think about when they wake up every morning; that only comes with age. Therefore, some of the arguments about the harm are not fully understood. We must protect people who are vulnerable by virtue of their developmental capabilities.

Finally, if the representatives of the tobacco companies appear before the committee and argue that they are not marketing their product at children, they should stop spending money on marketing because their marketing is failing. A total of 78% of smokers start smoking when they are children. Their marketing, therefore, is skewed and wrong and they are wasting money. The facts are available in respect of any argument to suggest they are not being marketed to children. The tobacco companies know as well as we do that the earlier one can get people to smoke, the greater the chance that they will continue to smoke throughout their lives.

Ms Caroline O'Sullivan

I do not have much to add to the wonderful responses already. Why children start to smoke is the biggest issue, and prevention is better than cure. As Paul says, the longer that can be delayed, the better the chance the child or young person will not take up smoking. Anti-smoking campaigns can work, but they are working more for adults. Adults can reach a point where they have been smoking for so long, for example, 15 years, that they think it is time to give up. The campaigns work on that basis, but from our discussions with young people, they look upon lung cancer and other diseases as something that could happen in 30 years. At present, they are more concerned about looking good, having peers, going out with their friends and enjoying themselves. Thirty years in the future is completely irrelevant to a young teenager. The issue is about ensuring they are not attracted to the product in the first place. Education could work alongside that.

Deputy Robert Dowds

Deputy Peter Fitzpatrick asked a question about young women, in particular. Are they tempted to smoke to keep their weight down? Is that an element of the culture or not? I am trying to understand the culture. When I was 13 or 14 the smoking culture in my school was down in the bicycle shed and it was fellows who were showing a bit of bravado.

Ms Cliona O'Neill

I believe guys do not start to keep down their weight, but they do not want to give up because they think they will put on weight.

Deputy Robert Dowds

Yes, that is a good point.

Deputy Sandra McLellan

It is definitely about the weight.

Chairman

Is there anything we should be communicating to young people about smoking that we are not already doing? It might be something you have not mentioned this morning or something you wish to emphasise. Are we on the same wavelength as you or, because we are wearing shirts, ties and suits, does it appear that we are different? You said you do not take notice of adults but if you see somebody, such as a surgeon general or a doctor, making the comment, is that more effective than one of us? How do we get young people to become ambassadors to prevent smoking? How do we encourage the Tipperary Regional Youth Service, multiplied across Ireland, to be the ambassador to prevent smoking?

Ms Amy Maher

If the plain packaging decreases the number of young people who start to smoke and if a young person does not see their peers smoking around them, over time that will decrease it even further. If the plain packaging is introduced, I believe the number of young people who start to smoke will definitely decrease. It is more to do with peer pressure. One sees more young people starting to smoke rather than adults because there is more peer pressure among young people than among adults.

Deputy Robert Dowds

Tell them they have a better chance of beating Cork if they do not smoke.

Deputy Catherine Byrne

I am sorry I could not be present earlier but I was listening to the proceedings while I was at the other meeting. I have one question, but I do not know if it has been asked already. It is about the education system in school and the civil, social and political education, CSPE, course. How do the witnesses think that impacted on how they think about their health, alcohol, addiction and so forth when they were in school or if they are still in school? Has the programme being taught in school at present made any impression?

Senator Jillian van Turnhout

I have a question about young people's access to cigarettes. Are the witnesses reaffirming to the committee that access to cigarettes is not a difficulty for a young person going into a shop? Are they going directly to the shop or are adults buying the cigarettes for them, in the witnesses' experience?

Deputy Peter Fitzpatrick

I am feeling my way with this, because I never drank or smoke so I do not know how alcohol or smoking tastes. However, I know how chocolate tastes and I am very fond of chocolate. If I do or taste something I do not like, I will not do it again. I am trying to understand how people feel when they take a few puffs of a cigarette. I am sure it cannot be nice on the first few occasions. The same would apply to alcohol. I have heard people say that when they start drinking it takes a while to acquire the taste. Will the plain packaging help? Would increasing the price of a packet of cigarettes to €20 help? The problem is that if one starts a price war on tobacco, the smuggling will cause hassle. What can we do to stop young people smoking? As I said, it takes a while to get addicted to cigarettes, so what keeps the process going with cigarettes and alcohol?

Ms Cliona O'Neill

It is the image of holding the box and smoking in front of one's friends. It is down to image at the start. The more they smoke, the more they get to like it and it goes from there.

Chairman

Good answer.

Ms Danielle Gayson

Deputy Byrne asked about the education in school in subjects such as social, personal and health education, SPHE, and whether it affects us. I am only in third year at present and we have been doing different modules in SPHE for the past three years. In first year it was smoking but we did not really do much about it. It did not give us any information about how much it can affect us or what it can do to us. It did not influence people in the class in their decisions on whether to smoke. In second year we did alcohol. We had to do a project for that. It was a little poster about the different things alcohol can influence and the effects it can have. That did have an influence. We had a different teacher so it was taught to us slightly differently from how the first year module was taught. It affected many people in the class. They all had their own opinions on it and they made their decisions based on them. It is not really the course that has an influence, but the teacher's means of teaching the course.

Deputy Catherine Byrne

The witness is right.

Ms Amy Maher

It is not the SPHE class that is influencing us as to whether we should or should not smoke. It is more the people around us. Young people feel that if they smoke, they will fit in with their peers, because everyone else is doing it. If they do it once and it is okay, they will continue. Over time they will get addicted. I believe the plain packaging will definitely stop them from starting to smoke.

Ms Cliona O'Neill

We learned a lot more on the youth project than we learned in school about smoking and drugs.

Chairman

Why is that?

Ms Amy Maher

We were with young people and there was a range of ages. There were people who had experience with smoking and alcohol already to offer their points of view to other young people. As there is a younger group starting and we are older than them, we can tell them. It is better than adults telling them because they probably listen more to younger people than adults, so it is good to be in a youth project like that.

Mr. Paul Gilligan

Addictions are probably determined by three key factors - availability, attractiveness and vulnerability. We must tackle tobacco at all those levels. In the case of attractiveness, price is obviously important but it is not the only factor. If something is attractive enough, people will pay the price for it. We know that from many other things. With regard to vulnerability, young people with mental health problems are more susceptible to develop tobacco addictions because they are particularly vulnerable.

We need to examine that issue. Obviously availability is a key issue.

The last point I want to make is that the new health strategy should be supported by everybody. It is vital that we promote health in schools as much as we promote other stuff and environmental education is a good example. It is important that emphasis is placed on young people having healthy lives because it will stand to them throughout their lives, in all aspects.

Ms Caroline O'Sullivan

All of the points have been well covered. The strategy is about preventing young people from taking up smoking. If one prevents them from doing so then they will not smoke in the future. Children take up smoking because it is the thing to do. It is like standing on the corner with their mates chatting, it is what they do. If it is considered to be unattractive or not the right thing to do then they will not do it and the packaging will help in that regard.

Chairman

I thank Ms O'Sullivan. I finally thank Ms Cliona O'Neill, Ms Danielle Gayson and Ms Amy Maher, along with Mr. Paul Gilligan and Ms Caroline O'Sullivan. I also thank Ms Catherine Doyle and her colleagues from the Tipperary Regional Youth Service for their assistance today and for accompanying the girls here on their journey from Cashel. We hope that they have enjoyed the experience and hope that they will come back here again in the future. It is important that we engage with and hear the viewpoint of youth groups as Leinster House is also their house. Young people will vote in a few years' time and will have a say in who comes in and out of this place.

The clerk of the committee has asked me to inform the witnesses that he will organise for a DVD of their visit and presentation today to be forwarded to them as an expression of our thanks and a memento of their visit to Leinster House. I also thank Mr. Paul Gilligan and Ms Caroline O'Sullivan for the tremendous work that they do on behalf of young people. Does Senator Crown wish to comment? He was late joining the meeting due to having to attend another meeting. The Senator can speak if he wishes.

Senator John Crown

I have no comment to make at the moment.

Chairman

Deputy Healy has just returned and I advise him that we are just finishing up. Does he wish to make a final remark?

Deputy Seamus Healy

No, thank you.

Chairman

I thank everybody for attending. The debate is part of our scrutiny of legislation and the insight and input by the delegations have proven very valuable and I thank them all most sincerely. I thank members of the committee and remind them of the good news that we will not meet next Tuesday but will adjourn until this day week at 9.30 a.m.

The joint committee adjourned at 12.35 p.m. until 9.30 a.m. on Thursday, 6 February 2014.

Joint Committee on Health and Children debate - Thursday, 30 Jan 2014

Public Health (Standardised Packaging of Tobacco) Bill 2013: Discussion (Resumed)

Ms Kathleen O'Meara

Mr. Chris Macey

Ms Sharon Cosgrove

Dr. Ross Morgan

Mr. Damien Peelo

Ms Kathleen O'Meara

Mr. Chris Macey

Ms Niamh Kelly

Dr. Ross Morgan

Ms Norma Cronin

Ms Norma Cronin

Mr. Damien Peelo

Ms Norma Cronin

Mr. Damien Peelo

Dr. Ross Morgan

Dr. Ross Morgan

Ms Norma Cronin

Ms Niamh Kelly

Ms Sharon Cosgrove

Mr. Chris Macey

Ms Kathleen O'Meara

Ms Caroline O'Sullivan

Ms Cliona O'Neill

Ms Danielle Gayson

Ms Amy Maher

Mr. Paul Gilligan

Ms Caroline O'Sullivan

Ms Danielle Gayson

Ms Amy Maher

Ms Danielle Gayson

Ms Danielle Gayson

Mr. Paul Gilligan

Ms Caroline O'Sullivan

Ms Cliona O'Neill

Ms Amy Maher

Ms Cliona O'Neill

Ms Danielle Gayson

Ms Amy Maher

Ms Cliona O'Neill

Ms Amy Maher

Mr. Paul Gilligan

Ms Caroline O'Sullivan

Joint Committee on Health and Children debate -
Thursday, 30 Jan 2014