Report on Health and Smoking: Statements.

Minister of State at the Department of Health and Children (Dr. Moffatt): Tobacco use was established in our society long before we became aware of its harmful effects. Over the past 50 years, in particular, we have begun to understand more fully the degree of harm tobacco smoking causes. There has been extensive investigations by public health authorities throughout the world and the conclusions are the same: tobacco smoke causes lung disease, cancers, cardiovascular disease and other diseases. Environmental tobacco smoke is further implicated in other illnesses such as cot death.

Tobacco products contain nicotine which is a highly addictive drug. The World Health Organisation regards it as more addictive than cocaine or heroin. It follows, therefore, that it is extremely difficult to break smoking addiction. Most smokers recognise the harm tobacco causes and more than 80 per cent of them wish they could quit. The severity of withdrawal symptoms varies but for most smokers they are extremely difficult to cope with. As a result, only about 1 per cent of smokers who attempt to quit succeed in their first attempt. The better we understand all aspects of this problem the more likely we will be to succeed in our efforts to address it. It might be helpful to give some technical background.

The tobacco plant grows to a height of about 1.5 m to 2 m and is cultivated annually. It is a very labour intensive, difficult and expensive plant to grow. It is estimated that it takes 2,200 hours of work per annum for each hectare of tobacco compared with 147 hours for general crops. The plants are harvested at the end of the summer. The leaves, once dried, are sorted with regard to their delicacy, colour and integrity of their lamina. There are a large variety of tobacco plants but tobacco is usually classified as to how it is cured – flue-cured, light-cured, sun-cured, dark air-cured, fire-cured. Once the crop is dried it is sold to a processor who prepares the tobacco to a state that is ready for warehousing and is sometimes referred to as baled tobacco. The product is then delivered to manufacturing plants for processing into consumer products – cigarettes, cigars, pipe tobacco, etc.

Traditionally only the leaf of the plant was used in manufacturing but in recent years we have learned that, with certain technologies which, up to now, were kept secret within the industry, the stalk and other residues are also harvested. Using various chemicals, these stalks and residues are rendered into a fine paste and then a variety of chemical agents is added. The paste is then processed into cardboard like sheets known as reconstituted tobacco sheets which are distributed to cigarette manufacturing plants around the world where they are added to regular tobacco. It is believed that the levels of nicotine in these reconstituted sheets are manipulated. It is also believed that other chemicals, including additives which contain ammonia, are added which help release higher levels of nicotine from the burning tobacco. It is thought that reconstituted tobacco may account for up to 25 per cent of the tobacco in cigarettes.

Cigarettes are the most common form of tobacco product in use and I am focusing my remarks particularly on them. Cigarettes are made from tobacco, reconstituted tobacco sheets, genetically modified tobacco and other additives. Since the end of the last century, cigarettes have been mass produced. In fact the real tobacco epidemic did not start until industry developed the manufacturing technology to mass produce cigarettes.

From the mid-nineteenth century to 1977 it was illegal to introduce anything other than tobacco into tobacco products. Following changes in the legislation the use of an extensive range of additives, approximately 600, became legal. At present there are no regulations on what may be added to cigarettes or what chemicals may be used in the manufacturing process. This is one area the Minister is actively considering.

The smoke from cigarettes has many well-known carcinogenic agents. Once a cigarette is lit, it burns at approximately 600 degrees. This temperature increases to approximately 900 degrees when the smoker draws on the cigarette. Smoke from the burning cigarette, when it is not being smoked, is referred to as "side stream" smoke. The smoke inhaled by the smoker is referred to as "mainstream" smoke. The lower heat at which the resting cigarette burns ensures a lesser combustion of the product and this in turn delivers higher levels of gaseous carcinogens and smaller sized particulate matter. This smoke is then inhaled without the benefit of a filter. For these reasons side stream smoke is more toxic than mainstream smoke.

As I mentioned, tobacco smoke contains nicotine. This drug has effects on brain dopamine reward systems similar to those of drugs such as heroin, amphetamine and cocaine. The pharmacological actions of nicotine are predominantly stimulant, affecting nearly all brain neurotransmitters and neuroendocrine systems. Chronic exposure to nicotine causes structural changes in the brain by increasing the number of nicotine receptors.

Tobacco smoke also contains many chemicals other than nicotine. Some of the more destructive are ammonia, benzene, benzo[a]pyrene, cadmium, carbon monoxide, formaldehyde, hydrogen cyanide, lead and mercury. These are all well known cancer causing agents.

I will address the issue of so called "light" cigarettes. Many smokers believe that "light" cigarettes are safer than regular cigarettes. They believe that by smoking "light" cigarettes they will inhale fewer cancer-causing chemicals or less nicotine. "Light" or so called "low tar" cigarettes are at least as harmful as standard cigarettes. These cigarettes are generally made with tiny air holes around the filter which allow extra air to mix with cigarette smoke. This gives lower tar and nicotine readings on a smoking machine. On some cigarettes these holes are visible to the human eye, on others they are impossible to see. Smoking machines do not block the ventilation holes and so the smoke they measure is highly diluted with air. This is not true for smokers. It is difficult for smokers to avoid covering up the vent-holes when holding the cigarette in the normal manner. Smokers also adjust their smoking behaviour by drawing more deeply on these types of products. The reality is that smokers, once addicted, need to absorb a certain amount of nicotine to satisfy their addition and they will usually adjust their behaviour accordingly. This adjusted smoking behaviour can result in different types of lung cancer. The Minister recently attended a European Union Health Ministers Council where he supported a proposal by Commissioner Byrne to introduce further regulation in this area. The Minister is in favour of banning these misleading claims completely.

I am afraid that the news for cigar and pipe smokers is no better than for cigarette smokers. Compared to a cigarette, one cigar has 20 times as much ammonia, and five to ten times more cadmium. Cigars cause a wide variety of cancers of the throat, mouth and lungs, as well as heart disease. There also is evidence that cigar smoking is linked to cancer of the pancreas. In general, pipe smokers are prone to the same diseases as cigar smokers.

Tobacco use is a major public health problem in Ireland. In common with all western countries, tobacco use is endemic in our society and is the leading preventable cause of premature death. Despite considerable reductions in smoking rates since the 1970s, little progress has been made in recent years in addressing this concern. There is a disturbing underlying increase in smoking prevalence among children and young people, especially girls and young women. This disturbing trend points to inadequacies in our present public health arrangements.

Shortly after his appointment as Minster for Health and Children, Deputy Cowen set up an expert group, the tobacco free policy group, to conduct a fundamental review of all aspects of tobacco and health and to prepare a full report on this matter. This group is now finalising its report entitled Towards a Tobacco Free Society and hopes to publish it in the near future.

One aspect of concern, which is apparent in all developed countries and in most emerging ones, is the behaviour of the tobacco industry. The industry's continued denials that tobacco is addictive or that is a direct cause of many diseases poses societies with a serious challenge which we must address. Smokers and would-be smokers as well as parents, teachers and retailers have a right to be fully and truthfully informed of the dangers of tobacco use.

It is also regrettable that the industry's marketing practices impact so heavily on children. The glamorising of tobacco products induces children to experiment with tobacco and become addicted before reaching adulthood. Children are particularly affected by advertising and especially by the subtle forms, such as product placement in children's movies and in high profile sporting events such as Formula 1. In a survey conducted in the United States in 1996 the opinions of professional advertisers overwhelmingly supported the view that tobacco advertising is targeted at and impacts on children. The view is particularly marked among the most senior executives. Some 77 per cent of those with over 20 years experience in advertising say that marketing to teenage smokers is a goal of tobacco advertising while 68 per cent of those who have worked on tobacco accounts say marketing to children is the goal.

In an analysis of one tobacco company an investment analyst identified the industry's business opportunity as "the emerging markets where there are no strict rules in those markets relating to advertisement. That is why the international sales are surging". In a survey published by the European Commission 68 per cent of Irish people surveyed said that they believed tobacco advertising was aimed particularly at young people. This view was shared generally across European Union member states. Based on that survey over 61 per cent of Irish people favour a complete ban on tobacco advertising. Senators will be aware from media reports that the Minister, Deputy Cowen, advised the tobacco industry and the media industry of his intention to introduce an effective prohibition on tobacco advertising with effect from July 2000.

The Joint Committee on Health and Children's report "Minutes of Evidence Relating to Smoking and Health" is a valuable contribution to the debate on tobacco and health. The Minister has referred this report to the expert group and has directed it to conduct a detailed study of its contents. The Minister and I are looking forward to the group's recommendations.

Mrs. Jackman

I am surprised by the Minister's statement because this is listed on the Order Paper as Statements on the Report of the Joint Committee on Health and Children and it is only the last paragraph of the Minister's speech which makes reference to the report. Perhaps we should have pushed for this to have been taken as a motion rather than as statements and then we probably would have achieved greater adherence to the report of the Joint Committee on Health and Children, of which Senators Glynn and Fitzpatrick are members.

I will keep to the subject of these statements, that is the report on health and smoking which was adopted by all members of the Joint Committee on Health and Children, from all parties in the Oireachtas. I am bemused at the Minister of State's scientific references, the three or four pages which related to how tobacco is grown. I thought that would have been more appropriate to a debate on horticulture but I do not see that it adds much relevance to the report, which is definitive and sizeable.

The Joint Committee on Health and Children spent 18 months specifically emphasising the prevalence of smoking among children. The committee's deliberations culminated in Deputy Shatter taking six months to write this extraordinarily detailed national anti-smoking strategy report which contains specific recommendations. During the 18 month period the committee received oral and written submissions, which form part of the report and take up almost two pages in the preface, from interested groups, individuals, organisations and, importantly, major Irish tobacco companies – not that the committee received much information from them.

To show that this report is to be taken seriously, this day last week Deputy Shatter launched his first step towards implementing the recommendations contained in the report by introducing the Tobacco (Health Promotion and Protection) (Amendment) Bill, 1999. The Bill was published both in his name and that of Deputy Stanton and it was given a reading.

Deputy Shatter is keen to highlight the prevalence of smoking among young people. He makes the point that cigarettes can be sold to teenagers of 16 and 17 years of age. The report details that 21 per cent of children between the ages of nine and 17 smoke cigarettes and 34 per cent of those between the ages of 15 to 17 are regular smokers. The report documents an important statistic, that 80 per cent of adult smokers become hooked on nicotine before reaching 18 years of age. It also documents how cigarette companies make cigarettes more user friendly for children by the use of additives and this received significant coverage when the report was launched. The Deputy's point is that the enactment of the legislation, which he will push in Private Members' business, is a first step on the road to what should be the aim of all – to reduce and ultimately eliminate youth smoking. I make that point to emphasise that Deputy Shatter has been extremely proactive in dealing with the recommendations outlined in this report.

It is difficult in the space of 15 minutes to give the report adequate coverage but I hope this will be just the first of many debates on this issue. The report is comprehensive in the sense that it considers the health consequences of smoking, nicotine addiction, youth and adult smoking, and tobacco, budgetary and financial issues. I thought the latter would have been addressed by the Minister in the context of the forthcoming budget but we must wait and see whether the Minister will increase the price of a packet of cigarettes by 50p or 25p and provide for other issues to which the report refers, such as financial supports for cardiovascular services.

The report also considered the existing legislative and regulatory framework in Ireland and the European Union because it must be taken in that context, the manufacture, importation, sale and promotion of tobacco products, the present posi tion in Ireland regarding the US approach to anti-smoking health promotion and education and the enforcement of tobacco controls and prohibitions.

The most important chapter in this detailed document is No. 8 which proposes the implementation of an anti-smoking strategy, the aim of which is the elimination of underage smoking and a reduction in the number of adult smokers. All the statistics show that the percentage of young people who are smoking is on the increase. There was a slight decrease in the mid-1990s but it is now on the increase again, particularly among young women. The public needs to be protected from what is correctly termed environmental tobacco smoke.

It is alarming to note that 80 per cent of adult smokers were hooked on nicotine before the age of 18. There has been much media coverage of the attractive additives that are introduced to cigarettes to make them more user friendly. These include syrup, cocoa, caramel, glycerine and liquorice root, all of which make cigarettes more user friendly for children and adolescents. We must deal with that aspect.

Despite the fact that successive Ministers for Health have warned over and over again about the serious health consequences of smoking, there has not been a coherent overall strategy to tackle this health threat. I am calling on the Minister, Deputy Cowen, to do so. All Members of the Oireachtas – not just the members of the Joint Oirreachtas Committee on Health and Children – should be pushing for a national anti-smoking strategy. This matter should not be a political football. It is in all our interests to improve the situation for those who want to give up cigarettes. There must be more awareness in schools, through education, to prevent young people from becoming addicted. As a teacher, I have seen over the years the worry caused by 12 and 13 year old first year pupils becoming addicted. They are inhaling cigarettes at that age, even when their lungs are not properly formed, and they find it virtually impossible to give them up. It frightened me to see so many young people – boys and girls, but predominantly girls – becoming addicted to cigarettes. The problem will be difficult to address because so many different reasons are put forward as to why young girls smoke, including weight and peer pressure. It is a combination of many factors but the reality is that they become addicted at a very young age. Statistics for 1998 show that the downward trend was reversed and there was a proportionate growth in female smokers, which continues to escalate. The relevant figures are contained in the report.

Chapter 2 is extremely important when discussing health matters. I am sure that, given his medical experience, Senator Fitzpatrick will be particular interested in that chapter. It provides frightening statistics concerning the effects of smoking on people's health. I had to read this four or five times in order to believe that some 20 per cent of all deaths in the Republic of Ireland are attributable to tobacco-related illnesses. Yet this fact was not upheld by the representatives of the tobacco companies who appeared before the Oireachtas committee. They spoke at length and used the expression "risk factor", but never once mentioned smoking-related deaths, despite the research in the United States. Tobacco kills in excess of 6,000 people here annually. Six times more people die prematurely as a result of smoking cigarettes than from car accidents, alcohol or illegal drug abuse, murders, suicides, fires, hepatitis C and AIDS combined. Many thousands more suffer from chronic debilitating disorders as a result of smoking. The statistics show that smoking is the single biggest cause of preventable death.

I am not a smoker and I find it hard to understand addiction when I am speaking about smokers. Nonetheless, we must accept there is an addictive element to smoking. The tobacco company representatives who came before our committee said, in a very dismissive comment, that smoking was as addictive as surfing the Internet. I am sure Senator Glynn remembers the day that was stated at the committee. We could not believe that this comment was thrown out as something that was considered appropriate to such a serious issue.

According to the report, smoking is also the major cause of cancer, cardio-vascular disease, stroke, respiratory illness, peptic ulcers, emphysema and accelerated rates of post-menopausal bone density loss in women. In Ireland, 1,500 people die from lung cancer annually, with smoking being a major causative factor in 95 per cent of lung cancer deaths. I could go on and on about smoking shortening life expectancy. Approximately one in every three young people who become regular smokers dies prematurely as a result of smoking. If we were to say that of any other area, people would take the issue extremely seriously.

According to definitive research, the report says that the risks of environmental tobacco smoke, or what we would call passive smoking, affect non-smokers and smokers alike. It is not just an unpleasant nuisance but also a deadly risk. We would all agree that the impact of passive smoking is dependent on the exposure dose and its regularity. The report contains a frightening reference to the effects of passive smoking on children, which include acute and chronic middle-ear disease; possible hearing loss; respiratory tract symptoms, such as cough, phlegm and wheeze; decreased lung function; and asthma. This is backed up by medical evidence which is provided line by line in the report.

I would like to go through the pages in the report which detail what the tobacco companies stated, but suffice it to say that I was not impressed by what they said to us at the Oireachtas committee. Chapter 3 contains much material on addiction and the different stances the tobacco companies take in relation to it. According to the US Food and Drug Administration, the major tobacco companies target children and adolescents as potential smokers in marketing campaigns through the use of advertising and the sponsorship of sporting events to which young people are attracted.

I happen to have a copy of the American magazine Newsweek in my bag and I was quite shocked to see the colourful advertisement it carries – which we would not have in Irish publications – for Marlboro Lights cigarettes. There is a small warning in the advertisement from the US Surgeon-General that cigarette smoke contains carbon monoxide. The Philip Morris company recently did a U-turn and admitted that there was a connection between smoking and disease, yet here we have a very attractive cigarette advertisement in Newsweek magazine. I am glad to say that we are not as irresponsible in our advertising, but we could do even more.

In adopting this report, all members of the Joint Oireachtas Committee on Health and Children agreed with what Deputy Shatter, its chairman, is seeking. The committee agreed that we should have the same powers to protect the public health as are vested in the equivalent committee in the US Congress. The committee is requesting that a motion be placed before both Houses of the Oireachtas which would extend to the committee the powers contained in the compellability legislation to enable the committee to hold further hearings and to make any orders it deems appropriate for the discovery of documentation against each of the tobacco companies whose cigarette products are sold on the Irish market. They certainly have not made their documents available to us. I am sorry that I have to cut short my presentation but I am sure we will be able to continue on this.

I hope the Minister for Health and Children, Deputy Cowen, will deal quickly and specifically with the implementation of this report because I do not want to see it gathering dust. This is an extremely comprehensive report. It has taken 18 months of our time and six months of Deputy Shatter's time to produce this definitive document, the first of many. I would like to see the immediate implementation of the recommendations in the document.

Dr. Fitzpatrick

I welcome the Minister of State, whose speech was illuminating. We could all go through it line by line and discuss it in detail. However, one or two things jumped out at me. In 1977 we moved away from organic tobacco and allowed 600 different chemicals to be used in the processing of tobacco. That was only 20 years ago. This is an amazing thing to hear in Seanad Éireann. I would have thought that governments all over the world, particularly the Irish Government, would have looked at the health implications of allowing something like that because it has been known for years that the inhalation of tobacco is harmful. A study carried out by Doll and Hill in the 1950s was the first to investigate smoking and it showed conclusively that there was a correlation between lung cancer and the amount of tobacco smoked. Since then successive studies have been carried out which show that tobacco has no good effect at all. Recently I came across a copy of the Reader's Digest dating back to the 1950s or 1960s in which a leading member of the American Medical Association extolled the benefits of a certain kind of cigarette. I think it was the Camel brand but that is irrelevant. Even as late as that, when we knew the ill effects of cigarettes, doctors still advocated smoking.

The Minister of State's speech was full of surprises. Do cigarettes burn at 600º centigrade or Fahrenheit? Think of what that would do if you had a cigarette between your lips. A person would be well on their way to the burns unit at St. James's hospital. I do not doubt that cigarettes get extremely hot because I have seen the effects of cigarette burns on people and they can be unpleasant.

People do not appreciate the addictive properties of smoking. I have, like the Minister of State, Deputy Moffatt and Senator Henry, seen people dying, on oxygen, suffering from lung cancer, amputees and they are still smoking, even though they know they are making the quality of their lives a lot worse. They subject themselves to severe medical intervention, none of which is pleasant, but still they continue to smoke. It is in this that we have to question the attitude of the tobacco companies. They have known this for years. In the Minister of State's speech we have seen the steps they have taken to hide the effects of tobacco and how they have added carcinogenic chemicals to their tobacco products. This was hidden from the public. If someone in the food manufacturing chain tried to do this they would be out of business in the morning. Yet as legislators, doctors and the general public we stand for this and condone it. This is public health damage on a massive scale and no one seems to be raising their voices against it. We are allowing young people and the general public to be poisoned by these companies yet there is not a cheep out of us. As a Government, we are prepared to take the money raised in taxes over the years but I suggest it has now reached the stage that we are not getting enough money in taxes to pay for the ill health that tobacco causes.

Whatever about imposing punitive taxes, we must look at how tobacco companies push their products, their advertisements, what they include in the tobacco, the chemicals they add and their manufacturing processes. We should also look at how they target their advertising at vulnerable people. They persist in doing this. They appear to go for glamour advertising occasions, with motor racing being the biggest. I am not an addict of tobacco but a reformed or post smoker. If you turn on any sporting programme on a Saturday afternoon, especially motor racing, you will see that it is dominated by tobacco advertising. Huge amounts of money are involved. One Govern ment acting alone cannot do anything about this issue because the motor racing circus moves around the world. However, we could start in Europe if the European Commission came forward with a proposal to ban tobacco advertising.

We will have to deal with another problem if we are to ban the sale of tobacco. Tobacco is a cash crop whose production is labour intensive. The people who produce and harvest tobacco are poor. If we take away their livelihood they will have to be provided with an alternative cash crop. We must consider this problem because we cannot take away the basis of their livelihood without replacing it with something else.

I welcome this report produced by the Oireachtas Joint Committee on Health and Children. I am honoured to be a member of the committee. I congratulate its rapporteur, Deputy Alan Shatter, on the hard work he put into it. I regard this report as being part of the educational process as well as an indication as to what legislation we should enact to prevent the horrific side effects of tobacco smoking. The more we discuss this, the more it is put out in the public domain, the more we educate people about the dangers of smoking. We must get them to see that they are harming themselves and the general people in whose company they are. Statistics show that the unborn child is affected by the smoking habit of its mother and that the blood supply to the placenta and to the child in the womb is reduced. This has a knock-on effect and health implications for future generations.

Apart from the educational results of this report and the basis it provides for future legislation, this Government should initiate legislate against tobacco companies as a matter of urgency. One fact that has come out of this report – not just this report but other reports as well – is that tobacco companies hid the effects of their actions from the people they were selling to. If a car manufacturer was caught doing the same thing he or she would be out of business and be faced with punitive damages.

Dr. Henry

I am grateful to have the opportunity to comment on this comprehensive report which the committee has brought forward. However, the Minister of State did not say and the report does not mention whether Ireland is involved in the World Health Organisation's Framework Convention on Tobacco Control. When Dr. Gro Harlem Brundtland became Director General of the World Health Organisation, she decided to address what she described as the "pandemic" of tobacco-related diseases and pointed out forcefully that only intergovernmental initiatives would bring this to fruition. As Senator Fitzpatrick pointed out, the livelihoods of those producing this drug must also be taken into account. It is bizarre that EU subsidies are being given to tobacco producers in Greece while a large amount of money is spent on trying to reduce tobacco consumption in other parts of the EU. This document is inclined to focus on the Irish initiative, which is not all that is needed. We must look at the effect this is having on world health while noting the effect on commerce and how we will deal with that.

It is interesting, as the Minister said, that 80 per cent of smokers want to stop. It is important to prevent them starting. Tobacco is addictive, as even the tobacco firms have now been obliged to admit, and it seems to be extraordinarily difficult for people to give up cigarettes. Mercifully, I have never been a cigarette smoker myself so I do not have to go through the pangs of giving it up – it has been described as being more difficult to give up than heroin. We have a serious problem with children smoking. The report is excellent on advertising and I commend the former Commissioner Flynn for his efforts in this area. Advertising, without a shadow of a doubt, is aimed at children and the sooner tobacco advertising is banned, the better.

The report suggests the introduction of better legislation and more environmental health officers to police the sale of cigarettes to children. I always thought this was a good idea. However, some months ago in the New England Journal of Medicine, I read a report dealing with two contiguous health board areas in New England. One area rigorously enforced the legislation on selling cigarettes to children while the other did not. Unfortunately, the results were not much different – children appeared to be able to acquire cigarettes if they were looking for them, no matter what happened.

Price is important in cutting cigarette consumption by children and people on lower incomes. It is ridiculous that cigarettes are £1.20 cheaper per pack of 20 in the Republic than in Northern Ireland. Many millions of pounds in tobacco tax are collected by the Department of Finance and it is probably worthwhile to let people smoke. Smokers die about ten years younger on average so they do not collect their pensions. However, they cost a great deal in health care before they die, particularly in the past two years when a fortune can be spent cutting off bits of their legs, taking out bits of their lungs and doing heart bypasses. During their lives, they visit their general practitioners more frequently than non-smokers. Now that we know more about passive smoking, we must also take into account that it has a serious effect on those who work with them. The committee has done a good job in dealing with smoking in public places and the workplace. Those who have to work with smokers suffer everything from sore eyes to chest and upper respiratory tract infections. The jury is out on whether smoking causes cancer but certainly, given the amount of smoke inhaled by barmen, perhaps they would have a case. When smoking was permitted on buses, bus conductors won cases because of the effect on their lives.

This is a difficult problem with which to deal. However, it is cheering that 45 per cent of people smoked 25 years ago while that figure has now decreased to 30 per cent. The sad thing is that the number of women smoking has increased while the number of men smoking has decreased. It is difficult to deal with the problem of young women smoking. They have an image of smoking as glamorous, are under peer pressure and they worry about their weight – we know that people think if one smokes one will not put on weight. We are becoming fatter as a nation and they have good reason to worry about this, but it would be better if they decided to eat less and take more exercise. Perhaps it would be better to focus on the scientific facts that one is more likely to become old and wrinkled-looking earlier if one is a smoker and that one's skin thins. We are focusing on more serious diseases when perhaps focusing on the more cosmetic results would be better. I have asked people without a cigarette in their hand how much they smoke and they ask me how I know they smoke? I reply that I know at once because I can smell it from their clothes a mile away. People do not find it attractive when they are told that. Perhaps it is hard-hearted but we should be more unpleasant when we urge people to cut down, especially young women.

We also have the problem that those who are most likely to take notice of us are those that are the least likely to smoke; only 10 per cent of university graduates smoke but 40 per cent of the unemployed do. The fact that there are fewer unemployed should be useful as the number of smokers should decrease. There is a hard core of about 30 per cent in both sexes, among the unemployed and unskilled manual labourers, who are the really heavy smokers and are least likely to get good health care. The message we are preaching is often to those who do not smoke. We must become more focused and ask community groups and those involved with the unemployed what they think are the best initiatives. The education of doctors would do no harm either. The Irish College of General Practitioners, the IMO and other organisations have urged doctors to be more proactive in trying to get their patients to stop smoking. This report states that only 36 per cent of patients who were smokers said their GP had mentioned to them that it would be a good idea to stop. At least we were better than England, where the figure was 29 per cent. General practitioners say they are pushed for time and cannot discuss this with their patients. I tell people they really should stop smoking which is not very useful. More help would be better.

I will finish by referring to the serious problem with young women smoking. The incidence of lung cancer in women is increasing. As I have said before, in the Tower Hamlets health authority in London last year, the death rate of lung cancer in women was higher than that from breast cancer, which is an incredible statistic. Women also seem to do particularly badly if they get lung cancer. The influence of smoking in relation to heart disease among women is also serious and affects them at an earlier age. I do not think many women are taking much notice of this. There is also the effect of smoking on women during pregnancy. If it is difficult enough to stop when one is not pregnant and it must not be any easier to stop when one is. A large number of women who smoke do not manage to give it up when they are pregnant although they are aware that on average children born to smokers are 200g. lighter than children born to women who do not smoke at the same gestation period. It is a significant weight difference and could be up to 8 per cent of the baby's weight. We must make a big effort regarding pregnant women in particular.

I work in the Rotunda Hospital where smoking is not allowed on general wards or out-patients' areas and it is extraordinarily depressing to see the number of people outside the doors dragging on fags. One would be asphyxiated in one of the small rooms where people can smoke. It is extraordinary to see pregnant women smoking who may be in hospital for a condition which might not affect their baby as seriously as their smoking. It is difficult to do anything about it but a greater effort must be made. Many of these women are from the more deprived socio-economic areas of the city, but it is in these areas that greater efforts must be made.

Unfortunately, there is a higher incidence of cot death in families where the mother or father, or both, smokes. There is a need to bring home to parents the great importance of keeping babies away from cigarette smoke. Small children have a higher incidence of respiratory disease if they come from families where there are smokers.

The number of smokers in Ireland will be reduced but the shameful point is that the tobacco companies will not lose because they are already doing unbelievable damage in Eastern Europe. I saw an advertisement beside the pyramids for Camel cigarettes, which nobody would agree is subtle. The companies will not lose but we must be determined that we will win given the increased prosperity and the possibility of better targeting of campaigns.

Smokers are often unemployed or from lower socio-economic groups and many of them, particularly women, work in the home. They might benefit greatly from doing part-time work given that women who work full-time are the least likely to smoke. The additional social benefits of increased child care and improved working facilities might lead to a lower incidence of cigarette smoking in ten years. We should not have a policy of despair because the level has been already reduced from 45 per cent to 30 per cent. There is a need now for much better targeting, particularly of women and those in lower socio-economic groups.

Mr. Glynn

Cuirim fáilte roimh an Aire Stáit. It is difficult to know where to begin on this topic but, as the Minister of State said, tobacco is the leading preventable cause of premature death in Ireland and the developed world generally. I wish to add the rider that it is legal and the conclusion, therefore, must be that tobacco companies are legal drug pushers. I am honoured to be a member of the Joint Committee on Health and Children which was addressed by representatives of the various tobacco companies, one of whom, Mr. Ian Birks, was a master at stonewalling. If the evidence that tobacco is harmful to health jumped up and bit him on the nose, he would still deny it.

The evidence on tobacco and health is robust and conclusive. Tobacco is addictive and it kills. The tobacco industry has promoted the argument that there is a need for more research into whether tobacco is a cause of disease or is addictive. This must be the joke of the century and it is a diversionary tactic. We know enough and now is the time to act.

We have all seen the glamorous advertisements to which Senator Fitzpatrick referred at major sporting and international events which promote various tobacco products. I remember when I was a young man working across the water seeing an advertisement, before such advertising on television was banned, featuring an individual walking along a strand at night. He looked a forlorn figure but then he took out a packet of cigarettes and lit one. The caption was "You're never alone with a Strand". It was a totally dishonest, misleading and untruthful glamorisation of a seriously addictive and health harming substance. More recently, there were advertisements featuring an individual in an obviously melancholic mood who finds a wonderful mood altering cigar. The caption was "Happiness is a cigar called Hamlet".

As pointed out by the Minister of State, by Deputy Shatter in his report, Senator Fitzpatrick and others, younger age groups are being specifically targeted. This fact of life is demonstrated in the statistics to which speakers referred. I do not intend to be sexist, but there is a high incidence of smoking among teenage women. People will try to do many things to get off the hook in relation to their addiction. They say that they have switched to a different brand which is not as heavy or rough or that they are cutting down and they are now smoking filter tipped cigarettes instead of untipped cigarettes. They may also say that they have moved down another rung of the ladder and are smoking smaller tipped cigarettes. However, in other areas involving addictive substances, there is the concept of denial and delusion. There is obviously denial on the part of individuals that they are addicted to a substance and they are deluding themselves because, as everybody knows, a delusion is a false belief that cannot be corrected by appeals to reason.

The Minister of State made an interesting reference to the temperature of a lit cigarette. One of the most well known forms of torture, which has been glamorised in Bond films and books, is a cigarette burn. Undoubtedly, a cigarette burn has much more serious implications than an ordinary burn from a fire or a scald injury. This has been medically established.

Senator Fitzpatrick referred to the huge amount of taxes collected by governments from tobacco companies. What is spent on people who are addicted to tobacco? I worked in the health services for many years and I concur with Senator Fitzpatrick's comments. People who are staring death in the face would still have a drag from a cigarette. I have often given patients oxygen or put them on nebulisers and when I removed it the first thing they asked for was a cigarette. An acquaintance of mine had a triple bypass 20 years ago because of cigarettes, yet recently this man needed an additional bypass. When discharged from hospital, he began to smoke cigarettes again, even though he knew they were harmful and had already caused him major problems.

The tobacco companies have three main planks for rebutting the evidence which exists on to the harmful effects of smoking. They say that smoking is voluntary. Of course, it is voluntary. People who shoot heroin into their veins do it voluntarily but they do so because they are addicted to the drug. The attitude of the tobacco companies is that smoking is voluntary and not addictive. Of course, it is addictive. As Senators Fitzpatrick and Henry and the Minister of State will know, those who attend their doctors and are advised about the serious implications of the continued use of tobacco, ignore this advice and continue to smoke. I am sure Senators Henry and Fitzpatrick will recall two people who came in to address the joint committee. They were not able to walk, one was in a wheelchair as a result of the use of tobacco. Tobacco companies deny that smoking injures health. If it jumped up and bit them on the nose they would give the same answer.

Tobacco is a global problem. The world tobacco trade is controlled by a small number of supranational companies. Public health interests must organise globally to meet the challenge. I commend the Minister, Deputy Cowen, for what he is doing. I hope the price of the packet of cigarettes will be increased in the budget because we must try to deter people from injuring their health. We must welcome the World Health Organisation's initiative to develop a legally binding treaty that is the framework convention on tobacco control. We call on Commissioner Byrne to prioritise the fight against tobacco and to build capacity to do this at EU level. We call on the Government to renew its commitment to fight tobacco and to build the necessary capacity to do this. This must have Community and all-party support.

I wish to comment on the concept of tobacco smoking. How does someone who does not smoke and who goes into a smoky atmosphere breath when they leave that atmosphere? I say they do so with great difficulty. Throughout the years, tobacco companies have made every effort to entice people to smoke by way of glamorised advertisements. They even reduced the packets to five cigarettes and people stupidly thought they were facilitating them. They were – they wanted to make absolutely sure that if people had not the price of a packet of ten cigarettes, they would have the price of a packet of five.

I am pleased to have been involved in producing this report and I commend the rapporteur, Deputy Shatter. There is only one way to greet cigarettes – that is with the thumbs down.

Dr. M. Hayes

I am extremely grateful to the committee for producing the report. It is an excellent and comprehensive document and I congratulate the rapporteur, Deputy Shatter. I am grateful to the Minister of State for the technical information on the growth of tobacco. However, I would have been more content if he had told us what the Government intends to do in terms of a concerted plan to deal with smoking.

There is no question that the health case against smoking has been made. It is beyond doubt that it is the single biggest killer and the single biggest contributor to ill-health and misery among people. However, it is deeply ingrained in the culture and it is very difficult to get an attitudinal and cultural change. For professional reasons I am more aware of the figures for the United Kingdom than for Ireland. In the United Kingdom, there are 2,000 tobacco-related deaths per week. If anything else was killing 2,000 people per week there would be riots on the streets. I am not arguing for the legalisation of cannabis. People are extremely concerned about drugs, and rightly so, but there are other drugs, such as tobacco and alcohol, which are deeply ingrained in our culture. We worry about BSE, salmonella etc. whose impact on health and killing capacity is infinitesimal compared to tobacco.

Smoking must be tackled on several levels. The main target must be the cigarette manufacturers. I am pleased that advertising will be banned and I commend the Minister for this. However, there is a need to take a slightly wider view of this issue. Formula 1 racing in Britain will be allowed to advertise for cigarette companies for God knows how long more – perhaps for as long as some of them contribute to Labour Party funds. We must not keep an eye on direct advertising only, but also subliminal advertising. This glamorises smoking and makes it appear an exciting and interesting activity.

Another way to deal with this problem, which has been fairly well proven throughout the world, is by way of pricing. I hope the Minister for Finance will reflect this in the budget. There is an effect in Northern Ireland because the number of cigarettes being smuggled across the Border at present is enormous. The cheap price of cigarettes here is contributing to ill-health and tobacco consumption there. It should also be made easier for people to sue tobacco firms, to take class actions. Health authorities should be more ready to take massive actions against tobacco firms for the costs related to tobacco-induced diseases. In the United States tobacco firms have paid out billions of dollars.

If this activity is glamorous for some people and addictive for others, it is not necessarily the answer to have a complete prohibition on it. Prohibition has not worked with other substances. There must be some means of addressing this issue.

Senator Henry was correct in identifying the two most at risk groups as young women and people living in deprived areas. People living in deprived areas often smoke to relieve tension and stress. This must be part of an attack on poverty generally – in dealing with the root causes of poverty and mutual deprivation, one might well be removing a considerable constituency from smoking or, at least, making them more receptive to a particular message. There should be an enhanced education programme in schools and youth clubs which would relate to young people. Sometimes young people should be spoken to by other young people.

There are strong arguments for comprehensive community health programmes to help people, especially women, young girls and children, to deal with their own health problems and to see the effects of smoking on them and their unborn children. Since addiction is part of the problem and a very clear strategy of tobacco firms is to secure addiction at an early age, there should be a great concentration on methods of detoxification. Great concentration is placed on putting in place detoxification programmes in respect of other drugs. Why not establish detoxification centres for those suffering from nicotine addiction?

Our entire society must make an enormous effort to recognise smoking as a dangerous and filthy occupation. I do not smoke but I am extremely aware that I am in more danger from toxic fumes from passive smoking than I would otherwise be. If we start applying the health and safety legislation to people such as barmen, those involved in the entertainment industry, etc., the situation would be transformed. It is wrong that people are required to earn their living in polluted environments which are a danger to their health.

There are many aspects to this problem and a number of treatments are required. I commend the report and I congratulate the Minister for Health and Children, Deputy Cowen, on the stand he has taken. I support my colleagues in asking for the early production of a national programme to counter smoking. This should be linked to European Union and World Health Organisation programmes so that the problem is tackled on as many fronts as possible. I return, however, to my point that the place where we will hurt tobacco companies most is in their pockets.

Mr. D. Kiely

I welcome the Minister of State and I thank him for his interesting and broad-minded contribution which, perhaps, differed a great deal from the views expressed by Senator Jackman. I am not a member of the Joint Committee on Health and Children but I have read the report and it is an interesting and worthwhile document which requires further debate.

The problem of smoking is quite serious. We constantly hear news reports about the number of deaths on our roads but no announcements are made about the fact that three times as many people die from tobacco-related problems on a daily basis. There is a need to take this situation in hand.

The Minister of State indicated that the Minister, shortly after his appointment, established a review group which is to produce a report entitled Towards a Tobacco Free Society. I look forward to the publication of that report because I would like to see the recommendations it contains. I would also like to see the legislation the Minister introduced in respect of this area being fully implemented because people seem to completely ignore its provisions.

People who smoke seem to believe they have a God given right to light up wherever they please, without taking account of the feelings of others. If you inform them that you are sitting in a non-smoking area because you do not like smoking, they look at you in surprise and say that it is their God given right to smoke. At this point I usually inform them that it is not their God given right to force me to inhale their smoke or to interfere with my health. There is a need to introduce further regulations to stop people from behaving in this way.

The public transport authorities must take a stricter approach in respect of smoking. For example, people specifically travel in non-smoking carriages on trains to avoid inhaling toxic fumes. However, others often smoke in the corridor outside and make the excuse that they are not smoking in the carriage. As a result, the people in the non-smoking carriage are obliged to inhale the fumes. All forms of public transport should be made non-smoking, as should the Houses of the Oireachtas.

Studies and research into smoking show that tobacco companies focus primarily on young people. They do this because they want to hook young people on to smoking and they achieve their goal by running attractive advertisements which show a cowboy on horseback smoking a Marlboro. Sports advertising is used in a similar way. The first thing these companies try to do is trap young people by encouraging them to smoke. Once that happens, they are usually hooked for life and research shows that 80 per cent of them cannot stop smoking.

Previous speakers referred to the number of young women who are taking up smoking. These women believe smoking to be the "in" thing and they think they will look fashionable if they walk around with a cigarette in their hand. Nothing could be further from the truth because it is terrible to see a young girl leaving school and lighting a cigarette. We should educate these girls and inform them they are fooling themselves if they think smoking is attractive. Parents have a major role to play in discouraging young people from smoking. The Government and the Minister must put in place television advertising campaigns and encourage the production of television programmes which show the seriousness of this problem. In addition, educational programmes should be put in place in our schools to warn children about the dangers of smoking.

Many members of the public are not aware that 50 per cent of those who smoke die prematurely. That is a frightening statistic. There are many health clinics in operation throughout the country and people are seeking to keep fit by using herbal remedies and eating food which contains no contaminants. However, I have often seen people who immediately light up a cigarette after eating a meal which contains the proper vitamins to keep them healthy.

As already stated, smoking should be banned on all forms of public transport, in the Houses of the Oireachtas and in all public buildings. We should show people an good example. A number of weeks ago, Deputy Shatter stated that two thirds of football stadia should be smoke-free zones and I fully agree with his comments. Sports grounds should be sectioned off so that smokers and non-smokers can enjoy the games they are watching in comfort. I attended a county football recently and the man beside me started smoking. The smoke did not bother me very much but, as the Minister of State indicated, more damage is done by the toxic fumes one inhales from passive smoking. I am alarmed that a person who inhales smoke at second hand will incur greater harm than the person actually smoking the cigarette. That is frightening and people should be made more conscious of the dangers of passive smoking.

At the end of his contribution, the Minister of State said the Minister for Health and Children, Deputy Cowen, has advised the tobacco industry and the media industry of his intention to introduce an effective prohibition on tobacco advertising with effect from July 2000. I look forward to it and I am delighted that the Minister has given this commitment. This is a step in the right direction. The Minister should stop taking out advertising campaigns on the seriousness of the risks of tobacco smoking. On top of that he should implement the law where there are now non-smoking areas in restaurants and so on, because people just seem to ignore them. There were large non-smoking signs in our own restaurant but until recently, people would come in and immediately light up. They felt no responsibility for those around them until the signs on the walls were made bigger and stated that areas were non-smoking. Eventually the penny dropped and the Captain had to tell these people where the non-smoking areas were, and rightly so. Some of the people who think they have a God given right to smoke should look around them.

Much research and statistics on this subject are produced in America. When one goes into a restaurant in America, the first thing one will be asked is whether a smoking or non-smoking area is required. That right at least is given, even though many people in America are smokers. When one goes into a public building the right of the citizen in respected. Slowly but surely, this will be the case here. I welcome the Minister to the House and thank him for his initiatives. I look forward to an in-depth study of the report published recently.

The Seanad adjourned at 6.50 p.m. until 10.30 a.m. on Wednesday, 24 November 1999.

Seanad Éireann debate - Tuesday, 23 Nov 1999