Seanad Éireann debate -
Thursday, 7 Jul 2011

Vol. 209 No. 5

Public Health (Tobacco) (Amendment) Bill 2011: Second Stage

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

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

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

Due to their reach and frequency of exposure, tobacco packages are an excellent medium for communicating health information. Tobacco health warnings are also unique among tobacco control initiatives in that they are delivered at the time of smoking and at the point of purchase. As a result, the vast majority of smokers report a general awareness of package health warnings and pack-a-day smokers are potentially exposed to the warnings over 7,000 times per year. Health warnings on tobacco packages are among the most prominent sources of health information. Findings from Canada, Thailand and elsewhere indicate that considerable proportions of non-smokers also report awareness and knowledge of package health warnings. As a result, health warnings are a very cost-effective public health intervention and have a tremendous reach.

Health warnings on the packaging of all tobacco products are guaranteed to reach all users, and can increase smokers' awareness of their risk. The use of pictures with graphic depictions of disease and other health-related and cessation images has a greater impact than words alone and is critical in reinforcing the warnings. The first guiding principle of the World Health Organization's Framework Convention on Tobacco Control is that every person should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke.

Combined text and photograph warnings, also known as pictorial or graphic warnings, were developed by the European Commission for member states that wished to adopt them. The Commission proposed a library of these warnings but, as their introduction is not mandatory, further legislation is required prior to their introduction on the Irish market. While an enabling provision allowing the Minister to make regulations was included in the Public Health (Tobacco) (Amendment) Act 2009, which was enacted in July 2009, the Department was advised by the Office of the Attorney General that this provision in the 2009 Act did not adequately empower the Minister to make the necessary regulations. The AGO advises that an amendment of the 2009 provision is therefore required to give the Minister the necessary authority to make the required regulations.

The 2010 global progress report on the implementation of the WHO Framework Convention on Tobacco Control reported that 44 parties require health warnings to take the form of or include pictures. A total of six EU member states have introduced combined text and photo warnings and a further four EU member states are in the process of doing so. Full-colour picture-based health warnings on tobacco products are far more effective than text-only warnings. Pictorial health warnings on tobacco products make the product less attractive and target smokers by providing them with information on tobacco-related health risks. They are an essential component of a comprehensive tobacco control programme.

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

Despite the significant tobacco control measures that have been established to date and the widespread knowledge of the harm caused by tobacco consumption, smoking prevalence in Ireland remains high, which is a matter of concern. The most recent SLÁN survey estimates that 29% of our population smoke. Clearly, we cannot become complacent, and we must continue to build on the work that has already been done.

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

Tobacco use is also a major cause of increased morbidity. Smoking is the main cause of chronic obstructive pulmonary disease, COPD, and causes nearly 90% of all cases of emphysema. There is also a causal relationship between smoking and acute respiratory infection including pneumonia and tuberculosis. Smoking increases the risk of cardiovascular disease with the risk of mortality from cardiovascular disease in cigarette smokers being 1.6 times that of never-smokers.

The impact of smoking on health care costs in terms of treatment services for cancer, cardiovascular disease and respiratory diseases is significant. In the next ten years, if progress is not made on reducing the impact of tobacco, it is estimated it will cost the health service in excess of €23 billion. This would pay the entire cost of running our health services for two years. Smoking costs the economy at least €1 million per day in lost productivity.

A concern could be that the use of shocking images is not the best way to inform smokers. However, qualitative research in the UK has shown images tend to be most effective when they convey shock, immediacy and empathy. Smokers tend to respond to shock images that are disturbing or unpleasant to look at. Research in Belgium has demonstrated similar results. The warnings shown to have the most impact were those that were felt to be the most graphic and most disturbing.

In Ireland, pre-testing of the 42 images in the EU library was carried out by TNS-MRBI on behalf of the then Office of Tobacco Control. Subsequently, 14 warnings to be used on the Irish market were identified. The research found images impacted differently depending on age group and sex. For example, the apple image particularly impacted on the important target group of younger female smokers in the 18 to 35 age group. They could readily see that smoking causes damage to the skin, predominantly around the eyes and the lips. Impotency was found to particularly impact on younger male smokers.

International research into the use of combined text and photo warnings indicates that pictures improve memory from the text that accompanies it. Smokers are more likely to remember a health consequence of smoking, when smoking, if they have seen a picture. More than 50% of Canadian smokers say the warnings compel them to smoke less around other people. Smokers who read, thought about and discussed the combined text and photo warnings were significantly more likely to quit, attempt to quit or reduce their smoking. Up to 31% of Canadian ex-smokers participating in a study reported that combined text and photo warnings had motivated them to quit in the first place and 27% reported that warning labels help them to remain abstinent.

This Bill will allow for the introduction of regulations which will provide that all tobacco products sold in Ireland will carry a combined text and photo warning. This will, in turn, help to reduce the numbers of people smoking and more particularly encourage children and young adults not to start smoking.

The Government is committed to health promotion and tobacco-control measures that will support the aim of de-normalising tobacco. We will work constructively with all stakeholders in the broad health family to achieve this goal.

I recommend the Bill to the House.

Senator Marc MacSharry

I certainly do not plan to delay a Bill which has all-party agreement.

While the Office of Tobacco Control did not figure too much in the Minister of State's speech, it is worth noting the good work it did from when it was first established. We must commend the many health professionals and various others who served the office, advising Ministers and the Department of Health on tobacco-control measures. In 2002, I recall the Seanad ante-room used to be filled with plumes of smoke as Members used to take their leave to have a cigarette or pipe. In nine years, it is great to see the transformation the smoking ban has made. It is still a concern that 29% of the population smokes and that younger females, in particular, are still being attracted to the vice of smoking. Much progress, however, has been made by some of the tobacco-control measures introduced.

In 2004, section 47 of the Public Health (Tobacco) Acts 2002 and 2004 came into force to protect third parties, such as workers, from the ill-effects of exposure to second-hand smoke. Legislation was introduced to remove point-of-sale advertising, display of tobacco products at retail outlets and licensed premises in July 2009. The national register of tobacco retailers for persons selling tobacco products came into effect on that date too. Test purchase inspections conducted by environmental health officers resulted in almost 20 prosecutions for sales to minors, which seems quite low but shows the progress made on the issue. From May 2007, it became illegal to sell cigarettes in packs of less than 20. Up to 95% of workplaces inspected as part of the national tobacco control inspection programme were found to be compliant with section 47 of the Public Health (Tobacco) Acts. In November 2005, Ireland became the 101st country to ratify the WHO framework convention on tobacco control.

These are some of the more notable progresses made in the past several years in the bid to rid society of tobacco use. As a former smoker myself, I know graphic images are found to be the most powerful in deterring people from smoking. I gave them up five and half years ago through a combination of Allen Carr and the impact of family members being diagnosed with lung cancer. For each person it is a different approach, so we need to support the various approaches. If graphic images are to be part of the arsenal of the attack, then bring them on. The Minister is to be commended for this approach.

There could be strange allies in the war on tobacco. Outside football matches and markets one sees smuggled cigarettes being sold below cost. The State is losing out from a tax perspective in this regard. Our ultimate goal is to put these people out of business. I refer here to legitimate tobacco manufacturers.

Perhaps there is a need for us to work with the latter, in the first instance, in order that we might close off the routes which facilitate the illegal importation of cheaper tobacco. The companies to which I refer have collected large volumes of data which could prove useful. Given that they have a vested interest in this matter, however, there may be a need to obtain an independent assessment in respect of the advice they are offering. These companies are active in the context of lobbying and there may be something to what they have to say. I ask that the Department engage with them regarding our ultimate goal, namely, ridding society of tobacco. I do not know how easy it will be to achieve that goal in the short term. However, we must use all the resources at our disposal and, in that context, there is a need to engage to a greater degree with tobacco manufacturing companies such as Philip Morris and others.

I accept it does not relate to the Bill before the House but smoking remains glamorised to a great extent. Magazines such as Hello, OK! and others which people, both young and old, read and contain information and photographs relating to film stars, footballers and the wives and partners of celebrities. Quite often such individuals are photographed while smoking. Cigarettes are also featured in fashion shots taken for these and other publications.

Movies and television programmes also contain scenes in which people smoke. While such scenes may well depict manifestations of real life, their use must be discouraged. Surely it must be possible to depict such scenes in an equally entertaining way in the absence of cigarettes or whatever. If a scene is a factual reconstruction of something that happened in the past, I am sure it would be possible to remove the use of tobacco products from it. Movies, television programmes, magazine articles, etc., tend to glamorise smoking. When one is a particular age, one has a tendency to feel somewhat bullet proof. If there are small actions we can take to deter people from using tobacco products in the way I have outlined, then we should by all means take them.

The fact that young girls are particularly susceptible to taking up smoking — to an even greater degree than was the case in the past — is a matter of concern. Perhaps cigarettes are seen as some form of fashion accessory. If the latter is the case, then what I said in respect of the glamorisation of tobacco products in movies, television programmes, magazine articles, etc., is being borne out. If a particular film star, model or whomever is seen to be a user of tobacco, then that makes it acceptable for some young people.

There is very little else one can say in respect of this Bill, which is good and which should not be opposed. On behalf of the Fianna Fáil group, I commend it to the House. There are a number of health-related issues I wished to raise but I did not have the opportunity to refer to them in the context of the Bill. I understand, however, that the Minister for Health, Deputy Reilly, will be attending the House tomorrow to debate the Medical Practitioners (Amendment) Bill. The latter is a little more general in nature and might allow me to get stuck in to the Minister in a legitimate way. I did not want to get stuck in to the Minister of State, Deputy Shortall, in respect of such matters in the context of the Bill before the House.

Senator Colm Burke

I welcome the Minister of State and thank her for bringing forward the Bill at such an early opportunity. One often believes that the position with regard to regulation is adequate and that there is already legislation in place to allow Ministers to regulate in respect of particular matters. There was a case a number of years ago where regulation was in place but where there was a lack of adequate legislation. As a result, the relevant Department incurred a liability of €400 million. It is important, therefore, that Departments should react immediately when it is discovered that particular legislation is not adequate. That is what the Minister of State's Department has done on this occasion prior to proceeding to insist on the use of photographic warnings on tobacco packaging. In such circumstances, I welcome the legislation. It deals with a technical issue but it is important that we get matters right.

Some 25% of people who smoke will die before they reach the age of 69. The Minister of State provided some comprehensive figures in respect of health care matters in that regard. It is sad that a substantial number of individuals will die before the age to which I refer as a result of smoking. When one considers that 29% of people engage in smoking, one realises that some 1 million people are actively using tobacco products. These individuals are contributing to their own health problems, perhaps not immediately but certainly in the long term. We must continue to send out the message that every time a person smokes, he or she is damaging his or her health. It is important, therefore, to do everything possible to discourage people from smoking.

I accept that it is very difficult for people to stop smoking. However, we should all do our part in the context of encouraging people to kick the habit. Those to whom I refer should be given every possible assistance. Many people who smoke do not wish to do so. These individuals have made repeated attempts to give up but they find it difficult to do so. Using photographic warnings on packaging will get the message across. The Minister of State indicated that if someone smokes 20 cigarettes per day over the course of 12 months, he or she will see such warnings some 7,300 times during that period. That is one way to ensure that the message to which I refer is communicated.

The Minister of State outlined the fact that the cost of health care in respect of smoking-related diseases will be €2.3 billion in real terms. That is a massive amount of money and there are many things for which it could be used elsewhere in the health system. The cost factor is another reason for encouraging people to stop smoking.

Another issue that arises relates to the number of cigarettes that are imported and sold illegally. I am not sure whether those involved in producing or selling such cigarettes will be able to adapt in the context of including photographic health warnings on packets. Many people are able to purchase cigarettes illegally. Not only are these individuals damaging their own health, they are also affecting the way in which business operates in this country.

One of the areas in which major successes have been achieved in recent years is that of road safety. The campaign which has been run in that regard has proven very effective. It includes some shocking filmed images and is important in the context of getting across the message regarding the need to reduce speed and to discourage those who drink from driving.

We should target young people in the context of discouraging citizens from smoking. If individuals have not yet become involved in smoking, we have a better chance of getting the message across to them. We should do everything possible to discourage young people from smoking. In Australia, Brazil, New Zealand and Singapore, the telephone number of what is called a "quitline" is included on tobacco packaging. I understand that such information is included on cigarette packets in 14 countries of the EU. Perhaps we might consider the inclusion of a helpline number on packaging in this country. This is a matter in respect of which we must work.

The important aspect of this legislation is that it will not give rise to a cost for the Government. I accept that it will still be obliged to foot the bill for various advertising campaigns designed to discourage people from smoking or to stop smoking. However, it will not be obliged to pay in respect of the photographic warnings which must be included on packaging from now on. That is crucial.

The legislation is important from the point of view of long-term planning with regard to health care. It is also important to ensure that we are upfront with regard to ensuring that people who smoke are made aware of all of the risks on a daily basis, or even an hourly basis. I welcome the legislation and have no difficulty in recommending it for immediate enforcement.

Senator John Crown

This is an issue in which I have a great interest. On a daily basis, practising doctors in Ireland, particularly practising cancer specialists, see the results of the carnage caused by cigarette smoking. A quick, off the top of the head, list of the cancers for which cigarettes are the principle cause makes for frightening reading, beginning with lip, mouth, tongue, throat, oesophagus, pancreas, bladder and some other rare forms. Lung cancer in particular has been a critical problem in Ireland.

It is very interesting to look at what has happened in the case of the two leading causes of death from cancer in women in Ireland and other western countries. The incidence and mortality of breast cancer have both gone down quite dramatically. On the other hand, lung cancer among women has increased strikingly, and the death rate for lung cancer among women has risen dramatically throughout the 1950s, 60s, 70s, 80s and 90s to the present day. The reason for this is that it became socially acceptable for women to smoke in the aftermath of the Second World War, to the extent that Virginia Slims, one of the leading cigarette brands, targeted a specific product at women. It used a feminist advertisement showing a woman not allowed to play tennis without a long skirt 50 years ago but telling her "You've come a long way, baby" and now she can smoke Virginia Slims. It is a sad mark that so many lung cancer doctors, when they give a talk on lung cancer in women, show the "You've come a long way, baby" slide, because that is exactly what happened.

Lung cancer is becoming a particular problem for women and there are some other quirks in that story. The disease appears to appear in women with a more trivial smoking history than in men. Also, some kinds of lung cancer are becoming more common, even in people smoking lower tar cigarettes. This is not only a general health issue, but also a critical feminist issue. Lung cancer has now taken over from breast cancer and become the number one cause of cancer death in the western world for women. There are two reasons for this — lung cancer became more common because women smoke and we have got much better at treating breast cancer. Advances in lung cancer treatment have been much slower and early diagnosis of lung cancer is much slower.

The point needs to be made that people sometimes blithely assume that giving up cigarettes quickly restores them to their pre-smoking risk. That is untrue. It is always a good idea to give up smoking because that has a powerful impact on circulatory risk, heart attack risk and on the risk of ending up horribly disabled by stroke. All of these risks drop dramatically and quickly when one stops smoking. The lung cancer risk also reduces, but not as completely nor as quickly. The later one leaves it to give up smoking, the less the impact. The time for a smoker to give up cigarette smoking is now, not next Monday or New Year's Eve. People must understand that the longer they delay the decision to give up smoking, the more cumulative carcinogenic damage they have done to their lung. The greater proportion of that damage will be irreversible.

The biggest impact is where people under the age of 30 are persuaded to stop smoking. While we are justifiably happy that the prevalence of cigarette smoking has reduced dramatically over the past several decades, for which I credit enlightened public policy and the former Minister's, Deputy Martin's, courageous decision to lead the world with a smoking ban, I note with alarm the numbers of people in the younger age group, under 30, who are still smoking, where the incidence is approximately 30%. This is the target audience we must reach. We must do everything in our power to get at these people because once they cross the threshold of 30 years, the lung cancer reduction impact starts to dwindle. It takes on average 20 years after smoking exposure for lung cancer to occur. It usually occurs in people's 40s, 50s or 60s. Therefore, it is people under 30 we must reach and that is the reason I strongly support any measures the Government can take.

We are all aware of a general tendency to regard people who get pernickety about smoking as being unctuous or politically correct. This is not true. Every time somebody tries to defend his or her decision to be allowed to smoke in a given place or at a given time we must remember it is an addict talking and it is "addiction thinking". It is the same level of addiction as one would ascribe to someone craving the next fix of a more serious registered drug. All of the arguments advanced in favour of continuing smoking are spurious. People say it reduces their tension, they get on better with their spouse or it stops them from beating their children. None of these arguments is worth a toss. All of these arguments are addiction thinking. In addiction circles the kinds of rationalisations people use are called "stinking thinking".

We have largely succeeded in curbing smoking because of enlightened public policy, but also because there is now a general sense that it is no longer socially acceptable. People who smoke are now often seen by non-smokers as having some kind of personal failing, because they cannot control something which is so obviously bad for them. While I hate being judgmental about anybody with any degree of substance abuse addiction, this perception is not a bad societal standard for us to try to encourage. We must constantly hammer home the message that smoking is a bizarre, unnatural and unhealthy habit which has its roots in addiction.

It is entirely justifiable to be as explicit as we can with the warnings given to people who smoke. If we were starting off now and if Sir Walter Raleigh returned with tobacco tomorrow and we tried to start manufacturing cigarettes, they would be banned and the smoking habit would never be legalised. No part of smoking would be made legal if smoking was only starting now. However, we have kind of grandfathered it into legal acceptability because it has been done for 600-odd years in Europe, since tobacco was introduced by returning explorers from North America. We should feel zero compunction for doing whatever we can to penalise the manufacturers of this addictive drug and should constantly ratchet up the pressure on them so as to make the manufacture of these drugs as unappealing and as commercially unacceptable as possible. It is not being health fascist to make it our goal to eradicate smoking. This should be something we regard as a bizarre, historical quirk, in the same way that it was socially acceptable for people to smoke opium, chew betel or do any one of number of other bizarre addiction based behaviours. We must set out our stall and be the country that aims for zero tolerance for anybody smoking anywhere.

I speak with some authority on this issue because among my credentials, I am an ex-smoker. I can recall all of the rationalisations I would have offered back in my addiction-addled days, thinking how unfair it was of people to try and stop me getting access to the cigarette I needed so badly. However, we have the moral imperative to work on the consumers and the suppliers. I know we in this Chamber are not permitted to suggest anything which involves the evil spending or collecting of money, but before being ruled out of order I will quickly say we should slam a fiver on each pack of cigarettes as a health tax. In addition to all the other excise duties, another fiver should be imposed on every pack. This money should be ring-fenced for health and health research.

Am I out of order for making that suggestion? If I see the security guards, I will go quietly.

An Leas-Chathaoirleach

Not at all.

Senator John Crown

I believe we should do that. We should also consider extending the legal limits on where people can smoke. It was a subject of some amusement to me — working as I do in environs where it is illegal to smoke either indoors or outdoors — to discover that within the hallowed campus of Leinster House there are several locations officially or unofficially designated as smoking areas. It would not be unreasonable for whichever of our committees deals with internal privileges to consider the possibility of setting a good example for the country by making the entire Leinster House campus, within the gates, a smoke-free zone. If it can be done in hospital complexes, there is no reason we cannot do it here. Hospital patients are generally not well enough to go out to the street for a cigarette, although one will occasionally see some poor addicts who do. Most Deputies and Senators are well enough to leave the confines of barracks for a cigarette.

I warmly support this measure, as I do any extension of measures which limit smoking. The single greatest action we can take as a society to improve health is to reduce the rate of smoking. I often put it to patients who continue to smoke after cancer treatment that if they had two choices, either never to see a doctor again or to give up smoking, the choice that will have the greatest positive impact on their health is the latter.

An Leas-Chathaoirleach

I am loth to stop the Senator as he is eminently qualified to speak on this matter all day. Unfortunately, however, his time is up.

Senator Mary Moran

I welcome the Minister of State at the Department of Health, Deputy Róisín Shortall, and thank her for engaging with this debate. I congratulate Senator John Crown on his excellent contribution, which I am somewhat reluctant to follow. I only wish the Chamber and Gallery were full because he has made the case clearly.

I recall, as a child growing up in Dundalk, the significant cultural and sociological influences on the community of multinationals such as PJ Carroll, then the largest tobacco distributor in Ireland, and the former Harp brewery. Every Friday the employees of these companies were the beneficiaries of free cigarettes and alcohol for their personal consumption. Some might say it was a great town in which to live. These perks were given out willy-nilly, notwithstanding the long-term consequences for the beneficiaries' health or for the health service. That culture has changed in the intervening years. The PJ Carroll facility is closed down and is now the home of the music department of Dundalk Institute of Technology.

The Minister of State and other speakers pointed out the frightening statistics on the health effects of smoking. It is the greatest single cause of preventable illness and premature death in Ireland, responsible for more than 7,000 deaths per year. Some 90% of lung cancers are caused by smoking and 50% of all smokers will die from smoking-related diseases. Smokers have an increased risk of cancers, heart disease, strokes, bronchitis and emphysema. Pregnant women who smoke are at greater risk of delivering babies with low birth weights. Smokers lose an average of ten to 15 years from their life expectancy.

The costs of smoking in terms of damage to health and well-being far outweigh the economic costs of tobacco use. Smoking costs the economy at least €1 million per day in lost productivity, while it costs €1 billion per year to provide health services for smokers. If we do not make progress at reducing the impact of tobacco in the next ten years, it will cost our already over-burdened health service in excess of €23 billion. To put it in perspective, that sum would cover the running of the entire health service for almost two years or go a long way towards building a new national children's hospital.

The introduction of a combined image and text health warning on cigarette packaging will lead to a long-term reduction in the number who smoke, with tangible benefits for society in both social and economic terms. We are all familiar with the Government text health warnings that have been included on cigarette packages for several years. These are effective because of the frequency of exposure. For instance, a person who smokes 20 cigarettes a day is potentially exposed to the health warning 7,300 times per year. The location of the warning means it is visible to the smoker every time he or she opens the packet. Including a picture of a diseased lung or any of the other proposed images can only enhance smokers' exposure to the health risks every time they light up and thereby act as a deterrent.

The most recent large-scale report on smoking in Ireland, SLÁN: Smoking Patterns in Ireland, found, somewhat surprisingly, a slight increase in the smoking rate from 27% in 2002 to 29% in 2007. This increase came despite the introduction of text health warnings on cigarette packets and the commencement of the ban on smoking in public places in 2004. Another worrying trend identified in the report is the increase in recent years in the number of adolescent girls who smoke. It is vital that we catch young people at the time when they are most likely to become addicted to nicotine. The Irish Cancer Society has indicated its concern that it is losing the battle to prevent young girls from taking up the habit.

As a parent of teenage children, I am heartened by the reference, albeit a minor one, to the dangers of smoking which is included in the junior certificate social, personal and health education, SPHE, curriculum text book. We must explore ways such as this of targeting young people. Most schools have an anti-smoking policy, but we must do more. The SPHE textbook includes four pages of text on the dangers of smoking and one picture of a smoker's lung. My four children were unanimous in their view that the image had a much greater impact and was a far greater deterrent than the four pages of text.

There are many reasons that we should inform smokers of the health risks of smoking through the use of pictorial warnings on tobacco products. First, an image is eye-catching; as the saying goes, a picture paints a thousand words. This is shown time after time in the case of children who have no speech or adults who have lost their speech through strokes or illness but who learn to communicate effectively through picture signing. A picture also crosses the barrier of language. For example, when abroad, a health warning in a foreign language may communicate something of its message to us, but a picture requires no translation.

Images are also informative. Research has shown that in Canada, where pictorial warnings include information about the risks of impotence, smokers were almost three times more likely to agree that smoking causes impotence compared with smokers from the United States, United Kingdom and Australia. In the same study 44% of smokers in Canada agreed that pictorial warnings increased their motivation to quit smoking. Pictorial health warnings on cigarette packages make the product less attractive and target smokers by communicating the health risks in a clear and striking way. Another vital consideration is that the introduction of pictorial warnings will impose no additional financial cost on the Exchequer. We are all aware that the adolescent years can be the most vulnerable. Therefore, it is imperative to target this age group when addressing the dangers of smoking. The effectiveness of coloured graphic warnings over other illustrations was highlighted in a directive of the European Parliament in Greece in 2003 where 96.1% of current smoking adolescents opted for the graphic warning labels as being more effective in preventing them from smoking and in informing them about the health effects of smoking in comparison to the EU text-only warnings. It was also noted that younger adolescents up to the age of 14 not only opted for the graphic warnings more often, but were also more likely to rate them much higher in comparison to their elder peers aged 15-plus.

The proposed EU graphic warning label, supported by other tobacco control policy interventions such as smoke-free environments, advertising bans and increasing the price of cigarettes, must play a vital role in de-normalising smoking and preventing smoking initiation especially during the crucial years of adolescence when smoking experimentation and addition is more likely. I recommend the Bill to the House.

Senator Deirdre Clune

I am pleased to have an opportunity to contribute to the debate. I welcome the Minister of State, Deputy Róisín Shortall. The Bill is broadly welcomed. It is another step on the way to help discourage people from smoking, particularly young people. The proposed text and images will be very effective in targeting the young age group to which so many speakers have referred. Senator Moran indicated that a picture paints a thousand words. I have been reading research from the Library and Research Service. Reference is made to it in the Minister's speech also. There is much research internationally from the World Health Organization and across the EU of the benefit of images on cigarette packaging. Senator Moran mentioned speaking to her teenagers at home and how graphic images make a bigger impact. We all instinctively know it is the right way to go, particularly when targeting young people.

The legislation is another step towards reducing the consumption of tobacco. Initially text warnings were placed on cigarette packets. The national smoking ban has been very effective. I class myself as a non-smoker although in my student days I was a social smoker. The ban on smoking in the workplace has been a lifesaver. It has improved the environment and is a most welcome move. In July 2009, new rules were put in place to control tobacco products at the point of sale. In effect, tobacco products are to be hidden and individual purchasers must ask specifically for such products which are no longer allowed to be prominently displayed. In the case of vending machines in pubs, one must ask for a token rather than use cash. That has been another effective step in reducing the incidence of smoking as it introduces another barrier which people have to cross. In spite of that, we still have 1 million people, 29% of the population, who smoke.

The Office of Tobacco Control, to which Senator MacSharry referred, has been effective in advising the Department of Health in the area. Its research into the effectiveness of legislation and regulation has been helpful. It was able to track the effectiveness of the introduction of the control of tobacco products at the point of sale. A total of 50% of retailers asked young people for ID and they refused to sell them tobacco products if they could not provide it. More care was taken by retailers because they had to think about accessing tobacco products. The measure has been effective. The worth of the Office of Tobacco Control has been noted. I wish to associate myself with those comments. The office has been extremely beneficial and effective in developing policy and in informing the development of legislation to the current position.

The Minister referred to the cost of health care as being €2.3 billion. That is a lot of money. I made a calculation of the cost to a smoker for someone who smokes 20 cigarettes a day. A packet of cigarettes costs €8.65. As the money comes out of the purchaser's pocket it does not matter to him or her whether the money goes to the Government or to cigarette companies. The cost amounts to €3,157 per annum.

Senator Marc MacSharry

It is the minimum wage.

Senator Deirdre Clune

That is before tax, if one is earning money. That amounts to a contribution of approximately €4,000 or €5,000 depending on one's income. It is a substantial amount of money for a person who is addicted to smoking.

Mention has been made of young people, particularly young women. Anecdotal evidence suggests there is an increase in the number of young women smoking. Image and weight are cited as factors, as is the case with older women. They fear the consequences for their weight if they give up smoking.

Senator Crown outlined the long-term consequences of smoking such as lung cancer and other cancers. I attended a launch last year early on a Friday morning in the Dental Hospital in Cork which also took place in Dublin. A lip and throat cancer awareness week was launched. Free screening was offered to members of the public. The launch was relatively low key. I was very surprised to read subsequently that the organisers could not cope with the uptake of the free screening. Queues stretched out the door and around the building, similar to what we have seen at the Passport Office. People are conscious of health care now. Graphic images such as provided for by the legislation will go a long way to reducing the incidence of smoking in the population.

Senator Imelda Henry

I welcome the Minister of State, Deputy Shortall. I also welcome the Public Health (Tobacco Amendment) Bill. It is a serious statistic that half of the smoking population who continue to smoke for most of their lives will die of the addiction. We must reduce the number of people in this country who smoke. We spoke about young people but we must start with children. Believe it or not, nine and ten year old children in this country smoke.

Having graphic images on cigarette packages is a positive move which I hope will discourage children in particular from starting to smoke. Senator MacSharry spoke about it being fashionable to smoke. I know that as I have a teenage daughter. We must deal with the fact that as children reach the age of 14 or 15, they like to do what everyone else is doing. Statistics such as that to which I referred bring home the seriousness of the situation. Smoking affects one's quality of life and health and many people die from it.

Senator Moran mentioned how a picture tells a thousand words. Senators have said everything that needs to be said on this Bill. I welcome it and I hope there will be a positive reaction from the graphics on the cigarette packets. Hopefully the number of people in this country who smoke will have drastically reduced.

I thank all of Members who contributed to this debate. I listened very carefully and some important points were made. I also welcome cross-party support for this legislation and I welcome the general support for the approach taken by the Government and the health agencies to work together to reduce the incidence of smoking. Other members have referred to be ex-smokers and how they understand the difficulties involved. I am an ex-smoker but I am not off them as long as Senator MacSharry. I am getting there as it is four years this summer.

Senator Marc MacSharry

Well done.

Deputy Róisín Shortall

I am not under any illusions about the difficulty of those who have developed an addiction. It is difficult to get off them and a number of factors are in play to finally enable a person to quit. We keep our fingers crossed that one is off them for good. It is important that the tone of any campaign is not a lecturing or judgmental tone. One must set out the facts of the impact of cigarettes on our health and letting people know about the data and the extent of the risk they are taking. The law has a clear role to play in making it difficult for young people, in particular, to access cigarettes. Advertising plays an important role in the education and awareness programme. We must also ensure there is support for people in terms of being able to avail of smoking cessation programmes supported by the State. It is a multifaceted matter and members referred to the other point that must be addressed. This Bill does not pretend to be all encompassing, it is a specific item of legislation to deal with the specific issue. It was hoped that we could introduce the graphic to a limited as under the 2009 legislation but some concern was expressed at the legal situation was not entirely watertight. We are introducing this legislation in order to close a loophole. We are keen to move on that by introducing the regulation and making arrangements to require the images to be incorporated into the packets. We want to make progress as quickly as possible and I welcome the support of all members in passing this legislation speedily before the summer recess.

A number of Members raised the question of price. The point was strongly made by Senator Crown in this regard. It is important to point out that cigarette pricing controls in Ireland are definitely part of a long-running an ambitious effort to decrease smoking prevalence. Evidence shows that pricing is the key tool in assisting and supporting efforts to encourage people to stop. A study undertaken by the EU anti-smoking campaign, entitled help for a life without tobacco, showed that a 10% increase in price in high-income countries result in a 4% reduction in smokers. The efforts to keep prices high have been successful. Cigarette prices in Ireland are the highest in the world. Ireland is price, €8.65, is over one year of 50 more expensive than the next most expensive country, the UK. Our tax take per packet, €6.71, is higher than the retail price of cigarettes in all but one EU member state. There has been strong campaign and it would continue. We have been successful in spite of much opposition in maintaining cigarette prices at this high level. Notwithstanding that, the Minister has signalled his intention to seek further increases in the price of tobacco products in the forthcoming budget. I hope her cross-party support in this action. In addition to a general increase on tobacco products, the Minister has raised the possibility of introducing an environmental charge of the tobacco industry in light of the litter problem resulting from tobacco use. Hopefully that will also assist.

It is also important to talk about what is happening in respect of illicit trade. There is a major problem in this area. At my advice clinic last Saturday, I dealt with a constituent who had a social worker query. I did not believe he folded his shopping bag and put it under his arm and told me that he was going into town to buy cheap cigarettes. This is a common practice across the country in markets are on Henry Street. It is a serious problem and efforts are being made to clamp down on this. The war needs to be strengthened and maintained a high level. The quantity of cigarettes in which Judy was paid well from 4.6 billion cigarettes in 2009 to 4.1 billion cigarettes in 2010 even though there was no reduction in the prevalence of smoking. The total excess duty on tobacco products was €1.1 billion in 2010 to €1.2 billion in 2009. It must acknowledge that tobacco taxes in Ireland are the high highest in the EU. The revenue commissioners have a responsibility in this area and it is important that we keep pressure on them to tackle this problem.

According to a report published earlier this year by Japan Tobacco International, an estimated 22% to 24% of all tobacco consumed in Ireland is aided Irish tax and excise duty. This amounts to a decrease from 27% in 2009. This is the first decline since recording began in 2005. The actions are having some measure of success there is no doubt we need to continue putting pressure on that regard. I am also concerned that the extent to which, outside of illegal activity of cigarettes being smuggled in a commercial sense and sold on street in markets, there is common practice of people travelling to other European countries, particularly Eastern European countries, and coming back with bags of cigarettes are a distribution in various states. That is prevalent and must be addressed.

I wish to respond to the point made by Senator MacSharry in respect of the office of tobacco control. The public health tobacco memo amendments act of 2010 provided for the merger of the office of tobacco control in HSE with effect from one January 2011. The functions of the office transferred to the HSE and those functions include the maintenance of the tobacco retail register, advice to the Minister on control and regulation of tobacco products, consultation with national and international bodies in the field of smoking prevention, making recommendations to the Minister on measures to reduce or eliminate smoking, supporting research to identify measures to reduce the incidence of smoking and preparing and publishing research. That work continues and there is no let-up. A separate national office for tobacco control has been set up in the HSE.

Senator Burke referred to putting the details of the quitline on the packet. That is included on one of the images. Perhaps it should be more widely available and I take the point in that regard. We will examine the matter.

A number of other points were made in regard to the SPHE programme, including by Senator Moran. I have no doubt that the messages young people receive can be greatly strengthened through that programme and I undertake to look at it in order to see what can be done in that regard.

On health promotion in general, including the issue of smoking, much more could be done within the schools where, clearly, there is a captive audience. I am conscious that teachers will say they have been loaded with many additional responsibilities. However, I would like to move towards the idea of the health promoting school and much could be done in regard to diet, exercise and healthy lifestyle habits in general. Smoking and use of alcohol and illicit drugs would also come under that heading. Perhaps in the same way we have the five green flags promoting environmental consciousness and responsibility we should have a sixth flag concerned with establishing the status of the health promoting school. I would like to do more work in that area.

Senator Crown made a very important point about making people aware of the need for smokers to quit smoking at the earliest possible stage. Many of us have fooled ourselves into thinking we could get away with it for a certain length of time but very often it is not until people are in middle age that they start to realise they want to live into their 70s, 80s and 90s and concentrate their minds on the matter at that point. Many people think they can get through until they are in their 40s. That is a very important message we must get across, one that is probably not made often enough to people. We must look at ways of incorporating it into the general messages we need to put out in respect of smoking.

It is a matter of serious concern that, in spite of the fact that we were world leaders with the smoking ban and are also leading it in respect of legislation, we are still not reducing our smoking rates which have been stuck at 29% for a long time. We must be more proactive in terms of discouraging people from getting started in the first place and must provide very clear messages about the damage that is done and support people to quit smoking. The images this legislation provides for certainly are very stark — they have been circulated to Members in colour. If one flicks through them they make one wince, which is the point. We want to move as soon as possible to bring about a situation where it will be mandatory for tobacco companies to display these images. We hope they will do the job intended and there is every possibility they will.

I thank everybody for their support and for facilitating the session today. We shall return next week with the remaining Stages and I look forward to dealing with the legislation, getting it out of the way and up and running as soon as possible.

Question put and agreed to.

Sitting suspended at 1.05 p.m. and resumed at 2.45 p.m.