Táim sásta a bheith anseo inniu chun tús a chur leis na hóráidí seo a bhaineann leis an gcosc a chuireadh le tobac 20 bliain ó shin. I am very pleased to be here to reflect on the 20th anniversary of the prohibition on smoking in the workplace, one of the most significant and memorable days in my own public life. For the past two decades, since 29 March 2004, we have become accustomed to breathing in fresh air indoors. It is almost impossible for anyone who came to adulthood after that point to comprehend that before that day, people were exposed to second-hand smoke and to the risks of lung cancer, respiratory disease, heart disease and much more on a daily basis just going to work.
I clearly remember the day in December 2002 when a scientific review entitled Report on the Health Effects of Environmental Tobacco Smoke in the Workplace landed on my desk. The report was unequivocal in its findings that passive smoking causes cancer. That underlined the importance of evidence-based research. A peer review group, chaired by Professor Allwright, was commissioned by the Office of Tobacco Control, which was then headed by the late Tom Power, who had been principal officer in the Department of Health. He was a key civil servant involved in shaping and guiding the whole approach to tobacco generally. He was a good confidante of mine and a person for whom I have always had the greatest respect. That report and the research relating to it immediately posed a moral question for me to which there was only one answer: things had to change. If this had been asbestos in the workplace, for example, there would have been no question over what we would or should do. Therefore, weeks later, in January of 2003, I announced that we would be introducing a workplace smoking ban the following year.
It is easy enough perhaps to forget how controversial and, indeed, unimaginable the measure was. That decision then sparked ferocious debate over the following 12 months in what was, and this is an important point, a real national debate on public health. The idea of a ban on smoking captivated the people. It took up hours of airtime on “The Late Late Show”, “Liveline” and all the current affairs programmes. In newspapers, columnists questioned whether Ireland was becoming a nanny state - we have heard that again in recent times - and if we were going too far. Many business owners, particularly publicans, were fearful of such change and the impact it could have on their livelihoods. The Irish hospitality industry alliance warned that the ban would cost 65,000 jobs. In the face of intense backlash, doctors, health professionals and a variety of health organisations, including the Asthma Society of Ireland, Irish Heart Foundation and Irish Cancer Society, all stood up to ensure their perspectives and expert opinions were heard and counted on in the debate. To this day, I am very grateful to them for their courage and resolution.
While we intended to introduce the ban in January 2004, it was delayed by three months on foot of European legislation that enables member states that feel it might interfere with the Single Market to object to it. I can recall the editorials giving me an awful time when we announced we were delaying it until March of 2004. In hindsight, however, it was a blessing in disguise because the weather was far better by March for people who now had to smoke outdoors. When we look back on it, 1 a.m. on New Year's Day would maybe not have been the best time for someone to adjust to a law like this. In the days and weeks before the smoking ban came into effect, my anxieties and the anxiety levels of officials were very high.
What would we do if, for example, there was mass non-compliance? I recall health officials in New York saying to us that if they had their time again, they would have worried less about that because people really wanted this kind of legislation. We were also concerned as to whether the ever powerful tobacco industry would challenge the ban legally. When we learned the industry had retained the four big legal firms in Dublin, we took in some senior counsel to go through what we were doing with a fine-tooth comb. They worked with the then Attorney General, the late Rory Brady, who gave fantastic support in anticipating any loopholes there might be.
I will never forget the morning of 29 March 2004. "The Gerry Ryan Show" sent an undercover reporter to a late pub in Dublin, which we used to call dockers' pubs, to test the ban early in the morning. When she took out a cigarette and went to light it up in front of the barman, she was told to cease and put the cigarette away. A huge cheer went up throughout the then Department of Health and Children when we heard that report. It gave us a sense we were out the gap, so to speak.
Since then, we have continued to push ahead with tobacco control measures. We have done this simply because there is nothing good about smoking. It is addictive. It is lethal. I have yet to meet a smoker who is glad that he or she started smoking. Some of the research at the time was very telling. Whether people smoked five or ten cigarettes a day, they all supported the ban. When we asked why, they said it was because they felt it would help them to give up the habit. That is an important point. It is worth reminding ourselves that today, in 2024, the evidence is even clearer that there is no risk-free level of exposure to second-hand smoke. That is why proposals for smoking areas or smoking rooms in premises, which were pushed heavily at the time by the tobacco industry, could never be an acceptable alternative to, or mitigation of, an outright ban.
Second-hand smoke is simply awful in every respect. It causes lung cancer in those who have never smoked. In addition to causing cancers, exposure to tobacco smoke enables tumours to grow because many of the more than 7,000 chemicals in cigarettes discourage the body's normal reactions to fight the growth of abnormal cells. We also now know that exposure to tobacco smoke can decrease the benefits of chemotherapy and other cancer treatments. Second-hand smoke, or environmental tobacco smoke, is also a cause of coronary heart disease. Low levels of exposure can lead to the damage to the lining of blood vessels that is implicated in strokes and heart attacks. For strokes, the estimated increased risk from exposure to second-hand smoke is between 20% and 30%. Since the introduction of the ban, we have learned more about the damage from second-hand smoke. We now know there is a causal relationship between maternal exposure to second-hand smoke during pregnancy and a reduction in the birth weight of babies. We know children who breathe second-hand smoke are at risk of having a lower level of lung function during childhood and can suffer from bronchitis, pneumonia and ear infections. For children with asthma, breathing second-hand smoke can trigger an attack of such seriousness as to require hospitalisation.
These are difficult issues to consider and discuss but we cannot shy away from them. Tobacco smoking causes catastrophic damage to smokers and those around them. That is why radical interventions like the indoor workplace ban are not only justified but absolutely necessary to protect personal and public health. If we want a country in which all of our population has the right to good health, we must continue in our efforts to eliminate tobacco smoking. We have the evidence that the ban worked. After its introduction, studies found significant reductions in air pollution in pubs and related improvements in the respiratory health of workers. There were reductions in the number of emergency admissions due to respiratory illness and in hospital admissions due to cardiopulmonary disease. A 2005 study that examined the effect of the workplace ban on second-hand exposure in 42 Dublin bars and among bar workers found an 83% reduction in air pollution in bars. More significantly, it found an 80% decrease in the quantity of airborne carcinogens to which staff and customers were exposed on a daily basis.
Research published just over a decade ago found that by 2013 the smoking ban resulted in 3,726 fewer smoking-related deaths than would have been expected if it had not been introduced. That study also found the smoking ban was associated with a number of immediate reductions in ill health in the general population. It found an immediate 13% decrease in all-cause mortality and a 26% reduction in ischaemic heart disease. It also found a 32% reduction in stroke and a 38% reduction in chronic obstructive pulmonary disease, COPD. Regarding lung cancer specifically, a 2019 analysis found the workplace smoking ban had caused decreases in cancer incidence and mortality in Ireland and was associated with an estimated 32 fewer lung cancer incident cases per year and 113 fewer lung cancer deaths per year.
Along with these improvements in health outcomes, we know the ban impacted on smoking rates. A 2020 analysis found its introduction reduced girls' smoking prevalence by an estimated 7.3% and boys' prevalence by approximately 5%. We have made much progress on smoking prevalence since the workplace ban. Our adult smoking rate, which was 27% in 2002, is now 18%. The smoking rate for children was 19% in 2002, compared with the current rate of 5%. That progress is not incidental but we need to keep the pressure on in respect of children and young people. We made that progress because successive Governments built on the success of the workplace ban with the consistent introduction of additional tobacco control interventions to drive down our smoking rate. Part of that involved our international role with the World Health Organization, including working with it in on ratification of the WHO Framework Convention on Tobacco Control, FCTC. The officials in the then Department of Health and Children played a significant role, with their colleagues in the Department of Foreign Affairs, in putting a very progressive convention in place in 2005. This represented a national public commitment to action the measures set out in the convention in order to eliminate what WHO calls the worldwide tobacco epidemic. We have been and continue to be very active parties to the convention.
In 2007, we introduced a prohibition on the sale of cigarette packets containing fewer than 20 cigarettes. The way children got hooked by the tobacco industry long ago was by being able to buy two or three fags over the counter, then moving on to the ten-pack and so forth. Eliminating all of that and increasing the tax on cigarettes helped to denormalise smoking among children and young people.
In 2009, the ban on the display and advertising of cigarettes at the point of sale in retail outlets was, eventually, introduced, having been provided for in the Public Health (Tobacco) Bill 2002. The purpose of the ban was to make clear to people that cigarettes are not an ordinary consumer product and should not be displayed in the same way as other items. Other products do not kill one of out every two of their users. In the same year, we also introduced a requirement that all tobacco products must be stored within a closed container that can only be accessed by the retailer.
In 2010, the HSE introduced its tobacco control framework, which led to the development of its award-winning Quit advertising campaign. The tobacco control framework underlines the importance of smoking cessation services. It is generally understood that nicotine is as addictive as, if not more addictive than, heroin. It is extremely important that we support people who wish to quit. It is not easy to quit tobacco and nicotine. The work being carried out in this area currently by the HSE's tobacco-free Ireland programme is critical. I pay tribute to those involved.
On reflection, one of the most important actions we took back in the period we are discussing was to establish the Office of Tobacco Control. It gave a focus to the issue and a specialised resource of personnel who could commission all the research, organise the campaigns and so on. There are people who think there are too many agencies, with the usual calls from some political parties for a cull of quangos. "Quango" is the one word I hate in terms of public policy. I know from my own experience that all such organisations, whether the Office of Tobacco Control or the Crisis Pregnancy Agency, did very focused and important work in their day. I do not mean any slight to the then Department of Health and Children, which introduced the legislation to implement the smoking ban, in saying that if the Office of Tobacco Control had not been established outside the Department, we might not have achieved the central focus on the issue to drive it home. We should always reflect on the fact that if we have specific targets we want to attain in society, measures like that are important. All the measures I have outlined flowed from that legislation and from the work of the Office of Tobacco Control, which was headed up at the time by Tom Power.
In 2011, we introduced graphic health warnings on tobacco packaging. Again, this was very important in terms of how the product is presented to the public. The tobacco-free Ireland policy and framework include 60 recommended actions to create a tobacco-free society. The objectives of the policy are to denormalise tobacco within society. The action plan was published in 2015 and included more specific actions.
We have to ensure momentum is not lost here and that we report annually on the outcomes of the action plan.
An important measure was introduced in 2016, namely the banning of smoking in cars when children are present. No level of exposure to second-hand smoke is safe, and exposure is particularly harmful in closed places such as cars, particularly given the combination of chemicals in addition to nicotine. Children's exposure to second-hand smoke in cars is voluntary. They are unable to remove themselves from risk if people smoke around them, and that is why this legislation was an important element of our commitment to the protection of children.
We have transposed the EU tobacco products directive into Irish law. Many of the associated measures were ones that we had already implemented or gone beyond. We will continue to work at EU level and internationally to keep up the battle against tobacco.
Plain packaging was another welcome initiative. The aim was basically to eliminate all forms of branding. Trademarks, logos, colours and graphics have been removed from tobacco packs. The various brand names must be presented in a uniform typeface and the packs must all be in one plain, neutral colour.
I caution the House that in the battle against nicotine and tobacco, we face an endlessly, relentlessly, ruthlessly determined and creative opponent, an industry that never stops in its effort to capture and ensnare new users, particularly children and other young people. I mentioned earlier the deadly addictiveness of nicotine. In his landmark contribution to the US television show "60 Minutes" in 1995, tobacco industry whistleblower Jeffrey Wigand exposed the truth of the industry's core strategy and business model. He said, “We are in the nicotine delivery business.” Over the years, as we have made the progress I have just talked about in the fight against cigarettes and tobacco, the industry has gradually shifted its tactics but its strategy remains the same – the nicotine delivery business.
This brings me to what I believe may be one of the industry's most insidious initiatives in a very long time, the proliferation of vaping products. Again, the same playbook is in operation. The industry is using many of the marketing techniques used for cigarettes in the earlier days, from the emphasis on flavour and celebrity endorsement to unsubstantiated claims about safety and relative health benefits. The explosion of these products into our schools and society in general and onto our streets is a matter of great concern to me. We need to be every bit as aggressive in our response to the latest incarnation as we continue to be in our battle against tobacco more generally. In that context, our most recent tobacco control legislation, the Public Health (Tobacco Products and Nicotine Inhaling Products) Act, was enacted last year. That Act contains a range of measures tackling nicotine inhaling products, such as e-cigarettes. There are three major objectives: to introduce strict licensing and regulation of the retailing of tobacco products and nicotine inhaling products; to introduce new restrictions on the sale of both types of product and restrictions on the advertising of nicotine inhaling products; and to provides additional enforcement powers to the national environmental health service, the enforcement authority for tobacco-control law.
The current position on licensing is that a retailer who wishes to sell tobacco in one or more premises needs to register once and pay a single fee of €50. The new provisions in the Act mean an annual licence will be required for each premises through which products are sold. Licences will not be issued for temporary or mobile premises, so pop-up shops at festivals, for example, cannot sell these products. Minimum periods of suspension of licences will apply on conviction for certain tobacco control offences, and licences will be revoked if the licensee commits two or more serious offences.
Our Act will also introduce sales restrictions for tobacco products and nicotine inhaling products. The sale of both types of product by a retail worker who is a minor will be restricted and their sale by self-service – for example, through self-service vending machines – will be prohibited. We will continue to prioritise the protection of children in this Act. We have already introduced a prohibition on the sale of tobacco products and nicotine inhaling products at events for children. More powers will be given to the national environmental health service in terms of the Act and new tools concerning compliance.
The Act is good. It is a necessary start in this new phase but I wish to make it clear that it is not enough and that we need to do more. Consultation is ongoing on the introduction of much more restrictive laws on flavouring and packaging. As far as I am concerned, this cannot happen soon enough. I am crystal clear in my view of what the industry is doing: it is trying to seed new generations of people with lifelong nicotine addictions. I am very clear in my view on what needs to be done to stop it. We have achieved much with the workplace smoking ban and have done much more since, and we are planning more for the future. I am grateful and honoured to have been able to play my part in the journey to this point, but my primary focus now is on what still needs to be done. The nicotine delivery business never rests, and neither will we or should we.
