The next matter is a discussion with the Irish Cancer Society on the issue of the increase in cigarette prices in the forthcoming budget. I welcome Mr. John McCormack, chief executive, Ms Norma Cronin, health promotion manager — tobacco control, and Ms Jean Curtin from the communications section. I invite Mr. McCormack to make a presentation. I advise the delegates that some of our members are in the Dáil for the Order of Business and the motion following it. They will join us shortly.
Irish Cancer Society: Presentation.
I thank the committee for the opportunity to make this presentation. The Irish Cancer Society is the national charity for cancer care in Ireland. We are dedicated to preventing cancer, saving lives from cancer and improving the quality of life for the many people in Ireland who live with cancer. We do that work through research, education, patient care, health promotion and cancer prevention.
The National Cancer Registry estimates that in 2006, 22,500 new cases of cancer will be diagnosed in Ireland and 7,800, just under 8,000, will die from cancer. That means that one in three of us will develop cancer during the course of our lifetime and, sadly, one in four of us will die from cancer.
The most common cancers in Ireland are breast, lung, prostate, bowel and skin cancer in its two different forms, melanoma and non-melanoma skin cancer. While many people in Ireland have cancer, many more will develop cancer in future. We are facing a cancer epidemic in Ireland largely due to our ageing population. While there are 22,500 cancer cases, that number will be closer to 43,000 by 2020, which is only 14 years hence. That is due to our increasing ageing population and a neglect in lifestyle behaviours and, in particular, tobacco smoking. That is the issue we especially want to discuss with the committee. I will hand over to our health promotion manager — tobacco control, Ms Norma Cronin.
Ms Norma Cronin
I thank the committee for inviting us to appear before it. Mr. McCormack highlighted the number of cancer cases diagnosed every year and the number of deaths resulting from cancer. I will deal with the burden of smoking, which is the single largest cause of preventable ill health and premature death in Ireland. It causes 30% of all cancers. Therefore, we estimate that one third of cancer cases are directly caused by tobacco smoking. Smokers lose on average ten to 15 years of potential life. There is not only the issue of the deaths associated with cancer, there are premature deaths related to cancer and the morbidity associated with it, which accounts for a poor lifestyle and quality of life.
As to what makes tobacco smoking so dangerous, if we consider why tobacco smoking causes these cancers or why it is responsible for 30% of all cancers, there are 60 known cancer-causing substances in tobacco. It contains 4,000 chemicals. Of those, there is nicotine, which is not the most dangerous substance in tobacco, tar, which is the cancer causing substance, and carbon monoxide, which is the poisonous gas emitted from the exhaust fumes of cars, of which there is a high proportion to found among smokers and that increases the risk of heart disease especially. Other chemicals in tobacco include toluene, ammonia, arsenic, DDT, acetone and methanol, which are only a few of the 4,000 chemicals to be found in tobacco.
I will deal with other forms of cancers in addition to the common cancers that people normally associate with smoking. It is known that lung cancer is directly linked to smoking, and smoking causes 95% of lung cancers. In addition to lung cancer, smoking is associated with cancer of the mouth, larynx, which is the voice box, throat, oesophagus and cervix which is strongly linked to smoking. Smoking is also a proven cause of bladder cancer and is also associated with cancer of the pancreas.
Other illnesses linked to smoking that are unrelated to cancer include chronic obstructive pulmonary disease, symptoms of which are bronchitis and emphysema, which is disabling and causes considerable morbidity. Coronary heart disease and strokes are strongly related to smoking. Peripheral vascular disease, with which some members might be familiar, which affects circulation, is directly related to smoking and in some incidents people suffering from it have had to have amputations. I am sure members are aware that women who smoke during pregnancy have an increased risk of having a premature birth among other complications. Smoking during pregnancy is also linked to sudden infant death syndrome. Lung cancer is the leading cause of cancer deaths in Ireland and accounts for more than 1,500 deaths each year. Some 95% of lung cancers are caused directly by smoking.
As to what works in regard to tobacco control, we have considered this on a national level. The World Health Organisation has identified a number of strategies that work in terms of comprehensive tobacco control interventions. We introduced legislation banning smoking, and in that respect Ireland has been a world leader. We have made great progress on that front and other countries are following our example. That legislation has been successful and there is a high compliance rate. Another intervention is comprehensive bans on advertising and promotion of all tobacco products. Ireland has been successful in banning all tobacco promotion and advertising.
Another intervention is the making available of consumer information and public awareness campaigns, and we are doing well in our campaigns. From the point of view of the Irish Cancer Society, we need continued funding as part of a comprehensive programme to ensure we have ongoing campaigns to increase awareness of the smoking related cancers and other diseases associated with tobacco, and also to help people to quit smoking.
With regard to direct health warning labels on cigarette boxes and other tobacco products, we do not yet have the large warnings such as those used in Canada, which have been proven to work very effectively in encouraging smokers to quit smoking and in highlighting some of the other health issues related to tobacco. In Canada, for example, the packets carry good warnings about oral cancer. This has been shown to be effective. The quitline telephone number is also on the packet and it encourages people to pick up the telephone and seek support in quitting.
What about treatment to help dependent smokers stop? Again, Ireland is doing well. There is the National Smokers Quitline which requires ongoing funding. We must ensure that funding continues to be provided to support smokers and to highlight the support available, be it in the community or the HSE, and to refer people further from the National Smokers Quitline. Nicotine replacement therapy is available to medical card holders, which was a good step forward. It should be more widely available because it is proven to double people's chances of success in quitting. It is an important therapy that must be considered in the future.
The main reason we are attending the meeting this morning is to discuss price increases through higher taxes on cigarettes and other tobacco products. Ireland has done well in the areas I have mentioned but it is failing in one area. A scientific paper was published this year regarding a new scale to measure a country's activity. Ireland came out tops in everything apart from price, where it did very poorly. That was because there has not been an increase in tobacco taxes for the last few budgets. How does that have an impact? The key message from the National Cancer Forum's report, A Strategy for Cancer Control in Ireland, was that tobacco accounts for one third of all cancer cases and that the single most effective measure against smoking is a sharp price increase.
That is the message we bring from the Irish Cancer Society. How would it affect prevalence? Members have a copy of our submission. The chart for smoking prevalence in Ireland shows that there was a decrease in 2004. That was the impact of the smoke free legislation and a multimedia campaign. However, smoking prevalence is increasing. Adult smoking prevalence is just under 25%. There has been a decline but members will see from the chart that there has been an increase in smoking prevalence among women, that is of major concern. The larger chart shows that increase.
This is very important. We know that lung cancer is preventable in 95% of cases if women did not smoke. More than 500 women die in Ireland every year from lung cancer. In other countries, for example, the US and Scotland, deaths from lung cancer in women have surpassed the number of deaths from breast cancer, and that will happen in Ireland. That is a preventable cancer and if we addressed smoking prevalence and the issues I have outlined, we could reduce the number of deaths.
Of even greater concern is smoking among the younger population. The next chart shows that smoking prevalence among 15 to 18 year olds and 19 to 35 year olds is on the increase. Research has shown that young people starting to smoke are particularly susceptible to price disincentives. If price can encourage delay in the onset of experimentation with smoking among many young people, there will be a clear reduction in the number of young people taking up smoking. It is a concern that there has not been a decline but an increase in the incidence of smoking among younger people. The earlier younger people start smoking, the greater their risk of developing ill health in later life, particularly cancer. There was an upward trend for 19 to 35 year olds during the past 12 months.
What about the impact of tobacco taxation? According to the World Bank, price increases are the most effective, including cost effective, tobacco control measures, especially for young people and others on low income who are highly price sensitive. It estimates, and figures from studies internationally show, that a price rise of 10% decreases consumption by approximately 4%. The taxation of tobacco products has a unique role to play in the development of a Government price policy aimed at discouraging consumption.
When the price of tobacco increases there are three main effects. There is a reduction in consumption, particularly among young people and lower income groups. Reduction in consumption has the consequent result of lowering the burden on illness in the population in the medium and long term and a relative increase in Government revenue due to the effects of elasticity of demand.
Increasing tobacco taxation could reflect potential health benefits for the population. The Irish Cancer Society believes there is an opportunity in budget 2007 to significantly increase the price of tobacco products, especially as there has been no price increase in recent budgets. The measure we request in the budget is a price increase to make the cost of smoking prohibitive, especially for young people and low income groups. We propose that the price of a packet of cigarettes be increased by at least €2. The evidence shows that only a significant increase in price is likely to be effective in reducing consumption of cigarettes, thus reducing the up-take of smoking among young people. A significant increase of €2 is needed.
What will the benefits be to the State? Apart from the health benefits, which are very important, the benefits to the State are immense both in terms of improvement of the nation's health and increased revenue. Progressive financial disincentives are crucial in the fight against tobacco.
Mr. John McCormack will talk about the consumer price index and its importance in this context.
We have been seeking an increase in the price of cigarettes in the last two budgets. Arguments put forward against increasing the price of cigarettes largely revolve around the effect it will have on the consumer price index. Tobacco is an element in that index. The consumer price index measures monthly changes in the cost of purchasing a fixed representative basket of consumer goods and services that consumers would typically purchase or consume. Over 1,000 items are included in the make-up of the CPI. It reflects consumption by all private households and by foreign tourists on holiday in Ireland.
Each item in the CPI is given an expenditure weight to reflect its share in total consumer expenditure, based on the household budget survey. The greater the level of expenditure on an item or group of items, the greater its weight in the overall consumer basket. If tax is increased on tobacco the result affects inflation for only one year until the anniversary of the increase. Making a once-off significant increase in the price of cigarettes will not have an inflationary effect in two or three years. In other words, it would be a comparison between January 2006 and January 2005. Depending on the time of the tax increases there might be no effect on inflation. If fuel prices fall at the same time, for example, they will not have any effect.
The EU has already recommended that member states exclude tobacco products from their respective consumer price indexes to ensure they do not have an inflationary effect. Luxembourg, France and Belgium have a CPI which does not include tobacco products. In France it is illegal to have a consumer price index with tobacco included. Indexing in France is regulated by a special law, the Neiertz law, which bans linkages to indexes that include tobacco. That law has been in place since 1991. The authorities in France increased the price of cigarettes over a two-year period by 45% and it resulted in 1.8 million fewer smokers. Belgium also uses a sub-index for specific purposes, such as wage negotiations.
That is the classic conundrum in Ireland because the consumer price index feeds into wage negotiations and national agreements. Ireland has been very successful in using national wage agreements to improve its general economic outlook. As part of the next national agreement — the one we are currently involved in is a 27-month project — we need to negotiate on a basis whereby future pay rises will be worked out based on an index that excludes tobacco. That is really important. We are constantly being told that the Government cannot increase excise duties because of inflation. Whereas the Government has the ability to increase excise duty on cigarettes, it also has the power to reduce tax on other items, such as unleaded petrol or diesel. The Central Statistics Office can demonstrate that the inflationary effect of a €1.50 increase in the price of 20 cigarettes can be offset by a 32 cent reduction in tax on a litre of unleaded petrol or diesel. There is an ideal opportunity for the Government to increase the price of cigarettes in the budget and also give people a break by reducing the price of unleaded petrol and diesel.
We urge the Minister to use the power of the Government to make an important pro-health change in behaviour through increasing the price of cigarettes in budget 2007. Essentially, we are here today on behalf of the people of Ireland who suffer as a result of tobacco. Every day at the Irish Cancer Society, I get letters about people who are dying or have died from lung cancer. People write to the Irish Cancer Society looking for €300 to pay for counselling for teenagers who have been left behind. All these deaths are wholly preventable because they are all tobacco-related. Our plea to the joint committee is to support our case for a €2 price hike on a packet of 20 cigarettes in the forthcoming budget. The Chairman has made representations on our behalf to the Minister, Deputy Cowen, and hopes to grant us an opportunity to meet the Minister also. We would welcome that opportunity.
I apologise that there is a low turnout for this presentation but we must make it clear why that has happened. Some Deputies have to be in the Dáil Chamber, while others are holding regular meetings with outside groups, such as the Irish Cancer Society, not in committees but in other meeting rooms. Some Deputies are dealing with policy issues and many are also dealing with priority issues for their constituents. We are getting closer to the general election and I assure Mr. McCormack that Deputies do not get elected for contributions they make in the Dáil Chamber. Unfortunately, when it comes to their work on this or other committees, even though the contributions that are made here are extremely valuable, they have no impact on our re-election chances. Sadly, when we get to this stage, one sees people tailing off from the type of long meetings which take up most of the morning.
Mr. McCormack said that 95% of the 1,500 annual lung cancer deaths are caused by smoking. Is that correct?
Yes.
That slightly contradicts what I heard on "Morning Ireland" today where it was stated that 200 lung cancer deaths per year are caused by radon gas.
Ms Cronin
That is an estimate. We have a reference to that from the cancer registry. It shows that of those who developed lung cancer, 178 were smokers as well as having been exposed to radon gas. Therefore, as regards the true effect, it is estimated that of that number, some 17 were non-smokers. The majority of them were smokers, so there would be a combination of the radon and smoking factors.
Would radon act in the same way as asbestos acted in times gone by? In other words, it is a factor that would almost guarantee that one would contract lung cancer if one is exposed to high levels of radon and is a smoker as well?
Ms Cronin
Exactly. It is a combination, so the risk to smokers who are exposed to radon is far greater than for non-smokers.
The submission focused a lot on price increases but it also showed the increased prevalence of smoking is occurring among younger people, both men and women. Older people seem to have stopped smoking, which happens anyway. That seems to be the case, however, and it is where the problem is recurring. Would the witnesses say that, in some respects, the smoking ban has contributed to this? Perhaps we have all taken our foot off the pedal following the smoking ban, giving ourselves a clap on the back about how great we are. Perhaps we have dropped the ball concerning other aspects of health promotion that have been going on the past 40 years to try to get people to stop smoking. It is not price sensitivity alone, but also the fact that we have stopped putting an emphasis on many of the other things we have done in past years to get people to stop smoking.
Ms Cronin
That is an important point. There is complacency among the general public as regards general services that should be made more readily available. I am not saying that is the case for us working in the Irish Cancer Society, however. A combination of factors support smokers in quitting or prevent people from starting in the first place. Price is a very important factor, although we cannot get away from some of the other factors in place that contribute to effective tobacco control policies.
Price increases constitute an important factor but we also need to offer more support for smokers who wish to quit. We have the National Smokers Quitline and we had a multimedia campaign in the lead-up to the smoke-free at work legislation, commonly called "the ban". That went on for six months but funding was not continued. Sustained campaigns are required for successful health promotion or to assist people to change their behaviour. A number of those factors are involved.
The most effective way to deal with young people smoking is price. Our young people are completely inured to health messages. Young people start smoking at a time when they think they will never die.
Yes.
It has been shown that price is the most effective way to get to our young people — our 15 to 18 year olds and most of our 19 to 35 year olds. In the past two years, young people's disposable income has increased, along with everyone else's disposable income in an Ireland of low taxes. What has not increased is the price of cigarettes. Ironically, the price of cigarettes is probably the only thing in the consumer price index that has not increased in the past two years.
Ms Cronin
Yes.
If anything, it is beginning to work against us. In other words, inflation in Ireland has been kept artificially low because it contains this item called cigarettes, the price of which has not increased in the past two years. It is crucial to increase the price of cigarettes because our young people are smoking more and more as they have so much money to do so.
The concern always was that because this is an addictive product there is no sense in doing anything with the price — in other words, it confounds the laws of economics. However, research by the World Bank and a person called Toluca in the US, who has done a lot of work on this issue, has shown that price increases still work, despite the fact that tobacco is an addictive substance. A 10% increase in the price of cigarettes will lower consumption by 4%. Our plea to the Government this year is to do that. It should set aside important issues, although inflation is an important issue, and examine ways to negate and reduce other items in the basket to reduce the inflationary effects. Those issues should be set aside. We are fighting lung cancer whereas the Government is fighting inflation, but it needs to examine the real concern about lung cancer in Ireland and the resurgence of smoking among young people.
I understand where Mr. McCormack is coming from on this matter. I fully supported the smoking ban and the Irish Cancer Society strongly supported it also. Believe it or not, however, there can be a certain backlash in the community because of it. I felt it after the smoking ban was introduced. It struck me during the presentation, which referred to making smoking prohibitive, especially for young people in low-income groups. Politically, there could be quite a strong backlash because there might be a sense of triumphalism when we do not put price with health promotion in getting that message out. The last thing young people need is to be lectured to.
Ms Cronin
That is true.
They are the ones who will cause the backlash. There is a positive aspect of focusing the health promotion campaign on this point. When we were 15 or 16 we all thought we were never going to die, or if we were, we wanted to die doing something spectacular. One reaches a point in one's life, however, when one realises that one is not so invincible after all. Perhaps the delayed effect of health promotion in former years could reactivate itself. That is why we should ensure the two go together so that we are always winning people's hearts and minds.
Ms Cronin
I agree we need effective programmes in our schools to ensure that young people possess the assertive skills to refuse the peer influence on tobacco and to make informed choices. Young people under estimate the addictive nature of tobacco and Deputy Twomey is correct that it is important for us to have that knowledge brought into the schools and to younger people. Due to the fact that they underestimate it, young people think they will start and never become addicted, but anyone who ever smoked knows that tobacco is very addictive. Nicotine reaches the brain in seven seconds. It is a faster delivery system than most other drugs. Unfortunately, young people start and think they will quit when they are 18 or 20, and then the other pressures continue. We will work towards ensuring that the SPHE will include a module on tobacco and that there are community based programmes to prevent people starting and obviously to support people in quitting as well.
The Irish Cancer Society might send a submission to the committee on the price comparisons between different countries because one of the arguments against increasing taxes and making cigarettes too expensive is that it would only encourage smuggling and other illegal activities.
We will do that. We dealt with that in our larger budget submission. The experts show that a price increase is still effective. The figures I quoted of a 10% increase in the price results in a 4% reduction in consumption show it is still effective, despite the danger of smuggling.
Twenty cigarettes cost approximately €6 and we hope the price will be increased to €8, which is what they cost in Norway. Whereas a €2 increase would put Ireland at the high end of the European average cost of cigarettes, it is not an outrageous price and we believe they should be even more expensive.
Perhaps it would be better to make a comparison with the UK, our near neighbours, where the difference would be important.
Ms Cronin
Tobacco costs much more in the UK than in Ireland.
Twenty cigarettes in the UK cost approximately £6.
Ms Cronin
Yes. If we increased the price by €2, we would be on a par with the UK. Cigarettes are more expensive in the UK.
I welcome the delegation and also apologise for the small attendance — Deputy Twomey outlined some of the reasons for it.
The delegation's submission states that smoking prevalence is now increasing. Does that apply across all cigarette sales or specifically among the groups mentioned such as young people? If one compares total cigarette consumption in Ireland this year with that of two years ago, has consumption risen or fallen?
Consumption fell after the ban but is on its way back up again.
I noted from the delegation's graphs on subgroups that while there was a rise until April last, it looks like there was a downward trend in May and June in all three graphs which is most pronounced in those between the ages of 19 to 35 who smoke. Is there a particular reason for that?
There is not. We are not familiar with any particular reason for that. We are discussing the overall trend here. I agree there are monthly trends at different times. These graphs are produced by the Office of Tobacco Control. It is hard to know how useful they are to try to explain a trend from one month to another. Our case today is on overall consumption.
While I accept that, I note that there was an upward trend from April 2005 until April 2006 but it would appear that from April 2006 there may have been a downward trend. I wondered whether there was any explanation.
No.
The kernel of the problem with their presentation on a price increase is the CPI. I note that in France and other countries tobacco products are taken out of the CPI. I would strongly suggest that in speaking to the Minister for Finance the Irish Cancer Society must stress that angle. While the Minister for Finance would be sympathetic to the proposal from the Irish Cancer Society and this committee, unfortunately, the effects of a tobacco price increase on inflation cannot be ignored. If countries such as France and Belgium place tobacco outside the CPI, that should be highlighted.
We will take that on board. I thank Deputy Devins for that helpful advice.
My apologies for being late. I had to attend the Order of Business.
We understand.
I support the Irish Cancer Society's proposal. It makes complete sense. We know from all of the research that raising the price has an effect.
Does the delegation believe the tax collected should be hypothecated, in other words, ring-fenced and used for certain issues which the Irish Cancer Society has dealt with here such as research, professional education, patient care and health promotion? It would be better if the person knew the tax was going towards something beneficial and was being used to help more people give up cigarettes. There is a telephone line to encourage people to give up cigarettes and that is a helpful initiative. The plastic bag tax is the only example of a hypothecated tax. The Department of Finance does not normally opt for hypothecation and is against it. Would Ms Cronin agree that such a move would be a step in the right direction?
Ms Cronin
Yes. We discussed that among ourselves just before we came in here. It would be good to earmark some of those tobacco taxes for health promotion interventions, and particularly to compensate the poorer smokers or those who encounter more difficulty in quitting, so that there would be more community based services and a great deal of resources put in to increase access of the higher percentage groups of smokers, which are the lower socio-economic groups. While we did not provide such a graph, obviously a much higher percentage of smokers are in the lower socio-economic groups. That was done in the UK as a once-off provision. Quite a large amount from the tobacco taxes was earmarked and used as a health promotion strategy.
Deputy Gormley is correct. There is approximately €1.5 billion collected from tobacco taxes in Ireland. This relates to the point about inflation. If the Government was serious about helping us, imaginative ways would be found to reduce inflation in other areas such as transport. For example, in lower socio-economic areas it should be free to use the Luas, in other words, when one goes to the station in a lower socio-economic area it should be free to get on the Luas. The reason I say so is that when the Minister increases the tax on cigarettes in the budget, sadly, those people will be affected even more. Cancer is about inequalities. There are parts of Ireland where the Irish Cancer Society is working where there is a smoking prevalence of 60% and there is a smoker in eight out of ten homes. We would support such a measure in lower socio-economic areas and that then would off-set the inflation effects. Even though tobacco needs to be taken out of the CPI, the Government, if it was truly serious about helping us, could find a way to reduce the inflation effects and fight lung cancer.
The Irish Cancer Society made the point in its pre-budget submission that smoking is the leading preventable cause of cancer. We take that as a given and the society's report goes on to show that. From the presentation today and from having met the delegation some time ago, I take it that the Irish Cancer Society feels it will be fighting with its hands tied behind its back unless there is an increase in cigarette prices. That is a given. Without trying to lead the delegation into saying anything, I also pick up from them that if the Government ignores this call, it reduces the society's impact on the health issues surrounding smoking——
And the increase in the prevalence.
I take Deputy Devin's point on the CPI and maybe there are ways around that. Accepting and parking that for a moment, the Irish Cancer Society is really asking the committee to be more proactive by way of supporting in a written submission to the Minister the need for the price increase. It is a given. The committee should go along with that and I propose that we do so. I will ask the clerk to the committee to take up that matter of correspondence to the Minister, based on the indisputable facts the Irish Cancer Society has presented before us and, more importantly, the fact that we do not seem to be gearing our ammunition towards the younger smokers, where the point must be made that they feel it is easy to quit but, obviously, it is not.
I forget the figures, which Mr. McCormack mentioned on the last occasion we spoke, on the impact of smoking on the body. He might reiterate the impact of cigarettes on the system.
In addition, Ms Cronin referred to programmes that operate on a one-to-one basis. Many Members of the Houses, including me, smoke and have passed the point where they believe they can quit. If we were to roll out a one-to-one programme in the Oireachtas, it might encourage other public and private sector concerns to do so in respect of employees who feel that there is no point quitting now. How long after one gives up smoking can one expect to free of the bad effects of cigarettes?
The most important request being made of us is to support the Irish Cancer Society's call. I formally propose that we do so. Will Ms Cronin indicate whether the society has the resources to provide one-to-one programmes within the Houses of the Oireachtas and, thereafter, on a nationwide basis?
Ms Cronin
We would be delighted to avail of the opportunity to provide such programmes. The aim of the Irish Cancer Society is to support smokers in quitting. Research shows that 70% of smokers want to quit. The Chairman is correct that most people want to quit. The reason they probably do not take action in that regard is because they feel that it will be too difficult to quit or that adequate support is not available.
The Irish Cancer Society manages the National Smokers Quitline in partnership with the Health Service Executive. We have a team of very experienced smoking cessation counsellors who deliver the service. Our other programmes are those which are delivered on a one-to-one basis and also our six-week stop smoking groups. The one-to-one model is proving to be very effective. Our smoking cessation counsellors are highly trained and possess skills to advise people on the best method of quitting and in providing them with coping skills. Our counsellors also provide advice on the benefit of nicotine replacement therapy and other pharmacotherapies, which are aids that help people to quit smoking.
Our one-to-one model works on the basis of devising a plan for a particular individual. We first assess a person's smoking pattern, namely, the number the smoke each day, how long they have been smoking, how early in the morning they smoke their first cigarette, etc. When the history is taken, we set about planning a strategy with the individual on how best they might quit smoking. Thereafter, we support them along the way.
We would be delighted to provide one-to-one programmes in the Houses of the Oireachtas. We tailor our interventions to the needs of particular individuals. If a person wants a one-to-one programme, that is fine. Other people may wish to attend the six-week group or a stop smoking course and we can facilitate them in that regard. We have provided services on a nationwide basis in the past number of years. The Health Service Executive has smoking cessation counsellors — there are not enough of them — in place to deliver some of the type of interventions to which I refer.
In that event, we will take up the Irish Cancer Society's offer.
Ms Cronin
We would be delighted——
We will be obliged to contact the Captain of the Guard in respect of rolling out one-to-one programmes before proceeding.
Ms Cronin
I was asked about the benefits involved. The reason I work in this area and I am so passionate about it is because I have helped many smokers. When I started working with the Irish Cancer Society, my background was in nursing. However, I then moved into the area of general health promotion but also into helping people quit smoking. I was involved in one-to-one and group interventions for many years. Quitting smoking is the best thing people can do to improve the length and quality of their lives. They also gain a great deal of freedom from quitting. We would love to empower people to accept our assistance and quit. It is not easy to stop smoking and success rates are not always that high. If, however, the correct support structures are in place and if people want to quit, they will succeed.
We will take up the society's offer. I thank our guests for their presentation. We will make a submission to the Department supporting the call for an increase in the tax.
Deputy Gormley referred to the backlash. A great deal of research was carried out following the introduction of the smoking ban regarding its popularity. The information from the Office of Tobacco Control indicates that the workplace smoking ban was very popular among all people. It was also popular among all social classes. Other members indicated that when they knocked on people's doors, they were accused of representing the nanny state. When, however, people were approached and asked if they supported the ban, they indicated that they did. I ask politicians to be courageous.
We were contacted by 100,000 people on the National Smokers Quitline and we asked them, not in a scientific way, about the price of cigarettes. We inquired whether an increase in the price would have an effect or whether they would object to such an increase in order to stop young people smoking. Generally speaking, the answer we received was "No". People who smoke want to stop. Many of those by whom we are contacted have been smoking 40 cigarettes a day for 40 years and they really want to quit. They will do anything to do so. From a political point of view, the 1 million smokers in this country form a captive audience because they are struggling with their addiction and they want to be helped. They will see as a positive any measure the State takes to help them. I include among their number those who, when confronted by politicians on their doorsteps, refer to the nanny state making their lives difficult.
Mr. McCormack stated that there are 1 million smokers in Ireland. What percentage of adults smoke?
Ms Cronin
The Office of Tobacco Control indicates that 25% of the adult population smoke.
The population is approximately 4.2 million and we are saying that approximately 1 million smoke.
Ms Cronin
If we are to examine the issue of inequality — which is extremely important for the Irish Cancer Society, particularly in the context of tobacco control — the prevalence of smoking among members of the lower socio-economic group is much higher. The highest smoking prevalence rate is seen in social class C2, namely, the skilled working class. Over 30% of people in that category smoke. The rate among the upper middle class is lower than average. It is fine to highlight the fact that Ireland is doing very well because the percentage of adults who smoke is down to 25%. However, that does not present the real picture because the gap relating to inequality and social disadvantage is actually widening. We are involved in an intervention project in an area of high disadvantage, to which Mr. McCormack already referred, where there is an extremely high prevalence of smoking. We are trying to address that matter.
I was asked about the benefits of quitting. When we speak to smokers about quitting, we find that they always want to know about the pay off. It is not always the financial pay off in which people are interested. We tell them that it is great to save the money they would otherwise spend on cigarettes but our focus relates more to the health benefits. As stated, there are 16 known cancer-causing substances in tobacco. One must also take account of the nicotine, tar and carbon monoxide content. The nicotine leaves a person's system within 48 hours. However, nicotine is not the most dangerous component of tobacco. The carbon monoxide, which gives rise to the greatest risk in terms of heart disease and stroke, leaves the system within 36 hours. When someone stops smoking, they will, therefore, reduce their risk of heart disease almost immediately. Their lung function will also improve over a three-month period.
Nicotine affects the cilia, the lining that runs from the nose down into the respiratory tract. Regeneration of this can occur when people quit smoking and this happens quickly. Some ex-smokers develop coughs and think that this never occurred before. However, the reason is that the body has started working again and is clearing out the mucus and what has accumulated in their airways.
The risk of all cancers and heart disease decreases along the way. After ten years, the risk of contracting lung cancer for a person who has quit smoking is the same as that for someone who has never smoked. The period relating to heart disease is shorter. However, it all depends on the length of time during which the person smoked. The earlier someone starts smoking, the greater the risk. This is why it is important that young people should not start smoking. The earlier a person begins to smoke, the greater the risk of them developing cancer at a later stage in life. However, the benefits of quitting are enormous. It is incredible to see how the lung function improves, how coughs are reversed over a period and how skin improves. Women do not realise the benefits to the skin. In addition, there are fantastic benefits during pregnancy. Circulation to the skin is very much affected by tobacco which causes premature ageing and wrinkles. Smoking affects fertility in women and causes cervical cancer. Fertility in women is being highlighted as a major issue and when women attend fertility clinics they must quit smoking before they are treated.
Availability of alcohol is a significant issue. Does the same not apply to cigarettes, given they are available in every corner shop? Does Mr. McCormack agree there should be a clampdown on availability?
The Deputy is correct and officials in the Department of Health and Children deserve a great deal of credit for their courage because the workplace smoking ban was provided for under the Public Health (Tobacco) (Amendment) Act 2004. However, other provisions of that Act are being challenged by the tobacco industry, including the plan to put cigarettes out of sight in shops so that when one walks into a shop, one cannot see the cigarettes. For example, one will not see the famous clock. All of that will be gone. However, that is being challenged by the tobacco industry. The Department of Health and Children and the Office of Tobacco Control are fighting the most powerful industry in the world. They have the best legal brains and the deepest pockets and this is part of the battle we are fighting. These companies must replace with our young people the smokers they are killing. They have no choice from a business point of view but to replace the 1,500 smokers who die annually. The Department is fighting this major battle to ensure cigarettes are out of sight in shops. That will also lead to a reduction in the social acceptability of smoking in Ireland. The same also needs to be done with alcohol because these products have the largest display area in supermarkets nowadays. However, that is a different issue. Vending machines were taken on and Professor Luke Clancy told the operators clearly that they had to put something else in them because there was point in putting cigarettes in them. That is the way forward because vending machines, which can be easily accessed by young people, cannot be used for cigarettes at the end of the day.
Ms Cronin
Deputy Gormley referred to the point of sale and it is also important that the ten pack provision, which is included in the legislation, should come into effect. However, the Department has stated this will happen in the near future.
The elimination of ten packs will make a contribution.
We went through the legislation in detail on Committee Stage and it would be helpful to know which provisions need to be enacted more speedily. If the society could forward a note to us on that, we would make representations on its behalf.
The committee should invite departmental officials before it because they have done Trojan work, even though they are under-resourced. The big problem is only one or two officials are dedicated to this work and more officials need to be focused on this battle.
I thank Ms Cronin and Mr. McCormack for their presentation. We will do what we can at our end.
The joint committee adjourned at 11.55 a.m. until 9.30 p.m. on Wednesday, 22 November 2006.