The Tobacco (Health Promotion and Protection) Bill, which I have brought before this House today, has been discussed in some detail in the Dáil and I am glad to say that it received the wholehearted support of all parties in that House. The Deputies agreed that the Bill represented a vital and progressive piece of health legislation which was necessary to address one of the major preventable causes of ill health which was affecting this country.
The Bill is a specific legislative initiative designed to tackle the problem of tobacco smoking. It is designed to complement the legislative controls on the tobacco industry which were introduced by the Taoiseach in the 1978 Tobacco Products Act by providing the necessary statutory framework for the control of smoking in public places and the restriction on the sale of cigarettes to young people.
The control of tobacco consumption is necessitated by the continued evidence of an ongoing epidemic of illness and premature death in this and other western countries as a result of widespread tobacco smoking over the last 40 years. The overall objective of the Bill which I have brought before the House today is to reduce the toll of preventable smoking-related illnesses by further encouraging a decrease in the consumption of tobacco products. My growing concern for the health risks of passive smoking by non-smokers is also reflected in the provisions of the Bill. While I am aware that most people have now become conscious of the serious health risks that result from tobacco smoking, I feel that the House should be fully aware of the extent of these problems and of their impact in this country.
Smoking became very common in the western world after the Second World War and it was not until the fifties that the medical profession began to discover the links between smoking and lung cancer. A vast collection of medical evidence on the variety of serious diseases associated with tobacco smoking has accumulated over the last 30 years and the medical world is now united in its indictment of tobacco smoking as a major cause of ill health.
It is now accepted that smoking is associated with coronary heart disease, cerebrovascular disease, chronic bronchitis and emphysema, cancer of the bronchus, the lung, the trachea, the mouth, the throat, the pancreas, the bladder and the kidney. In the face of this conclusive medical indictment of traditional tobacco products, the majority of countries in the developed world have been grappling with the problems of how to reduce the consumption of these widely used and very addictive products.
Smoking-related illnesses result in high levels of morbidity and mortality in Ireland every year. There are over 16,000 deaths each year from smoking-related illnesses in this country and it is estimated that as many as 5,000 of these deaths are directly due to smoking. The annual figures are more striking when expressed on a weekly basis. They indicate that as many as 100 Irish people each week are experiencing premature and often painful deaths, directly as a result of tobacco smoking. Many of these people are middle aged, a fact reflected in the statistics which show that 52 per cent of all deaths of those aged 35-64 years in 1982 resulted from smoking-related illnesses. The extent of preventable illness from tobacco smoking is now such that no Minister for Health could fail to take appropriate action to reduce the consumption of these injurious products.
The level of preventable illness resulting from tobacco smoking is such that it also places an enormous strain on the health services. Smoking-related illnesses account for almost 480,000 days spent in hospital each year and it is estimated that the yearly hospital costs associated with these smoking-related illnesses are in excess of £50 million.
To these costs must be added the costs of out-patient services, general medical services, disability payments and days lost at work. Together these costs are likely to impact on the Exchequer at least as heavily as the hospital costs. Finally, the costs associated with the pain and suffering experienced by so many families as a result of these high levels of preventable illnesses are incalculable.
The problem of reducing tobacco consumption is a complex one, and the Government have considered all aspects of the issue. On balance, they decided that the public health considerations are of such magnitude that they far outweigh the marginal economic impacts which a gradual reduction in tobacco consumption over a number of years will effect.
The evidence in relation to the injurious impact of smoking on smokers has been supplemented in recent years by growing medical evidence that smoking also impacts on non-smokers through breathing in air which contains other people's smoke. This phenomenon is now known as passive smoking and it raises significant public health issues with regard to the protection of the health of non-smokers.
The inhalation of environmental tobacco smoke was, until the late seventies, simply regarded as an unpleasant social nuisance. Medical research has now shown that it poses significant public health risks. Passive smokers breathe in the smoke that comes from the end of the burning cigarette as well as the smoke exhaled by the smoker. Research has now shown that the unfiltered smoke of the smouldering cigarette is more dangerous than that inhaled by the smoker. People with bronchitis, emphysema, asthma and chronic lung disease are now all known to be adversely affected when forced to remain in smoking atmospheres. Also people suffering from certain forms of heart disease are vulnerable when forced to breathe in a smokey atmosphere and people with angina suffer attacks more readily when exposed to tobacco smoke.
The most worrying finding to date in relation to passive smoking is that there is emerging evidence that there is an increased risk of lung cancer for non-smokers who are exposed to passive smoking for many years. The weight of available evidence indicates that about a quarter of the cases of lung cancer in non-smokers in general may result from passive smoking.
Growing awareness of the health risks of smoking have now reduced it to being a minority habit in this country. Two-thirds of the Irish adult population choose not to smoke. However, it is not easy to stop smoking once you have become addicted. Research has shown that almost half of smokers cannot break their addiction despite having negative attitudes to smoking and being aware of its harmful effects. Seventy five per cent of smokers interviewed have indicated that they would like to smoke less and over half of all current smokers expressed a moderate to strong wish to give up smoking. The research, therefore, shows that the majority of smokers want to cut down or give up but find it hard to kick this highly addictive habit.
The proposals contained in this Bill, which are designed to encourage non-smoking, therefore represent the wishes of the majority of smokers and non-smokers. The research shows that most smokers and non-smokers are anti-smoking. The tobacco industry and the pro-smoking vested interests have no factual basis when they present themselves as the protectors of the rights and wishes of the smoking population. The findings show that over half of all smokers have indicated a desire to overcome their addiction.
In addition to their overall desire to give up smoking, it has been indicated in recent research that 56 per cent of Irish smokers "strongly agree" that smoking should be confined to special smoking areas. The provisions of this Bill which are intended to restrict smoking in public places are therefore a reflection of the majority wish of smokers as well as non-smokers and there is no majority of public opinion to support the argument that smokers should be free to smoke everywhere.
The provisions of this Bill are also in line with international developments, both within and outside the European Community. The European Community has as part of its overall "Europe Against Cancer" programme, targeted the reduction of tobacco consumption as the main priority in reducing the high levels of morbidity and mortality from cancer in the Community. This programme was discussed by a European Council of Health Ministers which I attended in May of this year. The majority of member states expressed strong support for a number of specific initiatives designed to reduce tobacco consumption within the Community.
As part of the "Europe Against Cancer" programme the European Commission will be submitting to the Council by the end of this year a proposal for the control of tobacco smoking in public places. In addition, the European Parliament, on 11 February of this year, adopted a resolution which welcomed the measures taken by various member states to introduce a ban on smoking in public places and called on other countries to follow suit with a view to the complete prohibition of smoking, both in public buildings and in enclosed spaces which are open to the public.
The provisions of section 2 of this Bill are, therefore, fully in line with developments within the European Community and internationally. By 1982, 31 countries had enacted legislation restricting smoking in public places. This number has increased continually since then.
Within this country, public opinion has in recent years encouraged greater restrictions on smoking in public places. The DART train services and Dublin bus services have both introduced voluntary prohibitions on smoking and the success of these initiatives has shown that control on public smoking are both highly popular and well respected by the general public. While these voluntary initiatives have been most encouraging, there is a limit to voluntary action in this area and the statutory provisions contained in this Bill will give the necessary support to owners and managers who are anxious to restrict smoking on their premises.
Since coming into office, the Government have taken a number of initiatives to ensure that health promotion is given a central position in health policy and the health services. I have established a health promotion unit within my Department and an overall advisory council on health promotion made up of a broad representation of experts in appropriate sectors. The increased emphasis which I have placed on health promotion is an attempt to create, through public policy, an environment which is protection of, and conducive to, healthy living.
The Bill which I have brought before the House today is a classic piece of health promotion legislation in that it will, when enacted, make the healthy choice the easy choice for the smoker while simultaneously improving the quality of the environment for the non-smoker. I believe that it is this type of initiative which will become increasingly necessary if we are to reduce the enormous burden of preventable illness in this country and switch the emphasis of health policy away from expensive acute hospital care.
The Bill as drafted is an enabling piece of legislation which gives the Minister for Health power to make regulations to prohibit or restrict smoking in a variety of public places. The places which are designated in the Bill are those in which there is a high level of public support for smoking control. They are all enclosed public places which smokers and non-smokers are forced to share. The discretionary power to prohibit or restrict smoking will allow me to consider the nature of the areas concerned and the duration of stay in them, before drafting my specific controls. In view of the growing evidence of the health risks of passive smoking, it is imperative that the Minister for Health should retain the power to prohibit smoking totally in any area where he feels the public health risks are unacceptable.
In the Committee Stage debate on these provisions in the Dáil a number of Deputies asked that I outline the specific areas in which I intended to control smoking. Sections 2 (a), (b), (c), (d) and (e) highlight the specific public areas which I would regard as priority areas for the enactment of these controls. However, it is not possible to indicate the extent to which restriction or prohibitions will be introduced in specific areas at this stage and I will consult with all interested parties before drawing up the detailed regulations.
Under the provisions of the Bill the owner, manager or person in charge of the public places in question has the primary responsibility for enforcing the controls on smoking. In the event that individual smokers fail to comply with the restrictions they can be fined a sum not exceeding £100. However, I would expect, on the basis of existing controls on smoking that there will not be any great difficulty in getting public co-operation with regard to these controls. In the event that prosecutions are necessary regarding the enforcement of these controls, I have made it an express provision of the Bill that it will be a defence for the owner or manager of the public place to show that they have taken all reasonable steps to ensure that the prohibitions or restrictions were enforced. I believe that this is a reasonable approach that will ensure that these important public health provisions are adequately enforced.
As well as the provisions of the Bill in relation to smoking in public places, I have included a number of other provisions which are necessary to update the law in relation to tobacco and particularly in relation to its sale to young people. Under section 3 of the Bill I have updated the law on the sale of cigarettes to children. At present, it is an offence to sell cigarettes to persons under 16, under the Children Act, 1908. However, the provisions of that Act, allowing for a maximum fine of £2 are well out of date. Research has shown that smoking among schoolchildren is a significant problem.
One study of Irish adolescents between 11 and 13 years of age found that 49 per cent experimented with smoking. The earlier a person begins smoking the greater the damage to health. The evidence indicates that if people had not started smoking in their adolescent and teenage years they are very unlikely to begin in adult life. I believe that we must now take a strong stand against teenage smoking and provisions in section 3 are designed to significantly reduce the access of young people to these injurious products. The provisions of section 6 which I will be referring to later are also primarily intended to discourage tobacco consumption among younger people.
Under section 3 any person who sells or makes available tobacco products to children in relation to the sale of any other product, will be liable to a fine not exceeding £500. This section is designed to ensure that tobacco products cannot be supplied to children in any form of commercial transaction. As young people often purchase cigarettes from automatic vending machines, section 3 (2) of the Bill is drafted to ensure that these machines are properly supervised. This is a common international response to this problem. In Canada, a legal duty is imposed on the person in charge of a vending machine to make sure it is not used by children. Similarly, in Finland the sale of tobacco products from vending machines is permitted only where the machine is under supervision. Cyprus has banned vending machines altogether. I am sure that Senators will agree that it is only reasonable that the people in charge of vending machines make sure that they are not used by children as an easy way of obtaining cigarettes.
Section 4 of the Bill also deals with restricting the access of children to cigarettes. Under the Old Maximum Prices Orders for cigarettes it was illegal to sell cigarettes singly. However, the previous Government removed this provision when they abolished the relevant Maximum Prices Order. My Department consistently receive complaints about unscrupulous shopkeepers who break packages of cigarettes and sell them singly. Single cigarettes are a particular attraction to children with limited money and a desire to experiment with cigarettes. The provisions of section 4 of the Bill will outlaw this undesirable practice and together with the other provisions of the Bill should go some way towards reducing teenage smoking.
Section 5 of the Bill gives to the Minister for Health the power to determine what additives are used in tobacco products and to prohibit specific additives which he thinks are particularly injurious to health. At present, a voluntary agreement exists between my Department and the Irish tobacco manufacturers which achieves the objectives of section 5 of the Bill. However, this agreement does not extend to importers of tobacco products and the statutory provisions set out in section 5 will ensure that the Minister can treat imported and Irish manufactured products similarly. With a general movement by both smokers and the tobacco industry towards low tar cigarettes and the general development of tobacco technology, an ever growing list of additives and tobacco substitutes are being used in tobacco products. It is imperative that the Minister for Health should have statutory power to control these additives in the interest of public health. Just as statutory powers exist in relation to the use of additives in foodstuffs, it is necessary that the use of additives in tobacco products should also be controlled.
Section 6 of the Bill deals with the ever growing range of products know as oral smokeless tobacco products. These are a range of tobacco products largely developed in the USA and Scandinavia which are designed to be used by being placed in the mouth and sucked or chewed. These products contain high levels of nicotine and this is absorbed through the mouth. They are highly addictive and are often marketed at people who wish to give up smoking but who cannot break their addiction. The section is thus preventative in this context and further strengthens our controls over under-age smoking contained in section 3.
A wide variety of these oral smokeless tobacco products have been developed and promoted in North America, Scandinavia and more recently within the European Community. These products are being promoted to young people as an alternative way to enjoy tobacco and it is estimated by the World Health Organisation that about 10 million people, most of them teenagers, in the United States of America are now using these products.
These products cause serious health problems. The International Agency for Research on Cancer, an agency of the World Health Organisation, has determined that there is sufficient evidence that these products cause oral cancer. The use of these products also causes serious dental damage. Continual use can cause white patches, known as leukoplakia, to appear on the gums. Some of these white patches may subsequently become cancerous. The use of these products can also cause dental damage due to a receding of the gums where the tobacco regularly comes in contact with the mouth. In June 1987 a World Health Organisation Study Group on smokeless tobacco control recommended a "preemptive" total ban on the importation, production and sale of all types of smokeless tobacco.
As Minister for Health, I am deeply concerned at the potential availability in this country of the type of chewing tobaccos which are being promoted in other countries at young people as safe alternatives to smoking. The scientific and medical evidence relating to the range of oral smokeless tobaccos, including chewing tobaccos, is such that it would be remiss of me as Minister for Health not to provide comprehensive legislation protecting the public against these products. A number of other countries where these products were recently introduced have taken similar action to protect public health. The use of certain forms of smokeless tobacco has been prohibited in Hong Kong, Israel and New Zealand. The UK Government have now announced their intention to ban certain smokeless tobacco products under their Consumer Protection Act. The Federal Government in Australia have also announced a similar intention.
In 1985, when it was first proposed to import some of the new smokeless tobacco products into this country, the then Minister for Health made an order prohibiting their importation under the Health Act, 1947. This order was subsequently challenged in the High Court and in a judgment delivered in September 1987, Mr. Justice Hamilton found the order to be ultra vires the power of the Minister under the Health Act, 1947. The public health basis for the Order was not an issue in the judgment.
Section 6 of the Bill currently before the House is intended to restore the effect and intention of the previous Order and to ensure that no other smokeless tobacco products can be promoted in this country. To allow forms of nicotine addiction which are not yet established in the country to be promoted, particularly to our young people, would be irresponsible of me as Minister for Health. To allow new products and products not widely used, which are known carcinogens, to be marketed would be indefensible.
While this provision received cross party support in the Dáil a number of Deputies sought to have the existing brand of domestically produced chewing tobacco exempted from the provisions of the Bill. However, I indicated that the exemption of any specific oral smokeless tobacco could not be justifed on health grounds and an exemption of a specific class of an oral smokeless product would leave the legislation wide open for exploitation. Given the current developments by the tobacco industry internationally of new forms of tobacco consumption I have no doubt that any gaps in the law would encourage the development and promotion of the products exempted.
The remaining provisions of the Bill are of a more technical and routine nature, providing for the enforcement of the Bill. Section 9 of the Bill is included to amend the procedures whereby summary proceedings may be brought under the Tobacco Products (Control of Advertising, Sponsorship and Sales Promotion) Act, 1978. The revised section will make it easier to take summary proceedings under that Act. Sections 10, 12 and 13 are standard provisions and section 11 simply repeals the relevant sections of the Children Act, 1908, which will be replaced by section 3 of this Bill.
In conclusion, I would reiterate that I am bringing this smoking control legislation before the House as a major piece of public health legislation. The smoking controls proposed in the Bill are designed to minimise the risks of passive or involuntary smoking and to provide a healthier smoke-free environment.
They will also help to deter young people from smoking by conveying the idea that non-smoking is the normal majority behaviour. They will provide support to the majority of smokers who wish to give up smoking and who want smoking to be confined to special smoking areas. The provisions of the Bill will introduce a type of smoking control which has broad public support among smokers and non-smokers alike.
This broad public support was well reflected in the general welcome which all parties gave to the Bill in the Dáil. Indeed the debate in that House was most constructive and supportive. I look forward to similar broad based support for the Bill in this House and commend the Bill to you.