Mr. Fitzgerald: I thank the Chairman and I am pleased to have the opportunity to address the committee today to clarify a number of issues raised at the last meeting in relation to contact between representatives of the tobacco industry and officials of the Department of Health and Children in the context of smoking in the work place.

I am the Principal Officer in charge of the Department's Health Promotion Union, a position I have held since March 1998. Immediately prior to that, I was an Assistant Principal Officer in the unit since January 1993 and prior to that, an Assistant Principal Officer in the public health division with responsibility for policy on tobacco control. I have been working on and off in the tobacco area generally for the past ten years.

It is important, in the interests of establishing the facts of the matter under discussion, that I set out for the committee's information the exact timetable of events during that period in 1993-4 referred to by Dr. Fenton Howell in his presentation to the committee at its last meeting. The situation was as follows.

In October 1993 a consultative committee on smoking in the work place was established by the Minister to consider what next steps should be taken to reduce exposure of workers to passive smoking. I was a member of that committee which was chaired by a colleague from the public health division of the Department. The committee had wide representation, including the social partners - ICTU and IBEC - the Health and Safety Authority, the Irish Heart Foundation, the Irish Cancer Society, ASH Ireland and the Department of Enterprise, Trade and Employment.

On 4 February 1994, following a number of meetings of the committee, it finalised a policy document for submission to the Minister. In brief, the document stated that having considered the various options, the committee recommended that the voluntary code of practice set out in the booklet entitled "Clean Air at Work" should be updated and strengthened and with the active involvement of ICTU and IBEC more vigorously promoted at the level of the work place. It further recommended that, if following a two year review it did not prove effective, consideration would have to be given to introducing legislation. The rationale for this recommendation was that legislation would be very difficult to enforce and, notwithstanding the growing evidence of the dangers of passive smoking, it was felt the climate was not right for the extension of the smoking regulations already in force to the work place at that time.

It was further recommended that a subcommittee be established under my chairmanship to redraft the booklet containing the voluntary code. The subcommittee was to be representative of IBEC, ICTU, the Irish Heart Foundation, the Irish Cancer Society and the Health and Safety Authority.

On 28 February 1994, these policy recommendations were accepted by the Minister. That is an important date for Members to bear in mind. At that point policy was set in relation to smoking in the workplace. On 6 May 1994 the first meeting of the subcommittee took place. We set ourselves a target date of 31 May for the completion of our work because that was World No Tobacco Day and we had hoped to be in a position to launch the booklet on that date. The general outline and format of the revised booklet was agreed at the first meeting.

On 24 May the second meeting of the subcommittee took place. Having firmed up the consensus on the shape of the booklet various drafting tasks were assigned to different members of the committee. The Irish Cancer Society was asked to draft a piece as were ICTU, IBEC and the Health and Society Authority in the interests of trying to be meet the 31 May deadline.

On 30 May 1994 I met with Mr. Flor O'Mahony of ITMAC in my office in Hawkins House at his request. I stress to the committee that the was in no sense a secret meeting or an unusual occurrence. For good operational reasons, it has long been practice in the Department to meet with representatives of the tobacco industry from time to time. I will give one example of many which I found when researching this matter. In order to give effect, for example, to the 1991 tobacco product regulations which, inter alia, regulated the size, content and rotation of health warnings on cigarette packs, it was necessary to have series of detailed meetings with ITMAC, which represented the industry, to ensure that packs of cigarettes had on display, after the effective date, the new requirements. It was in that sort of context in which the discussions took place on and off. Such discussions still take place with ITMAC in terms of seeing that regulations are put in place effectively and to ensure a synchronisation of activity in that regard.

It is important to stress - and I am glad of the opportunity to do so this morning - that these meetings were never to seek their input into policy formulation but rather to address the implementation of policy decisions which had already been taken. At no time did we seek an input from ITMAC into the formulation of policy.

In the course of this short meeting with Mr. O'Mahony, at which no documents were exchanged, he expressed concern about the strength of any statement which might be included in the booklet on the subject of passive smoking or ETS, environmental tobacco smoking, to which it is directly referred. He argued that the jury was still out on international scientific evidence in this regard. I told him the committee had already decided to include a strong message on passive smoking and that it was, in fact, being draft. I went on to outline to him in very broad terms the shape of the document as it had been agreed at that time and the proposed timetable for its launch. It was a short brief meeting and those were the issues discussed.

On 13 June and 28 June 1994 two further meetings of the subcommittee took place which were largely concerned with drafting and editing text and with discussions on design, layout, printing and the general shape of the document. On 13 July 1994 the booklet was sent to contractors for design and printing following the usual tendering process. On 13 September 1994 the revised booklet entitled "Working Together for Cleaner Air", copies of which I have made available for committee members, was launched by the Minister. I have also made available to members a letter which the Minister sent to 5,000 employers throughout the country introducing the voluntary code of practice, urging their support and that of their employees for it and pointing out that the code would be reviewed in two years with the possibility of legislation if it was seen not to be working.

In February 1996 a randomly selected subset of 500 from the original 5,000 employers was asked, by way of questionnaire, to evaluate the effectiveness of the code and to categorise it into having worked very well, well or not at all. There was a 49 per cent response with approximately 88 per cent of the respondents rating the code as having worked either well or very well. Based on this outcome it was decided to continue to promote the code but to keep the question of extending legislative control to the workplace as a live issue for consideration in the context of any extension of the existing regulations. This remains the position.

Finally, Chairman, may I address the suggestions made here that the tobacco industry exerted influence on the policy formulation function within the Department? Based on my ten years experience dealing with tobacco related issues in this Department, I am prepared to state categorically that this was not the case. In fact, Ireland has long been regarded as a leader in the fight against tobacco consumption. Indeed, many of the directives emanating from the European Commission in the past ten years on smoking control were based on existing Irish legislation. In the case of our policy on smoking in the workplace, I think it will now be clear to members of this committee that the policy decision to maintain the voluntary code approach had already been taken on 28 February, long before the meeting with Mr. O'Mahony on 30 May as indeed had the decisions relating to the outline and general content of the revised code. It will, I am sure, also be clear that Mr. O'Mahony's concerns over references to passive smoking in the revised booklet were not met. In fact, the opposite is the case. May I read, Chairman, from the introduction to the booklet to illustrate this point.

It has long been been recognised that passive smoking is an annoyance to non-smokers, irritating eyes, nose and throat, leading to tiredness and headaches and leaving a persistent smell on clothes and hair. More recently, however, research has shown that passive smoking may not just be an annoyance but may be a risk to health. It is now believed by some researchers that it increases the risk of lung cancer and the risk of death from heart disease in non-smokers exposed over a long period of time. It also aggravates angina and respiratory conditions such as asthma and bronchitis. Respiratory effects of passive smoking. have been shown in adults by increased frequency of coughing, phlegm, throat discomfort and reduction in lung function.

The introduction goes on to say why it is important to have regard to the danger of passive smoking in the workplace. It is clear from that, that notwithstanding the strength of Mr. O'Mahony's statement on passive smoking his concerns were not met. It is obviously open to Mr. O'Mahony or to anyone else to interpret the outcome of meetings as they see fit and to go on to convey this interpretation to their employers. From my point of view and that of my colleagues in the Department I reassure the committee and the general public that policy decisions relating to our ongoing fight against tobacco consumption were made and will continue to be made in an objective and open manner with the best interests of the Irish population at heart and without any interference from the tobacco industry.

Deputy Shatter: May I ask a few questions individually and then I will respond? I do not wish to deliver a long speech. Letters were handed in by our speaker at the previous meeting. These included the documentation emanating from Mr. Flor O'Mahony. I do not have them with me and I would be grateful if I could have additional copies of those documents.

Chairman: They are being copied.

Deputy Shatter: Mr. Fitzgerald says it is not unusual for the Department to meet representatives of the tobacco industry. Is he in a position to tell the committee how many meetings have taken place either with representatives of the tobacco industry or with Mr. Flor O'Mahony, representing the tobacco industry over the last three years and the dates of those meetings?

Mr. Fitzgerald: I do not have the exact detail of that but I can certainly get it. A similar question was asked in the House yesterday. I looked at the number of meetings which took place in 1998 when preparing to come to the committee this morning. There were, I think, three meetings in 1998. I do not have the details of how many meetings took place over the last three years.

Deputy Shatter: Does Mr. Fitzgerald know what those meetings were about?

Mr. Fitzgerald: The meetings were about the ongoing implementation of various sets of regulations. They were not with the health promotion unit but with my colleagues in the public health division who are responsible for legislation and legislative control. I understand they were about discussions in relation to the implementation or non-implementation of certain regulations that had already been put in place.

Deputy Shatter: One of the major issues which remains unaddressed in an adequate way is that of people smoking in public houses and restaurants. That is an issue about which the Department has been deliberating for some time. Is Mr. Fitzgerald in a position to tell the committee whether there have been discussions with Mr. Flor O'Mahony about the likely development of policies in this area?

Mr. Fitzgerald: There have not been any discussions with him in relation to that matter. There is a policy group in the Department under the chairmanship of an Assistant Secretary which is currently working on a policy document, an advice document for the Minister. It is looking at a range of issues including the question of legislation and it is also looking at the question of litigation as it arose in the United States. It is reviewing all the legislation at the moment including the legislation covering the workplace and it is also looking at the possibility of extending the existing controls to other places where people congregate. I have spoken to the chairman and secretary of that committee. They have assured me that there has been no contact whatsoever with Mr. O'Mahony. That would be consistent with the position I have already set out, that we would not talk with the Irish Tobacco Manufacturers' Advisory Committee in the context of formulating policy. Our discussions with them have, in my experience, always been post factum . When we have decided on a policy and have to implement a range of technical matters it is sometimes in our interest to talk to ITMAS to see that the implementation is synchronised and dovetailed properly. There was certainly no discussion with him in the context of the work of that committee. I am a member of that committee myself.

Deputy Shatter: Has the Department received any submissions from Mr. O'Mahony or from anyone else representing the Irish Tobacco Manufacturers' Advisory Committee on the issue of whether this state should take court action against the tobacco companies?

Mr. Fitzgerald: Not that I am aware of. It would not come to me in the normal course but I am not aware of any such submissions.

Deputy Shatter: Is Mr. Fitzgerald saying he has seen the document which we received at our previous meeting in which Mr. O'Mahony is beating his breast and explaining the great influence he has had over departmental officials in making policy decisions as to whether smoking in the workplace should be dealt with by legislation or by the publication of guidelines? Mr. O'Mahony claims very substantial credit for dissuading departmental officials, and perhaps Mr. Fitzgerald personally, from advocating legislation. Is Mr. Fitzgerald saying that Mr. O'Mahony's letter which he felt the need to send to the tobacco industry in the United States and which is now on the World Wide Web is lies?

Mr. Fitzgerald: I was advised at the beginning of these proceedings that I do not have the protection of privilege. You will forgive me, Chairman, if I do not directly answer that question. As I said in my statement, the policy decision of which direction to take in relation to legislation versus a voluntary code was made in February. The meeting in question took place May when the policy decision had already been taken. To my knowledge, and I have checked with colleagues who were involved, Mr. O'Mahony had no involvement at all in that process. The one very brief discussion he had with me was in relation to the contents of a booklet. I do not wish to presuppose anything else for Mr. O'Mahony but I am saying to the committee that Mr. O'Mahony had no influence at all, under any circumstance.

Deputy Shatter: Could I suggest to Mr. Fitzgerald, in retrospect, that it was perhaps unwise for him, as chairman of the subcommittee, to have a private meeting with Mr. O'Mahony?

Could I suggest in retrospect, as chairman of this sub-committee, that it was perhaps unwise for you to have had a private meeting with Mr. Flor O'Mahony. I am not suggesting that anything improper took place, but it was unwise in the context of the deliberations of this committee because it left your discussions open to misrepresentation. If Mr. O'Mahony, on behalf of the tobacco industry, wanted to make an input into this booklet it would have been wiser if he had been given an opportunity to address your committee. In that context, would you accept that any future committee or group operating within the Department should not result in a one-to-one meeting taking place between a representative of the tobacco industry and the person who chairs that group? Perhaps you would inform us whether your meeting with Mr. O'Mahony was specifically reported by you to the group when the meeting of 13 June took place and whether any briefing document was given by you to that group arising out of your discussions with Mr. O'Mahony?

Mr. Fitzgerald: I will take the questions in the order in which they were asked. I suppose retrospect is a great gift. Looking back, I agree that meeting Mr. O'Mahony without having another colleague present, or without bringing him into the formal committee meeting, was probably not the wisest thing to do. I presume it gave rise to the position in which we find ourselves today. With the benefit of hindsight, that is a lesson well learned. I do not propose to put myself in a similar position at any stage in the future.

In relation to whether I advised the other members of the sub-committee, I do not have a note of having advised them. I hope I told them informally, but as I cannot recall this, I do not want to say for certain that I did.

Deputy Shatter: There is no memorandum.

Mr. Fitzgerald: No. In fact, I attached such little importance to the meeting that I did not formally inform the committee of what took place. As I believed the discussion was very brief and perfunctory, I did not keep minutes or produce a document for the committee. In retrospect, perhaps this was not a smart move.

Deputy Shatter: Mr. O'Mahony is puffing at his own importance. He did not regard the meeting as perfunctory.

Mr. Fitzgerald: Yes.

Deputy Shatter: In the context of meetings with the tobacco industry and the Department's approach to the tobacco issue, we learnt at the previous meeting of a meeting that took place, without any publicity, between representatives of the tobacco industry and the Minister for Finance prior to the last budget. Was the Department of Health and Children, prior to our being informed of that meeting and receiving from the previous speaker a copy of the submission made by the tobacco industry to the Minister for Finance, privy to that information? Did the Department of Finance, prior to making decisions on the rate of increase of tax on cigarettes in the last budget, submit to the Department of Health and Children the memorandum received from the tobacco industry? Did it submit to the Department of Health and Children a memorandum or minutes of the meeting that took place between the Minister for Finance and representatives of the tobacco industry? Was there a written submission or memorandum from the Department of Health and Children to the Department of Finance in the weeks leading up to budgetary decisions being made making recommendations or proposals of any nature as to the level of increased tax to be imposed on cigarettes or other tobacco products?

Mr. Fitzgerald: I cannot give you a detailed answer to that question because this would not be within my area of responsibility. However, to my knowledge, no such documents were issued by the Department of Finance to the Department of Health and Children. It is possible that another colleague might have received them. I would prefer to check that out rather than give an incorrect answer.

Chairman: That question might be more appropriate to the Secretary General of the Department when he appears before the committee.

Mr. Fitzgerald: As to the second point raised by the Deputy, the Department of Health and Children makes a pre-budget submission every year to the Minister for Finance arguing the case for a substantial increase in the price of cigarettes. This is done routinely, and I have drafted such a memorandum on many occasions. I presume it was also done this year.

Deputy Shatter: In conclusion, would it be possible to arrange for this committee to receive a copy of any memorandum from the Department of Health and Children to the Department of Finance regarding proposals in relation to tobacco in the recent budget? Could there be an inquiry into whether in advance of the budget the Department of Health and Children received from the Department of Finance the tobacco industry's submission? I find it entirely inappropriate in the battle against tobacco that the Department of Finance should receive a submission from the tobacco industry calling for minimal increases in the price of tobacco products, that there was an absolutely minimal increase in the price of tobacco products in the last budget and that prior to making those decisions there was no consultative process of any meaningful nature between officials of the Departments of Health and Children and the Department of Finance. It seems to me that while the Department of Health and Children has a policy in this area, the Department of Finance makes taxation decisions on tobacco in a political vacuum. I am concerned that in the last budget the Department of Finance took more seriously the submission from the tobacco industry than the genuine health concerns which need to be advanced by way of policy. I suggest that in future the Department of Health and Children should ask the Department of Finance for a response to any pre-budgetary submissions from the tobacco industry, received by the Department of Finance or furnished in the Department of Health and Children, prior to budgetary decisions being made about tobacco products.

Mr. Fitzgerald: Certainly, I will.

Senator P. Gallagher: May I ask Mr. Fitzgerald in relation to the work of the consultative committee, in the normal course of events, how soon after a meeting of the committee would a minute of that meeting be circulated to members?

Mr. Fitzgerald: In the normal course of events - I am speaking from memory because the consultative committee has not met for some time - a week or ten days.

Senator P. Gallagher: Can I ask you, if it takes a week or ten days to circulate minutes of a meeting, how was Mr. O'Mahony able to give his employers a detailed account of the meeting, including details of who said what at the meeting, on the day following the meeting in January 1994?

Mr. Fitzgerald: I do not want to speculate, but all I can say is that he did not get details of the meeting from the Department of Health and Children because, in fact, we did not have detailed minutes. That is not a criticism of my colleagues in the Department but we did not have detailed minutes of that meeting for a week or ten days. He certainly got no documentation from anyone in the Department of Health and Children. It was a widely representative committee, so it would be speculation to suggest where he might have got the minutes from.

Senator P. Gallagher: Given your work with members of the consultative committee, do you believe they would have been aware that their contributions to and deliberations at meetings would have been passed on to individuals or bodies outside of that group in advance of minutes being circulated and agreed?

Mr. Fitzgerald: I do not know. I would be surprised if they knew that. That matter was never discussed.

Senator P. Gallagher: Given Mr. Fitzgerald's long experience in dealing with this issue, would he agree with the points made for many years by representatives of the Cancer Society, the Heart Foundation, Ash Ireland and others that the only effective way to combat this problem is the introduction of legislation?

Mr. Fitzgerald: As I said, we looked at this in 1993-4. At that stage there was quite a body of regulation already in place controlling where people could smoke. That was being extended piecemeal over a number of years. At that time our view was that it would be very difficult to police legislation. We were unwilling to introduce legislation which would subsequently be discredited by its non-enforcement. Given the profile of workplaces in this country where the majority of people work in very small employments, we considered it would be very difficult to enforce it. It is the whole issue of enforcement which needs to be addressed. The other argument we used at the time was whether the climate was right and if there was public acceptance and a scientific consensus. The climate has changed because now there is a more scientific consensus about the real dangers of passive smoking and the exposure of workers to it. There would be a greater acceptability by workers for regulation in the workplace. The only issue to be considered at this point is the enforceability of that legislation and we are reluctant at all times to introduce legislation which is discredited by its non-implementation. The group that I referred to earlier in response to Deputy Shatter is looking at that issue at the moment and we are hoping to bring recommendations to the Minister on this subject very soon. I think the climate is changing in relation to this issue. Its consideration in 1999 is different to that in 1994.

Senator Gallagher: When do you expect those recommendations to be sent to the Minister?

Mr. Fitzgerald: Within the next number of weeks.

Deputy Shatter: I have now had an opportunity to go back to correspondence we received. Have you seen a letter dated 19 January 1994 from Flor O'Mahony to the ITMAC members?

Mr. Fitzgerald: Yes.

Deputy Shatter: Your meeting with Mr. O'Mahony took place on 30 May. In the briefing note that you supplied to us it was stated after the heading 4 February 1994 that following a number of meetings the committee finalised a policy document for submission to the Minister.

Mr. Fitzgerald: That is correct.

Deputy Shatter: I find the letter dated 19 January 1994 not just extraordinary but alarming and we should not go past this letter without dealing with it in some detail. Was Mr. O'Mahony a member of the committee?

Mr. Fitzgerald: No.

Deputy Shatter: Who were the members of the committee?

Mr. Fitzgerald: The members of the committee were the Chairmen from the Department of Health, one representative each from ASH Ireland, the Irish Cancer Society, the environmental health officers unit in the Eastern Health Board, the Irish Heart Foundation, the Health and Safety Authority, the Department of Enterprise and Employment, ICTU, two representatives from IBEC, Professor R. Mulcahey who is an eminent cardiologist and myself.

Deputy Shatter: Were the meetings of this committee which took place prior to 4 February private?

Mr. Fitzgerald: Yes.

Deputy Shatter: What were the dates of those meetings?

Mr. Fitzgerald: I do not have the exact dates for them but they took place between October and February. The last meeting took place in February and that was when the policy document was signed off and sent to the Minister. I checked my diary and there was a meeting on 19 February.

Deputy Shatter: At the start of the letter dated 19 January it states: "the second meeting of the consultative committee took place yesterday" so I presume there was also a meeting held on 18 January.

Mr. Fitzgerald: That is right.

Deputy Shatter: This letter is quite extraordinary because it says the issues before the committee were to decide three options. The three options listed are basically the continuation of present policy, promoting the introduction of voluntary codes and the introduction of legislative requirements on all employers or the introduction of legislation which would require smoking policies in all workplaces in line with requirements set out in legislation.

This letter for three pages goes on to detail the individual contributions made at a private meeting of various members of this committee. Mr. O'Mahony details what he understands to be the contribution of Dr. R. Mulcahy and Ms Buttermore of ASH Ireland. He then goes on to say what the representatives of the Health and Safety Authority argued about. He further stated:

After I gather a much heated discussion Seán Berry of IBEC indicated his organisation favoured a particular approach..... After further discussion the chairman summed up what he perceived to be an emerging consensus as follows

and he goes on to outline what the chairman summed up. Does Mr. Fitzgerald agree that it is both outrageous and scandalous that the deliberations of a private departmental committee to consider an initial policy suggestion - not even a recommendation - to the Minister for Health should within 24 hours of having taken place behind closed doors be the subject of a verbatim report by the public relations representative of the tobacco industry to every member of the tobacco manufacturing industry of Ireland? How could this happen?

Mr. Fitzgerald: I agree with the Deputy that it is outrageous. I do not know how it happened. I know that no-one in the Department of Health advised Mr. O'Mahony on what happened at the meeting. I did not speak to him at that time nor did any of my colleagues. After that it is entirely a matter of speculation as to which member of that committee may have told him. I do not want to speculate on who may have told him. There were a lot of people on the committee. All I can tell you and your colleagues is who did not tell him.

Deputy Shatter: Has the Department at any time made any inquiries of the members appointed to this committee as to whether any of them individually, following this meeting or other meetings, were briefing Mr. O'Mahony, the public relations representative and lobbyist for the tobacco industry, on what each individual at that meeting was saying? Is there a suggestion that the meeting was bugged or recorded in some way?

Mr. Fitzgerald: No, we did not ask the members subsequently. This information only came to light in the context of it being brought to your attention. The committee has long since ceased to function in its present format and little would be served by going back and asking members about the matter. In the event of our reconstituting this committee or a similar committee I suggest we have an agreed protocol in relation to the observance of confidentiality of meetings. That would be the case if I was involved with it in the future. This matter arose four or five years ago, a lot of the players have changed and the committee is now defunct. I do not know what can be gained by going back now and asking members about it. Perhaps it would be a useful exercise. I do not suggest that the meeting was bugged. I do not know how the meetings were bugged because they took place in Hawkins House.

Deputy Shatter: Could one of the committee members have been sitting there taping the meeting?

Mr. Fitzgerald: It is conceivable, yes.

Deputy Shatter: It is an extraordinary detailed report of what individual people said at what they perceived to be a private meeting. What is the composition of the current group considering whether court action should be taken?

Mr. Fitzgerald: The current group consists of its chairman the Assistant Secretary in the Department, a member of the medical staff in the Department, a chief executive and a director of public health from one of the health boards and myself.

Deputy Shatter: How many meetings has that group had so far?

Mr. Fitzgerald: About half a dozen.

Deputy Shatter: Is there any concern that the deliberations of that group might in some way be relayed to Mr. O'Mahony for the benefit of the tobacco industry?

Mr. Fitzgerald: No, it is a very closed group of public servants involved in the health sector and officials. I spoke to the chairman about this matter in anticipation of it arising today and he is sure that is not the case.

Deputy Shatter: Has the tobacco industry made any submission to the group on that issue?

Mr. Fitzgerald: No.

Deputy Shatter: You mentioned that officials of the Department have had three meetings in the past year with the tobacco industry presumably in the guise of Mr. O'Mahony. I suggest that before any further meetings with Mr. O'Mahony are held to discuss any issue of substance, the Department should formally advise him it is seeking information from him as to how he came about obtaining the information contained in his letter of 19 January 1994, which details information from a private meeting that he should not have been privy to. It is in gross violation of the rights of the members who attended that committee and raises a serious public doubt about the deliberations that took place within the committee. It also raises a suspicion that one or more members of the committee were aching under the influence or on behalf of the tobacco industry during the time when the committee was considering the policy decision of whether to recommend a voluntary code or legislation.

Mr. Fitzgerald: The suggestions made in Mr. O'Mahony's correspondence raise a number of questions for us which we will have to consider. It will be appreciated that my focus is in terms of preparing for today's meeting. Now that we have reached that point a number of issues have been raised for us by Mr. O'Mahony's activities over that period of time which will have to cause us to look again at the context and type of discussions we will have with him and his group in the future. It has often been in our interest to meet them and we have kept lines of communication open because it served the interest we were pursuing. If such meetings are to be misrepresented in the way they appear to have been in this instance it must call into question the manner in which we conduct them in the future. In that sense I would take on board the Deputy's suggestion that before any further discussions take place we would have to raise and discuss these matters.

Deputy Shatter: I hope they will be raised with Mr. O'Mahony and that specific responses will be received from someone who seems to think he is some kind of tinpot private investigator on behalf of the tobacco industry as opposed to a lobbyist

Chairman: On the question of the present consultative committee, I gather you are looking at the possibility of litigation. Has the committee undertaken any research on the cost of hospital treatment of tobacco related illnesses?

Mr. Fitzgerald: Not specifically. It is a difficult issue and is one which many people have been asking us to try and do. It is very difficult to try and trace every tobacco related incident in terms of treatment. We are considering the new arrangements for tracking activity in hospitals to see if we can do that. It will be useful to have a figure indicating the total cost to the health service of treating tobacco related illnesses. We do not have that figure at present.

Chairman: I raise this in the context of a motion I recently placed before the Southern Health Board asking it if it had such figures. It indicated it had none. It is strange that a committee is looking at the possibility of taking an action against the tobacco companies yet there is no data for the past two years. It would be appropriate to ask the health boards to provide figures for the last number of years on this matter.

Mr. Fitzgerald: I agree. It is not so much a question of the health boards not being asked. The difficulty is the classification of illnesses. There is a process called the hospital in-patient inquiry system which we use to track activity in hospitals and to try and match expenditure to activity. It is very difficult within the classifications and designations that exist there to pin down the treatment of every illness to a tobacco related cause. One could look at the lung cancer treatments and be sure that 90 per cent of those were tobacco related. The same could probably be done for the emphysema treatments.

However, it is very difficult to get accurate figures regarding the greyer areas of treatment. We would like to get such figures because we believe it would be important ammunition in our armoury, both in terms of our ongoing work and our discussions with our colleagues in the Department of Finance. However, we have not been able to do this because of the technicalities of classifying the data. It would be useful for us to have such information in the context of litigation or anything else.

Chairman: I recently had a meeting with the chairman of the health committee in New York. Much information is available relevant to this area. Given their success in suing the tobacco companies, it might be no harm to see how they approached their litigation. We could learn much from them.

Mr. Fitzgerald: We will pursue that suggestion.

Deputy Shatter: What contact, with any, has your group had with the various states in the US of the Attorney Generals of such states to learn of the progress they have made in dealing with the various huge court cases that have been brought against the tobacco industry?

Mr. Fitzgerald: I am not up to speed on the detail of that because it would not fall within my remit in the Department. Colleagues on the public health side would be looking at that. I am aware that extensive research has and is being done on what has happened in the US and that is being compiled for the group. However, I would not be familiar with the detail.

Deputy Shatter: You are on the group that is considering whether court action should be taken. Is that correct?

Mr. Fitzgerald: Yes.

Deputy Shatter: Your group has not yet had that contact. To whom has it been delegated to collate this information?

Mr. Fitzgerald: Officials in the Department are collating that information.

Deputy Shatter: Have there been any visits to the US to talk to these Attorney Generals?

Mr. Fitzgerald: There have been no visits to the US as of yet, but there has been much contact with the US and a dossier is being prepared at present.

Deputy Shatter: When is it expected to receive the dossier?

Mr. Fizgerald: That has to be fed into the process. I do not know what date we have set for that. It is being compiled at the moment and the group is due to meet shortly. We are to get an update on the research regarding the US.

Deputy Shatter: Some 14 months ago I raised in the Dáil with the Minister for Health and Children the need for the Attorney General and his departmental officials to engage in direct discussions with representatives of a number of different states in the US who were involved in the direct processing of actions against the tobacco companies. From what you are saying that still has not happened. There is a collation of paper work but there has not been direct meetings or discussions. Two weeks in the US involving representatives of the Department and the Office of the Attorney General would obtain a huge amount of information. I obtained a large amount of information in just a few days. Why has that not happened?

Mr. Fitzgerald: The Deputy will appreciate I am a member of this committee from the health promotion perspective. I am not involved in the litigation process and am not au fait with the detail of how this data is being collected. I know a lot of data has been collected. We have had sight of a good analysis of the present position in the US. I do not know what contact has been made, or whether it is by telephone or electronic transfer. I will look into that aspect.

Deputy Shatter: I suggest that when the Secretary General attends the committee we might get a detailed brief setting out the level of contact that has occurred and the progress that has been made. I regard progress in this area by the Department as extraordinarily slow, bearing in mind the developments that have taken place in the US and the very successful court cases that have been brought and the huge pressure placed on the tobacco industry.

I appreciate the Department is constantly under pressure under various fronts, but there is a mañana mentality in the Department - nothing ever seems to be urgent. In the context of the fight against the tobacco companies, including discrediting them in the eyes of young people so they do not take up the habit, these types of court cases have a major role to play in the public arena of the battle we should be fighting.

Mr. Fitzgerald: I would like to respond to the suggestion that we are not tackling the fight against tobacco with any urgency. Our ongoing fight against tobacco is a matter of record. Our body of legislation is there. It has been used as the basis for much European legislation. From my own point of view in the health promotion unit, we have been constantly initiating running media campaigns aimed at young people. We have also been involved in schools and the schools curriculum in this regard. The biggest single issue in the area for which I have responsibility is the fight against smoking. The biggest single investment on any one issue of the money available to me has been in the fight against smoking. We are currently running a media campaign which I hope Members have seen. If they have not we are not doing as well as I thought. It is a multi-media campaign with an advice kit, advising people to stop smoking. We are spending in the region of £400,000 on this two month campaign. We constantly evaluate our campaigns and we have them evaluated academically and from a market research viewpoint. We attach considerable urgency to the fight against tobacco. It is a slow process and an uneven process in terms of the money which is available to us compared with the money available to the tobacco industry.

Deputy Shatter: The funds are minuscule compared to the advertising budgets of tobacco companies who can pay for the type of advertisements we see on the back of glossy Sunday magazines.

Mr. Fitzgerald: That is certainly an issue. In terms of the funds available to us we are giving the highest possible priority to the campaign against tobacco and we will continue to do that.

Chairman: We will bring this section to a conclusion because Dr. Barry is waiting and we have another meeting in an hour's time. Thank you Mr. Fitzgerald for coming before the committee and elaborating on the issues raised.

Chairman: I welcome Dr. Joseph Barry, Dean of the Faculty of Public Medicine in the Royal College of Physicians of Ireland. Dr. Barry has been invited to brief the committee on tobacco related issues as part of the overall process of involving ourselves in health promotion issues. Again, I remind the meeting that while Members are covered by privilege, unfortunately Dr. Barry, you are not. You must be aware of that. I invite you to make an opening statement. We will follow it with a question and answer session.

Dr. Barry: It gives me great pleasure to be invited to address the committee. I have a brief submission which has been circulated to Members. I propose to read the short text to give some context to some of the data and briefly go through the recommendations we are making.

Public health medicine is concerned with the practice of population medicine, the production of health statistics, carrying out epidemiological studies, managing and organising public health and health care programmes, the practice of preventive medicine and the promotion of public health generally. The faculty has approximately 400 members and is a nationally recognised post-graduate training body for public health doctors. Members of the Faculty of Public Health Medicine are employed almost exclusively in the public service, primarily in the health boards, university departments of public health and other public health bodies. The faculty also organises training in public health medicine in designated training locations including the aforementioned bodies and the Department of Health and Children itself. The chief medical officer and the four deputy chief medical officers in the Department of Health are all members of the faculty.

There is unanimity within the faculty that smoking is one of the single greatest remediable public health issues in Ireland and that appropriate action, particularly of a regulatory nature in relation to tobacco advertising and sponsorship, offers great opportunities to provide health benefits to current and future Irish citizens. In this regard, the faculty welcomes very much the opportunity to address the committee and hopes that its submission will inform the future deliberations and actions of the committee.

Although Ireland has a very well developed economy at present we still have one of the highest overall mortalities in the European Union and particularly one of the highest mortalities for cardiovascular disease of which tobacco smoking is a prime cause. Of particular concern, and not necessarily reflected in the tables which have been circulated to Members because of the long incubation period of many tobacco related health damaging effects, is the relatively high prevalence of Irish teenage girls and women who smoke. Of the 15 EU countries, smoking prevalence in Irish females is the third highest, a fact which bodes ill for the future health of Irish women. A number of studies of a public health nature have been carried out in Ireland over the last number of years which highlight specific aspects of smoking in Irish women. These are summarised in Table 4. In brief, they highlight the fact that poor women in urban areas are more prone to tobacco addiction and that most women who smoke would like to stop.

A recent survey carried out as part of a Master of Science degree in community health in Trinity College showed that environmental health officers in Ireland do not feel that they are in a position to carry out current legislative programmes in relation to tobacco. The results of the survey were surprising and disappointing in that Ireland and the Department of Health and Children has prided itself on a good legislative record in this record. The findings of the survey suggest that the current legislative framework is not strong enough and that what legislation is there is not easily implementable. Another survey carried out in the Rotunda Hospital outlined the great difficulties women face in trying to give up smoking. Smoking prevalence was very much higher than quoted figures - it was 59 per cent in this study - and only 10 per cent of smokers had given up smoking since becoming pregnant.

The situation with regard to smoking in Ireland, particularly female smoking, is quite worrying. The current legislative framework is grossly inadequate to protect the health of present and future citizens from the harmful effects of tobacco. A great public health service can be accomplished by effective legislative action and change. Most public health practitioners would accept that a good tobacco control strategy has many elements but, given the experience with the tobacco industry at a worldwide level over the last 20 years, a strong legislative background that is not reliant on voluntary guidelines or consensus is necessary in order to stem the harmful effects of tobacco.

The following are our recommendations and I hope the committee will appreciate that we are not parliamentary draftsmen.

1. Introduce legislation to ban smoking in the workplace. This is linked to the question of environmental tobacco smoke. There is a considerable amount of evidence on this issue. The tobacco industry says one thing about this question and the public health community says another. We say that environmental tobacco smoke is harmful to health.

2. Introduce an absolute ban on all linkage between sport and tobacco advertising with immediate effect. Let me give an example from my own experience. For the last ten years I have been an adjudicator at the young scientist exhibition at the RDS. For the last two years the company which sponsors the exhibition also has a sponsorship arrangement with a formula one motor racing company which in turn has a sponsorship arrangement with a tobacco company. For the last two years, in the central hall of the RDS, where 1,000 Irish school pupils are doing their best to promote their scientific endeavours, a formula one car has been exhibited with B and H written on it. That is not illegal but it is an indirect form of advertising. A recent survey in the British medical journal estimated that one television transmission of a formula one race is equivalent to about 50 advertisements of 30 seconds each.

3. The legislation on the sale of tobacco to minors should be amended to empower environmental health officers to enforce the legislation. The age at which it is illegal to sell tobacco to minors should be increased to 18 years.

4. A licensing system should be operated for the sale of tobacco products. Loss of the licence should be a sanction for breaches of the law or of the conditions attached to the licence. Many small retailers make a large proportion of their profit from selling cigarettes. It is impossible to walk into many small shops without being assailed by an extensive range of tobacco products right inside the door.

5. The annual taxation increase on tobacco should be significantly above that necessary to keep pace with inflation.

There is a lot of evidence that pricing is very important, and the recent increase in tax on tobacco was very disappointing from a health perspective.

6. The additional tax collected over and above that compensation should be used for tobacco health education initiatives. I work in the health board and in Trinity College, and tobacco is not the main area of my work, but even for those people for whom it is, the amount of time that they can devote to good information campaigns is fairly limited in comparison with the amount of money the tobacco industry can use to promote its products.

7. The full constituents of cigarettes, including additives, should be made available by the tobacco industry on a brand by brand basis. There are many harmful ingredients in tobacco - nicotine, tar and others.

8. There should be a regulatory change in the health insurance system so that health insurance policies can take account of the dangers of smoking; this could include a reduction in health insurance premia for non smokers. There is already a house insurance premium adjustment for house smoke alarms, so there is a precedent. It may not be the immediate job of this committee, but imaginative ways to encourage people not to smoke should be looked at.

9. Nicotine replacement therapy should be available on the GMS. This is a proven and effective treatment that helps people to give up smoking.

10. It is recommended that data on tobacco smoking among adults should be collected on an annual basis, as was done until 1993. It has not been done since then, so our data is a little out of date. Information is power, and good lobbying from a public health perspective is dependent on good, accurate, up to date information. We recommend that the Department brings the committee annual data on smoking among adults.

11. The Departments of Health and Children and Justice, Equality and Law Reform should review existing tobacco control legislation and take steps to ensure it is fully implemented. This is a multifaceted issue that we believe the Department of Health and Children should co-ordinate, with perhaps a Tobacco Act including everything that is pertinent and relevant, such as prices, advertising and economic factors.

12. Tobacco should be removed forthwith from the list of items in the Consumer Price Index. Its inclusion in this list is often used as a reason why the price of tobacco cannot be raised, as it would look like inflation is rising. This is a spurious and unhealthy argument which is used to prevent good public health policy in relation to tobacco.

Regarding the figures in the tables I have supplied, we have the lowest life expectancy for adults in Europe - that goes for men and women, though for women more than men. We have quite high mortality rates for heart disease; many people who die from tobacco-related diseases are also ill with other diseases, and that puts a lot of pressure on the health services. There are many people ill with tobacco-related illnesses, and good preventative measures now will lessen the burden on the health services as well as on individual smokers.

Most smokers want to quit. The addictive nature of tobacco is underestimated; it is addictive and people need more support than they are getting at the moment to quit.

Deputy Shatter: Doctor Barry should not take it that if we ask brief questions that we are disinterested in his presentation, as it went along the lines of other presentations we received. Dr. Barry referred to the need for the full constituent parts of tobacco to be made known. Under the Tobacco (Health, Promotion and Protection) Act, 1988, the tobacco industry is required to disclose the ingredients of tobacco products. One of the more recent issues of great concern is the fact that tobacco companies are adding sweeteners to particular types of product which do not in themselves pose a danger to smokers but which are designed to make cigarettes a more user-friendly product to children. It is my understanding that on 30 November 1998 Department officials met representatives of the tobacco industry concerning the failure of the tobacco industry to comply with the request under section 5 of the 1988 Act to disclose the ingredients in tobacco products. There is now a possibility that the Attorney General will have to take action against tobacco companies. Has Dr. Barry come across concerns about additives in cigarettes which make them more user-friendly to children in terms of sweeteners being added to them?

Dr. Barry: As I said, it is not stated what is in tobacco. The evidence on young people of both sexes starting to smoke - there is reams of it - supports the suggestion that the tobacco industry's efforts to entice young people to smoke are succeeding. Smokers die and the tobacco industry must replace them. The tobacco industry, as a collection of private companies, is there to make profits, and the way to do so is to get as many people as possible smoking as many cigarettes as possible. The public health community in the broadest sense - including other people who have come to this committee - are trying to stop that, and we are trying to get the Government on our side. If the tobacco industry has been asked to do this and they have not done so, it is typical of a lot of other behaviour from those companies. They have enormous resources and legal teams which we do not have. I focused on the need for legislative changes because the public health sector requires legislative bulwarks and supports of an explicit nature. The study I mentioned regarding environmental health officers showed that they were unable to enforce the laws that were there, which were in themselves insufficient.

I do not have direct evidence on sweeteners, but the evidence of young people starting to smoke earlier suggests that any efforts made by the tobacco industry either by advertising in magazines or adding sweeteners to tobacco are succeeding. They make tobacco smoking very seductive.

Senator Jackman: The point has been made that poor women in urban areas are more prone to tobacco addiction, and that most women who smoke would like to stop. We are all concerned by the statistics for Ireland compared to other EU countries and by the fact that young Irishwomen are still smoking in great numbers. Have any studies been done on why women in poor areas would turn to cigarettes? I suppose it could be drink, which would be worse.

What sort of evidence does Dr. Barry have specifically in that regard? Is it stress related? Is it an immediate comfort which they can get at the corner shop?

Dr. Barry: It is very difficult. The department in Trinity did a community based health survey in Tallaght where there were many health issues. Almost all the women were smokers and they did not perceive it as their highest priority. My surmisation is that there was, from their perspective, a feeling of comfort. However, they were also addicted. This point needs to be made. Many people might start to smoke. There is evidence that young teenage boys and girls will be sold one or two cigarettes, which is illegal. The old favourite, peer pressure, is also part of it. In micro surveys which have been done, the prevalence of the rate of smoking is much higher than the 30 per cent quoted. For many it is an addiction and a habit. Other women have done it and it happens in a widespread way in the community. Even at the stage where people want to stop smoking, no addiction is easy to give up.

Deputy Clune: Mr. Fitzgerald from the Department of Health and Children explained the background to the production of the booklet. Is Dr. Barry aware of it?

Dr. Barry: Not in great detail.

Deputy Clune: It is called "Working together for cleaner air - Developing smoke-free policies in the workplace". It was produced by the Department of Health and Children in September 1994 instead of the introduction of legislation to ban smoking in the workplace. The Department decided it was a better way to go. Is Dr. Barry aware of it?

Dr. Barry: I am aware of it. In the organisation in which I work, smoking is banned in some parts of the workplace but not in others. There are organisational difficulties in banning it, but they can be overcome with commitment.

Deputy Clune: My understanding from the previous speaker is that it would be very difficult to overcome. Has Dr. Barry any information on the booklet or has he tracked its success? Mr. Fitzgerald told the committee that after the booklet was circulated they asked employers about its effectiveness and 45 per cent of respondents said it had worked well and others thought it worked very well.

Dr. Barry: There has not been a national smoking prevalence survey since 1993 so it is difficult to say how effective it has been. However, at an anecdotal or impressionistic level, smoking in the workplace is still very prevalent. Hospitals tend to be better able to ban it because it is more easily accepted. However, it is still a difficult problem for people approaching it from a public health perspective to try not to target individual smokers and victimise them more than is already the case. On Ash Wednesday this year, we are doing a survey in the building of Dr. Steeven's Hospital. There are approximately 300 employees in the main headquarters and we will survey them on issues in relation to practices and attitudes on smoking in the workplace. We will have a local answer in the health board for the Deputy after Ash Wednesday.

Deputy Clune: Good.

Deputy Keaveney: I thank Dr. Barry for his presentation. Many of the relevant questions have been already raised because many groups have appeared before the committee. The biggest issue raised was whether smoking is addictive. The tobacco companies gave many reasons to demonstrate that it is not addictive and they avoided the question quite well.

Many of the recommendations made by Dr. Barry are sensible and straightforward. Many of them relate to the point that many people smoke. Are more young people starting to smoke or does it go in cycles? Are there fads where more young people smoke? Some 88 year olds boast that they started smoking when they were seven years old and there was little tobacco advertising at the time. Should we focus on young people to stop them smoking? At what age would that be a success? Do general practitioners have a role? A dentist visits schools to take care of pupils' teeth. Is there a role for a school doctor or is the issue too big to deal with from that angle?

Dr. Barry mentioned the ban on the link between sport and tobacco. Young people are very influenced by sport. They are also influenced by music and pop bands who are their idols. This aspect is important. Does Dr. Barry consider that one avenue is more appropriate than another in terms of encouraging young people not to start smoking? This would mean it would not be necessary to have other aspects such as nicotine replacement therapy, etc, which try to help people stop smoking. Is the main point to stop people starting to smoke in the first place?

Dr. Barry: There is not one single thing and one will never get smoking prevalence down to zero. However, particularly in terms of women, smoking is more prevalent in Ireland than in all but two other European countries. A ban on advertising would help. It would prevent some people starting. More support through nicotine replacement therapy, etc, would help more people who want to quit to stop. The numbers would gradually come down. A reduction in smoking prevalence from 30 per cent to 20 per cent would be an enormous improvement in public health. It is huge. I cannot think of any argument for not banning cigarette advertising, ergo, could it be done?

Smoking will never be totally stopped. Young people will experiment and other people will smoke. If one considers the amount of money spent on advertising, the people who pay for advertising believe it works. It works. All of us have a problem admitting that we are influenced by advertising. However, we must admit that we are all influenced by advertisements. Some of them are indirect and I mentioned the example of the young scientists competition. Members are aware of the brouhaha last year in the UK about the donation from a Formula 1 company to the British Labour Party. Big money is at stake.

I am making a presentation as a public health doctor. Members are probably bored at this stage with the facts but most of the people appearing before the committee are coming from the perspective of trying to make improvements in the health of the people. The tobacco industry is making money from as many people as possible smoking. These two conflicts are almost irreconcilable and I would like the Department of Health and Children to be unambiguously and fully in the public health camp. At a wider level, I would also like the Government to be in this camp. An overarching tobacco Act would allow all the different Departments to link together. If the Act was sponsored by the Department of Health and Children, it would have a health focus. Otherwise, there will be gaps. However, no Act does everything. We are talking about a percentage reduction in the number of people who start to smoke and a percentage increase in the number of smokers quitting.

The Irish College of General Practitioners has been given some funding to give family doctors more skills in helping people to stop smoking. Some people are happy to smoke but the evidence is that most people who smoke want to stop. There are huge benefits to be had from taking the matter seriously and having a focused approach by regarding it as a major issue for the health of the people.

Senator Moylan: I thank Dr. Barry for his presentation. His recommendations are something to which we all aspire. We should try to achieve the aim of those recommendations. Financial payments in the form of set aside are made to farmers for producing grain which could be used to feed the hungry in this world.

It might be better from a medical or Government point of view if we pushed the case for paying set aside to farmers who produce tobacco so they would not to produce that product. It might ensure the price of that product would increase to such an extent that it might turn people away from smoking. The other point, which you rightly mentioned, is the difficulty with television, sports and the huge number of channels available in every home. Many young people follow sport, and you mentioned motor sport. It is easy to bring advertisements into the family home where people are trying to stop young people smoking. Again, I compliment you on your presentation.

Dr. Barry: There are tobacco manufacturers and distributors, but we do not have tobacco manufacturers in this country. It is a highly political issue in the United States, as Members will know. Historically, the tobacco industry lobby in the United States has been very powerful. The American Government is being very active. It has a much bigger issue to address in terms of potential compensation and finding other work for people who grow tobacco. We do not have to provide set aside and do not have tobacco mountains because we do not have tobacco growers here, so it is not really an issue for us. We have tobacco distributors and suppliers which are targeting the developing world. At a global level, tobacco consumption is rising very much, including in the continent of Africa. We would not have to do anything to compensate people who make money out of tobacco. They have had many warnings and much time to think about things. It is dragging on for a long time.

As I said, it is estimated that about 5,000 people die of smoking related illnesses each year in Ireland, which is nearly 15 per day. If our prevalence is going up a little, it means that about 15 to 20 people are being recruited to smoking every day. That is a lot. Those are the people who we should try to compensate not those who make money out of tobacco.

Chairman: I thank Dr. Barry for what has been a useful and informative presentation. We will certainly take into account the information which has been received from his presentation. We will draft a report in the near future on health promotion and the tobacco industry so his suggestions will be extremely useful to us.

Dr. Barry: Thank you, Chairman.

The Joint Committee adjourned at 11 a.m.