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Up | Previous A NATIONAL ANTI-SMOKING STRATEGY INTRODUCTION (1) See concluding observations of the Committee on Economic, Social and Cultural Rights; Ireland, E-C.12/1Add.35 (14th May 1999) p.2 Tobacco consumption is the single most preventable cause of early mortality in the State. The Committee believes that it should be a central objective of health policy not merely to effect a global targeted reduction in the prevalence of smoking and tobacco consumption in the State but also, to entirely eliminate cigarette smoking and the use of other tobacco products by minors - persons under 18 years of age. Most people who suffer the adverse health consequences of using cigarettes begin their use before attaining eighteen years of age. Only by preventing children and adolescents from starting to smoke can we succeed in substantially reducing the overall number of smokers in the State within a reasonable time frame. The Committee proposes a new national health objective - that smoking by all persons under eighteen years be entirely eliminated by 2005 and that by that date, adult smokers be reduced to below 15% of those aged 18 years and over. The Committee also believes that non smokers are entitled to be protected from environmental tobacco smoke (ETS) or passive smoking. Having considered all of the relevant research and scientific evidence, the Committee has concluded that ETS poses a genuine health risk from which the State is obliged to protect its citizens - both adults and children. Whilst the Committee does not accept the view of tobacco companies that the case against ETS is not proved, it is of the view that even if this were so (and no tobacco company has submitted to the Committee that it is absolutely certain ETS poses no health risks) the precautionary principle which has in the past decade been adopted in international environmental treaties and declarations, requires the State to act against ETS. The right to enjoy a smoke free and smog free environment was recognised by the coming into force of regulations made in 1990 under the Air Pollution Act, 1987 to ban the use of bituminous coal in urban areas (2). This ban was implemented to protect the elderly and all of those susceptible to respiratory illness from the detrimental impact of smog. It makes no sense to the Committee that such measures were enacted to counter-act smog whilst smoking is still permitted in a variety of public places and locations where the general public congregate. (2) See Air Pollution Act, 1987 (Marketing, Sale and Distribution of Fuels) Regulations, 1990 (S.I. No. 123 of 1990). See also Air Pollution Act, 1987 (Marketing, Sale and Distribution of Fuels) Regulations, 1998 (S.I. No. 118 of 1998) The Committee recognises that the elimination of under age smoking, a substantial reduction in the number of adult smokers and protection of the public from environmental tobacco smoke cannot be achieved by one single initiative. A comprehensive multi-faceted approach with a mixture of strategies is required to put in place an effective tobacco control and elimination programme. The Committee considers that what is required is a National Anti-Smoking Strategy which includes the following:- A new legislative framework which includes:-
New dynamic comprehensive anti-smoking initiatives which include:-
Properly supported State and Health Board Smoking Prevention and Cessation Programmes:-
Regular monitoring of the prevalence of smoking amongst children and adults:-
The extension of new powers to Joint Oireachtas Health and Children Committee:-
Initiation and processing of litigation against tobacco companies:-
The creation of new structures in the Department of Health and Children:-
The Committee wishes to emphasise that if we are to seriously tackle the problem of cigarette smoking and its impact on the health of our people, initiatives are required under all of the above headings within a very short time frame. Selecting some to implement and ignoring others will substantially undermine the impact of the Committee's proposals. The Committee considers that each of the initiatives proposed by it should constitute the first ever "National Anti-Smoking Strategy". Each of these initiatives is now further discussed in the following pages. LEGISLATIVE ISSUES 1. UNDERAGE SMOKING: The Committee notes that the Irish tobacco companies who participated in the Committee's proceedings stated that children should not smoke. The Committee further notes, however, the same tobacco companies distribute in Ireland cigarettes for major American and British tobacco companies who have been exposed as engaged in such targeting in documentation currently available as a result of orders for discovery made in the courts of the United States and similar orders made by the US Congressional Committee on Commerce and as a result of inquiries conducted by the Food and Drug Administration (FDA) in Washington. Most of this documentation is accessible through the internet. It is a matter of judgement whether the public presentation made to the Committee by Irish tobacco companies that children should not smoke was made for public relations purposes and whether it is consistent with their commercial behaviour or that of companies such as R J Reynolds and Philip Morris whose cigarettes the Irish companies distribute within this State. Nevertheless , it is noteworthy that no one expressed support to the Committee for the continued sale of cigarettes to 16 and 17 year olds. The Committee believes that it is anomalous and illogical to continue to permit the sale of cigarettes to 16 and 17 year olds, whilst imposing a ban on cigarette advertising in publications directed at persons under 18 years of age. It is the view of the Committee that section 3 of the 1988 Act should be amended to render it an offence to sell or permit the sale of cigarettes or any other tobacco product to persons under 18 years and that the shop or store proprietor or manager should be held responsible for any under age sale by an employee. The Committee also considers that it should be an offence to have a cigarette vending machine in any premises in any place into which any person under 18 years of age is permitted to enter or to be present. The Committee also recommends that section 3 (3) of the Act be amended to provide that a person prosecuted for the sale of cigarettes to a minor should not be able to rely on the defence of having taken "all reasonable steps to assure himself"/ herself as to the age of the alleged underage purchaser unless the seller satisfies the Court that he/she sought and obtained an appropriate document of age verification, inclusive of an identity photo of the purchaser which attested to the purchaser being over 18 years. It is further recommended that the newly enacted measure require that specified and prominent notices be in place at the point of sale of tobacco products in retail outlets warning of (a) the addictive and health dangers posed by cigarettes and (b) detailing the age restriction on sale and the vendors obligation to ask for age verification. Failure to have in place the appropriate notices should render the proprietor or manager of a retail outlet selling cigarettes liable to prosecution and the imposition of the same penalty upon conviction as applies to under age sales (3). (3) In the United States, the Synar Amendment has since 1992 required that all States must enact and enforce a law prohibiting the sale of cigarettes to minors under 18 years - see Synar Amendment to the Alcohol, Drug Abuse and Mental Health Reorganisation Act 1992. The Committee has considered the fine of £500 that may currently be imposed upon summary conviction for the offence of under age selling. The Committee recommends that the fine that can be imposed for under age selling or for a failure to display appropriate notices should , on summary conviction, be for a sum not exceeding £2,500. Upon conviction for a second offence, the Court should have jurisdiction to impose a fine of up to £5,000 and /or require the offender to undertake community service or as an alternative to community service have jurisdiction to impose a term of 6 months imprisonment. The Committee has considered whether in addition to banning the sale of cigarettes to persons under 18 years, it should be an offence for a person under 18 to have cigarettes or any other tobacco product in his or her possession. The Committee is of the view that new and properly resourced education initiatives , health campaigns and anti-tobacco TV, cinema and poster advertising together with the formation of anti-smoking campaigning youth groups, the banning of smoking in a variety of locations frequented by young people (see further on) and the ending of all tobacco advertising and sponsorship are all major policy initiatives which should be taken to counteract youth smoking. The Committee does not believe it appropriate at present to criminalise young people for being in possession of or for smoking cigarettes, in particular, when a young person smoking may simply be mimicking parental conduct. This is an issue that might be the subject of further public discussion and debate. However, as is stated further on, it is the view of the Committee that any person who violates a smoking ban by smoking in a no smoking area as designated by an Act of the Oireachtas or by regulations made under any such Act should continue to be liable to prosecution and upon conviction to the imposition of increased penalties. Action required: 2. CIGARETTE HEALTH
WARNINGS: It suggests that one of the following notices could be printed on the front of every cigarette packet - an equal number of such notices being printed annually on the packets of each cigarette brand sold in the State:- NICOTINE ADDICTION DEVICES The Committee also recommends that the warnings on the back of cigarette packets be modified and that the statements used refer to the dangers of addiction and of Environmental Tobacco Smoke (passive smoking). It is suggested that the following statements be used with equal frequency - DON'T GET HOOKED ON NICOTINE Action required: The Minister for Health should on behalf of the Government propose at the earliest available opportunity that Council Directive 89/622 EEC be amended to permit this State and other Member States require tobacco companies to print on cigarette packets health warnings which explicitly focus on the fact that cigarettes are nicotine delivery devices and that nicotine is an addictive drug. The new Directive should also continue to require that health warnings highlighting the various serious diseases and health risks caused by smoking be printed on the back of cigarette packets and that there be greater flexibility with regard to the contents of such warnings to include all of the warnings recommended by this Committee. Consideration needs to be given to allowing such health warnings to be published in the various officially used languages of the Community in terminology that communicates effectively to children and young people and is in tune with and adaptable to evolving and contemporary youth culture. Less formal terminology than that used at present should be considered. 3. CIGARETTE INGREDIENT
LABELLING:
The Committee is also of the view that cigarette packet labels should list the toxins present in or delivered by cigarettes and detail the ingredients in addition to tobacco added to individual brands. Action required: 4. CIGARETTE INGREDIENT
NOTIFICATIONS: Action required: 5. LEGAL MECHANISM TO
IMPLEMENT 1998 EUROPEAN UNION DIRECTIVE: Action required: 6. PROHIBITING TOBACCO ADVERTISING, SPONSORSHIP AND PATRONAGE: The Committee has considered the options available to the State in implementing by an Act of the Oireachtas the provisions of Directive 98/43 EC; (a) Advertising - as already noted, the Directive provides for a general ban on tobacco advertising to become effective no later than 30th July 2001. Moreover, the Directive is permissive , in so far as it permits Member States to lay down stricter requirements concerning tobacco advertising than those contained in it. It also allows Member States to defer for 1 year (that is , to 30th July 2002) application to the press of the ban on tobacco advertising. The Committee has considered the ban on press advertising and has taken specifically into account the very substantial teenage readership of newspapers. It has also noted that tobacco advertising is often carried in newspaper magazines which by their content frequently attract a younger readership. It is the view of the Committee that a law banning the advertising of tobacco products in the press should be brought into force as soon as possible. The Committee appreciates that some reasonable time is required for the preparation and enactment of the required legislation. It recommends that the Minister for Health should shortly announce on behalf of the Government that such a ban will become operative in the State as and from the 30th July 2000. At the very latest, such ban should become operative as and from the 30th July 2001. It is the view of the Committee that the State should not by legislation defer the ban on tobacco advertising in the press from the 30th July 2001 to 30th July 2002 as the Directive permits. Action required: (b) Sponsorship and Patronage - as already noted the Directive provides for a general ban on tobacco sponsorship but permits Member States to defer implementation of the ban for two years (that is , until 30th July 2003). It is the view of the Committee that a law prohibiting tobacco sponsorship should be brought into force as soon as possible. The Committee is conscious that too frequently tobacco sponsorship of events present tobacco products as attractive to children, adolescents and young people. The Committee believes it is in the interests of the health of individuals and the community generally that tobacco sponsorship in the State be prohibited. The Committee is also conscious that sponsorship of events or activities may be arranged 12 months or longer in advance. It proposes that the ban on tobacco sponsorship of events in the State come into force by the 30th July 2001 and that the State should not defer the ban on tobacco sponsorship applying until the 30th July 2003 as the Directive permits. It recommends that the Minister for Health should shortly announce on behalf of the Government that such a ban will become operative as and from the 30th July 2001. Such an announcement will afford event organisers a reasonable time frame within which to arrange alternative sponsorship for events which are arranged to take place after that date where tobacco sponsorship has either already been secured or where it was envisaged such sponsorship would be secured. The Committee notes that "in exceptional cases and for duly justified reasons" Member States are permitted by the Directive to authorise the continuation of existing tobacco sponsorship "of events and activities organised at a World level" up to the 1st October 2006. In so far as there are any such events scheduled to take place in the State, it is the Committees view that no legislative provision should be made for any such authorisation to be given. The Committee acknowledges that Irish domestic legislation cannot prevent other Member States from providing in their legislation for such authorisation up to the 1st October 2006. It deplores the fact that directive 98 /43 EEC would not have been adopted by the Member States without this deferment authorisation. It is the view of the Committee that the continued sponsorship of events such as Formula One racing by tobacco companies and the worldwide glamorisation of cigarettes which results from both press reporting and the televising of such events, encourages children and adolescents to smoke cigarettes and actively colludes with the tobacco companies in ensuring that young people become nicotine addicted. Substantial advertising revenue is earned by television stations broadcasting tobacco sponsored world events. Domestic legislation should require that Irish television stations broadcasting tobacco sponsored world events taking place outside the State after the 30th July 2001 carry free of charge in each advertising slot broadcast immediately before, during and immediately after any such event an appropriate anti-smoking public service advertisement of specified duration specifically targeted at persons under 18 years of age. The press reportage of tobacco sponsored world events will provide tobacco companies up to the 1st October 2006 with a mechanism to circumvent the press ban on tobacco advertising. The Committee notes that it is commonplace for Irish newspapers to publish spectacular pictures of Formula One racing cars prominently advertising popular brands of cigarettes. It is also usual when writing about tobacco sponsored racing teams or golf tournaments to repeatedly refer in newspaper reports to the tobacco brand sponsorship for example, the Jordan Racing Team is frequently repeatedly referred to in the press as "Benson and Hedges Jordan" and the Ferrari team as "Marlboro Ferrari". Eddie Irvine, the successful Irish Ferrari Formula One driver who is a role model to so many Irish children, during his time with Ferrari effectively became the new "Marlboro Man". When celebrating his impressive victories on the winners podium or being interviewed on sports or other popular television programmes viewed by children and young people in his Marlboro gear, he presented as a mobile human advertising placard. The advertising impact of such images and publications is in the Committees view worth millions of pounds in cigarette sales to the tobacco companies concerned. The subliminal messages of glamour and excitement associated with cigarettes conveyed in this way to young people is extremely damaging. The Committee is concerned that such reporting will between the 30th July 2001 and the 1st October 2006 substantially undermine the ban on press advertising of tobacco products. The Committee is also conscious of the constitutional right of freedom of expression and does not believe it to be desirable or constitutionally permissible to ban such reportage. As reportage of such events does attract a young press readership, it is accordingly proposed that immediate discussions be entered into between the Minister for Health and Children and the press to discuss putting in place an agreed press code of practice whereby an agreed prominent anti-smoking message will after the 30th July 2001 appear on the same page as any major reportage of any such sponsored events in newspapers or magazines published in the State after that date. Should it not prove possible within a reasonable time scale to agree an appropriate code of practice which the press and publishers will apply, the Committee recommends legislation be enacted to require the publication of prescribed anti-smoking advertising. Where interviews of the type described are televised, the Committee believes domestic legislation should require the broadcasting of such anti-smoking public service advertising as it proposes should be broadcast in conjunction with the televising of a tobacco sponsored world event. The Committee further notes that some tobacco companies circumvent the present law on sponsorship by funding as "patrons" projects with which they identify and by which they attract favourable publicity. It is of the view that the new legislation to be enacted should ban such tobacco industry patronage (4). (4) It is arguable that such patronage at present without the prior consent of the Minister for Health and Children is unlawful. See the definition of "sponsorship" contained in Chapter 5. Action required: 7. TOBACCO OUTDOOR
ADVERTISING IN TOBACCO RETAIL OUTLETS: Action required: 8. INTERNAL ADVERTISING IN TOBACCO RETAIL OUTLETS: Directive 98/43 EC does not apply to tobacco advertising internally in shops at locations at which tobacco products are sold. Such internal advertising is permitted under current domestic Irish law but visual electronic media or sound cannot be used. It is the view of the Committee that no advertising promoting the sale of cigarettes and other tobacco products or brands should be permitted. However, it should be permissible to state in a retail outlet the location at which cigarettes are sold and to display at such location the prices of the individual brands and products. The new proposed legislation should also require that specified addiction and health warnings be displayed prominently at all such locations together with a specified notice concerning under age sales, as already discussed. Action required: 9. CLEAN AIR AND COMBATTING
ENVIRONMENTAL TOBACCO SMOKE:
The Committee notes that the prohibitions on smoking contained in the 1995 Regulations do not apply to a number of specific areas in which teenagers traditionally meet, socialise and congregate. For example, premises used by teenagers such as discothèques, dance halls and snooker halls are not covered by the Regulations. The Committee considers that to counter-act teenage smoking, the advantages of extending smoking prohibitions to such premises are compelling. In the psyche of tobacco addiction, repeated tobacco use after initial experimentation (occasional use) leads to an early stage of dependency. Prohibiting tobacco use in premises where teenagers congregate is likely to reduce the proportion of experimenters who become nicotine dependant. The prohibition on smoking contained in the Regulations should extend to all such premises. Public houses/licenced premises are also expressly excluded from the current regulations. In the context of young people, the Committee notes that strict application of licensing laws would exclude persons under 17 years of age from licenced premises. Members of the Committee, however, are anxious that the Committees recommendations reflect reality and not theory. The reality and widespread experience of members of the Committee is despite the laws on under age drinking, it is common place for teenagers of 15 years and upwards to be present in public houses. A public policy to discourage adolescent smoking, in particular, one which prohibits the sale of cigarettes to persons under 18 years of age, must include a prohibition on smoking in all licenced premises to which persons under 18 years of age are admitted. The Committee has considered whether the prohibitions proposed in the preceding paragraph should be confined to such premises frequented by teenagers or whether they should extend to all licenced premises. It is of the view that a prohibition on smoking in all such premises, not only premises frequented by children and teenagers, is also essential to protect the health of the staff of such premises as well as non-smoking adult customers. Non-smokers should not be the involuntary victims of Environmental Tobacco Smoke (ETS). The Committee accepts that ETS contains many of the same toxins as primary smoke and that it is a leading preventable cause of death and disease in the State. Moreover restrictions on public smoking can also reduce the overall level of cigarette consumption by smokers who spend significant amounts of time in no smoking venues. Since the incidence of tobacco induced disease increase with heavier smoking, smoking-restricted environments will reduce morbidity and mortality among adult smokers. The 1995 Regulations apply to indoor spectator and games areas and sports centres but do not apply to outdoor sports stadia. Both adults, adolescence and children are subjected at venues such as Croke Park, Lansdowne Road, Dalymount Park to the nuisance of ETS when sitting adjacent to spectators smoking cigarettes and cigars. Such anti-social behaviour can destroy a non-smokers enjoyment of a match and presents a very bad example to children and adolescence. The Committee proposes that the prohibition on smoking and other tobacco consumption be extended to outdoor sports stadia and that provision be made to require two thirds of the spectator areas be designated "no smoking". The Committee has given general consideration to the contents of existing regulations. It views the variety of exceptions contained in the regulations as no longer acceptable. The Committee proposes that all hospitals, nursing homes, maternity homes, centres for the intellectually and physically disabled and all other health facilities should be designated as no smoking areas. Continued maintenance of special smoking facilities in hospitals and health premises particularly undermines a no smoking public health policy and insinuates that smoking is approved and acceptable provided it takes place in specially designated rooms. The Committee also recommends that all child care centres and schools be designated as no smoking areas and that no special smoking facilities be provided for staff. The integration of a no smoking philosophy into our educational system will be essentially undermined by the continued provision of smoking facilities in child care and educational establishments. Current regulations permit smoking on aircraft provided at least two thirds of the seating area is identified as no smoking. In practice, all Irish airlines are presently no smoking and there is no reason for preserving this exception. In the interests of cabin staff and for safety reasons, smoking is now prohibited by many airlines throughout the world. The Committee also believes that no trains should have designated smoking areas and that the ban on smoking applicable to the Dublin Area Rapid Transit and Arrow Train Systems should apply to all trains operated by Iarnrod Eireann. The Committee recommends that smoking should be totally prohibited in restaurants, canteens, cafés and snack bars and in all retail outlets in which food is sold, such as shops, delicatessens and supermarkets. The Committee has considered the voluntary code of practice applicable to smoking in the work place. It is the view of the Committee that no person working for a government department, a state agency or in private employment should in their work place be subjected to environmental tobacco smoke. It is the view of the Committee that where two or more people work indoors together in the one location (for example, factory floor, shared offices, meeting rooms, trading rooms, studio) smoking should be prohibited by law in any such location. It should be a matter for consideration by individual employers as to whether to provide a smoking room for employees. Action required: 10. PENALTIES FOR VIOLATION OF NO SMOKING REGULATIONS: The Committee has considered the offences prescribed by the 1988 Act for breach of the regulations made under it to prohibit or restrict smoking and tobacco consumption. The Committee recommends that the fine of up to £100 that can be imposed on any person who is convicted for smoking in a no smoking area should be increased to £250. Upon conviction for a second or subsequent offence, the fine should be increased to a sum up to £500. In the event of an offender failing to pay a fine imposed within a time specified by the court, the court should be able to impose the alternative sanction of community service. The Committee recommends that the fine of up to £500 which can be imposed on an owner, manager or other person in charge for a failure to ensure smoking prohibitions or restrictions are complied with, should be increased to £1,000 for a first offence and £2,000 for a second or subsequent offence. In the event of a failure to pay the fine within the time specified by the court, the court should be able to impose the alternative sanction of community service. Action required: 11 ENFORCEMENT OF TOBACCO CONTROL MEASURES: The Committee has generally considered the enforcement of tobacco controls, the offences which may give rise to Health Board prosecution under the 1978 and 1988 Acts and the recommendations already made concerning such offences. In each Health Board, it is the Environmental Health Officer (EHO) who is the enforcer of tobacco control legislation. The Committee has considered the contents of a recent study undertaken to examine the attitudes and practices of EHO's and their superiors, that is, principal EHO's, concerning their enforcement role (or lack of) under the legislation. The study confirms that the legislation is poorly enforced, most EHO's only being pro active when tobacco control is linked to the implementation of hygiene regulations (5). Many EHO's identify procedural difficulties in implementing existing legislation. Reasons cited for lack of enforcement included bad legislation, lack of resources, low priority and directives from more senior managers in the health care system not to prosecute offenders. Both EHO's and their immediate principals at best appeared ambivalent about their role as enforcement officers and did not appear to regard enforcement of tobacco controls as an essential and important part of public health policy. The Committee is surprised to learn that there is the equivalent of only 10 designated EHO's for tobacco control activities nationally and that of these, only two are pro-actively enforcing the 1988 Act (6). (5) See Eimear Simms,
Tobacco Control legislation, Ireland - a view from the Enforcer (October
1998) a Dissertation submitted for the degree of MSc.Community Health,
University of Dublin (Trinity College) The Committee notes the very small number of prosecutions initiated under either Act by Health Boards. It is clear from the study already referred to and from the response to enquiries made to each of the eight health boards by the Committee's Rapporteur, that health boards are reluctant to use volunteer minors (7) to test retail compliance with the ban on under age sales. It is of the view that the Environmental Health Officers and Health Board Managers need to be made more aware of the significance of applying enforcement measures to tobacco consumption prohibitions and controls due to the health implications of smoking. Formal specialist training in the application of tobacco control legislation and regulations should be provided for EHOs and a statutory obligation to enforce the legislation and regulations should be imposed on Health Boards. Each health board should prioritise enforcement of tobacco control legislation in its annual service plan. The Department of Health and Children should allocate to each health board the funding required to ensure the training of EHOs and the enforcement of tobacco controls becomes a reality. The Health Boards should also be legally required to detail their tobacco control activities in a published annual report which should be laid before both Houses of the Oireachtas no later than three months after the completion of the year to which the report relates and should detail in such report the extent to which their tobacco service plan targets were achieved. Power should also be extended to the Gardai to bring summary proceedings against those who commit offences under either Act or under any new tobacco control legislation that is enacted in the future. Moreover, new legislation should extend the following powers to those required to enforce tobacco controls-
(7) An exception is the Western Health Board which has successfully prosecuted three cases for illegal sales of cigarettes involving the use of a test purchase procedure using a volunteer child with parental permission. See letter of WHB of 10th September 1999 in response to queries from the Committee's Rapporteur. It is the view of the Committee that the health boards should continue to be invested with and to exercise their current statutory tobacco enforcement powers and that they should also enforce the additional tobacco control measures proposed by this Committee. An exception, however, relates to the bringing of prosecutions against tobacco companies for failing to disclose to the Minister for Health and Children the constituents of tobacco products or for violating any constituent prohibition or control order that might in the future be made. As the "constituent" request is not made by health boards and as health boards have no function in analysing the constituents/ingredients of cigarettes to ascertain whether any such prohibition or control order is being complied with, such prosecutions should only originate through the Department of Health and Children. Action required: 12. EXTRA HEALTH INSURANCE
LOADING FOR SMOKERS (8) The Department of Health and Children White Paper on Private Health Insurance (Dublin Stationary Office 1999) p.37 Action required: ANTI-SMOKING INITIATIVES 1. ALLOCATION OF GREATER
RESOURCES: Action required: 2. ANNUAL INCREASES IN
TOBACCO TAXES: As detailed in Chapter 4, very substantial revenue through tobacco taxes is received by the State. The Committee considers that a central objective in the levying of tobacco taxes should be to deter children from smoking and to reduce the disease burden caused by smoking and that the sole focus should not be on the targeting of a specific gain in revenue. Insofar as government is concerned that higher tax rates would reduce government revenues, the Committee notes that the World Bank in its report of the 17th June 1999 entitled "Curbing the Epidemic; Government's and the Economics of Tobacco Control" (9) states that "the empirical evidence shows that raised tobacco taxes bring greater tobacco tax revenues. This is in part because the proportionate reduction in demand does not match the proportionate size of the tax increase, since addicted consumers respond relatively slowly to price rises". The same report, addressing the impact on the economy of falling demands for tobacco, states "money that smokers once spent on cigarettes would instead be spent on other goods and services, generating other jobs to replace any lost from the tobacco industry. Studies for this report show that most countries would see no net job losses and that a few would see net gains if tobacco consumption fell". The Committee considers that the health goal of deterring children and adolescents from smoking and reducing the tobacco disease burden should be the central objective which informs our tobacco taxes policy. (9) See www.who.int Action required: (10) See Chapter 4 3. EXPLICIT ANTI-SMOKING
TELEVISION, CINEMA AND PRESS ADVERTISING CAMPAIGNS: (11) See www.wholetruth.com Action required: 4. INTEGRATED ANTI-SMOKING
EDUCATIONAL PROGRAMMES: Action required: 5. THE FORMATION OF A
NATIONAL ANTI-SMOKING ANTI-TOBACCO YOUTH ORGANISATION (NASTY) The philosophy behind SWAT is that youth empowerment is the best way to reach other youth about the dangers of tobacco use and smoking. From the input of SWAT, the "Truth" message and advertisements were born. SWAT creates events and activities around the "Truth" message, which is to discourage tobacco marketing to kids and to attempt to de-normalise youth tobacco smoking in communities. The "Truth" brand stands for a generation making a rebellious stand against tobacco. The four main goals of SWAT are:-
Training programmes for young people interested in joining SWAT were funded by Florida State and the organisation has rapidly and successfully spread throughout Florida (12). (12) See www.state.fl.us/tobacco SWAT as an activist organisation often conducts "in your face" activities aimed at the tobacco industry. These activities are on the youths own terms, must be within the law but are without regard to how adults might perceive them. They promote a mechanism whereby rebellious young people can take centre stage in highlighting the lies inherent in cigarette promotion activities by tobacco companies. Peer pressure currently and substantially contributes to youth smoking. Harnessing peer pressure to discourage youth smoking will substantially contribute to reducing the number of adolescents who start smoking and who get hooked on nicotine. A proposal to establish a similar organisation in Ireland to tackle the problems of "youth drink and smoking" was received by the Committee (13). It is the view of the Committee that the two issues (drink, cigarettes) should not be mixed and that a dedicated anti-tobacco youth organisation such as SWAT should be formed in Ireland. The Committee, however, agrees with the submission's central objective which is to create a new peer culture for our youth. Upon the formation of the proposed anti-smoking youth organisation, an interactive internet site should be established containing resource information and detailing the objectives and activities of the organisation and local chapters or branches should be encouraged to contribute material to it and also to develop their own linked sites. The establishment of such a site would provide an additional educational tool and focus for both primary and post-primary schools. (13) See World Alcohol and Ash Foundation, A New Peer Culture for our Youth (June 1999) Action required: 6. EUROPEAN POLICY AND
GOVERNMENT FOCUS Action required: STATE AND HEALTH BOARD SMOKING PREVENTION AND CESSATION PROGRAMMES 1. TARGETED CHILDRENS
SMOKING PREVENTION AND CESSATION PROGRAMMES: 2. ADULT SMOKING CESSATION
PROGRAMMES: 3. THE PROVISION OF SMOKING
CESSATION PRODUCTS: The rationale for excluding nicotine replacement products from the current schemes is that they do not require a medical prescription and products advertised or promoted to the public generally do not fall within the new schemes. It is illogical and contrary to basic principles of health promotion to deny the provision of or payment for products which can result in the avoidance of serious tobacco related illness and disease. As a cost cutting measure, it is also extremely short-sighted as millions of pounds are annually spent by the State and tax payers in general in meeting the cost of treating those who suffer from tobacco related illnesses. Three months after nicotine replacement products were excluded from the Drug Payment and Subsidisation Schemes, the Minister for Health and Children in reply to a Dail Question from the Committee's Rapporteur told the Dail he was going to "ask the advisory forum to the Heart Health Task Force to bring forward proposals in regard to nicotine replacement therapy and the less well off sectors in the community" (14). (14) See Vol 508 Dail Debates Col 363 (29th September 1999) It is the Committee's view that nicotine replacement products should immediately be made available to all medical card holders and should be included within the categories of products covered by the present Drug Payment Scheme. Action required: REGULAR MONITORING OF THE
PREVALENCE OF SMOKING Action required: (15) See the Durbin, DeWine, Wyden, Chafee Amendment to Tobacco Legislation proposed in the United States 105th Congress Second Session S1415 Sub-title A-Performance Objectives to Reduce Under-age Use of Tobacco Products. EXTENSION OF NEW POWERS TO JOINT OIREACHTAS HEALTH AND CHILDREN COMMITTEE 1. EXTENSION OF
COMPELLABILITY AND DOCUMENTARY DISCLOSURE POWERS Action required: 2. ADEQUATE STAFFING Action required: THE INITIATION AND PROCESSING OF LITIGATION AGAINST TOBACCO COMPANIES 1. TOBACCO LITIGATION BY THE
STATE AND OTHER STATE AGENCIES AND HEALTH BODIES
The Committee has considered the issue of the possible initiation of civil legal proceedings against tobacco companies by the State, State agencies (such as the Health Boards and the Voluntary Health Insurance Board), public and voluntary hospitals. The Committee notes that substantial taxes by way of excise duty and vat have been received by the State annually through the sale of cigarettes or tobacco products. However, at no time was it suggested that the payment of taxes properly levied on cigarettes sold by tobacco companies gave the tobacco industry a licence to kill or destroy the health of those who smoked their products. If the payment of tobacco taxes were to be accepted as a reason for not proceeding against the tobacco companies, any company or individual could be regarded as immune from suit by the State or State agencies regardless of their conduct, simply because their business activities generated revenue income. It is also important to note that the tobacco industry does not pay tobacco taxes, consumers do. The Committee has given further consideration to the fact that for many years, the State has been aware of the health risks of tobacco and despite such awareness continued to permit the sale of cigarettes and to benefit from tobacco taxes. As is evident from the proceedings of the Committee, none of the tobacco companies either manufacturing cigarettes in Ireland or distributing cigarettes on behalf of manufacturers outside the State have to-date been willing to acknowledge and accept that cigarettes are a cause of specific illnesses. At most, they are prepared to say that cigarettes are a "risk factor" amongst a variety of other risk factors. On the basis of the documentation now revealed in the United States, it is clear to the Committee that the tobacco industry and the companies which comprise it, conspired to suppress the results of their own research and deliberately engaged in a campaign of misinformation over decades. They concealed that they know nicotine to be addictive and smoking to be not simply a risk factor but a cause of premature death and disease. The Committee further notes that the only major United States tobacco company whose cigarettes are sold in Ireland which now acknowledges that cigarette smoking causes serious disease; that there is no "safe cigarette" and that cigarette smoking is addictive, is the Philip Morris company which after years of denial finally told the truth on the 14th October 1999 on its own website (16). The Committee considers that this conspiracy of the majority of tobacco companies is of a continuing nature and that they continue to financially benefit from it in the sale of their products. The Committee has considered in detail the proceedings brought by 46 States in the United States and the contents of the tobacco settlement ultimately concluded by them. It notes that collectively those States obtained the largest settlement in the history of civil litigation, worth $206 billion when measured over the 25 year period to which it is applicable. The Committee has also considered the settlements concluded in separate litigation brought by the States of Mississipi, ($3.6 billion), Minesota ($6.1 billion), Florida ($11.3 billion) and Texas ($15.3 billion) (17). The Committee also notes that on the 23rd September 1999, the Federal Government of the United States commenced proceedings against various tobacco companies to recover federal health care costs. The defendants in these proceedings include Philip Morris Inc; Philip Morris Company (18); RJ Reynolds Tobacco Company; American Tobacco company; Brown and Williamson Tobacco Corporation' British-American Tobacco Plc; British-American Tobacco (Investments) Limited; Lorillard Tobacco Company Inc; Liggett and Myers Inc.; the Council for Tobacco Research U.S.A. Inc and the Tobacco Institute. In these proceedings, it is alleged, amongst other things, that the defendants:-
(16) www.philipmorris.com/tobacco_bus/tobacco_issues/health_issues.html The Committee has considered the desirability of such proceedings being brought to claim recovery of tax payers money spent in the treatment of tobacco related illnesses. Such proceedings could be instituted by the State, State agencies (such as the health boards), public hospitals (individually or under the aegis of the health board responsible for their management) and voluntary hospitals. The Committee has also considered the possibility of the Voluntary Health Insurance Board instituting such proceedings to seek to recover insurer's monies spent on the treatment of tobacco related illnesses. In relation to the very substantial tobacco settlements effected in the United States and the proceedings now instituted by the United States Federal Government, the Committee notes that some of the tobacco companies who are a party to the States' tobacco settlement and who are defendants in the federal action sell their products in this State and have done so for decades. The Committee is also aware, as already documented, that cigarettes of the Philip Morris company, which has now admitted publicly the dangers of smoking, are imported into and sold in the State. The Committee further notes cigarettes and other tobacco products manufactured and sold in this State are not in any way substantially different from the tobacco products which have been the subject of legal action in the United States. It is the view of the Committee that legal action to recover the costs of treating tobacco related illnesses be taken by the State on a co-ordinated basis in conjunction with the state's eight health boards. It is also the view of the Committee that state agencies who have incurred expenditure which is reasonable calculable as either contributing to the treatment of tobacco related illnesses (such as the Blood Transfusion Service Board) or in the payment for treatment of such illnesses (such as the V.H.I.) should consider in consultation with the Minister for Health such legal action. Consideration should also be given by each voluntary hospital in the state to its either individually or by way of a joint action with other such hospitals initiating such proceedings. The Committee in its visits to the United States has had various discussions concerning the complexity and time consuming nature of state tobacco litigation. It notes that some states undertook such litigation through the State Attorney General's Office in co-operation with or in partnership with private law firms. The Committee further notes that the litigation in the United States which lead to the tobacco settlement may never have been initiated or achieved a successful outcome without the involvement on the State's behalf of private practice law firms. The Committee has learned that the documentary discovery process was crucial to the success of the States' proceedings and without the assistance and involvement of private practice lawyers it would have been impossible to sift through and process within a reasonable timeframe to the States' advantage. The Committee is concerned that the State legal services may presently lack the capacity to take action against the relevant tobacco companies whilst continuing to process all other legal matters for which it is responsible and could be overwhelmed by such litigation. As usual, where legal action is initiated on behalf of the State it will be processed by the Attorney General's office arranging for private Counsel to act on the State's behalf under the instructions of the Chief State Solicitor's Office. In the context of tobacco litigation, it is the Committee's view that a firm or firms of solicitors in private practice should be recruited to work in conjunction with a nominated solicitor from the Chief State Solicitors Office to process such proceedings. The appropriate mechanism to effect such an arrangement should be considered by government. Action required: (19) See further the submission received by the Committee from Ward and Fitzpatrick, solicitors (Dublin) and Haggens Berman, Attorneys, (Seattle, USA). 2. THE REMOVAL OF STATUTORY
BARRIERS WHICH COULD HINDER OR OBSTRUCT PERSONAL LITIGANTS TO INITIATE
CIVIL ACTIONS AGAINST TOBACCO COMPANIES: Action required: THE CREATION OF NEW STRUCTURES IN THE DEPARTMENT OF HEALTH AND CHILDREN There should be formed in the Department of Health and Children a new division or unit solely concerned with and dedicated to smoking and health. The staff of the section should solely deal with tobacco related issues. Its functions should include:-
The elimination of smoking by minors (persons under 18 years of age) and the targeted reduction in adult smoking proposed in this Report should be a "key priority" driving the work of the new proposed division or unit equal in priority to the "key priorities" prescribed in the Departments own strategy document for the period 1998-2001 (20). (20) See, for example, the functions of the Bureau of Tobacco Control of the Canadian Department of Health. |
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