Minister Reilly Speech at RCPI 10th Anniversary of the Smoking Ban

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Speech by Minister for Health Dr James Reilly, T.D. at the RCPI 10th Anniversary of the Smoking Ban Business Breakfast & Seminar

Minister Reilly with Professor Hilary Hoey (RCPI) and Dr Ross Morgan, Chair of ASH Ireland

Minister Reilly with Professor Hilary Hoey (RCPI) and Dr Ross Morgan, Chair of ASH Ireland

We are all here today to mark the 10th anniversary of something many people said couldn’t be done and many others felt wouldn’t be worth doing even if it could.  All of them were wrong.  Not only was the smoking ban successfully implemented research has shown that there have been 3,726 fewer smoking related deaths than expected in the decade since the ban.  In other words it has saved nearly 400 lives for each year of its existence. And if that doesn’t count as something worth doing I don’t know what does.

It is also a tremendously encouraging example of how seemingly unchangeable situations can be changed and long held habits and behaviour can be altered for the better.

We should rightfully be proud of this achievement and gain confidence from it in tackling the challenges ahead.  Because there is still a long, long way to go in the battle against tobacco addiction and its many devastating side effects.

Smoking is still a widespread addiction and one that causes damage to the health of both the immediate consumer and the individuals around them. Environmental tobacco smoke is a carcinogen. It contains the same cancer causing substances and toxic agents that are inhaled by the smoker.   We need to move to a smoke free environment as quickly as possible for the sake of the health of everyone in this country.  In a few moments I will talk about some of the actions we have taken and plan to take as we work to achieve this.

But first I want to say a little more about the people and the process that brought about the sea changing action that was the workplace smoking ban.

On 29th March 2004, smoking was prohibited in most enclosed workplaces in Ireland. This was the culmination of a long and complex five year battle.  One of the first moves in that direction was made in a 1999 report produced by my colleague Minister Alan Shatter, in his capacity as rapporteur to the Joint Committee on Health and Children, on ‘Health and Smoking’. That report identified many of the targets we continue to work towards today, and, crucially, it was the first report in Ireland to recommend a ban on smoking in indoor workplaces, restaurants, cafes and retail outlets in which food is sold, and in all licensed premises.

The report took the view – which we uphold today – that such a ban was essential to protect the health of children, teenagers, staff in licensed premises and non-smoking adult customers. It noted that restrictions on public smoking can also reduce the overall level of cigarette consumption by smokers thus reducing morbidity and mortality among adult smokers.

In the years that followed many politicians, civil and public servants, health care professionals and non-governmental organisations worked tirelessly to make the ban possible.

I want to mention the contribution of one of my predecessors, Mr Micheal Martin T.D. for his role, and that of the late Mr Tom Power, the first CEO of the Office of Tobacco Control.  I also want to acknowledge and express my gratitude for the work of The Royal College of Physicians of Ireland, ASH Ireland, and the Irish Cancer Society, the Irish Heart Foundation and indeed every individual and group everywhere who made a contribution to the process.  It truly was a collective effort.

Studies carried out since the ban was implemented have found

  • Significant reductions in air pollution in pubs and related improvements in the respiratory health of workers.
  • Reductions in emergency admissions due to respiratory illness.
  • Reductions in hospital admissions due cardiopulmonary disease.

The most recent research, published only last year, found that the smoking ban was associated with a number of immediate reductions in ill-health in the general population:

  • an immediate 13% decrease in all-cause mortality
  • a 26% reduction in ischaemic heart disease
  • a 32% reduction in stroke, and
  • a 38% reduction in COPD (chronic obstructive pulmonary disease).

In spite of the arguments beforehand against the ban, and the dire predictions on its consequences for a range of business and social interests, I must now give credit to the publicans and restaurateurs – once the ban became law it was widely embraced. Research by the National Tobacco Control Office shows that compliance with the legislation is 97%. We are, for the most part, sensible people here in Ireland – those affected by the workplace ban can see its benefits for the health of their staff, as well as for their own health and that of their families. I must also give credit to smokers for complying with the legislation, and embracing it to the extent that many now no longer smoke in their own homes.

While the workplace smoking ban was and is a great success, keeping it that way requires regular monitoring. In this regard, I want to acknowledge and express my gratitude for the work of the HSE and, in particular, the Environmental Health Teams for all the vital work they do.

The 2004 ban was the first in a series of effective measures including:-

  • The ban of the sale of 10 packs
  • The ban on candy or sweet cigarettes
  • The ban on point of sale advertising;
  • The HSE’s QUIT campaign
  • And more recently the introduction of graphic warnings on packs.

And I am delighted to say that these measures are having an effect on smoking rates.

In 2013, the National Tobacco Control Office reported that 21.5% of Irish adults smoked (22.9% men and 20.2% women).  This represents a decline of 2.2% since 2010, and a decline of 7.5% since 2007 when the last comprehensive large scale study on smoking prevalence in Ireland was undertaken (SLAN study).  Recent data on school aged children also indicates a clear downward trend. Eight out of ten 15 to 17 year olds don’t smoke, and nearly nine out of ten 12 to 17 year olds don’t smoke.

It’s vital that this momentum isn’t lost, so we are currently actively engaged in developing further measures to build on these successes. Tobacco Free Ireland, our latest policy document, sets a target of Ireland being tobacco free by 2025.  What this means in reality is a smoking prevalence rate of less than 5%.  Tobacco will still be available but at a higher price and in restricted outlets.  This is ambitious but a necessary target to aim for if we really want to transform our attitudes and behaviour and improve our health as a nation.

The main focus of Tobacco Free Ireland is on protecting children and de-normalising smoking.  As we are aware, nicotine is an immensely addictive substance. Once our children and young people start smoking they are often trapped by this addiction.  We know that 78% of smokers in Ireland began smoking before the age of 18 – so making smoking less attractive to our young people is extremely important. If we are to succeed in achieving a tobacco free Ireland, it will be essential to alter the mind-set of our young people so that they see smoking as socially unacceptable.

Tobacco Free Ireland contains over 60 recommendations, including a number of measures which, combined, will go a long way towards achieving its focus.  They include:

  • Banning smoking on the campus of primary and secondary schools and child care facilities.
  • Promoting tobacco free areas in our 3rd level campuses, sporting facilities, public parks and beaches.
  • Continuing the good work of creating smoke free playgrounds and smoke free campuses of our hospitals and health facilities.

We are already making progress; local authorities have engaged with ASH Ireland and to date 75% of county councils and 60% of city councils have introduced smoke free playgrounds.  I understand that many third level colleges throughout the country are also interested making their campuses smoke free and I would encourage them strongly to do so. The HSE is making great progress with its Tobacco Free Campus programme; at the beginning of February this year, I am pleased to say that the smoke free policy had been implemented in 92% of HSE acute hospitals nationally.

Ireland has a strong track record in the area of tobacco control policy, and is regarded internationally as a leader in the area, ranked second out of 30 European countries in terms of tobacco control. The workplace ban had a significant impact internationally, with several countries, including the UK, following Ireland’s example.  But smoking is a global problem so to successfully reduce its influence and impact we have to look beyond our own shores for initiatives and support.

During our recent Presidency, Ireland made great progress chairing the negotiations on the revised Tobacco Products Directive. This was no easy task, but I was pleased to achieve the outcome of an agreed position among the Member States at Council in Luxembourg in June.  I am delighted that the Tobacco Products Directive has now been agreed and that, despite intense tobacco industry lobbying, the European Parliament voted in its favour on 26th February 2014. The Directive is a crucial step in protecting public health and in harmonising the marketing of tobacco products at EU level.

The Irish public have shown a healthy appetite for the introduction of tobacco measures.  In a recent report undertaken by the European Commission, Irish citizens were in the top rankings in their support of initiatives relating to tobacco.  We were the highest ranking in our support of banning advertising from the point of sale in shops, a ban which has already been introduced in Ireland.  Also we ranked top in our support of banning the sale of tobacco on the internet; and banning of colours, logos and promotion elements from cigarette packs.  This is important evidence of support in my view.

I was very pleased that we received approval from Government last November to publish the General Scheme of a new Public Health (Standardised Packaging of Tobacco) Bill 2013, and to proceed with the drafting of a Bill. The General Scheme was referred to the Joint Oireachtas Committee on Health and Children, which held a series of public hearings on the matter, concluding on 13th February 2014.

Plain or standardised packaging means that all form of branding – trademarks, logos, colours and graphics would be removed from tobacco packs.  The brand and variant names would be presented in a uniform typeface for all brands and the packs would all be in one plain neutral colour.

People love brands.  Young people in particular love brands.  Even if, in the case of their chosen cigarette brand, it may well kill them. The tobacco industry knows this and has invested heavily in pack design in order to communicate specific messages to specific groups.  And it’s working.

Despite the ban on tobacco advertising, the ban on point of sale display and the introduction of graphic warnings, a gap still exists which I believe can now be eliminated by the introduction of standardised packaging.

Australia was the first country in the world to introduce plain packaging in December 2012.  While it is too soon to fully evaluate the impact of this policy in practice, research is already available to us on the effects of tobacco packaging in general.  It indicates that standardised packaging can reduce the appeal of tobacco products and increase the effectiveness of health warnings.  In addition, it reduces the ability of branded tobacco packaging to mislead people about the harmful effects of smoking.

We are also working towards introducing legislation to prohibit smoking in cars where children are present.  The legislation stems from a Private Members Bill initiated in the Seanad by Senators John Crown, Mark Daly and Jillian van Turnhout. I would like to be clear that prohibiting smoking in cars where children are present is not about restricting the rights of adults but is about protecting children.

Because they don’t get to choose whether or not they travel in those cars. We cannot allow a situation where people and, in particular children, are involuntarily exposed to tobacco smoke.  Smoking is optional – breathing is not.

So today is about taking time to celebrate success and also, I hope, to forge ahead with renewed enthusiasm for in the effort to bring about a tobacco free Ireland.

To illustrate how vital that goal is I can think of no better way to close than with the words of former World Health Organisation Director General, Dr Gro Harlem Bruntland

A cigarette is the only consumer product which when used as directed kills its consumer.”

1 in every 2 smokers will die of a tobacco related disease.

Our task is to bring that reality home to the hearts, minds and actions of every Irish citizen and through information, education, initiatives and, where necessary, legislation.

The workplace smoking ban shows that things thought to be impossible can be achieved so I have every confidence that we can achieve even more impossible things in the months and years ahead.

Thank you.