ASH Ireland feels it’s important to draw attention to a report published by the W.H.O. in June 2014, which confirms a specific link to smoking and dementia.
This study, which reviewed publications dating back to 2007 provides us with a comprehensive assessment and a clear view on the dementia risk.The report also confirms that up to 14% of Alzheimer’s disease cases can be attributed to smoking.
Dementia is a disease of particular concern as there is no established cure.It is estimated that 7.7 million new cases are diagnosed each year with the worldwide cost for treatment running in the order of US$604 billion annually.
To date all in the health sector and wider society have been concerned about the established link between smoking and other diseases such as cardiovascular disease and cancer.However, this confirmed link with dementia and smoking is of immense concern and should contribute to governments all around the world introducing more extensive and more stringent pro-health legislation.
ASH Ireland welcomes the announcement by the HPRA that nicotine replacement therapy products will be now become available on general sale, as opposed to being available only in pharmacies. This wider availability of nicotine replacement therapy should be of assistance to smokers who wish to quit, both in respect to greater availability and reduced cost, which hopefully will now emerge.
The availability of nicotine replacement therapy is widely accepted as one of the factors which assist smokers in quitting. ASH Ireland raised the possibility of nicotine replacement therapy being made available on general sale with the Irish Medicines Board which preceeded the Health Products Regulatory Authority, the providers concerned and IPHA in 2013. We are very pleased that a decision has now been taken, which will assist consumers who are considering or involved in the decision to quit smoking.
ASH Ireland has consistently called for significant increases in the price of tobacco as a way of encouraging smokers to quit and discouraging young people from experimenting with tobacco products. There is evidence to show that the more significant the price increase, the more significant the related outcome in terms of reducing smoking prevalence. One study shows that an increase of €1 on a pack of cigarettes could lead to a reduction of 4% in the number of people who smoke. ASH Ireland has and will continue to support Minister Reilly in his ongoing efforts to tackle smoking in Irish society and we are fully supportive of his endeavours to reduce smoking prevalence in Ireland to 5% by 2025. The stark reality remains that 5,200 people die from tobacco related disease in this country every year and we spend well over €1 billion on treating a range of tobacco related diseases annually.
ASH Ireland strongly supports a call from the World Health Organisation (W.H.O.) for Governments all around the world to increase taxes on tobacco products. This intervention by the W.H.O. is made in the context of World NO Tobacco Day, which falls on Saturday 31st May 2014.
Dr Ross Morgan Chairman of ASH Ireland, said today, ‘Tobacco kills 5,200 people in this country every year, with some 500,000 in Europe and 6m around the world. It is well established that higher priced cigarettes are especially effective in reducing smoking in lower income groups and in preventing young people from starting to smoke’
Dr Morgan continued, ‘It is also established that a 10% increase in tobacco price can reduce smoking prevalence by 4% in high-income countries and by up to 8% in low-income countries. On this basis; If the Government put an extra 90c on a pack of 20 and related products in the next budget, we can take smoking prevalence to under 18% of the population. This would save lives and significantly reduce the annual health spend on tobacco related disease’
ASH Ireland has consistently called on successive Governments to increase taxes and tobacco price. The response has generally been to place a zero or very small increases, such as 10c – and as the smoker largely ignores small increases – no benefit has emerged.
Ends
For contact: Wally Young, Young Communications – 087 2471520
Like most health focussed organisations, ASH Ireland is keeping the issue of e-cigarettes constantly under review. Despite an initial hope that these products could be of assistance in regard to cessation, we are now forming a view that this product, which is being marketed forcefully by the Tobacco Industry, may become another addictive product with few benefits and little impact on smoking cessation possibilities. We have noted and responded to the Irish health authorities (HSE) decision to ban e-cigarettes in all its facilities. We have also noted that in some jurisdictions e-cigarettes are being banned, and in other countries such as Ireland, authorities are struggling with the appropriate response. The lack of regulation in regard to manufacture, content levels and marketing is an on-going concern. E-cigarettes, despite their current presentation as an attractive item on the one hand, and less harmful than tobacco on the other, carry nicotine which is highly addictive and can be dangerous if not consumed in appropriate and recommended doses. Some recent publicity is actually highlighting the poisonous qualities of nicotine in the e-cigarette environment.
The lack of definite research in regard to benefits or cessation possibilities in regard to the use of e-cigarettes is an on-going concern, as some years ago there were expectations that such outcomes could have been possible.
As the Tobacco Industry has invested heavily in this product; it will be more difficult to see any agenda other than profit being pursued by the manufacturers.
ASH Ireland will continue to keep the e-cigarette environment under review and we will continue to communicate with the Irish government in regard to the publication of guidelines and regulation on this product.
ASH Ireland takes this opportunity to congratulate all involved at Westport College of Further Education on its announcement today that the college campus will henceforth be smoke-free.To our knowledge, Westport College of Further Education is the first third level college in Ireland, or perhaps in Europe, to announce a smoke-free campus policy.We wish Westport College every success with this hugely important health initiative and we encourage other third level institutions to adopt a similar policy.
Dr Ross Morgan, Chairperson of ASH Ireland said today “ASH Ireland is particularly pleased with the announcement by Westport College of Further Education today; as we were the first organisation to propose such an initiative with Ireland’s third level sector, as far back as January 2011.In 2011 we contacted all third level colleges asking them to consider voluntarily introducing a smoke-free campus policy.This policy is in keeping with a major initiative undertaken by the third level sector in the United States, which has led to well in excess of 1,000 colleges having implemented a smoke-free campus policy.Some US Colleges have done this on a local rule basis, while others have secured the support of the state legislators”.
Dr Ross Morgan went on to say, “In 2011, ASH Ireland organised a seminar for third level colleges, designed to explore this initiative – and we have had meetings with many colleges in the sector who are now actively considering going smoke-free. We prepared a toolkit which has been forwarded to all colleges to assist them with the evaluation, planning and consultation required to implement such a policy.ASH Ireland is very aware of the power of any initiative which denormalises smoking behaviour.
ASH Ireland has been directly involved in lobbying for the ban on tobacco advertising, the ban on smoking in the workplace, the ban on marketing and display of tobacco products in retail outlets and more recently, for the introduction of legislation which bans smoking in cars transporting children.All of these initiatives including a smoke-free campus policy will assist in denormalising smoking and this in itself will assist smokers to quit and greatly assist young people in deciding not to experiment with tobacco products.We congratulate Michael Murphy, the Principal and all those involved in Westport College of Further Education on the announcement of the introduction of a smoke-free campus policy today.”
ASH Ireland supports HSE’s announcement today, to ban the use of electronic cigarettes on all HSE campuses – effective from 1st May 2014.The market for electronic cigarettes has expanded greatly in recent years; mainly because of major a marketing drive and the more recent investment by the Tobacco Industry.
Initially many people in the health sector felt there could be some potential in electronic cigarettes being used as a cessation tool; however there is no evidence to support that this is actually happening, which is very disappointing.
Until there is clear evidence available to support the use of electronic cigarettes as an asset in cessation, then there is no justification for this product being used in any health sector environment.
ASH Ireland would welcome more definitive research on electronic cigarettes and we would certainly welcome regulation of this product in regard to manufacture, content, sale and marketing.
All of us can look back with pride on the decision of the Irish government to introduce workplace smoking legislation on 29th March 2004 – 10 years ago. This health initiative has been replicated by countries all around the world, and the Irish government, that took such a brave and revolutionary decision have been rightly complimented for this lifesaving health initiative.
When we look back some 10 years we have to ask how an Irish government could have developed consensus around this initiative, tackled major opponents and simply put the health of the nation ahead of the wishes of well-established profit based vested interests. It all seems so obvious now, but at the time and in its time, this was ground-breaking.
There were a number of key factors which perhaps contributed to the Irish government’s decision. There was significant exposure of key information regarding the international Tobacco Industry in the 1990’s. This primarily emerged through major litigation against the industry in the United States. The World Health Organisation also decreed that environmental tobacco smoke was a Class A carcinogen and this essentially changed the entire debate. One could say that the individual has a right to smoke and suffer the health consequences, but that no individual should have the right to smoke in areas where other persons could be harmed. Clearly the workplace, which included bars and restaurants in particular, could be clearly defined as areas where environmental tobacco smoke harmed the non-smoker.
The revelations around the practices and activities of the Tobacco Industry through the US litigation also led to a significant reduction in the impact of their global advocacy machine. Governments, especially in the US, Europe and Australia became more questioning and in many ways were left with little option but to address the serious issues which had now been clarified in regard to the harmful effects of smoking and crucially, second-hand smoke.
During the 1990’s some major pro-health and anti-tobacco advocates became more prominent in Ireland, one of those being ASH Ireland. Two of its leading spokespeople at this time, Professor Luke Clancy and Dr Fenton Howell, had a deep interest in the harmful effects of tobacco, and the questionable practices of the Tobacco Industry. Groups such as ASH Ireland, the Irish Cancer Society and the Irish Heart Foundation ensured that the Joint Oireachtas Health Committee, under Deputy Batt O’Keeffe, examined the possibility of a workplace smoking ban in 2001.
In 2002 Dr Shane Allwright from Trinity College researched a range of available evidence on environmental tobacco smoke and produced a report entitled “The health effects of environmental tobacco smoke in the workplace”. This report essentially found that employees must be protected; that ventilation was ineffective; that environmental tobacco smoke causes heart disease, respiratory problems and cancer; and critically that legislation was required to deal with this. In responding to the report Minister Micheál Martin said “There is no moral option open to me other than to take action…. this report changes everything”.
The old arguments which had been put forward by the vested interests who were opposed to a workplace smoking ban were:
• Environmental tobacco is harmless;
• Ventilation works;
• Severe economic consequences will emerge from such a ban;
• This ban represents a nanny state policy.
These arguments were firmly rejected by the Allwright report and the leadership taken at this time by Minister Martin in introducing the legislation was critical.
It is also very clear that Tom Power, a most astute and strategic civil servant in the Department of Health, now deceased, was a key player in the entire process of planning for, and the introduction of the workplace smoking legislation.
From early on it was obvious that Minister Martin and the government would have significant support; emerging from opposition parties, the public service, the unions, and in particular major health bodies within the NGO sector. The introduction of the legislation in March 2004 represented a major success by the pro-health coalition and a major defeat for the Tobacco Industry and its partners. As other countries examined the possibility of introducing workplace smoking bans, they consulted with some of those organisations involved here in Ireland, and essentially adopted the Irish model as a way of implementing this health initiative.
The overall support among the Irish public for the workplace smoking legislation runs continuously, at 90% or greater. Whereas there is no direct scientific correlation, smoking prevalence in Ireland has been reduced from 29% to 21.7% over the past 10 years. In evaluating the drop in prevalence we also have to consider the introduction of the ban on advertising and promotion in retail outlets, and the greater awareness worldwide of the health risks directly linked to smoking and passive smoke.
In more general terms, we now have bars and restaurants that are generally smoke free and more importantly, carcinogen free. We are also aware that people who suffered from respiratory diseases such as asthma found it very difficult to socialise in bars and restaurants prior to the ban. Thankfully for them this is not now the case.
Evidence continues to accumulate for large public health benefits since the ban. Immediate improvements in lung function tests and reductions in symptoms were reported by barmen. Subsequently reductions in death rates, with specific benefits observed in heart attack, stroke, and respiratory disease have been found and these findings replicated in other parts of the world. Importantly, these benefits have persisted with longer follow up and been shown to be proportional to the extent of the smoke-free environment; the more comprehensive and encompassing the legislation the more significant the public health benefit.
At a recent seminar to celebrate the 10th anniversary of the introduction of the ban Professor Luke Clancy of the TobaccoFree Research Institute Ireland advised us that, as a direct result of the ban in Ireland, over 3,700 smoking-related deaths have been prevented in this country – and this is a very important bottom line. In addition, the smoking ban has been shown to reduce the number of small-for-gestational age or pre-term birth rates, demonstrating benefits from early life in a vulnerable population group.
ASH Ireland is firmly of the view that we must continue to introduce legislation and support initiatives which continue to denormalise smoking and protect the health of our citizens. Without doubt all of us in the medical profession have a specific responsibility in this area. ASH Ireland is strongly supportive of Minister Reilly’s plans to introduce a ban on smoking in cars transporting children; an initiative first raised by ASH Ireland, and we are also strong supporters of the proposal to introduce standardised packaging of tobacco. Currently ASH Ireland is involved in encouraging all county councils to introduce smoke-free children’s play areas and we have had a 75% positive response on this initiative.
Over the past 3 years we have been liaising with the third level sector with a view to voluntarily introducing smoke-free campuses and we are very pleased to confirm that several of our third level institutions are evaluating this health initiative.
Recently we have contacted the three main sporting bodies in this country, the FAI, IRFU and the GAA to again ask them to consider voluntarily introducing smoke-free stadia at local, regional and national level. This has the potential to be a vitally important initiative in regard to the de-normalisation of smoking among our young population.
Much has been achieved in this country in fighting the scourge of tobacco and nicotine addiction, but there is much more that can be done in assisting our citizens to quit and discouraging our young people from commencing the habit.
Yesterday (3 April 2014), was a good day for progressive health policy on these islands. Our Oireachtas Committee on Health and Children published a most progressive report on plain packaging legislation; while in Britain there has been a very positive indication yesterday that similar legislation to that which is being introduced in Ireland could emerge after a brief period of consultation.
The Joint Oireachtas Committee, which has made twenty-six recommendations in total, has presented its report on the Public Health (Standardised Packaging of Tobacco) Bill 2013 to the Minister for Health James Reilly. These include:
• the standardisation of the size of tobacco packaging;
• the inner packaging of tobacco products to be the same colour as the outside surface;
• a separate and distinct definition for brand, company and business name so as to prevent tobacco manufacturers from promoting brand variants to the status of brands; and
• the maximum length/number of characters in brand and variant names.
• Brand and variant names appearing on individual cigarette sticks should also be prohibited.
• Information messages which set out the ingredients and emissions of tobacco products, should be required on at least one side of tobacco packaging.
The Committee, under Deputy Gerry Buttimer, has also recommended that consideration should be given to the introduction of a ‘polluter pays’ type levy on tobacco manufacturers to be used to offset the health care costs associated with tobacco use. This proposal has been included in the ASH Ireland pre-budget submission for the past five years.
Speaking today, Dr Ross Morgan, Chairman ASH Ireland said, “Effective pro-health anti-tobacco legislation is a vital tool in the battle against smoking and nicotine addiction. Our Oireachtas Committee has met with various health bodies and other pro tobacco vested interests in its deliberations and has made important recommendations in support of the ‘standardised packaging legislation’. We now urge Minister Reilly to proceed without delay and introduce this health legislation and be encouraged that Britain has also decided to once again follow the Irish lead in the publication of the “Report of the Independent Review undertaken by Sir Cyril Chantler” yesterday which is a significant step closer to the introduction of plain packaging legislation in the UK.
Back Row L/R: Dr Kristina Mauer-Stender, Dr. Pat Doorley Front Row: L/R: Prof. Greg Connolly, Prof. Luke Clancy, Minister James Reilly, Deputy Micheál Martin, Prof. Hilary Hoey, Dr Ross Morgan
This morning (24th March 2014) a major academic Symposium was organised by ASH Ireland, Royal College of Physicians of Ireland (RCPI) and Tobaccofree Research Institute Ireland, in celebration and in recognition of the 10th anniversary of the introduction of the workplace smoking legislation in Ireland on 29th March 2004. The seminar was held at the Royal College of Physicians of Ireland on Kildare Street.
Prior to the Symposium, which commenced at 10.00 a.m., a business breakfast was also held at the RCPI, which was attended by many of those who were directly involved in advocating for and introducing this ground-breaking health legislation 10 years ago. The breakfast was addressed by both Minister for Health, Dr James Reilly, and Opposition Leader Micheal Martin, who was the Minister responsible for the introduction of the workplace smoking legislation in 2004.
Speaking today, Dr Ross Morgan, Chairperson of ASH Ireland said “We have decided to formally recognise the introduction of Ireland’s workplace legislation here today, as it has not just been remarkably successful here in Ireland, but has also been replicated in countries all around the world. All involved should feel very proud of what this legislation has achieved for the nation’s health. Lives have been saved by the introduction of the legislation and that is a very important bottom line”
Dr Pat Doorley, Chair of the Royal College of Physicians of Ireland Policy Group on Tobacco said “Ireland is a world leader in successfully implementing a workplace smoking ban, with many countries having followed suit since its introduction in 2004. It is the world’s first country to introduce smoke-free bars and restaurants. Since the ban came into effect, smoking prevalence has dropped from 28-21% and the growing denormalisation of smoking has led to less young people picking up the habit. “
Addressing the seminar this morning Professor Luke Clancy, Director of the TobaccoFree Research Institute Ireland, who as Chairperson of ASH Ireland in 2004was one of the main drivers for the introduction of the legislation said, “On the 29th of March 2004, Ireland became the first country in the world to implement comprehensive national smokefree workplace legislation, which protects all workers equally including those employed in the hospitality sector, in particular pubs and clubs. Since then, many countries throughout Europe and elsewhere have followed suit by enacting comprehensive or partial bans.
While smoking prevalence and second-hand smoke exposure rates were on the decline before the legislation, over a quarter of the population were still current smokers and a significant body of workers, particularly those in the hospitality industry were still exposed to environmental tobacco smoke (ETS) or secondhand smoke (SHS) continuously in their place of work. The National Survey of Lifestyles Attitudes and Nutrition (SLAN) conducted in 2002 showed that 29% of men and 16.6% of women reported often spending part of their day exposed to SHS in their workplace with exposure rates much higher among those working in pubs or clubs (47.3% of men and 31.6% of women).
When Ireland introduced its comprehensive smokefree laws, including all service and entertainment industries and most prominently pubs and clubs, the economic boom known as the Celtic Tiger was at its peak. Threats of loss of employment, damage to tourism and loss of taxes, while arguably unfounded and needing refutation were not serious challenges to a confident thriving economy with a “can-do” national attitude. It also meant that the resources necessary to implement the law and auxiliary policies, such as treatment of tobacco dependence, were available.”
A full synopsis of Professor Clancy’s address is at 1 below.
Professor Greg Connolly of the Harvard School of Public Health and a recognised international expert on tobacco and health said this morning “Ireland was the first and possibly least likely nation to adopt the world’s first Clean-In-Door air law in March, 2004. This law protected the health of the most vulnerable of Society from lung cancer among healthy exposed non smokers and bar and restaurant employees as well as respiratory illness particularly among children. The law was the central element of the Framework Convention for Tobacco Control . Through this law the small country’s contribution to global health became immeasurable. Irish action affirmed the ability of all nations to do the same despite fierce tobacco industry opposition. More importantly the action made real that all of the articles of the FCTC could be implemented globally. The roar of the Celtic Tiger was heard in every parliament and Congress throughout the world and was sufficient to counter the false messages of the tobacco industry with science, moral virtue, political leadership and concrete strategies for success. Ireland’s contribution was precise and strategic than simply passing a law. It established clear guidelines for other nations to follow on how to foster social support, the importance of monitoring compliance with the law once passed, and the need for economic and scientific evaluation of benefits from Clean Indoor Air laws once enacted.”
A full synopsis of Professor Connolly’s address is at 2 below.
Dr Kristina Mauer-Stender of the World Health Organisation addressed the seminar and said, “In order to talk about our future vision for tobacco control in Europe, we have to look into the past. What has happened in Europe in tobacco control since the adoption of the first ever international health treaty, WHO Framework Convention on Tobacco Control ten years ago? Are European adults and youth smoking less? Have countries been committed to health and taken bold actions in tobacco control? Who have been leaders we can be proud of and learn from?
In light of the newly adopted global voluntary targets on non-communicable diseases by 2025, what is the vision of Europe in terms of achieving the global target, 30% decrease in tobacco use in 10 years? Are we ready to look beyond tobacco control and start discussing about a Tobacco Free Europe?
Key questions are what should be done and how to make the 2025 target a reality in Europe? And is a Tobacco Free Europe inspiring and realistic?”
A full synopsis of Dr Maurer-Stender’s address is at 3 below.
Dr (Senator) John Crown delivered a paper to the seminar entitled “Politicians, scientists, the Tobacco Industry and the WHO FCTC (Framework Convention for Tobacco Control) Article 5.3: He said, “Every day in Ireland, five people get the news that they have incurable fatal lung cancer. In 95% of cases, their illness was caused by smoking. Smoking remains the leading cause of preventable death in Ireland and other western countries through numerous cancers, heart disease and stroke.
Tobacco kills approximately 100 times more Irish people annually than illegal drugs. If it was discovered tomorrow, it would surely be illegal. Everyone knows smoking is bad for you. Most smokers want to quit. But smoking is an addiction.
Tobacco companies must recruit 50 new tobacco addicts daily just to replace the deaths that are caused by their own products. In 80% of cases, these novice smokers are children. Big tobacco will deny the reality that its business plan can be summed up in four words: “addict children to carcinogens”.
Big tobacco wants more people smoking, whereas public health policy is aimed at reducing and ultimately eliminating tobacco use. For these reasons, the goals of public health and those of big tobacco are fundamentally incompatible. Their relationship must be perpetually adversarial and unremittingly hostile.
A full synopsis of Dr Crowns address is at 4 below.
Dr Pat Doorley, Chair of the Tobacco Policy Group, Royal College of Physicians of Ireland said this morning, “Tobacco is a lethal and addictive drug that kills when used as intended. It is the most deadly consumer product ever to be marketed. It is fully attributable to serious and fatal cardiovascular and respiratory disease as well as lung cancer and other cancers. While great progress has been made in the fight against tobacco in Ireland, the fact remains that one in every two smokers will die of a tobacco related disease. We need to act now to wipe out this statistic and we call on the Government to act on the recommendations set out in the new Tobacco Policy Statement as issued by the Royal College of Physicians today.”
A full synopsis of Dr Doorley’s address is at 5 below.
ENDS
Media Enquiries:
Siobhán Creaton, Communications Manager Royal College of Physicians of Ireland:
Mr Wally Young, Public Relations Advisor: 087 2471520
Note to Editors
ASH Ireland
ASH Ireland, founded in 1992 is the leading anti-tobacco advocacy organisation in Ireland. It continues to work towards creating a tobacco-free society in Ireland so that a greater number of our citizens can be protected from the scourge of nicotine addiction and the illnesses caused by tobacco use. For further information check www.ash.ie
Royal College of Physicians of Ireland
The Royal College of Physicians of Ireland (RCPI) is Ireland’s largest post graduate training body for doctors. Founded in 1654, the college seeks to promote health nationally and internationally and play a leading role in the delivery of high quality patient care by setting and maintaining standards of medical practice and promoting clinical excellence.
As part of this commitment to improving healthcare and public health, RCPI convenes a number of issue-focused policy groups where medical and other experts can meet to discuss the issues and concerns about a specific health matter with the aim of producing evidence based policy statements that outline the issues, propose specific steps to deal with the issues, and clarify RCPI’s position.
In response to the continuing public health consequences associated with tobacco, and building on RCPI’s past work on smoking, a policy group on tobacco was established in early 2014. The overall aim of the policy group is to influence national tobacco policy and legislation, particularly in support of the Tobacco Free Ireland plan launched by the Minister for Health in 2013. The policy group comprises representatives from a range of medical specialties, from within RCPI’s own Faculties and Institute, and from other external bodies such as the Irish College of General Practitioners, the Irish Thoracic Society and the Psychological Society of Ireland.
TobaccoFree Research Institute Ireland
The TobaccoFree Research Institute Ireland (TFRI), under the leadership of the Director General, Professor Luke Clancy, was founded in 2002 and supports the development of a tobacco free society by engaging in research in all aspects of tobacco from a public health perspective.
Professor Luke Clancy2004 – A new beginning for Smokefree Ireland
On the 29th of March 2004, Ireland became the first country in the world to implement comprehensive national smokefree workplace legislation, which protects all workers equally including those employed in the hospitality sector in particular pubs and clubs. Since then, many countries throughout Europe and elsewhere have followed suit by enacting comprehensive or partial bans.
While smoking prevalence and second-hand smoke exposure rates were on the decline before the legislation , over a quarter of the population were still current smokers and a significant body of workers, particularly those in the hospitality industry were still exposed to environmental tobacco smoke (ETS) or secondhand smoke (SHS) continuously in their place of work. The National Survey of Lifestyles Attitudes and Nutrition (SLAN) conducted in 2002 showed that 29% of men and 16.6% of women reported often spending part of their day exposed to SHS in their workplace with exposure rates much higher among those working in pubs or clubs (47.3% of men and 31.6% of women).
When Ireland introduced its comprehensive smokefree laws, including all service and entertainment industries and most prominently pubs and clubs, the economic boom known as the Celtic Tiger was at its peak. Threats of loss of employment, damage to tourism and loss of taxes, while arguably unfounded and needing refutation were not serious challenges to a confident thriving economy with a “can-do” national attitude. It also meant that the resources necessary to implement the law and auxiliary policies, such as treatment of tobacco dependence, were available.
Somewhat more difficult was the cultural shift required to countenance what was pushed by opponents of the ban as an infringement of freedom. Research had shown that support for the ban was strong and not confined to non-smokers but yet the image of the poor old man being pushed out into the cold, wet, night air to have his cigarette was powerful. Irish people in Ireland have always been slow to officially complain so the vast majority who were non-smokers would never complain about SHS in a pub while it was legal. This raised serious doubts in some people’s minds about whether the law would be obeyed even if introduced. They argued that the cigarette and the pint were inseparable and nobody was going to interfere and policing the law was not going to be feasible. They forgot two very important precedents. In 1990, a much less affluent time, similar arguments had been current in the debate about making Dublin coal free and again a few years before the smokefree laws Ireland had banned plastic bags for routine use in supermarkets and shops. In both cases the law was accepted overnight with almost full compliance immediately and permanently. The Irish public were no more going to accept that dirty, unhealthy smoke filled pubs were here to stay than that Dublin should be smothered in dense preventable smog. The cure had been offered and they embraced it with gusto making the Smokfree law the most popular event in 2004 in an RTE national poll.
A comprehensive review of the international literature carried out by respected scientists who had not been involved in the campaign and Chaired by Prof Allwright concluded that SHS has many adverse health effects, exposure infringes on the basic human right to good quality air. Problematically from an advocacy stance it stated that further research was required to measure and monitor occupational exposures and adverse health outcomes in Irish workplaces, and that high risk groups, specifically hospitality workers, pregnant workers, and those with genetic susceptibilities to SHS require special consideration. This weakened the rationale for immediate comprehensive legislation and was seized on by the Tobacco industry
International/exogenous factors
Meanwhile, eyes were on the USA where some states were introducing bans on smoking in the workplace which extended to bars and restaurants. These successful examples proved that comprehensive bans were implementable and enforceable, at least in America, and gave a preview of the tobacco industry’s tactics in their effort to subvert legislative measures, which would later be repeated in other jurisdictions.
Kingdon’s (1984) three stream policy model suggests that policy windows open, allowing issues to feature on the political agenda, when the three streams – the problem stream, the policy (solution) stream and the politics stream collide. The NGO demand led by ASH Ireland for a comprehensive ban on workplace smoking (policy stream) was a feasible solution to the problem of workplace exposure to second-hand tobacco smoke (problem stream), which already had significant cross party support led by Michael Martin (politics stream).
Arguments for this model strongly emphasised that hospitality workers were entitled to the same level of protection as government, professional or office workers. Mandate Trade Union, representing workers in the Dublin bar trade, actively advocated for a ban on smoking that extended to all hospitality venues and built support among their membership by giving information to them about the risks to their health of any exemptions in the hospitality sector and played a key role in supporting the Minister for Health’s commitment to a comprehensive workplace smoking ban. The resulting health benefit and reduction in exposure was closely monitored.
A comprehensive review of the international literature carried out by respected Irish scientists who had not been involved in the campaign concluded that SHS has many adverse health effects, exposure infringes on the basic human right to good quality air. Problematically from an advocacy stance it stated that further research was required to measure and monitor occupational exposures and adverse health outcomes in Irish workplaces, and that high risk groups, specifically hospitality workers, pregnant workers, and those with genetic susceptibilities to SHS require special consideration. This weakened the rationale for immediate comprehensive legislation and was seized on by the Tobacco industry.
2.Professor Gregory Connolly
The Scientific and Moral Roar of the Celtic Tiger
Ireland was the first and possibly least likely nation to adopt the world’s first Clean-In-Door air law in March, 2004. This law protected the health of the most vulnerable of Society from lung cancer among healthy exposed non smokers and bar and restaurant employees as well as respiratory illness particularly among children. The law was the central element of the Framework Convention for Tobacco Control . Through this law the small country’s contribution to global health became immeasurable. Irish action affirmed the ability of all nations to do the same despite fierce tobacco industry opposition. More importantly the action made real that the all of the articles of the FCTC could be implemented globally. The roar of the Celtic Tiger was heard in every parliament and Congress throughout the world and was sufficient to counter the false messages of the tobacco industry with science, moral virtue, political leadership and concrete strategies for success. Ireland’s contribution was precise and strategic than simply passing a law. It established clear guidelines for other nations to follow on how to foster social support, the importance of monitoring compliance with the law once passed, and the need for economic and scientific evaluation of benefits from Clean Indoor Air laws once enacted.
As the first nation, Ireland willingly providing technical assistance, support, training and research to every nation that asked. This contribution contributed to the majority of high income nations passing comprehensive Clean Indoor Air (CIA) laws over time. Yet, progress has been slower in low and middle income nations with some passing CIA laws but not implementing them.
This presentation will review how the Irish experience can be translated to all nations including the infrastructure needed to create the social and political will do so as well, methods for assuring compliance and research needs to prevent attempts to weaken a law.
The presentation will review adoption of CIA laws globally and critically assess actual compliance though presentation of air measurement studies from selective nations. Based on the Irish experience it is clear that regional and international corporation is needed and mechanism must be developed to foster multinational systems particularly for adoption and compliance.
As new challenges emerge in the 21st century such as the complaints of the multinational companies to the proposed EU directives backed by the US Trade Office, the scientific and moral roar of the Celtic Tiger maybe the single most important voice for protecting health in low and middle income nations from the new globalized tobacco authoritarianism that fails to value human life.
3. Dr Kristina Mauer-Stender
Tobacco control – the next 10 years
In order to talk about our future vision for tobacco control in Europe, we have to look into the past. What has happened in Europe in tobacco control since the adoption of the first ever international health treaty, WHO Framework Convention on Tobacco Control ten years ago? Are European adults and youth smoking less? Have countries been committed to health and taken bold actions in tobacco control? Who have been leaders we can be proud of and learn from?
In light of the newly adopted global voluntary targets on non-communicable diseases by 2025, what is the vision of Europe in terms of achieving the global target, 30% decrease in tobacco use in 10 years? Are we ready to look beyond tobacco control and start discussing about a Tobacco Free Europe?
Key questions are what should be done and how to make the 2025 target a reality in Europe? And is a Tobacco Free Europe inspiring and realistic?
4. Dr (Senator) John Crown
Politicians, Scientists, the Tobacco Industry and WHO FCTC Article 5.3
Every day in Ireland, five people get the news that they have incurable fatal lung cancer. In 95% of cases, their illness was caused by smoking. Smoking remains the leading cause of preventable death in Ireland and other western countries through numerous cancers, heart disease and stroke.
Tobacco kills approximately 100 times more Irish people annually than illegal drugs. If it was discovered tomorrow, it would surely be illegal. Everyone knows smoking is bad for you. Most smokers want to quit. But smoking is an addiction.
Tobacco companies must recruit 50 new tobacco addicts daily just to replace the deaths that are caused by their own products. In 80% of cases, these novice smokers are children. Big tobacco will deny the reality that its business plan can be summed up in four words: “addict children to carcinogens”.
Big tobacco wants more people smoking, whereas public health policy is aimed at reducing and ultimately eliminating tobacco use. For these reasons, the goals of public health and those of big tobacco are fundamentally incompatible. Their relationship must be perpetually adversarial and unremittingly hostile.
This is why I recently published the Protection of the Public Interest from Tobacco Lobbying Bill, which aimed to restrict and make more transparent, any meetings between the tobacco industry and our Government.
Big tobacco is not and cannot be the Government’s partner in any sort of enterprise.
Big tobacco has just one agenda: it wants to sell tobacco.
Big tobacco is incredibly rich and terrifyingly powerful.
Big tobacco uses the subtle weapons of lobbying, legal intimidation and bribery.
Big tobacco does everything in its power to thwart the tobacco control policies of democratic Governments.
Despite having a campaigning and committed anti-tobacco Minister for Health, the track record of the current Government in respect of tobacco control legislation is poor. I have published two Bills – one is making very slow progress and the other was opposed by the Government.
The Government has passed a Bill which has actually made it easier to sell cheap tobacco to kids. It was forced on us by the European authorities and the commercial authorities. Shame on them for making us do this.
I completely support the Minister’s proposed Bill, which would introduce mandatory plain packaging with explicit health warnings.
Let us be blunt; the tobacco industry imposed the death penalty on our citizens. There is nothing disproportionate about us criminalising any part of its activities.
5. Dr Pat Doorley
Moving towards a tobacco free society in Ireland
Ireland’s largest postgraduate training body for doctors, the Royal College of Physicians of Ireland’s Policy Group on Tobacco is today calling on the Government to continue to adopt strong policy measures to reduce the harm caused by smoking. Dr Doorley will launch the group’s new policy that includes a series of recommendations for the Government. The group, is calling for smoking in cars where children are present to be completely banned to prevent serious health problems for the next generation. We know that children of smokers exposed to second hand smoke are at risk of the same health problems as those smoking themselves. Indeed research shows that children exposed to second hand in cars, in the home and in other areas can suffer from tobacco related illnesses for up to 25 years later.
The RCPI Policy Group on Tobacco is also calling for a complete smoking ban throughout all publicly funded institutions, particularly hospitals and academic campuses. The RCPI Policy Group on Tobacco is also recommending that the Government continues to increase taxes annually on tobacco, a measure which has been proven in reducing the number of people who are smoking in Ireland.
Other recommendations include:
All expectant mothers should be offered comprehensive, structured support to quit smoking
A national guildeline should be developed to manage smoking during pregnancy.
Regulate the sale of electronic cigarettes. While we welcome the provisions on electronic cigarettes of the EU Tobacco Products Directive, more regulation is needed. The absence of age limits in that directive means that it will continue to be available to children. Further consideration also needs to be given to the efficacy and safety of these products based on best practice evidence.
The Tobacco Policy Group was convened in early 2014 in response to continuing public health consequences associated with tobacco. The overall aim of the policy group is to influence national tobacco policy and legislation, particularly in support of the Tobacco Free Ireland plan launched by the Minister for Health in 2013. The policy group comprises representatives from a range of medical specialties, from within RCPI’s own Faculties and Institute, and from other external bodies such as the Irish College of General Practitioners, the Irish Thoracic Society and the Psychological Society of Ireland.
In response to the continuing public health consequences associated with tobacco, and building on RCPI’s past work on smoking, a policy group on tobacco was established in early 2014.The overall aim of the policy group is to influence national tobacco policy and legislation, particularly in support of the Tobacco Free Ireland plan launched by the Minister for Health in 2013. The policy group comprises representatives from a range of medical specialties, from within RCPI’s own Faculties and Institute, and from other external bodies such as the Irish College of General Practitioners, the Irish Thoracic Society and the Psychological Society of Ireland. The group has drafted recommendations informed by their own experience, and review of international best practice and research. Pat will highlight trends in smoking prevalence and discuss the group’s recommendations aimed at reducing prevalence further. These recommendations include reference to the support that should be offered to people to quit, and the skills doctors need to provide this support.
Legislative and national policy measures to further denormalise tobacco smoking and to protect children from second hand smoke will also be discussed, in addition to standardized packaging and taxation.
ASH Ireland 