Smoke-Free Ontario Act – ten years and beyond

--submitted by Canadian Cancer Society (CCS), Heart and Stroke Foundation (HSF), Ontario Campaign for Action on Tobacco (OCAT)

Ontario just had an anniversary worth celebrating. On Tuesday, May 31, 2016 – World No-Tobacco Day – the Smoke-Free Ontario Act hit the ten-year mark. This life-saving milestone presents a perfect opportunity to reflect on our past successes, take stock of where we are today, and plan for our tobacco-free future.

What have we accomplished?

The Smoke-Free Ontario Act  (https://www.ontario.ca/page/smoke-free-ontario#section-0) is important legislation. Over the past decade it has greatly reduced tobacco use and lowered health risks to non-smokers in Ontario by providing significant protection from second-hand smoke; ending tobacco product displays in stores; and banning smoking in cars with children present.

Ontarians now enjoy a smoke-free environment in outdoor patios, enclosed workplaces, on hospital grounds, common areas in multi-unit residences, and children’s playgrounds and publicly owned sports fields. The recent regulations on flavoured tobacco products make smoking less appealing to youth, preventing them from going down a path that will destroy their health.

As well, several cessation initiatives funded as part of the Smoke-free Ontario Strategy have made substantial gains in addressing tobacco use in Ontario and supporting smokers who want to quit, including Smokers’ Helpline, the Ottawa Model for Smoking Cessation, the STOP Program and TEACH Project.

Each of these advances is worth celebrating, and each has contributed to reducing the devastating toll wrought by tobacco use. The government of Ontario has displayed leadership in protecting the health of its citizens, but the game is not over, there is still much to be done.

Where are we now?

Tobacco use remains the leading cause of preventable disease, disability, and death. More than two million Ontarians continue to smoke.

They are our family, our friends, our neighbours and colleagues, and more than half of them will die too soon, solely because nicotine addiction keeps them hooked on deadly products. Almost all will have a poorer quality of life, no matter how many years they live, and will spend thousands of dollars on products that harm them when used exactly as intended by the manufacturer, just as our health care system will spend $2.2 billion treating diseases caused by tobacco use.  

As organizations committed to a heathier Ontario, we need to consider what opportunities and interventions exist to effectively prevent the diseases we combat, which cessation methods best help those affected by smoking-induced illness and, most importantly, we must condemn the actor that plays the most dominant role in purveying nicotine addiction –  the tobacco industry.

More than 50 years after the UK Royal College of Physicians and the US Surgeon-General definitively confirmed the long-suspected link between smoking and lung cancer (with heart and lung disease and other cancers subsequently added to the grim list), the industry still fights to be treated like marketers of everyday commercial goods.

In a 2015 landmark $15-billion ruling last year in a pair of class-action lawsuits in Quebec, Superior Court Justice concluded, “by choosing not to inform either the public health authorities or the public directly of what they knew, the companies chose profits over the health of their customers.”

Sadly, despite that verdict, and despite all the protections gained by the Smoke-Free Ontario Act and its amendments these past ten years, we still face an implacable industry, willing to put profits over people, and what it terms commercial 'freedom' over the health, welfare and dignity of its own customers.

It's not hard to understand that tobacco products, while legal, are lethal. It is therefore incumbent upon health professionals to continue our advocacy efforts on all fronts and work towards the end of this epidemic.

Nearly 10,000 retail outlets sell cigarettes and other tobacco products in Ontario. Do we need that many? Should cigarettes continue to look like normal consumer products, sold alongside milk, bread, lottery and bus tickets? To move the needle, we must consider these and other important questions.

It's said that familiarity breeds contempt but, in fact, it breeds consent. We need to help our farmers and convenience store owners’ transition away from their dependence on tobacco products and on an industry that lures them with promotional practices that must be banned, as they've recently been in Quebec.

Smokers are addicted, and the disease of addiction can be overcome. Every survey ever conducted shows the vast majority of smokers regret the decision to have ever picked up a first cigarette. We need to offer hope. We need to invest in campaigns across all platforms that empower and engage tobacco addicts with the right support programs. Moreover, we must support our engagement by advocating for effective pricing and availability policies that can reduce temptation and triggers for those who are suffering.

Where do we go from here?

What can we do now to ensure that current smokers put down their cigarettes for the last time and that young people never start? A Tobacco End Game summit will be held at Queen’s University in the Fall, attended by public health groups and tobacco control professionals. We hope the result will be policy recommendations that will speed up the encouraging, yet still too slow, decline in tobacco use in Ontario and across Canada.

The Ontario government could implement the following:

  • Retain current funding levels for the Smoke-Free Ontario Strategy. The strategy (https://www.ontario.ca/page/smoke-free-ontario?_ga=1.114505159.155912536...) combines programs, policies, laws and public education to get smokers the help they need to quit; it protects people from exposure to second-hand smoke; and it encourages young people to never start.
  • Ensure a comprehensive smoking cessation system that is supported by public education, leveraging the $5 million in new money in the last provincial budget.
  • Prohibit all industry incentives and promotional payments to retailers, as Quebec has done, to disrupt the linkage between the industry and its retail delivery system.
  • Reduce the industry’s retail delivery system by licensing all vendors of industry products and require that for every new licence issued, at least two have to be permanently retired. At the same time, assist the sector in switching over to less harmful products.

To help make all of the above workable and feasible, tobacco industry interference in policy-making must be limited. This can be done by observing the Framework Convention on Tobacco Control, an international treaty signed by Canada that also binds the provinces. The treaty contains specific provisions to help signatories prevent tobacco industry interference in policy-making through limitations on lobbying and other activities designed to slow or stop government regulation of the industry.

We have a lot of work to do these next 10 years and beyond.

Statistics

Smoking is the "single most important modifiable behaviour in terms of impact on health and longevity." http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11676-eng.htm

"Smoking tobacco is the main risk factor for 4 of the leading causes of death in Canada (cancer, heart disease, stroke and lung disease). About 37,000 people die each year in Canada as a result of smoking tobacco." http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-fac...

Smoking "is responsible for 30% of all cancer deaths and is related to more than 85% of all lung cancer cases."  http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-fac...

"Smoking is responsible for close to 15% of all heart disease and stroke deaths in Canada. In 2002, 10,853 Canadians died from heart disease and stroke as a result of tobacco use and second-hand smoke." http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581729/k.359A/Stat...

"Smoking triples the risk of dying from heart disease and stroke in middle-aged men and women." http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581729/k.359A/Stat...

Every year approximately 13,000 Ontarians dies from tobacco use – that is one death every 40 minutes. http://www.on.lung.ca/page.aspx?pid=460

Each year, tobacco use costs Ontario $2.2 billion in direct healthcare costs. In the 2016 Ontario budget, the Minister of Finance projected tobacco tax revenue to be $1.2 billion. This represents a revenue shortfall of nearly $1 billion. Including productivity losses increases the economic cost by an additional $5.3 billion. http://www.on.lung.ca/page.aspx?pid=460