Thursday 10 February 1994

Tobacco Control Act, 1993, Bill 119, Mrs Grier / Loi de 1993 sur la réglementation de l'usage du tabac, projet de loi 119, Mme Grier

Niagara regional health services department

Dr Megan Ward, medical officer of health

Canadian Cancer Society, Metropolitan Toronto region

Sandy Bassett, co-chair, health promotion committee

Jeff Brewster, university student

Kathleen Leach

Margaret Frankovich

City of Scarborough

Joyce Trimmer, mayor

Sandra Pritchard, chair, board of health

Dr Zofia Davison, medical officer of health

Dr Colin D'Cunha, associate medical officer of health

François Coutu

James Snowdon

Borough of East York

Michael Prue, mayor

Dr Sheela Basrur, medical officer of health

Ontario College of Pharmacists

Midge Monaghan, president

Jim Dunsdon, registrar

David Hetherington

Ontario College of Family Physicians

Dr Brian Morris, member and spokesperson

Cheryl Katz, executive director

Council for a Tobacco-Free Region of Peel

Raymond Langlois, chair

Richard Gallagher, school principal

Equally Healthy Kids

Michael Polanyi, coordinator

Theresa Martin, volunteer co-chair

Julia Sherbot, volunteer member, steering committee

William Broderick

ROM No Smoking Committee

Lydia Bell, member

Bob Biggs, member

Marilyn Robertson, member

Sylvain Smeets, member

Roy Cameron

Canadian Cancer Society, Ontario south central region

Patricia Wise, regional board member

Karen Poshtar, chair, tobacco reduction committee, Mississauga chapter

Allergy/Asthma Information Association

Susan Daglish, executive director

Bruce Gitelman

City of York board of health

Dr Rosana Pellizzari, board member


*Chair / Président: Beer, Charles (York-Mackenzie L)

*Vice-Chair / Vice-Président: Eddy, Ron (Brant-Haldimand L)

Carter, Jenny (Peterborough ND)

*Cunningham, Dianne (London North/-Nord PC)

Hope, Randy R. (Chatham-Kent ND)

*Martin, Tony (Sault Ste Marie ND)

McGuinty, Dalton (Ottawa South/-Sud L)

*O'Connor, Larry (Durham-York ND)

*O'Neill, Yvonne (Ottawa-Rideau L)

Owens, Stephen (Scarborough Centre ND)

*Rizzo, Tony (Oakwood ND)

*Wilson, Jim (Simcoe West/-Ouest PC)

*In attendance / présents

Substitutions present / Membres remplaçants présents:

Caplan, Elinor (Oriole L) for Mr McGuinty

Dadamo, George (Windsor-Sandwich ND) for Mr Hope

Haslam, Karen (Perth ND) for Ms Carter

Wiseman, Jim (Durham West/-Ouest ND) for Mr Owens

Also taking part / Autres participants et participantes:

O'Connor, Larry, parliamentary assistant to the Minister of Health

Clerk / Greffier: Arnott, Doug

Staff / Personnel:

Boucher, Joanne, research officer, Legislative Research Service

Gardner, Dr Bob, assistant director, Legislative Research Service



The committee met at 1014 in room 151.


Consideration of Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others / Projet de loi 119, Loi visant à empêcher la fourniture de tabac aux jeunes et à en réglementer la vente et l'usage par les autres.

The Chair (Mr Charles Beer): Good morning. We're a little late. The committee was in Sudbury yesterday, so I think that's affecting getting people back in from wherever the time change, wherever they've been. But we are here and look forward to the proceedings today.


The Chair: Our first witness this morning is Dr Megan Ward, medical officer of health of the Niagara region health services department.

Dr Megan Ward: The lights are on here. Does that mean I'm on?

The Chair: You're on.

Mrs Elinor Caplan (Oriole): It's all his fault.

Dr Megan Ward: Technology's wonderful.

I'm Megan Ward. I'm a physician. I'm the medical officer of health for Niagara region. As the medical officer of health, I serve a population of nearly 400,000 people. My board of health is the regional council for Niagara region, which has 29 elected members. I'm here to speak in support of the Ontario tobacco act.

I'd like to start by giving a perspective of somebody who's worked in public health for 10 years. This has been the issue for everyone working in public health for a very long period of time because of the devastating health effects tobacco has on the health of the population as a whole and on individuals.

Tobacco use is lethal and it's highly addictive, but it's also legal, and we're in this very awkward situation of having to develop tobacco policy for a substance which truly is deadly, widespread, and its use is legal. Tobacco policy needs a long-term vision, a strategy that will eliminate its use in the population of Ontario over time, and I think that long-term vision includes the prevention of young people ever starting to smoke. I think that is the key and I'm a strong supporter of this bill because that's its focus. I congratulate the civil service and the government in bringing forward this act. It's wonderful.

In health departments, we have been focusing for a long time on initiatives which will prevent children from ever starting to smoke. As you know, children begin to experiment with cigarettes in late childhood and the early teen years, actually a long time before they've ever reached the age of reason and are able to predict the effect on their future. They haven't developed cognitively enough by the time they've started to experiment to know about the health effects,

We have had initiatives for a long time. I think the initiatives that are educational, and environmental support such as non-smoking policies, will be enhanced by this act, which really focuses on the retail of cigarettes and prohibiting it to children.

You're right on target by, first of all, raising the legal age of smoking to 19. We know that if we can get children to 20 without starting to smoke, it is likely that they will be non-smokers for the rest of their lives. So we're working with a generation now, and as we move that generation forward into adulthood, if they are non-smokers, it is also likely that their children will become non-smokers. The age of smokers will gradually increase in the population of Ontario and eventually I think we will move towards a smoke-free society. That's what we want. The health effects are too devastating for this product, and at the same time we have adults who are highly addicted to a lethal substance. The solution for adults is not an easy one. It's not easy to stop, so we need to prevent them from ever starting.

I am also very supportive of having a ban on vending machines for tobacco products and cigarettes. I know this has raised a little bit of a furore for the people who operate these vending machines. However, this is a very easy point of access to tobacco products for children. We are dealing with people who are not yet able to understand the impact on their health in terms of the use of tobacco products. Having free access through a vending machine really is a very negative thing for children. So I support you in the ban on vending machines.

I'd also like to talk a little bit about the prohibition of sale of tobacco in various premises. I know the most controversial one has been pharmacies. My board of health discussed this issue at great length on Monday, and I can tell you that it is in support of the Ontario College of Pharmacists position on this. When the minutes of that meeting become available, I will be forwarding them to this committee, since they do represent 400,000 people on health issues.


I think it is completely inconsistent for a health professional group that is self-regulating to take a position which would promote the sale of a lethal product. It's lethal when it's used as it's intended to be used. I don't think pharmacists can be self-regulating and have a monopoly on the dispensing of drugs and at the same time be retailers of tobacco products. This is completely inconsistent and their college has said this is inconsistent and I support it on that. I understand that they themselves have asked you as the Legislature to legislate the prohibition of sale of tobacco products in pharmacies. I support them, my board supports them, the people of Niagara support them, for what that's worth to you.

Finally, I'd also like to commend both the Premier and the Minister of Health for their strong public stand on the federal reduction of tobacco taxes. They have condemned this position by the Prime Minister to reduce tobacco taxes nationally and they've made early public statements about not following suit to reduce provincial taxes.

We know that children are the most price-sensitive for tobacco products, and probably children and teens are the only people who are price-sensitive for tobacco products in terms of level of consumption. High taxes help children and teens the most. They simply can't afford cigarettes. I think lowering tobacco taxes condemns thousands, and perhaps more than thousands, perhaps hundreds of thousands, of Canadian children and teens to a highly addictive habit, and I think it's wrong. I commend the government on its early condemnation of that.

If I had any point where the Premier and the Minister of Health and the Legislature might push the federal government, since it has decided to lower taxes, perhaps they could push very hard for plain packaging. We also know that children and teenagers respond to elaborate advertising, and particularly product identification on cigarette packaging. Cigarette companies know this too, because they pay a lot of money to have their brand in movies, for example, that children and teens will see.

A plain brown or other wrapper with only words on it will actually go a long way to helping children never start smoking or not smoke enough to become addicted to it. This is a point where the province could push the federal government, since it's taken such a retrograde step in the business of taxation. That's not the concern of this committee directly today, but the province can really help in this.

In conclusion, I support you. I think this is wonderful. The public health community across the province thinks this act is wonderful. I say, "Carry on," and I'm looking forward to it going through the House again and being passed into law.

Mrs Caplan: I'm particularly interested in and supportive myself of most aspects of the legislation. I have a concern about one, not that it shouldn't be in here but that it's not going to have the desired effect. One of the things I've heard is that the prohibition on sale in drugstores might just lead to a proliferation of kiosks or having just part of an existing drugstore dedicated and petitioned off, so that it wouldn't have the desired effect of eliminating the sale in or around drugstores; it could have the opposite effect. Have you or your board considered that or heard of that as a result of the legislation?

Dr Megan Ward: I'm not sure that's quite on the point, to be honest, in the sense that this act is in no way going to prevent the sale of tobacco products. It is legal; it is a legal substance; the sale of it is legal. The issue is whether or not health professionals who benefit from having a monopoly in one aspect of the provision of health care should be selling lethal products. Their college has said no. But tobacco products are going to be sold. Personally, I strongly support, as does my board strongly support, the position of this particular group of health professionals that it not be in their retail space.

Mrs Caplan: I was actually quite encouraged. An article in the Ontario Pharmacists' Association magazine said that almost 40% of pharmacists agree with the position that pharmacists should not be selling -- I think it was 37%, 38% or 39% -- and that about 62% were concerned because of (1) the economic interest and (2) because it wasn't going to reduce access, as you just stated. In fact, they saw it more as window dressing. But I was encouraged that 40% of pharmacists believe that pharmacists should not be selling and benefiting --

Dr Megan Ward: We have surveyed our pharmacists in the Niagara region and there are very few who have any trouble at all with the idea of eliminating tobacco sales from their pharmacies. What they're most interested in is that all their colleagues have also eliminated tobacco sales from their premises.

The Chair: Both Ms Cunningham and Ms Haslam say they have short, sharp supplementaries, and when they say they have short, sharp supplementaries --

Mrs Dianne Cunningham (London North): We are both unbelievable, I'll tell you that, but we got on.

Mrs Karen Haslam (Perth): What he's saying is, in a pig's eye.

Mrs Cunningham: I was keen to ask a question, because I think it's great that the medical officers of health have come forward during these hearings. Some of them have been quite -- what should I say? They're very ahead of their time in thinking. We heard from the medical officer of health of North Bay in Sudbury yesterday, and in London on Monday from the medical officer in the Essex-Windsor area. Both of them said that we should consider licensing stores that sell tobacco, because this is a proliferation of the present system and we don't enforce it. There are fines now for people who sell to minors.

They've gone so far to say we should consider licensing and they have gone so far as to say that we should be selling cigarettes in LCBO stores and taking them right off the public market. The medical officer of health in Essex said that we should start fining young people. I just wondered if you had had any of those discussions within your own unit, because those are the kinds of things we have to think about, in my view.

Dr Megan Ward: I also strongly support the concept of licensing. That takes some work to put together. You've got sort of the first piece of the puzzle here, as far as I'm concerned. I think licensing would deal with some of the enforcement issues very well and could easily be another piece of this whole strategy that would be very helpful. Similarly, having tobacco sales in designated outlets does the same sort of thing. Again, we're focusing on children and young teens. This is the target group. This is the kind of thing that will prevent access until they become capable of making their own decisions. That takes some work to put together and I think that would be an extremely helpful process to go through, extremely helpful.


Mrs Haslam: Mine's even shorter. On page 4, "A University of Minnesota study found that teenagers aged 14 to 15 successfully purchased cigarettes from vending machines, including those in bars and clubs, 82% of the time." Are you aware of any other studies? I was really pleased to see this one. It's the first time we've seen a study alluding to the availability of cigarettes in vending machines.

Dr Megan Ward: No, not in terms of the published literature, I'm not.

Mrs Haslam: What about unpublished?

Dr Megan Ward: We have looked at that very issue and have found that they are definitely able to get access in this way. It's a key way for them in our region.

The Chair: Dr Ward, thank you very much for coming today and for your submission. We appreciate it.


Ms Sandy Bassett: I'm Sandy Bassett. Thank you for the opportunity to speak about Bill 119. I am one of 500 volunteers who work with the Canadian Cancer Society in Metropolitan Toronto. I co-chair the health promotion committee for Metro Toronto and in this capacity I work with many volunteers who try to raise people's awareness about the relationship between lifestyle and health.

We talk to people about the four key messages of the society which can greatly reduce their risk of cancer. We talk about diet and healthy food choices; limiting exposure to sun; breast health, especially breast self-examination; and abstinence from tobacco. This committee's review of Bill 119 presents an excellent opportunity for the Canadian Cancer Society to reinforce its message about the dangerous effects of tobacco.

I also appear before this committee as a mother of two young boys who I pray will never have to experience the addiction and devastation of tobacco, and as a nurse who has seen the pain and suffering experienced by patients and their families. I also appear as a daughter whose father died less than a year ago from lung cancer after a short, nine-week battle.

My father smoked a pack a day from age 14 until his untimely death at age 63. What really saddens me is that his death was completely preventable. My father was addicted to tobacco and tried to stop many times. He tried cold turkey, gradual reduction and hypnosis, but the nicotine addiction was too strong to overcome, despite his genuine desire to stop smoking.

I am accompanied today by Jeffrey Brewster, a university student who smokes and whose attempts to quit smoking have been unsuccessful to date, despite his mother's recent diagnosis of lung cancer. Jeff wanted to share with you his views about the perils of smoking and his thoughts about the need to restrict its sale and use. Like me, Jeff has experienced cancer in his family. We both know the anxiety that comes with the diagnosis and we are both here today because we believe so strongly that everything must be done so that others do not have to face cancer themselves or in their families.

In a few moments, I will ask Jeff to speak to you. However, I would first like to take this opportunity to congratulate the government for introducing legislation that will protect the public from the harmful effects of tobacco.

A 1990 survey found that smoking was more prevalent among people with lower education and income, and this provides some evidence that non-legislative attempts to reduce tobacco consumption have not been uniformly successful. We cannot ensure that health promotion programs affect everyone equally. However, we can be fairly certain that everyone is equally affected by legislation. Legislation which controls tobacco use does not recognize differences in education, income level or employment status. It is applied equally across the population and has the potential and the power to effect the same outcome for everyone in Ontario.

There is no disputing the evidence that links tobacco consumption to cancer and premature death. Yet tobacco is the only legal product that, if used as directed, will lead to disease and death.

I find the statistics I'm about to review particularly disturbing because they highlight the extent and seriousness of tobacco use among the youth of Ontario. A number of statistics are noted on page 3 of my submission. However, I'm only going to speak to the three which relate to tobacco use among teens.

We know that if people smoke before the age of 20, they are more likely to become addicted to tobacco. Yet from 1991 to 1993 smoking among students in grade 7 increased by 50%. Currently, almost 10% of grade 7 students smoke. These kids are not even old enough to drive, yet they are old enough to be addicted to nicotine.

We know that tobacco is highly addictive. The Ontario student drug survey, from 1977 through 1993, found that among teens who tried to quit, 46% could not remain abstinent for more than one week. In addition, the Addiction Research Foundation noted that between 1991 and 1993 the percentage of young people trying tobacco for the first time before grade 9 increased from 69% to 75%.

We know also that in Ontario, 3,000 new adolescents begin smoking each month. If we are ever to achieve our goal of a smoke-free generation, we have to restrict youth access to tobacco.

I will ask Jeffrey to speak about his own tobacco use and his thoughts and concerns about Bill 119.

Mr Jeff Brewster: Hi. My name's Jeff Brewster. I've been smoking for seven years and I've tried to quit a few times. I was able to quit for four months at one point, but I ended up going back. I don't buy cigarettes myself in pharmacies; I usually go to the corner store. I'm pro this bill because I don't believe pharmacies should be selling tobacco products, for reasons that have been stated here and stuff like that.

Obviously, when my mom was younger there was not much legislation to stop her from smoking. Kids had a lot of access to cigarettes when they were young. They didn't realize what they were getting into, obviously. A lot of older people now have cancer and a lot of them are related to cigarette smoking and stuff like that.

I found it really hard to accept the fact that my mother had cancer and hearing her hacking and coughing and going to chemotherapy and seeing her go through all the side-effects of stuff like that. It's scary and I feel that any legislation that will allow fewer people to smoke and give them a chance of not contracting cancer themselves will be beneficial to society as a whole.

Ms Bassett: Thank you, Jeffrey, for your sincere and candid reflections as a young smoker. Your comments highlight for all of us the personal consequences that smoking has on oneself and on one's family.

Jeffrey and I believe that our government has a responsibility to translate the evidence we have about tobacco-related disease into legislation that will alter behaviour and serve the public good. We also believe that Bill 119 is an effective way to restrict access to tobacco, limit the influence that tobacco manufacturers have on children and ensure that those who provide the public with tobacco exercise that privilege responsibly and within the limits of the law.

On pages 4 and 5 of my submission, a number of important recommendations are listed. However, I will only speak to a few of these, again as they relate to the youth of the province.

Section 3, which effectively restricts access to tobacco by raising the legal age to 19, is vital to decreasing the incidence of addiction. This is especially important in light of the fact that people are unlikely to become addicted after the age of 20. However, the requirement for proof of age should not be contingent on the purchaser appearing to be less than 19 years of age. As currently stated, this section allows the vendor excessive discretion, and in practice could contradict the intent of this provision.

Section 4, prohibiting the sale of tobacco in designated places, particularly pharmacies, is critical to the integrity of this legislation. Pharmacists are unlike other vendors. They are health professionals, as am I. However, they have an exclusive right to dispense drugs. This right is accompanied by a responsibility to advance the health of their patrons. By selling tobacco, pharmacists convey an implicit message that tobacco is in the same category as other goods sold on the premises. The legislation must clearly define the term "pharmacy" in order that there be no opportunity to use a technicality to circumvent the law and defy the intent of the legislation.


Section 5, regarding packaging, health warnings and signs, is central to limiting the influence we know tobacco manufacturers and vendors have on our vulnerable consumers. Tobacco companies should not be allowed to capitalize on our naïve and unsuspecting youth. If government is serious about reducing tobacco consumption, it can make a very strong statement by ensuring that tobacco products are clearly differentiated from normal consumer products.

Cigarette packaging is designed to attract young people and convey an image. For young people, the package they carry is similar to the clothing they wear or the knapsack they carry. It becomes part of their identity and a means to position themselves with their peers.

Research funded by the Canadian Cancer Society and carried out by the Centre for Health Promotion at the University of Toronto indicated that if cigarettes were sold in plain packages, fewer children would smoke. Further, the plain package would confirm the serious nature of the contents and make the health warnings more evident. It breaks the link between the cigarette package, the act of smoking and the exciting activities portrayed in tobacco advertisements.

We recommend that the regulations also ensure that explicit and clearly presented warnings on the exterior and interior of the package will help to meet the consumer's right to know the harmful effects of tobacco.

The regulations under this section must also prohibit the sale of kiddie packs, or packages of fewer than 20 cigarettes. We know from research that teens are very price-sensitive. The tobacco companies know this too. It is a marketing strategy they use to encourage young people to buy a product which can ultimately kill them. The lower cost associated with packages of reduced size will undoubtedly increase the availability of children to purchase cigarettes.

In addition, the sale of promotional paraphernalia such as cigarette cases must be prohibited. Such items could undermine section 5 by permitting the sale of an item which depicted brand name and logo and conveyed no health warning.

Section 7, banning the sale of tobacco in vending machines, must remain in the legislation. Without this control, children would have easy access to tobacco. They would not have to show proof of age. They would not even have to be tall enough to reach a counter. It seems to me that if the city of New York can ban tobacco vending machines, then the province of Ontario can do as well. Tobacco should not be as easily accessible as is a chocolate bar or a bag of chips.

In conclusion, we would like to thank this committee for considering our recommendations. We trust that your deliberations will result in powerful, progressive legislation which places health above all other concerns. However, so much of what we are trying to achieve could be diluted by the rollback in taxes. We applaud the government for its strong stand. However, the government will need to reconsider licensing as a measure to control the sale of tobacco.

We trust that as a result of this legislation, the tobacco-related cancer statistics that we review in the future will differ dramatically from the ones we note today. We look forward to the early passage and proclamation of this bill.

Mrs Cunningham: Thank you very much, both of you, for coming here today. Your presentation was very personal. We've heard a fair bit of it and I think it enhances the real need to be strong with this legislation.

I was pleased that you pointed out the need for regulations with regard to the plain packaging, and I'd ask you to speak to the fact that I think that probably ought to be in the legislation as opposed to regulations. If you can ban vending machines, maybe you can ban the cigarettes that aren't in plain packaging and also the kiddie packs. I think they should both be in the legislation.

I also wondered what you would do with regard to (3)(a). Right now -- you probably heard me before -- I feel very strongly that people should take responsibility for what they do. If they're breaking the law by buying things that they shouldn't, they should be penalized in some way, maybe by community work. What right has the vendor got to ask for proof of age, or should we be writing that in the legislation as well? How would it work? Those are two things I'm asking you, obviously, to strengthen the legislation.

Ms Bassett: I would certainly personally agree with strengthening the legislation. Licensing is a very important way that we can use to control access to youth. That's really what this legislation is aimed at.

Mrs Cunningham: Right; I agree.

Ms Bassett: As we mentioned earlier this morning, we're not going to ban the sale of tobacco completely. What we really want is to --

Mrs Cunningham: Control it.

Ms Bassett: -- aim for a smoke-free generation.

I believe the plain packaging should be in the legislation. It is an image issue for teenagers. They will not want to be seen with a package of cigarettes that is uncool, that looks ugly, that is --

Mrs Cunningham: In buff packages.

Ms Bassett: -- in buff. I think that's really important.

In terms of the vendor's responsibility, in preparing for today, one of the briefs that I read talked about that children are less likely to smoke if they are turned down on their first attempt at purchasing it in a store. That in and of itself is very significant.

Mrs Cunningham: Do you think we should be asking for proof of age?

Ms Bassett: Yes. I think there should be some method, whether we use our age of responsibility card or something else.

Mrs Haslam: I was very interested in your comment about lower education and income and the incidence of smoking. The probable result of what Mrs Cunningham and I have been talking about is the apparent lack of change through education processes, and that makes me very pessimistic about the federal government putting more money into an education program when statistically it's shown it's not working effectively. I would rather see the $200 million go into some other form, so I'm pleased to see you've mentioned that.

What interested me also, on the last page of your presentation, is that you're the first group that's really come to us and said that you would like to see section 15 strengthened, looking at the penalty. I say "the first group" because most other groups come and say, "We would like you to go to a licensing idea and a licensing proposal."

Would you just comment, is this your second choice? "If you're not going to go to licensing, then we'll comment on what's in the legislation. If you stick with that, we would like to see some higher penalties, some longer length of time." Or is your priority licensing? Could you comment on that?

Ms Bassett: I think it's vital. The way the legislation is currently written, we do have to have stronger penalties. It won't be effective without that.

Licensing would be the first choice. I think, though, that perhaps we thought we would try strengthening section 15 and then, as I mentioned in the very last, if the tax rollback takes effect, then we do really have to reconsider this whole licensing aspect.

Mrs Haslam: Actually, I couldn't agree with you more. I think a lot of us are now looking at the legislation saying, "We could have maybe been a little more hopeful out of this legislation, reaching our goals," but now since the federal government has done what the federal government has done, looking at our legislation and our goals, we really have to rethink some of the clauses here. I appreciate your bringing that forward.

The Chair: Thank you very much. I'm sorry for the time problem, but we appreciate you coming before the committee today.


Ms Kathleen Leach: I'll be very brief. I decided to come here today. I'm an independent community pharmacy owner. I was concerned that the impression this committee might be receiving was that pharmacists support the sale of tobacco in pharmacies. I do not support the sale of tobacco in pharmacies, and I wanted to make sure that my voice was heard.

Mrs Caplan: If I could, what is the number, do you know, of pharmacists who do not support it? Did you see that article?

Ms Leach: It's difficult, because we're running into a problem where you look at pharmacists or pharmacies. Many pharmacies are governed by a corporate image which imposes beliefs on them that they don't necessarily hold themselves.

I've long advocated the removal of cigarettes from pharmacies. I consider myself to be a smoker. Even though it's been a long time since I've had a cigarette, it never goes away.

In 1990, I was successful in convincing the previous owner of my business to cease selling tobacco products. I did that by coming in on my day off and getting a stopwatch out and keeping track of exactly how long his staff spent, actually timing the amount of time a person sold only cigarettes, counted only cigarettes, ordered only cigarettes, and then I asked him if it was really worth his while to sell cigarettes. So on January 1, 1991, we stopped selling tobacco. I felt it was inconsistent with health promotion.


Initially, I supported my association's views of voluntary cessation of sales, but the tobacco lobby is much stronger than the will of individual pharmacists, and unfortunately we haven't been able to meet our goals in that manner. It's time for a legislated removal of tobacco products. It should be from all retail establishments, including pharmacies.

We have a distribution network whereby we could sell them through government-controlled stores and the government could use the profits to support health care, as opposed to private business obtaining the profits of tobacco. If it's going to continue to be sold in Ontario, I think that's a route that should be considered.

I want to share with you a little bit of the business impact of removing tobacco from my drugstore. Prior to removing tobacco, sales were growing in the store at approximately 10% to 12% annually. In the first fiscal year following the removal our sales increased 4%, so we did not see a decline but we did see a slower rate of growth.

Gross margin declined 1.3% and net profit declined exactly $1,251. It's absolutely negligible. That's not going to harm any pharmacy whatsoever. The decline in gross margin and net profit can be attributed to other economic factors which I have outlined. In the second fiscal year following the removal of tobacco sales our sales actually increased 10.4%. So we were back to our normal rate of growth within one year.

We didn't replace tobacco with any other product. Some are saying, "Get into home health care, get into this, get into that." All we did was start paying more attention to our customers. We increased our customer loyalty and we increased our credibility with our customers.

Lots of people will also come here and tell you that tobacco is a legal product and that therefore they should have the right to sell it. Alcohol is a legal product; I can't sell it in my store. Valium is a legal product; I can sell that in my store but a lot of other people can't because there are a lot of rules and regulations that go along with selling it. Those kinds of precedents are very apparent for the tobacco issue.

I don't think it goes far enough. As I said, I think we should totally restrict the sale to Ontario government stores.

I can tell you that I acquired the cigarette habit in high school. I bought all my cigarettes at the Tamblyn's drugstore right next to my high school, and when I was in university I bought them all at the Shoppers Drug Mart that was conveniently open till midnight, even when I ran out at 11. I probably still would have tried smoking in high school, but if accessibility had been a lot less possible, I would probably not have continued to smoke as long as I did. In 1983 I quit a very heavy-duty habit and, as I said, it never goes away, because that only lasted two years and I had to quit a second time.

I think our profession has to make a very important decision as to whether we're retailers or professionals. This is the opportunity to demonstrate that we are professionals, and that's why I'm here. I'd like to thank you for your time, and if you've got any questions I'd be happy to try and answer them.

The Chair: Thanks very much for coming to the committee with your personal history. We have time for a couple of short questions.

Mrs Yvonne O'Neill (Ottawa-Rideau): I'm interested to hear the results of your study when you did the stopwatch. That's certainly a novel way and the first time we've heard of an employee helping an owner make the decision. If you could, just tell me what your experience is with the pharmacy that sells tobacco asking for ID from minors.

Ms Leach: I really don't have the results from the stopwatch study. I did it for two days. I never thought I'd need them. They were on a scrap piece of paper and they went straight into the garbage when it was over. All I remember is that as to the concept that tobacco sales create traffic and draw people into the pharmacy, it became more and more apparent to the owner that people were only buying cigarettes. They weren't buying other things. They weren't getting their prescriptions filled at our drugstore. Therefore, it's a misnomer that it creates traffic and that it helps your business.

As far as being carded is concerned, so to speak, when I purchased cigarettes as a minor: never once.

Mrs O'Neill: Did you feel the store you work in was responsible in that respect?

Ms Leach: Very, yes. I'm in a very old neighbourhood, so there are very few minors in the area.

Mrs Cunningham: Your persistence in the world of work really paid off. It does sometimes here too.

I was interested to see that you have taken the strong stand that tobacco should be distributed just like alcohol through government-run monopoly stores. I can tell you that more and more people are saying that. What would that do to the business in your community, for instance, not just your drugstore but around you? Not that I'm that concerned about it, but I thought since you're so observant, you might tell me maybe the downsides, if there are any. I don't know.

Ms Leach: Having spoken to other business owners, both pharmacy and non-pharmacy, who sell cigarettes, I've been told recently that there is no money in tobacco any more unless you live in the States, because that's where it all comes into Canada from. I don't know what's going to happen after yesterday, but something that's not in my comment is that Ontario should not lower tobacco taxes regardless of what happens federally. People have said that the tobacco is there, that it does create a bit of a traffic problem, but if we don't have it they're still going to come in for their bread and milk. The actual profitability of tobacco in and of itself is minimal.

The Chair: Thank you again very much for coming before the committee this morning.


The Chair: I then call on the representative from the Brooklin Pharmacy, Peggy Frankovich. Welcome to the committee, Ms Frankovich. You have distributed a copy of some material, which committee members have. Please go ahead with your presentation.

Ms Margaret Frankovich: I think it's just going to be more of the same, but --

Interjection: We love it.

Ms Frankovich: Okay. As a pharmacist and pharmacy owner in Ontario, I would like to voice my strong support for Bill 119 and to applaud the government for the introduction of this legislation. I have appeared before the committee before as a founding member of the group Pharmacists in Support of Bill 119, but I'll just remind the committee of my background.

I've been an active practising pharmacist in Ontario for 22 years and I have owned a community pharmacy in Brooklin, Ontario, for the past 10. Previous to moving to Brooklin, I practised community pharmacy in northeastern Ontario, where I had the opportunity to work at the Northeastern Regional Mental Health Centre and to work with the Addiction Research Foundation.

I am presently the coordinator of continuing education for the Durham Region Pharmacists' Association and I'm one of those pharmacists who is absolutely committed to pharmacy as a health care profession and to pharmacists as members of the health care team.

Our pharmacy is located in the village of Brooklin, which has a population of approximately 2,000 people. We are the local community pharmacy. We have not sold tobacco products since the end of 1983. We are very happy with our decision and we have been given a great deal of support from our community because of this decision.

In coming before the committee as an independent pharmacist-owner, there are three areas that I would like to address: pharmacy closings, potential job losses and the pharmacist's intervention in tobacco cessation techniques.

To support my position that pharmacies will not necessarily have to close because they stop selling tobacco products, I have enclosed copies of sales figures from our financial statements from 1982 until 1985. We stopped the sale of tobacco products at the end of 1983. As you can see, our sales did not decrease as a result, although our gross margin did decline slightly in 1984. I have enclosed our sales figures for 1992 simply to indicate that after 10 years we are continuing as an economically viable pharmacy.

Because not all pharmacists will be able to appear before the committee, I thought it would be appropriate to have another example. Another pharmacist-owner has agreed to share his financial data with the committee. This pharmacy ceased the sale of tobacco products January 1, 1991. You will notice that his total sales did decrease slightly in 1992 but gross profit did not, and his projected sales for his year-end 1993 are up.

These are two examples where community pharmacies were able to stop the sale of tobacco products and still remain viable in their community. May I also mention that in neither of the above cases did any employee lose his or her job because of this action.

I do not wish to imply that the loss of tobacco sales will not affect any pharmacy in Ontario. There may be pharmacies with high tobacco sales on which this legislation will have an adverse effect, but I urge the committee not to let this dissuade it. Pharmacists are health care professionals and pharmacies are health care facilities and cannot be involved in the sale or promotion of a product which causes such morbidity and mortality to the people of Ontario. To function successfully as members of the health care team, the public must see our profession as one which has their best interests at heart, and selling tobacco products does not do that.


I have listened to some of the presentations and was interested to hear that some pharmacists would have you believe that you can best counsel people about stopping smoking if you have tobacco products for sale in your pharmacy. Let me assure you that even though we do not sell tobacco products, we regularly counsel people on techniques for stopping smoking. It is because we promote ourselves as a health care facility that people ask for advice. It is certainly not because they see cigarettes in our pharmacy and therefore expect us to know about smoking cessation techniques.

I thank you for giving me the opportunity to state my position and that of other pharmacists like me who believe that this legislation is important in both the fight to improve the health of this province as well as the stature and profession of pharmacy.

The Chair: I'd just note for the record that you have attached a variety of statements with respect to the costs and so on. Those are all there and I'm sure we'll find them interesting to look at.

Mrs Caplan: I personally agree with you. I don't think that any health professional should benefit economically from the sale of a product which is so lethal and has such adverse impacts on the individual's health, even though it is a legal product.

I'm wondering whether you think there should be a statement in the legislation that says it is professional misconduct for any health professional to sell tobacco products or to benefit economically from the sale of tobacco products.

Ms Frankovich: That's an interesting concept.

Mrs Caplan: I'll give you the example. One of the things I've heard is that it's likely you will see a proliferation of kiosks selling cigarettes. It would seem to me that you could well have a health professional who owns a kiosk and that this would be as much anathema to the health profession in their professional responsibility. Someone had suggested to me that perhaps you should have a statement about it being professional misconduct to benefit economically from the sale of tobacco, and I wondered what you thought of that.

Ms Frankovich: I think it might be difficult to legislate. I believe the Ontario College of Pharmacists will be addressing the concept of kiosks and the partitioning off of sections in the pharmacy, so I believe they will address that.

Mrs Caplan: That's only as it relates to pharmacists. What about other health professionals who might have an interest in a kiosk?

Ms Frankovich: I truly believe that no health professional should benefit from the sale of this product. Whether or not it can be legislated, I'm not sure.

Mrs Caplan: That's my question as well. Thank you.

Mr George Dadamo (Windsor-Sandwich): As a reformed smoker two and a half years ago, as a father -- my father died from lung cancer at 64 in 1979 -- it's easy for me to talk about, and I think that we should go a long way. Should we take the sale of cigarettes from private and perhaps bring it to a monopoly kind of forum in government-run stores?

Ms Frankovich: Many pharmacists would support this concept. They feel this product is a lethal and dangerous enough product to be sold under such strict control. That is certainly something the committee could look at.

Mr Dadamo: I only bring that up because some European countries do that now, sell them only in government-run stores.

Do we go far enough to educate the kids in schools as to the bad effects of this? Should there be curriculum?

Ms Frankovich: More work could probably be done there. I'm a believer that the new smokers are these young people, even in public school, and probably more work can be done in this area in education.

The Chair: Thank you very much for coming to the committee today. We appreciate it.


The Chair: We're now going to put together two presentations by the City of Scarborough. I welcome Mayor Trimmer and her associates. They've requested to make their submission together, and then we'll follow that with questions, if both the city and the public health department would come forward. Welcome, all, to the committee.

Mrs Joyce Trimmer: I'm going to sit at the end, because I will not be the main presenter today. I have just come from another of your committees and made a presentation on the secondary units. It turned into quite a ruckus and I'm still about two feet off the ground. The work has all been done by the chairman of our board of health and our staff, our MOH and deputy MOH, so they are going to carry the ball on this one. Then, if I may, at the end if I feel there's anything I can add to their arguments, I will have my two cents' worth then. I'm very supportive of everything they have been doing.

The Chair: Perhaps you'd be good enough to introduce the other members, whoever is going to present, and please go ahead.

Ms Sandra Pritchard: I'm Sandra Pritchard and I'm the chair of the Scarborough board of health. With me are Dr Zofia Davison, our medical officer of health, and Dr D'Cunha, who is the assistant medical officer of health as well as the chairman of the medical officers of health of Ontario.

I have come more as just representing the chair of the board, and these people will give you the gist of our presentation. Scarborough council has before the Legislature a private member's bill to help regulate smoking, particularly to ban that in Scarborough, and we don't feel it's within our jurisdiction just to do all of that. We are asking your support in that. Somewhere in the system is this private member's bill.

We in Scarborough have worked very hard through the years, all our staff and all our people, to get a grip on the smoking problem, especially with the younger people, and we felt we were starting to make a bit of headway. We're very concerned now, and we would like you to really think very strongly about what our people here are going to be presenting to you.

Dr Zofia Davison: Good morning. I'd like to begin by commending this government for introducing this significant piece of tobacco control legislation. I hope the opposition parties are supporting it, since this is a high-priority health issue and deserves non-partisan support.

The evidence of the enormous damage done by tobacco to our population's health has been clear for decades, yet we continue to battle on this issue. The public health community, of which I am a member as a medical officer of health, together with other health professionals and their various organizations, have all been fighting for this kind of legislation for a long time and stand behind the province in this matter.

The issue we cannot lose sight of is that tobacco kills more than 13,000 Ontarians each year, 6,000 from heart disease alone and others from diseases such as cancer, respiratory disease and low-birthweight babies born to smoking mothers.

With respect to the legislation itself, I want to make three main points. First, it is very appropriate that its key emphasis is on reducing tobacco use in children. I strongly support the bill's measures to reduce access to young people, including raising the age for the purpose of tobacco sales to 19, posting health warnings as well as minimum-age requirements at retail locations where tobacco is sold, and banning cigarette vending machines.

I would go even further. Bill 119's provisions should be strengthened by:

-- Implementing a licensing system for tobacco retailers.

-- Prohibiting the sale of kiddie packs of fewer than 20 cigarettes to reduce low-cost tobacco targeted to children and adolescents. Other provincial governments have taken steps in this direction, including Nova Scotia and Prince Edward Island and, I understand, the government of British Columbia.

-- Packaging cigarettes in plain packages. A recent Canadian Cancer Society study concludes that young people are less likely to start smoking if cigarettes are sold in ugly packages as opposed to the attractive packages innocently designed to look like candies or any sort of condiment that one can consume.


I'm deeply concerned, as undoubtedly you've heard from others, about the federal tax rollbacks and lower-cost tobacco since their impact will be primarily felt by children. This makes a strong Bill 119 all the more essential. We know that children are risk-takers and that children who start smoking stay hooked on the habit and years later become part of our heart disease and cancer statistics. We must do everything possible to prevent this addictive and life-threatening behaviour in our young people.

Specifically with respect to sales of tobacco in pharmacies, the province is showing great leadership in responding to the Ontario College of Pharmacists' request for a ban on tobacco sales in pharmacies; 8,200 pharmacists and 2,000 pharmacies support the bill as well, and independent pharmacies in Scarborough are choosing to ban tobacco sales voluntarily in their pharmacies, given the obvious incompatibility of selling tobacco with providing health services.

One of our local pharmacists states, "How is it that a child can understand the contradiction between selling tobacco and providing health care, but adults are blinded by the financial bottom line?" Another local pharmacist said he does not sell tobacco products because he feels he's promoting poison. It is noteworthy that both of these local pharmacies continue to survive economically.

Finally, with respect to environmental or second-hand smoke, Bill 119 addresses this important issue, but it could go further to ensure that Ontarians are protected against the detrimental effects of second-hand smoke in both workplaces and public places. The hazards of second-hand smoke are well documented. As outlined in the provincial medical officer of health's report, Tobacco and Your Health, second-hand smoke has been linked to such illnesses as lung cancer in non-smokers and respiratory problems in young children and infants.

I would also urge that the smoking-in-the-workplace act, which is largely ineffective, be improved. Currently, there is no definition in that legislation of a designated smoking area, thus allowing employers to comply with the law by putting smokers and non-smokers on separate sides of a single room. Moreover, the Smoking in the Workplace Act does not require smoking and non-smoking areas to be independently ventilated.

I would also urge that the list of designated public places where smoking is proscribed in Bill 119 should be expanded to encompass all enclosed public places such as shopping malls, recreation centres, theatres and cinemas, restaurants and fast-food outlets.

I again would refer to the leadership of our board of health and our city council, spearheaded by our mayor, with respect to the proposed bylaw, which is now going through the process in the Legislature of getting enabling legislation. It is the strongest bylaw in Canada. It bans smoking in local workplaces and enclosed public places. A copy of the bylaw is attached to the submission that we've given to you.

We ask for your support in getting the enabling legislation. We would also emphasize, however, that individual municipal efforts are not enough and we call on the province to strengthen Bill 119 with respect to smoking in public places as well as strengthening the workplace act.

In conclusion, I would congratulate this government first of all in looking, during these tough fiscal times, at how to maximize our population's health while minimizing costs. The whole health care reform issue is before you. You would be absolutely correct in putting tobacco use prevention as the highest priority health issue to be addressed by prevention initiatives that are not associated with high-tech costs. If you do a cost-benefit analysis you have a preventive measure that will have the greatest impact on the public's health, and you will not be incurring hospital, OHIP or other technology costs.

The landmark piece of tobacco control legislation will make a major contribution to the health of Ontarians. We call on all MPPs to vote yes to this legislation and to capitalize on the opportunity to augment its effectiveness by strengthening its provisions.

I thank you, and all of us are available to answer questions. If don't know if the mayor would like to add any comments.

The Chair: I think there are a number of questions, but Mayor Trimmer, did you wish to comment?

Mrs Trimmer: I'd like to reiterate a couple of points and maybe add a couple of my own, if I may, just to remind everyone that tobacco does kill more Ontarians than die as a result of murders, accidents, suicides, alcohol, alcohol-related traffic fatalities, illicit drugs and AIDS combined.

The British Royal Society compares the tobacco epidemic to cholera epidemics of the last century. Tobacco is as addictive for some smokers as heroin or cocaine, and yet over 3,000 children join the tobacco market each month in Ontario. I would also add that the use of tobacco is growing among young women, and that is particularly disturbing.

I think it's also interesting to note with regard to pharmacists that one of our Metro mayors happens to be a pharmacist and has been for many years. He stopped selling cigarettes many years ago and he told me that it made absolutely no difference to his bottom line.

The tax rollback is of concern to all of us, but it seems to me that to some degree the impact of that, not financially but the health impact, could be decreased if you were to support the private member's bill for Scarborough to have its bylaw. If that were to be extended to all of Metro, for example, then the impact of a rollback of taxes would be much lower in this area.

In that regard, it was interesting that I met with some representatives, leaders of the restaurant associations, because they are the ones who are most concerned about our bylaw and that bill preventing smoking within their restaurants. It wasn't that they didn't agree with what we were trying to do; they were concerned about the competition. They said to me that if such a ban could go right across Metro, or preferably across the province, then they would not object because they knew that there would not be competition for any of them and they would all survive very nicely, just as the airlines have in their total non-smoking, and of course cinemas for a long time.

Finally, a suggestion perhaps with regard to the sale of cigarettes: I wonder if you have ever thought of selling cigarettes in the same manner in which you sell beer and alcohol. In other words, the only place for purchasing them would be in a liquor store or a beer store, and taking it right out of everywhere else. That also would give you a better control over the age of the children coming in. It's just a suggestion that I haven't run past my staff.

Dr Davison: It's in the brief.

Mrs Trimmer: It's in the brief; okay.

Mr Jim Wilson (Simcoe West): Thank you very much for your presentation; it was quite good. You began by saying you hope the opposition parties support this bill. I was out in the hall talking to the cancer society. Somebody out there is running around saying that the opposition parties don't support this legislation.

I can only refer people to the second reading debate in the House and to how each party voted. Everybody voted in favour of this bill. In fact, we're probably doing you a favour by poking some holes in it and having these hearings, because otherwise it would have won on the nod on third reading. I would ask all groups out there to consider that, that we wouldn't have the opportunity to receive all this wisdom.

Secondly, and it's more of a comment than a question, this will be landmark legislation if we see the regulations. It currently doesn't deal with plain packaging, it doesn't deal with kiddie packs and it doesn't deal with a number of things that you've suggested. So part of our role in opposition is to challenge the government to bring forward the regulations.

We're going into an election year. Anything could happen. It all sounds good in the bill, but there's no meat on the bones. In fact, it's just extending the current model, and we've been told by a number of young people that the current model, in terms of penalizing retailers and not putting any responsibility on young people, for example, just doesn't appear to be working. They tell us: "Raise the age to 19? Whippy ding-dong. It hasn't any effect on us."

We're trying to actually challenge the government. It's got a lot of credit in the media for banning kiddie packs. That's not in the bill, so I don't know what piece of legislation the media have been reporting on. It won't be in the bill until we see the regulations. We're prepared to help the government with amendments if it brings them forward.

There are a number of other things I agree with. One is the mayor's comments with respect to -- obviously, where we do have a disagreement is on the pharmacy issue, because we see some of the larger pharmacies as retailers, and that's their own testimony to us, that they're both retailers and health professionals.


It seems to me that certainly in my lifetime I can see us moving towards selling cigarettes in controlled outlets like beer and liquor stores. I can see that's the trend. I think people probably want that in the province. It would take a lot of political courage to do that, and we've been challenging the government to think about that idea too. So I appreciate your comments, your worship.

The Chair: Any comments?

Mrs Trimmer: I think we'll --

The Chair: Just so Hansard knows, we'll state it. We'll move then to Mr Wiseman.

Mr Jim Wiseman (Durham West): I think a lot of us have become aware of the need to have very strong legislation in the face of the abrogation of the federal government in its responsibilities in this area, and the fact that its actions are going to make it incredibly difficult to sustain the kinds of policies that will prevent cigarettes going down in price to where kids can afford to buy them. I am so angry about this I can hardly contain myself. As a father of kids who are just coming into that age group, I really want to have some strength and some teeth in this.

We heard a presentation yesterday in Sudbury from a school called Lively. They have a very interesting policy where they've put together a group of students and faculty and they've discussed how they were going to ban all cigarette smoking from the school property and so on.

The one area where they were found they were running into problems was the same area that you're running into, and you need the amendment to enact your bylaw. I didn't see it in here and I'd like you to discuss this, and that is if there was some way of putting an area around the school, on public sidewalks or public roadways or public green spaces, where the kids couldn't escape to to smoke. If you ban it on the school property, I know where they're going to go. They're going to go to the sidewalk, and you sit there as a teacher or an administrator and you ring your hands and you get really frustrated. There's one comment.

The other comment is that in order to enforce this, and it was raised by a number of people, Mr Wilson and I think Ms O'Neill, and it came out of an idea, I would like to see some kind of civil action being possible on the part of parents to sue or to proceed against people who entrap young people who are under age, so that they can sue them in a civil way in order to be able to charge them. As a parent myself, I would like to have that right. Could you comment on those two things?

Dr Colin D'Cunha: In the area of public places, I think that could be addressed through definition in the proposed regulations when they come out. At the city level, we didn't go beyond enclosed public places because the feeling at the city level, based on advice from our legal department, was that these are matters beyond municipal jurisdiction, which is partially why it's come to you. I suspect you're looking at the environment in the broader sense, and at the end of the day I suspect you're going to end up at the federal-provincial table.

Dr D'Cunha: On the second point, in the area of civil action, it's certainly within provincial jurisdiction to look at some matters, and again you're going to be at the federal-provincial table, because if you're getting into acts involving the Criminal Code, the feds very much have to be involved. This is totally out of municipal jurisdiction.

Mrs Trimmer: On the question of the area around a school and the roads, I'm not sure that we would have the jurisdiction to deal with that in that way. I can guarantee that we'll take a good look at it, but I really don't think we would be able to do anything.

I have to wonder -- I go back to the time when I was in school -- what is wrong, or do the school boards or the schools themselves, the principals and the administration, not have the ability to say to all their students, "There are certain things you will not be seen doing"? For example, when I was growing up, if any students in my school were seen eating anywhere out on the streets and not in a restaurant, if we were chewing or eating anything at all, even ice cream, we were hauled up before the principal. I realize things have changed over the generations.

Mr Wiseman: Boy, have they ever.

Mrs Trimmer: However, when it comes --

Mrs Haslam: There are a number of teachers here. You're talking to former teachers here.

Mrs Trimmer: I'm a former teacher too, and I'm well aware that there is a lot of responsibility on the administration and on the teachers. I don't like situations where the buck is passed to someone else and I saw that happening when it came to selling drugs in schools. Everybody denied responsibility for being able to do something. I don't buy that. I think that collectively the schools, the teachers and the parents have to take some action themselves and to set down the rules.

Mrs O'Neill: I have to correct the record first. I have no recollection at all of talking about prosecution regarding this matter and parents initiating such, and Mr Wilson said he has no recollection either and he wanted me to bring that into the record, so let's get that straight.

I know that Scarborough is known across the province, indeed across the country, as being a leader in this area and I want to congratulate you. I come from the Ottawa area and my community also is looked upon as a leader in the area. I want you also to know that the Liberal members of this committee certainly feel the bill should be strengthened. We will be supporting it, but we think it should be strengthened. I'm very happy that you brought the workplace situation forward. Yesterday, in Sudbury, we had several presentations and one group actually brought forward its workplace health and safety officer. I thought that was a very good idea to make their point very clear.

What we heard more of in Sudbury -- I wanted to ask you if you'd thought about it at all -- was that they are really, and I think at this moment, supporting it in their community by encouragement, not monetarily, cessation programs in the workplace, cessation programs in the schools, having them as part of the credit programs in the schools and offering in the workplace that no pay will be lost; for 10 hours a week they will be permitted. I felt that was a very progressive move.

I'd like to also ask you, if this bylaw that you're suggesting, and if this bill goes forward as such, are you thinking, as a fallback position, of the municipal right to license that you have, which some other communities in the province have used. Perhaps you would like to comment on either the licensing or the cessation. Those are my questions.

Mrs Trimmer: I think Dr D'Cunha probably knows more about the licensing aspect.

Dr D'Cunha: In terms of licensing of tobacco sales, I should point out for the record that it belongs to Metro council and not to Scarborough city council or North York city council or Toronto city council, so I can't shed any wisdom from the local perspective because the power is simply not ours.

In terms of the cessation programs, as a major employer, the corporation of the City of Scarborough does offer cessation programs for its own staff, and through a process of leadership, encourages through the business community, namely, the Scarborough Chamber of Commerce, to offer similar programs. Perhaps down the road -- again, this one has to go to the federal and provincial table -- serious consideration should be given to tax credits to employers for instituting such programs, as distinct from taxing health benefits, which is another proposal floating out there.

Mrs O'Neill: A very good idea.

Mrs Trimmer: One of the other concerns we have with regard to the workplace -- this was brought to my attention by Dr D'Cunha -- is the studies that have been done in the United States with regard to the impact upon workers in, for example, bars and restaurants who are non-smokers but are of course smokers by virtue of the second-hand smoke. There is, it seems to me, a high degree of liability for the health of those people and that has to be considered as well.

The Chair: Mayor Trimmer, ladies and gentlemen, we appreciate very much your taking the time to come before the committee this morning and thank you also for the copy of the bylaw which you left with us.



The Chair: If I could then call on our next witness, Mr François Coutu, president of Maxi Drug Stores, bienvenue au comité. Please make yourself comfortable and then go ahead with your submission.

Mr François Coutu: Even though English is not my mother tongue, I'll speak English. It'll give me a chance to practise anyway. I'm François Coutu. I'm a pharmacist. I represent 17 drugstores in the province of Ontario under the name of Maxi and under the name of Jean Coutu. I read Bill 119 and even though there are obviously a lot of good things in it, I can't believe we've really singled out the pharmacist as being the guilty person in this bill.

A pharmacist, as you know, is a health professional by formation, by training, but also a retailer and that's a fact of life. The pharmacist, first of all, doesn't sell tobacco products; usually they're sold at the front shop. I don't know if you have any experiences of a pharmacist selling you cigarettes. I don't believe it ever happened.

As a matter of fact, when he works at his prescription counter, he offers this community and this province a good service, a service that is provided to the public, I believe, at a cost saving to the government. I want to explain this to you by saying that mainly because he has developed a strong commercial side attached to his professional practice, this has enabled him to offer other services, to have extended hours.

For example, it's very easy, very accessible to call a pharmacist if you want to talk to him personally. He's always there to give you advice on health and everyday matters, but also, like I said, he has to compete with other people who are selling health and beauty aids or selling certain other items that he carries in his store.

One of the things that is for real is that tobacco has been a traffic-builder for a retailer. The way the bill is proposed, it's like taking all the tobacco sales that are done in pharmacies and handing them out to our competitors, with no real action on dropping or to curve down the consumption of tobacco.

For example, in our stores, we sold last year close to $5 million worth of tobacco. With these times, I don't think I'm ready to hand it out to somebody else without having a promise that the consumption will go down. As a matter of fact, the convenience store will probably be more than happy. They're going to look at me, "Good, now that you lost this, I'm going to have a good drive at it and sell it for you." So what's it going to bring? Nothing.

What I'm saying is that the way the bill has been proposed is actually hurting my people, my pharmacists, without even having a second opinion or a second chance of making that business that they've been losing with something else.

It also points out a discrimination issue where again I'm saying, why in this bill is the pharmacist being singled out as being the guilty person? Everybody in this room knows that tobacco is hazardous to your health. There's no question about it. I cannot even discuss it; you've heard plenty about it.

We've made a lot of progress over the years. A lot of pharmacists have taken their own decision to take tobacco out of their pharmacies and I think the trend is going further and further. As a matter of fact, in the 17 stores we have in this province, two have decided not to sell tobacco. I think it's a question of freedom of choice. If you decide that tobacco is hazardous and should be restricted, I would support restriction for everyone, not just for pharmacists but for everyone who is in the retail industry, because in this case I'm telling you the pharmacist is a retailer and is competing with other people in the same situation.

One thing that pharmacists have done, especially in our group -- we have done something two years ago that it may be interesting for you to know about.

There are a couple of products we sell in our pharmacies that can help people who have had the smoking habit for a long time and cannot get rid of it. Unfortunately, we cannot advertise these products, so there are some people who are not even aware they exist.

Two years ago, we made a strong commitment with one of the companies that manufacture these products to try to see if it could make it more available to the public. A couple of years ago, and still now, to get these products -- called Habitrol by Ciba and there's also Nicoderm and Nicorette which is a nicotine gum, and this one is a nicotine patch -- to get a prescription for this, or at least to get this product, you have to go and see a doctor.

You're not sick; you just want to stop smoking. You have to go and see a doctor where he writes you a prescription. Obviously, this is costing something to the government. The doctor has to be paid. Contrary to the pharmacists, you go and see a doctor and he's going to get paid for it. A pharmacist, if you go and see him and ask some advice, he's not necessarily going to be paid for it, unless he sells you something. I just want to make this clear.

Anyway, you go and see a doctor and he writes you a prescription. Then he has to go to the pharmacy and fill it and that's where it goes.

We wanted to make this product more available. You don't need to go and see a doctor to get a pack of Nicorette; I don't think so. That's where I think pharmacists can help. If this product could be made available, if the pharmacist could really help in advertising this product more and make sure that the community knows about this, I think we could help a lot of people to stop their habit.

Smoking cessation is something that is possible, and these are good products. These are a lot safer than cigarettes; you know that. As a pharmacist, I can recommend them. We've done it. For the last six months, we've tried to really work with the people we know are smokers, and believe it or not, it has worked out. Probably not all of them have stopped, you know that, but with some of them we've really worked at saying: "Listen, do you know this exists? Let's try it." Believe it or not, we've we've helped in stopping some of the people who had this habit for a long time.

I think in this fashion that's how pharmacists can really help.

That's my position. The way the bill is stated, I don't think it does a favour to the public. It certainly doesn't do a favour to the pharmacist because it doesn't do anything to curve down the consumption of tobacco. I wish we could bring forward some more positive way of looking at it.

Mrs Haslam: Are you a licensed pharmacist?

Mr Coutu: Yes.

Mrs Haslam: Obviously, you do believe in the negative effects of smoking and of cigarettes. We're trying to get towards a smoke-free Ontario. Would you be in agreement that was a good goal to be aiming for?

Mr Coutu: I think so, yes.

Mrs Haslam: Then your arguments lead to the presumption that the financial benefits of tobacco sales supersede the health goals of a tobacco-free Ontario.

Mr Coutu: It supersedes in one way, because you're making a judgement and it says that as a health professional I have to really take this as my priority, before my financial gain. The problem is that the way I practise pharmacy -- I'm not in a clinical setting where doctors are sending their prescriptions over to downstairs and so on -- I have to fight every day for my living and for this I have to advertise and I have to compete with other people.

Mrs Haslam: I understand that.

Mr Coutu: In this way, I am saying, if you take my business that I am taking now and give it to somebody else who is competing with me, I say no. You are doing me a disfavour.


Mrs Haslam: I have a couple of questions and a comment. We get letters, sometimes from people can't come in and take part in the hearings. This came from a pharmacist in a pharmacy in Sarnia. I am reading it because you said you had a comment and this actually has an exact opposite comment.

"In this legislation, pharmacists are not being picked on. Rather, the legislation is recognizing both the unique role we play in promoting public health and the importance of this role in moulding public opinion. It is therefore a public health measure in the spirit and tradition of the Pharmacy Act of 1871 and its great-grandchild, the Regulated Health Professions Act of 1994."

I wanted to ask a couple of quick questions. The Nicorettes: Are they habit-forming?

Mr Coutu: They are, obviously, because they have nicotine in them.

Mrs Haslam: Would that be one of the reasons why it requires a prescription in order to get it?

Mr Coutu: As a matter of fact, for the last six months it hasn't needed a prescription any more. It's under strict control by pharmacists.

Mrs Haslam: Why do you think the prescription is needed for the patch? I don't think of the patch as being habit-forming. Am I incorrect in that?

Mr Coutu: It is still habit-forming, because it does provide you with a certain dose of nicotine every day, and that's what people are driving for, having this dose of nicotine on an everyday basis.

Mrs Haslam: Would that be why there is a requirement for a physician to give you a prescription in order to fill those then?

Mr Coutu: Yes, that's what I believe, plus it should be supervised in a certain way as to how the people are taking their regimen. It's not just chewing gum; you have to have a certain fashion of doing it. As pharmacists, we have to explain how to do it to people so eventually you have this habit-forming reduced or even lose it.

The Chair: The parliamentary assistant on a point of clarification.

Mr Larry O'Connor (Durham-York): It's my understanding that the patch itself, for example, if it got into the hands of a child could in fact be lethal if it was ingested, or that even if an adult had it on their tongue, it could actually be lethal.

Mr Coutu: I've never heard of someone taking a patch and really swallowing it or something like that. It's been going a little further than what it is exactly. The patches have been made to steadily give a certain percentage of nicotine. It is a dangerous product. You should not have it handled by children, I understand, like any other drugs in the house. It's not a product that obviously you can have taken by children, but as an adult there's no problem using it.

Mr Jim Wilson: Thank you, sir, for your presentation. As you know, my party has some sympathy for the pressure this bill puts on the retail end of your business, but I have to be perfectly honest with you: With the entire broader health care sector against that argument, I don't think we're making much headway with the government on that particular provision in the bill. Unfortunately, this is a government that is not particularly interested in any retail arguments or business arguments when it comes to --

Mr Coutu: I know it's not very popular, because we're only a thousand pharmacists, and you've been elected by a few million people.

Mr Jim Wilson: Yes. You may want to start focusing your guns on a constitutional challenge, much like the home care providers are doing. I know that's probably in process. I want to talk about Nicorettes because you mentioned that finally they're over-the-counter now. With patches, I somewhat question also whether pharmacists could do that without -- when you're doing 21 milligrams of nicotine, high-end patches, somebody's heart might explode or something. They probably need a bit of a physical prior to that prescription being issued.

None the less, you did say something about you can't advertise these cessation products. I just wondered about that, because Nicorettes are certainly advertised.

Mr Coutu: There's advertising, but as pharmacists we cannot because it has a DIN number on it. We just cannot promote the sale of these products, by law.

Mr Jim Wilson: I wonder about that, because I agree with you because of the DIN number. Maybe we could help you with that, because currently you can advertise cigarettes in your front window.

Mr Coutu: That's what I'm saying.

Mr Jim Wilson: But you can't advertise this.

Mr Coutu: It's ridiculous; I agree with you.

The Chair: Thank you very much for coming before the committee this morning.


Mr James Snowdon: Good morning. My name is Jim Snowdon. I'm the owner and manager of Snowdon Pharmacy. That's a 1,500-square-foot, full-service drugstore located in downtown Toronto. It's on the ground floor of the Medical Arts Building at St George and Bloor streets. It's not too far from where we are right now. This pharmacy has served the area for some 65 years and my family has been involved for the last 55 years: my grandfather, my father and myself.

I'm a graduate of the University of Toronto faculty of pharmacy, 1970. I'm currently a member in good standing of the Ontario College of Pharmacists, the Ontario Pharmacists' Association, the Canadian Pharmaceutical Association and I am a fellow of the American College of Apothecaries.

I'm pleased to be before the committee today to speak of my experience in the discontinuance of tobacco sales in my pharmacy and to share my personal views with you.

It has been clearly established by many others that smoking is deadly. For me, it then follows that ethically pharmacy tobacco sales are deadly.

But what was I to do? The doctors would trudge into my drugstore, plunk their money down and trudge out with their smokes. It was becoming a daily ritual at Snowdon Pharmacy and some of my staunchest cigarette buyers were physicians. But the routine bothered me. How could I, a health care professional, reconcile selling Ontario's leading cause of preventable death, and to doctors at that? I just couldn't reconcile that.

Sometimes silence is not golden; it's yellow. So in June 1989, I sold my last cigarette. I proudly did that. The consequences were that I felt 10 feet tall. I was proud as punch. I lost $5,000 in tobacco sales a month -- that's a month -- and I lost an equal amount of sales in other products the smokers would have purchased with those tobacco sales. Some 12% of my business disappeared overnight. I voluntarily gave that up for a principle.

The Canadian Pharmaceutical Association had a little bit of data at the time. They promised that the prediction would be that the money would come back in three months. Well, they were slightly wrong. The sales dollars did return in six months, but the profit dollars did return in three months. Recover we did, by selling other merchandise which had a larger gross profit. We actually gained by giving up the infamous tobacco subsidy.

We gained in several ways: We gained in dollars, we gained in customer loyalty and we gained in ease of work. We didn't have to run quite as hard to serve as many people because the items we now sold had a higher profit margin, which allowed us more time to interact with the people, which brought an upward spiral to more customer loyalty.

In this whole scenario, no one lost their job in my store. No one got penalized on their pay. The landlord received the rent on time. I paid all my bills on time. Five years later, we are still an economically viable operation without the tobacco sales, despite the fact that our neighbouring pharmacies still sell tobacco.

The big question is, will this bill make any difference to not selling tobacco in pharmacies? In the overall scheme of things, I honestly don't know. But what I do know is that smoking is contrary to good health -- nobody's going to argue with that -- and that change has to start in my own backyard. I started in my pharmacy and the next step is my profession. Every tub smells of the wine it holds and I want mine to smell as sweet as it can.

I'd like to acknowledge the Ontario College of Pharmacists for initiating this bill to ban tobacco sales in pharmacies and I offer OCP my complete support in the matter. I'd like to thank the Ontario government for bringing forth OCP's request in the form of Bill 119, and I support this legislation.

I'd like to thank you, the committee, for hearing me this morning in your deliberations about Bill 119. I welcome your questions and comments as time permits. I realize this is just before lunch, so I've kept it short.


The Chair: That's quite all right. We thank you for coming. Just anecdotally, I can certainly remember as a young kid going with my father to the Medical Arts Building. He was a diabetic and so I realize that on many occasions we would end up in the pharmacy in the Medical Arts Building. As a kid that was always a wonderful experience to go through, to be able to go down with dad to that place, and then to go into the pharmacy where of course we always got not cigarettes but chocolate or some such good thing to eat.


Mr Snowdon: The soda fountain is still around.

The Chair: Some of us do date back, Mr Wiseman.

We have time for several questions, beginning with Mr Martin.

Mr Tony Martin (Sault Ste Marie): I'm sure that in arriving at your position on this issue, you also agree with the framework and the principles behind this legislation, which are to try to prevent and stop the smoking of cigarettes because of their impact on health.

I find myself this morning in a very troubling mood around the issue of what the federal government has done. Listening to your presentation, you are a person who certainly made a difficult decision at one point that had economic ramifications. We're in a position now where we've made a difficult decision in front of a challenge that we still haven't seen the full ramifications of, because as we hold strong to our sense of principle on this one, we will be impacted. The talk is already out there about an influx probably of contraband cigarettes from Quebec that we will have to deal with.

Do you have any advice for us as a government in front of that, in light of the fact that we will be criticized severely by people, as Jean Chrétien said last night, for having our head in the sand, that kind of thing?

Mr Snowdon: It does present you with a unique dilemma. I do not have much hope that your continued high tax will deter people from smoking in Ontario. Their sources and our borders are close enough that the tobacco is still going to run in across the borders. The tax position is not a threat to decrease tobacco consumption, and I don't think the present position is going to decrease tobacco consumption in Ontario.

Mr Martin: Although we're being encouraged to a person by public health groups to stay the course, what would you suggest that we might do otherwise to have the same impact that we now have with the price of tobacco?

Mr Snowdon: Nothing will ever be as quick as a price change. This you will not combat easily. My preference for seeing your activities directed would be to education and some changes further in legislation.

The education is well looked after in many aspects and I'm sure will be expanded. The changes in legislation I refer to are what my predecessor just mentioned, the easier availability of nicotine substitutes. We appreciate that the items he mentioned, Habitrol and Nicodette, are potentially dangerous and do need some education, but some of the roadblocks to their access need to be removed. Perhaps one of these would be the removal of the physician's visit requirement to get some of this product. There are many people with good intentions out there. Give them half a chance. They might use some of these other products, which would reduce our tobacco consumption.

I strongly support some change in the legislation as to the restriction of the nicotine intervention and support material, Habitrol and Nicorette gum.

Mr Ron Eddy (Brant-Haldimand): I think that's very important. Thank you for your presentation and your views on this particular matter that you've just expressed, because I think that's awfully important. Indeed, I didn't know there were the restrictions to that extent. I do know people who have used some of those products.

We've had suggestions that all sellers of tobacco should be licensed. We've had other suggestions that tobacco products should only be sold through government outlets. There have been very few suggestions that all tobacco products should be banned, I guess for various reasons. In view of the fact that these rules or regulations are going to help somewhat, but that they're certainly not going to reduce tobacco smoking or the use of tobacco products by very much, in my opinion, what do you see as a further step that would help this situation, help eliminate or reduce even more?

Mr Snowdon: As it stands now, it's all a negative approach, saying, "We don't want you to have this product." You haven't offered them an alternative. Going back to what we just said, you have to offer some education, which is there, but it's a very soft type of approach. Now you need to offer product, which is the nicotine substitute product, and you have to offer it freely accessible; I don't mean without charge dollar-wise, but free access to this material so that it can be consumed.

I truly feel there's a groundswell out there. Many people who smoke would like to stop smoking. It is a snowballing effect. Given half an ounce of chance, the snowball will gain in size considerably. People will move from the smoking of tobacco, the chewing of tobacco, into the nicotine substitutes, into non-smoking, and it will occur at a faster rate as the upcoming years approach. We can encourage all that with education and with the increased availability of substitutes.

I don't think you have to do any grandstand plays. I think if you stay with your tax line as it is, fully appreciating that you're not going to deter the smoking, but maintain your posture and your position and your principle by maintaining that tax line, continue with the increased education and change some other legislation rather quickly on the availability of alternative products, you will probably make a better long-term effect on the population and their smoking habits than anything else.

Mr Eddy: And that would reduce the beginning smokers too, the kids?

Mr Snowdon: I think it would.

Mr Eddy: It would have an effect.

Mr Snowdon: Just as a little footnote, pharmacists have been oft referred to as the least used health care professional. Here's your golden opportunity to flag them and let them do some work for you.

The Chair: Mr Snowdon, thank you very much for coming in this morning. We appreciate it.

The committee recessed from 1158 to 1335.


The Chair: The first witness this afternoon is from the borough of East York. Mayor Prue is here. Welcome, your worship. If you'd be good enough to introduce the members of your delegation, we have a copy of both your oral presentation as well as the written presentation. We had one of your colleagues, Mayor Trimmer, here this morning. As we move a little bit to the west, we welcome you as well.

Mr Michael Prue: Thank you very much. Mayor Trimmer and I are really very thankful to come here for two reasons: (1) to present what we have to say and (2) to escape from the budget meetings at Metro council. I know that she was gone and just returned. I didn't ask her where she went, but we'll have to compare notes when I get back.

I'd like to introduce the two people with me. On my right is Dr Sheela Basrur, the medical officer of health for the borough of East York, and on my left is the chairperson of the board of health, Mr Geoff Kettel. You have my written statement. I guess I'm going to read a good portion of it, but I'm going to ad lib here and there to try to make it a little more interesting.

Mrs Haslam: I see you've written the ad lib part in already.

Mr Prue: No, no. That ad lib part was written in for me. My writing is much neater. That is a doctor's writing.

The Chair: That's right; it's a prescription.

Mr Prue: You know what they say about doctors' writing. When they scribble that note to the pharmacist saying what you're supposed to get and then the pharmacist scribbles something back, what they're really doing is saying in code, "I got mine, you get yours."

Anyway, we're very delighted to be here. On behalf of the board and the staff of the East York health unit and on behalf of the members of council for the borough of East York, we congratulate the Ontario government for taking a leadership role in this fight, and we consider it a fight, against tobacco. We applaud the opposition for taking a non-partisan supportive position on the province's number one preventable cause of death.

At a council meeting on Monday night we had an emergency resolution before us to deal with: the proposed federal government initiative to lower taxes. We didn't have much time to research it, but the council -- I believe the vote was 7 to 2 -- voted to commend the Ontario government for any initiative or any actions that it could take to resist the reduction in the taxes. We're hearing on the news this morning that this may not be too good. You only have to see the lineups crossing the bridge into Hull to know what's happening. I think the government is in a no-win situation. But our council is on record opposing any reduction in the federal or provincial tobacco taxes and we commend the province of Ontario to do whatever you can, and it might be very difficult, to resist following the direction of the province of Quebec.

Overall, we strongly support Bill 119 for its focus on smoking prevention among youth. We believe the committee is well aware of the health benefits of supporting the bill, so we have chosen a different focus for today's presentation. Basically, what we'd like to talk about is what we think has been a very successful initiative at a local level, that is, within the borough of East York and within the East York health unit, to combat smoking, particularly among young people in the borough.

I don't have to preach to the members of the committee on tobacco. We know that it's probably the leading preventable cause of death and we as a community all know the thousand or so carcinogens found in cigarettes. What we have attempted to do over time is to convince our community of the very real dangers of environmental tobacco smoke, the very real dangers of cigarette smoking. We've tried to do that in a way that's both fun and educational. We've tried to do it for young people, for old people. We've tried to go into public institutions. I think very much we've been successful.

A couple of the major programs: The first one's A Change of Heart. The health unit launched A Change of Heart, a community-based health promotion program modelled on large demonstration projects from around the world. We focused on three main areas: smoking, diet and exercise. We encouraged people to either quit or smoke less. We trained community dentists to counsel patients not to smoke.

Starting in the mid-1980s, true prevention began in day care centres with the smoke-free class of 2000 project. The health unit also became a pilot site for the Waterloo smoking prevention program, an initiative that focused on elementary school children. We've had several functions in the borough of East York over the last year, and to celebrate the coming into force of our bylaw, we had many children come forward. They put on plays and skits; they drew posters. They're very much involved in the whole Change of Heart program. I think we've made some significant progress among younger students, convincing them that they should never start smoking.

The tobacco-free high school project we aimed at older children, those who probably will succumb most easily to the media and to the stereotype that you see in the cigarette ads, that you see in the magazines: the cowboy riding the plains or everything else that a media genius can think of to tell people that this is somehow glamorous or sexy or important or virile or -- I don't know what other words to use. We've tried through the tobacco-free high school project to show them that maybe it's -- let me put it bluntly -- more than a little bit of hogwash.

A 1988 survey of East York high school students found that 40% were regular or occasional smokers -- I, on the board of health at that time, was really quite surprised it was that high, but it is -- and that 30% of these smokers wanted to quit. Using a grant from Health and Welfare Canada, the health unit developed the tobacco-free high school project. That project conducted research, raised awareness and promoted cessation opportunities in two East York high schools. The project was unique because it was based on student-initiated activities, and we felt this was absolutely important. It wasn't some older person coming in and talking to them; it was the students themselves who initiated the activities. The health unit has since expanded the program to all East York high schools with financial support from the board of education.

Our ETS bylaw -- this was a marathon session and I imagine you're going through a similar one now. This lasted four years. It took four years to come up with an environmental tobacco smoke law. We started in 1989 and we finished in 1993 and I think on May 1 --

Dr Sheela Basrur: May 31.

Mr Prue: -- May 31 this year it becomes law. There's a one-year phase-in period and it becomes law. It, in effect, took five whole years. The health unit started by advocating a bylaw to protect East Yorkers from ETS. Much time and expense was incurred to obtain special legislation to enable East York to enact such a bylaw, and we'll get to that at the end. It was a very long process that we feel may and should not be necessary. Certainly East York, although we're small by Metro standards, is about the 20th-largest community in Ontario and we do have some significant resources. It would be, I think, very onerous, if not impossible, for smaller communities that want to follow our lead to go through the process of having special legislation, all the lawyers' fees that were involved and the process.

We undertook widespread consultation while the bylaw was being developed. It showed strong support for tobacco control among various communities and interest groups. In fact, our council has unanimously on three occasions endorsed the bylaw when it was addressed before us. Of all of the people who came before our council meetings or committees to speak on tobacco smoke, on ETS, I think all but one were in favour of the action we took. When I say "all but one," I'm talking about East York people or East York communities. There were of course lobbyists for the pro and con who came from far and wide to address us, but among actual East Yorkers who came forward only one came forward to speak against the ETS bylaw. He wanted permission -- I forget exactly how he phrased it -- to do whatever he wanted and he didn't really care whether anyone else was affected.

Since our bylaw passage, in May 1993, we've received over 200 calls from employees, employers and the public. More than 75% of the callers complain about ETS and its disabling health effects, to the point of their being unable to work, and wonder why more restrictive regulations have not been implemented and certainly are waiting for May 31.

A 1993 survey of large East York workplaces found more than 70% of employers support smoke-free workplace policies. In fact, many employers were anxiously awaiting legislation to provide them with the legal support they felt they needed to implement a smoke-free environment.

Many health agencies across Ontario, indeed across Canada, have contacted East York Health Unit to seek our assistance in developing similar programs for their communities. We believe our efforts have been extremely worthwhile for East York and may have, in the long term, benefited other communities in their fight against ETS and tobacco usage.

Overall, we commend the province for proposing a minimum standard of ETS protection across Ontario. However, we believe that stronger provincial standards would be supported by Ontario communities and we urge you to raise these standards at least to the level of our own bylaw.

We realize that we are probably in the forefront, if not near the forefront, but we think that our bylaw will, over time, be supported by the vast majority of communities in Ontario. If the committee sees fit to do so, these municipalities will not have to incur the cost of special legislation to obtain a higher standard of protection than what might otherwise happen.

We also point out that 90% of adolescent smokers will continue their addiction into adulthood if they, in fact, start and one in five of them will die from tobacco-related diseases.

In face of federal and perhaps even provincial tax rollbacks, a stronger, more effective bill is essential to protect the health of future generations. We urge you to consider our recommendations to strengthen the bill, as outlined in the attachment that we gave you.

The Chair: Thank you very much for coming forward and we'll get right to questions.

Mrs Haslam: I know our time is very limited and I know Mr Wiseman put his hand up. I think we want to ask the same question.

I'm very interested in your tobacco-free project at your high schools. You didn't indicate the success of it. I would be interested in hearing a little bit more about how that worked. I understand the idea about student-initiated activities, because many of us feel that education programs don't reach our young people, and I'd like to know how successful this one was, given that you took a different tack.

Mr Prue: I'll turn this over to Dr Basrur who, I'm sure, can answer these technical questions.

Dr Basrur: Okay. The program has evolved somewhat over the years, so I'll just try to speak as briefly as I can to it and say that the tobacco-free project was almost a community development project within the high schools. There were some test high schools that we used and we worked through the student councils, the principals, the parents, what we would call the school community, to identify what they would like to have happen in the area of tobacco control and tobacco use prevention.

So the way in which it unfolded was really a reflection of the school community. In some cases it took the form of contests or challenges. It may have taken the form of assemblies and skits and songs and videos and all kinds of creative things that these kids come up with aimed at promoting a tobacco-free environment or getting kids to quit or not to start because it wasn't cool or it wasn't smart, that type of thing. That was the main thrust.

Mrs Haslam: I meant, you had an 1988 survey that found 40% were regular or occasional smokers. Was there an additional survey following these activities that showed the activities worked?

Dr Basrur: We are planning a survey to do exactly what you're describing, take a look and see if there is a downward trend. That survey's still in the planning stages.

Mr Wiseman: Yesterday we heard from two young people in Sudbury who had a similar project at Lively high school. The question I asked them was, were they then thinking about taking the peer groups -- the young people who had started to smoke, became addicted to smoking, wanted to quit -- into the elementary school, because some kids are starting as early as grade 6, 7 and 8 now, to talk about the negatives of being cool and trying to push that peer pressure down further so that they can have an impact at an earlier age?

Dr Basrur: It's an excellent idea. I'm not sure if it has actually been used in East York. It may well have been considered because we have focused in the past on role modelling for kids using their own peers, not to have parents try to describe a role model but to bring people that they can relate to, and certainly high school kids talking to elementary would be a terrific idea. It may or may not have been used; I don't know.


Mrs Cunningham: Thank you very much. It's a pleasure to see such leadership in the municipalities and some of the work that you've done. The research that you've done in East York I think is going to be very helpful, not only to us but to other school boards and municipalities, I'm sure.

I did read the additional submission, Dr Basrur. The medical officers of health, by the way, have been quite outspoken, at least as I long as I've been around, and it's about time, because it's that kind of leadership. So I'm complimenting you. You've helped some colleagues.

You talk about the bill being strengthened, that the regulation of tobacco retailers be actively enforced. There are more fines, but I was really thrilled to see you go so far as to say -- I think you did in here; I read it quickly -- that they be licensed to sell tobacco. I wondered if you would go further. One of your colleagues suggested that cigarettes ought to be sold along with liquor products in LCBO outlets, so if you would respond to that.

Also, you're aware that although we talk about plain packaging and the abolition of these kiddie packs, it doesn't appear anywhere in this legislation, something that everybody's talking about. Would you say it should be legislated or regulated? If you can respond to those two issues, I'd appreciate you elaborating on your own paper in that regard.

Dr Basrur: From my point of view, from a public health standpoint, tobacco is a hazardous product. I believe one of the other issues is whether it should be designated as such legally under federal legislation, and I would certainly support that. When one thinks of what tobacco contains and what it does, there's no reason why you would exempt it.

Having said that, again it makes sense to have very strict controls on the retail. Intuitively one might say that you either sell it in liquor control board outlets or you have a tobacco-control-board type of system. The question then becomes, if you do that, is the community ready to accept that or not? I think it's a gradual thing that needs to be in place or you might wind up with an unenforceable law, as we have seen the consequences of, and you might have a back-and-forthing that is ultimately not helpful. But I would certainly say that's the way to go.

It becomes unfair eventually on the retailers who are just trying to make a living. They've got a legal product; they're trying to sell it. There are more and more controls. Why not just take the issue out of their hands and sell it the way it ought to be sold, which is with very strict controls?

Mrs Cunningham: What about the packaging?

Dr Basrur: The plain packaging?

Mrs Cunningham: And the kiddie packs.

Dr Basrur: Kiddie packs, for sure, are aimed I think at people who are unable to afford the full price of a pack, whatever that happens to be today.

Mr Wiseman: Right now a full pack is less than a kiddie pack.

Dr Basrur: Yes, exactly. In principle, kiddie packs ought to be outlawed. Whether they can be under provincial legislation or whether it would require federal, which they've said they will do, of course that should be in place. The plain packaging, absolutely. Again it's a matter of whether society is ready to accept the fact that they are really buying the packaging; they're not so much buying what's in them.

Mrs Cunningham: Thank you for your leadership, all of you.

The Chair: Mayor Prue, on behalf of the committee, thank you and your colleagues for coming before the committee and for your presentation. We appreciate it.


The Chair: I next call the representatives from the Ontario College of Pharmacists. Welcome. I know you're not strangers to this forum. Please go ahead.

Ms Midge Monaghan: Thank you very much. My name is Midge Monaghan and I'm the president of the Ontario College of Pharmacists. I'm accompanied today by the registrar of the college, Mr Jim Dunsdon. We have a copy of our presentation for you, and I'm looking forward to your questions at the completion of our presentation.

As the official representatives of the Ontario College of Pharmacists, we appreciate this opportunity to make the following submission to the standing committee on social development respecting Bill 119, the Tobacco Control Act, 1993. We also compliment the committee on the work that it is doing and the time it is taking to hear submissions on this very important matter.

The practice of pharmacy is included in the list of health professions regulated by the Regulated Health Professions Act, and the Ontario College of Pharmacists is its governing body. Established in 1871, the college mission is to contribute to the health and wellbeing of the public of Ontario by ensuring that pharmacists provide optimal pharmaceutical care. In carrying out its objects, the college has an overall duty to serve and protect the public interest. While the college council consists of, in the majority, pharmacists elected by their peers, the college does not represent the mercantile interests of pharmacy.

To let you know how our college is structured, I wanted you to be aware of the fact that we have 23 members on our college council. Fifteen members are elected from community practice across Ontario. We're divided into 15 districts throughout the province. We have one hospital representative, we have the dean of the faculty of pharmacy, University of Toronto, and we have six lay representatives, who are appointed by the Lieutenant Governor of this government. Whether these members are elected or appointed, their role is all the same. We are here to advance the objects of the college.

The college's mandate includes the responsibility for licensing and regulating pharmacists in Ontario, for the accreditation of pharmacies in compliance with operational standards and for the regulation of the distribution and sale of drugs to the public. There are currently about 8,230 pharmacists in the college register and 2,330 accredited pharmacies.

Although it possesses significant pharmacological properties, tobacco has historically been considered a recreational substance and has been freely sold in both pharmacy and non-pharmacy outlets in the province. The adverse effects on human health of the use of tobacco are well documented, and the contentious issue of the appropriateness of the sale of tobacco in pharmacies, which are facilities providing health care services to the public, has been discussed by college council for many years.

I want to emphasize that the college's position that tobacco products be eliminated from pharmacies has been consistent since October 1990, spanning two council elections, and most recently reaffirmed in June 1993. All members of council, whether appointed or elected, share a common public-interest responsibility and any policy decision established by the college must reflect this responsibility, not the economic interests of its members.

At this point I'm going to ask the registrar to give some background on what's happened since then.

Mr James Dunsdon: Thank you very much. I'd like to just highlight a few things leading up to the introduction of the bill and to say first that the college's formal consideration of tobacco does go back about 15 years. There was concern about the hazards of tobacco use at that time and the council of the day did pass a policy urging those members who chose to sell tobacco products to post cautionary warnings which complemented those warnings that were on the tobacco packages at that time and as approved by Health and Welfare Canada. The posting of these warnings occur in the pharmacy premises. That was the first formal action that the college took with respect to this matter generally. That was in the early 1980s.

Then as the 1980s advanced, the Canadian Pharmaceutical Association developed a program urging its members to voluntarily cease the sale of tobacco products. This was supported by the Ontario Pharmacists' Association, and the college at that time supported these voluntary efforts. We also encouraged pharmacists to educate their patrons on the hazards of tobacco use at that time. These voluntary initiatives did result in some pharmacies removing tobacco products, but a large majority continued to offer tobacco for sale.

Then in June 1989, council adopted a policy of disapproval of the sale of tobacco products in pharmacies. At that time the college acknowledged that it had no legal authority to prohibit tobacco sale and indicated that the policy of disapproval was circulated as guidance to pharmacists who did have the legal right to make their own decision on the matter. At that time, council indicated that it would review its ongoing policy on this matter.

The result of this policy of disapproval saw a few more pharmacies remove tobacco, but it became clear that the voluntary approach had reached a high watermark, so to speak, with only a few additional pharmacies making the decision voluntarily, the rest continuing to offer the product for sale. As a result of this and also including various representations at the time from interested parties, including such agencies as the cancer society and other anti-smoking groups, the council, at its October 1990 meeting, adopted the following motion:

"Whereas it is the intention of this council to work towards the elimination of tobacco sales in pharmacies as quickly as it is practical to do so, be it resolved that a special task force be established by the president, such task force to present to council ways to accomplish this objective, and that the final report be presented to council at the April 1991 meeting."


This was approved, as mentioned, and a task force was accordingly struck with the following terms of reference:

"To assist council in reaching the goal of eliminating tobacco sales in pharmacies by:

"(1) Seeking the views of interested parties on issues and conditions in pharmacy practice relevant to the process of eliminating tobacco sales in pharmacies;

"(2) Identifying the components of an action plan to achieve the goal of the elimination of tobacco sales in pharmacies;

"(3) Identifying opportunities for individuals and groups, both within and outside the profession, to work towards the broader goal of the elimination of tobacco use by society; and

"(4) Reporting its findings and a course of action to the college council in April 1991."

The task force commenced its work, calling for submissions from interested parties, and it certainly did generate a fair amount of interest. We had I think just over 200 submissions to that task force. The final report of the task force was presented to college council in June 1991, rather than in April, largely because of the interest generated by this particular matter.

This report will be provided to you. It notes here it was appended to the submission. It's not appended to the submission, but we will provide the full report to you. In the meantime, I would like to just highlight certain aspects of the report, if I might.

The report incidentally was approved after discussion, with one minor amendment dealing with guidance to pharmacists respecting the reduction of tobacco promotion in their pharmacies. We set up some guidelines that were not requirements, but there was a minor amendment to the time line on that. Otherwise, the report was approved. The recommendations in the report included:

-- That the college request the Minister of Health to table in the Legislature enabling legislation which would ban the sale of tobacco products in accredited pharmacies in Ontario with a commencement date of July 1, 1993. There was a two-year-to-commencement date recommended at that time.

This was the key recommendation in the report. It followed an examination of various legal options available to us. They included the concept of including a specific reference to the matter in our code of ethics, or establishing a ban through professional misconduct regulations affecting members. These were possible approaches, but the legal advice at the time drove the task force to recommend and indeed the council to agree that legislation banning tobacco from pharmacy premises was the best approach.

-- That the legislation to be drafted be a cooperative effort between the college and the Ministry of Health.

-- That, for the guidance of members, a recommended schedule of activities -- I alluded to that before and that's where the amendment came -- aimed at the progressive reduction of tobacco promotion in pharmacy premises be published. These activities would include the placing of tobacco products behind service counters, the elimination of back-bar displays and all activities respecting the advertising and promotion of tobacco, locating tobacco products below the level of service counters and removing products from public view in a phased reduction or promotion.

-- Another recommendation contemplated the development of educational programs in cooperation with the Ministry of Health, utilizing pharmacists and aimed at the prevention of smoking, including the development of suitable materials and encouraging pharmacists to support and become involved in community programs aimed at the provision of appropriate information on the hazards of smoking.

Finally, a suggestion that the college urge the Minister of Health to examine the feasibility of establishing a controlled system of tobacco distribution, using as a model the sale of beer and liquor.

This report was sent to the Minister of Health shortly after its adoption. The Health ministry acknowledged receipt of it in August 1991 and pointed out to us that a comprehensive province-wide tobacco control strategy was being developed.

With respect to government proposals, you are all aware of the Minister of Health tabling, in January 1993, a discussion paper on tobacco which identified the health issue respecting tobacco and set out a proposed strategy, including legislative initiatives. These proposals had particular focus on smoking in adolescence and included the following statement:

"As it is contradictory for health professionals who restore and promote good health to sell tobacco products that are harmful to health, we propose to prohibit the sale of tobacco products in health facilities and prohibit the selling of tobacco products in pharmacies."

The Ontario College of Pharmacists, in commenting on the discussion paper, affirmed its policy position respecting the elimination of tobacco products in pharmacies, reiterated its view that a commencement date for enabling legislation should be in place, and expressed support for the idea that premises which contained a pharmacy should be free of the sale of tobacco. Subsequently, Bill 119 was then given first reading as a government bill on November 22, 1993. I would ask Ms Monaghan to conclude.

Ms Monaghan: The college commends the introduction of this proposed legislation and supports the provision of Bill 119. Noting that the bill contains a number of provisions relating to such matters as packaging, warning, vending machines and controls relating to smoking, our comments will be focused on the matter of prohibition of sale in designated places, as set out in section 4. The college concurs with the inclusion of pharmacies as designated places for the purpose of the bill. Pharmacies operate in a retail environment and many, but not all, include a wide variety of goods in their premises. However, unlike other retailers, they also provide prescription and non-prescription drugs to the public.

While accredited pharmacies are established in a variety of community settings, it is our position that all pharmacies provide an essential health care service to the public and, accordingly, meet the definition of a health care facility. We note that included in the definition of a designated place is a retail establishment if "a pharmacy is located within the establishment, or customers of the pharmacy can pass into the establishment directly or by the use of a corridor or area used exclusively to connect the pharmacy with the establishment." We are pleased to see this definition as it results in an equitable treatment between such establishments referred to as "non-traditional pharmacies" and the pharmacies that "stand alone."

We also note, and agree with, the one-year commencement period set out in subsection 4(3) of the bill to enable pharmacy owners to have the opportunity to comply with the provisions of the legislation.

In conclusion, the college is aware of the controversy surrounding the issue of tobacco sales in pharmacies. This has been a difficult issue for the profession as well as for the college. Self-regulation is not always easy, and the speculation you have heard about our election results reveals some misunderstanding about the objects of professional regulation, as illustrated by the Regulated Health Professions Act, of which pharmacy is a part.

While all pharmacists, in our experience, appreciate the health hazards associated with tobacco use, there are differences respecting how to deal with tobacco sales. For its part, the Ontario College of Pharmacists is convinced that the sale of tobacco in pharmacies, health care facilities, is simply incompatible with the role of the pharmacist as a professional providing health care to the public. This is the reason for the college's policy on this matter, and this is the reason why we support Bill 119.


Mr O'Connor: Thank you for coming. It certainly will be useful. I ask the clerk to pass this to you because it's part of what I wanted to ask you about.

We've heard many different views about where the college is at one this issue, so we certainly appreciate you coming and helping us out on this. The picture of a pharmacy that's going to be shown to you is actually one that was presented to us while we were up in Sudbury. You'll see in the picture it's got the du Maurier advertisement, which of course is for their jazz festival. I guess it's impacted by the federal legislation, Bill C-51, which has been tied up in the courts going through part of the problems. Just so that maybe you can help, because we've heard from people who are very disheartened that this type of advertising does take place, though it's not advertising; it's promotional and it's sponsorship. It looks like advertising to me, but it's not advertising.

Would you then, from the college -- I'm king of putting you on the spot here -- say that it is most likely inappropriate that this type of sponsorship advertising does take place? It doesn't deal with our legislation, but we're certainly going to hear from people because people have been coming to us saying that this is advertising. You can see by the sponsorship ad here that it's the package and the colours of the package that relate to the advertising that takes place.

Ms Monaghan: I share your concerns; I do. Perhaps I'll ask the registrar to respond to this particular issue.

Mr Dunsdon: We alluded to this in the task force report by way of the guidances. The college does not have legislative authority, yet I think it's clear from the task force report, the thrust of that report, which was to diminish and then eliminate any kind of promotion over time. It was the report's attempt to be helpful with respect to this, realizing that pharmacies which were selling tobacco products did need some time to get out of that particular area. Certainly this -- it's more than subliminal, I guess it goes beyond that -- is in that particular category of promotion and advertising. That sort of thing would be an example of the sort of promotion that the college would see diminishing and then finally being eliminated.

Mr O'Connor: That's why we get people coming to us suggesting we go to plain packaging.

Mrs Cunningham: I'm noting in your task force report of June 1991 that you suggested "that the college urge the Minister of Health to examine the feasibility of establishing a controlled system of tobacco distribution, using as a model the sale of beer and liquor," and others, including medical officers of health, have also brought that to the attention of the government.

I'm assuming you worked on this legislation with the government because you offered that support in the task force report. Were there any discussions around this model or was there any new information gleamed from your recommendation? Did anybody do anything about it? It's been around for two and a half years, I think.

Mr Dunsdon: Yes, there was some discussion between the college and the ministry with respect to legislation, and some issues were identified as a result of that, among which was this concept. As I recall, the Minister of Health at the time, I believe it was Minister Lankin, did in fact raise the matter of a control system prior to the release of the strategy in 1993.

I can't recall exactly how prior it was, but it was sort of floated as a possible thought, and it did not receive a very enthusiastic reception, as I recall, notwithstanding that there was some certainly informal discussion around this particular concept, and as mentioned in our brief, it was an idea that certainly the college felt was worth pursuing.

Mrs Cunningham: How do you feel about licensing retail distributors?

Mr Dunsdon: Could you just expand a little bit?

Mrs Cunningham: Right now, as you know, we have a system in place, and there are fines. This legislation increases the age and also makes the fines greater. Since no one is enforcing the legislation and hasn't done so, one has to wonder what difference this would make. I'm an optimist, so I hope it'll make a big difference.


Mrs Cunningham: Huge fines, all right? So there's going to have to be a system of enforcement in place, there's no doubt, for this to work.

Some members of the public have come before the committee and said, "If we're going to get into the controversy," like you've had in your own profession, "why doesn't the government take the lead and say, `If you want to sell tobacco, you get a license,'" and there would be certain requirements to get the license? But more importantly, if you're caught selling it to people under age, you lose your license, maybe after one warning or something.

Now, we've been told that this is a cumbersome system and that's why the government didn't put it forward in the legislation. But I wonder, because if you're going to take the stand you took, which I think is a step further than licensing -- when you say it wasn't met with support, I have to wonder who it was sent to. You can tell me who it was sent to. I know the retailers wouldn't like it, but I'm in the business of not having kids smoke. That's my job.

Mr Dunsdon: When I made that comment, I think it was with respect to the public reaction that resulted as a result of that idea being advanced. But as far as licensing is concerned, I guess one could say that's in effect an offshoot of the big license that the tobacco control board concept would result in, and to that extent it's certainly not in conflict with the college position.

I guess I'm struggling a bit because we did not specifically discuss at any length the idea of a license as distinct from a tobacco control board concept, which I guess you could describe as one big license.

Mrs Cunningham: That one would certainly meet your approval probably a little better, because you'd get rid of your own controversy within your group. It would be helpful.

Mrs Haslam: I'm glad we do have some extra time to question you.

We get some letters, even though people can't come in to the committee. This one in particular I found very interesting. It is from a Vernon K. Chiles from the Sarnia Pharmacy. I read a bit of it this morning: "The legislation is recognizing both the unique role we play in promoting public health and the importance of this role in moulding public opinion." He was talking as a pharmacist.

I found another part of the letter very interesting, given what you were saying, and I'd like you to comment on two aspects of what I'm going to read.

"A Minister of Health in the previous government recognized the need to get tobacco out of pharmacies when she provocatively suggested in a speech to the Ontario Pharmacists' Association in 1990 that it might not be appropriate to pay pharmacies that sold tobacco for drug benefit prescriptions. The present legislation is a more comprehensive approach and reflects the fact that, since 1990, the Ontario College of Pharmacists has asked for legislation to eliminate tobacco from pharmacies."

The first part you may or may not wish to comment on; it was an interesting idea, and I really don't know who said it. I don't know if it was my colleague or not.

The part I found very interesting is that we've had people come before us and say, "The board was overturned because of the stand it took." Yet I see that it has been consistent in its message, and I would like you to comment on what one of the people had said about that. Plus, one of the comments from an individual who came before us was that if the vote was taken today, he didn't believe it would be the same vote.

You're the college; you're here to answer those things. I couldn't say he was not in a correct mode when he was talking about that, but I'm looking for you to clarify those positions, if you could.

Ms Monaghan: Well, it's interesting from our point of view, and perhaps embarrassing also, to have these kinds of comments coming from our council members. Truly, we have to look at these comments as being speculation on their part. Perhaps their perception is that that would happen. But as you see, we have addressed the issue at least three times, and we have consistently shown that the college council continues to support our policy of October 1990. There is no question in my mind that that is the fact.

Now, as far as doing it again today is concerned, who's to say? I can't believe there is that ability to speculate and pretend that it could be different.

Mrs Haslam: That was the clarification I needed.

The Chair: Mrs Caplan, final question.


Mrs Caplan: I'd like to congratulate the college for the position that it has taken. I remember in the spring of 1989, when as Minister of Health I spoke to the Ontario Pharmacists' Association and asked the question of the profession at that forum, "Do you think drugstores should sell cigarettes?" there was a lot of discomfort as well as some applause. So I know that the profession is mixed in its views and I think it's come a long way under the leadership of the college.

We know that a lot of pharmacists, particularly independents, have voluntarily stopped selling tobacco products. We also know that there are some pharmacists who, while technically they have to own the pharmacy, are in a partnership relationship with one of the large tobacco manufacturing companies and I think feel some pressure about where their economic interest lies on the issue.

Have you, in the response from members of the profession you've heard from, had any sense that the attitudes are changing and that more and more pharmacists feel that they are health professionals and are supportive of the council's position to ban the sale of tobacco products in pharmacies?

Ms Monaghan: I don't know. Maybe I'll ask Jim to report on any numbers we may have on that.

Mrs Caplan: I saw a figure somewhere that said about 37% or 38%, almost 40%, were supportive of the ban, while some 60% were opposed. I get the sense that attitudes are changing. Perhaps these hearings are helping. I'm just wondering what you're hearing.

Mr Dunsdon: I guess we're hearing the same sorts of reports. I don't know that there's any definitive answer. It's such a dynamic situation and I know of no definitive study on the attitude. We would like to think certainly that attitudes have changed and are changing with respect to this, and unhappily, perhaps, there's really no way to really quantify it with precision.

Mrs Caplan: Someone suggested to me that it shouldn't just be a matter of economic interest but as a health profession; not only pharmacy but all the other health professions should consider it a professional obligation. It was put that perhaps there should be an amendment to the act that says it would be considered professional misconduct for any health professional to sell tobacco products. How do you feel about that?

Mr Dunsdon: It's certainly noteworthy that I can't think of any health professional who does in fact sell tobacco products.

Mrs Caplan: Right now there's nothing stopping a health professional from owning a tobacco kiosk.

Mr Dunsdon: True, there isn't, and the professional misconduct route was discussed. It was felt, though, that on the basis of our best legal advice the banning of the thing from the place was the better route.

Mrs Caplan: Thank you. I appreciate that.

The Chair: Thank you for coming before the committee today and for your statement. We appreciate it.


Mr David Hetherington: I'm very pleased to have been given this opportunity to present my personal views to you today regarding Bill 119.

My name is David Hetherington and I have been a licensed pharmacist in the province of Ontario for almost 20 years. I held the position, or rather I held several positions of increasing responsibility in hospital pharmacy for the first half of my career, and I have worked in the retail pharmacy environment for the past nine years.

For the past six years I have been a regional manager for a large pharmacy chain, Pharma Plus Drugmarts. In this position my responsibility is essentially to oversee and direct the operation of 20 retail drugstores, including both the front shop and pharmacy operations within each store.

As indicated previously, I am here today to provide you with my own personal opinions and viewpoint, although I will briefly draw upon my recent work experience in the trenches to emphasize several key points.

In general, as a health care professional and non-smoker, and I must say I have never smoked, will never smoke and am generally anti-smoking in philosophy, I wholeheartedly support the overall intent of Bill 119, this being to discourage smoking in our youth by restricting and controlling the acquisition of tobacco products, with the ultimate goal being to reduce the incidence of smoking in our society. The legislation is indeed a beginning.

However, I am very concerned about and strongly oppose the specific section of the bill which proposes the banning of tobacco sales from drugstores. My reasons for opposing this provision, and I'm sure most of these you've heard already, are as follows:

This ban will have no impact, in my opinion, on reducing the availability of tobacco products. The public will indeed quickly and easily find alternative sources. Hence, ultimately nothing will be achieved in the quest to reduce smoking and its related morbidity and mortality. If anything, the proposed ban will further divert legitimate sales into the very extensive black market, which is certainly a more affordable alternative.

Furthermore, pharmacies are undoubtedly one of the most vigilant retailers when it comes to prohibiting tobacco sales to minors. As a regional manager I periodically audit stores to ensure that required signage is posted and that staff are complying with the law. Is this likely occurring in convenience stores, restaurants and gas bars? I doubt it.

As tobacco is a legal product, I believe this proposed legislation is unfair, arbitrary and discriminatory against our segment of the retail industry. Unless you are willing to severely restrict, license and control the sale of tobacco as with alcohol, then retail pharmacies should not be disadvantaged to this degree.

While the topic of the economic ramifications of removing tobacco from drugstores stirs up great debate, my belief and indeed my experience are that such a ban will create significant economic hardship. When combined with the impact of the social contract and other potential professional fee-limiting legislation such as Bill 81, this ban truly will diminish the viability of retail pharmacy in Ontario and result in job loss.

For your information, in my region over the past two years tobacco sales and gross margin dollars have declined by just under 50%. Overall margin rates and profit levels have been salvaged in many stores only with very significant expense control, which includes man-hour reductions in most stores. Total removal of tobacco sales and the loss of companion sales would definitely result in further reduction in man-hours, therefore job losses, and I would suggest that in my region of 20 stores at least two stores that employ 18 people in total would close, as this move would push them over the brink.

Additional economic consequences would occur even if tobacco sales are replaced by sales in other categories of front-store merchandise in that these sales may be very low-margin promotional sales, and many stores have leases which are tied into percentage rent. In this arrangement, once a threshold of sales is reached, percentage rent kicks in, such that the rent based on the incremental non-tobacco sales may be four to five times higher than that based on the previous tobacco sales. Reduced profitability and its consequences are clearly to occur while again no public health gains are achieved.

The reality of pharmaceutical care in this province is that it exists and is provided by health professionals within a very competitive retail environment. We are indeed both health care professionals and retailers. Each component, each end of our stores, supports the other to varying degrees. Most stores require both in order to be economically viable. Hence, a move such as the banning of tobacco sales will significantly alter this balance. Indeed, certain layoffs and store closures will reduce the availability of valuable and free health care advice to your constituents and the people of Ontario.

While it has been argued that the sale of tobacco in pharmacies is paradoxical and conflicting, I do not see it that way. It would be conflicting if pharmacists actively promoted and encouraged tobacco use. However, reality again is that pharmacists do not promote tobacco use but rather actively promote over-the-counter smoking cessation products such as nicotine gum, and dispense and counsel patients on products such as the nicotine patches. I would suggest that the true health care value which the public of Ontario receives in pharmacies is derived from the quality and availability of the services and information which the pharmacists provide, rather than simply the nature of the products carried on the front-store shelves.

My recommendation to you, therefore, is to amend the proposed legislation to remove drugstores from the list of prohibited vendors of tobacco products. Allow retail pharmacies to retain the ability to decide whether they will continue to sell tobacco products or whether they will voluntarily remove tobacco from their stores. In this free and democratic society, let the public decide if they will continue to frequent pharmacies which sell tobacco products.


This is a complex issue, made even more so by our federal government only 48 hours ago. I urge you to follow their lead. In particular, I applaud their punitive focus, their public health education focus and their efforts to redirect tobacco sales back into the legitimate, better-controlled marketplace which includes retail pharmacies.

In conclusion, I again urge you to reconsider Bill 119. Make the necessary amendments so that it is a more rational piece of legislation, one which is more equitable and palatable to the majority of retail pharmacists in this province, pharmacists who wish to retain the ability to decide if they will continue to sell this legal product. Thank you.

The Vice-Chair (Mr Ron Eddy): Thank you. Questions? Mr Dadamo.

Mr Dadamo: You honestly don't see a conflict between on one hand giving medicine that makes people feel better and on the other hand selling a product that will ultimately kill you?

Mr Hetherington: As I indicated, no. Clearly, in an idealistic setting one arguably could agree. However, the consequences of that in Ontario, in Canada, in the marketplace that we trade, are such that certainly through this legislation nothing will be gained, and essentially in the bigger picture the availability of health care of the professional pharmacist's advice may in fact be reduced by legislation such as you're proposing.

Clearly I stated up front, and most pharmacists would agree, that tobacco is a significant health care risk. Then go the full step. Don't just stop where you're at today and put us in a disadvantaged position, but go all the way to license or further regulate the product. Then we probably wouldn't have this debate. The issue is that you're putting retail pharmacy at a great disadvantage relative to the rest of the marketplace. That's the reality of the world we're in today.

Mr Dadamo: The reality is, I guess if we cut through everything we figure out that the bottom line is the most important thing, is it?

Mr Hetherington: Bottom-line profits?

Mr Dadamo: Yes.

Mr Hetherington: I wouldn't say it's the most important thing. Obviously there are many pharmacies that marginally make money but exist to provide a service. The company I work for would be, I suppose, included in that group, but without profits obviously one can't operate. If we were in a different world, in perhaps a European setting where pharmacies are a quite different entity, a very professional apothecary, then clearly it would be a different playing field. But again the reality of the Canadian marketplace is that pharmacy, provided to the public, is in a very competitive retail environment.

Mr Dadamo: There have been pharmacists who have come here and said, whether they have one store or many, that the bottom line is not that important. In other words, if they took away the tobacco products, they wouldn't see such a significantly drastic profit --

Mr Hetherington: Again, I'm sure you've heard the arguments that pharmacies are a very dynamic and rather heterogeneous mix of stores. I would again agree that some rely very little on their tobacco sales while others rely to a significant extent on tobacco -- to the extent, for example, in my region some stores 2% to 3% of their sales are tobacco. The loss of tobacco sales in those quite honestly would be insignificant. However, where sales are 12% to 15%, that could be a significant factor.

Mr Dadamo: Yes. Okay. Thank you very much.


Dr Brian Morris: I'm Dr Brian Morris, an Ontario family physician. I'm here as spokesman for the Ontario College of Family Physicians. With me is Ms Cheryl Katz, who is the executive director of our college.

We are here to speak on behalf of the Ontario College of Family Physicians, which is a voluntary body of almost 5,000 members. We represent family physicians from Toronto, London, Sudbury, Thunder Bay, Burk's Falls, Iroquois Falls, Smoothwater falls, every other falls in Ontario. We likely represent your family physicians.

As family physicians, and as members of the Ontario College of Family Physicians, we have a mission statement, and I'll draw the committee's attention to two items on that mission statement: that we promote high standards of care in family practice and we contribute to public understanding of healthful living. It's on that last point that I wish to speak to you today.

We care about Bill 119 because we care about the health of our patients. We care because we see on a daily basis the results of tobacco addiction. We see the scrawny premature babies born to the teenage smoking woman. We see the elderly emphysemic huffing and puffing to walk across the room. We see the 35-year-old who has just had his first heart attack. We see the teenage asthmatic who's losing more and more time from school because of her smoking habit. We see teenagers continuing to get addicted, 3,000 new teenagers a month, I have heard. Indeed, 90% of smokers start before they are 20. These are children who are starting to smoke. Among 15-year-old boys in Ontario, 22% are regular or occasional users of tobacco. Among girls, 29% are regular or occasional users of tobacco. These are horrifying numbers. This is why we are here: because we, as your family physicians, see these things happening and we want it to stop.

What do we want? We want a smoke-free society. Coming in here to this committee hearing, I walked up the front steps of the Parliament buildings, coughing my way through a cloud of smoke on the front steps of this building coming in to address this committee.

Mr Dadamo: It hovers around here all the time.

Dr Morris: Thank you; I'm glad to hear that. That's why I live up in Barrie. We want a smoke-free generation. My daughters are young teenagers. I want them to grow up with smoke-free friends, smoke-free partners.

Specifically, what do we want? We want Bill 119 passed, with an early implementation date.

Among the specific features in Bill 119 that we would applaud this government for bringing forth is the ban on sales in pharmacies. I respectfully disagree with the previous speaker. They are health professionals. Buying cigarettes in a pharmacy is implicitly hearing that it's okay. We couldn't disagree more strongly. The sale of tobacco in pharmacies must stop.

We strongly applaud the move to increase the legal age for purchase of tobacco to 19. This is crucial. This gives these teenagers one more year to mature, one more year to understand our message about smoking, one more year to grow up without tobacco.

We strongly applaud the move to outlaw the use of tobacco vending machines. Children can buy cigarettes from vending machines very easily. Reducing access to cigarettes works. In every jurisdiction in which it's been done, reducing access to cigarettes works to reduce the number of smokers.

So those specific parts of Bill 119 we strongly approve of. We like all of Bill 119, but we want more and we would respectfully request that this committee consider some specific amendments:

First, an amendment that would outlaw kiddie packs, these being packs of five or 10 cigarettes that are more affordable for young teenagers, and require plain packaging. Buying your cigarettes in a dirty-brown paper wrapper about the colour of emphysematous lungs would be good, with the name of the company in small print on the bottom and the rest of the package filled with detailed health warnings. This would have a dramatic impact. It would also remove the implicit advertising. Every time somebody across the room pulls out one of those bright-red packs, you know they're a du Maurier smoker. Every time they pull out one of those blue packs with the nice navy blue on it, you know that's a Player's smoker. That is tobacco advertising that happens on a daily basis in Ontario. That is worth millions to these tobacco companies and they spend millions promoting their colours. Plain packages would remove that. We know it works for them; plain packs would work for us.

The next specific recommendation we would make is for more detailed health warnings with even more power to them. The Ontario warnings are good; let's make them tougher: "Cigarettes kill people." "Cigarettes will kill you if you continue to smoke." Let's get blunt about this.


Our next specific recommendation is tougher regulations with regard to environmental tobacco smoke. Asbestos is a cancer-causing chemical. It's a carcinogen. If a school is found to contain asbestos wrapped around some insulation in the ceiling, the school is evacuated. Crews in spacesuits go in to remove that asbestos. But we expose children to environmental tobacco smoke in restaurants and all kinds of other public places. This is a class A carcinogen, according to the Environmental Protection Agency in the States. Class A, the strongest type of cancer-causing chemical, and yet our children and the rest of us are exposed to this cancer-causing chemical involuntarily if we want to go out in public. Let's tighten the regulations on environmental tobacco smoke in the workplace and in public places.

Finally, we would respectfully request a system of licensing retailers. The LCBO is a licensed outfit that sells a potentially dangerous chemical. Let's get at least as tough a licensing system to license the sale of this fatal chemical.

The federal government has disappointed all of us in the health care community with its changes in the last two days. Our Ontario college has strongly protested this federal move to reduce taxes, and we would like to publicly acknowledge the strength of this government in standing tough and saying that it will not reduce taxes.

This government is doing good things. We applaud this government for these things and urge you to do more. History will bear witness to the courage and responsibility demonstrated by this government of Ontario when you pass this legislation. Thank you.

Mrs Cunningham: Thank you, Dr Morris, Ms Katz, for appearing before this committee with, as I'm not surprised to hear from this group, a very strong presentation.

A lot of the people we have heard from have recommended changes to the act with regard to the banning of kiddie packs and the plain packaging. I think I'm correct in saying there is going to be some serious thought by this committee and we're probably going to put forth amendments in that regard.

What I am interested in, though, is this whole thing about the retailers, because we have an act right now that says you get fined if you sell to kids under the age of 18, but no one's been fined that we know of, that kind of thing. So now we've got 19. I am interested in this licensing of tobacco retailers.

I also would like you to give your thoughts on a couple of other ideas. We've actually had, in London, the medical officer of health from the Windsor-Essex area tell us that he thinks we ought to go further and sell tobacco in the LCBO stores and that young people should be taking responsibility for their actions, that when they do break the law, there ought to be some fines for them. It could be community work; it might be monetary. Those are pretty strong opinions that won't be well received, we think, by the general public, but we'd like to have your opinion on those today.

Dr Morris: The issue of licensing retailers versus tougher enforcement of regulations to me is to some degree a manpower and feasibility issue. I like the thought of licensing, and whether it's through existing LCBOs or through a new tobacco agency, the licence fees would, I would hope, pay for it so that it would be a self-sustaining, self-funding system that would have built-in enforcement. Rather than trying to enforce corner stores and enforce gas bars and enforce all kinds of other places, let's limit it and let's licence it before the fact.

There's the old slogan for cigarettes, "I'd walk a mile for a Camel." Everybody remembers that one. People won't. If the nearest cigarette is a three-mile drive away, it's going to be tougher for a teen to smoke than if he can walk 100 yards to the corner store. So to put cigarettes into restricted locations such as LCBOs or similar agencies to me makes a whole lot of sense.

With regard to the issue of fines for youngsters who smoke, you and I discussed, Mrs Cunningham, the issue of individual responsibility for actions. Again, I see sense in this. I'm not willing to speak on behalf of my college on this. Individually, I would love to see that, in the same way that I think fines for people who don't wear bicycle helmets bears some sense. If those fines are funnelled back into tobacco cessation programs or if those fines could be applied towards getting enrolled in a tobacco cessation program, that's great, but trying to help people quit smoking is enormously difficult. I know. I try every day in my office. It doesn't work well. Hypnosis, Nicorette, nicotine patches and all of the other programs don't work well. What this disease needs is not better treatment but primary prevention. That's what this bill talks about.

Ms Cheryl Katz: The issue for the college is really one of where you can get the most cost-effective impact. If you're talking about after-the-fact sanctions, it presupposes that there is a mechanism in place to enforce those sanctions. It means the courts have to be able to sustain the work of the law enforcement agencies. It means that youth under the Young Offenders Act have to be treated appropriately and not just simply given a slap on the wrist. Otherwise, what you're doing is benefiting the legal system, benefiting the lawyers, and not really having much impact on the individuals whom you are trying to influence in terms of the smoking behaviour.

Sanctions may work if you can enforce them, but it's going to be arbitrary. You might find that there are going to be much more effective and cost-effective measures if what you do is license, because then you're not so much dependent on external factors that really are out of your control.

Mrs Cunningham: One of the problems here is that I think we've all also agreed we're not going to talk about schools; we're going to talk about school property. This means in your city and mine the students are going to go on to the neighbours' property or down to the corner store. So to leave it with nothing I think is a big problem. That's all I'm saying. We have to think a little bit more about the practical implications of this legislation and how we deal with them.

Dr Morris: An article from the American Journal of Family Practice entitled "Preventing Teenage Tobacco Addiction" has a model school policy on tobacco. One of the items in that model policy is that students shall not be allowed to possess tobacco products on school grounds. That would certainly eliminate smoking on the neighbours' grounds because you can't bring cigarettes into the school.

The Chair: Just before going on to the next question, could we get a copy of that article?

Dr Morris: My apologies. I didn't think to bring enough copies, but you're welcome to this.

The Chair: The clerk will just take it and while we're finishing off, he'll get a copy made. Ms Caplan, we have time for your usual short, sharp, succinct question.

Mrs Caplan: I will try and be short, sharp and succinct. An excellent presentation from the college of family physicians.

I would like to explore the concept of licensing. I think the regional municipalities right now -- certainly I know in Metropolitan Toronto -- issue taxi licences, licences to restaurants that are going to serve alcohol. Do you see any problem with just expanding that mandate of existing bureaucracies to license retailers for the purchase of cigarettes -- not health facilities, but other retail facilities? Use the same user-pay concept that you've expanded on but with existing bureaucracies rather than either creating a new government monopoly or a new bureaucracy.

Dr Morris: An excellent thought, Ms Caplan. My quick response there is that, yes, I do see a problem with it, and that is the enormous variability there would be between municipalities. In the county of Simcoe, in which I live, the city of Barrie, because of the efforts of a number of people in Barrie, has tough bylaws about smoking in restaurants and other environmental tobacco smoke regulations. The other municipalities in the county of Simcoe have none or very rudimentary bylaws, so if in a given municipality there are soft-spoken people like Ms Katz or me to address these kind of issues, then those municipalities will probably do well and the citizens in those municipalities will enjoy better health, thank you very much. But if in other municipalities there aren't these people, then such things won't happen. So I would like to see this as a provincial responsibility.


Mrs Caplan: What if the province were to establish the standard and require municipalities to enforce? We frequently have that relationship also, especially if it's not going to be a cost to the municipality, if it's a self-funding mechanism. Would that resolve your concern?

Dr Morris: That would help. Thank you.

The Chair: Thank you both very much for coming before the committee this afternoon for your presentation.


Mr Raymond Langlois: Thank you for allowing us this opportunity to speak to you this afternoon. I'm here to speak to you on behalf of the Council for a Tobacco-Free Region of Peel. Our representatives include the Heart and Stroke Foundation, the Canadian Cancer Society, the Peel health department, the Lung Association, the boards of education, separate and public, private citizens, pharmacists and a number of other concerned folks within the region.

We're all here for one common goal, and that is to prevent youth from smoking. I guess in the long run the bottom line is to decrease tobacco consumption, certainly to decrease disease and death and to decrease the health care dollars that we're going to spend this year and for the next number of years forthcoming.

The Chair: Excuse me, just before you continue, just to help Hansard, could you just introduce yourselves so we know who's who.

Mr Langlois: Yes, I would like to do that. My colleague with me today is Mr Richard Gallagher. He's principal of St Stephen school and he's going to be speaking to you shortly on one of the issues that I'll be dealing with as well.

The Chair: By the process of elimination, we know who you are.

Mr Langlois: There you go.

Certainly, in light of the recent federal tax drops, now is an especially important time to move quickly on some of the things that you have highlighted in Bill 119, in particular the pharmacy ban and plain packaging. It's rather unfortunate at this time to see what the federal government has come up with in the past few days and to see that a pack of cigarettes this morning was $3.25, I believe. The whole thing about kiddie packs and everything else is very upsetting, very disturbing.

Mr Wiseman: You don't need kiddie packs any more.

Mr Langlois: No, you certainly don't.

I think this provincial government should be congratulated for its efforts in introducing Bill 119. I believe this represents the first major initiative to address tobacco as a serious health issue in this province. We commend their actions thus far. In dealing with tobacco as the number one cause of death, it must be emphasized that this should be a non-partisan priority for all parties, and from the questions I'm hearing -- I heard a few this morning and this afternoon -- I certainly feel that it has that approach.

It is regrettable to see the federal government consider tobacco tax reductions at this time, when over the past 12 years taxation policies have played a significant role in reducing consumption, especially in youth, who are very price-sensitive. Provincial governments should be lauded for taking a very tough stand thus far against any tobacco tax reduction proposed by the feds and certainly we hope that you will maintain that tough stand. We see that you're feeling perhaps that you're being painted into a corner at this point, but I believe that the principle is very, very obvious and I think we should be standing for the principle, regardless of what is happening in terms of the tax at the federal level. It's unfortunate that there are some other political things that are happening between the feds and Quebec, and I believe that there are other influences here at work, but this is a health issue. Let's keep that in mind: This is a health issue, not an economic issue, not anything else but a health issue.

In proposing the current legislation, there are several positive steps that have been made, particularly, in order, the stronger non-compliance penalties, prohibition of vending machines and the elimination of tobacco in pharmacies. However, I believe that Bill 119 does fail to address several key areas that are of particular interest to residents in Peel, especially in light of a recent study that we conducted. Some of those areas include licensing of retailers who sell tobacco, prohibition of sales for specific time periods should a retailer commit a third or subsequent offence under your section 15, the prohibition of smoking in all public places, the establishment of appropriate enforcement practices and the expansion of workplace legislation.

To effect positive changes in the health of all Ontarians, it's paramount to initiate comprehensive legislation and education strategies together. Easy access to tobacco by youth has been identified as a significant problem in this province.

You all know the figures, the 13,000 deaths every year. You know that 90% of these people begin when they're in their school years. Over 3,000 youths are beginning smoking every month, so we know where it's starting. I think these facts alone demonstrate the need for this government to pass strong legislation and to prevent additional youth from becoming addicted.

This document highlights several areas of Bill 119 which could be improved with amendments or added provisions or regulations. Our recommendations certainly include to establish a provincial licensing system for retailers, like the LCBO -- they are both licence-type systems -- designating all public places smoke-free; implementing plain packaging with prominent warnings; prohibiting sales in pharmacies and vending machines immediately and not waiting for the one-year period to pass by; maintaining appropriate taxation policies, at least at the provincial level, and encouraging and lobbying at the federal level; ensuring adequate enforcement of any legislation that is passed forward; and evaluating and modifying the strategies for effectiveness as we go along.

These recommendations are further developed in the paper. I'm going to address one particular area that we feel is very pertinent. It's a very concrete example of something that we conducted in Peel.

In Peel region, which is Brampton, Caledon and Mississauga, the Peel health department conducted a study last summer which determined that 80% of retailers were willing to break the law and sell tobacco to youth. That type of study has been conducted in a number of other areas in this province and across the country and it shows probably quite similar rates.

It was determined also that 98% of these retailers did not request to see youths' identification. Pharmacists were more compliant with the law, while convenience stores and restaurants were least compliant, somewhere in the 80% to 89% range of non-compliance. There's an attached summary that you'll see that will further clarify the study. Also the original study is with the clerk and you can have a look at it as well afterwards.

These are cold, hard, disturbing facts which leave an indelible impression about the abrogation of their responsibility to youth and the absence of appreciation for the health consequences of their actions.

In addition to these results, we have also received numerous reports from parents, school personnel and concerned citizens about youth not only accessing tobacco from retailers but purchasing single cigarettes on a regular basis. My colleague here today has confirmed reports of over 20 students that they indeed purchase single cigarettes from a local retailer at 35 cents apiece. This is a clear violation of the federal Excise Act and provincial Minors Protection Act, yet it's a common occurrence in our region and in other regions. My colleague will speak to that shortly.

It is clear that the current legislation and accompanying enforcement have failed to ensure compliance with the law. We need to go further for retailers to adhere to the law. A licensing system should be established whereby retailers can have their licence revoked if they commit an offence for selling tobacco to youth. Retailers will be more accountable. They'll have entered into an agreement, they'll be aware of the conditions as to why they're getting that licence and what goes along with getting that licence, what the responsibility is.

As mentioned in the previous presentation, you can set a licensing fee, be it at the municipal level or if it was an LCBO type of system set up, and that licensing fee can be commensurate with the cost of administration and enforcement for that particular program.

Also, in raising that age to 19, you've already got in place age-of-majority identification which could become the standard request by retailers or whomever is using this particular system.

Since most smoking behaviour begins with youth in their school years, it's imperative that appropriate measures be established to prevent access to tobacco. A study in Nova Scotia demonstrated that the average age of initiation is 11 years -- 11 years old. They're starting very young. It has been estimated that almost half a billion dollars are spent on tobacco by youth. Most of these youth obtain their tobacco from retailers. Theoretically, it shouldn't be possible; however, the shortcomings of law and enforcement in this respect are rather obvious.


There are no details about enforcement released by this government at this time. I think we need to realize that without adequate human and financial resources to support this act, legislation will be futile. In the case where the present system proves to be ineffective, and I speak of a system where you're talking about increasing fines, we should in fact put in place a licensing system either where retailers have to purchase licences or something along the lines of an LCBO, which would go much further in taking care of any compliance problems. You'd have a better control over distribution and the like.

I think the pervasiveness of this product and the ill effects of tobacco and smoking must be stopped. Each preventive measure that we implement with this legislation can save thousands of lives. However, each measure that's delayed can cost thousands of lives. I hope that this group and all of us who are supporting you in putting forth Bill 119 will ensure that we pass comprehensive and effective legislation that will have a very significant impact on the health of current and future generations.

I'd like to pass along now to Mr Gallagher, who will speak to you about a particular example.

Mr Richard Gallagher: I guess giving an educator and a politician three minutes doesn't make much sense, does it? I've been in education for over 30 years and I can assure you that my cold at the moment was not cigarette-induced. Having had a father who died of lung cancer six years ago -- and I'd never smoked, as it so happened -- I heartily congratulate both the government members and the members of the opposition for taking a strong stand and working together. I've changed everything as I was listening, so I'm going to ad lib.

Children are smoking as early as eight and nine years old, and not 10. The 23 students in my school range in age from 9 to 13. I sought them out when I was called by a teenager from the high school to tell me that her sister had been buying cigarettes at the corner store. I went around and I asked the children to come down and see me if they had been buying cigarettes and assured them that there would be no phone calls home. As a parent, you may or may not agree with me on that, but otherwise of course they wouldn't have come. I've only got 440 students in my school, so when 23 came to me, probably a lot didn't come to me. You can imagine the number who smoke. It's in a very affluent, upper-middle-class area of Brampton.

I then called the police department and advised them that I had these people who were willing to testify, or commit themselves, and they told me they would not act. It was not in their jurisdiction. I'm not a lawyer, although my brother is, and I've been listening to him long enough. I said, "But if it's against the law, then you should be acting." They refused and told me it was a Brampton bylaw problem.

So I called the bylaw department. A gentleman called me. He did come to the school, we chatted and he said he would visit the store. But he said to me, "Mr Gallagher, we've never fined anybody, but I'll go over." He did and he reported back to me that he had done so. He called me a week in a much more agitated tone of voice when he found out that his own 12-year-old daughter had just bought cigarettes at the same store. A week after he had warned them not to sell cigarettes, his own daughter went in and bought them. So he was much more on my side but still said nothing ever happens.

My conclusion, I suppose, is that if you're going to change the law, you have to be prepared to enforce it, and if you're not prepared to enforce it, don't change the law. The cigarette-Quebec reservation business is a case in point.

I lean very strongly to a licensed approach. It's not been my experience that older children are selling cigarettes to younger children. The younger children are buying their own, and they were buying them singly at this corner store.

I called all my students in and had an assembly. We talked about what had happened. I was going to put a letter out to my parent group, but our board lawyer advised me that it might not work out quite the way I wanted. I'm kind of sorry I didn't do it anyway; I still might.

I do strongly feel that raising the age to purchase and licensing corner stores will not solve your problem. They're not going to stop selling cigarettes if they're not going to be fined. I'm not sure if as a taxpayer I want to pay 100 more people to go out and fine the corner store for selling cigarettes. I really urge that you go to a licensed approach.

One last comment about the doctor who mentioned that they shouldn't have cigarettes on school property: I think we would find ourselves, as educators, in dire straits if we started physically searching children to see whether or not they had cigarettes. I think you can imagine the fallout from that one. It is a problem. They are starting at eight and nine years old. They are buying their own cigarettes, they're not getting them from older brothers or sisters, and the corner store is definitely selling them to them.

Mr Jim Wilson: Thank you for your presentation. It strikes me that you're right on in your latter comments about enforcement. When I think of rural areas of the province, we don't have bylaw enforcement officers. Even a big place like Wasaga Beach has one or two bylaw enforcement officers perhaps in the summertime. We don't have 24-hour policing. We don't have enough police as it is. Once you get outside of Metro, there's an entirely different world out there, as you can appreciate. Certainly, enforcing tobacco laws is not high, as far as I'm aware, on the police agenda. They can barely respond to the B and Es in the Stayner and Nottawasaga and Collingwood area, for example. In fact, it may take three days to investigate a break and enter of your house.

This is the question. It seems to me if you go to a licensing approach, you also need enforcement. We've been floating around the idea that perhaps we should put some onus on the young people themselves under the age of 19. You'd need a phase-in period or something to exempt perhaps those young people addicted to tobacco now; but if we put some onus on them in terms of saying that tobacco products should be treated the same way we treat alcohol, and that is, illegal under the age of 19 to possess or smoke. They do that, in my understanding, in one jurisdiction in the States where there's a $25 fine associated and also a licensing system and sting operations. But at least there's some onus on the young people and they take some responsibility. What do you think of that?

Mr Langlois: You mentioned two pieces that are important. You mentioned something about sting operations. We carried out a compliance survey. It's not a sting operation, because we didn't identify the retailers nor were they fined or anything along that line. By carrying out compliance operations -- they've done this in a number of communities. I can think of Edmonton, I can think of Woodridge, Illinois, where they did implement stiff fines, and if a store was investigated and found to be selling, a stiff fine was applied the first time, if it was $2,000 or $5,000, and in a third offence maybe $10,000 or their licence was revoked. In some cases, the licence was revoked on a first offence. If investigated and found to be guilty, first offence: licence revoked, no chance. That works. I think that can work, and I think we can use that in varying degrees. There are any number of ways. You can involve kids, obviously, in this. We used three 16-year-olds who were interested in working on this particular project with us.

The other area that I'd like to address is, you proposed something about fining children for possession of tobacco.

Mr Jim Wilson: We do it for bicycle helmets.

Mr Langlois: That may or may not work.

Mr Jim Wilson: We'll be fining guardians or parents, under a certain age.

Mr Langlois: Right. We can fine a retailer, and if you fine a retailer, right away you're eliminating the source for maybe 150, 200 or 500 kids who are passing through that store. It's easier to go after one or two or however many retailers than it is to go after thousands of kids. If you're talking about manpower, there is that difficulty right off, which makes it very difficult.

There is also the other problem of victimization, in terms of health promotion theories, in going after the kid who is carrying a little bit of tobacco, something along that line. I'm not sure that it works. It needs to be studied further perhaps.

Mr Jim Wilson: We've heard the victimization argument, and I can see both sides of that one. But I think young people should take some responsibility, and I think it does warrant further investigation, because the young people we've had appear before the committee have told us, "It doesn't matter if you put the corner Becker store out of selling cigarettes; we'll just go to another one." Basically, they told us that if they want to buy cigarettes, they'll figure out a way to buy cigarettes no matter what we do: raise the age, put $100,000 fines on the retail stores or whatever. That's the model we've been using. Your own study, and I'm reading from page 19, shows it's not really working all that well, so that's why we're floating the idea.


Mr Langlois: There's no enforcement at this point and that's why it's not working. There is no enforcement.

Mr Jim Wilson: I can see a licensing system --

Mr Langlois: If you were to set up something along the lines of an LCBO or use the current LCBO, that's a form of licensing system as well. You've already got the system in place. It works for liquor; why can't it work for tobacco? As a number of other people have highlighted previously, I think it falls along the same line in terms of: it's a lethal drug, first of all; I'd like to see it banned altogether. Unfortunately, I don't believe we're going to arrive at that conclusion at this point in time. Maybe 20, 30 years from now, if it's placed under the hazardous products act, that might be a step in the right direction as well.

Mrs Haslam: I'll be very brief because actually I agree with Mr Wilson. It is important and I agree with you -- I know that's hard to believe, Mr Wilson, but I do agree with you right now. I'd like to commend you on --

The Chair: The Chair is happy to hear this.

Mrs Haslam: I know. Such a wonderful way to end the afternoon. First of all, I want to commend you, sir, for coming forward. I didn't realize it was really at the eight- or nine-year level. I knew it was getting low, but I think your coming here today has really drawn that out and drawn a much stronger picture for those of us on the committee looking at the age of the people involved. I want to thank you for coming and doing what you can in your own school.

I just want to be very brief and say that I agree with my colleagues and with you. It does boil down to enforcement and no matter whether we go with what's in the legislation on the statutory ticketing, a not-allowed-to-have-tobacco-on-the-premises type of model or whether we go a little further into a licensing situation for everyone and a self-financing, it still boils down to the enforcement and whether we have the funds to put into that, and whether we have the person power to put into that. I'll be very brief and just say I agree.

Mr Gallagher: Just as an educator, I think we mustn't give up on the idea that education is winning. I don't mean just in-school education. In the general public, the number of students who are smoking overall is declining. An example where education has worked parallel would be on littering and on recycling where some years ago all of us and the children were throwing everything away and we really are turning a corner on that. I think the more education we have by schools, by homes, we are going to get much more relevant than try to fine a 12-year-old $25 for having cigarettes.

Mrs O'Neill: I don't know how relevant it is, but many years ago I taught for the South Peel Board of Education, as it was called at that time, and enjoyed it.

You didn't mention at all the presence of contraband and that hasn't come up in many of the educational presentations in this area, though it has come up in other parts of the province where we've been holding hearings. Could you tell me whether you feel that's a problem? In London, for instance, they feel it's on every school property, the presence of contraband. Educators told us that on Monday. Do you feel there are car trunks accessible to all your students?

Mr Gallagher: You must understand that I had 19 years of teaching at the high school level and administering, and now I'm at elementary level. In an elementary school, no, I would not perceive that there is a great deal of that occurring. The environment is so different. In an elementary school, most of them, if they see a car stopped and a trunk open, you'll have eight kids running in to tell you there's a stranger on the property and it may in fact be a parent delivering lunches. If a surveyor, God willing, pulled out a surveying, "We have a rifle on the property."

Mrs Haslam: Which is good.

Mr Gallagher: Which is good. Yes, I don't mean to be facetious. I would imagine, at the high school level, talking to my colleagues, because we have a family of schools, that obviously if people are smoking and they can buy cigarettes contraband, they're going to do it. I wouldn't be surprised that it does occur, although I don't have firsthand proof of that.

Mrs O'Neill: Okay. The other thing I wanted to ask you, and this was seen to have a very high profile -- in Sudbury yesterday where cessation programs in the schools are part of the regular curriculum. This, mind you, I think was a high school presentation, but they were talking about it being part of the credit program and also involving both the support staff and the custodial staff in these programs with no docking of pay. I wondered if the Peel board has anywhere near that kind of presentation. From what you say, it perhaps needs to be part of the curriculum at the elementary.

Mr Gallagher: I'm going to put two hats on. I used to work for the Peel public board and now I'm Dufferin-Peel separate, but I'm on another committee for both boards, so what the heck; but only one pays me.

Both boards have smoke-free schools, board buildings, vehicles and property. Both boards have sponsored how-to-quit seminars for their employees and both boards, I believe, have censured -- I can't prove that, but I believe from what I've heard -- employees who have been smoking on property. So yes, they are both very active -- employer-employee.

Studentwise, both boards are very active in the classroom in phys-ed curriculums, the health curriculum at the high school level and certainly also at the elementary school level. In fact, Raymond has sent me packages on other schools and I've included that on school letters that go home to parents.

The average elementary child is quite aware of the dangers of smoking and if we can just prevent them from being hooked at 10, 11 or 12, I think we've got them saved. They're not unaware of the dangers and they are being educated. I would say that in Peel the schools are very active in preventing smoking through education.

Mrs Haslam: I'd like a clarification.

The Chair: I'm sorry. We've really gone over the time and we have a full afternoon. Perhaps you could just slip out and get that. I want to thank you both for coming before the committee.


Mr Michael Polanyi: I'll just introduce myself and the others. I'm Michael Polanyi and I'm the coordinator of the Equally Healthy Kids project. Next to me is Theresa Martin; she is the volunteer co-chair of Equally Healthy Kids, and Julia Sherbot is also a volunteer, a member of the steering committee of Equally Healthy Kids.

Thanks a lot for giving us the chance to come here today. Just a word about Equally Healthy Kids: It's a project in the south Etobicoke area and encourages and supports community action on health issues in that neighbourhood. We are here today because we are concerned, as members of Equally Healthy Kids, about the health implications of smoking and we also perceive it as being largely a youth issue. You've heard before already that most smokers start as youth. The last presenter mentioned that. You know the influence on health. You probably know that two billion cigarettes a year are smoked by youth under the age of 19. You're probably aware that the incidence of smoking among grade 7 students is up 50% since 1991. I think what's important is to understand why youth smoke. If we do understand that, then we can take action to stop youth from starting to smoke.

That's one reason, a major reason, we support Bill 119 and we commend the NDP government for pushing this bill forward. We encourage opposition members to support the bill. We feel that it's a major step towards addressing the causes of smoking in two ways in particular: One in reducing accessibility to tobacco by youth, and that's something that Theresa is going to speak a little bit about and, secondly, by delegitimizing, reducing the legitimacy of cigarettes. That's what Julia is going to talk about, particularly in relation to pharmacies and the ways that pharmacies legitimate the use of cigarettes.

A third factor that I'll just touch on, which is in our report, is that we feel it's important to get at a third cause of smoking and that's the marginalization of youth in our community and in other communities. When I'm speaking of that, I'm talking about the fact that a lot of youth feel they are excluded from their communities. They feel like their voice is not heard. They feel like there is a lack of recreation opportunities, there's a lack of opportunities for youth to participate meaningfully in their communities and to be recognized for that participation. Youth also feel stereotyped by the few youth who are often in the media. It's usually bad news we're hearing about youth and not good news.


So youth don't feel valued. Many feel angry and they don't feel good about themselves, and they use cigarettes to improve their self-image. They use cigarettes to establish their independence and to be adult-like, because even though adults often say, "Don't smoke," adults do smoke, so it is seen as being adult-like. They use cigarettes to deal with stress that they face in their lives, boredom and to fit in as well.

We feel that we need to pursue Bill 119. We also need to provide ways for youth to start to establish their independence and take risks in healthy ways, so we've included something on that in the report. Now I'll just pass it over to Terry.

Ms Theresa Martin: Thank you. I'm in favour of licensing cigarette stores. Any store that sells cigarettes should have a licence, and if they sell to minors, they should lose that licence. In our area, it is very, very easy for any age child. I've sent my nine-year-old granddaughter, just for the fun of it, to see if she could buy me a package of cigarettes, and she did. They gave them to her. They sold them to her. No problem. Any child can buy cigarettes in the stores.

I think making cigarettes harder for children to buy would work much better than preaching to them, "Don't smoke," because I find that the more you tell teenagers not to do something, that's what they're going to do, because you told them not to.

I would like to see the cigarette machines taken out of restaurants, doughnut shops, anyplace where teenagers have complete accessibility to and hang around, because if they can't buy them in the stores, who's going to stop them from taking them from the machines? They're very easy to get. Also, in the corner stores, those five-packs of cigarettes: You give your child $2 to buy a Coke or something with their lunch, they can go and buy a five-pack of cigarettes or they can buy one or two cigarettes. They should be against the law.

Mr Wiseman: They can probably buy a whole pack.

Ms Theresa Martin: For $2?

Mr Wiseman: Almost.

Ms Theresa Martin: Where?

Interjection: Places.

Mr Jim Wilson: Let's not advertise.

Ms Theresa Martin: I would like to see alternatives offered. Wherever cigarettes are sold, I would like to also see signs that advertise about the gum they can chew rather than smoke, for anybody who's interested. Advertise the patch right alongside where cigarettes are sold. Make them affordable for teenagers, for anybody, any teenagers who would like to quit smoking.

Kids start smoking in public school systems, not in high school. By the time they reach high school, they're steady smokers. In grade 6, there should be a program, not preaching "Don't smoke. It's going to do this to you; it's going to do that to you." Most children are well aware of it. They don't listen. They hear you; they don't listen. Just let them see films of what's happened to somebody who was smoking for a period of time. They're on these breathing machines, their lungs are so badly damaged. Let them see pictures of lungs before you started smoking and after you've been smoking for a few years. Let them see visually what's going to happen to them if they continue smoking. I would like to see this as a program in the public school system, before they reach high school, and carried on into high school.

For youth who are already smoking, I would like to offer support for those who would like to quit by, like I say, making deterrents affordable, like the patches and the gums. Offer smokers a smoke-free camp, a couple of the weeks in the summer, to encourage them. Make non-smoking the in thing in teen language. Make it cool not to smoke. Promote programs that make it cool not to smoke instead of being the in thing to smoke.

I think that's about it.

Ms Julia Sherbot: The community that I live in, sadly, is not unique, and this is the situation that I wish to address. Most specifically, my access to two pharmacists is my only access to pharmacists in the area. Both pharmaceutical outlets sell cigarette and tobacco products.

The promotion and use of tobacco products is markedly evident in my community, on the principal streets, in the school yards, janitors smoking outside of school yards. There is no visible promotion of cessation events. There's no visible promotion of healthy adaptation in relation to stopping smoking. There are no notices on store windows, in store interiors or on telephone poles, nothing at all that encourages young people, indeed even encourages adults, to stop smoking.

Participating in this culture of disease promotion and addiction maintenance are the only two drugstores most immediate in a very active part of New Toronto.

We have no quarrel with the professionalism with which prescriptions are dispensed and interpreted, but we cannot begin to respect the marketing process that offers service and advice at the back of the store on minimizing and stabilizing disease while promoting cigarette use at the front, in part through association with sweets, magazines, sports cards, troll pencils, colourful lighters and other desirable products. The association of cigarettes and these products is made starting in infancy. For those who are struggling not to begin or to stop smoking, there are the herbal cigarettes, a ginseng connection: an extremely profitable delusion.

We would like to see pharmacists in our community promote health; that is, facilitate healthy adaptation to the stressors in life, emotional and physical. Why do they not trust their professional education to bring to this community products and processes that promote health? Classes relative to nutrition, responsible use of medication and elements of fitness are all associated with the legitimate products that they dispense. Their contact with residents and other health professionals provides a wonderful opportunity for them to promote health. If they are to be respected, there must be integrity within individual practice.

It was suggested in this forum some days ago that pharmacists be allowed to continue the selling of tobacco products since they're best able to promote cessation counselling. The mere mention of counselling without any further elaboration, to my knowledge, was very well received in this forum.

But effective counselling involves a contract, a commitment of time, a building of trust by both client and professionals. Can pharmacists provide the time and, moreover, can they build trust with someone trying to quit smoking when they are simultaneously promoting tobacco sales?

There should be a choice for pharmacists in this province. Do they wish to serve clients or do they wish to serve customers? Several groups within the profession have argued that one must do both to exist in the retail climate of today. Why then are veterinarians, who sell prescription and non-prescription products, able to maintain their practice without selling tobacco products at the counter? Natural food stores are able to make a holistic decision.

More true to the intent of the pharmaceutical discipline are the professional peers who are willing to support each other in the decision to withdraw from the process of doing harm. Pharmacists should not be permitted to disguise harm with good.

The Chair: Thank you. We have a few minutes for questions. Ms Haslam.

Mrs Haslam: Actually, no, Mr Chair.

The Chair: I'm sorry. I anticipated there would be.

Mr Wiseman: This whole question about youth and the beginning: You raised a really good point. It's interesting that when you look at these vending machines, the cigarette packages are about eye level for a two-and-a-half-year-old, a three-year-old. So you're absolutely right. It starts early, and the association of cigarettes with other cultural things that are positive means that everything is positive. So you build up these connections. It's the way you build a good argument, you know, positive, positive. If you want to make somebody look bad, you put a negative in.


What we heard from some young people in Sudbury is that they have started in their schools to talk about reduction. I suggested that maybe if young people who wanted to quit and couldn't talked to younger people who hadn't started, that might be useful. How do you feel about that as an option? Have you tried it? Do you know anything about that?

Ms Theresa Martin: No, we haven't tried it, but I think it's a good option. It's making them feel useful and giving something to the younger children, knowing that he's a teenager but he doesn't want to smoke, but he's doing it because he's addicted to it. I think it's a very good idea, and we could maybe have teenagers who have smoked and gotten off it be counsellors at camps for younger children who do smoke at the smoke-free camp, if we ever got one.

Mrs O'Neill: Thanks so much for your idea about the smoke-free camp. We haven't had that suggestion. I think it's excellent.

You say you have a recreational drop-in centre with 300 youth. Is there a smoke-free area to that, or how do you, what should I say, practise what you preach in that drop-in centre?

Ms Theresa Martin: I don't think they're allowed to smoke. They have to go outside for a cigarette, as an incentive.

Mrs O'Neill: So you have got a no-smoking rule there?

Ms Theresa Martin: Yes.

Mrs O'Neill: And you don't have too much difficulty with that?

Ms Theresa Martin: No, they go outside and smoke. They don't like it, but they have no choice.

Mr Polanyi: A lot of the youth who do come to the drop-in centre are unfortunately addicted to smoking. As we mention in the brief, actually what we do with them at the centre is try and give them chances to identify issues that are of concern and take action on those issues. Well, one of the issues they identified to be of concern was having an indoor smoking area at the centre. So that was kind of a difficult issue for us, because we don't want to encourage that, but by the same token we want to encourage youth to be able to be part of their community and to work through some issues, to problem-solve.

We've said to them, "Sure. Go ahead and check the health regulations on the building and talk to the non-smokers in the building and talk to the staff and start to deal with the issue of how the staff feel or parents would feel if underage youth" -- so they're working through the issue a little bit, and as Terry was saying, they're not being preached at from the start but they are starting to work through it and maybe realizing that there's not going to be a lot of support for them. That's why it's important that there isn't smoking allowed in malls and public places and all this so they don't push things.

Mrs O'Neill: Thank you for expanding on the answer.

The Chair: Thank you very much for coming forward. We certainly wish you all the best, not only in this work but I know something of your organization in terms of the other things you're doing. It's extremely valuable.


Mr William Broderick: My wife and I are here today because we believe, along with the chief medical officer of health for Ontario, that tobacco-caused or -related diseases is our number one public health problem. According to Dr Schabas, more than 13,000 Ontarians die prematurely each year due to tobacco-related diseases, and that's a lot of people. As Dr Schabas points out in his 1991 report entitled Tobacco and Your Health, it's almost five times the number of people who die from traffic accidents, suicides and AIDS combined. Also, as he points out, these deaths are preventable.

When we have an outbreak of flu, hepatitis, rabies, pneumonia or tuberculosis everyone gets very excited. We say we have an epidemic on our hands and we take steps to try and prevent it. Well, what do we call 13,000 deaths a year from tobacco-related diseases?

As a society, I believe it is incumbent on us to recognize the tobacco epidemic for what it is and to try and take preventive measures so that people can live safe and healthy lives. Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others, is such a preventive measure. Bill 119, if and when it becomes law, will not prevent people who are already addicted to tobacco from smoking. It will not make tobacco products significantly more difficult to buy, but it will make it more difficult for children and young people to purchase tobacco products and so prevent many of them from entering the stream of replacement smokers taking the places of the thousands who die every year from the tobacco habit or who quit.

Studies show that people who do not start smoking as children or teens are unlikely ever to take up the habit at all. Bill 119 therefore has the potential to save many thousands of lives in the years ahead.

In speaking to you today I want to talk about four specific areas of Bill 119: tobacco retailing in pharmacies, smoking in schools, smoking in public places and plain packaging.

Taking these one at a time, tobacco retailing in pharmacies: I'd like to begin by quoting from the Principles of Ethical Behaviour of the Canadian Pharmaceutical Association, which says that, "A pharmacist shall not participate in any advertising or promotion program which might...encourage misuse or abuse of drugs."

Also, quoting from the Ontario College of Pharmacists' code of ethics, "A pharmacist should never knowingly condone the dispensing, promoting or distributing of drugs...which lack therapeutic value for the patient."

Tobacco is an addictive drug, one of the most addictive there is, and pharmacists have for years been participating in its advertising and promotion. They have for years been encouraging its misuse and abuse. They have for years been dispensing a drug that has absolutely no therapeutic value for anyone. Tobacco makes people sick. It kills.

Their own code of ethics, their own principles of ethical behaviour, say that they shouldn't be doing it. It's a conflict of interest of the worst sort. As health professionals they should never have gotten into the business of retailing tobacco.

Over the years the Ontario College of Pharmacists has repeatedly asked pharmacists to voluntarily stop retailing tobacco products. A few hundred drugstores in Ontario have in fact done so and they are to be commended for upholding the integrity of their profession. The great majority, however, have simply ignored the request of their own regulatory body that they stop their unprofessional behaviour, as if tobacco required no more regulation than candy bars and chewing gum. As a final resort the college, in June 1991, asked the government of Ontario to legislate tobacco out of our drugstores. The provisions of Bill 119 dealing with pharmacies are the government's answer to that request. I hope that this provision will pass.

A whole year of grace? In an effort to be fair, the proposed legislation gives our drugstores a whole year of grace after it comes into effect to make the necessary adjustments. I believe that time frame is too generous. The diehards have already had more than enough time to make the necessary adjustments. I would suggest to you that three months, or six at the most, are sufficient.


Remember, it will probably be summer or fall by the time this bill is finally proclaimed into law, three full years after the Ontario College of Pharmacists made its request to the government. Remember also the several hundred pharmacists who have demonstrated their integrity and professionalism already by making the necessary adjustments.

The diehards say that they want a level playing field. I suggest to you that January 1995 is late enough to give it to them, with their brothers and sisters in the pharmacy profession who have already shown their responsibility to society by removing tobacco from their stores. I urge you to shorten the implementation period so as not to extend it beyond January 1, 1995.

Regarding smoking in schools, we're pleased to see that smoking is not to be permitted in schools. However, in order to remove any confusion as to where smoking is or is not permitted, I would like to suggest that the grounds and property on which the school or institution is situated also be included so that this subsection would read as follows: "A school, post-secondary educational institution or private vocational school, including the property or grounds belonging to it." The purpose of this subsection, as I see it, is to remove as far as possible the example of adults smoking on school property or premises. So let's go all the way and include the entire premises.

Regarding smoking in public places such as retail stores, laundromats, barbershops, hairdressing salons and public transit shelters, these provisions are certainly welcome, but do they go far enough? It seems to me that if we're going to treat the issue of secondhand smoke seriously, we have to do considerably more than that.

If we're going to prohibit smoking in retail shops and similar establishments, it's just as easy to go the extra millimetre and prohibit smoking in shopping malls, for example. At the present time shopping malls present a serious problem for many non-smokers, especially people with allergies. Along with shopping malls I would strongly recommend that smoking be regulated in restaurants, sports arenas and other places of public assembly, hotels and motels and even public washrooms. Washrooms, by the way, are often overlooked. Like elevators, they're small, confined places and stale tobacco smoke in them smells really terrible. Please include washrooms.

Bearing in mind that environmental tobacco smoke is now recognized as a group A or known human carcinogen, I would recommend that as a general rule all public places should be non-smoking except for designated smoking areas. Adopting this suggestion would have obvious benefits not only for the public but also for the people who are employed in these places.

Plain packaging: It isn't clear from my copy of Bill 119 if plain packaging is being considered or not. But if we're really serious about wanting to dissuade young people from smoking, then mandatory plain packaging or generic packaging is the way to go.

According to the studies that I've heard and read about plain packaging, kids aren't even interested in smoking cigarettes that come in plain packages. Packaging is part of the experience of smoking. Take away the attractive, colourful, glamorous package and suddenly smoking isn't cool any more. So think plain packaging. It could be the single most important step towards a tobacco-free society.

To summarize my recommendations: The implementation period for pharmacies should be three months, or six at the most, after the act comes into effect; include the entire premises and grounds in the prohibition on smoking in schools; make all public places non-smoking except for designated smoking areas; and finally, adopt plain packaging.

In conclusion, I'd like to leave you with two thoughts. First, the tobacco issue is a health issue. The purpose of the Tobacco Control Act is to protect our children and young people. Almost without exception, people start smoking as children or teens. When they see cigarettes being sold in drugstores and being smoked almost everywhere, it's natural for them to think that the things can't be as bad as we've been told. My own grandchildren have used this argument on the two of us. We've got to stop giving kids mixed messages about tobacco. It's not like candy bars and chewing gum; it's deadly stuff.

Second, to borrow a phrase from an old tobacco advertisement, "You've come a long way, baby." The Ontario Legislature has drafted a bill which, if it becomes law, will make history. But history is not made by faint hearts. It's not made by half-measures. It's not made by caving in to those who have a vested interest in the status quo. History is made by making the hard decisions and sticking with them and taking bold steps. Unless we go the distance and pass the Tobacco Control Act, hopefully with a few improvements, we haven't gone anywhere. Let's do it. Let's make history. Let's show that we have indeed come a long way. Pass Bill 119.

The Chair: Thank you both for your presentation.

Mr Eddy: Thank you for suggesting some improvements to the bill. That's very helpful. One of the things that we've been asked to look at by several presenters is the matter of licensing any establishment that would be allowed to sell tobacco products, and the other one is to go even further and have it only at government outlets, a system like the liquor control board. What would your opinion be on even tougher measures to control sales like that?

Mr Broderick: I would think that would be a good idea.

Mr Eddy: To go even further.

Mr Broderick: That would have my whole support. I think licensing would give the government a little better control of the tobacco situation.

Mr Eddy: Fine. Thank you very much.

The Chair: Thank you again for your presentation and for coming down from Shannonville to be with the committee this afternoon. We appreciate it.


The Chair: If I could then call on the ROM No Smoking Committee. I'm assuming that this is the Royal Ontario Museum, or am I wrong on the ROM?

Ms Lydia Bell: The Royal Ontario Museum, yes. The non-smoking committee, not the ROM.

The Chair: We want to thank you all for coming this afternoon. If you would be good enough to introduce yourselves and then please go ahead with your submission.

Mr Robert Biggs: My name is Bob Biggs. We four are members of the Royal Ontario Museum No Smoking Committee. I hasten to add that this committee is in no way sanctioned by the museum.

We wish to thank your committee for this opportunity to present our brief on the smoking policy at the ROM and at other similarly publicly funded -- I was going to say institutions but I don't think that's quite correct -- centres.

I'd like to introduce you to Marilyn Robertson, Lydia Bell and Sylvain Smeets, each of whom will make a short presentation to, firstly, outline the problems that we have had with the museum's smoking policy in its main floor cafeteria, and secondly, to request that the proposed tobacco act be amended to exclude smoking not only in the Royal Ontario Museum but in all publicly funded museums, art galleries and science centres. So to start off, Marilyn Robertson is ready to go.


Ms Marilyn Robertson: Some background: We frequent the ROM once a week to attend and participate in the University of Toronto School of Continuing Studies, university lunchtime lecture series. After each session, we go to the main floor cafeteria to discuss the lecture and to eat lunch. It is our experience that the concentration of cigarette smoke from the smoking area wafts to the entire eating area and furthermore to the food-serving area beyond. As a consequence, we are subjected to the poor quality of air.

Our first approach to deal with this issue was to write a letter to Mr Tharwat Salem, director of food services, Royal Ontario Museum, March 26, 1993, a copy of which I submit. We received no response.

As a committee, we wrote of our concern to Mr Kenneth W. Harrigan, chair of the trustees, ROM, July 26, 1993, with a copy to Mr T. Salem. This too I submit. We received no response. We wrote again to Mr Harrigan, November 6, 1993, with a copy to the Honourable Ruth Grier, Minister of Health, and to Mr Salem; our third submission. We received no response.

On November 8, 1993, we wrote to the Honourable Anne Swarbrick, Minister of Culture, Tourism and Recreation, with copies to Ruth Grier, Kenneth Harrigan, Tharwat Salem and Elaine Ziemba, Minister of Citizenship, with responsibility for human rights, disability issues, seniors' issues and race relations. Anne Swarbrick responded to our letter December 10, 1993, and referred to our concern as a public health issue. She sent a copy of her letter to Kenneth Harrigan.

On November 6, 1993, we wrote to the Honourable Ruth Grier, with a copy to Elaine Ziemba, another submission. The Honourable Ruth Grier responded January 6, 1994. We submit total correspondence.

Ms Bell: Mr Chairman, members of the committee, I wish to express my concern with regard to a smoke-free environment in the Royal Ontario Museum cafeteria. I suffer from severe allergies and have experienced a great deal of respiratory distress when eating in the Royal Ontario Museum cafeteria.

It is my contention that those of us experiencing health problems caused by smoke in the cafeteria are being limited in our enjoyment of a publicly funded institution. It is for this reason that I wish to support this committee's submission for a smoke-free environment in museums, galleries and science centres. By not including these facilities in Bill 119, you will be allowing this inequitable situation to continue.

As a social worker, I protest the present process of exempting certain sites from legislation and by doing so depriving me and others of our right to go to and be comfortable in publicly funded buildings.

Mr Sylvain Smeets: We all know that tobacco kills people. Be brave and be courageous. Take the necessary steps to encourage smokers to stop killing themselves. In particular, act to stop young people from taking up smoking.

For the past year and a half we have been going to the Royal Ontario Museum for Friday afternoon lectures. After our lectures we would go into the cafeteria. We would stay for about two and a half hours. They've got dinosaurs in the museum; we think they also have them in the cafeteria. Twenty per cent of the cafeteria is set aside for smokers. Last week we were there. After two and a half hours we had tears in our eyes because of the smoke. It is our contention that museums, art galleries and science centres should be entirely smoke-free.

Regarding section 9, paragraph 2, of the proposed act, which refers to educational institutions, given that a portion of the attendees at museums, art galleries and science centres are students whom we do not want to encourage to smoke, we urge you to amend section 9, paragraph 2, as follows: "A school, post-secondary educational institution, private vocational school, museum, art gallery and science centre." Thank you.

Mr Biggs: That is the end of our presentation. Thank you very much.

The Chair: Thank you. Just before going to questions, I just want to be clear. You don't work at the ROM, you're members of the ROM who go to different programs. Am I correct there, or are you also on staff?

Mr Biggs: No. We are not on staff, neither are we members, but we do attend U of T lectures there.

The Chair: That in no way takes away from your presentation, but I just wanted to be clear in terms of the title that we have down.

Mr Biggs: We thought we would prefer not to be members so that we would not be told we could use the fourth-floor cafeteria.

The Chair: Thanks very much. The parliamentary assistant had a couple of comments.

Mr O'Connor: First of all, I want to thank you for coming. My son, who will be 7 on his birthday this Saturday, is certainly a great fan of the ROM and refers to it as the dinosaur museum. I'm sure he'll be pleased that you've come today to make this presentation on behalf of him as a visitor and all the other visitors who do go to the ROM to enjoy the many different exhibits they have there, as well as to take an opportunity to sit down and have a lunch break in the cafeteria in a smokefree setting.

I appreciate your coming. In fact what I will do on your behalf is undertake writing to the Ministry of Culture, Tourism and Recreation and try to get them to help us craft an amendment that we could put in for the regulations. That's what I can promise for you today.

I think what you presented here has certainly some good merit and I appreciate your coming to the committee and presenting a view for many people who have visited there. I think probably the highlight for many grade school kids is a trip to the dinosaur museum.

The Chair: Did you want to comment on the parliamentary assistant's comments? I know that wasn't a question but I'm just giving you another shot.

Mr Biggs: No. I appreciate your efforts. Do you, Sylvain? Go ahead.

Mr Smeets: On section 9, paragraph 2, just change it.

The Chair: We hear you.

Mr O'Connor: Could I clarify? A lot of people who have been following the committee hearings will know this already, but for yourselves who are here today, in referring to the school, we've used the definition that is found in the Education Act, which goes beyond just the school proper; it includes the school yard and all the premises about. I think we do need to clarify that. I know that legal counsel probably doesn't like to spell it out any differently for lawyer reasons, but what we've heard from people has been that it needs to be spelled out somewhat differently.

I'm sure legal counsel have got the point themselves, because they've heard this said so many times. Thank you for helping me highlight that again for our counsel who will be helping us to draft changes and amendments.

The Chair: You should know that legal counsel is sitting in this room and listening to everything that is going on, so we'll see what happens. May we thank all four of you for coming before the committee this afternoon. We appreciate it.


The Chair: Could I then call upon Dr Roy Cameron of the University of Waterloo, Centre for Applied Health Research. Dr Cameron, welcome to the committee. We have a copy of your presentation. Please go ahead.

Dr Roy Cameron: Thank you for the invitation to be here and thank you for putting forward this legislation.

What I'd like to do this afternoon is something that's quite focused. I've been involved in a number of research projects over the last 10 years pertaining to smoking prevention, smoking cessation, and some of the findings from a study that we're just completing now I thought might be pertinent to your deliberations, so I bring them forward.

The study that I have in mind is called the Community Intervention Trial for Smoking Cessation, commonly known as COMMIT. It's a study funded by the US National Cancer Institute at a cost of over US$40 million. It's a large multicentred trial. A group of investigators from Waterloo and McMaster is the only Canadian team involved. We've been working in Brantford, Ontario, as our intervention community, and as part of that study we've done community surveys. Those surveys have resulted in some findings that surprised us. They may or may not surprise you, but I wanted to bring them to your attention.

The first part of the story that I'd like to present is the remarkable support we found among smokers for legislation that would set limits on smoking. There's a concern among smokers with two things: First of all, they want to quit, and secondly, they don't want kids to start. I think those are the two conclusions that emerged from the data that I've presented.

You'll notice that baseline smoking rates in Brantford are high. They're higher than the provincial average; they're higher than the national average. Brantford is on the edge of tobacco country. I think a community located in that context provides kind of a conservative estimate of what the public thinks.

Randomly selected smokers and non-smokers were surveyed. As you can see, 81% of smokers indicate they'd like to quit. That's consistent with other surveys. They're not only saying they'd like to quit in a glib way over the phone, but over a period of approximately two years, 9% of all the smokers in Brantford, almost 1,900 people, signed up in a smokers' network, the intention of which was to support their efforts to quit. So people are serious about their interest in quitting smoking.

You can see that smokers in large numbers support a variety of non-smoking initiatives, particularly those targeted towards preventing youth from starting. Ninetytwo per cent of smokers indicate that merchants should be fined for selling tobacco to minors; 74% agree that vending machines should be eliminated, kids shouldn't have access to them; 61% of smokers, and this really surprised me, agreed that the sale of tobacco products should be as strictly controlled as alcohol products. I was really quite surprised by that.

Skipping ahead, we found alarming data when we surveyed grade 9 kids in Brantford. It's clear that smoking is still attractive to youth, with 20% of grade 9 boys saying they smoked, 20% of grade 9 girls saying they smoked, 16% said they didn't smoke but they intended to start and 92% of the kids said it's easy to buy cigarettes.

We need this legislation. There's a lot of political support for it, I think, not only among non-smokers but among smokers as well.

I hope that you'll move ahead with this. If anything, I hope you'll make it more aggressive, and I hope that as we move ahead with this issue we avoid being divisive. The quarrel, I think, is not with the smokers; the smokers and the non-smokers, to a large extent, are on the same side on most of these issues. One way of looking at what we're doing is we're trying to create an environment where the large number of smokers who want to quit are more likely to be successful, an environment that supports non-smoking.

A specific suggestion that I have that's not in your legislation is that we shield from view tobacco products in stores. A very well-known way of promoting a product is to display it prominently at point-of-purchase, and in fact I gather that many companies pay a premium for shelf space in that area. Given that we ban the promotion of tobacco products, I'm not sure why we allow that particular form of promotion to continue. I think that kind of promotion hits people, for instance people who are quitting smoking, at a very vulnerable point. They see their favourite product right there in a situation where it's readily accessible. Why not cover it up?

I also highlighted support for banning of sales in pharmacies, because in the press I gather this has been contentious. To my way of thinking, as somebody who's concerned with shaping youth attitudes around the smoking issue, it's nonsense to have cigarettes sold in a facility that's in the health business. That just doesn't make any sense. If we had doctors with cigarette vending machines in their waiting rooms saying that they needed to supplement their income because they're in an underpopulated area -- I can see the smiles around the table; the absurdity is clear. I agree with the speaker one or two ahead of me, who said: "You've got to make up your mind: You're a business person or you're a health care professional. Choose."

That's the end of my remarks.

Mrs O'Neill: I am very happy you brought the statistics in. It seems to be a recent piece of research, which I think is very helpful.

I think you're the first one who, at least with some statistics, has indicated that smokers and non-smokers have very much the same goal, particularly regarding young people. Could you say a little bit more about creating an environment that supports smokers who want to quit?

Dr Cameron: Sure. I think that smokers who want to quit really get into trouble and relapse under circumstances where other people are smoking, so I think the more they're exposed to people smoking in public situations, the more difficult it is for them to resist urges. They're more likely to have urges to smoke under those circumstances.

It's like most of us find it difficult not to eat when other people are eating. None of us is probably having a problem being tempted to eat at this moment, because there's no food in the room. It's easy. If there was good food available, we'd probably be packing it in whether we're hungry or not. I think that's essentially the phenomenon that we're dealing with. The more we can put smoking into the background, so that people are not only not exposed to smoke but they're not exposed to people modelling smoking, the more supportive the environment is going to be, I believe, towards smokers who are trying to quit.

Mrs O'Neill: Did your research look at all at contraband?

Dr Cameron: No.

Mrs O'Neill: Do you want to make any comments about that?

Dr Cameron: Well, it's a complicated problem. I spent a lot of hours writing letters and losing sleep when this legislation was working its way through. When I thought about this, it seemed to me the fundamental problem is this: There are huge bucks to be made in selling tobacco -- big, big bucks -- and as long as there are big, big bucks to be made in selling tobacco, there are going to be vested interests who have an incentive to work against public health. It seems to me the way out is to strip the profits out of those companies, just absolutely take the money away. We need a legal source of cigarettes as long as we've got smokers smoking, but why should people make hundreds of millions of dollars on a product that's killing 38,000 a year in this country? Does that make any sense to you? It doesn't make any sense to me.


I saw numbers in the paper indicating that there were 2,400 people employed in the four plants that manufacture cigarettes in Canada. That works out to nearly 16 deaths a year per job. Why do we put up with that? Does that make any sense to you? There are 1,000 tobacco farmers in this province, 13,000 deaths: 13 deaths per farmer per year.

Mrs Caplan: I found your presentation very interesting. Also, we have on our desk an article on preventing teenage tobacco addiction. In it, it recommends a model for school policies on tobacco, and I was wondering whether you were aware of any schools or school boards in Ontario that have anti-smoking or anti-tobacco-use policies in their schools or require them.

Dr Cameron: We're actually doing a study with 6,000 students now across seven boards in Ontario. We started working with these kids when they were in grade 6. They're now in grade 10.

I can tell you that it's really hard to work with kids in high schools. All this talk about educational approaches, I think, rings hollow, because when kids are that age and they're smoking to rebel, I'm really concerned that there's the potential for doing as much harm as good.

I don't think there are easy solutions. I think this is a community problem. I think we've got to reach the point where smoking is just stupid. It's not cool; it's stupid. Smoking is about as fashionable as wearing a green polyester leisure suit. When we get to that point, I think kids will quit.

The Chair: Mr Wiseman is not wearing a polyester suit, and he has the next question.

Mrs Haslam: Besides, his is blue.

Mr Wiseman: No, mine would be green. Mine's most likely to be green.

Dr Cameron: I said that because I own such a suit.

Mr Wiseman: I've spent a lot of time with young people. Before my life here I was a high-school teacher.

Mrs Haslam: You have a life here?

Mr Wiseman: This is a life, yes. I'm interested in your comments where you say that 16% of the kids in grade 9 are thinking about smoking, that 26% of the young women are smoking now and 20% of the young boys. When you did this survey, did they tell you at any point what was the trigger mechanism that got them to start the first time? Do you have any idea of what that is, and if you do, if there's anything they told you?

We've heard from a number of groups of young people. Some of them said that they'd like to quit now but they can't; they're hooked. Some cessation activities in the school were suggested, and even peer pressure is important. So I've asked if anybody has taken teenage youngsters who want to quit and get them into the elementary schools to say, "Look, guys, this isn't as cool as it looks."

Dr Cameron: What we've found in our data is that you can predict kids who are at risk. They're at risk if their parents smoke, they're at risk if they've got older siblings who smoke, they're at risk if their friends smoke. This is a very interesting one: They're at risk if they're in school. If they're a non-smoking kid in grade 6 and they're in a school where there is a high smoking rate in grade 8, they're at risk. They imitate older kids. They're at risk if they're in a school where the teachers and the principal smoke. So we're influenced by what we see around us. That's a major determining factor. Kids imitate older kids; kids imitate adults they look up to.

Another factor is disposable income. The more money a kid has in his pocket, the more likely that kid is to get into smoking. That's why I'm really concerned about the legislation that lowers the price of cigarettes. I think it's a real problem, and I don't think all the educational programs in the world are going to offset the damage that's done.

I was going to say, I'm just about out of time.

Mr O'Connor: First of all, I want to thank you for coming. I have had an opportunity to sit and talk about some different ways of involving people in the community in the whole tobacco strategy. The government alone can't do it. Maybe you could share with the committee the strategy. The COMMIT program also looked at some other jurisdictions within the United States, did it not? I wondered if the numbers were comparable. You might want to share that with the committee.

Dr Cameron: I agree with you about the federal tax, absolutely. But it's difficult for me to make a comparison because I don't have all the numbers in my head. In general, Canadian smoking rates are lower than smoking rates in most of the states, excluding California, and attitudes towards non-smoking are stronger here. There's more public support for non-smoking in Canada. Those are very broad generalizations.

Mr O'Connor: Does the US price affect that?

Dr Cameron: I'm sure it does. It would be a strange aberration of economic law if doubling or tripling the price had no impact at all on consumption. There are lots of data that show a relationship.

My final statement, I'm now speaking very personally; I don't want to become sentimental, but I do want to put a personal face on this. When I was 16 years old, I came home one night and I found the body of my 49-year-old father. He had died suddenly, unexpectedly. He was a heavy-duty smoker of Player's cigarettes, the folks who still put the racing billboards up. He left a 44-year-old wife. He left four children who ranged in age from 10 to 16. We had no income.

I find myself wondering how many families are on welfare because of this pernicious habit; I really do. I'll just leave it to your imagination to figure out what this does to families. It is not a pretty picture. Somehow we need to get beyond the statistics and put a human face on this. This is not a glamorous product.

The Chair: On behalf of the committee, thank you very much, Dr Cameron, for your submission and also for your personal testimony. We appreciate your presentation very much.


Ms Patricia Wise: Thank you for this opportunity to submit our brief to the committee on Bill 119 on behalf of the Canadian Cancer Society. Attending with me is Karen Poshtar, our tobacco reduction chairperson in the city of Mississauga.

In my capacity today, I'm past president of the unit in Mississauga and also presently on the board of the south central region, which as you can see from our report takes in quite a sizeable district. I'm sure everyone is very aware of where the cancer society has been on this issue.

The Mississauga unit of the Canadian Cancer Society, for those who may not be aware, serves the ninth-largest city in Canada. As volunteers, we are very committed to providing the public with information on tobacco risk and supporting education programs targeted to our children. Of course, there are many well-founded reasons for reducing tobacco, but our high priority is that we reduce the burden of cancer and other tobacco-related diseases.

We must be very thorough about our education with the teenagers, because truly they don't perceive the threat of illness. They're really following peer pressure, and it's not going to happen to them. Of course I think we're all very familiar with teenagers' approach to anything that could potentially endanger their lives. I've outlined some facts here, and I am sure that I am really just reiterating what has been published in many publications prior to my arriving here.


Tobacco, of course, is a major contributor to approximately 30% of all cancers, including 85% of lung cancer. I just lost my own father to lung cancer. He really didn't smoke until he joined the navy. Of course, during the war that was a major pastime; cigarettes were very cheap. It was some years later that my father quit smoking, but he still died just two years ago of lung cancer. I also have a husband who has a respiratory problem and has to avoid all places with smoke available to him. He doesn't have a choice in this, and of course it is our choice to not go where there is smoke because of his failing health.

The figure of 38,000 Canadians who die per year of tobacco-related diseases is staggering. I don't think many of us realize just how many of these people are young people. Everybody always attributes cancer to that certain age, but being in the cancer society, we unfortunately see far too many people under the age of 25 dying of cancer. In Ontario alone, one person every 40 minutes dies of cancer, which has got to be staggering to anybody.

There is a rise of young women smoking. Why, we don't know. Maybe they're just frustrated, I don't know, but they are on the rise. At the moment we note that there are about 32% men and 29% women who smoke.

Tobacco also kills nine times more people than traffic accidents and 101 times more people than fires. I always say there are always laws in place to enforce a penalty for a violation, but I don't believe a law has been written yet where it says, "You can't get cancer." There isn't a dime on earth that you could have that's going to protect you with a clean bill of health, and I think that's the bottom line of what law enforcement can do. Really, when I hear all of the media on the objections of smuggling and taxes and everything, I would like to just say to these people in power: "For crying out loud, come back and let's look at what the real issue is. We've got a major concern here. You can hire all the people you want to enforce your laws. You tell me how many people can enforce the law of a clean bill of health."

Some personal experiences that are very scary: For your information, we've attached some letters here from our schools, which Karen will speak to. But in addition to that, a number of our small convenience stores in a lot of Toronto areas are known to be selling single cigarettes over the counter, and to children, whatever age they may be: 10, 11 and up, it doesn't matter. In one of these cases, I witnessed a store owner selling to a minor and I said, "Why did you sell that child a cigarette?" The store owner replied, "Because he can't afford a package." It just sickened me. As a cancer society volunteer and a citizen with a concern for our upcoming generation, that sickens me. We urge our government to enforce Bill 119, the reduction of tobacco products to minors. The increasing of the age to 19 will help. Proper identification is definitely a must, and penalties for violation have got to be enforced.

Our recommendations are clearly stated out here. We have a strong agreement with what Bill 119 contains and the components that are essential to our concerns. Please reduce the age and the accessibility. Get those vending machines out. Enforce areas where smoking can't be maintained, of course always thinking of the areas where children are primarily found, and have strong penalties for non-compliance.

I would like to just reiterate that the volunteers of the Canadian Cancer Society appeal to the government to take a significant legislative step towards the eradication of tobacco-related diseases in our province. Collectively, by ensuring that this legislation is proclaimed and enforced, we will win the devastating war on cancer, in particular by altering tobacco use at an early age.

Our mission is to eradicate cancer. Our volunteers give their time and their money to ensure the hope for a cancer-free future. Why would we go backwards now, undoing all the gains we have achieved? I really have to emphasize that. I've been a cancer society volunteer for 11-plus years. During that time, I have not missed a beat with ensuring public information, raising money for much-needed research, having setback after setback, watching friends and family die. I just want it to stop. We have a mandate that will not allow for setbacks and we urge you as a committee to please support our work, save lives and ensure a quality living environment for our future.

I would like to ask Karen now to express a few comments about her work in the schools. She works directly with the children.

Ms Karen Poshtar: Education is a great idea. I think the education has worked to the point that I go into classrooms -- and I've done over 750 children in different classrooms for the Peel Board of Education this year, since January -- and they know the answers to the questions. They know that there are 3,000 cancer-causing ingredients in cigarettes. They know that their lungs are going to turn grey, their fingers are going to yellow. They know that it's bad for their heart and lungs. The answers come fast. There's no thinking about it. They've had the information; they know about it; they've seen the commercials.

But somehow, between grades 3 and 6, they get real stupid. The same grades 7 and 8 children that I do the presentations to know the answers too, but on the way out of the cafeteria or out of the parking lot after lunch, you see them. They wait till they're off the school property, but they've got their cigarettes and they're smoking. It's a very frustrating experience for the phys-ed teacher who talks about the students she's had on her teams and she's worked with for all of grades 6, 7 and 8. One in particular drives by the high school and she said, "Every year it's the same story: My star athletes are standing outside the high school smoking cigarettes."

Where do they get access to cigarettes? They don't perceive it to be illegal. They know that it's bad for them but they continue to smoke cigarettes. I think that legislation has got to take over from education. Unfortunately, one of the problems that you're going to face with even legislation is that their peers are the ones who sell them the cigarettes. There isn't a corner store or pharmacy or gas bar that doesn't have a youth working there after hours. Even in a store that's run by someone who is dedicated to not selling cigarettes to the children, when the owner goes home for his dinner, the student who takes over is willing to sell cigarettes to his friends. They have the ready access to them. The idea of having it similar to our local liquor control board for cigarettes is very appealing, because it's much more difficult, I think, for youth to get at them that way.

I just can't tell you that there's anything else we can do. We've done the education. They know the answers to the questions. We've got to eliminate the availability through vending machines and corner stores and pharmacies.

Mr O'Connor: I want to thank you for coming and making this presentation. We've heard from a lot of groups, particularly groups like the Canadian Cancer Society and the Lung Association. We've got one of their little placards here.

We're all part of the overall strategy, so I appreciate you coming, because, yes, the government has to do the legislative end. We also need to support the people in the community who are doing a lot of hard work for us. Legislation alone can't do it all; there's got to be many different focuses on this strategy.

I think it's an achievable strategy. I don't think it's something that we should give up on. I know that with the dedication that you've shown us here today, we've got a lot of support out there in moving forward with this.

So I appreciate you coming and making this presentation and keeping up the fight and allowing us the opportunity, because part of the education process will also be through even the committee hearings. There's a lot of people watching, and pointing out and putting a lot of different views forward is important.


The letters from the students in the back really hit the point, because some of the kids, you can get to. I don't know about -- you say there's a point where they turn stupid. Well, I saw a great poster, and I don't know who put it out -- it might have been the cancer society -- but it showed a hockey stick, it showed a bread stick and I think a stick of gum or something. Then it showed a cigarette and called it a stupid stick. So I think there are a lot of different approaches that we've got to take to this, and I appreciate you coming forward.

The Chair: Thank you very much for coming before the committee today. We appreciate it.


The Chair: If I could then call on Ms Susan Daglish. Welcome to the committee. We have a copy of your submission from the Allergy/Asthma Information Association. Please go ahead with your presentation.

Ms Susan Daglish: Thank you. When fibre optics first became available, we had a speaker who showed us a picture that was taken of the lungs by fibre optics. It showed an asthmatic's lungs, and that picture showed lungs that were so red and so raw and so sore-looking that everyone in the audience gasped. The doctor then went on to say that those lungs weren't really the worst. The person who had those lungs didn't even feel symptoms. That was mild asthma. So if those lungs look so red and raw, we know that people with asthma -- people with allergies have the same problem in their nasal system -- have very inflamed, very sore lungs. What happens when they're exposed to tobacco is that it's terribly irritating for that inflammation. It's a little like rubbing salt into a wound.

We know that asthma is a huge problem. We know that there are 10 asthma deaths a week and that the incidence of allergy and asthma is increasing each decade by 25%. So there are a lot of us out there who have a lot of problem being exposed to tobacco smoke. To us, having to be around tobacco smoke is a barrier. We are considered to be physically disabled.

The organization I represent is celebrating 30 years. We began as an organization that recognized a need for food labelling. We achieved it. We also recognized that tobacco was a big problem for us. We were very, very much confined to what we could do, where we could go, because tobacco was so open.

In the early 1970s one of our members called a meeting. She invited the Allergy/Asthma Information Association, any organization like cancer, lung, physicians' and nurses' groups, anybody she could think of who might be interested in doing something about the tobacco problem. Most groups didn't even show up to that meeting. One person did, Gar Mahood, and he had the vision to see that this was a problem and that it probably could be licked. He carried on and founded the Non-Smokers' Rights Association from that.

We were very, very high at that meeting, I can remember. I can remember we said things like, "The ashtray will go the way of the spittoon," that smoking would only be done in private by consenting adults. We had a lot of things we thought about. I don't think any of us would have believed 20 years ago that we could have come so far as we have in 20 years. In some ways it doesn't seem far, but in other ways we have come a long, long way.

To me, this Bill 119 is kind of a real step forward. I think it's just great. I want to come here and support that bill and to tell you that it is something that has to happen, especially in the light of the last few days.

We do feel that perhaps our prime concern, that tobacco acts as a barrier to our access to public places, could be tightened up. We would really like to see smoking banned in all public places. As the people from the cancer society said, it has to be legislated over a broader aspect. Right now a municipality can say, "We'll allow smoking here, but we won't allow it there." I think it has to be a provincial mandate, that we just say, "There isn't smoking allowed in public places." I think it's good for the health of everyone, but particularly people with asthma and allergy.

That's what I really wanted to come and tell you today, to urge you to think very seriously about this issue of smoking in public places and how it acts as a barrier to one in five people who live in Ontario.

Are there any questions you would like to ask me?

Mrs Caplan: Thank you for an excellent presentation. We've been discussing the idea of municipal licensing. There have been a number of suggestions made. One was the notion of a government monopoly like the LCBO and other considerations. A possible model would be as you have in Metropolitan Toronto. They license taxis and restaurants and that sort of thing on a user-pay so it won't cost the taxpayers any money. Has your group thought about municipal licensing or some kind of a licensing option to help the control of access to tobacco?

Ms Daglish: Actually, it's funny you mention that, Ms Caplan. We had often said that we thought it would be an excellent idea if cigarettes were sold through the LCBO simply because they seem to be in the best position to check for identification of age. Because they do such an excellent job of controlling underage problems with drinking, we felt that they could certainly do it with smoking. It's so terribly important that children be kept from cigarettes. That's just a key issue.

Mrs Caplan: We've heard that over and over, how important primary prevention, particularly of young children and youth, is. Had your group considered the kind of suggestions for policies in the schools around this issue? We've heard some are effective, some are not. Have you thought at all about that?

Ms Daglish: I know that my daughter, who is a severe asthmatic, which got me into it, said that she developed very, very good bladder control because she could not go into the washroom at her school.

Mrs Caplan: My goodness. Oh, dear.

Ms Daglish: I really feel very strongly that there should not be smoking --

Mrs Caplan: Permitted.

Ms Daglish: -- permitted in the school by staff or students, because we know that in the junior schools the children have trouble with the tobacco smoke in the environment from the staff room. We would certainly applaud any effort to get it out of that work area as well.

Mrs Caplan: I'm assuming you'd also like to see an amendment in the legislation that banned kiddie packs of cigarettes entirely?

Mr Wiseman: Those are irrelevant now.

Ms Daglish: It is, isn't it. Yes, I would. I understand that in some places they have even been known to break open tobacco packs and sell them singly or in threes.

Mrs Caplan: Perhaps a ban that would not permit the sale of individual cigarettes?

Ms Daglish: I don't know how you could do that. I think there probably is one, but I think if the age barrier was controlled, that would eliminate that problem.


Mr Wiseman: You raised an interesting question about not allowing anybody to smoke in the school, and I'm just wondering how you would do that, given that there is already a widespread addiction among staff and among senior students.

Ms Daglish: It is difficult. I must share with you people an interesting story. About this time last year I was in Ottawa and I was going to Tunney's Pasture for a meeting. The taxi driver took me along. Of course, there's no smoking allowed in the federal buildings, and so the people who were wanting to smoke were standing out in the doorways having their smoke. I said to the taxi driver, "My, they must be really addicted to want to stand out in this kind of weather and have their smoke." He said, "Actually, about three days ago I had a visitor from Europe in my cab, taking him to a meeting in Tunney's Pasture, and as we went along the visitor said, `All these office buildings are government buildings, aren't they?'" The taxi driver said, "Oh, yes." The visitor from Europe said, "You know, I'm surprised that the government allows so many prostitutes to hang around outside."

I'd be concerned about schools because there is the addiction. I think there would have to be some sort of place where staff could smoke that was ventilated adequately so that the children were not exposed. I would not like to see teachers hanging about outside the buildings having their smoke. I don't think it would send the message that we want to our children.

The Chair: Thank you very much for coming before the committee this afternoon. We appreciate it.


Mr Bruce Gitelman: This is the first time I've been in the Legislative Building. I am very impressed with the schedule that you have undertaken today and appreciate that you're willing to listen to all these groups. I'm sure their input has been helpful in getting ready for this bill.

As a concerned citizen, I wish to comment on Bill 119. I strongly urge all committee members to do whatever they can to promote the passing of Bill 119, as you can personally help to alleviate a great deal of human suffering and death.

My story begins with a trip to the old neighbourhood. I remember many years ago as a child when an old, decrepit store was demolished and a modern, gleaming white Shoppers Drug Mart -- a division of Imasco, manufacturer and purveyor of deadly tobacco products -- was erected on the site.

I fondly remember my trips to the new emporium of delights. No, I was not a drug addict, but simply a normal six-year-old child who knew a good thing when I saw it. You see, when my mother and I went to the Shoppers Drug Mart to buy medicine to make us healthy, I discovered the pleasure pyramid at the checkout counter. You know what I mean? Why, of course, the candy counter. You see, the pushers -- or marketers -- at Shoppers Drug Mart were very smart. Just next to the cash register, at kids' eye level and within easy reach, they had placed the candy counter. I was pie-eyed looking up at a glorious mountain of brightly covered and well-lit candy packages in their shiny foil wrappers. About as far as I could see, just beyond the candy, at the top of the mountain was a smiling cashier-pharmacist with a professional-looking white lab coat.

It was not until many years later when I got taller and after a few cavities that I noticed that the real treats were near the top of the pyramid. Those brightly coloured, well-lit packages with their shiny foil wrappers being sold by the smiling cashier-pharmacist were nothing else but deadly tobacco products. Those same people whom we had trusted all those years for excellent advice on health care products and delicious treats were just supplying one more treat for those adults who were addicted to tobacco.

While the candy had special contests for exciting kids' toys or promised bursting flavour, the tobacco products held even greater promise. Everywhere you looked in the city, from first-class sporting events to the finest shows and culture, the tobacco brand names were there to celebrate them with you.

This story does not have a happy ending. Many years later when I had to visit the old neighbourhood Shoppers Drug Mart where my mother bought her cigarettes, it was still gleaming white and well maintained with tobacco profits from human suffering. In a reversal of roles, instead of my mother taking me to the drugstore for medicine, I was going to get the drugs she needed to make her happy. The final product at the top of the Shoppers Drug Mart product pyramid was the morphine that my mother needed to kill the pain from the cancer that was killing her. Only this time the package was not bright or shiny, but dark and brown like all narcotics should be marked.

Bill 119 is very important because it will take the tobacco products out of the drugstore and identify or package them like the really dangerous narcotics that they are.

Don't let the tobacco companies hoodwink you. They will tell you many things, but do not listen. They will tell you that generic packaging will confiscate their valuable brand names. This is only fair, given the number of lives their products have confiscated.

The tobacco companies will tell you that tobacco does not cause cancer. Do not believe them. My mother died of pancreatic cancer. I spent many days in medical libraries researching the world's databases looking for a cure. Pancreatic cancer is terminal. There is no cure. Pancreatic cancer consistently appears in higher levels in countries where there are high levels of smoking. All of the epidemiological studies that I have read linked it to tobacco. The one fact that I found most disturbing was a report in the late 1800s written by a doctor in the respected British medical journal the Lancet which reported that pancreatic cancer did not appear in Britain until after the introduction of tobacco.

This is 1994 and it is about time that we stand up to the powerful tobacco lobby and stop the suffering.

Mr Tony Rizzo (Oakwood): Thank you for your appearance here. I understand that the British government stopped pharmacists from selling tobacco around 1987. It is very revealing that connections were made between pancreatic cancer and smoking over a century ago in England. Do you have any figures of the results since 1987 in England, after the legislation was changed?

Mr Gitelman: To be honest, I'm not aware of what happened in England, but I know that it takes many different things to reduce the amount of smoking. I understand we've been very successful in Ontario. I would hope that any steps that we can take in Ontario similar to England and elsewhere will be taken.

Mr Martin: You reference in your presentation in a couple of places this powerful tobacco lobby that seems to have control, and certainly in the last few days we've seen just how much power and control it does in fact have. They've created a situation where now we as a government find ourselves on the horns of a dilemma, pushed into a corner, taking what I feel is the high road, making the right decision, but ultimately, will we be able to maintain that position in light of the discussion that is now happening out there?

Do you have any suggestions for us, any encouraging words, any ideas, any thoughts that might be helpful in front of that at this point in time?

Mr Gitelman: I can appreciate the stress that the Ontario government must be under right now with the recent changes. All I can say is to stick with what you're doing, and that is to continue to pass legislation that makes it more and more difficult for these products to get out in the marketplace. Label them for what they really are and try to get them away from places where children can start using them. I just wish you all the best in continuing to do that.

The Chair: Thank you for coming and for your personal presentation. We appreciate it.


The Chair: Our final witness today is from the city of York board of health. Welcome to the committee.

Dr Rosana Pellizzari: Good afternoon. My name is Dr Rosana Pellizzari. I am a family doctor. I work in a community health centre in the city of Toronto called Davenport Perth Community Health Centre. I am a member of the board of health for the city of York. Unfortunately, the chair of our board, Councillor Joe Mihevic, is out of the country and wasn't able to join me today. I'm going to be reading to you my brief, which you, I believe, have copies of.

The recommendation we bring to you is that the Tobacco Control Act is a necessary and effective component of a strategy to reduce tobacco consumption in the province of Ontario. Compliance and enforcement are crucial. The board of health for the city of York applauds and supports the government and urges consideration of more effective means of enforcement such as compulsory licensure for retail sales.


Tobacco kills over 13,000 people in Ontario every year. Smoking among grade 7 students has increased 50% since 1991. In Ontario, smoking accounts for one in five preventable deaths. These are not new statistics to you. Whether we are active smokers or exposed to tobacco smoke in our homes, workplaces or environment, we are aging, we are sick and dying. This is the legacy of tobacco consumption. This is why we, as a board of health, are concerned that government introduce policy which will secure and protect a healthier future for all Ontarians. This is why we support Bill 119, especially and maybe in spite of the federal government's actions this week, which undermine any provincial attempt to reduce consumption.

Cigarette smoking in Canada has shifted significantly, both socially and demographically. The city of York represents those trends. Men and women in the lowest education group -- less than high school diploma -- have greater rates of smoking. Our city is culturally diverse with newcomers coming from countries with a high prevalence of smoking. In addition, some groups have shown less of a decline in smoking rates, particularly women less than men, girls less than boys, unemployed less than those with jobs and low-income people less than high-income Canadians. Welcome to the city of York.

Canada's tobacco control policies are among the best in the world. As health care providers, we are dependent on our legislators to create strong disincentives for smoking. It is within this greater context that our work becomes meaningful. Research indicates that counselling and education have limited effectiveness in prevention and cessation. In order to achieve true tobacco reduction, we need Bill 119 to reduce access, to reduce exposure and to strengthen enforcement, particularly to new smokers: the youth of this province.

What we applaud is the commitment of the government to move beyond taxation, to address access by prohibiting the sale of tobacco to youth under 19 years of age, by banning the sale of tobacco in health facilities, including pharmacies, and by banning tobacco vending machines.

We hope it will be the intent of this government to use section 5 to introduce generic packaging of cigarettes. We must do everything possible to dissipate the glamour and brand-name recognition of tobacco products, especially for young consumers.

We are pleased that the act includes the prohibition of smoking in certain places. This reinforces and supports work being done in several municipalities, including our own, to restrict exposure to tobacco smoke.

We hope that enforcement of the act will be possible and effective. Although fines and bans have been outlined, a system requiring the renewal of a vendor's licence would make enforcement much more conducive. Such a system could be implemented at the municipal level.

The board of health for the city of York has gone on record in support of Bill 119. We do not want to see the act diluted. On the contrary, we want reassurances that the act will be enforced. We congratulate this government's effort to go beyond the rhetoric of the health goals for Ontario into effective action.

Mr O'Connor: Thank you for your strong presentation. I have to agree with you that in light of the recent changes in Ottawa by the Liberal government, I'm quite disheartened by those moves. It really seems to undermine a lot of what we're trying to do here and the overall strategy that has been in place by legislators for a long time.

It annoys me, the fact that Mr Clinton and Mr Chrétien can go on the telephone and make decisions to have air strikes, yet at the same time we've got 40,000 Canadians across this country dying annually and they can't make a phone call and say: "Look, we got a smuggling problem. Let's try to work something out." I'm really annoyed by that.

Anyway, to get to your submission, do you have any experiences around the licensing system? You're part of Metro. Does Metro not have that and can you share some of your experiences with us?

Dr Pellizzari: As a member of the board of health, we discussed licensing as one strategy, in that, if in order to sell tobacco products you had to be licensed, you could then enforce certain criteria or you could withhold licences for people who had actually not complied with the act.

Not being a politician and not being involved within the municipality at that level, I can't comment on what exists in Metro. I know that we, as a board of health, were very interested in pursuing that as a possibility to strengthen the act.

Mr Eddy: Thank you for your presentation and helpful suggestions and especially that you want us to go beyond the rhetoric of the health codes for Ontario and do something. I had expected maybe you'd offer some suggestions for even more effective and tougher legislation. Maybe you'd want to comment on that.

I'm not by nature argumentative, but there is a statement on page 3 that I wanted to ask you about. You said, "Canada's tobacco control policies are among the best in the world." My view is that they're the very worst.

We've seen a past federal government and a provincial government absolutely ignore the contraband tobacco situation to the point that the OPP says it's nothing to do with them; the RCMP says it's nothing to do with them. I've seen it grow and it's in my riding, so I know how -- to the point where the other day there was a release that one out of every two cigarettes smoked in Metro is contraband. It horrified me that it was to that extent.

So what did you mean by that sentence? Would you mind, because it was going to bother me if I don't ask you.

Dr Pellizzari: Sure. What I was referring to was the taxation of tobacco products --

Mr Eddy: Oh, I see.

Dr Pellizzari: -- because we know that consumption is linked to cost and that every time you increase the cost of a package of cigarettes, you do -- especially with the young, who are more price-sensitive. However, it also includes the prohibition of smoking in public places, in workplaces. We have some of the more progressive types of policy around exposure and access through taxation in the world.

Mr Eddy: They're not quite enough, though, but they're good.

Dr Pellizzari: Obviously, no, they're not.

Mr Wiseman: My concern is enforcement and how to make sure that vendors and people don't distribute the necessary four cigarettes to get a child addicted. That's something I would like you to comment on, because you do mention enforcement, but I think we need a little bit more in terms of what we should be doing and what we could try to do.

Dr Pellizzari: I think whenever you have law, then of course you need policing of that law. Do you mean what kind of auditing or monitoring you would need in order to make sure that vendors were complying?

Mr Wiseman: Yes.

Dr Pellizzari: You need to put the human resources into that, of course. That's why if you had some kind of licensing, even with a nominal fee, you might be able to cover some of your costs of actually having inspection to see whether people were complying with the regulations of that licence.

Mr Wiseman: Would you see a greater role for the health units in making sure that retailers and people who are selling cigarettes would comply with that?

Dr Pellizzari: Again, at least in the city of York, it has boiled down to the problem of human resources. Historically, public health boards have not been the beneficiaries of large pockets of money in this province. We have been a sector of the health system which has been, some would say, underfunded, so we don't have a lot of human resources.

However, municipally, we do have public work inspectors. We have other staff municipally that we could use. We're currently using health inspectors now to enforce some heating bylaws in the city of York. In fact, if we had more health resources, those people could be freed up to do some of the enforcement around something like this. I think this is an area where municipalities can play a role.

The Chair: Thank you very much, Doctor, for coming before the committee this afternoon.

Members of the committee, we will gather again in Thunder Bay on Monday and be back here Tuesday morning at 10 o'clock.

The committee adjourned at 1700.