Tuesday 15 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

Asthma Society of Canada

Elizabeth Kovak, executive director

Frederick King

Donna Ritch

Lesley Lavack

Council for a Tobacco-Free Metro Toronto

Krista Saleh, member

Etobicoke Board of Health

David Bain, member

Dr A.M. Egbert, medical officer of health

Lovell Drugs Ltd

Douglas Sumner, marketing manager

Michael Niznik, pharmacy manager

Carol-Anne Foty; Elio Roppa

North York public health department

David Shiner, chair, board of health

Dr Graham Pollett, commissioner and medical officer of health

Fred Ruf, director, environmental health

College of Dental Hygienists of Ontario

Evie Jesin, professional member

Maria Lee, public member

Dr Michael Gaspar

Canadian Physicians Concerned About Smokeless Tobacco

Jack Micay, chair

Dr Gregory Connolly, smokeless tobacco consultant

Arts and Health Alliance

Anne Bermonte, member, steering committee

Valerie Hepburn, member, steering committee

Zellers Inc

Robert Seibel, pharmacy general manager

Canadian Society of Hospital Pharmacists, Ontario branch

Gordon Murray, president

Lung Association, Metropolitan Toronto and York region

Ian Morton, environment coordinator


*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:

Haslam, Karen (Perth ND) for Mr Hope

Villeneuve, Noble (S-D-G & East Grenville/S-D-G & Grenville-Est PC) for Mr Jim Wilson

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

Also taking part / Autres participants et participantes:

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

Clerk pro tem / Greffière par intérim: Grannum, Tonia

Staff / Personnel:

Boucher, Joanne, research officer, Legislative Research Service

Gardner, Dr Bob, assistant director, Legislative Research Service



The committee met at 1003 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, ladies and gentlemen. Just before we begin the morning's deliberations, I draw to committee members' attention that we have received the second of the summary of recommendations from research and also recent press clippings covering the February 11 to 14 period, for your information.


The Chair: We have another busy day. Let us begin by calling on the representative from the Asthma Society of Canada, Ms Elizabeth Kovak, executive director.

Ms Elizabeth Kovak: Thank you for this opportunity of appearing before you on behalf of the asthma society. We're a national volunteer-based organization devoted to enhancing the quality of life of people living with asthma.

We're very pleased to see what has been proposed in Bill 119. We also want to applaud the efforts of all parties in working together in a non-partisan way for something which is so obviously for the common good.

I'm speaking from two points of view today, first of all, representing the asthma society. Up to 10% of Canadians have asthma. We're now told that 20% of children are diagnosed with asthma symptoms, so it's of grave concern to us.

Asthmatics know that smoking increases asthma symptoms. They also know that if they smoke, they're at much greater risk of developing irreversible airway damage. However, they're often exposed to the dangers of passive or secondhand smoke. There's evidence to conclude that increased severity of asthma and also additional asthma attacks are caused by passive smoking. In the United States, in a study by the Environmental Protection Agency, information indicated that in utero exposure to a mother's smoke can also produce increased bronchial responsiveness, which may predispose children to early respiratory illnesses.

Through our telephone counselling services, we often hear of the deleterious effects of smoke in the workplace and other public places. Sometimes people simply have to leave because of an asthma attack. It causes severe discomfort, but it also causes attacks, which certainly add to health care costs. We ask that section 9 of Bill 119 be strengthened so that smoking is only permitted in public places so designated and where it has been determined that no harm will come to other people because of this.

I'd also like to speak as a concerned citizen. I've given you some facts in my presentation, but I'd like to personalize it. I started smoking when I was 15 years old. I started because cigarettes were cheap, they were very easy to get, and because it was so cool to be seen to be smoking. I liked the fact that my peers thought I was really sophisticated because I carried that glamorous cigarette package. Now I find that it really wasn't that much fun.

Colon-rectal cancer is the second leading cause of death from malignancies in the United States. Recent studies show that I now run a much higher risk of having colon-rectal cancer even though I haven't smoked for over 25 years. The other part of the study indicates that this risk is fixed for life. Even though I don't smoke, the risk has been fixed and will not stop throughout my lifetime.

There are more things that are being found. Expectant mothers are also at risk. Because I smoked when I was pregnant for a brief time, my daughter, even though she has never smoked, should she become pregnant, runs a 29% greater risk of miscarriage than if I hadn't smoked. So we're looking at health care costs that impact on future generations. If both my daughter and I had smoked, the risk of miscarriage would rise to 60%. These are frightening figures.

The addiction to smoking for most people more than likely started when they were young people. A Health and Welfare Canada study shows that 90% of young smokers started before the age of 17. Of course, this is when I started too. Young people are very sensitive to peer pressure and the need to be cool. The health risks, even if they're told about them, aren't really something they linger over. That's something far in the future.

We strongly support the measures in Bill 119 which will deter people from smoking. Banning of cigarette sales from vending machines and drugstores, increasing the legal smoking age and plain packaging will help to do this. We also support our colleagues in recommending the banning of kiddie packs -- where you can buy less than 20 cigarettes -- because young people are price-sensitive, and the regulation of tobacco paraphernalia.

The asthma society strongly urges you to consider the measures in this bill. We believe that the implementation of Bill 119 will show the government's strong commitment to preventive health care and will make possible smoke-free generations in the future.


Mr Dalton McGuinty (Ottawa South): Thank you, Ms Kovak, for your presentation. First of all, I should make it clear that there's every indication that Bill 119 will receive unanimous support in the House, and that of course recognizes that by and large it's a very good bill.

You've made an important suggestion here dealing with section 9. If I quote from your paper, it says, "We ask that section revised and strengthened so that smoking is only permitted in public places so designated and where it has been determined that no harm will be caused to others by the resulting smoke."

First of all, what do you mean by the specific words, " has been determined that no harm will be caused to others by the resulting smoke"? What does that mean in terms of the physical setup?

Ms Kovak: I'm saying that to allow smoking, the onus should be on the owner of the premises to prove that other people will not be harmed. In other words, great strides have been made in having non-smoking areas, but if you have a smoking area in a restaurant and a non-smoking area, it has very little effect for the majority of people in that restaurant, because they're still breathing the smoke. I'm not a scientist, but I believe you would have to have two different systems to expel the air in the same room to actually allow places for smokers and non-smokers. What we're advocating is that in such places, where you want to have smokers, you have to prove that other people there who don't wish to smoke won't be harmed.

Mr McGuinty: One of the things I've noticed, and I'm sure you've noticed this too, is that marketing yourself as a non-smoking restaurant, for instance, has become something that is more and more common, because more and more people have become educated about the adverse effects of secondhand smoke. I gather you're impatient with that progress and you prefer that the law would step in. Am I correct?

Ms Kovak: Yes. I think great strides have been made, but there's still much more to do, because we hear of people who go to restaurants and have to leave because of an asthma attack or exacerbation of their symptoms. So we feel that there is still more to do. We applaud what has been done, I think the results are very good, but we think there is still more to do.

Ms Jenny Carter (Peterborough): We were listening to a doctor yesterday in Thunder Bay, and he suggested that secondhand smoke is very detrimental, especially to children, and that it could actually increase the number of cases of asthma among children. Do you have any evidence of that?

Ms Kovak: It certainly increases asthma symptoms, and the fact that 20% of children now are diagnosed as asthmatic -- yes, it will.

Ms Carter: Some 20%? That's terrible.

Ms Kovak: Yes. The symptoms sometimes disappear as they get older, but 20% of children.

Ms Carter: You also mention that 90% of smokers start before the age of 17. We had heard the age 19 mentioned, I guess, so it doesn't make a lot of difference. What would you suggest as the means by which we could minimize that number of children starting smoking? What particular measures do you think would deal with that?

Ms Kovak: I think anything that would make cigarette smoking no longer be a cool thing to do. Plain packaging: That glamorous package and the marketing by cigarette companies and the lifestyle are very powerful.

When I was much younger, the Virginia Slims ad in the US was always with a beautiful girl whose legs appeared to go all the way up to her shoulders. I really liked the way those girls looked and I wanted to be one of them. Smoking Virginia Slims, because I lived at that point near the border, was a very glamorous thing to do.

Ms Carter: People feel that if you smoke you will remain slimmer, maybe because you eat less?

Ms Kovak: That it lessens your appetite. I think also the availability of cigarettes. Of course it's a long time ago, I realize, since I was a teenager, but no one ever asked my age. I think anyone could go and buy cigarettes. They were reasonably cheap and no one ever asked whether they were for you or for father or whoever. So if they're less available also.

But I think more powerful than anything is to remove that glamorous idea about cigarette smoking. Also, the point of purchase: If the cigarettes are shown in a retail outlet with signage that indicates you have a glamorous lifestyle if you smoke, I think that has an effect on young people. It may have an effect on other people too.

Ms Carter: Of course, there are educators in the schools trying to convince children that they shouldn't smoke. We hear that at that age they think they're invincible and nothing they do is going to have a bad effect on them. One suggestion is that instead of the slim young ladies, you show what smoking really does to people, how they look when they've been smoking for a few years.

Ms Kovak: Yes. Someone with an oxygen tank beside them would be powerful.

Ms Carter: What about another aspect of it, that in fact they are succumbing to manipulation when they take up smoking? If you could demonstrate that, then it would seem that rather than being cool and independent and leaders, they would be just the opposite. Do you think that may be all right?

Ms Kovak: Yes, that might be something to stress, that advertising does manipulate us.

The Chair: Final question, Mr Villeneuve.

Mr Noble Villeneuve (S-D-G & East Grenville): Thank you, Miss Kovak. We certainly all sympathize with the asthma society and asthmatic people, and certainly smoke is one of the no-nos around these people. There are some in my family, so I know all about it.

I certainly will be supporting Bill 119, but I have a problem with having some of the rural pharmacies being told that they cannot sell a legal product that is available across the street from them. I live in an area in southeastern Ontario where we have Akwesasne next door, we have New York state, and now we have the province of Quebec. We have deliveries made to our high schools. As long as the students have $22, a carton of cigarettes is very much available to them.

I hope that can be discontinued as soon as possible; however, going with the provision of eliminating the sale in some of our small pharmacies where the front end of the store carries a good deal of the overhead, we may well have some of our pharmacies, hopefully not closing, but certainly suffering a fairly major reduction in their economic ability to stay and serve the public.

Would you have great problems, if indeed cigarettes remain legal, as they are and I presume they will remain, that pharmacies would be allowed to retail them as the store across the street does, or is this just political correctness?

Ms Kovak: I think I have less concern, to be honest, about pharmacies selling cigarettes than I have about the glamorous packaging and the way cigarettes are presented. Because I lived in a small community, I also understand someone who will drive miles to buy a pack of cigarettes. So I realize that.

However, someone at a meeting recently said that cigarettes are the only legal substance which, when used as recommended by the manufacturer, can kill you. I think that's a powerful argument.

Mr Villeneuve: That's a most powerful argument, and certainly education is the best weapon. But I have a problem with limiting the sale in pharmacies and in other areas of a legal product. If they make it illegal, then it's fine. But I think it's simply political correctness and I think many of the major chains will find a way around it.

Ms Kovak: I understand that.

The Chair: Please go ahead with your response, and then we're going to have to move on.

Ms Kovak: I understand your problem with that. I initially had a problem with the idea of freedoms, that someone should have the freedom to do what he wished. However, and you probably have heard this earlier in your hearings, to combat that, one can say there is no freedom in the cancer ward, and that's a powerful argument too.

Mr Villeneuve: The use of cigarettes, I have a problem with; I want to see them restricted to those areas. But the sale is my area of concern.

The Chair: Ms Kovak, thanks for your presentation.



Mr Frederick King: Good morning. My name is Frederick King and I'm a licensed Ontario pharmacist of Ultra-Mart Pharmacy, Oakville's family pharmacy. I thank you for the opportunity to express my views regarding the proposed Bill 119. The views that I will express are purely my own. I represent only myself and my fellow employees, although the views I put forward represent a similar situation for every pharmacy in Ontario which operates under the same venue as my pharmacy.

My pharmacy practice is set up inside a large megastore of over 40,000 square feet. Basically, the setup involves a large grocery store in the middle of the floor space surrounded all around the perimeter by individual mini-store franchises. One landlord owns the entire building, with the individual stores all paying rent per square foot towards the gross rent.

This is not a traditional mall setting with each store contained within its own four walls, but rather each store has a territory of its own beneath the single roof of this 40,000-square-foot room. If you will, the walls are invisible. There is the grocery store, a flower shop, a delicatessen shop, a fresh fish market, a bakery, a butcher shop, a wine shop, a proposed coffee-doughnut shop, my pharmacy and a tobacco, lottery, photo-finishing shop. Therein lies my problem.

Although I neither sell nor, for that matter, condone tobacco product sales, Bill 119 as it presently is worded will force either my pharmacy or the tobacco shop to vacate the premises. Paragraphs 4(2)8 and 9 of Bill 119 preclude the sale of tobacco products in a pharmacy or any area that is directly accessible from a pharmacy.

My pharmacy and the tobacco shop are at opposite ends of the building, are not visible to each other, and certainly in no way does my pharmacy even remotely appear to promote or send the message that tobacco product consumption is acceptable behaviour. We can't even get around this restriction by walling off either the pharmacy or the tobacco shop within this location, as this has been deemed unacceptable as the present bill stands.

Having talked to the other merchants at my location, I can tell you that although they agree that cigarette consumption is hazardous to one's health, they also feel it's a product which all individuals of legal age in a free society may legally consume if they so desire. The other merchants also strongly believe that tobacco sales bring in extra traffic to the location, and we all know that traffic is the lifeblood of any retail operation.

If the landlord decides that tobacco sales and the traffic it brings in is more valuable to the overall operation, then I'm afraid my pharmacy, my livelihood, will be banished from our megastore operation. I and my eight employees will be effectively put out of a job, and we don't have anything to do with tobacco sales or promotion of tobacco whatsoever. We will be innocent victims of a well-meaning but slightly flawed Bill 119.

In fact every pharmacy that exists in this type of situation, that is, every Zellers, every K mart, every Woolco, every A&P, every Safeway, every Miracle mart, every Loblaws, every Knob Hill, every Zehrs, every Eaton's etc that has a pharmacy operation within its megastore setting -- and we heard earlier that there are about 150 of these types of pharmacies throughout Ontario -- could all be permanently closed, tossing hundreds of pharmacy clerks, technicians, stocking personnel and of course pharmacists out of a job, all because tobacco is located under the same roof as a pharmacy, even though in every case the pharmacy department has absolutely nothing to do with the sale or promotion of tobacco products in these locations.

I at this time implore you to enact an amendment to Bill 119 which would allow special status for pharmacy and tobacco shops to coexist under the same roof, only -- and I stress only -- in the megastore setting and only as long as the pharmacy, the pharmacist or any pharmacy employee has no physical or financial connection to the tobacco shop and neither shop is visible to the other.

Furthermore, a megastore should be defined in the regulations as a location of, say, 30,000 square feet or more. This would effectively limit this amendment to the type of situation intended, with no room for cheating on the law by certain other vocal advocates of tobacco product sales in pharmacies.

Let me again reiterate that I agree that tobacco is a dangerous and addictive product which should be regulated and controlled. But as the present Bill 119 stands, it could very well force many innocent and compliant pharmacies out of business simply because of the location of their practice, not because of their desire or need to sell tobacco products.

One final comment I have concerns the direction of Bill 119. I am hoping that this is only step one in a multistep process to ultimately ban the sale of tobacco products in all retail establishments. I'm hoping the government is aiming for a single outlet for tobacco, such as an LCBO outlet, but since the government has not yet enunciated any plans or desires to expand upon the bill, I can fully appreciate other pharmacists' fears of being singled out as the only retailer banned from selling tobacco products.

If the government could only assure us the retail ban of tobacco sales will be gradually expanded to encompass all outlets to eventually dry up the sources of tobacco supply at the retail level, except for the government stores of course, then I feel all pharmacists could more readily and comfortably cooperate with the government's desire to make step one in the process the banning of tobacco products in pharmacies.

Thanks for your attention, and please give serious consideration to the amendment I have requested.

The Chair: Thank you very much. I want to clarify and make sure we understand. The operation that you have is not like, for the sake of argument, a Loblaws or a Zellers, where you are part of that operation. You're in an area that is open and has a series of different merchants who are selling a variety of goods, but they're all independently owned. Am I right?

Mr King: That's correct. Actually, a Zellers or a Loblaws would still fall under the same category because the pharmacy is under one roof, there are no individual walls, and part of the bill says if you can get the tobacco from the pharmacy, then one or the other has to go.

The Chair: But in your case everybody's totally independent, one from the other, which is different from some of the other situations we've had where one company owns everything there.

Mr King: Basically, yes.

The Chair: I just wanted to be clear on your situation. We'll start questions with Mr McGuinty.

Mr McGuinty: Just to pursue that, I'm not clear. If I walk into this Ultra-Mart store, this actually consists of a number of different booths, so to speak, owned by different owners?

Mr King: Yes.

Mr McGuinty: That's the way it works?

Mr King: Yes.

Mr McGuinty: So do you generate any returns as a result of cigarette sales that take place somewhere else?

Mr King: Absolutely nothing. I have nothing to do with cigarette sales whatsoever.

Mr McGuinty: Do you have any say over whether cigarettes can be sold elsewhere within Ultra-Mart?

Mr King: Not at all, no. I have absolutely nothing to do with cigarettes. I have no desire to have any dealings with cigarettes. But as the bill presently stands, since cigarettes are sold under the same roof as the pharmacy, one or the other has to go, even though we have no connection to each other.

Mr McGuinty: How many people work in your pharmacy?

Mr King: Eight people.

Mr McGuinty: How many pharmacists?

Mr King: Myself and a second pharmacist, so there are two pharmacists, two technicians and four clerks, cashiers.

Mr McGuinty: Those technicians, have they received special training?

Mr King: Absolutely.

Mr McGuinty: Through a college program?

Mr King: Either through a college program or else they've been trained on the job.

Mr McGuinty: What are your chances of getting a job elsewhere?

Mr King: I like to look at the paper every day, and there just aren't too many pharmacist jobs in the paper any more. I might get lucky and find a job somewhere else. I have credentials and I have experience. But we're talking about 150 pharmacies here, and if you're talking two pharmacists for a location, that's 300 pharmacists who are suddenly going to be looking for work if tobacco is deemed to be more valuable to the operation than the pharmacy. In a lot of these cases, like some of the Zellers and some of the K marts, the pharmacies are not making very much money, so obviously the landlord could very well decide, "Let's get rid of the pharmacy and keep the cigarettes."

Mr McGuinty: What are you going to do if you don't get another job?

Mr King: I guess I'll be down at the unemployment office.

Mr McGuinty: Do you have any dependants?

Mr King: Oh, yes.

Mr McGuinty: Who have you got?

Mr King: I have my wife and I have a son.

Mrs Dianne Cunningham (London North): You didn't think you'd get asked questions like that, did you, coming down here to give us some good advice?

Of all of the witnesses who have come before the committee, I think we haven't had anybody who hasn't been in support of the legislation. What we're looking to do here is to make amendments, as you've suggested, so I'd like to thank you for your assistance. I'm wondering if your brief that you made today is in writing and we'll get a copy of it, or at least the amendment. We have to have a copy of the amendment.

Mr King: It's handwritten, but sure.

Mrs Cunningham: That's all right, as long as we have something that we can put on the record.

The Chair: Mrs Cunningham, you should know it is part of our record now, because he has read it.

Mrs Cunningham: In the Hansard.

The Chair: Yes, so we at least have that.

Mrs Cunningham: All right. It takes a long time for us to get the Hansard, though, and if we're looking at clause-by-clause --

The Chair: We will be getting the recommendations, though, more quickly.


Mrs Cunningham: Okay. I'll count on the research people to give us the intent, anyway.

We've actually been having some very interesting presentations, and some have gone so far as to say that any retailer that sells tobacco has to be individually licensed so that we can have some jurisdiction over revoking a licence as the fine, as opposed to money, and others have gone so far as to suggest that tobacco is so lethal that it should be sold only in LCBO stores, along with alcohol. Would you like to comment on either of those alternatives?

Mr King: As I said at the end of my presentation, I'm a little bit confused as to the direction the government is taking. Is this just a one-shot deal where tobacco is taken from pharmacies and everybody else continues to sell it unimpeded for ever? I think that's why a lot of pharmacists are upset about losing tobacco, because they figure they're being discriminated against, singled out as the only retailer that's going to lose this product.

If the government could just tell us that this is a multistep process -- you know, maybe every six months they're going to take tobacco away from another retailer until by the year 2000 there are no retail establishments selling tobacco, and in the meantime they're going to be phasing in the government type of store to sell and control the sale of tobacco -- then I think we could all happily accept what this bill is gearing towards.

But as it stands now it's just like a one-shot -- cut tobacco off from pharmacies and everybody else keeps on selling it. Quite frankly, I can agree with all the other pharmacists that that's not going to stop smoking. It's just going to shift the sale of it from one location to another.

Now, who's going to sell it? Sometimes I have hesitations, really, about the government getting control of a product because the government tends to get hung up a lot of times with red tape. Sometimes they don't get the best value for their dollar when they run operations.

Mrs Cunningham: I certainly share your view on that or I wouldn't have taken this job, I'll tell you that. It's the one reason I did it, and I haven't been very successful in reducing the bureaucracy in opposition. Maybe I'll get a chance in government. But don't get us on that one.

I think the real issue is that we're supposed to be looking at the sale of tobacco here, especially to young people, and if you want to get tough about it, one of the suggestions was to license the retailers; the other was to take it right out of retail stores and put it somewhere else, and that's really the only reason. But I appreciate your comments in that regard.

Mr King: I think the ideal situation would be into a single outlet, which is obviously going to be very diligent about checking for ID. But you just can't one day be selling tobacco everywhere and the next day have it only in one location. It has to be a phased-in process. You have to give these retailers that are presently selling it an opportunity to phase out of the product, and if it's the government that's going to take over the sale of it, it's got to have a phase-in period to get its operations set up efficiently.

Mrs Cunningham: You make very good sense.

Mrs Karen Haslam (Perth): First of all, I've got to apologize. I'm just so tired right now I'm not understanding this, and I want to follow through with Mr McGuinty's questions. Are you hired by this group that you are there with, or is it your store that you operate? Because when he started asking about where you would go and what you would do and things like that, this Miracle Ultra-Mart Pharmacy -- are you the owner of Miracle Ultra-Mart Pharmacy?

Mr King: I do have some interest in it, yes, but I'm not the whole owner.

Mrs Haslam: Of just the pharmacy part?

Mr King: Right.

Mrs Haslam: It is an individually owned entity within a larger setting. Is that correct?

Mr King: That's correct.

Mrs Haslam: And there are other entities within this that are separately owned.

Mr King: Separately owned, yes. That's correct.

Mrs Haslam: I see. So you own part of this pharmacy. When we talk about the possibility of the landlord, we're talking about the landlord, meaning this conglomerate that owns this --

Mr King: The owner of the building, yes.

Mrs Haslam: So it's a building.

Mr King: A building. It's not a mall with little stores in it; it's one big room, so to speak, with several little stores set up inside it.

Mrs Haslam: It's almost like a flea market.

Mr King: A little more sophisticated.

Mrs Haslam: What I mean is, it's like a flea market because they have individual booths and each booth looks after itself. They pay to be there in this building.

Mr King: That's correct.

Mrs Haslam: This is a situation where the landlord has the building. Do you pay him rent?

Mr King: That's right.

Mrs Haslam: On your area that you have in the building, okay. You would have an opportunity, then, as an owner of this building, to choose to go to another location, because you own the business.

Mr King: In theory, yes, but in reality, no, because first I'd have to go out and find myself another location, another store, and my business is not necessarily going to follow me there. Plus, the big thing about having this location is that there is all this built-in traffic. If you go to a little corner store and set up your pharmacy, the traffic's not there.

Mrs Haslam: Your business would follow you because you're in the business of pharmacy.

Mr King: Not necessarily. Convenience is what people are looking for nowadays.

Mrs Haslam: But you're a pharmacist, and you have a monopoly on prescriptions. So if you're not there, you must have that business follow you because you're the only one who gives the prescriptions.

Mr King: Not necessarily. In a rural setting that could be true because there's nowhere else to go, but in an urban setting there is basically a pharmacy on every corner, and convenience is what rules. Unfortunately, loyalties aren't what they used to be, and people are going to go where it's convenient. That's the bottom line, convenience nowadays.

Mrs Haslam: I do appreciate your idea about the phased-in and phased-out approach. That has not come before the committee. When you talk about the government not knowing where they're going, that's what these consultations are about. We've had consultations about it before --

Mrs Cunningham: Karen, do you know what you just said?

Mrs Haslam: I didn't interrupt you, Dianne, thank you very much.


Mrs Haslam: We had consultations beforehand where we had people come in and talk to us about what should be in the basis of the legislation. The legislation was put out. Have you looked at the legislation?

Mr King: Yes, I have.

Mrs Haslam: Okay. I want to be very clear on this: We did not single out pharmacies. What we said was "health facilities." You are one health facility. When you came before another committee saying, "We are health practitioners and wish to be governed by the RHPA," you came before us as health practitioners. "We are a health entity." What this legislation does is say that tobacco is not sold in health facilities, of which you are one.

I know you feel that pharmacies have been singled out, and that's not true. What we're saying is that there are some businesses that sell tobacco and they hire a pharmacist, and that is a difficulty for that person who has a business selling tobacco but it's more difficult for the pharmacist, because under the code of ethics, you are not to promote the selling or the giving of drugs that hurt people.

Mr King: I have no problem whatsoever with pharmacies not selling tobacco. I'm just trying to help appease the situation, maybe get the other pharmacists who want to keep selling tobacco to understand that everybody is going to lose it sooner or later. But the government hasn't said that yet, so as a result, a lot of pharmacists who are presently selling tobacco feel that they are being singled out, discriminated against, and everybody else is going to keep selling tobacco for ever.

Mrs Haslam: I understand that.

Mr King: I just wish the government could say that this is a multistep process and six months to a year from now tobacco is going to be taken out of department stores, and then in another six months to a year they're going to take it out of gas bars, until the final step kicks in, in the year 2000 or whenever, when nobody is selling tobacco except a certain regulated outlet.

Mrs Haslam: This is the first time that's come forward, and I think we all appreciate it, because it's the first time anyone has broached the subject in this way.

The Chair: Mr King, thank you. I think you've raised a number of issues from a different perspective that obviously have taken the interest of the committee, and we appreciate it.


The Chair: I call on the Tobacco Use Prevention Coalition of Durham Region, Ms Donna Ritch.


The Chair: Order, please. I note committee members have been on the road, so they're a little tired.

Ms Donna Ritch: Everybody's a little excited. I've been watching your hearings on TV. At 6 o'clock every night at our house we are supposed to be eating dinner and we're all watching you.

The Chair: I don't know whether that's frightening or pleasing.

Okay now, committee members, if everybody just kind of does a stretch and --

Ms Ritch: Yes, good idea. Have a little health break.

The Chair: Ms Ritch, we have a copy of your written submission. Please go ahead.


Ms Ritch: Thanks very much. Good morning, everybody. I'm excited to be here. I know that you're not excited, but I am. Actually, I'm here today wearing two invisible hats. I'm here representing the Canadian Cancer Society volunteers as well as the Tobacco Use Prevention Coalition of Durham Region. Now, that is quite a handle, isn't it?

Before I begin my submission, may I say, and I do mean this sincerely, how gratifying it is to see members from different political parties working together as a team. Like our coalition, you are all working towards a common purpose: the passage of a sound Bill 119.

You have before you our formal submission, which substantiates many of the opinions expressed to the committee thus far. I'd like to share with you a few personal stories to reflect the thoughts in the submission before you.

Like many of the people you heard from, I too was the child of smoking parents. I began smoking at age 11. In those days, if you can believe it, I didn't like the fact that I looked younger than my age. Today I would love it. I could just think that a cigarette would add to this more mature image.

I smoked off and on until I met my husband, who is a non-smoker. It's interesting to note that a lot of people who care about those who smoke try everything, including the worst possible guilt trips, to get them to quit. Fortunately, my husband did not do that, but I knew that it was very distasteful to him and he was not impressed by it. I was impressed by him, so I quit. At that time I quit cold turkey.

My parents never did quit smoking. While my father had a known heart condition, smoking no doubt contributed to his early death at age 60. My mother required bypass surgery due to failing circulation related directly to smoking. While she did survive that surgery, she went on to require further surgery. The day before she went for that last surgery, I can remember my sister telling me that she was pleading for just one last cigarette. My mother's overall health was weakened by a lifetime addiction to a deadly product. She did not survive that surgery. She was 60 years old.

My children tell me that I lived in the olden days. I don't know; if any of you have children, you might relate to that kind of comment. In those days, interestingly enough, teens really did care what their parents thought and they cared about getting caught smoking. That was even more interesting, considering both my parents smoked, but I did care about that.

My best friend and I, though, developed this really neat strategy; we thought this was terribly unique. This committee can probably tell me it has heard this before. At her house we lit one cigarette and we said it was mine. We thought that at my house we would say it was hers. That worked really well until our parents met each other and the truth came out.

Interestingly enough, both sets of our parents smoked. My friend Christine's mother was successful in quitting years later. The week that I joined the Canadian Cancer Society, I'll never forget the tearful call I had from Christine telling me of her father's diagnosis of lung cancer. Having had surgery, he is doing very well five years later and is probably an unusual statistic, because that's not usually the case. Christine still smokes, despite a passionate desire to quit.

My husband and I are happy that our three teens are at present smoke-free. Coming from a smoke-free home may be just one contributing factor that keeps them away from cigarettes. Many others in my family have smoked long before it was legal to do so. I had been a sad observer of their health problems related to smoking, as well as the many attempts to quit. It is truly a powerful and painful addiction.

How then can we spare our young people from this addiction? I have a lot of compassion for those people who are addicted, and it's not about being cruel and mean. It's about looking at ways to prevent other people from going through this kind of suffering. I believe Bill 119 is a really good start. It has so many components that those of us who care about the concerns of tobacco look for.

To be specific, those concerned about tobacco -- keeping in mind that two thirds of us are non-smokers; we couldn't have said that 15 years ago; we have come a long way -- want to live in a society that promotes health, and that includes government and health-related organizations. I'm interested in some of the comments I've been hearing this morning, but it wasn't too many years ago that you could find cigarettes sold in hospitals. We know that cigarettes are not compatible with health and do not belong in hospitals. Is the same not true for pharmacies? How can we look at that any differently?

About four years ago we moved from Scarborough to Whitby, Ontario. I was canvassing the neighbourhood, checking out the local pharmacies and being basically nosy. I went into one of the pharmacies and I found the pharmacist to be very, very pleasant, but I did ask him, "How is it that you sell tobacco products?"

I think he was afraid the next day I was going to go out with banners picketing his pharmacy, which I didn't do. I just wanted to know, "How can you do this?" He said: "I don't believe in smoking. My family is smoke-free. None of us smoke. But I choose to sell it in my pharmacy, and unless I'm legislated not to do so, I will continue to do so." At that point I decided to find another pharmacy.

The Canadian Cancer Society and the Tobacco Use Prevention Coalition of Durham Region applaud the inclusion of the tobacco ban on pharmacies in this bill.

As this committee has heard, there are all kinds of little special situations, and certainly we need to work through them. I don't think there's any one person you've heard from who has all the answers to every problem. It's something that we need to work through and keep talking to each other about.

What else do people concerned about environmental tobacco smoke look for? We want places to eat, shop and play that are smoke-free. You were talking earlier about stores and retail outlets that are smoke-free. There's a Tim Horton in Pickering, Ontario, and it's doing wonderfully well with a smoke-free environment. We also have a terrific place in Whitby called Wheelies. It's a roller skating rink. I am not brave enough to try it, but I do let my kids go there. It's smoke-free and, interestingly enough, it has not suffered any loss of revenue by doing that.

By legislating public places to be smoke-free, the bill conforms to the majority of smokers who want to be protected from environmental tobacco smoke. You've heard before that there is no safe level of tobacco smoke. Interestingly enough, you keep talking about the legal issue. We know, and you've probably heard this -- I haven't heard you every day, but I'm sure someone else has said it -- that if it was invented today, tobacco wouldn't be allowed. We know that.

We know it would have tremendous ramifications if we stopped it completely and it would be an incredibly cruel thing to do to people who are so terribly addicted to the product. We'd have mass hysteria. That's not the answer. However, in public places there is no safe level of tobacco smoke. The only way to get around it is separately ventilated areas. The same is true of course of workplaces.

The emphasis is on helping our young people remain smoke-free. It is clear from listening to the young people that I've heard present to your committee and from other organizations that not one strategy alone will work. It will take a multidimensional approach. Any possible health consequences from smoking are believed to occur only to old people, a group to which young people will never belong, or so they think. Smoking is attractive to young people and we can help make it less so. Restricting smoking to those 19 and over with credible identification is a good start.

You've also heard that the Canadian Cancer Society did a study on plain packaging and you've heard the results of that which support plain packaging as being an uncool product. I don't think it's time to study it; I think it's time to implement it. We know as human beings we are all influenced by image, and youth are no different.

Visiting Oshawa last summer, if you came to see us, you would have noticed the huge banners advertising Players Ltd auto racing. Do we not think our children will link the image of smoking in a sporting event? Let's ban tobacco industry sponsorship.

Added to this multidimensional approach, we need to recognize that youth are influenced by role models. Positive, age-appropriate role models could deter youth from smoking.


This committee has also heard recommendations for controlling accessibility to tobacco. Vending machines cannot adequately be supervised in all areas to ensure young people will not have access to them. Maybe this committee can find a way to help phase that out. We're not talking about changes due tomorrow. We're not talking about not helping people in a compassionate way. We're talking about a plan.

It is clear, as I've stated, that not one strategy alone will work but a multitude of strategies. We, health organizations and the government, need to work on this challenge together to find the answers. We need to keep talking to each other.

In summary, what do Canadians need? We need a government that promotes health, we need communities where the air is clear and we need to help our young people in every conceivable way to remain smoke-free. Bill 119 can help to accomplish this.

My heartfelt congratulations for this excellent piece of legislation. The Durham region tobacco coalition and the Canadian Cancer Society are anticipating a strong, decisive Bill 119. This is your opportunity to deliver it to them. Thank you very much.

Mr Villeneuve: Ms Ritch, thank you for a very good presentation. We've also received correspondence totally supporting your stance from Dr Robert Kyle, who is your medical officer of health in Durham region, and certainly we support him.

My problem is that the pharmacists at the back of the store do not dispense cigarettes, either one by one or packages. It's at the front end of the store. I come from an area, as you may have heard earlier, that is very much rebelling, to the point where cigarettes, tobacco products and other products are driving a very thriving underground economy. My concern is that we still have a legal product here in tobacco, like it or not.

Ms Ritch: Regrettably so.

Mr Villeneuve: I agree with you that if it were to come on the market today -- it causes cancer. You light it up, you put it in your mouth and yuck, it's not good. However, people are addicted, as you have so ably pointed out.

My problem with this legislation is, your recommendations I think are great except the legislation we have probably only covers about half of those, and then we come into an area of regulations. I agree that a minor or a person under 19 should not have access to cigarettes, but in the underground economy there's only one thing that speaks, and it speaks loudly, and that is dollars. In the high schools that I represent, we have a very, very extensive network of onsite deliveries into the school, out of the trunks of cars, and if you've got $22, whether you're 10, 12, 14 or 19, you're going to get your carton of cigarettes.

Ms Ritch: They don't care. That's right.

Mr Villeneuve: I am concerned with overregulating in this area. A pharmacist in rural Ontario will not be allowed to sell cigarettes, whereas someone across the street, next door, whatever, who is not a pharmacist -- the pharmacist himself may own the business, but he's not dispensing cigarettes. They're simply there. Could you maybe express your comments?

Ms Ritch: I hear what you're saying. My question would be, how could a pharmacist be made to somehow be separate and not in support of tobacco product when it's in the same room, no matter how large that room is? Is there a way to do that? It's almost like a question to your question. If a pharmacist could be shown to be against selling tobacco and for smoking cessation, then there would be no problem, if you could find a way of doing that.

Mr Villeneuve: The licensed person may well be the lady at the cash register and not the pharmacist. The pharmacist may well be totally against the use of tobacco products, but we are discriminating against him as a business person when we do this. The licensing is an excellent idea I believe, and the penalty for breaking the law, selling to minors, would be the revoking of the licence.

Ms Ritch: Yes. So you're not worried about banning tobacco sales in pharmacies that are completely separate? That part does not concern you. Is that right?

Mr Villeneuve: To me, the front end of the store and the prescription end of the store are totally different. I've never viewed the back end of the store as being even tied to the front end of the store.

The Chair: Sorry. We've got questions here and we're going to have to keep moving.

Ms Ritch: I'll talk to you later.

Mr Jim Wiseman (Durham West): Thank you for coming to the committee from my neck of the woods.

Ms Ritch: My pleasure, Mr Wiseman.

Mr Wiseman: I have a decidedly different view of the world than Mr McLean.

Mrs Haslam: Than Mr Villeneuve.

Mr Wiseman: Oh, Villeneuve, sorry.

Mr Villeneuve: You're in the right party.

Mr Wiseman: You're all so nondescript.

Mrs Haslam: They sit beside each other. The Tories all look alike.

Mr Wiseman: Yes, they all look alike.

The reason I have a different view of the world is that this legislation is primarily designed to drive home a message to young people. The message is: "Don't smoke. It's not healthy. You may think it's cool right now but you are going to regret it later. So the best view is, don't start." We have heard time and again where young people have come before the committee and said that it's cool, that it's in.

Ms Ritch: Yes, absolutely.

Mr Wiseman: And you had this detachment of the medical profession at one point in our history saying, "Hey, smoke this one, because this is really great."

Ms Ritch: You'll be thin and beautiful.

Mr Wiseman: Thin, beautiful and dead soon, and going out in a very bad way. This is a terrible mixed message. The pharmacists I believe have got to decide what they are. They are either retailers and vendors of an addictive product in cigarettes or, as they want to claim themselves, they are health practitioners. They can't slice it both ways.

Ms Ritch: I'm in total agreement with what you're saying.

Mr Wiseman: We heard from a 12-year-old boy yesterday in Thunder Bay who purchased eight packages of cigarettes and no one asked him for his identity. He said, "Hey, look at me, do I look 19?" Obviously, he wasn't. He had purchased them and some of them he had purchased from pharmacists. One was from a Shoppers Drug Mart. All of them have claimed that they do a wonderful job at preventing the sale of cigarettes to young people. Have you run any kind of comparative studies in Durham to find out how many pharmacists or how many vendors actually say, "I'm not selling to you because you're underage"?

Ms Ritch: That's a great idea, Jim. That's a really good idea. To date, I don't know of any. I have just looked at my own little town of Whitby. Of course we have two or three Shoppers Drug Marts in Whitby alone, several Guardians, and then we have Whitby Community Pharmacy, which does not sell tobacco. You also heard from Brooklin, which is just north of us.

Mrs Haslam: Who made up their profits over a stretch of time.

Ms Ritch: Yes. I was very impressed with their submission.

Mr Wiseman: They didn't lay anybody off.

The Chair: Mr Wiseman, I'm sorry, we're going to have to move along.

Mr Wiseman: Thank you for your presentation.

Ms Ritch: My pleasure.

Mrs Yvonne O'Neill (Ottawa-Rideau): I'd like you, if you could, to say a little bit more about the annual evaluation. I really don't think Bill 119 is going to do all that people think it will do. It requires an extreme amount of self-monitoring in every little hairdresser, in every little laundromat in this province. We all know that they're very short-staffed in law enforcement and inspection groups, and I don't think that's going to change.

Could you just say a little bit more about this annual assessment? You're one of about two people in our entire hearings who have mentioned it. I think it's very important. I think the Ontario population has a right to know how this bill is progressing, because there has been a lot of approval of the bill, but enforcement is going to be a very big part of its success.

Ms Ritch: Yes. You're absolutely right. It's so interesting that we implement things without looking at the long term and how well it worked. When we think back to the approach that we took to smoking 15 years ago, when it did become socially unacceptable, it has had an enormous impact on society when we know that two thirds of Canadians used to smoke. Now two thirds do not. So some things are very obvious.


What we would have to do is sit down, and it would have to be with someone who has background in evaluation. Certainly, a lot of the leading universities are very, very good, and certainly the cancer society has used them in the past -- the University of Waterloo, the University of Toronto -- who can help us set out some kind of, number one, criteria of what we are looking for, what we are trying to measure, who will help us measure that and who should be involved.

You are absolutely right, it's not something you're going to decide today, it's something that would have to require several people coming together and a long-term plan. Probably you're looking at a five-year plan.

Mrs O'Neill: Thank you so much for that suggestion.

Ms Ritch: My pleasure.

The Chair: Parliamentary assistant, you have one comment?

Mr Larry O'Connor (Durham-York): I'd like to make the comment that up in the north part of Durham region, we've got quite a bit of work going on up there. The Uxbridge community is really involved: two pharmacies, one smoke-free, one not, which will be going smoke-free. The work in the community is really wonderful. We know we can't do it alone, we know you can't do it alone and we're working with you. There was nothing more warming for me, being the parliamentary assistant working directly with the minister on this legislation, than to drive into Uxbridge and see that banner across the main street saying, "Let's be smoke-free."

Ms Ritch: Fantastic.

Mr O'Connor: There's a lot of good work going on in Durham. I just wanted to say that.

Ms Ritch: That's great. Good stuff. Thanks for smiling so much, Larry.

The Chair: Durham must just be full of wonderful folks.

Ms Ritch: Oh, yes, you'll have to come and see us some time.

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

Ms Ritch: Thank you. It was entirely my pleasure. Good luck with all your work and I hope you all get some rest.


The Chair: I call on Ms Lesley Lavack, the coordinator of professional practice for the faculty of pharmacy at the University of Toronto. Welcome.

Ms Lesley Lavack: Thank you, first of all, for giving me an opportunity to appear before you today. I'd like to congratulate the government on its initiative in introducing Bill 119, the Tobacco Control Act.

I've been a pharmacist in Ontario for almost 26 years, although sometimes it feels like 126, and I've seen significant changes in pharmacy practice over that time. I've worked in community practice, in both retail and medical centre settings, in hospital practice as a clinical pharmacist and as the manager of an outpatient pharmacy. Presently I'm the coordinator of professional practice at the faculty of pharmacy, University of Toronto. I have also, over my career, been very fortunate to have worked with pharmacy organizations, government and industry.

Individuals and organizations appearing before this committee have made no attempt to dispute the well-documented health hazards associated with tobacco, both through direct consumption and through indirect effects. Debate has occurred, however, about some of the components of the bill. My remarks today will focus primarily on issues related to the sale of tobacco in pharmacies and the role of the pharmacist. In addition, I will comment on issues related to the general sale of tobacco.

As a legislative body, you're working hard to manage programs and to meet increasing constituent demands with finite and often shrinking resources. You must assure that tax dollars are spent wisely and that taxpayers get good value for their investment. Of particular interest to me is the investment that governments make through the Ministry of Colleges and Universities in the education of pharmacists.

Pharmacists are educated at significant cost, both to themselves and to taxpayers. Pharmacy education at the University of Toronto is challenging. Our graduates are educated to be health professionals. This includes four years of post-secondary education, 32 weeks of student training, 16 weeks of internship, pharmacy examining board examinations, all as requirements before students are eligible or considered for licensure in Ontario.

It is essential that pharmacists be utilized appropriately. This means a focus on professional activities. If this does not occur, I suggest that the citizens of this province are not receiving appropriate value from this well-educated health profession.

Shortly before I graduated in 1968, the dean of pharmacy at that time, Dean Norman Hughes, made an address to the Ontario College of Pharmacists. In that address he expressed concern about the dichotomous nature of community pharmacy. He suggested at that time that the emphasis on the commercial rather than the professional aspects of community pharmacy was having many damaging effects.

He said, "We have all known, and some of us have said it many times, that the only possible future for pharmacy as a health profession lay in concentrating on and developing and expanding and improving our professional services and competence." In the same address, he suggested that it was the 11th hour for pharmacy.

With the debate that has occurred before this committee about the professional versus the commercial side of pharmacy, many of you must be wondering if the pharmacy clock stopped ticking over 25 years ago. It didn't, but some issues continue to plague our profession and tobacco is one of them.

Pharmacy, as I know it and as I've practised it, has always been a health profession. Pharmacists are educated as health professionals. Pharmacies, it follows, are health facilities, since they must be owned and/or operated by pharmacists. From beginnings in apothecary shops, where mysterious potions and mixtures were compounded, pharmacy evolved to being a distribution centre for manufactured pharmaceuticals.

Pharmacy has continued to evolve as patients' needs change. Today, in the changing face of health care, pharmacy is meeting different needs. Patients need information about their medications in order to use them safely and effectively and to minimize problems associated with drug use. Pharmacists must take responsibility for identifying, preventing and solving drug-related problems in individual patients. In addition, and in line with government principles, all health professionals must find ways to promote health and prevent disease.

The societal and economic impact of preventable morbidity and mortality must be addressed. Tobacco is the number one cause of preventable death in Ontario. The impact of tobacco-related morbidity is huge. It is absolutely incompatible for pharmacies as health facilities to sell tobacco. I also believe that it's a conflict of interest for pharmacists to profit both from the sale of tobacco at one end of a pharmacy and the sale of medications to treat the effects of tobacco consumption at the other.

Committee members are well aware that this ban also reflects our own licensing body's request for legislation. This committee, I believe, has a responsibility to assure that pharmacy, as a self-regulating profession, is given the legislative authority requested by its college.

Pharmacists have appeared before this committee to argue that on economic grounds pharmacies must be permitted to maintain tobacco sales. The committee should also be aware that, in fairness, some pharmacies that continue to sell tobacco have made efforts to enhance their pharmacy services through patient counselling, improved medication monitoring and other professional services.

While I applaud these efforts, the argument that revenue from tobacco sales is necessary to support these activities is simply not convincing. Although I am sensitive to the potential economic impact that the removal of tobacco may have on these pharmacies, no one ever said that doing the right thing is going to be easy.

I expect that these pharmacies will find creative means of meeting their bottom line. These means may include developing alternative reimbursement schemes for professional activities, and that may include reimbursement for smoking cessation counselling and monitoring.

A more compelling argument is that the removal of tobacco from pharmacies will not reduce overall tobacco consumption and may in fact lead to easier access to tobacco by youth. This is a real, serious concern. The underlying principles of this legislation relate to reducing tobacco consumption generally and to preventing youth from starting to smoke.

In view of this very serious concern, I recommend that amendments to this legislation be considered. These should include, in my view, controlled sale by licensed vendors, strict enforcement policies and stiff fines for contravention of regulations. These measures are necessary if the overall objectives of this legislation are to be met.


I would also like to suggest to the committee that responsibility and accountability for tobacco use must be shared. Pharmacists can meet their professional mandate by removing tobacco from pharmacies and becoming involved in smoking cessation programs. Vendors can be made accountable for compliance with regulations related to the sale. Governments can ensure that the sale of this harmful product is controlled and can continue to provide educational materials, suggest packaging changes and require clear warnings about the dangers of tobacco use.

But what about the individual who, regardless of these measures, chooses to smoke? Surely this individual must share some responsibility for his or her health outcomes. Although I do not have an answer to how this could be accomplished, I do believe that the changing face of health care today means that your constituents, taxpayers of this province, must take reasonable steps to maintain their own health.

In summary, although the problems associated with the sale and use of tobacco are difficult and complex, I am personally confident that the end result will justify these very controversial means. Thank you.

Ms Carter: Thank you very much for your presentation. It was very helpful. I work with the Ministry of Citizenship and I have a special interest in seniors and drugs and some of the problems that happen with overmedication and so on. It has come to my attention in that context that -- after all, the government is trying to economize on drug benefit plans and other things and there is a growing trend towards medication by mail, I guess, which would circumvent regular pharmacy outlets.

Of course, a big argument on the other side is that the pharmacist is a skilled person and can give advice to a client, can make sure that the medication is correct. Also, in conjunction with the government, there is now an electronic system whereby the history of what medication a patient has had is readily available to the pharmacist and they can therefore make sure that the person is not taking drugs that will produce complex side-effects and so on.

There is, in other words, an emerging picture of the pharmacist as somebody who is not just there to hand out drugs, because that can be done by other means, but who is there as, if you like, another health practitioner who complements the doctor and can make sure that people get the right medication and know how to use it. This, it seems to me, does conflict very much with the whole idea of selling cigarettes, so I just wonder if you could enlarge on that.

Ms Lavack: I think you've made some very important points and they're all valid and questions that are occurring daily and something that I am personally very concerned with and I think all of us should be.

The Ontario drug benefit program provides essential services and needed medications to many eligible members of the program. The supply of products -- drugs -- to patients is something that pharmacists have control over; however, the emerging role and the real need for pharmacists' services really lies in ensuring that those products are used safely and effectively. The simple dispensing of a medication pursuant to a doctor's prescription can be done, as you and I both know, with the use of technology today. We have Baker's cells, bar coding, we can do that very easily.

What the citizens of Ontario need are the cognitive skills of a pharmacist to put medication use into a context of that patient's life, of their needs, and that can only be done if a pharmacist moves away from the counting, pouring, licking and sticking aspects of pharmacy into using what they know for the benefit of the patient.

In terms of the initiatives with the network that you were referring to, I think the use of technology is absolutely essential and I really applaud the beginnings of that technology. We have to use it. We have to use it more effectively.

In terms of how patients purchase products, and you referred to products by mail, prescriptions by mail, that's certainly a concern for some of us, because unfortunately over the years many individuals have felt that when they purchase a prescription from a pharmacy, it simply is a commodity, a thing. A purchase from a pharmacy should in fact include the service of a pharmacist, and I would like to suggest to this committee that that has great value.

Ms Carter: And it's not compatible with selling cigarettes.

Ms Lavack: Completely incompatible with the sale of tobacco.

The Chair: Final question, Mr Villeneuve.

Mr Villeneuve: Thank you very much for an excellent presentation. I was quite interested in your mentioning a conflict of interest, and I believe it is to some degree a conflict of interest. Some 25 years ago someone suggested to the College of Pharmacists that indeed conflict should be looked at. What have they done since 1968?

Ms Lavack: It's very interesting and I think it's somewhat embarrassing. However, I must admit that we have made progress, and I'd have to come to the college's defence and to the profession's defence. We're not all bad. We're very good people, by and large, and even for those individuals who continue to sell tobacco, it's a difficult situation for them. There are many, many good people.

In terms of pointing a finger at the college, progress has been made, and defining a pharmacy -- what is it? -- well, we're trying. Our request to the government, through our licensing body, is in fact an attempt -- and I would agree with you, perhaps late, but better late than never -- to define and suggest that and in fact ask you to help us define a pharmacy as a health facility.

Mr Villeneuve: As soon as governments step in and legislate, loopholes become apparent. Would you, as one representing the college, be ready to take to task some of your colleagues who may be just on the periphery of the law, legal but yet connected with -- would the college be prepared to take one of your colleagues to task if indeed they are maybe within the law but yet still in conflict?

Ms Lavack: That's sort of like being a little bit pregnant, isn't it?

Mr Villeneuve: Those are the realities.

Ms Lavack: I'm not sure how you can be within the law but not quite there.

I need to clarify, first of all, before I say anything else, I do not represent the college. The College of Pharmacists is a licensing body for pharmacists in Ontario. I am employed by the University of Toronto and I work as the coordinator of professional practice at the faculty of pharmacy, which is the educational organization and institution for pharmacists, and the only one, I might add, in Ontario.

I am interpreting now as a pharmacist who is licensed by the college. Would the college take action? Certainly. If regulations are codified, then it is a mandate of the college to require pharmacists to comply. Absolutely.

Mr Villeneuve: I believe that's the raison d'être for the college, and I am one who does not think governments can be the be-all and end-all. They can spend a lot of money and yet not really accomplish what they set out to do.

Ms Lavack: That's true.

Mr Villeneuve: Whereas you have the power, with your college of professional pharmacists, to make things happen.

Ms Lavack: We'll try. You've got me going on a topic that's dear to my heart. Thank you very much for your time.

The Chair: Thank you for coming in and for your presentation this morning.



The Chair: I call on the representative from the Council for a Tobacco-Free Metro Toronto, Krista Saleh.

Ms Krista Saleh: Thank you, Mr Chair, members of the committee. My name is Krista Saleh. I'm the tobacco issues coordinator at the Lung Association of Metropolitan Toronto and York Region, but I am representing the Council for a Tobacco-Free Metro Toronto, which the Lung Association is a member of.

Just to give you a little bit of background, the Council for a Tobacco-Free Metro Toronto is a Metro-wide coalition of public health units, non-profit health agencies and other health organizations, such as hospitals, which represent the Metro Toronto area. The council is also a member of the Council for a Tobacco-Free Ontario, which is the provincial organization overseeing the local councils.

One of the projects the council is working on right now is a tobacco-free awards program which awards certificates to organizations that have voluntarily gone smoke-free. We're also in the process of distributing fact sheets which the council developed for health professionals on the areas of tobacco prevention and tobacco cessation, and copies of this fact sheet were handed out to you as well.

The goals of the council are to prevent tobacco use in Metro Toronto and to advocate for a smoke-free society.

The council is excited about Bill 119 and what it can do for tobacco control in Ontario. It's a precedent-setting piece of legislation and we're thanking the government and opposition parties as well for bringing this bill as far as it's already gone and for introducing it. In light of the recent tobacco rollbacks, Bill 119 is even more important than it originally was and it's very important that it becomes a strong bill.

We are supporting Bill 119, especially in the area of the pharmacy ban. We believe that pharmacies, being professional health organizations, should not be selling the number one preventable cause of death, cigarettes, and it's even more contradictory that pharmacies say they promote smoking cessation and sell cigarettes at the same time. That's just a professional mistake, we think.

The council's also in support of tobacco retailer licensing, as well as plain packaging of cigarettes, in helping to make teen access to tobacco more difficult and also in helping the smuggling problem, which is the main issue with the tobacco tax rollbacks.

My focus today, though, other than these issues I just mentioned, is going to be ETS, environmental tobacco smoke, and the workplace.

Bill 119 does not at all address the issue of smoking in the workplace, and it's something that definitely needs to be addressed, because the current legislation, the Smoking in the Workplace Act of 1988, is really ineffective.

Through this legislation, 25% of a workplace is designated as a smoking area, but it makes no requirement that the smoking area is confined to a certain area of the workplace and it makes no requirement that the smoky air be separately ventilated to the outside. Since people spend a majority of time at their work, almost up to 90% of their time, this type of legislation is ineffective and exposes countless numbers of people to environmental tobacco smoke.

You probably know now that ETS is classified by the United States Environmental Protection Agency, or EPA, as a group A carcinogen, which means it falls into the class of cancer-causing agents such as arsenic, asbestos and radioactive substances.

Attached to my written report is a story on Mr Debus, a man who knows what ETS is and what it can do to him. Two years ago, he was diagnosed with lung cancer, and this lung cancer was caused by smoking. The only thing is, he never did smoke a cigarette in his life; maybe once to try it out, but that's it.

Lung cancer of this type that was seen in Mr Debus is usually seen in smokers, but since he was not a smoker, it was determined that his lung cancer was caused by more than 20 years of breathing in secondhand smoke from his workplace. In the words of Mr Debus, he wants the growing numbers of smokers' rights activists to understand the consequences of their actions and he says, "My days are numbered...they took my life."

Cigarette smoke contains more than 4,700 chemicals. Several of these chemicals are carcinogenic. One of the main damaging substances in cigarettes is tar, and ETS, or environmental tobacco smoke, constituents include essentially all the same carcinogens found in mainstream smoke that smokers ingest. Many of these carcinogens appear in greater amounts in ETS than in mainstream smoke, per unit of tobacco burned, that is, and when we say that pack-a-day smokers usually accumulate at least a half a cup of tar in their lungs over a period of about a year, we can also say that non-smokers exposed to ETS on a consistent basis can expect to accumulate alarming amounts of tar in their lungs as well.

With the Lungs are for Life program that the Lung Association runs in the Metro Toronto-York region area, we actually take out a jar of tar, about a half a cup of tar, with us to show students that this is something that can accumulate in your lungs over a period of a year as a smoker, but also as somebody who is a non-smoker exposed to ETS on a long-term basis or a consistent basis.

At the Lung Association, I myself receive countless numbers of calls from people at work exposed to secondhand smoke. They complain of ETS aggravating their asthma conditions, lost productivity due to headaches and general irritability at the odour of the smoke and other things, and also of management especially being the ones who smoke and therefore the ones who refuse to bring in a safe-smoking policy. Many of these people are not exposed to ETS in their workplace but are concerned family members whose loved ones are actually exposed to ETS. They wonder what can be done and what is being done about this situation.

Therefore, based on what I've just said, current workplace smoking legislation is really not working. Municipal non-smoking bylaws vary in the Metro Toronto-York region area, but put together they basically make up a patchwork quilt. They're all very different. Scarborough, for example, is one area we get a lot of calls from, because the bylaws are different and the amount of smoking that is allowed in workplaces is more than in Toronto, for example.

Therefore, we need a strong piece of provincial legislation that makes workplaces safe for everyone, not just a selection of employees who happen to work in smoke-free environments. Why should one person's life be valued more than another's based on where that person works?

The council recommends that effective amendments be made to the Smoking in the Workplace Act in time for the fall 1994 session of the Legislature. Ideally, the council would like to see smoking completely banned from all public places as well as workplaces. This recommendation of banning smoking totally is really the only way to truly eliminate the hazards of ETS in the workplace and is much, much easier to enforce.

The decision to ensure that innocent victims like Mr Debus do not continue to suffer rests in your hands. You really have the power to make a real difference for the people of Ontario. I'm just expressing what I see in the community. I thank you for the opportunity to present this information, and if you have any questions, I'll be pleased to answer.

Mr McGuinty: Thank you very much for your presentation. I think you make some very good points about the adverse effects of secondhand smoke, and I have to agree that the legislation that's in place now really isn't working, especially in light of the fact it doesn't require separate ventilation. The way I like to put it is to say that you're in a swimming pool and there's a urinating end and a non-urinating end.

Ms Saleh: Everyone's going to get it.

Mr McGuinty: Sooner or later we all swim in it.

Let's assume, because we've been given no indication that this is so, that the government is not prepared to move further with respect to protecting workers this way.

Ms Saleh: Through Bill 119, you mean, or just the bylaw?

Mr McGuinty: Through extending the Smoking in the Workplace Act to ban smoking entirely.

Ms Saleh: Okay.

Mr McGuinty: You're making use of an old psychological -- not ploy. What would I call it? You're using positive reinforcement here, which is very commendable. You've announced that you're giving tobacco-free awards in order to reinforce certain kinds of behaviour.

What is it that the government could do for employers to reinforce their either making expenditures to install a separately ventilated area or to eliminate smoking entirely? I'm thinking of a tax break, something along those lines, so we'd put a policy in place which allows employers out there to take advantage of it and encourages them to go forward, and then we wait and see what happens and see how many positive results it would generate. Any ideas on that line?

Ms Saleh: Obviously, anything that's going to present an incentive for people to get rid of smoking or create a separately ventilated area is going to be a positive step forward, and I think more people are likely to jump on board that way. But there are also going to be the people who oppose change and are not going to do it on a voluntary basis and are going to need the backing of others or the mandate of legislation before it will really happen.


The examples that you were suggesting, though, were good examples. If the government was to encourage people in that way by giving them some sort of monetary incentive or recognition in some way, that would be terrific, which is what we're trying to do as well.

Of course, we don't have the power to make the legislative changes, but it's something that people, on their own, have actually done in some cases, that some pharmacies, some restaurants, whatever they are, have decided. These are the people who are generally very health conscious or concerned about the people who come into their business or pharmacy. There are also going to be people who are concerned more about economics at the time than they are about the health of the people who come there.

It's the government that needs to set the example and let people know that, although economics is an issue, health is also an issue, especially when you consider the economics of health care costs.

Mr McGuinty: From a purely economic perspective, I think you could even make a good argument: the effect that we spend a lot of money in this province to treat our sick people. One third of our budget we dump into health care and a lot of that goes to treat preventable illness and a lot of that is caused by smoking. It seems to me that if we were to give employers -- this is just an idea I'm throwing up -- some kind of a break in terms of their expenses, the money they send back to the province, we could save that money by not having to treat people who are exposed to these kinds of things. Just an idea.

Ms Saleh: Great idea.

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


Mr David Bain: My name is David Bain. I'm a member of the board of health for the city of Etobicoke. My colleagues who have joined me for this presentation are Dr Egbert, medical officer of health for the city of Etobicoke, Mrs McGuire, vice-chair of the board of health and Councillor Marchetti, also a member of the board of health and a city councillor from the city of Etobicoke.

I'd like to start my presentation by indicating that a fairly extensive brief has been provided and there's no practical way to summarize the extent of this brief in 15 minutes. So, like most presenters, I'm going to take this opportunity to try and focus on the key issues.

I'd like to congratulate the government for the work it has done in bringing Bill 119 to second reading and I would like to congratulate the opposition parties for their work in a cooperative effort. Hansard reveals that this has been a non-partisan debate, and I think we can say this is a room full of good people with good intentions. That issue must be borne in mind during this presentation and throughout this entire process.

I watched these hearings with considerable interest. I watched representatives of the Canadian Cancer Society come forward and give you personal stories that moved everyone in the room and everyone who watched that presentation and will watch.

I'm not here today to give you personal accounts, but I will start by telling you tobacco issues have directly affected my life as well. Among other issues, I have a 13-year-old child who is directly affected by this issue and although I won't discuss those matters in detail, I will appeal to all of you to recognize that these matters affect all of us, all of the citizens, and directly. My point is that this is a very prominent issue, not simply because it's controversial, but because we're going to do some very good things with this bill, and I think that needs to be understood.

One of the chief concepts has been boiled down to a debate about pharmacies and whether pharmacists, as health care professionals, should be dispensing a product that when used as prescribed is lethal. I heard presenters before me debating the economics of this issue.

On that point in particular, and I think it's germane to drive to the main points when we have a 15-minute presentation, let me pose to you another consideration: Is it just, from a moral reasoning perspective, to spend $3 billion a year on health costs that are directly related and indirectly related to tobacco use in our province? We talk about the allocation of scarce resources in a recession, yet we don't hesitate as a province to spend this amount of money on health care that is necessitated by something that is preventable.

These are very important points. I hear about symbolism; in fact, I've heard the expression "just symbolism" numerous times throughout these hearings. Ladies and gentlemen, honourable members, I ask you to really contemplate symbolism.

As I approached Queen's Park today, I saw a very grand building, a building under renovation, but nevertheless a very grand building. I think it's important that we all remain cognizant of what's happening here. The provincial government, within a country that is very big on government by comparison to the United States of America, for example, is undertaking a process that's going to effect an awful lot of good.

There isn't just symbolism in the issue of pharmacists dispensing drugs and contrary messages to our youth. Symbolism is very, very powerful indeed. Let's not try to underestimate symbols: symbols like the Canadian flag to our troops in the former Yugoslavia, symbols like the Canadian flag when members of Canada travel abroad and are treated quite respectfully, and symbols like the Red Cross for help.

Let's talk about trust, because I think that's a very important concept in this presentation as well, the trust that exists between a health care professional and the client or the patient. I think that trust is essential. If anyone in this room was to suffer a medical malady, an illness or an injury, you would not hesitate for a second to provide intimate details of your lifestyle and of your personal health history to health care professionals. The reason you do that without any hesitation at all is because you know this trust is essential to your wellbeing and that these professional health care providers are trying to be efficient and effective and as helpful as they possibly can towards resolving your problem.

All health care professionals are affected by a situation where health care professionals call into question this trust relationship. It's most important that this trust relationship be maintained, and symbols about whether this health care professional is a retailer or a professional draw that trust into question.

I'd also like to refer to the concepts of responsibility, the responsibility that we have to correct this problem, the responsibility that we have to recognize those who are vulnerable in our society, namely, children, but clearly all people who are addicted to this substance.

The Addiction Research Foundation has told you that it's quite effective and quite appropriate to refer to the addictive qualities of tobacco in relation to drugs such as cocaine and heroin. In fact, our own Addiction Research Foundation here in Ontario surveyed over 1,500 individuals who were addicted to cigarettes as well as either heroin or cocaine and they found it more difficult to give up the addiction to tobacco than to either heroin or cocaine.

Numerous health care professionals and health promotion agencies have presented themselves here in person at your hearings and have provided extensive research to tell you what I suspect most of you already know and that really is not at debate here: We have a substance that is causing tremendous harm, tremendous suffering and premature death to the people in our province and our country, and we have an opportunity to do something about it.

I think it's very important that we recognize the federal government's response to the smuggling issue. Discussing this issue without recognizing the big picture is a little naïve and it is because of recent developments that have clearly increased the access to cigarettes that I suggest to you we must make Bill 119 the very best bill we possibly can.

In her opening remarks to this committee, the Minister of Health made numerous valuable points, one of which was that this specifically was what she hoped she would receive from this committee and all the presenters: valuable information on how to make this bill the best it could be, striving towards reduction targets established by the ministry and striving towards a smoke-free province.


Unlike some of the other presenters, I don't call that a Utopian goal. I concede it is idealistic, but in the face of the immense suffering that goes on every day, suffering from environmental tobacco smoke that causes asthmatic attacks in children who were doing nothing irresponsible themselves, suffering that causes premature death -- you've had the emphysematous and the chronic obstructive lung diseases described to you personally by people who have suffered them, the last few years of their lives being incredibly difficult. We must take every effort to stop that.

To that end, I believe you will find that the printed brief presented to you by the Etobicoke board of health makes numerous suggestions, all very valuable, that will help you achieve this excellent effect that we would all like to see. Some of those effects are simply amending technical amendments. I think there's clear agreement that there would be tremendous value in legal photo identification, so I've borrowed some language from the LCBO, because it has worked very effectively for them.

Other suggestions are not simply technical amendments, but they are substantive improvements, points like, for example, recognizing the harmful effects of ETS, or environmental tobacco smoke. Numerous people have referenced that the United States Environmental Protection Agency classified this as a group A carcinogenic in the same category as asbestos. You don't need me to give you further examples. I'm sure everybody around this table is convinced that this is a harmful product.

What are we going to do about it? What about that theme of responsibility? What about that opportunity to do good work? We all must share in that responsibility. Whether we're involved with government parties that believe government should take a more regulative role, or whether we belong to a party that believes government should be less involved but should promote by way of example, I think there is consensus with you, and most important, ladies and gentlemen, with our public that we must address this problem.

We must do it effectively and we must do something real, something substantive. To do that, we need excellent enforcement. There have been laws on our books for over 100 years dealing with this and presently the efforts represented in enforcement make that, quite frankly, even if it does sound a little unprofessional, a joke.

This has been a very divisive issue. You're going to have pharmacists tell you that they are retailers as well as health care professionals. Like some of you here in this room, I sat through and lobbied and advocated for health professionals to have new rights, to recognize new health professionals under regulated acts. The pharmacists wanted to be recognized as health care professionals.

We recommend from the Etobicoke health board that the action with respect to banning cigarettes in pharmacies be implemented within 90 days of royal assent of the Tobacco Control Act. We tell you, as you already have heard and as I'm confident that you know, the professional regulatory body of pharmacists in Ontario gave their members ample warning. They had been working towards this goal for more than five years. The reason pharmacies sought government assistance is because they had an issue of non-compliance.

I would suggest to you that the concept of not supporting a health college this very Legislature has granted regulatory authority to has implications for public safety in and of itself. If we grant them the power to regulate their members: physicians, nurses, pharmacists -- and as of January this year, close to 50 different health care organizations are self-regulating -- we're going to have immense problems if we don't support the organization we put in place. I'm watching the clock too, Mr Chair.

In conclusion, I would ignore the notes and tell you that you have a wonderful opportunity to do some very good work here today. Please let's not forget that. Let's make this bill as good as we possibly can. Let's remember that at least from a commonplace perspective, most public people, most non-governmental representatives will tell you that if our government and our opposition parties have made a concerted effort, as you have, through this bill and the hearings, you're not likely to return to this issue in short order, you're not likely to amend it any further. Let's do it right now. Let's make it the best bill we can and let's recognize that we do this not within a vacuum but on a continent where other jurisdictions, other countries, do not take the preventive approach that we do presently. Therefore, we must give this bill all the strength, all the focus and all the opportunity to do good for our children and our adult population within this province.

I'd like to thank you for your attention. In closing, I'd like to say that if I have sounded enthusiastic, if I have presented myself with strong views, I'm appealing to you to recognize that this is all for good reason and that we must make a good effort of the work.

The Chair: Thank you very much. I will also just indicate for the record that you have provided us with quite a lengthy brief with specific proposals. We appreciate that. There are a number of members who want to ask a question. Could I ask each to put it into one question, please, because we are short on time, beginning with Mr Wiseman.

Mr Wiseman: I don't want to downplay the health side of this, but there is an economic side of this, the question of tobacco smoke and the cost of the medical bill. You made a comment of about $3 billion in total cost. I actually think it must be higher than that, given all the spinoff and secondary effects. I'd like to know where you got that number.

Just for information's sake for the viewers, the total health care budget in Ontario is $17.5 billion. The total taxes raised from tobacco last year was in the area of $935 million, and in employer health tax, the total amount of money that was raised was $2.6 billion. All of the tobacco money and all of the employer health tax wouldn't even cover the number that you gave us, so I'd like to know your comments on where you got that number and on the costs.

Mr Bain: Thank you very much for the question. In a succinct answer, the $3-billion figure is directly from the ministry. It was in the minister's opening remarks to this very committee. I concur with you that this is a conservative estimate. I will tell you with confidence that the Canadian Cancer Society, Ontario division, financed a study that was recently completed, about eight months ago, at the University of Toronto on the preventive effects and the economic spinoffs.

If you attach to that figure those individuals who are not just absent from work due to direct causes but those individuals who are not free to provide services that our society does not directly pay for -- individuals who cannot attend voluntary functions, individuals who cannot be parents, individuals who cannot act in non-employee functions -- and you deal with the economic effects of those incurments as well, the study estimated you were looking in Ontario, just within our jurisdiction, at a figure closer to $7 billion.

It's clearly a conservative estimate, but I went with that conservative estimate because I felt confident that if the government was prepared to use this figure, you would accept it as a legitimate one.

Mrs Cunningham: It's an interesting process you've gone through here. Your board of health has seen the motion and the brief that you've made to city council? This is a representation on behalf of the board of health?

Mr Bain: Like most agencies, we work on the principle of majority rule. What that means is that when we pass a resolution, it is not a guarantee that we will not have dissenters or that we will have absolutely every individual saying the same thing, but that when a vote of a majority supports a resolution, we feel free to act on that.


Mrs Cunningham: I'm just interested because a lot of the city councils have not endorsed the issue of where cigarettes are being sold, especially in pharmacies, but I'm just pointing that out to you.

I'd like to ask you a question with regard to the statement you've made with regard to licensing, because there seems to be a lot of support for that on behalf of presenters to the committee. If in fact we had licensing, would you go so far as to say that any individual who sells must be licensed? How would it work, in your view? You mentioned the LCBO. We've even had presenters who have come and said that they would go so far as to sell cigarettes out of the LCBO outlets. So perhaps you could comment on either of those things.

Mr Bain: Thank you for the opportunity to respond to your question. Specifically on the first point with respect to the sequence of events that brought us here, clearly the Etobicoke board of health is made up of 12 members. In Etobicoke four of those members are city councillors; another five of those members are appointed by the municipality; and another three members, to total 12, are appointed by the Lieutenant Governor on behalf of the province but through a process of mutual appointment. The city undertakes interviewing processes initially.

This particular board felt that it was most important, as we are the regulatory body for the department of health, that we make a strong statement. We are not representing the Etobicoke city council, but you should understand that the mayor of Etobicoke has written a letter not only in support of our presentation but clearly in support of Bill 119. That has been distributed to you along with the brief that the board of health presented.

To your subsequent questions with respect to licensing, extensive research has been done in this area. I believe that if we based our comments on empirical data, all of us would have sounder grounds on which to debate and discuss this matter. The Journal of the American Medical Association, JAMA, article published in 1991 has been quoted by, at last count, at least 18 different agencies that presented to you.

They made it quite clear based on studies done in the United States of America. They surveyed 15 different community programs and they found that the single most effective element was an enforcement program that did not focus on monetary penalties but that focused on suspension of licence in addition to monetary penalties. If we do not have licensed retailers, we'd be in an awfully difficult position to suspend licences. So I suggest that we must recognize the value of licensing retailers. With respect to your question about the LCBO, it is far more appropriate to use a system that is already structured and already effectively uses surveillance systems and control with respect to who has access. I would like to expand that I have heard some people suggest that pharmacists might be the appropriate people to distribute cigarettes, because of course they can counsel and they already deal with deadly, dangerous products.

I think it is imperative that we all remember that these pharmacists do not distribute dangerous drugs. They're regulated health care professionals. They distribute narcotics, which when used appropriately help people and when used inappropriately have side-effects.

I am not convinced, particularly when I listen to pharmacists talking about cigarette sales occurring in the front of their stores and pharmacies in the back. Although it's a reference, it's not specific to the geography of a store, the concept is that we often have people in the front of the store selling these cigarettes who are not pharmacists. I think everyone on our board had a difficult time accepting that pharmacists would counsel people as they sell every single package of tobacco, so -- licensing.

The Chair: Final short, sharp question.

Mrs O'Neill: I just want to continue with the licensing. I think I asked one of the other municipalities -- the city of Etobicoke does not license because Metro does not license. Is that the --

Mr O'Connor: Metro licenses.

Mrs O'Neill: But Metro has not made the decision to go for licensing of tobacco vendors, is that correct?

Dr A.M. Egbert: There is a bylaw in Metro to license facilities that sell tobacco. Metro has a bylaw.

Mrs O'Neill: Then may I ask you why Etobicoke has not bought into that plan with the powers they have? Has your board made representation to the council? It would seem to me to be fundamental with the recommendations for substantive improvements that you have suggested to this committee.

Mr Bain: In response to that question, a simple yes. We have certainly made that recommendation to city council. We will leave you with a copy of our present municipal bylaw.

I will tell you that your initial comments were not entirely off the mark, that this issue has been discussed and there has been agreement within the department not to proceed on this matter until there is a consensus within Metro. We feel we'd be far more effective acting collectively than acting unilaterally.

But it is a matter that is presently under discussion, and a matter for which there is considerable support in every municipality. We have a liaison committee where all of the boards within Metro try to function consistently, and this particular issue is waiting for the outcome of this bill.

The Chair: I'm sorry I'm going to have to end our questioning there, but thank you very much, all of you, for coming before the committee today and for your written presentation.


Mr Douglas Sumner: My name is Douglas Sumner. I'm the marketing manager for Lovell Drugs.

Mr Michael Niznik: My name is Michael Niznik. I am a pharmacy manager for Lovell Drugs in Oshawa. In the interests of brevity, I'll skip the introduction to our brief and go directly to our position.

I would like to make it quite well known that Lovell Drugs supports the Ministry of Health's strategy as presented in the Tobacco Control Act as well as most of the proposed amendments and additions suggested to this committee since January 31. We are prepared to work with and support the Ministry of Health to help achieve its stated year 2000 goals.

Lovell Drugs is, however, opposed only to the Bill 119 provision that the selling of tobacco products in pharmacies be prohibited. We believe that the termination of sales of tobacco products in pharmacies should be undertaken on a voluntary basis.

We consider the banning of sale of tobacco products in pharmacies to be discriminatory and of dubious constitutional legality. We would also welcome publication of any studies done by the ministry that would suggest that such a ban would result in reduced tobacco consumption at any age level.

We feel that such a prohibition will have little or no impact on the health of the public, since those who wish to purchase tobacco products will be able to do so in other nearby retail outlets. It is our position that the bill as written will not achieve its major objective, which is to prevent the provision of tobacco to young persons. We feel that it will simply move the sales to convenience outlets or, more likely, to contraband sales, with the subsequent loss of tax income and revenue to the ministry, at the same time developing illegal market acceptance in those same targeted juveniles.

We have in fact over the past two years reduced to seven the number of our outlets selling tobacco products. In light of present marketing trends and sales levels, plans are under way to delete sales of tobacco products in two additional outlets by the end of fiscal 1994.

We are prepared to endorse nearly all of the supplementary initiatives introduced to this forum by colleagues and proponents of Bill 119. We would actively support, first, a total ban of tobacco products -- all of our locations are smoke-free as far as employees are concerned; the restriction of the sale of tobacco products to controlled outlets, and our recommendation is that they be taken to the LCBO stores, where the mechanism is already in place; the introduction of legislation that would fine underage possession of a controlled substance; and also any incentive that would relocate responsibility of personal actions as an onus on the smoker, either by education or legislation.

To this point, there has been substantial progress in reducing the number of people using tobacco. Some of this has been achieved by pharmacist-sponsored programs providing public education and counselling. Among pharmacists, there has been a steady decline in those who sell the products, but the decision to date has always been based on their own volition. Independent studies have always shown that pharmacies are the most responsible retailers of tobacco products. If the reduction of tobacco use among younger people remains the stated objective of this bill, why eliminate the sale from the very group that is least likely to sell to those minors?


The economic impact of this legislation on pharmacies in general is defined by the Coopers and Lybrand study which has been well documented to this committee. The immediate impact on Lovell Drugs will be that six to 10 employees will be terminated at once, with the ripple effect of lowered customer traffic to be an ongoing evaluation to determine future dismissals. Profit on the sale of tobacco products, while small, was sufficient to pay those salaries. These employees will be terminated, and since they are entry-level positions, those situations will be permanently eliminated.

I've then included a small table showing the diminution of our sales.

The problem would appear to be somewhat self-solving, as the year-to-year sale of tobacco products, even allowing for 25% to 75% contraband purchases in some of our trading areas, is dropping about 10% to 15% per year, and within a period of three of four years, would not be a viable product line at any of our locations. That kind of moratorium would, however, allow a gradual realignment of our product mix, perhaps without any staff deletions.

The proposed ban will impose further economic penalty on a group of retailers already forced to cope with a series of Ministry of Health economic downsizing initiatives which have had a severe negative effect on our operations. The retail component of pharmacy is not only a separate and distinct entity from the dispensary but is absolutely critical to the financial viability of pharmacy today. In actual fact, the Ministry of Health has itself continuously taken the position that it expects the retail segment of pharmacy operations to cross-subsidize dispensary expenses and overhead that are a part of the Ontario drug benefit plan.

It is our wish that this legislation be amended so that pharmacy is not placed at an unfair disadvantage with competing retailers.

Lovell Drugs further recommends that the Ministry of Health not prohibit any retailer from selling legal products. This present action would establish precedents to encourage other single-interest groups to descend on pharmacy and others demanding that certain products be prohibited.

Legislation of this social significance requires market control prior to usage control. The American experience with the Volstead Act should be a historical window to the ministry regarding both contraband sales and public acceptance.

We have been described as a profession in conflict. We suggest that there is a cognate analogy between pharmacy and government, especially as indicated by the events of the past week, in the application of diverse philosophies to terminate the contraband tobacco market.

At this point I'd like to have my associate, Mr Niznik, make a short commentary on the impact on his individual store.

Mr Niznik: The Lovell drugstore which I currently manage is a small pharmacy located in downtown Oshawa. My staff is presently comprised of 13 persons, four full-time and nine part-time.

My purpose in appearing here today is to voice my belief that the ideas behind the Tobacco Control Act are valid and justifiable. However, the intention of restricting the availability of a legal product from only one type of retailer, be it pharmacy or otherwise, is not.

The sale of tobacco products in my store, though modest, generates sufficient profit to pay the salary of one employee. The decision to sell tobacco products is not then entirely voluntary. The loss of these sales would mean the loss of yet one more part-time position. Staff hours were recently drastically reduced due to the Social Contract Act, and further staff reductions could make much of my retail operation unworkable.

As a health professional, I am intimately aware of the dangers associated with smoking. I do urge and counsel patients to quit. If it appears that I and other members of my profession are arguing solely on an economic basis, please remember that it is this economic basis that allows me to deliver my professional services, and I believe as a pharmacist I am very unique as a professional in that sense.

I do support the voluntary cessation of tobacco sales in pharmacies. My own location, perhaps in the near future, may also be able to eliminate tobacco on a voluntary basis. I fear that the legislation as written will not serve its intended purpose, ie, I do not believe that banning the sale of tobacco products in pharmacies will achieve the objective of restricting the sale of tobacco products to minors. I believe it will be the patients themselves who may lose if pharmacies are forced to lower service levels or to close because of legislation.

Mr Sumner: In conclusion, I would like to reiterate that Lovell Drugs applauds the ministry initiative with Bill 119, and we urge its passage, but in modified form. Thank you.

Mr Villeneuve: Gentlemen, thank you very much for a presentation that I think makes a lot of sense. I want to re-emphasize one statement that you make here: "If the reduction of tobacco use among younger people remains the stated objective of this bill, why eliminate the sale from the very group that is least likely to sell to those minors?" I have to agree with you. Do you have any stores east of Oshawa?

Mr Sumner: Yes. In the introduction, which I'm sorry I bypassed, I note we have stores in Whitby, Oshawa, Kingston, Brockville, Cornwall and Ottawa.

Mr Villeneuve: How's your Cornwall store doing?

Mr Sumner: Our sales have dropped about 85% over the past two years.

Mr Villeneuve: Therein is the problem.

Mr Sumner: Yes.

Mr Villeneuve: Cigarettes by the carton in trunkfuls of cars are being delivered to high schools. If you have $22, you're in business. With the events of last week, corner stores in the province of Quebec will now sell you a 24 of beer for a couple of bucks less than in Ontario, they'll sell you a bottle of wine and they'll sell you a carton of cigarettes at half price. We don't need this bill in eastern Ontario at all, even for pharmacies and for corner stores.

However, I think you make a very, very good point when you say a total ban. This product is lethal, there's no doubt about it. It's certainly a cancer-causing agent. Ban it totally, and if you're not going to, then limit it to the LCBO. I agree with that. However, in the area that I represent, with a total ban, you'll never have enough police officers or enforcement people to control what's coming in now from Quebec, Akwesasne and New York state.

Mr Sumner: Absolutely.

Mr Villeneuve: I rest my case. I agree with you wholeheartedly.

Mrs Haslam: Gee, I feel like a lawyer. With all due respect to my opposing lawyer here, Mr Villeneuve is new to this committee. Mr Villeneuve wasn't here yesterday when we were out of the town of Toronto, when 23 people made presentations to our committee and 22 agreed with the legislation, that we should be looking at pharmacists.

With all due respect, we've had presentations from Brantford where they had a questionnaire of students in a secondary school, and 26% to 28% of them said, "Yes, we can get them in pharmacies." So when you say, "The group that is least likely to sell to these minors," I might agree, but we had a 12-year-old in Thunder Bay say: "I got cigarettes. I don't look 18. I'm 12 years old." He did get them from a Shoppers Drug Mart and from a pharmacy. We've had other presenters say that it is available in pharmacies.

My comment on that is, you may be the ones least likely, but when we can stop just one 12-year-old, to me that's worth it. So although I understand pharmacists saying, "We're the ones who can control it the most," it's been proven by other people coming before us that it isn't happening, that they are able to get it in pharmacies. That concerns me when one extra child is hooked on this kind of thing.

When you also take a look at prohibition having little or no impact on the public, again I disagree. Even if we have one person hooked on cigarettes who has to drive a little farther to get those cigarettes and decides it is a little more cumbersome to obtain cigarettes because they aren't available in his pharmacy, if that one person decides to quit smoking, to me that one person's life out of 13,000 people who die every year because of this disease is worth it. It is worth it to the extent of saying, "I don't think a profit is worth the life of that child and I don't think a profit is worth the life of that person who's hooked."

I do commend you that you said in the last two years you've reduced to seven the number of outlets. Any job losses?

Mr Sumner: Two at the moment, and with the two outlets that are gone now, there will be another termination.

Mrs Haslam: You wanted to delete the sale of tobacco products at two additional outlets by the end of 1994.

Mr Sumner: Yes.

Mrs Haslam: The college asked you to start in 1990. There was a two-year gap before you started to do that.


Mr Sumner: If I may interject, it was approximately one year that it went. There have been some credibility problems with the college.

Mrs Haslam: Not according to the college. They made a presentation here.

Mr Sumner: I realize that. Little action was taken on several recent initiatives that required their intervention which are not appropriate to discuss here, but I suspect the membership expected that apathy to continue. I have no excuse. I make no further commentary on that, other than perhaps as far as pharmacists are concerned and others, procrastination is a bit of an art form.

Mrs Haslam: You're talking about a moratorium. You're saying this type of moratorium over the next --

The Chair: Ms Haslam, final question.

Mrs Haslam: Okay. You're saying it's absolutely critical to the financial viability, which other people coming before the committee have said it isn't. You talked about, "This present action would establish precedents to encourage other single-interest groups to descend on pharmacy." Single-interest groups like who?

Mr Sumner: I shudder to think what's going to happen when the abortion pill is introduced into Canadian pharmacy sales. There is a group out there that is prepared to protest and ban infant formulas.

Mrs Haslam: Infant formula doesn't kill people.

Ms Carter: Indirectly it does.

Mr Sumner: I'm sorry, I was using those as examples of the type of thing.

The Chair: I think that has certainly focused on one of the issues. Thank you for your presentation.


Ms Carol-Anne Foty: Mr Chairman, honourable members, thank you very much for allowing me to give my views to this committee this afternoon.

My name is Carol-Anne Foty. I am a licensed Ontario pharmacist with 26 years of hospital and pharmacy experience. I'm a graduate of the faculty of pharmacy at the University of Toronto and a member of OCP and OPA. I have been a pharmacist-manager with Pharma Plus Drugmarts at my Etobicoke location for the last 10 years. Present with me today is Mr Elio Roppa, regional manager of Pharma Plus Drugmarts Ltd.

Speaking personally, I have never smoked and actively discourage it for anyone who will listen. My own two daughters sincerely assured me when they were 6 and 8 years old that they would never smoke those yucky, smelly cigarettes. However, the world changed as they became teenagers and they now lament that smoking monkey on their backs. All my mothering and professional health care advice to no avail, they are learning from their own experience that mom was right about not starting to smoke in the first place.

Let me state at the outset that I am in heartfelt agreement with the intent and direction of Bill 119 to prevent and deter tobacco use and to encourage progress towards a smoke-free society. I know you have heard many of the same arguments pro and con from many witnesses who have presented already. I sincerely hope you will truly hear the blunt reality of our store's situation.

At our Pharma Plus location in Etobicoke, our community pharmacy has serviced the area for upwards of 30 years. Our clientele includes close to 70% seniors and welfare recipients. We are a diabetic training facility, recommended to patients by St Joseph's and the Queensway hospitals. For my clients at the dispensary, we are essential health care professionals. Our store however is also a retail outlet, the front shop physically abutting a large Dominion food store which also sells tobacco products.

I know that if Bill 119 is passed in its entirety, forbidding us from selling tobacco in the front shop, our store may well close. Tobacco products currently represent 8.6% of our total gross sales. Our retail sales in this terrible recession are simply not strong enough to sustain such a blow. My job, as well as that of our other full-time pharmacist and 16 other full- and part-time employees, is on the line.

Furthermore, I doubt that our smoking customers will stop smoking or be deterred from smoking by our demise. They will simply go next door. Also, the loyal elderly clientele, who trust me, who depend on our services, will be left hanging. Like it or not, we are a retail operation that depends on front-shop revenues to pay the bills, especially since ever-diminishing ODB payments have minimized our operating margins.

My children are typical of most young people. They and their friends assure me they would never bother to buy their smokes from any pharmacy simply because cigs are too expensive there and they would always be ID-ed. The corner convenience store was always cheaper and a ready source.

If the legislators are truly sincere in their approach to deterring tobacco sales, they should not strangle one type of retailer when it will make absolutely no impact on resolving the problem. At the same time, I applaud those retail pharmacies that were and are able to voluntarily discontinue tobacco sales. I am sure they did not jump off a limb in faith for this decision, but reviewed their marketing and fiscal position carefully beforehand. Not all retail pharmacies, however, have the luxury of optimum market vectors to make that same decision.

I practice in a retail location that depends on front-store revenues. For my clientele I am available for free health care consultation 12 hours a day, all day long. I do not sell cigarettes at the dispensary and I do provide anti-smoking counselling to all who seek my professional advice. My customers do not confuse my practice as a caring health care provider with what is sold at the front of the store.

In closing, let me point out that the practice of pharmacy has evolved dramatically over the years. We will continue to evolve towards that pure practice of pharmaceutical care where some day we won't have to look at the profit margin of the front shop for survival. Until we develop a different way of being paid for our professional services, we will be linked to retail products and the front shop. It is my fervent hope that the positive and progressive focus of Bill 119 is kept, while the untimely, unfair and misdirected aspects are reworked.

Thank you for the opportunity provided in this democratic platform for presentation of my perspective. I welcome any questions you may have.

Mr O'Connor: Thank you for your presentation and your thoughts. My son is now 7 -- he had a birthday on the weekend -- so he fits into that range, and I hope that right now, knowing that I'm involved in the tobacco issue, he doesn't want to start smoking. He thinks it's yucky, just like your children did, and maybe at that point somewhere down the future he wouldn't then be turning around to some sort of situation where maybe he'd be turning to his parent for the purchase of that product.

It must be really awkward for you to sell the product in your store when your children, whom you counselled not to take up the habit -- here you're pleading that the economic impact that you face is something that your children can help you with by coming in and buying this deadly product. I guess it's a real difficult situation.

We had some college grads. We got a wonderful little presentation that was left on our desks this morning by the graduating class of the faculty of pharmacy. It was a response to Bill 119. We actually had a group of pharmacy students -- right now, they're probably writing their exams actually -- and they lined up right across the front there and sat here and made a presentation to us. Every one of them was committed. They were health care professionals. They wanted to go out and be involved in health care practitioning and be part of that.

I guess you're trying to paint a little different reality here, and if you had then the opportunity to speak to this graduating class of health care professionals, people who wanted to go out there and provide for optimum health care for the benefit of the people who come in to see them -- they don't see them as consumers in a retail market; they see themselves as somebody who's going to be involved in health counselling -- what would you say to them when -- they're young, they don't have children, in most cases -- somewhere down the line saying that you're going to have to swallow your pride and maybe sell these lethal products to your children some day?


Ms Foty: That's exactly the opposite of what I just presented. I said that we are evolving towards the pharmaceutical care where we will not have to depend or look to the front-shop revenues. I agree totally with the optimism and the goals of university and of all my colleagues. I am not opposed to dealing with the social evil that is tobacco. I loathe it. I cut my kids' allowance off because I suspected they might be buying tobacco, let alone never allowing them to ever think of buying it in my store. I did not sell it to them. I think it's a terrible thing.

What I'm saying, as you would hear in my presentation and from many other people who have presented their arguments, is that the timing is terrible. You're cutting off our hands and our feet to deal with an issue so that the government can look good and so that an easy goal is reached to look good. I agree with the college's stance. I just say we need more time to develop it thoroughly.

I cannot but be offended by the aspect that I am less of a health care professional because I work in a place that also has tobacco products for sale. I think it's a very short, naïve stance to pick on that aspect. It's not dealing with the problem really. To deal with the issue is very complicated. You don't cure a brain tumour by cutting off the head. It's a complicated aspect. You have to look at the health, the goals for health, for the future health of the individual or of the profession.

Mr McGuinty: Thank you for your presentation. What are we going to do with you pharmacists? We've had, as you know, a number of presentations made by pharmacists representing both sides of this issue. My understanding is that there are about 1,400 out of 2,200 pharmacies which continue to sell tobacco products -- 1,400 out of 2,200.

Let's say that we eliminate Shoppers Drug Mart. That brings us down to 1,100 out of 2,200. Half of the pharmacists in this province are selling tobacco products. I'm sitting in opposition, but as a government member I'd certainly be very concerned about wading into an area where there is no consensus.

I don't believe that, by and large, pharmacists are any more careful in terms of selling tobacco products to kids, and I really have difficulty with the idea of pharmacists selling tobacco at the front end and counselling at the back end.

But where I do agree with you is this idea that -- first of all, I think everybody agrees as well that we're not going to reduce overall the usage of tobacco as a result of eliminating it from our pharmacies. There are 120,000 cigarette retailers in the province. We're going to reduce them, when we cut them out of the pharmacies, by about 1%. If there are 100 in town, we're going to knock it down to 99 locations now, which I don't think is going to be significant. Nobody suggested it is.

What they're saying is that the symbolism here is important. To tell you the truth, for me, and you can comment on this, the symbolism is not so much whether my four kids can go to the pharmacy and get cigarettes. The symbolism for me is that now I'll simply be telling them, "Look, it's not illegal for you to smoke." I've got a problem with that. My kids smoke and it's not against the law.

The other problem I've got is in terms of the mixed messages: "Just wait until you're 19. It's true it kills you. It causes all kinds of health problems and you're likely to contract some kind of inoperable cancer. But just wait until you're 19." That's the problem I have. That's the big picture. That's the mixed message that I have a great deal of difficulty with. I just don't see how eliminating it from pharmacies helps to deal with that.

Ms Foty: I dare say it's a very addictive habit and substance, and the government is also addicted to its revenues. I think it's very hypocritical to be dealing with it at this one level. You know, they ask us to bite the bullet and be the sacrificial lamb, to give up our jobs. My children won't finish university. The university kids who are working part-time for me will have to forget about continuing. Of course, I'm speaking as a typical example, a little segment, pie, of the population that's going to have these ramifications to live with.

The aspect is that it is not going to cure the social ill. It has to be dealt with more thoroughly. Deal with the manufacturers. Deal with the source. You know, put it in LCBO stores. Prohibiting it outright is going to lead to an explosion of contraband, I agree, but it just is hypocritical to me, when the government needs the revenue from tobacco sales, to say that we can't survive and we should be the sacrificial lamb. It doesn't appeal to me.

Mr Villeneuve: Thank you for your presentation. I think you've put to rest the conflict of interest that was brought forth a little earlier, and I'm glad you touched on it because that's an important aspect. Whether it's symbolic, political correctness or whatever, I think you've clarified that.

Your tobacco sales are something less than 10% of the total revenue. Have you seen that drop in the last five years?

Ms Foty: I think so, definitely.

Mr Elio Roppa: In the last two years there has been a drop.

Mr Villeneuve: So you quite obviously, in spite of the fact that you're in downtown Toronto, which I gather you are --

Ms Foty: Etobicoke -- Islington.

Mr Villeneuve: To someone from eastern Ontario, downtown Toronto is a long way around. Would you attribute the total area here of your reduced sales to fewer smokers or more smuggling?

Ms Foty: In tobacco?

Mr Villeneuve: Yes.

Ms Foty: In our area?

Mr Villeneuve: Yes.

Ms Foty: I can't say because I don't pay attention to tobacco sales; I pay attention to the dispensary. Sales are down across the board in our store. Our Ontario drug benefit recipients, however, are high. But as far as the reason for the loss --

Mr Roppa: I would attribute that mostly to smuggling.

Ms Foty: Yes.

Mr Villeneuve: Mostly to smuggling.

Ms Foty: They're welfare recipients. We've had two or three break-ins going for the cigarettes. Never mind the narcotics any more; just get to the cigarettes and load up the shopping bags and break thousands of dollars worth of plate glass.

Mr Villeneuve: Now, if Bill 119 were not to be implemented, and I guess it will probably have across-the-board support -- certainly we would like to support it with some amendments, but we may have the opportunity. If your sales continue to dwindle, which they have, in tobacco products, there will come a point where you will say, "It's not worth it." You've had some break-ins. Do you feel you're far from that decision?

Mr Roppa: Let me answer that one. In this particular location, we do rely on tobacco. If it wasn't for the tobacco sales, we would more than likely close the store.

Mr Villeneuve: That's pretty final.

The Chair: Thank you both for coming this afternoon. We appreciate your presentation.

We stand adjourned until 2 o'clock this afternoon.

The committee recessed from 1228 to 1404.


The Chair: Our first witnesses this afternoon are from the North York public health department. Welcome.

Mr David Shiner: Maybe I'll start. I'm David Shiner. I'm a councillor in the city of North York and I am chair of the board of health. Dr Graham Pollett is our commissioner and medical officer of health, Fred Ruf is our director of environmental health, and Romilla Gupta is our tobacco policy analyst. You gave us four chairs and we filled them for you.

As chairman of the board of health for the city of North York, I would like to thank this committee for the opportunity to speak on a subject of vital importance to the city of North York. I commend the government and the two opposition parties for the support provided in bringing Bill 119 to this committee for hearings.

We're here today to make a strong appeal to you to forge ahead with Bill 119 and provide the protection the public needs from tobacco industry products. The evidence has been stacked up against tobacco companies for many years. The human toll from tobacco use is enormous. Tobacco is poisonous and addictive. It kills more than 13,000 people a year in Ontario. More than 36,000 children in Ontario take up the habit each year. This is entirely due to the massive tobacco product promotions directed at young children by the tobacco industry.

Past governments have passed on taking action to curb the tobacco epidemic. Tobacco is not a matter of personal choice, as the tobacco industry would like the public to believe. It is a highly addictive drug. The Addiction Research Foundation in 1991 concluded that tobacco use is as addictive as heroin.

The tobacco industry's marketing techniques appear to focus on enticing thousands of young Canadians to become addicted to tobacco. Statistics tell us that people are exposed to tobacco company sponsorship ads at least 295 million times each year. Children must not be taught to deal with stress, low self-esteem and poor body image by turning to cigarettes.

Finally, this government has had the courage to take a stand on the issue and not be discouraged by the predictable criticism and opposition that has come from the tobacco industry and tobacco retailers. By the passing of Bill 119, the public will be assured that this government is dedicated to protecting the public and preventing yet another generation of young children from becoming addicted to tobacco.

One does not have to be particularly astute to appreciate the utmost importance of passing tough legislation to prohibit youth from buying cigarettes. Children have little or no difficulty buying their cigarettes.

Bill 119 recognizes the importance of delaying young children from starting to smoke. If you haven't started to smoke by the age of 19, the chances are very small that you will ever smoke in your lifetime. We fully endorse the provision in Bill 119 which raises the legal age of purchasing tobacco products to 19.

We recommend one amendment to Bill 119, which is that a licensing system for tobacco retailers be established. This would prove to be a more efficient and effective means for dealing with violations and convictions in that the licence can be removed temporarily or permanently. A court order to remove the right to sell tobacco products, as required under the present wording of the bill, we believe is a lengthier and more bureaucratic process.

For children and teenagers, the inconsistencies in policies related to tobacco are very clear. How can they take our smoking prevention efforts in the school seriously when on the one hand we emphasize the importance of not beginning to smoke, and on the other hand they see tobacco products being sold in the pharmacies, see people smoking all around them in restaurants and malls, and know they can easily buy a pack of cigarettes from the local corner store or from a vending machine.

To add to the presentation today, what really concerns me is children. Even on my way in to the office this morning, I passed by a school, and standing outside, seven-, eight- and nine-year-olds were smoking. You pass by a high school and they're smoking outside. Yet when I walk into a store, prominently displayed is a sign saying it's illegal to buy cigarettes. But in checking, I can't find any convictions. What's the sense of having a law that isn't enforced?


It's actually from your own information. Just a few of the statistics that really alarm me are: Smokers rarely begin their habit after the age of 20; according to the Addiction Research Foundation, 24% of students in grades 7 to 13 smoke; as well, in 1991, the percentage of young people trying tobacco for the first time before grade 9, and it's illegal to buy it at that age, was 69%, and from 1991 to 1993 the percentage increased from 69% to 75%.

The way the bill is written now, if I'm correct in my interpretation, you have to be convicted in court twice before you lose the right to sell cigarettes for six months. You really don't make the retailer put any emphasis on having to ask for identification. If you're a smoker and it's legal, you don't mind showing identification at 19 or 20. But the way it is now, it'll be the same; it'll just continue to be where kids walk in and ask for a pack of cigarettes and there really is no harm to the retailer if he sells them. Who's out there, a bylaw enforcement officer? No one's out there from the courts. No police are out there laying charges.

I think licensing will really help. I think that if someone knows that if they are caught selling a package of cigarettes to an underage person they could lose their licence on the first offence for six months and on the second offence permanently, they'll know it will hit them in the pocketbook. They don't have to go through the courts. They don't have to be convicted over and over again. You don't have to fill up the court system with it. You have to have something a retailer could lose and you have to affect them where it will hurt them most, which is in the pocketbook. If they don't have cigarettes, they don't have the draw to the stores and they won't make the profit. They'll notice it's there.

Really, I think it's time to put an end to the hypocrisies once and for all by passing an amended Bill 119.

Dr Pollett, North York's medical officer of health, will now address you on a second amendment we propose for Bill 119.

Dr Graham Pollett: The second amendment we recommend for Bill 119 deals with the environmental tobacco smoke issue. Environmental tobacco smoke kills more than 4,000 Canadians each year. In 1992, the United States Environmental Protection Agency classified environmental tobacco smoke as a group A, or known human carcinogen.

Bill 119 takes the approach of specifying places where tobacco smoking is prohibited. Unfortunately, this approach allows smoking to occur unregulated in a considerable number of public places, including restaurants, entertainment facilities and shopping malls.

The city of North York recently passed its new environmental tobacco smoking bylaw. During the consultation process that took place while drafting the bylaw, a major concern identified by the business community was the existing lack of consistency in non-smoking regulations across jurisdictions. Business operators expressed the need for a level playing field, as they put it, in non-smoking regulations; that is, they asked, why should a restaurant on one side of the street be subject to legislative requirements which differ from those restaurants on the other side?

Bill 119 offers a golden opportunity to once and for all offer the needed protection to the public from environmental tobacco smoke. We recommend that Bill 119 reverse the onus of definition to those places in which smoking would be allowed. We further recommend that in all cases where smoking is permitted, smoking be restricted to a designated smoking area, which would be required to be fully enclosed and separately ventilated to the outdoors.

In closing, we would like to congratulate you again for the leadership you have demonstrated in proposing one of the most comprehensive and toughest pieces of anti-smoking legislation in the world. In our view, the recent decision by the federal government to reduce tobacco taxes makes the passage of an amended Bill 119 an urgency. Passage of an amended bill would send a clear message to the people of Ontario that this government is seriously committed to protecting the public from the hazards of tobacco products.

Ms Carter: Obviously we all have the same main objective, which is to prevent children from starting to smoke. That's been very clearly identified and that is what the bill is aiming at. The question is how to do that. You mentioned some things and I'd like to go into that a little bit further.

First of all, you mentioned that a business can only be closed after two convictions; I believe that's within a five-year period. You obviously don't feel that is sufficient and that it would be better to have a licensing system. Could you say a little bit more about why you think it would be better to have a licensing system?

Mr Shiner: When I tried to find out the number of convictions under the current legislation, which makes it illegal to sell cigarettes to someone under 18, I couldn't find offences, and I'm looking at not just the system that's in place but how you enforce the system. If you're talking about someone having to be charged, having to go to court, having to be convicted once, and then hopefully they would be caught a second time and after a second time they're only suspended for six months, I don't think, in my personal opinion, that if I was a retailer that would really deter me or make me tell my staff to be on guard when someone asks for cigarettes, to show me identification if I'm in doubt about their age.

I know that if you buy liquor products you have to show your proof of age. If you go to a bar you have to show your proof of age. There's no proof of age required now that I know of, nor do I see people asking for it when they go to buy cigarettes. I think the onus has to be on the vendor to know that it's his responsibility to ask for it, and that if he doesn't ask, it could cost him seriously by losing the right to sell that product.

Ms Carter: Some people have actually suggested that sales of tobacco should be confined to the LCBO outlets. Do you think that would be a good solution?

Mr Shiner: As long as cigarettes are legal, then you have to decide where you can allow them to be purchased. We're already controlling where people can smoke them, but I don't think it's the same as having to put it behind the counter, only give it to the LCBO, because you may then be perpetrating a larger contraband market out there where people just sell them out of their trunk. I understand that even now with kids at school, one kid will buy and other kids will buy cigarettes from him. They buy individual cigarettes. They're able to do that.

Ms Carter: Kiddie packs. Another suggested strategy is having plain, unattractive packages and I understand that our Health ministry is talking to the federal government about that, because that's something that would be better done at a national level. Do you have any opinions on that as a strategy?

Mr Shiner: I think it's a good idea to have a plain package and I think what you're doing is correct; I endorse that.

Mr Jim Wilson (Simcoe West): Just before I thank the group, I want to apologize to members for not being here this morning, but I was in the city of Barrie, in which the county of Simcoe was awarded the International Plowing Match for 1997, so that will be --


Mrs Haslam: Mr Villeneuve so accurately mirrored what you would have said here, Mr Wilson. Your choice of replacement was uncanny.

Mr Jim Wilson: Thank you. We try to be consistent on this side, Mrs Haslam.

The Chair: All that being said, Mr Wilson --

Mr Jim Wilson: Thank you very much to the North York public health department. I just wanted to know whether you have any university or college campuses in North York.

Mr Shiner: We have York University, and I have a letter that came to my office this week --

Mr Jim Wilson: That's what I wanted to ask you about.

Mr Shiner: -- concerned about even the lack of areas for them to have smoke-free environments.

Mr Jim Wilson: Right.

Mr Shiner: I've sent that to the medical officer of health, so we will deal with that.

Mr Jim Wilson: I think all members have probably received a similar fax or the letter. Do you want to make any comment on that at this time, because they're looking for an exemption to the banning of smoking in post-secondary institutions.

Mr Shiner: I know that our city is moving towards a total ban on smoking, but we're trying to work with the public out there. We were very successful in working with the shopping malls, to come to an agreement with them and the restaurateurs as to where smoking would and wouldn't be allowed, and you did not see the uprising and vocal chorus against the city of North York when it enacted its smoking bylaws, which are extremely tough and extremely tight. If that's what York University is looking for, I'm sure we'll be considering that very seriously.


Mr Jim Wilson: Could you explain what the current bylaw is and how it affects the university now?

Mr Shiner: Fred, would you like to cover that?

Mr Fred Ruf: I'll respond to that. The current smoking bylaw makes it illegal to smoke in public places or areas which are not separately ventilated. For example, if we take into account an area like a public mall, there's no smoking in the mall, but the operator can designate up to 25% of that floor space for smoking provided it's fully enclosed and separately ventilated.

York University, which you refer to, is an interesting case. We are working with the York University administration to work out some details where smoking is permitted in bar areas or lounges -- they refer to them as student lounges -- where the student lounge is served by the same ventilation system as some classrooms. So herein lies a real dilemma.

Mr Jim Wilson: I can see that being a problem.

Mr Ruf: A real problem, so we're trying to work out a way where they can either separately ventilate the lounge or simply ban smoking entirely if it impacts on the classroom.

Mr Jim Wilson: What about in the dormitories or residences?

Mr Ruf: I'm not aware that there are any rules or regulations against dormitories. Those will be private residences.

Mr Jim Wilson: Could we just check that with the parliamentary assistant, whether the residence rooms are considered private residences? At York it's all kind of in one area.

Mr O'Connor: That's something we haven't got put in. It would be something we'd be looking at in regulations. If the committee members here want to make some recommendations, I'd be willing to listen to them. In talking to one university that called me, I welcomed the opportunity for them to send me off a letter, something that they've talked about with their residences, that if they wanted an amendment, we're certainly be amenable for something to happen.

Mr Jim Wilson: Would there be any objection from your department if we were to exempt the residence rooms -- as you said, now it's not effective anyway -- as it's considered a private residence?

Mr Ruf: I'm not sure they would be covered by our existing bylaw. I would interpret that to be a private residence. However, we certainly wouldn't object to your considering that.

Mr O'Connor: On the licensing, this is all part of a problem that we have somewhat around the interpretation and enforcement. The key here is that we want to have something that's enforceable.

To me, a licensing system could entail some areas that would allow grace periods, would allow time for retailers to comply, of course delaying the effects of the bill, tribunals and hearings, so that if there is discussion or a discrepancy, they've got that sort of appeal process, plus then maybe a court process afterwards. We could be delaying things for a much longer period of time than what I see is something that is spelled out fairly clearly and concisely.

I'd welcome your comment on how you could maybe see yourselves as being part of the enforcement. I'd just suggest that you take a look at section 3, and maybe we need to change some of the wording on it, around the provision of selling to young people. I think it's pretty clear but I know I've got some difficulty around section 2. It just seems that the wording is a little bit awkward and maybe we'll have to amend that somewhat, but to me the direction is pretty clear, and maybe the photo ID is the way to go, but it's clear that anyone under the age of 19 will not be sold or even given cigarettes. On the enforcement, if you can see a role for yourselves there, I'd certainly appreciate that.

Mr Shiner: I think the intent is there and I commend you on the intent. That's not the perspective I'm coming from. I'm saying what I said before, knowing that you know there's a problem. We license dry cleaners. It's a Metro licence. We license hot-dog vendors. If they don't follow their regulations, they could lose their licence and they're out of business.

Mr O'Connor: That's why I asked you about the role. You're part of Metro. You would have a licensing system as opposed to going to a large bureaucratic problem of trying to come up with a provincial licensing system. Is there a role for you in there?

Mr Shiner: I haven't made the statement that you have to operate the licensing system.

Mr O'Connor: I appreciate that then.

Mr Shiner: At tomorrow's council meeting this item is on the table. I believe you had a deputation this morning that also talked about licensing. I was the one who put it to the board of health two weeks and sent it on to our council, where I'll be putting a motion forward asking Metro to license.

Remembering the levels of government as I do, and my post on the totem pole, which is what I have, we're a city government. We're very close to the people but it's very hard to enforce our regulations even in the malls. Our enforcement is to bring a charge against the mall owner if he allows somebody to smoke. We can't call the police in to lay a charge. There's no smoking police. We can talk about what we want to do and we can enact, and with the help of the mall owners and the restaurateurs we have some bylaws in place and they are going along with them and cooperating.

I think that licensing, and I don't have all the areas worked out, is the avenue to go. If you're driving a car and you have a conviction or two, you don't worry about it, but once you get eight or nine points you say: "I could lose my licence. I'm not going to do this any more." People tend to slow down until they get their points back, if they're habitual at it. If they keep doing it, they lose the right to drive and I'm looking at the same thing.

I'm trying to make a simple system out of it, not a complicated one. I don't mind if you give the jurisdiction to municipalities to carry it out, those that have licensing in effect now.

I don't have the means worked out for it. I don't come to you with a solution to the problem completely. I just come to you and say that if I was store owner and you told me that I had to pay a minimal amount for a licence, and that if I sold to minors or if I sold contraband cigarettes, which is another problem that's being wrestled with, and if I had a package of those there, I could lose my licence for six months, and if I knew those cigarettes were not only a large cash producer from which I made money but attracted people to my store to buy their bread, their milk and their incidentals, which is all they come for in many of these small stores, I'd be concerned.

If I lost it once and I knew it could happen a second time for more than six months I'd be extremely concerned about that happening to me.

The Chair: Thank you all for your presentation.


Ms Evie Jesin: I'm Evie Jesin, a professional member for the College of Dental Hygienists of Ontario, and assisting me with this presentation is Maria Lee, a public member for the College of Dental Hygienists of Ontario.

With the proclamation of the Regulated Health Professions Act on December 31, 1993, the College of Dental Hygienists became the regulating body for the profession of dental hygiene. This college governs 5,000 professional dental hygienists in Ontario whose primary mission is to promote the health of the people of Ontario through the practice of preventive oral health care.

As primary health care providers, dental hygienists recognize the adverse effects of smoking. This presentation will serve to officially register the College of Dental Hygienists' support for Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others.

Ms Maria Lee: First of all, we want to congratulate the government for bringing this bill forward, and the opposition parties for supporting it. The College of Dental Hygienists of Ontario is a member of the Ontario Campaign for Action on Tobacco with all major Ontario health organizations. As a member of OCAT we support the recommendations in the brief presented to you by the coalition.

In particular, we support the banning of the sale of tobacco by licensed health care professionals such as pharmacists. We believe that pharmacists should not participate in any advertising or promotion which may encourage the use of tobacco. As a regulated health professional body, we firmly support the Ontario College of Pharmacists' position in removing tobacco sales from drugstores.


Ms Jesin: In addition, the proposed legislation has no provision banning the sale of chewing tobacco. The College of Dental Hygienists would like to have such a ban included in the legislation because of the serious harmful effects of chewing tobacco.

This presentation will focus on the profound ill effects on the tissues of the oral cavity caused by smoked and smokeless tobaccos. The impact of tobacco use on pre-cancerous oral diseases and other oral conditions, as highlighted in the comprehensive review by Christen, MacDonald and Christen in June 1991, will be discussed.

The scientific literature has identified a number of intraoral malignancies and conditions that have been directly or indirectly linked to the use of smoked and smokeless tobacco. Regardless of whether the tobacco is chewed, smoked as a cigarette or cigar, sucked as smokeless tobacco or reverse-smoked whereby small quantities of tobacco are placed in the mouth between the cheek and the teeth, the health of the individual is harmed. Both smoked and smokeless tobacco are considered to be prime causes in the development of the pre-cancerous condition known as leucoplakia. Referring to photograph 1, leucoplakia is observed to consist of a whitened, thickened patch or lesion, usually located on the inside of the cheeks, floor of the mouth, corners of the mouth, borders of the tongue or the tooth ridge.

The scientific literature addresses the positive correlation of the condition of leucoplakia to the frequency, amount and length of tobacco use. The highest prevalence is seen in pipe and cigar smokers. A site-specific association occurs between leucoplakia and the area where smokeless tobacco is placed. Furthermore, research indicates that leucoplakia has a definite but undetermined risk of malignant transformation and that most oral cancers are related to the oral habit of smoking.

Photograph 2 is a clinical picture of nicotine stomatitis, whereby the roof of the mouth of a smoker exhibits red lesions, representing the irritated salivary glands surrounded by a white ring. Reverse smoking, whereby the lit end of a cigarette is held commonly in the mouth is associated with nicotine stomatitis. Dental hygienists, as primary oral health promoters, work with clients to change their smoking and tobacco habits.

A number of comprehensive reviews have discussed the cause and effect relationship occurring between tobacco use and a variety of periodontal or gum diseases and conditions. There is strong evidence that smokeless tobacco use causes direct damage to the gum at the site where the tobacco is held, between the gum and the inside of the cheek. Furthermore, localized gum loss and bone loss may occur at that side.

Photograph 3 depicts a client with gum disease associated with the habit of smoking one pack of cigarettes per day. Photograph 4 shows a smoker with severe periodontitis, which is characterized by bone loss, loosening of teeth and an increase in pocket depth. The scientific literature contains many studies which correlate the increased acceleration of bone and tooth loss to the more tobacco the individual uses.

Photograph 5 represents acute necrotizing ulcerative gingivitis, commonly known as trench mouth or Vincent's infection, which is more often associated with smokers than non-smokers. Research has indicated that it is possible that the chronic exposure to nicotine may contribute to this disease by restricting the delivery of oxygen to the affected tissues. The clinical picture of individuals with acute necrotizing ulcerative gingivitis is one of painful, bleeding, ulcerated gums and extremely offensive breath. Heavy smoking, high stress levels, emotional anguish and oral self-care neglect contribute to this condition.

Numerous clinical investigators have concluded that both adult and adolescent smokers have higher levels of calculus above and below the gum line than do non-smokers, which in turn may be correlated with poor oral self-care practices. Photograph 6 highlights intense calculus formation on the teeth of a smoker whose habit consisted of smoking two packs of cigarettes per day.

Tobacco smoking and smokeless tobacco usage are common causes of offensive, stale and unpleasant odours. Brown to black staining of tooth enamel, dentures and dental restorations are commonly found in smokers, as depicted in photograph 7. Many of these stains penetrate into the tooth enamel and dentin and are associated with the accumulation of large amounts of plaque and calculus on the tooth, in conjunction with poor oral self-care practices, as depicted in photograph 8.

Dental hygienists can remove these deposits and stains, as is seen in photograph 9, but the avoidance of tobacco products would prevent the problem. Chewing tobacco and associated staining of teeth are seen commonly in major and minor league professional baseball players.

Photograph 10 depicts the association of cigarette smoking with increased caries or cavity rate. The smoking process alters the oral flora and causes increased changes in tooth structure. From clinical observation, adolescent and adult male smokers have more plaque than do comparable non-smokers. Dental caries is also associated with smokeless tobacco use, especially because of the sugars contained in the smokeless tobacco, which may result in more cavities.

The habitual holding of the pipe stem in the same position will cause dental abrasion or the wearing away of the hard enamel tooth surface. Furthermore, the weight of the pipe stem may promote tooth drifting and cause spacing to occur between the teeth.

Heavy smoking predisposes the smoker to develop a yellowish, white, brown or black fur-like coating on the upper part of the tongue, commonly referred to as hairy tongue, as seen in photograph 11. As more and more debris becomes trapped in this fur-like coating, a burning sensation can occur on the tongue, coupled with bad breath. Numerous studies have shown that the ability to both smell and taste is diminished among smokers.

In conclusion, the slides of this presentation highlight the adverse effects of tobacco use on the tissues of the oral cavity. The College of Dental Hygienists of Ontario fully supports Bill 119, as it will impact positively on the health of young persons.

The Chair: Thank you very much. As a veteran of the hearings on the RHPA, I can recall slides that dental hygienists and dentists and others brought in. I can recall always saying to myself, how could anybody view that and then waltz out and light up again? I don't know what the reaction of my colleagues has been, but you just take one look at that and say, "There must be an easier way to live my life."

I thank you for that, even though it's hard to look at, because it's the first time we've really addressed, in a very specific way, a number of these issues. If members' stomachs have settled, I'll now turn for questions.

Mr McGuinty: I had been looking forward to a big dinner this evening, but maybe I'll pass and have a glass of water or something.

Tell me, can you notice signs of tobacco-related problems in the mouths of young people?

Ms Jesin: We notice problems of tobacco in all our clients. That includes young adolescents and adults in general.

Mr McGuinty: You described a number of conditions there. What's the most likely condition or the one you'd see the most in a young person who's smoking, and how much do they have to smoke before these telltale signs become apparent?

Ms Jesin: It's very apparent. You can always tell a smoker from a non-smoker because of the brown staining that occurs on the teeth. That is the first indication that someone is a smoker. The second will be the irritation to the tissues, the gum tissues, and then the consequences of periodontal breakdown, gum breakdown.

Mr McGuinty: I gather there are additional costs associated with cleaning a smoker's teeth as opposed to a non-smoker's teeth. Is that right?

Ms Jesin: Perhaps the time. There is a responsibility factor and there's a time factor, and when you have a lot more staining, especially the brown heavy staining, as you see in the slides -- incidentally, seven of the 11 slides are of my own clients whom I have treated. I can tell you that it does take longer. It takes more pressure. It takes more strokes. There may be more discomfort to the client because of the time factor involved and the number of strokes to scrape off the stain.

Mr McGuinty: Do you consider it your mandate or obligation to raise this with any of your clients? I'm not suggesting that you should, but I'm just wondering, what is your approach to this?

Ms Jesin: As a dental hygienist I have an obligation to make an assessment and to inform the client of that assessment, that their teeth are brown, that their tissues are red. I also go through oral self-care with them. We assist them so that if they don't want to floss every day, we try to work with them. It is our obligation to inform them of the changes that are occurring in the mouth directly related to the smoking.


The Chair: Ms Carter, before you begin, just to finish that thought off, in terms of your clients, if you go through all that, then do you find that some of them actually stop, or is it your experience that because of the addictive nature, the tragedy is that no matter what you do or say to them, they continue?

Ms Jesin: Many of them stop, especially when they come in saying, "Look, I want the brown stain off my teeth," as these slides depicted. Then they do get them white, but some of them light up a cigarette right there in the reception before they pay the bill.

Ms Carter: In these hearings yesterday, which were out of town, we were listening to some people who were involved with the educational approach to preventing children from starting to smoke, which seems to meet with mixed success. There are different things that they highlight to discourage kids from starting to smoke. Is this kind of information ever used in those kinds of educational materials, and if not, should it be?

Ms Jesin: Yes. I happen to be a coordinator of one of the community colleges that teaches dental hygienists. In fact, it's the largest program in Ontario. In that program, we encourage our students to develop flip charts that include pictures like the ones I have demonstrated today, which they use with their clients in showing them the effects of smoking. As far as education is concerned, dental hygienists are trained to do that and to take part in that activity, both at the educational level and throughout their clinical practice.

Ms Carter: We are trying to counteract the cool image of Virginia Slims and the young beautiful person who is going to be even more cool and beautiful because they smoke.

Ms Jesin: Absolutely. As I said, my students make flip charts. I'm fully aware that many offices have other audio-visual aids to depict the ill effects.

Ms Carter: If somebody starts to smoke really young, and we're hearing that this is indeed the case, that people do start at very early ages, what is the outlook for a person as far as mouth problems are concerned if they start smoking, say, at the age of nine or 10?

Ms Jesin: Some of the stains will penetrate into the tooth, and they will not be able to be removed. We can only remove those stains that are extrinsic, on the outside, but with time they will penetrate. If they are smoking for long periods of time, then the teeth will never appear clinically white. There may be associated cavity formation and then further tooth breakdown related to that and gum disease. Gum disease is the number one reason why teeth are lost right now, because fluoride, as you know, has taken care of a lot of the cavities.

Ms Carter: At what kind of age might that happen?

Ms Jesin: It peaks around 35.

The Chair: Thank you for coming before the committee, even if you did perhaps disturb our lunch a little. It was effective and we appreciate it.


Dr Michael Gaspar: I'm grateful to the committee for this opportunity to present my views to you today. I'd like to add my voice to the chorus of praise that's been given to the provincial government for tabling this bill, to the opposition parties for the warm reception they've given the bill at first and second reading, and certainly credit is due this committee for its ongoing efforts to consider the views of the public and hopefully improve this bill in any way possible.

I'm a general practitioner employed by the Barrie Community Health Centre. Perhaps some of you are familiar with CHCs. We have a special mandate that emphasizes health promotion and illness prevention. As well, we try to selectively target those patients from disadvantaged groups, generally lower-income, and other so-called marginalized groups that traditionally have received a lesser standard of health care than other citizens here in Ontario.

As such, I maybe have some different experiences as a health centre physician compared to other primary care physicians. I thought maybe it would be of interest to the committee to hear a CHC perspective on tobacco issues. In particular, I wanted to describe some of the negative effects of tobacco that I see with some of our poorest patients in the practice.

As well, I am appalled by the recent developments in Ottawa concerning the cigarette tax rollback, and although I offer no expertise in law enforcement, I felt strongly enough about it that I wanted to use this occasion to offer some opinions about how I thought Bill 119 may counter some of the negative effects the tax rollback may have here in Ontario.

By now the committee has heard all kinds of testimony from other doctors and public officials on the devastating health effects of tobacco. You've just seen it very graphically demonstrated 10 minutes ago. As a family doctor, I can certainly add my own tragic vignettes to the accounts you've already heard: the severely asthmatic child whose parents won't quit smoking, the young man left without a tongue after a cancer operation, the elderly woman who is completely oxygen-dependent and can't leave her home for the rest of her life; as well, the many deathbeds I've stood helplessly by. Rather than relate these in detail, I thought instead I would emphasize some of the more subtle but equally tragic ways that I see tobacco affecting some of my poorer patients.

As mentioned, CHCs tend to selectively target disadvantaged groups. In our own CHC, for instance, we see street youth, people in social housing, people with mental illnesses trying to live out in the community and a lot of lower-income families just from the surrounding neighbourhood. It's well established that lower-income groups have much higher rates of tobacco use. We know that this is true of our patients from a 1990 survey which showed a smoking rate of 37% among the low-income households, but only 23% in households earning $50,000 or more. In other words, the poor smoke at approximately twice the rate of wealthier Ontarians, and that's particularly true in our area.

It is also well known that the higher smoking incidence among the poor is a contributing factor to their higher rates of morbidity and lower life expectancy compared to higher income groups. I refer to a study that was done in Alameda county to support that.

We commonly see patients who complain that they can't afford to eat nutritiously or live in decent housing but who think nothing of spending $4,000 a year on smokes. The harmful health effects of nicotine are, for these people, compounded by the effects of a poor diet, poor clothing, poor housing and a lack of transportation, which increases their exposure to bad weather. While tobacco can't be blamed for all their woes, the income that is so casually squandered on cigarettes would make quite a difference in most of these lives.

Nobody suffers more than their children. The link between low birth weight and low income is largely explained by the above factors, with tobacco use figuring quite prominently. Thus, a lot of these kids enter the world with a strike already against them. As infants and children, they're exposed to secondhand smoke and hence are more likely to acquire respiratory problems. It's clear from the patients we see that many parents will unfortunately compromise their kids' clothing, food and shelter to help pay for their tobacco habit, so it's little wonder that the kids are constantly sick and absent from school.

By the time these children reach their teens, they are far more likely to smoke than other kids because of self-esteem issues and also their parents' role modelling of tobacco use. Thus, the cycle of poverty and ill health threatens to continue on to the next generation.

Counselling these people to quit is generally quite futile; I'm unsuccessful probably 90% of the time. The addiction itself is of course a very powerful one, but there are other factors too which defeat cessation efforts. For instance, popular social gathering places are veritable temples of tobacco use: the bingo halls, the legions, the clubs and taverns. One's smoking habit is constantly reinforced in these settings, making it unlikely that you will ever be motivated to quit or that you will get the support and the validation you need if you're attempting to quit.

Also, with less disposable income it's more difficult to pursue other recreational interests to cope with the psychological needs that smoking appears to fulfil. Health professionals are essentially powerless to deal with these kinds of environmental obstacles.


There are other health and economic effects of tobacco use that we, as physicians, see but don't as readily recognize. For instance, employees who smoke are much more likely than non-smokers to be absent from work for health reasons. I've cited the Whitehall study of British civil servants to give you some statistics on that. These are mostly the smokers we see in practice who, in their 40s and 50s, come to us with prolonged lung infections complicated by pneumonia and bronchiectasis, needing a medical excuse for work or perhaps insurance forms completed for disability.

The Whitehall study had previously shown that employees who smoke were more likely than non-smokers to die or otherwise leave the labour force prematurely due to illness. These are the smokers we see in their 50s and early 60s who have had heart attacks, angina, claudication, strokes or lung disease, who need their disability pensions before they've really been able to properly retire. While these are less dramatic than the mortality statistics that are often quoted, they include some of the hidden costs which are not often included with the other direct health care costs of tobacco use when we're trying to estimate its impact on society.

I realize that nobody on the committee is likely at this point in the proceedings to really need further convincing that tobacco is a terrible health and social menace. What is at all controversial about the bill are those proposals such as the ban on tobacco sales in pharmacies that may conceivably result in job loss.

I believe that the committee must not be distracted from the fact that what it is dealing with is essentially a moral issue. We would agree, I think, that it would be wrong to murder someone for their money. It doesn't matter how much money they have, how badly we might need it or what wonderful things we might be able to do with it. We are compelled as a moral society to place greater value on human life than on any economic or monetary gain that might be made by taking that life.

I would challenge members of the committee to tell me in what substantial way the issue of job loss through the restriction of tobacco sales is different from this simple moral position. No, we're not talking about murdering people outright, but they are gradually being poisoned to death over 40 or 50 years; in the end, they're just as dead. Of course, we're not talking about one life but the lives of 13,000 Ontarians every year into the foreseeable future. People must come before profit. Health must not be sacrificed for wealth.

I'd like to use my remaining time to offer some opinions on the smuggling issue. Last week, the Canadian health community was devastated to learn of Ottawa's decision to roll back the federal tax on cigarettes. It is to the great credit of the Ontario government that it has so far refused to comply with tobacco tax reductions. Unfortunately, if both Ottawa and Ontario maintain their present positions, it will predictably lead to increased smuggling into Ontario from the United States. Ontario basically has three choices: It can do nothing and allow smuggling to increase; it can abandon the moral high ground and capitulate to Ottawa's ill-advised policies; it can seize the opportunity afforded by Bill 119 to legislate tough measures that will counteract smuggling without further sacrificing the lives and health of Ontarians.

There are several provisions that are currently proposed for Bill 119 which I believe will help curb smuggling. Prohibiting the sale of tobacco in designated places, including hospitals, nursing homes and pharmacies, as well as banning vending machines will reduce the number of retail outlets substantially. There would be a lot less ground for provincial health inspectors to cover, and one would expect this to increase the effectiveness of enforcement measures.

Bill 119 also seeks to further regulate packaging, including the nature of health warnings appearing on packages. Plain packaging and prominently featured health warnings should make it easy to distinguish cigarettes sold in Ontario from products sold outside the province and therefore should help to expose contraband.

Lastly, Bill 119 proposes to establish new penalties, including fines and sales prohibitions, on retailers caught violating its terms. These would hopefully be a lot more severe than the slap on the wrist currently given to people involved in illegal tobacco trade and should be much more of a deterrent, especially for selling to minors.

In addition to the provisions already suggested for Bill 119, I feel there are several ways it could be toughened to further combat smuggling. Bill 119 could be amended to call for the licensing of tobacco retailers. This could generate additional revenue for the government to help beef up its enforcement. With licensing would presumably come some kind of review process to make sure retailers understand and are complying with tobacco control measures before licences are granted or renewed.

This ought to make it more likely that those breaking the law are exposed and penalized. The threat of revoking a licence has been shown in other jurisdictions to be a powerful motivator for retailers not to sell to minors. I refer you to one study from the Journal of the American Medical Association. It stands to reason that if you know that the licensed retailers are on side with the law and yet minors are continuing to smoke, this would help expose illegal tobacco trade. With a licensing system would hopefully also come additional sanctions for selling tobacco without a licence, which could be additional legal leverage to use against the pushers of contraband.

In addition to penalizing retailers and pushers, I believe that Bill 119 needs to place some onus on underage smokers to comply with the law. Perhaps any minor caught purchasing tobacco or even caught smoking in a public place could be fined and have his cigarettes confiscated. Anyone assisting in the provision of tobacco to a minor could be similarly fined, whether or not a licensed retailer. The police or other officials could exercise the right to question offenders as to their source of supply, and maybe the size of the fine could be based on their willingness to share this information.

If Bill 119 is passed intact or with tough amendments, the effect should be to decrease the demand for tobacco over time, and hence the profitability of illegal trade. Ontario could present a strong example of the political resolve necessary to take on the tobacco industry, most notably to the United States, which is also presently looking at stricter tobacco controls and which could well end up solving our smuggling problems for us.

This concludes my presentation. I've provided just a small appendix to substantiate some of my positions. I just want to add that I feel the work you're doing is of the utmost importance and that I and the health community anxiously await the product of your combined wisdom. I'd welcome any questions.

The Chair: Thank you. We really do appreciate this particular perspective, which is not one that we have had, coming from a community health centre.

Mrs Cunningham: Welcome to the committee. You had a predecessor from your community last week representing the Ontario College of Family Physicians, Dr Brian Morris, who made an outstanding presentation.

I'm interested in the fairly strong opinion that you've taken on this whole issue of licensing. We're hearing it more and more. I'm also interested in perhaps some kind of penalty for the young person who purchases the cigarettes. Maybe we heard it before, but I heard it first from a medical officer of health from Windsor and Essex when we had the hearings in London.

We've had some opposition to it. I think, quite frankly, that the administration didn't recommend licensing to the government because they thought it was somewhat cumbersome, but as time goes on, we're getting our questions answered. Perhaps you could just explain how you think this would work, and also what your opinion or ideas would be around some kind of a sanction for the young person under the age of 19.

Dr Gaspar: For your first question about licensing, we do have research. I mentioned the one article from the Journal of the American Medical Association. In this particular article they demonstrated that within a year and a half of licensing retailers, and through strict enforcement, they were able to cut down on the amount of sales to minors by 50%. So we have evidence that a licensing system is extremely effective, okay?


I know it hasn't been proposed by this administration. If licensing doesn't go through with this bill, perhaps there could be some kind of compromise where, say, the chief medical officer of health would review the situation in 12 or 18 months and advise the government further as to the success of the proposed fines and prohibitions that are currently in the bill.

As to sanctioning minors, I think it's clear that most minors who smoke are well aware that they're breaking the law and this is some of the allure of underage smoking, sort of the James Dean mentality that, "I'm a rebel and I'm breaking the law and I don't care who knows it." I don't think it's out of line for the government to expect minors to pay a price for that kind of attitude. It encourages maybe a certain cynicism towards the law from a very early age that could conceivably lead to other forms of lawbreaking later on, maybe underage drinking or reckless driving. Who knows?

I think it's well within the government's right, if it feels this kind of measure's enforceable, to specify some kind of sanction like that.

Mrs Cunningham: We had community work. I just wanted to add that so Dr Gaspar would know that everybody didn't think money was the answer; a lot thought that some community involvement might be helpful.

Mr McGuinty: Thank you, Dr Gaspar. I too appreciated your comments about the advisability of putting in place some kind of mechanism which would fine young people or help bring home to them that there's something fundamentally wrong with this. The example I'd like to use is that if you've got a couple of kids sitting on the curb, one drinking beer, the other smoking, the police officer can confiscate the beer and charge the child drinking it, but he cannot confiscate the cigarettes from the other one and he cannot fine him, notwithstanding that we've heard all kinds of evidence over the past three weeks that tobacco-related illnesses far outweigh, in terms of their severity and their numbers, the effects of alcohol.

The other thing that I really have found very helpful was your bringing home to us the direct link between the lower socioeconomic groups and the higher rates of tobacco use. I'm not sure if we've had that evidence yet. I can't recall, anyway, somebody bringing it before the committee. I guess it's not politically correct, but in the old days we called them poor people. For a child growing up in poverty, the chances are that one or both parents are smoking. They've got a couple of strikes against them already. What is it we can do that we're not doing right now? Is there any hope for that child?

Dr Gaspar: Unfortunately, the negative role modelling of the parents is probably one of the greatest influences in these kids' lives. I believe a tough and consistent approach from government, following through with some of the sanctions that are in the bill and that I've discussed today, would probably have more of an impact than practitioners like myself providing counselling. As I mentioned, I'm a pretty abysmal failure as a counsellor, as are most doctors. I don't take a very high view of what I'm able to accomplish or what other public health initiatives are able to accomplish.

The Chair: Thank you very much for coming down from Barrie and appearing before the committee.

I'm going to ask Bob Gardner to note a couple of things that have been distributed. Bob, do you want to report on some of the material you've distributed to us?

Mr Bob Gardner: Thank you. I just wanted to show the pile of things we've given members today. It's easy to lose them in all the other briefs and so on.

First of all, the second summary: This is from last week, so up until the end of last week. Then a couple of memos, one that Mr Wilson raised for the committee, the criteria for establishing a pharmacy in Ontario; another issue that Mr McGuinty asked for, background information on the federal legislation and the court challenges to it; and just to be perfectly non-partisan, we have something coming later on that Ms Haslam raised, an article that a witness in Thunder Bay wanted us to get from the Canadian Medical Association Journal.

Mrs Haslam: Oh, you found it?

Mr Gardner: We did. Librarians particularly like the challenge of finding articles without authors and --

Mr Wiseman: Without titles.

Mr Gardner: No, we had a title. We had the wrong decade, I will point out, but anyway.

Mrs Haslam: Please convey to the library my congratulations and my thanks, because I know how hard librarians work and this is really something.

Mr Gardner: I certainly will, Ms Haslam. Thank you. Then there are two sets of press clippings, one from over the weekend and one from today.

Mr O'Connor: I will ask the clerk to circulate this cartoon from the Globe and Mail today that talked about what our friend from Barrie just presented to us about the illegal cigarettes, smuggled cigarettes, and the federal government's approach to it.


The Chair: Gentlemen, we welcome you both to the committee. I understand, Dr Connolly, that you have come a somewhat longer distance than some of our witnesses and we appreciate that. I'll leave it to both of you how you wish to proceed with the presentation.

Dr Jack Micay: I'm going to begin. My name is Dr Jack Micay. I'm a family physician in Toronto and I'm actually here for the second time, so I beg your indulgence. I'm representing a group of physicians who are concerned about a form of tobacco use that's not included in this legislation and that's what this presentation is on. Although my particular group is a small one, I think it's fair to say that we represent the general opinion of the medical profession.

Cigarettes now pose our largest public health problem. This is a product that kills 13,000 Ontarians a year when used as intended, is at least as addictive, if not more, than cocaine or heroin, which is primarily pitched to young people, and which has no nutritional or other benefit. If today such a product were introduced to the market, surely it would be stopped, it would be banned, it would not be allowed on the market.

Unfortunately, it's too late to ban cigarettes. Far too many people are addicted to them and it would be as futile to ban this product now as it was to ban alcohol during Prohibition.

However, there is another group of tobacco-based products that are equally addictive and cause serious health problems including lethal cancers again when used exactly as intended, and my colleague Dr Connolly will detail this further in his presentation. Some of the data's included in our fact sheet and I won't go over it right now. These products are also pitched to young people and they also have no redeeming value.

This is smokeless tobacco, otherwise known as spitting or chewing tobacco. The only good news about these products is that they are not yet widespread, and it's possible to avoid the mistake that was made with cigarettes and to get rid of them now before it is too late.

Smokeless tobacco is divided into chewing or plug tobacco, such as this package I'm holding of Redman, and snuff, such as this package of Skoal Bandits, which includes dry and moist snuff and fine-cut tobacco, all of which are held between the gum and cheek. Fortunately, their use is not nearly as widespread here as in the US, where they are used by a large and rapidly increasing segment of the teenaged population, as Dr Connolly will no doubt report. However, I was able to buy these products this morning at the very first convenience store I went into.

Over 99% of all the smokeless tobacco products sold in Canada are imported, mostly from the US. As I mentioned, right now usage of these products in Ontario is low. However, there is every reason to believe that if we do nothing, the use of smokeless tobacco among Ontario youth, particularly boys, will increase as it has in the US.

For one, they are a cheaper form of nicotine than cigarettes, even at low US prices. What is more, in the US they are being targeted to young teenagers. In fact, US surveys have shown that the age of initiation for these products is even lower than it is for cigarettes. A case in point is this product, Skoal Bandits, which is a low-nicotine brand that is aimed at the 10- to 13-year-old as a sort of starter kit. It has a low nicotine content which they are better able to tolerate than stronger brands of snuff or chewing tobacco.

In the US again, smokeless tobacco is heavily promoted and these products are endorsed by professional athletes, lately racing-car drivers. Here in Canada, kids are exposed to many of these same promotions through television, magazines and to the local major league baseball players who can be seen chewing tobacco on television. Not only do kids begin using this product at a younger age than they do cigarettes, they are sadly misinformed about it.


A survey of teenagers by the Red Deer, Alberta, regional health unit revealed that kids are under the illusion that smokeless tobacco is less addictive than cigarettes and that it is a safe alternative and an aid to quitting cigarettes. By coincidence, on the Rush Limbaugh television show which was aired on CFTO last night, there was an advertisement for a brand of chewing tobacco called Quit, which indicates a new marketing strategy for chewing tobacco as an aid to quitting cigarettes.

In fact, surveys have shown that smokeless tobacco is actually a gateway to cigarettes rather than a way to avoid cigarettes, and the majority of kids who use it eventually add in cigarettes or switch over completely to cigarettes. It's a great way for the tobacco industry to introduce kids to nicotine addiction and at the same time to increase their future cigarette sales.

Now that the price of cigarettes has been dramatically and tragically reduced in Quebec and less so in Ontario, tobacco product use, with its resulting addiction, death and disease, will soon be increased equally dramatically among young Ontarians. It's known that in the US one of the gateways to cigarette smoking is smokeless tobacco, as I mentioned. Dr Connolly will also perhaps provide evidence of how a majority of kids who use smokeless tobacco eventually switch over to smoking cigarettes to maintain their addiction.

Bill 119 is intended to "prevent the provision of tobacco to young persons." It's a very timely piece of legislation that can help to offset the lower price of cigarettes and to protect the young people of Ontario from this deadly product. However, in order to do so, certain provisions must be added and others strengthened.

In the first category is a ban on all smokeless tobacco products. It will remove a tobacco product that is deadly in itself and which is particularly aimed at very young teenagers. It will also remove a product that the tobacco industry uses as a recruiting tool for cigarettes and as a fallback product for those smokers who wish to quit but cannot break their nicotine addiction. There will never be an easier time to remove this pernicious product than right now.

Smokeless tobacco now occupies less than 2% of the total tobacco sales market, and as surveys by the Addiction Research Foundation have shown, most of these sales in Ontario are illegal ones to minors. Many other jurisdictions have banned smokeless tobacco, as detailed in our fact sheet. There is no reason why Ontario should not add its name to this list of honour.

Banning smokeless tobacco is an easy and effective way of reducing access to tobacco products by young people, but it is not enough in itself. We believe that other steps to reduce access are also important, particularly banning the sale of cigarettes in pharmacies to reduce the number of outlets, but more importantly to remove this implied endorsement of cigarettes by the health profession of pharmacy which undermines all the anti-smoking messages from the government and the health community.

Another provision that in my opinion should be added to the bill to counter the allure of cheap cigarettes is to mandate generic packaging. This will remove an important marketing tool from the cigarette industry and it will break the link between their tobacco brand promotion, much of which is aimed at young people in the form of sports and fashion events, and the product itself.

I'd now like to introduce Dr Greg Connolly who, as mentioned, has come here especially from Boston for this presentation.

Dr Connolly is a world expert on smokeless tobacco. In Boston, he's the director of both the Massachusetts tobacco control program and the Massachusetts dental health program. He's a graduate of the Tufts dental school and the Harvard school of public health and a consultant to the United States National Cancer Institute on oral cancer associated with smokeless tobacco use.

He has published widely on the connection between smokeless tobacco and oral health. He's also the chairman of the World Health Organization study group on smokeless tobacco and a consultant on this issue to the health departments of many countries.

Last but not least, he's an adviser on this issue to major league baseball and has lectured about it to the Toronto Blue Jays, he tells me, on three occasions. I'll hand it over to Dr Connolly.

The Chair: What success had you on those three occasions? We'll check Pat Borders out in the --

Dr Gregory Connolly: I'm going to show in a few minutes a young man I brought with me to spring training this year. By happenstance, the Phillies were playing the Blue Jays on opening day and we brought the Surgeon General down. I think we pleaded not enough to the Phillies, if you looked at the fifth game of this year's World Series. We were more successful with the Blue Jays.

I'm pleased to be here. I want to report that Toronto's closer to Boston than Washington, DC. I testified before the House ways and means committee in Congress a few weeks ago on the Clinton tax package to raise the cigarette tax $1, and the only members who remained in the committee were from the grand states of North Carolina, Virginia and Kentucky, and that was one tough hearing. I hope this is a nicer hearing here in Canada.

Mr Wiseman: We all agree that cigarette smoking and tobacco are bad for you.

Dr Connolly: I also say that my grandmother was from a nice farm in Deseronto and my grand uncle was an Ontario physician who invented the voice box, Dr Hainey, at the beginning of this century. So I find my roots in health probably are more here in Ontario than with my relatives in Boston.

The Chair: Welcome back.

Dr Connolly: Thank you. I reproduced a fact sheet here talking about the problem with smokeless tobacco. I'd like the committee to consider that these products are really new tobacco products. This is where an industry, when losing its consumers for cigarettes, has used high technology, particularly for the oral snuff, to design a nicotine delivery system to recruit either smokers who quit or young people who haven't started tobacco use.

The nicotine content in this has been scientifically reduced to a level where you don't develop toxic effects such as gastric distress or harm to the nervous system. So the user can gradually develop dependence on the product over time. This is not a traditional tobacco product. This is really using high technology to introduce new products into a marketplace over time to replace people who quit or keep people using tobacco products.

To think of this as something that's been around for 100 years is really fallacious. When we grandfathered cigarettes into use into North America at the beginning of this century, we really grandfathered in something that's far different than what we see today: cigarettes with all the additives, with nicotine being sprayed on. We really need a format for regulating the introduction of new products, particularly those that appeal to young people.

I've brought a few slides with me. Could we just flip that on? This is an advertisement for smokeless tobacco. It's Skoal Bandit. This is where the nicotine yield has been lowered to about four milligrams per gram. As part of a graduation strategy, the industry had a clear strategy. This is snuff in starter wheels. This is heavily advertised and promoted, with free sampling. On the other page, you see a coupon for a free sample. They had a college marketing program on 200 college campuses.

Part of the program called for a graduation strategy. In this ad here, it tells them how to use it. "How long should I put the Skoal Bandit in my mouth?" It says: "The first time, just for about a minute, then remove it. The next time, leave it in a little bit longer, just like your first beer."

Finally, the graduation strategy moves users up to this brand, Copenhagen, where the logo says clearly, "Sooner or later, it's Copenhagen." There's four times the amount of nicotine in this product.

Research at West Point shows the cadets, the plebes, started with the Skoal Bandits and they graduated to Copenhagen by senior year. My research with major league baseball finds that by the time they're professional baseball athletes, they're using Copenhagen primarily. They started off in high school and college using the Bandit, but they're hooked on Copenhagen. My research, including an article published in the New England Journal of Medicine that included the Blue Jays, found that 60% of the athletes wished they had never started; 50% reported sores in their mouths; 60% reported trying quitting during the past year but they relapsed. They're highly addicted to this product.

This product also delivers about three times the amount of nicotine in a pack of cigarettes. It's a very cheap source of nicotine. If you're faced with buying three packs of Marlboro or a can of Copenhagen, you're going to buy the Copenhagen. You're going to save money because of the high nicotine yield. It's particularly true in Canada, where your taxes for cigarettes are high. For young individuals who have limited disposable income, these products become popular.

Use in the United States has soared. This is for moist snuff only. We've gone from 23 million pounds to 40 million; today's number is about 55 million pounds. That represents about a billion tins in the United States of America, compared to we estimate that in Ontario it's about 2 million to 4 million tins. You really don't have a problem right now. In the United States, we've got a very serious problem with use of this product.


Who are the new users? This is a kid in Brookline, Massachussets. We didn't have use; we discovered use in 1984. We failed to act as a state. Now we're finding that in our male cohorts, 18 to 25, we have high use rates. For us to look at a prohibition is extremely difficult now, given the fact that these individuals are over the age of 18. But the new use rates have soared among high school kids, and it sort of spreads. Where the captain of a baseball or football team will move from one high school to the next, it becomes widespread.

These products are also easier to use than cigarettes. The age of initiation is about age 10. You don't have to inhale. A 10-year-old's lung is not going to tolerate tobacco smoke that well, but you can place it in your mouth. If smoking's been banned within the high school campus, this product can be discretely used. Teachers won't smell tobacco breath and one can quietly spit the tobacco product.

Following this marketing campaign, in 1970, highest use rates were among males over age 50; by 1985, it was males between 16 and 19. Now the upper slide, we're not concerned with that. The old gentlemen will probably die with their tobacco and save on our social security fund. We are concerned with the bottom chart, because that's a ticking time bomb in the mouth of youngsters.

Smokeless tobacco does produce nicotine addiction, believe me, with baseball players. Borders has tried to quit. I worked with Kelly Gruber five years ago, although I know we don't want to talk about Kelly Gruber today. But he reported a red lesion on his tongue. He was very concerned. He quit. He stayed tobacco-free for about four years, and all he had to do was have a touch of it and he slipped back again, although he's using a lower-nicotine brand. It does produce powerful nicotine dependence, at blood nicotine levels equivalent to that of smoking, although they'll use about a third of a can a day compared to about a pack of cigarettes.

What do we see? This is a common, garden variety gum recession. The nicotine, the alkaloid, burns the gum tissue. The irritation of the tobacco cuts it and results in destruction of the periodontium, the bone. This is a grade 3 lesion. This individual could lose that tooth over time, and it's very expensive to treat. We're talking a large amount of money. This is another young man, a West Point cadet I treated, who began using it as a freshman, a plebe, and he lost that tooth just about four years later. This is fairly frequent.

I would have fun playing with baseball players and the game is, "I can guess how many cans you dip a week." They said, "You never can guess." I think it was the Blue Jays I tell this story about. I looked at one athlete -- I don't want to share names -- and I pointed and I said, "A can a week," and he said, "I beat you, Doc." I said, "Well, let me look over here." So I looked in this side of the mouth. I said, "A can there and a can over here." He said, "How did you know?" Three cans.

You can see the lesions in the mouth, and this is what you see. This is about one can a week. It's a leukoplakia. It's a patch. The body's trying to protect itself with a slight irritation. This is about a can and a half a day. This is a major league player using the product. You see a very severe white lesion with furrowing. Now, if you biopsy those, anywhere from 3% to 6% are going to show dysplasia, that is, an indication of going on to cancer, and in research done by the University of San Francisco in the Cactus league of 98 lesions biopsied, three were actually precancerous lesions pointing towards cancer. I'm going to show you in a few minutes a video I took of a baseball player who suffered from this disease.

This is an erythroleukoplakia. This is where the white lesion breaks down and the body's protection is lost. This is a very vicious lesion. These lesions will progress very rapidly and contribute to oral cancer.

The compounds we're concerned with: Smokeless tobacco in any tobacco plant contains a number of carcinogens. You have arsenic, formaldehyde is in the product, you have cadmium, but the potent carcinogens include a class of compounds called nitrosamines.

Nitrosamines are species- and site-specific. There are four nitrosamines. When you feed them to animals, you will get brain tumours in rats. If you inject it in a hamster, you'll get a lung tumour. It appears that for the animal species, when you place the nitrosamines on the oral mucous membranes, you produce cancer of the oral mucous membranes at exposures that would be equivalent to what you need to produce a cancer in a laboratory animal.

Generally, for any consumer product, we would like to set tolerance limits at about 1/10,000th of the dose received by the consumer product. This country also regulates nitrosamines in beer. We've set a limit of five parts per billion; bacon, five; baby bottle nipples, 10. For these products that are unregulated, the concentrations range from 1,000 to 10,000 times greater than what you'd receive in any regulated consumer product. There are more nitrosamines in this product than would be in a truckload of bacon outside this building.

Again, this is a new product. This is not something that all of a sudden people are going out and growing in their backyards. This is being produced by good science with high technology, without a regard, though, for the damage to human health or human life.

This is a verrucous carcinoma, a slow, wart-growing lesion. This is probably a good lesion because it's not going to metastasize. It can be taken out of the mouth and we would look at good remission.

This is a young man from Texas, 28 years old, who consumed smokeless tobacco rather heavily. He has what we classify as a site-specific lesion; that is, the squamous cell carcinoma perforated the lower lip. He unfortunately went through a series of cancer treatments and it metastasized throughout his body. He subsequently lost a portion of his face and died in two years from metastases. These lesions are very, very aggressive lesions. There are time bombs ticking in the mouths of young people. The industry, as we make progress with cigarettes, is only bringing in new products to maintain its profitability.

For Canada, it's a particular concern because I've looked at data for the past few days when I was asked to testify. If you look at use among adults right now, nationally it's about 0.7% using chewing tobacco, about 0.4% snuff. It's virtually an unknown practice; it's less than 1% of the adult population. However, among school-aged children in Ontario, among the males, grades 7 to 13, use rates according to a survey done by the Addiction Research Foundation of Toronto report 3% of males currently use spitting or smokeless tobacco only and an additional 10% both use smokeless tobacco and smoke cigarettes, for an alarming rate of 13%. Primarily, if you look at those numbers, the sales are going to children.

What's happened internationally? I had the distinct pleasure of chairing the World Health Organization study group in 1988. We had representatives throughout the world on that panel. We reviewed the scientific evidence and I'm going to leave for the committee the report of WHO on smokeless tobacco. We recommended, based upon the experience in the United States and the Scandinavian nations, that nations without a history of use ban this product before use becomes widespread among young people.

I'm pleased to report that following that recommendation the governments of Hong Kong, New Zealand, Australia, Ireland, Great Britain and Belgium banned the product. I'm pleased to report that following the Irish ban, which was challenged by the tobacco industry in the High Court of Ireland, as well as a challenge on the Treaty of Rome, the European Parliament banned oral snuff throughout the European Community. The only developed nations in the world today that allow the sale of this product are the United States of America and Canada, as well as the Nordic nations. Action by this body here would set a very important precedent for North America in particular.

I'd also say that in the United States, the United States has banned new forms of tobacco. The United States Food and Drug Administration banned a chewing gum with tobacco called Masterpiece in 1988. The United States of America Food and Drug Administration banned Favor cigarette, which was a look-alike cigarette with a nicotine inhaler. The states of Colorado and Missouri banned the R.J. Reynolds Premier cigarette before it was introduced. There's clear international precedent for treating this product the way you treat any other product.

I'd like to end, if I may, by showing a three-minute video that I brought of a young man who spoke to the Blue Jays this past year and I think had an impact. This man started using smokeless tobacco at age 8 in Texas. Could I have the video please?

The Chair: The parliamentary assistant had a clarification. Maybe we could just deal with that.

Mr O'Connor: Thank you for your presentation and coming up here and discussing and adding your valuable expertise to this. I don't think we're at the point right now where we have completed things, so we have time for some input and some changes. If we were to try to encompass everything you're asking us to encompass, are there certain names of tobacco products we should be including that would then perhaps not allow somebody to undermine the intent of a ban, if we were to move in that direction?

Dr Connolly: We could provide the committee with the European Community's definition of smokeless tobacco: chewing tobacco and oral snuff. There was some discussion within the European Community about not encompassing nasal snuff that was for traditional use. We could provide the committee with a clear definition other nations have developed in their policies.

Mr O'Connor: Thank you.

The Chair: Would you just tell us about the snuff, which I always had thought was nasal but I see clearly is also something you put in your mouth. How is that determined, these different kinds of tobacco? What do those words mean?

Dr Connolly: Moist oral snuff is a finely ground tobacco that's fermented, and the fermentation process unfortunately creates this witches' brew of carcinogens. That is the product that's being marketed heavily. That is the product that's being used by young people.

With nasal snuff, you still see a tradition of use among the very old. In Britain, there are some snuffers, and some in southern France. Those products have not been banned because of use by old people. The policy is just to let the old people die. It's truly the moist oral snuff, the high-tech nicotine delivery devices, that we're trying to encompass in a regulatory schema.

The Chair: Thank you. I think now we're all set.

Video presentation.


Dr Connolly: That man began before he could legally purchase, became addicted, and it's a situation where he just couldn't stop despite known effects. I brought this individual down to major league ball and he talked to the players here in Toronto. These people are highly addicted. This individual couldn't motivate them to quit because of the power of nicotine addiction. If we can prevent children from becoming addicted to these products, then it makes very reasonable, rational policy for government to do so.

Mr Wiseman: How old is he?

Dr Connolly: He's 28.

The Chair: Dr Connolly, thank you very much. While we have gone a bit over time, given the fact that we haven't looked at this issue other than briefly yesterday, I think there may be some questions and we'll try to deal with this now.

Mr McGuinty: Thank you both, gentlemen, and a particular thanks to you, Dr Connolly, for taking the time out to come and speak to us here in Toronto today. You've made a very important presentation. We have been learning about and experiencing the frustration associated with trying to control a legal product which has developed over a lengthy period of time, on a road over which we've travelled a great distance.

The import of your presentation today is that this is a new road that's just opening up before us, which comes with smokeless tobacco, and we have an opportunity we didn't have before to properly address this. I haven't had a great deal of time to think about it and I didn't really put it in that context before you made that argument. I think it's a very powerful argument.

I want to ask you about the ban in other countries. Has there also been a prohibition on possession? I'm worried about it coming in from Quebec or from the States. What have they done in those other countries?

Dr Connolly: It varies from country to country. In the European Community, it's a ban on sale, not on possession, because of the number of Scandinavians who would go through the European Community. So it's sale and manufacture, not possession. In Australia, again it's sale and manufacture. I believe it was possession in Australia, but by and large the bans have been on manufacture and sale.

I'd point out too that this is a legal product for persons 18 and over, but in a population where the primary use rate is among people below 18, then it's really trade in an illegal product. You have to put it in perspective. In the other countries it is not a problem because, like Canada, they don't have use rates. They've really intervened before they have use rates.

Mrs Cunningham: Thank you both very much for being here. I think that as the hearings proceed people are becoming more daring in the recommendations they're making to this committee, based on the kind of evidence you've presented today. I think one of the great problems we face as legislators is that we're not as well informed as we could be, but we're finding that at the end of hearings on almost anything, we're much better informed and the problem seems to be getting out to the public with regard to education. But there's a lot of impatience around this committee, because we've been part of education programs in our former lives as members of lung associations and heart and stroke foundations and all those things for maybe 20 years. There's a bit of impatience with this group, I detect.

I just have to say that personally, I'd just ban it. That would be my vote. It's that simple.


I am interested in the point you made about banning the manufacturing, which I think is something we're going to have to have some advice on, Mr Chairman. If we decide to go in that direction, we're going to need some research, because we need to know what to ban.

Secondly, banning the sale is something we're looking at in this bill in a sense, because we've got larger fines, but we've been looking at three other alternatives: One is to license the person who is doing the sale, the retail salesperson. Two is to look at moving all these products, if we don't make them illegal, into outlets which we already have in Ontario for alcohol, the LCBO; they're right out of the public place altogether. We're very concerned about bureaucracy here, but we already have a system in place that you don't have in most of your states. The third one, of course, is to look at fining or penalizing in some way the young person under the age of 19. If you can respond to some of the other alternatives, based on your experience, we'd appreciate it.

Dr Connolly: I make two points. I don't think the alternatives are mutually exclusive. I don't think you can only do one. The point in Canada is that if you look at your own data on smokeless tobacco manufacture, it's probably fallen from about 500 million tons 15 or 20 years ago to less than two million tons. Primarily what you see here is two US manufacturers manufacturing a product in the US and exporting it here and then taking back the proceeds minus taxes and retail markup, so the manufacturer is really not an issue.

What we're saying is that for the new class of tobacco products that are going to be brought into society, we need some sort of policy framework to deal with their introduction. Maybe in lieu of a ban, you could say, "Yes, you can sell new nicotine delivery devices, so long as they're done in a policy framework where nicotine is used to help people quit their dependence." Maybe you could develop a sachet of tobacco minus the carcinogens or set tolerance limits to help people quit tobacco use, to help smokers stop smoking. That would be an alternative to a total ban.

Mrs Cunningham: Is that something the product you just held up is used for, to help people quit?

Dr Connolly: No. It's promoted as a temporary alternative where you can't smoke -- at least there have been marketing campaigns among adults -- and it hasn't been successful. In essence it keeps you on cigarette smoking, because it's highly flavoured and it's sweet. It's not designed like nicotine chewing gum that's really hard to use: You don't want to stay on it that long. You want to break the habit. This is sort of the reverse of it. One ad was, "Take a pouch when you can't take a puff." You see it in airports. It keeps people smoking. This is a way to keep you addicted to nicotine.

If you said to the manufacturer, "Reduce the cancer-causing levels," and you probably could do it to an extent, you couldn't eliminate it --

Mrs Cunningham: I see what you're getting at.

Dr Connolly: -- and make it so it helps you quit, what they would say to you is: "No business. We're not going to put ourselves out of business."

In the United States, the Food and Drug Administration asked the manufacturer of a chewing gum with tobacco -- it was the lady's equivalent of this product -- to come in and say why it was good to ingest tobacco, what the beneficial good was, and the manufacturer then took it from the marketplace when asked to prove that.

In the United States, we have the R.J. Reynolds Tobacco Co manufacturing nicotine inhale -- it's called Premier cigarettes -- to keep people smoking when they're banned from the marketplace. Our Food and Drug Administration in Washington didn't take action, but two states did. They banned the product, and then the R.J. Reynolds Tobacco Co took it off the marketplace.

We're trying to develop a future policy so we don't repeat our historical mistakes, and the WHO recommendation is, if the only people who use it in your country are kids, ban it before the adults use it.

I think that's a reasonable public response. I don't think it's puritanical. I don't think it's extremist. What I see in that video is extremist. For a society to tolerate that among its young people is really not a reasonable, acceptable approach. Just look at this product and say it has 10,000 times the amount of nitrosamines of a can of beer or a baby bottle nipple. Treat it. Give it fair and equal treatment. It's a highly addictive product that's been designed to encourage young people to use it. Give it fair and equal treatment.

I don't think the ban is an extremist position. If you look at what's happened in other parts of the world, other nations have looked at this issue. The vast majority of developed nations have made a reasonable public decision, and that is, control the new products.

The Chair: I regret I have to play the heavy as the Chair. We have gone a bit over our time in view of the nature of the presentation, not to mention the distance you've come. We want to thank you both, but Dr Connolly in particular, for what you've brought before us here this afternoon.


The Chair: I call on Ms Valerie Hepburn, member of the steering committee of the Arts and Health Alliance. Introduce your colleague, who is also welcome.

Ms Anne Bermonte: I am Anne Bermonte and I'm on the steering committee of the Arts and Health Alliance.

The Chair: We have a copy of your written submission, so please go ahead.

Ms Valerie Hepburn: Good afternoon to you all. Thank you for allowing us this opportunity to speak to you about the concerns of the Arts and Health Alliance regarding the legislation at the heart of these current hearings.

To begin, the alliance would like to acknowledge the efforts of the Ontario government as well as the opposition parties in attacking head-on our most important public health challenge today: reducing tobacco use, particularly among young people. We acknowledge too that this challenge has taken on even greater magnitude in significance in light of recent federal tobacco policy.

Before I deal with the alliance's specific interest in Bill 119, I would like to tell you briefly what the Arts and Health Alliance is all about, and I hope you're burning with curiosity to know.

The Arts and Health Alliance, or AHA! as our brilliantly coloured acronym exclaims, grew out of a debate in Metropolitan Toronto over the issue of tobacco sponsorship of the arts. While in general there was a clear line between health and arts interests at that debate, let me be specific here that arts groups opposed a ban on tobacco sponsorship because they very much needed the funds that tobacco companies provided through sponsorship, whereas health groups opposed to that view supported a ban because they see and continue to see sponsorship of the arts as thinly veiled advertising by tobacco companies. However, many people on both sides came away from that debate feeling that some very important things had got lost, namely, those things which arts and health have in common.

Let me be specific. Arts groups care deeply about public health and they contribute to it every day, and here I'm not just talking about the more, shall we say, élite arts like opera and ballet, although they are wonderful and we know they are. Every time you buy a CD or go to a movie or attend a community theatre production or watch your child play in the school orchestra or in the school play, you are participating in the arts. The arts add immeasurably to our quality of life. Public health recognizes that the arts are fundamental to social, emotional, creative and, yes, economic health.

The real issue at Metro and the real issue on tobacco sponsorship continues to be funding, and we thought there had to be a better way.

In 1992, the Arts and Health Alliance was formed to find that better way, to build on our common contribution to quality of life and to seek alternative funding sources that would first give arts groups the ability to choose not to take tobacco sponsorship -- they do not have a choice right now; there is no meaningful alternative -- and second, to give health groups the ability to tap the arts venues, so successfully used by tobacco companies essentially to advertise, to advertise messages about health.

A major goal of the alliance was and still is and will be to replace a tobacco culture with a health promotion culture, a goal we believe is particularly relevant to the young people who are the focus of Bill 119.

Today the alliance numbers over 70 supporters in Metro Toronto and other Ontario communities. They include health agencies and public health units, arts councils, performing arts groups in theatre, music and dance, literary and visual arts, film, arts education groups, elected officials and members of the general public, and we continue to grow rapidly.

Through several joint projects in 1993 and more planned for 1994, we've made a start in locating other funding, but we have a long way to go before we have a meaningful alternative to tobacco sponsorship, which brings me to Bill 119.

Clause 5(a) of the bill, which reads in part, and I quote, "No person shall sell...tobacco...or distribute it," and these are the vital words, "unless the tobacco is packaged in accordance with the regulations," allows the government the regulatory authority to introduce measures related to packaging. The Arts and Health Alliance is particularly interested in the possibility of plain packaging and its effect on the sponsorship issue.

We should be clear from the start that we do not oppose plain packaging; we accept plain packaging as undoubtedly an inevitability. However, we ask this committee to consider and address with us its implication for arts groups in Ontario.

Tobacco companies have achieved instant brand recognition through the use of corporate colours, logos and word marks in conjunction with the events they sponsor. In Toronto, for example, the well-known du Maurier Jazz Festival features the same brilliant red colour of the package on the billboards, on the banners which are around the city, on programs, on other kinds of promotion, as well as the words du Maurier, which as we know is not the name of the tobacco company; it's the name of the cigarette.


All these elements carefully replicate the package for the product. This is advertising by another name, and that name is sponsorship. We believe that if plain packaging comes in, instant brand recognition will go; at that point, so will the sponsorship. For the arts that is the problem because a major source of private funding for arts groups in Ontario will disappear. It is the view of the Arts and Health Alliance that replacement funds for tobacco sponsorship must be secured before this happens. Hence, we ask this committee to recommend to the government to work with us to examine particular models of replacement funds that advance the arts and the public health goals of this province.

One model for consideration comes from the state of Victoria, Australia, where a percentage of the tax on tobacco products is allocated to arts and sporting events that include a health promotion component. This model has gained international recognition and it's been strongly advocated by the World Health Organization.

At the same time, the alliance feels that a combination of public and private moneys could provide an even greater and more stable funding base for arts activity and health promotion and should be pursued.

In conclusion, in light of the implications of clause 5(a) of Bill 119, the Arts and Health Alliance requests that the standing committee on social development recommend to the government of Ontario that the Ministry of Health, together with the Ministry of Culture, Tourism and Recreation, begin to work immediately with the Arts and Health Alliance to:

(1) Investigate models of public funding to replace tobacco sponsorship, with part of these funds designated for appropriately targeted health promotion campaigns in conjunction with individual arts events.

(2) Research corporate sponsors for arts events that want to target the same market as the tobacco industry does currently.

(3) Establish an expanded funding base of public and private moneys for arts and health activities and promotion.

The Chair: Thank you very much. I think it's fair to say that this is probably the first time this specific issue has been addressed directly before the committee. Just at the outset, do you have any idea how much money goes into arts support from tobacco companies?

Ms Bermonte: If I may, I should also introduce myself as the associate director of the Toronto Arts Council. We don't have an exact amount because a lot of the funds from tobacco companies to arts groups are not done as grants. It's not an outright cheque for X amount of money. They're done through sponsorships either in kind or, for example, the du Maurier Theatre Centre at Harbourfront.

Even though an organization, an arts group, that is performing there is not receiving any kind of cash contribution from the company itself, they must have the logo on their brochure. The reason for that is that in a sense they're receiving an in-kind contribution, they're getting a subsidized grant, and that facility is available to the community. So it's very hard to say X amount of money goes directly to the arts from tobacco companies, because it takes many forms.

The Chair: I appreciate your difficulty in quantifying this, but you mentioned being in Toronto. In terms of arts sponsorship, is it possible to give us some sense -- I'm talking here of all of the arts in terms of different productions and so on in Metro -- of the percentage, roughly, that would be sponsored by the tobacco companies versus other businesses or corporations?

Ms Bermonte: At this time it's not. There hasn't been sufficient research done to determine that. In many ways, looking at it from an arts point of view, I just want to point out that the arts are operating and always have operated in many ways on the brink of survival. The highest subsidy, if you want to look at it in terms of subsidy, comes from artists themselves. It's not a matter of X million dollars will come out of funds to the arts community. Right now any money that is taken away from the community can send organizations that, as I mentioned, are on the brink of survival over the edge.

In response to your question, there really hasn't been a lot of research to say this amount of money is made available to arts groups in the form of sponsorships.

Ms Hepburn: As a matter of fact, that is one of the things the Arts and Health Alliance wants to do. We want to investigate that very item because that question is asked again and again and there is no satisfactory answer. In fact, the hidden moneys, the in-kind moneys are part of the problem. The other part of the problem is that tobacco companies do not want to say what they give because in some ways they're not direct funds. They're using them on promotion of themselves as promoters as well. It's hard to get a handle on what those funds are.

The Chair: Thank you both very much for coming before the committee and raising this issue and for your recommendation. We appreciate it.


The Chair: I call on Mr Bob Seibel, the pharmacy general manager for Zellers Inc. Welcome.

Mr Robert Seibel: Good afternoon. Thank you for the opportunity to speak to you today. My name is Bob Seibel. I am the pharmacy general manager at Zellers. We are a large retailer that does just over $3 billion in sales. We carry an extremely large variety of products in our stores. I would like to stress that we do not consider ourselves to be a drugstore, although 70 of our stores across Canada and 47 stores in Ontario do in fact have a pharmacy.

I would like to address the issue of Bill 119 and the impact it will have on our department store business if it is passed as currently written. There are three points I would like to highlight.

First, tobacco is a legal product available for sale in this province. Second, one possible result of this legislation would be to force the closure of 47 pharmacies in our department stores. Third, this legislation literally seeks to change the definition of the name "pharmacy" or what that means in a way which will be detrimental to the pharmacy sector and to retailing in general.

Tobacco is a legal product currently sold in a very large number of retail outlets. The size and type of these outlets vary widely and include everything from a small convenience store to a 70,000-foot Zellers department store and a 120,000-foot Woolco department store. We believe that any retailer should be allowed to sell any legal product and that no class of retailer should be singled out for special treatment.

If today this government seeks to put limitations on the sale of tobacco in certain types of retail units, what are we to expect in the future? It has been said by some that it is inappropriate for a single retailer to sell both health products and tobacco because of the mixed messages that would be sent to the consumer. In a Zellers store, however, because of its massive size, pharmacies are located in an area away from where tobacco is probably merchandised. There is absolutely no relation whatsoever between the two areas, and in the intervening space a large number of products completely unrelated to either drugs or cigarettes are on display.

If today this arrangement is considered inappropriate and unprofessional, will it be inappropriate tomorrow to sell automotive products, to sell gardening supplies, to sell women's undergarments in a store that includes a pharmacy? The issue of what can be sold in a single store is particularly relevant to Zellers as a department store, since we sell such a variety of products while at the same time licensing pharmacists to operate in 47 of our stores in Ontario. I say licensing specifically, since Zellers does not own the pharmacies that operate in our stores. They are owned and operated by the individual pharmacists in place.


The pharmacists in our stores are health care practitioners with authority over the space taken up by the pharmacy itself, and with no involvement at all, financial or otherwise, with the rest of the store. I cannot stress enough the fact that pharmacists in our stores have no control over any space other than the few hundred square feet taken up by their pharmacy.

Some presenters have argued before this committee that pharmacists cannot be both health care professionals and retailers. In our stores, pharmacists are not retailers, they are just health care professionals. Zellers is the retailer. However, we should not be forced to make a choice between selling tobacco in one part of our store and allowing a licensed pharmacist to operate a relevant service to our customer in another part of that same store.

If Bill 119 does force Zellers and other similar retailers to make a choice between selling tobacco and licensing pharmacies, then decisions will be made according to the profitability of each of these lines of product. I stress again that we believe we should not be forced to make this choice. If we must however, then the jobs of over 90 licensed pharmacists and 100 dispensary assistants working for them will be put at risk.

In the situation of a department store, it is simply not a case of, "Will we make money and continue to sell tobacco or pharmacy?" We will make a business decision based on your objective that we have to carry one or another, and one part of that industry will immediately shut down in our store.

The loss of these jobs and the inappropriate intrusion into the freedom of retailers to sell legal products is made worse because it will not further the objectives of this bill. Forcing Zellers to close pharmacies and put pharmacy licensees out of work and out of their own businesses will not lead to a reduction in smoking, nor will it prevent young people from obtaining cigarettes. You have heard from a number of presenters who have admitted that there will be no demonstrable benefit from a ban on tobacco sales in pharmacies.

Finally, I would like to focus mainly on the issue of the definition of "pharmacy." According to the Health Disciplines Act, a pharmacy is defined as follows: "`pharmacy' means a premises in or part of which prescriptions are compounded and dispensed for the public, or drugs are sold by retail."

One of the functions of the Ontario College of Pharmacists is to accredit pharmacies, which as I have stated is the area where prescriptions are compounded and dispensed. However, what your legislation is in effect proposing is that the entire 70,000 square feet of a Zellers department store will now be defined as the pharmacy. The college of pharmacy today defines our pharmacy as 400 square feet, the actual dispensary and the over-the-counter medication restricted to sale in a pharmacy. You are literally looking at changing that definition from 400 feet to 70,000 feet, and I believe you are unaware of the implications.

We believe this is a ridiculous proposition because the College of Pharmacists will now have jurisdiction over 70,000 square feet of space, including lingerie, sporting goods and everything else you could think of which it has no interest in controlling or in fact no right to control.

As you may be aware, we are owned by the Hudson's Bay Co, which owns the Bay. I've given you the example of a Zellers store and I would like to give you a further example. If the Bay contained a pharmacy -- for example, in BC there are several Bay stores with pharmacies -- on the fifth floor of one of its locations, and it sold tobacco on the first floor, the proposed legislation in Bill 119 will effectively make the entire Bay store into a pharmacy. So now you will include in this "pharmacy" definition furniture, linens, restaurants, electronics, appliances, kitchenware and so on, all part of the pharmacy. I'm sure this was not the intent of your legislation.

When the government considered an Act to Amend the Regulated Health Professions Act, representation was made to the government by the Ontario College of Pharmacists to ensure that pharmacists would only be responsible for sexual abuse misdemeanours that occurred in the dispensary. The Ontario College of Pharmacists fully appreciated why it requested this special amendment. It knew that pharmacists could only be responsible for sexual abuse that took place in the pharmacy lockup or cage and that they could never be responsible for an offence if it occurred in their entire normal store, or in this case, a 70,000-foot department store, or in the case of the Bay, four floors away. The Ontario College of Pharmacists is aware of the definition of a pharmacy, and the front shop of a Zellers store or the other four floors of a Bay store are not within its definition.

As a point of reference, please note that the word "premises" used in the definition of a pharmacy is not defined in any legislation or regulation under the Health Disciplines Act. Your legislation is flawed in our opinion because you are trying to define a pharmacy beyond the scope of the Health Disciplines Act and beyond the jurisdiction of a pharmacist as contained in the Regulated Health Professions Act.

There is another important flaw in your definition. Under the Retail Business Holidays Act, there is a provision on Sunday opening that states that no retailer can force an employee to work, no landlord can force a tenant to open and no licensor can force a licensee to open. So by legislative power in this province, I cannot force one of my pharmacists to open Sunday. If your legislation goes through the way it's written, you have just closed the total department store of Zellers, because you have made the definition of the pharmacy the entire 70,000-square-foot store. If that pharmacy from BC was located at the Bay in downtown Toronto, you have closed the entire Bay department store due to this definition.

In some of our Zellers stores, our pharmacies are not open Sundays. Under the lock-and-leave provision of the Ontario Legislature, we close the pharmacy with a six-foot movable gate. Under Bill 119 however, the pharmacy will be defined, as we stated, as the entire 70,000-square-foot store, and if the pharmacist elects not to work or operate, we would be forced to close the entire store.

We think the standing committee is having difficulty distinguishing between a pharmacy and a retail drugstore. They are two distinctly different entities, as evidenced by a Zellers store. We have a 200-square-foot pharmacy in the back and the other 69,000 square feet is truly a department store made up of various departments. If you can appreciate and understand that there is a difference between a pharmacy and a drugstore, then you must similarly appreciate that there is a difference between a health care professional and a retailer. The licensed Zellers pharmacist is the health care professional; Zellers Inc is the retailer. That is why we should be free to sell at Zellers any legal product and we should also be free to provide an important and valuable service to our customers by licensing space to pharmacists.

This bill, if passed in its current form, will not lead to any public health benefits. It will not stop people from purchasing cigarettes. It will not lead to changes in what people think when they shop in a Zellers store. What it will do is threaten the livelihood of over 190 people who are currently providing front-line health care. At least 190 jobs and several small businesses represented by my licensees will be placed in jeopardy.

This legislation will give the Ontario College of Pharmacists and the government a new and untenable definition of what constitutes a pharmacy. Such a flawed definition would leave itself open to constitutional challenge. My main purpose for being here is to ask you to consider the definition, because if push comes to shove, if you cause me to close my whole store over this bill, we will fight.

Thank you for the opportunity to make this presentation and I'd be happy to answer any questions you have.


The Chair: Thank you for setting out a particular element of the bill. I think one can see the issue there. We have questions on it, beginning with Ms Haslam.

Mrs Haslam: A couple of comments first. On page 2 when you talk about "inappropriate and unprofessional," will it be inappropriate tomorrow to sell automotive products which are not addictive, gardening supplies which are not addictive? Undergarments, whether they are worn by everyone or not, are not addictive.

Mr Seibel: In the province I live in, pesticides are now being brought before legislative committees because they're trying to ban them. I as a consumer want to use them. A government committee such as this is now deciding if a store like ours should carry them.

Mrs Haslam: With the proper qualification, certification to carry dangerous products under --

Mr Seibel: No. They're just saying we cannot use them on our lawns. I take exception to that, but I bow to the stature of this committee.

Mrs Haslam: What I'm talking about, though, are addictive cigarettes. When you compare them to other products in your store, we have to look at another type of thing and that is addictive cigarettes.

Could you explain a couple of things to me? You say you license pharmacists; you don't hire them. How is that licensing done?

Mr Seibel: It's a sublease, in effect. A pharmacist comes into our organization. He owns the pharmacy cage, the fixtures, the inventory in the dispensary. He hires the technician and the other pharmacist, and he operates it as a small business. He carries a bank loan through a recognized bank. He files income tax as a sole proprietor or a small company.

Mrs Haslam: That's what I wanted to know.

On page 3 you talk about the lines of products and the choice that you have to make in a business decision. We've been informed by many sources that the profitability and the markup on tobacco -- that it's not a good profitability product, that what it does help is with the cash flow because you end up having the product come in and not paying for it, and then you sell it and it increases your cash flow, that when you take a look at the profitability and the markup on your tobacco, especially when you use it as a loss leader, it is not a profitable product compared to some you sell.

Mr Seibel: Because you're not allowed to advertise tobacco, we do not use it as a loss leader. It is a profitable product. You can order cigarettes three to five times a week. You can literally turn cigarettes 40 to 45 times a year.

Mrs Haslam: Which helps your cash flow.

Mr Seibel: Which will be very profitable.

Mrs Haslam: So tobacco, adverse to what other people tell us, is a profitable problem.

Mr Seibel: Absolutely.

Mrs Haslam: That's not what we're hearing from other stores.

Mr Seibel: With respect, in our company it is a profit setter.

Mrs Haslam: Is it the volume?

Mr Seibel: It's not the volume as such, it's a combination of volume and other traffic. If you cause a customer to go someplace else to buy cigarettes, they will buy shampoo, they will buy a rake, they will buy an undergarment.

Our problem as a department store is that there are three major competitors in this country: There is Woolco, K mart, ourselves, and unfortunately Wal-Mart is coming. We are the biggest operator of pharmacies in the department store area. K mart, for example, has under 20 pharmacies. They could make the decision to go out of pharmacy and use tobacco in massive displays. We are now at a competitive disadvantage in our own business.

We have never tried to put one thing in our store that would cause us to not be competitive with one of our other target groups. We do not consider, for example, pharmacy as a competitor. Our competitors are major department stores. If we had a level playing field that all department stores carried or didn't carry, that is not my problem. My problem is, the way the legislation is set up and the way history has driven it, K mart, which is a major retailer, does not have pharmacies.

Ms Carter: They do in my city.

Mr Seibel: I understand. As I stated, they have under 20 in 122 stores.

Mrs Haslam: Would you be recommending taking a look at a square footage idea around the sale of tobacco?

Mr Seibel: I believe the health professional is a small area in the store, and I think this body has every right to govern that part. For example, I would never let my pharmacist sell tobacco. Okay?

Mrs Haslam: That's not the problem. We're dealing with a perception and young people and mixed messages, and that's a concern. However, I see your concern when you talk about 70,000 square feet. It is a conundrum, I think, that the committee will have to look at, so I'm asking you, would you recommend we look at it as a square-foot problem?

Mr Seibel: You also have to be careful then of the size you look at. For example, depending on the definition, Bi-Way is a department store. Bi-Way is in some cases 12,000 to 15,000 feet. There are some drugstore formats, such as Herbie's if they're still around, that are over 20,000. So by using square footage --

Mrs Haslam: You miss a few and catch a few?

Mr Seibel: Exactly.


Mrs Haslam: No, I know, it didn't work with Sunday shopping. I don't think it's going to work in this area.

Mr Seibel: But you've found a way to close us.

Mrs Haslam: No. I think we've found a way to address it as a health issue, and that is really what this committee has to deal with. I've been told that stores will probably get around this by moving cigarettes right to the front wall, walling them off and having a separate entrance, which is one way that a store could deal with the problem of what a pharmacy is and what a pharmacy isn't. Would that be something Zellers would consider?

Mr Seibel: I think what Zellers is doing is what Zellers is doing right now. We're saying to you that we think it's an unfair level playing field and we're asking you to adjust it.

Mrs Haslam: Would a level playing field be a tobacco control board?

Mr Seibel: I don't know. That's your decision; it's not mine. All I want is, when I'm competing with K mart and Woolco and Wal-Mart --

Mrs Haslam: If a tobacco control board had cigarettes and none of you did, is that a level playing field?

Mr Seibel: Yes.

Mrs Haslam: Okay. Thanks.

Mr McGuinty: Mr Seibel, thank you very much for a very informative presentation. I think you've explored more fully than any other presenter the implications of the definition and the contradictions that raises.

What we're talking about here at the end of the day, and you must have heard this before, is the symbolic value of associating a pharmacist, a practitioner in health care, with the sale of a tobacco product, which we know causes health problems.

I personally have difficulty seeing that symbolism. I think it's overshadowed dramatically by the much more dramatic contradiction between our telling our children they can't smoke, and yet when they turn 19 they can smoke; our telling our kids that they can't smoke, but yet it's a legal product. I see that as the contradiction. I see that as symbolism that's going to overshadow dramatically the kind of symbolism that the government's trying to get at through this particular bill.

Whereas you might be able to make the argument -- I don't believe it, though -- for smaller operations, smaller drugstores or pharmacies, you sure as heck can't make it for a big operation like yours. If I was to stand in front of a Zellers store somewhere in this province and simply ask people whether they thought Zellers was primarily a health care operation, I don't think many of your customers are going to give me the answer "yes." I think by and large they'll see it as providing a variety of services and goods.

Mr Seibel: I respect your opinion, but with respect what you're going to do is make that customer find out, because when you stand there and ask him if we're a health care professional, you may have made me not one. If this legislation goes through as such, we will have to decide between tobacco and pharmacy, and quite frankly, pharmacy is a very small cog when we are fighting other department stores. Make no mistake, our fight is with department stores, and if in our opinion to fight a Wal-Mart, to fight a Woolco, we have to keep tobacco in the back pocket, we will keep it.


I have pharmacies that have been in this province for 25 years. I have pharmacists who have worked for me as corporate pharmacists and have gone on to open their own stores. We're going to have to explain to these people why they can no longer function in our store.

I understand your idea on the contradiction, and if I could, I'd like to give you a small example from my personal life. I'm Catholic and I'm a pharmacist and all my life I dispensed birth control pills and I sold condoms. Honest to God, I can't figure out why. But I know that the person out there who doesn't believe as I do has that choice. I don't want them to buy condoms in backyards, on the school ground, wherever. It's a legal product, and if this committee were to say, "It is no longer a legal product; we're going to take it off the shelves," I'll get up and walk out of here, but if you're going to tell me, "You as a department store can't sell it, but K mart can," I have a problem.

Mr Jim Wilson: Thank you, sir. I had to watch your presentation via the television in my office because I was actually doing an interview at the same time with a radio station on the telephone. I found your comments to be most persuasive.

It's been a confusing day for us, I have to tell you, because we're told a lot about perception and the fact that the government has said many times, as you've heard, that pharmacists have to make up their minds whether they're retailers or health care professionals. Yet when I read the Environics survey that was done for the Ontario Campaign for Action on Tobacco, I note in their results summary that it says a majority of 67% consider pharmacies and drugstores in Ontario to be retail stores that sell a variety of products. Just 24% see them primarily as health care retailers.

I have argued that all the way along and I thank the Ontario Campaign for Action on Tobacco for actually doing an Environics survey on it, because my perception of not only what we call the non-traditional drugstores such as yourselves, but other drugstores, is that people increasingly see them as large retailers, which I'd like you to comment on.

Mr Seibel: I think that if you, as a committee, were to research simply Metro Toronto, you will find in medical clinics a pharmacy half the size of this room that dispenses only, has some OTC product. You would not find Pampers in there, you would not find bubble gum in there, you would obviously not find cigarettes. That is a true definition of a health professional area.

If you move out to a Shoppers Drug Mart, a larger format, if you move to a department store such as ourselves, if you move to a grocery store, we dispense the same product, we give the same patient counselling, we give the exact same service, but your perception is that we're retailers. The truth is that we're health care givers.

I have worked in this industry long enough to work with a discount drug chain and with a full-price drug chain, and I'm usually in front of a committee like this explaining why one guy has a dispensing fee of two bucks and another guy has a dispensing fee of 12 bucks. The answer quite simply is that we are health care professionals; we choose to discount our fee.

What I'm saying to you, in your perception, is that the guy in the medical clinic, the guy in the food store, the guy in Shoppers Drug Mart, the guy at Zellers, we are all giving the same professional care.

I do not doubt for one minute that if you allow me to sell cigarettes, I'm going to have trouble with my own licensees. They will probably be telling my customers, "Well, I don't think we should be selling it." But I need a level playing field; you are quite right.

The other thing you have to look at is the economies of pharmacy. It's fine to say I want to keep it on a professional services and health standards basis, but we also have to look at the reality. If you go into a shopping centre today that's a regional mall, you will either rent an 8,000-foot drugstore or you will go into my store and take 200 feet as a licensee. If you have an 8,000-foot store, that's one heck of a large pharmacy, or you'd better find a hell of lot of other products to put into it.

Every little bit of profit you can make to drive traffic and to make profit pays your bottom line so you can give the professional services to those customers who need them. Otherwise, you're going to end up in a situation down the road where big regional shopping centres don't have pharmacies. You will go to secondary strip malls where they can afford the rents.

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


The Chair: I call Mr Gordon Murray, the president of the Canadian Society of Hospital Pharmacists, Ontario branch, and someone else who will identify herself momentarily. Welcome, both, to the committee.

Mr Gordon Murray: Andrea Cameron, our senior delegate to our national organization, is here with me today.

I'd like to thank the committee for this opportunity to present our views on the bill that's currently before you. I'd like to start off by just characterizing our organization so you have some understanding of who we are and who we represent.

The Canadian Society of Hospital Pharmacists is Canada's national voluntary association of pharmacists who share an interest in pharmacy practice in hospitals and related health care settings. The Ontario branch is one of eight branches and currently represents approximately 900 pharmacists practising in Ontario's health care institutions today.

The mission of our national association is to provide leadership in all aspects of pharmacy practice in hospitals and related health care settings, to promote the provision of patient-focused pharmacy services, and to represent and provide services to the membership.

In terms of Bill 119, the Tobacco Control Act, we do not presume, in a sense, to review the information about the negative effects of tobacco in our society. I think that's been well established. The Ontario branch, at its 1990 annual general meeting, presented a resolution to membership supporting the ban on tobacco sales in pharmacies as proposed by the Ontario College of Pharmacists, and it was accepted. Therefore, our position is to recommend the banning of tobacco products from health care facilities and pharmacies as specified in the proposed legislation.

We believe that pharmacists, in practising pharmaceutical care, have the opportunity to provide positive impacts on patients' health care, and in such regard, pharmacists can provide this even in the area of smoking in that the Canadian Pharmaceutical Association has already prepared a smoking cessation counselling program for pharmacists entitled "Butting Out For Life." Pharmacists would be more appropriate in providing their skills in that area than providing tobacco to the marketplace.

Our second recommendation in a sense speaks to that in that we recommend the adoption of one of the recommendations from the Lowy inquiry, which speaks to looking at establishing "pilot projects to examine and assess alternative reimbursement and payment mechanisms which would reward the provider of professional pharmaceutical services and be independent of the sale or dispensing of a drug." We think there is a role for pharmacists in terms of trying to end the problems of tobacco in society.

We also believe that the legislation, I think as others have spoken to, should go further than simply prohibiting sales but also look at the issue of licensing sales. Therefore, our third recommendation is that we do recommend the licensing of the sale of tobacco products.

The Chair: I note for the record that in your written submission you set those out in some detail, and we appreciate that. We'll begin questions with Ms O'Neill.

Mrs O'Neill: You have a different slant and emphasis than many of the other presenters. I wonder, for the record particularly and for those watching, if you'd say a little bit more about the Lowy recommendation that you feel fits into the backdrop of this piece of legislation.

Mr Murray: Certainly. I guess we have the good fortune that we are not paid for the dispensing of a product; our responsibilities in hospital pharmacy are provision of services to patients, as well as the physical handling of the product. Therefore, we have focused on those recommendations in Lowy that spoke to that role of pharmacists, because we feel it's an undeveloped role in society, as Professor Lowy pointed out in his own report.

I believe that in the report he estimated that if pharmacists were providing that kind of service to the public here in Ontario, there was an estimated, at the time of the report being issued, $350 million worth of recoverable moneys to be saved through the drug benefit system for an investment of approximately $50 million in improving pharmacists' education and reimbursement in the area providing cognitive kinds of service.

He spoke to a number of different examples. I don't believe there is a current model that any of us could point to and say explicitly that this is the way to go, but I think there are a number of alternatives to be explored. The one that I'm most familiar with at the moment is the initiative in Quebec for the Opinion pharmaceutique where they're reimbursing pharmacists there for intervening to do things like set up withdrawal schedules for benzodiazepines, and to counsel physicians about problem drug therapy to eliminate or reduce drug therapy in patients etc, and therefore the pharmacist is exercising his judgement in the best interests of the patients and positive outcomes.


Mrs O'Neill: How would that be billed? Would that be billed by the hour? Do you know how they're doing it in Quebec?

Mr Murray: Currently in Quebec it's done on fees based on a schedule of reimbursable interventions. For example, if a pharmacist in Quebec in his opinion feels that a prescription is inappropriate for a patient and refuses to fill it on those grounds, he will fill out the appropriate intervention and be paid the same fee as if he'd provided the drug, and that he document it.

They'll admit a weakness at the moment in their system with that right now about notification to the physician, whereas Lowy, in terms of his talking about this kind of model, did speak to the idea that there should be appropriate communication of decisions like that.

Mrs O'Neill: And you would agree with that?

Mr Murray: Exactly. We're not doing anything for a patient's health care if the pharmacist is saying one thing, the physician is saying another and the poor patient is trapped in between. In terms of their reimbursement for some other acts, it is greater than their dispensing fee, depending on exactly the act. For example, developing a benzodiazepine withdrawal calendar and working a patient through it I believe ends up being reimbursed at approximately double the dispensing fee.

The way they've set this up in Quebec as a model to test and prove out is that the pharmacy owners in Quebec have set up a fund using 1% of what would be considered the likely income to be received from their dispensing for the comparable thing to the drug benefit program here in Ontario, and then the pharmacists apply to that fund for reimbursement for the acts that are on the schedules.

The Chair: I'm sure somebody told us this at some point in our hearings, but after a while it all begins to mesh, but in terms of hospital pharmacies in Ontario, how many are there and how many members do you have as hospital pharmacists in Ontario, roughly?

Mr Murray: At this particular point in time, it's hard for me to give you a precise number in that for years we had the good fortune of the Ontario Hospital Association supporting a couple of pharmacists being on staff. One of the things they did was regularly survey to see what was going on in terms of positions in hospitals etc, but that service was discontinued a couple of years ago. The last numbers I'm aware of would say that the current situation would be approximately 1,200 to 1,300 pharmacists practising in hospitals. Our membership is somewhere in the neighbourhood of two thirds to 75% of that.

The Chair: In how many hospital pharmacies? Would you have any sense of that?

Mr Murray: In terms of hospitals in Ontario, I think virtually all have either a pharmacist on staff or on staff in some sort of retained way. They may actually use nurses or in some cases pharmacy technicians to do physical distribution in the hospital, but they will retain a pharmacist as you set up appropriate procedures etc.

Ms Carter: I was just wondering, in view of our last presentation, what your definition of a pharmacy would be.

Mr Murray: In terms of provision of tobacco products, I would agree with the definition in the act in that I do see a problem of associating the sale of this product with health care provision, and whether you have a 70,000-square-foot or a 700-square-foot location, the mixed message does occur when in a sense you can pick up your tobacco at one end of a store and you can pick up your prescription, if you like, for your morphine for your lung cancer at the other end.

It's a dilemma. I understand where he's coming from as a retailer. I think that's why he would appreciate the idea of a licensing system that took it and made a completely level playing field for him. Nobody wants to, I think, in this legislation give anybody an unfair advantage in terms of marketing tobacco products, and I guess that's the tough job you've got of trying to make sure you don't do that inadvertently.

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


The Chair: I call our last witness for today, Mr Ian Morton, the environment coordinator for the Lung Association, Metropolitan Toronto and York region. Welcome to the committee, Mr Morton.

Mr Ian Morton: It's been a long day, it sounds like.

The Chair: But our days are always interesting.

Mr Morton: That's fun; that's good.

The Chair: We've learned a lot.

Mr Morton: My name is Ian Morton. I'm the environment coordinator for the Lung Association, Metro Toronto and York region. On behalf of my organization I want to congratulate the government and the opposition parties for introducing Bill 119 and ensuring its second reading and really taking the time to hear from all the different groups and their comments. I know you've been all around the province and you've heard from a number of colleagues of mine from the Lung Association and we do appreciate the amount of time and interest you've taken in this issue.

I'm going to be speaking to a very specific issue related to the bill. That's section 9, dealing with environmental tobacco smoke in public indoor settings. I will be referring to environmental tobacco smoke as ETS, so please stop me if there's any unclarity as far as my acronyms are concerned and I can clarify any of the terms I'll be using.

The Lung Association's concern about this section is based on the following. In 1986 the United States government estimated that approximately 86% of American non-smokers were routinely exposed involuntarily to ETS at home, at work or in other public indoor air settings. I suspect these figures would probably accurately reflect exposures that are happening here in Ontario. Why that would be a concern to our organization or why it is a concern in our organization is that we spend approximately 90% at least, minimum, of the time within the indoor environment.

As many of you have heard throughout these hearings, there are many documented health or associated health effects due to exposure to secondhand smoke. I would refer to the OCAT document which has been submitted to you. They've gone extensively through some of the health effects, so I'm not going to spend much time on it. But none the less I would like to point out that ETS puts far more hazardous substances into the air than exhaled smoke does, and contains twice as much nicotine, three times as much tar and 50 times as much carbon monoxide.

Especially dangerous, in my opinion, are some of the toxic, some of the carcinogenic compounds which are released, specifically 2-naphthylamine and 4-aminobiphenyl. These are just two of the more powerful carcinogens which have been identified with ETS and have been released with the Environmental Protection Agency's recent report on secondhand smoke. The EPA has gone so far as to suggest that the impact of these exposures may be so great that there should be no exposure at all, that the exposure limit should be as low as possible. In other words, I guess my point would be that there should be no tolerance for smoking at all in any public indoor air setting, that it should be banned altogether.

Many of the chemicals which have been described through the OCAT submission are produced through the elements which are added during the manufacture of tobacco. I'm not sure many of you have seen this and I would be happy, Mr Chair, to submit this if this would be useful for your committee. We received this through the freedom of information act from Health and Welfare.

As I'm sure some of you are aware, the tobacco manufacturers had to submit this back in 1989, which listed all the ingredients that went into a cigarette. I don't have time to summarize 11 pages, but I will point out some interesting goodies in here. Specifically, some of the ingredients include shellac, acetone, turpentine and many other lovely little ingredients which, during combustion, will produce other nasty chemicals which I've referred to earlier. This is a public document.


The Chair: Sorry to interrupt; if the clerk could get that copy we'll make one and give that back to you.

Mr Morton: In addition to the side-stream smoke being released through ETS, I would add that ETS can act synergistically with an indoor environment to increase the severity of adverse health effects. The magnitude of the synergistic effect is always greater than the sum of the individual effects.

Asbestos and smoking are the most dramatic example of the greater health damage resulting from these combined exposures, but other substances appear to act synergistically with tobacco smoke, which would include chloromethyl ethers, silicon dioxide and radon. This has led some researchers in the United States, specifically with the EPA, to suggest that ETS poses a greater health risk than all the hazardous pollutants combined.

When you think that, at minimum, there are about 4,000 identified contaminants in secondhand smoke, and that for some of them, for example, arsenic, when we're dealing with this in the ambient environment, we have very strict laws and regulations regarding their use and disposal in Ontario right now -- in many public indoor air settings, people can be routinely exposed to quite high levels of these toxic elements.

Not only does ETS substantially increase the level of toxic gases to indoor air; it rapidly disperses throughout indoor environments and persists long after smoking ends. Moreover, most of the ventilation systems which exist in many indoor environments are not designed to handle the specific demands associated with removing many of the toxic elements which are contained within tobacco smoke.

As well, research conducted by the Lung Association this past year has shown that even if you have ventilation systems which are equipped with high-flow filtration systems, the removal rates are limited. In other words, even if we have some of the best equipment to remove some of these toxic elements, there's little that, in many cases, filtration can do.

Clearly, source removal and prudent avoidance are the best two strategies to mitigate exposure to ETS. However, I would suggest that Bill 119, specifically section 9, provides us with a tremendous opportunity to have some regulatory emphasis to restrict exposure in public indoor settings to this hazardous substance.

Given the overwhelming evidence documenting the deadly properties of ETS, the Lung Association, Metro and York region, is asking for a comprehensive ban on smoking in all public places. These indoor settings would include recreation centres, shopping malls, fast-food outlets, hockey arenas; the list is essentially endless. These public places often employ young people who could be subjected to the dangers of ETS. As well as the young people who are often exposed, I also point out that there are many adults who are working in these types of centres who are going to be exposed to ETS as well.

Currently in Ontario there is no legislation which protects those types of workers who would be exposed to ETS; for example, if they were working in the Eaton Centre and in the long term developed a lung ailment or something else and had to give up their work. The Occupational Health and Safety Act does not cover that type of exposure. In summary, it's reasonable to assume that a large proportion of the labour force could be left unprotected and exposed to a serious pollutant under the proposed legislation.

Equally, the Ontario Smoking in the Workplace Act has not protected workers exposed to ETS in many workplace settings. There's no definition of what a designated smoking section is, which essentially allows for smokers and non-smokers to be on separate sides of the room with an imaginary line drawn in the middle. It's anybody's guess, in many situations. Moreover, the Ontario law does not require smoking and non-smoking areas to be independently ventilated. If the smoke-polluted air is simply recirculated, even in large, ventilated, modern buildings, the carcinogenic risk to which many non-smokers may be exposed is still unacceptable. The legislation in effect currently gives virtually no protection to an employee working for an employer who wishes to allow smoking in the workplaces.

Since many of the hazardous materials contained in environmental tobacco smoke have no safe level, the Lung Association is encouraging the province of Ontario to strengthen section 9 of Bill 119 and ban smoking from all public indoor and workplace settings.

Ms Carter: You mentioned the synergistic effect of smoking in workplaces. Of course, some workplaces do have their own chemical hazards. You mentioned radon, which I take it could be uranium mines. Then there are factories that have problems --

Mr Morton: Or your residence too, your home. I'm speaking to associations here. There's a strong association between the two working together to produce an effect.

Ms Carter: Sometimes I think smoking has been used as an excuse in the sense that if somebody was trying to prove that their workplace had caused health problems and they were also a smoker, they would be told, "It's because you are a smoker," but it's probably two things or more coming together and increasing the effect.

Mr Morton: If we can measure it; sometimes that's very hard to do. Most notably with asbestos, we know there is a very strong relationship between asbestos exposure and tobacco exposure leading to the development of mesothelioma, which is a very specific lung cancer. In some cases, yes, we are concerned that the two combined could have a greater health impact.

Ms Carter: There would be the added benefit that if smoking were prohibited in such workplaces, then any illnesses that did occur would be directly traceable to what was there. There wouldn't be that same dilemma.

Mr Morton: It would reduce it, yes, possibly. There are many factors when we're talking about indoor air quality and sick building syndrome which have to be taken into account. But reducing the loading to the air would hopefully lead to improved health of your workforce and reduce long-term health care costs as well.

Ms Carter: So you are advocating no smoking in workplaces?

Mr Morton: Correct.

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

Before we break, just a reminder that we're back here tomorrow morning from 9:30 until 10:30, roughly. You should all have your flight information and airline tickets for tomorrow afternoon. We begin at the Westin Hotel in Ottawa at 3 o'clock tomorrow afternoon.

Mr Tony Martin (Sault Ste Marie): Is the clerk providing transportation from here to the airport?

The Chair: You're on your own. You should have been given all the information.

Mr Martin: I arranged my own fare, so I didn't get any of that. That's okay. From time to time, I've been on committee where there have been cars out there and we all took off to the airport, but I guess not this time.

The Chair: Wednesday afternoon and evening and Thursday morning and afternoon we're in Ottawa. That brings great joy to the hearts of Ms O'Neill and Mr McGuinty. We're all looking forward to that.

The committee adjourned at 1647.