Monday 14 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
Lakehead Board of Education Secondary School Principals and Vice-Principals Association
Brian McKinnon, member
Thunder Bay Heart and Stroke Foundation
Jim Morris, president
Lakehead Women Teachers' Association
Julie McKay, president
Stuart Holtby; H.S. Dhaliwal
Ontario Public School Teachers' Federation, Thunder Bay district
Jim Green, president
Canadian Institute of Public Health Inspectors, Ontario branch
Michael Reid, president
Lakehead Elementary Administrators
Lise Haman, elementary school principal
Peggy Mason, elementary school principal
Tobacco Free Thunder Bay
Sophie Wenzel, lung association representative
Ontario Lung Association, Thunder Bay region
Kathryn Kaipio, executive director
David Nobel, volunteer
Thunder Bay Medical Society
Dr Antonio Belda, member
Fort William Collegiate Institute
Gillian Batay-Csorba, student representative
Canadian Cancer Society, northwest Ontario region
Lynda Kvarda, volunteer and member, health promotion committee
Dr Geoffrey Davis, chair, medical affairs committee
Ontario Physiotherapy Association, northwestern district
Diane Hiscox, member, executive committee
Brenda Adams; John Ginn
Ontario Secondary School Teachers' Federation, Thunder Bay division
Kevin Holloway, president
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
*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:
Carr, Gary (Oakville South/-Sud PC) for Mrs Cunningham
Haslam, Karen (Perth ND) for Mr Hope
Wiseman, Jim (Durham West/-Ouest ND) for Mr Owens
Also taking part / Autres participants et participantes:
Ministry of Health:
O'Connor, Larry, parliamentary assistant to the minister
Williams, Frank, legal counsel
Clerk / Greffier: Arnott, Doug
Staff / Personnel: Boucher, Joanne, research officer, Legislative Research Service
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
MONDAY 14 FEBRUARY 1994
The committee met at 0905 in the Valhalla Inn, Thunder Bay.
TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
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. The standing committee on social development is in session. We are meeting today to consider Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others.
May I say first of all that we're all delighted to be here in Thunder Bay, especially to be in a room that has this gorgeous view. Those of you seated in the audience can't see, but I assume you see it every day so you won't mind if our eyes seem to wander a little from time to time. Perhaps I should make at least one reference to the fact that it's Valentine's Day and hope that peace, love, compassion and harmony will guide the deliberations of the committee as we listen to the testimony today.
LAKEHEAD BOARD OF EDUCATION SECONDARY SCHOOL PRINCIPALS AND VICE-PRINCIPALS ASSOCIATION
The Chair: We have a very full schedule, so we will start with the Lakehead secondary school administrators association, Mr Brian McKinnon.
Mr Brian McKinnon: I'm pleased to be here. As you can see from my report, the Lakehead Board of Education Secondary School Principals and Vice-Principals Association gives its unbridled support to Bill 119. We're very pleased that it is in the process of being made into law, we hope. That is one of the reasons I am here to represent our association.
The report, which is succinct, essentially says what probably you all know anyway. We deal with teenagers who are ages 13 to 19. That's a very vulnerable group. We are very concerned about the availability of cigarettes to this group. We do what we can to teach them good, healthy lifestyles, try whatever we can in our health classes and other curricula, but it's increasingly difficult when these same students can leave the school at 3:30 or at noonhour, go across to the corner store, at the age of 13, 14 and 15, and purchase cigarettes.
As I've indicated in the report, the irony is not lost on us. We do what we can within the school walls, but I'm afraid we don't feel there's a lot of support outside of those walls. We are soliciting all of you at these tables to support us in our fight, and we will continue within the walls to try to get this legislation passed. We fully support your efforts in this and we applaud the NDP government in its efforts.
That is a résumé of the report. If there are any questions, I'd be pleased to field them at this time.
Mr Dalton McGuinty (Ottawa South): I appreciated your comments, especially about teenagers viewing themselves as somehow immortal. We met a medical officer of health in North Bay who told us it was her opinion that teenagers found themselves to be infertile, immune, invulnerable and immortal, and that's probably based on a great deal of truth.
One of the concerns we have is that teenagers or young people will still on occasion be able to obtain cigarettes elsewhere than your usual retailer, coupled with the fact that Bill 119 is going to address the problem of smoking in school yards and ban smoking on the school grounds in addition to within the buildings. In other words, our concern is that we don't want to simply bump kids off the school grounds on to the streets. When you combine that with the fact that kids may still be able to get cigarettes through some other means, through the black market, for instance, the only idea we've been kicking around is the idea of making it illegal to possess cigarettes, in the same way it is now illegal for a young person to possess alcohol. I'll give you an example.
If you've got two 14-year-old boys sitting on the curb, one smoking and one drinking a beer, the police officer is only going to talk to the kid with the beer. But the studies show us that cigarette smoking, the illnesses connected with tobacco, is the number one preventable source of illness in this country.
It seems to me we are failing to capitalize on an opportunity here to instil a sense of responsibility in our kids so that they know we mean business. I'm just wondering what you think of that idea.
Mr McKinnon: I support any kind of law enforcement we could add to the bill, any weight we could add. We would support that. But that's extremely difficult. I understand where you're coming from. I can see that trying to police that would be extremely difficult. I look at our own situation now. The Lakehead Board of Education has a policy which forbids any smoking on any of its properties, and that includes school yards right out to the edge. The problem, of course, is that the kids leave there and go out to the sidewalk of the neighbours, and then the neighbours get all excited -- cigarette butts all over the place -- so they constantly start to get on the edge of the property, closer and closer. It's a constant battle.
To take your fine point, if it were illegal for anyone under 19 years of age to have a cigarette, that would probably make our job easier, because then we could say, "What you're doing is illegal, and here is the consequence." Right now it's, "Get off the property." We don't have a lot of teeth in that right now. I support what you're saying. I think that's the next step.
Mr Jim Wiseman (Durham West): I'd like to pursue a number of things. First, I'd like to backtrack a bit. What would you suggest should be the legal consequences for anybody under the age of 19 having a cigarette in their possession? When we start talking about consequences, what are we going to do? Are we going to fine them? How big a fine? That kind of thing.
Mr McKinnon: I haven't given that a lot of thought, but my immediate reaction would be they could be sentenced to education, if that's not a contradiction. Perhaps they would be obliged to take some extra health courses -- I'm not saying this should be put back on to the schools, but a lot of stuff is put back on to the schools, so maybe that's an alternative. Teach them about the consequences and dangers of smoking. Get health care professionals involved in the schools and have noonhour classes or 3:30 classes, because I'm sure we would have lots of clientele.
Mr Wiseman: A high school in Sudbury called Lively made a presentation to this committee. They seem to have a rather interesting program there. They brought to the committee three young people, two of them smokers who wanted to quit. I asked them if they had thought about taking those students into the elementary school as peer role models and trying to convince the younger students that it's not really a great idea to begin. We've heard that peer pressure and price are two of the main reasons young people will smoke. The lower the price, the more likely it is they're going to. Of course, we're facing a really interesting problem now because of the federal Liberal government and the former director of Imasco.
My point is, have you thought about any of these kinds of programs in your school? Do you know about what's happening at Lively?
Mr McKinnon: I don't know about in Sudbury, but I'm sure there are lots of available strategies. Certainly within our own schools we have talked about, how do we get these kids to simply not start? We have looked at some of our health curriculum dealing specifically with that. We have endless parades of health professionals constantly coming to the schools saying, "Here's the danger, here's the consequence of one cigarette a day," and we do the demonstrations in the classroom. When I started, I taught physical and health education, and we showed the old films. If you go back to the 1960s when those films were pretty graphic -- I had kids fainting in the classroom, but they'd go out and have a cigarette to recover, was my sense. I could be a little cynical, but I'm not certain that kind of stuff is effective. I'm sorry, I don't have a particular answer.
Mr Wiseman: My last question has to do with enforcement. It is my particular pet peeve that I would like to see incorporated somehow within this bill the civil right of parents and health groups to sue in civil litigation people who sell cigarettes to minors. As a parent who has three young people below the age of 10, I'd like to have the opportunity to sue anybody who entrapped my kids into smoking by giving them free cigarettes or by making it so cheap that it is easily accessible, because we heard from the addiction centre in Sudbury that as few as four cigarettes will get somebody addicted.
Mr McKinnon: I would support that 100%, because any more teeth we can put into a new law would be beneficial. I would think that a few successful suits of that kind would make people sit up and take notice. That's a terrific idea.
The Chair: Mr McKinnon, thank you for coming before the committee this morning.
THUNDER BAY HEART AND STROKE FOUNDATION
The Chair: I call our second witness, from the Thunder Bay Heart and Stroke Foundation, Mr Jim Morris, president. Thank you for coming this morning. Please go ahead with your submission.
Dr Jim Morris: Just one little clarification. You could perhaps add "doctor" in front of "Jim Morris." It's Dr Jim Morris, and the reason I do that is because there is another Jim Morris who is quite well known in Thunder Bay. I often get his phone calls. He's a deputy grand chief of the Nishnawbe-Aski nation and until very recently he lived about two blocks from me, so it was quite confusing. I keep telling people: "Phone me. I'm the good-looking one." In fact, he's on television more than I am.
First of all, I'd like to thank the committee for allowing me to make the presentation, and perhaps I should give a bit of background. Like Brian, who just made his presentation, for 26 years of my life I was a secondary school physical and health education teacher, so I know exactly what Brian was going through when he was talking about trying to prevent smoking in the schools.
For 26 years, and sometimes in a number of grade levels, I would teach about the evils and the hazards of smoking, and I used to take the approach that Third World country educators take, referred to as "each one, teach one." I would start off my lessons by saying: "I'm one individual. I have lots of fallacies and problems and so on, but if during the next few lessons I can affect one of you in the classroom" -- and there'd be a classroom of 30 grade 9s, or if it was in the lifestyle classes, grade 11s or grade 12s, or even the grade 13 OAC course that I used to teach -- "to make you either not start smoking or to stop smoking, I've done my job. There are 30 of you here. If I affect one of you in that way, and if you in turn can go out and help someone to not start or to stop smoking, you've done your job." You would hope you'd have a better record than that, but that's the way I'd start it off.
A lot of strategies have been tried. You mentioned the Sudbury idea of peer teaching. Back in the early 1980s I was involved with a program here in Thunder Bay that was funded by the Ministry of Health in Kitchener, London and Thunder Bay, and the approach here in Thunder Bay, working with a lot of teenagers, was a peer teaching program which was very successful. We had grade 10 and 11 students going into the grade 5s and 6s, mainly grade 5s, doing peer teaching in the area of smoking. It was highly successful. It was mostly run by volunteers, including myself as head of the committee, but it was the youngsters who were doing it and it was very successful. The teachers in the elementary schools loved the program.
I'm also a member of the Tobacco-Free Thunder Bay Coalition. As I indicated, since 1980 I've been on the Heart and Stroke Foundation, and this year I'm the president.
Perhaps I should say that heart and stroke foundations have been involved in prevention of smoking for many, many years, since 1952. I would have to say I pretty well follow the party line with Heart and Stroke in the three main areas the bill addresses, and that includes vending machines, as I understand a number of studies have shown many children get their cigarettes from vending machines which are unsupervised.
It's bizarre to think there are health professionals who can defend or even rationalize the sale of a product that is demonstrably harmful to our health and in fact kills people, and at the same time sell things that are supposed to help people, and I'm referring to pharmacies. The College of Pharmacy has asked the government to ban sales of cigarettes in their establishments. Corporate Canada wants to have the freedom to sell cigarettes wherever they want. In years to come I think we will look back at this bizarre situation and bang our heads and say, "What were our legislators thinking of to allow this to happen?" It would be the same as the nursing profession saying: "We want to sell cigarettes at the nursing stations in our hospitals. That's free enterprise; we're retailers." Bizarre.
Increasing the age may have some effect, although as you get older, people tend to get younger and the world moves faster. It's the old policeman syndrome, where you look around and policemen seem to be getting younger as you get older. I don't know whether you have to have people at the retail counters who are the same age as the people they're selling to to realize, "This person is only 17 or 18" because they're in the same age bracket, but certainly that may have some effect.
Going back to the idea of making it illegal for teenagers to have cigarettes, it's the same idea, I suppose, that we could legislate that anybody who smokes sign a waiver that, if they get ill and it can be demonstrated that they became ill because of their cigarettes, we would not pay their health costs.
I read an article many years ago, and I used to quote it in my classes. It was in the Canadian Medical Association Journal and it was called "Don't Bleed on my Carpet." It was written by a physician in Kingston and he pretty well said, "If I'm dealing with a patient who's a smoker and he or she continues to smoke, and then they become ill and they want to be cured, if they don't stop smoking, then I say, `Don't come and bleed on my carpet.'" He was taking a stand, and this was in the 1960s. He didn't want to deal with smokers if they could not help themselves.
Going back to the bill at hand, I think we should have some form of licensing, and I know Heart and Stroke is pressing for licensing of some nature. The public health inspectors are around the community. There are many of them in the province. They could simply take that on as something in their job mandate. We may need a few more health inspectors, but it is something they would probably be glad to enforce.
The packaging of cigarettes: Studies have shown that the packaging of cigarettes does have a bearing on what brand people buy. I guess youngsters are like all of us: They're attracted to marketing. Generic packaging, a putrid yellow colour with skull and crossbones and simple letters for the brand name: Wouldn't it be nice if we could have something like this on our packaging?
Modern technology can do wonderful things. I have a little card here that, when you open it up -- can you hear it? -- it plays the American national anthem. Wouldn't it be nice if we could have a package of cigarettes that, every time it opened, said, "This will kill you, this will kill you, this will kill you." You've got to shut it up, and they'd probably tear them out, but it would make work. This is probably made in Taiwan, but it's making work, and it would be in cigarette packages.
Environmental tobacco smoke: Robin's Donuts -- and this is a plug for Robin's Donuts, by the way, folks. There are 17 of them in Thunder Bay and there are 129 across Canada and now in the States. A number of their outlets are smoke-free. I will not drive a mile for a Camel, but I'll drive across Thunder Bay just to go to a Robin's Donuts that's smoke-free, and I know many people who will do that, including some smokers, by the way. To go to a smoke-free environment to enjoy a cup of coffee -- and coffee is harmful -- in some respects is a treat.
Environmental tobacco smoke is a problem. How we deal with it -- whether it's legislated or just the fact that people know they're going to get customers coming to a smoke-free environment. Workplace smoke is certainly something that should be dealt with more severely. I'm not quite sure of the legislation, but 25% of the work area is supposed to be smoke-free, but if you're working next to somebody or in the far corner, the smoke still drifts, so that still is a problem.
One more thing just to wind up, and then I'll answer any questions. Enhancing and increasing support for smoking cessation programs: One thing some employers have tried is that if their employees stop smoking, they'll give them payroll bonuses or some inducements to stop smoking. Wouldn't it be wonderful if the government could encourage employers to have their employees stop smoking, and then somehow or other reward them so that they in turn would reward their employees? Incentives. We, as adults, are role models for our children, and anything we can do in this regard would help.
I know I've gone on, but I'm not quite through my 15 minutes. I'm open to any questions.
Mr Gary Carr (Oakville South): Some of your suggestions have been very creative. But if we proceed with this particular bill, do you have any idea of how much impact there will be? What are we going to see in terms of a reduction? It might be difficult to quantify it in terms of a percentage, but if this bill goes through, how much of an impact is it going to have?
Dr Morris: If it would prevent one youngster from starting to smoke, or at least make them think until they're 18 or 19 to purchase cigarettes -- when I first became involved in Heart and Stroke and as a physical educator, I never thought in my wildest dreams that I would see the day in which there were so many smoke-free areas. When we look back on this part of the century, maybe by the year 2000 -- and one of the goals of Heart and Stroke is, by the year 2000, to try to get children to stop smoking. But 10 or 12 or 15 years ago, I never thought the high schools in Thunder Bay would be smoke-free, I never thought the hospitals would be smoke-free. It has come so far, so fast, that anything we can do is certainly going to improve the situation.
Mr Carr: So you see this as just part of the steps.
Dr Morris: As part of the steps. Legislation is probably only one part of it. Perhaps in my lifetime, it'll become socially unacceptable, through peer pressure. Most smokers you talk to now, and there are probably some smokers on the committee -- I have friends who won't smoke in my presence because they think I'm with Heart and Stroke. That's weird; they're my good friends.
I recall one incident. I knew a friend smoked but he never, ever had smoked in my presence. I'd known him for 15 years. I pulled up to a stop light and he was in a car beside me. He had a cigarette and it was cute to see the way he immediately dropped the cigarette, as if I was going to -- and he's my age, too.
Mr Carr: You're right. We have made some very dramatic inroads with a lot of these things. The problem is, though, that they tell us we're still not winning the battle. A lot of kids are starting. Why? We seem to be winning with some of the older folks like myself. Why is it that we're still losing the battle with some of the young kids?
Dr Morris: Marketing. The cigarette companies simply will find ways to induce youngsters to continue smoking.
This is a tangential thing. I wish Kurt Browning, when he did his routine -- that's an imitative sort of thing. It's from the old Humphrey Bogart movie and so on, and you only have to look at old movies to see how far we've come.
Interjection: He threw it away.
Dr Morris: He threw it away, but he still was smoking.
I don't know, I just think that you as a committee will probably look back on the committee hearings, and the bill, whatever form it takes, as just one more step. Eventually it may become socially unacceptable, that kids won't start smoking because nobody will be smoking, period.
The Chair: Just for the record, I believe this is actually a smoke-free committee. I don't think anybody on the committee smokes. Some may have, but I think we are all fairly pure and pristine.
Dr Morris: Isn't it wonderful to be so perfect.
Mrs Karen Haslam (Perth): Those of us who have been on the committee for a long time have heard very similar presentations, and you're probably in the majority of the presentations. We're actually starting to feel sorry for the doctors who must face these people and say: "You're dying. You have lung cancer." For anyone diagnosed with lung cancer, statistics show that the rate of success in beating that kind of cancer is extremely low. As a woman I'm concerned, because we've seen the amount of lung cancer in women triple. That's scary for those of us on the panel who hear these types of things.
You talked of looking at a smoke-free environment or a smoke-free society by the year 2000. I'm quite concerned now, with the policy decisions made at the federal level around the taxes on tobacco, whether you still feel that can be attainable.
Dr Morris: It's certainly a major backward step, because all studies show, as someone indicated earlier, that the price of cigarettes is a determining factor in people purchasing them. Whether closet smokers will now come out and smoke more because they're cheaper, I don't know.
Mrs Haslam: That's one of my concerns. The other one is around your suggestion about licensing. In the legislation there is a model proposed. If there are at least two convictions of you selling tobacco to minors in a five-year period, it's automatic: You lose the right to sell tobacco. There is a sign put on your establishment saying, "I don't sell tobacco because I am prohibited." There are letters sent to the manufacturers to say, "You cannot sell tobacco to this store." You're not even allowed to store your products and wait it out. There can be no tobacco products in your location.
I was wondering why you would look at licensing over that proposed model. The result or the idea is the same; the model is what's different.
Dr Morris: There's no licensing involved in the present legislation, I take it.
Mrs Haslam: If you've looked at the legislation --
Dr Morris: About two weeks ago.
Mrs Haslam: It's a ticketing issue. In a sting operation, if you're proven to have sold to a minor, you are issued a ticket. You can either fight it or not. If you are convicted twice within a five-year period, you lose the privilege of having tobacco on your property, selling tobacco. There's a sign put up that says you can't sell tobacco. The manufacturers are informed you are not allowed to have tobacco; they can't sell you tobacco. It's that kind of model within the legislation.
People are coming and saying: "We'd rather see licensing, where you license every retailer and every gas bar and everybody in the province to sell tobacco. Therefore, when you're convicted, you lose the licence." I was wondering why you're recommending licensing over the model that's already in place in the legislation.
Dr Morris: If the legislation, as proposed, is that easily enforceable, then perhaps licensing wouldn't be necessary. Taking away their privilege for recurring sales to minors would be my justification for anything.
Mrs Haslam: Do you see enforcement as the key issue in this legislation?
Dr Morris: No, I primarily see it as a another step in the whole process. Now the government is saying, "We're going to do things to further encourage not to smoke, especially young people."
Just one more anecdote: My first three years of secondary school teaching were in the beautiful island of Jamaica. I taught at a grammar school of about 600 students. After a while, one thing became evident: Not one student in this school smoked. I couldn't get around this until at a staff meeting the headmaster said -- this was his expression -- "No student is allowed to smoke as long as they are a member of Manning's community." This was in a staff room where there were probably 10 or 12 of the 30 of us who smoked. The rule was that as long as you were a student at that school, you were not allowed to smoke -- not off the grounds, not on weekends, not at night. If you were caught and somebody reported that you, as a student, were seen smoking -- and we're in a Third World poor country. That was the rule of the school. I haven't been there for a number of years, but no child in that school smoked, and these were 12-year-olds to 18- and 19-year-olds.
Mrs Haslam: Was that a public system?
Dr Morris: Basically, yes. There were a few funded, but most of the kids paid their own way.
Mrs Yvonne O'Neill (Ottawa-Rideau): In the northern communities we've been in, cessation programs have come up more often. You've just suggested that the employers in Thunder Bay are into this kind of mode. I wondered if you could say a little more. Do they offer cessation programs in the workplace without any loss of pay? Are there cessation programs that are part of the credit program in the high schools?
Dr Morris: I can speak to the first. Five or six years ago, when many of the public buildings were becoming smoke-free, at the secondaries -- all the schools, in fact -- the Lakehead board offered two or three sessions for staff. I was involved in several of those. The employer put these on for employees, and I know a number of organizations have had them to help to encourage their employees to stop smoking. In the secondary schools the smoking education is done in the health classes, and I don't believe there are cessation programs as such. It's basically the health education aspect of the phys-ed programs.
Mrs O'Neill: It's something that seems very worthwhile, if it can be done. The workplace seems to be an area where we are dragging our feet now after some successes. If employers can be encouraged, there are lots of data to support the fact that they'll get more out of their workers in the end.
Dr Morris: The Quetico Centre was one of the leaders in this area, encouraging its employees to stop smoking and giving them enhancements in their paycheques and so on.
The Chair: Dr Morris, on behalf of the committee, thank you very much for coming here this morning.
Dr Morris: It's been a long battle as a professional physical educator, but I think we're winning it.
Dr Stephen Roedde: I'd like to thank you very much for allowing me to come here today. To introduce myself, I'm a full-time emergency physician at McKellar General Hospital here in Thunder Bay. I feel, in some senses, a bit awkward making a presentation to this group among such esteemed colleagues as have just presented.
I'm here because I face the effects of smoking every day and I feel passionately that all of us have a responsibility to do something to try to limit the ill effects of smoking. I'm not an expert in terms of health legislation. I'm not an expert in terms of Bill 119. I'm just somebody who is concerned, who feels that something has to be done, and I wanted to make a presentation essentially to support those people who have worked very hard to prepare what looked to me to be a good document that had a lot of positive components to it, and to make a few observations about some small changes I think might be made.
As I mentioned, I'm an emergency physician. I worked first as a family physician, attempting to get people to quit smoking, facing the frustrations of that. Subsequent to that, I've been working full-time, and every day I see the ill effects of smoking. I see suffocating in front of me people with chronic obstructive lung disease for which I can offer nothing but expensive treatment that palliates them as they slowly go downhill. I see sick kids with asthma who have had their illnesses either caused by or exacerbated by parents who smoke in the home. I see young people, 35-year-olds, initially just men but now increasingly women, having their first heart attacks. Sometimes they die, sometimes they live. We spend a tremendous amount of money and energy trying to treat the effects of smoking. I really believe that the only way we're going to get around this problem is to prevent people from starting, so I think this bill is very good.
I'd like to speak a little bit about section 4, which deals with limiting the sites in which cigarettes can be sold, specifically in terms of the role of pharmacies in the sale of tobacco products. I think this limitation is a really progressive move. I am really dismayed that we have a situation where health professionals are able to sell products that clearly do harm, that clearly kill people, juxtaposed with other products that seem to be helpful and promote health. As others have said, the professional body to which pharmacists belong has spoken out clearly, stating that it does not think this is something pharmacists should be involved with. I certainly support that view.
I assume there will be submissions here and elsewhere from people who have a self-interest in continuing with the sale of tobacco products, and I would be concerned that members of this committee may be swayed by those arguments. This is something that has nothing to do with statistics and numbers and studies. These are people who start smoking, who get sick, who die, who suffer. We see it every day. For those of us who see it, something like banning the association between products that encourage health and those that cause ill health is something that just should occur.
Other types of control of sale should be considered. We have controlled the sale of alcohol products through specific outlets, I suspect in part because it's easier to control the sales. I hear questions coming from the members of this committee about how one is going to enforce the components of this act and how people who break the law can be dealt with. I would argue that you could make a case for selling tobacco products in branches of the LCBO. We know then that they're not going to be sold to minors. We know then that you're not going to have all the problems with enforcement. That would be simple, possibly too simplistic, but that's something that should be considered.
In addition, in section 5, where it relates to packaging, in my experience as a family physician, there certainly does seem to be some status associated with having a particular brand in one's pocket. I can remember being a part of that when I was an adolescent. Having tobacco products sold in plain, unmarked packages would be a productive step. In doing so, the health warnings would be more prominent. There would be a break in the link between the manufacturers circumventing their advertising through sports and music events, and their brand names. That's something that could be included in this act. I think it would strengthen it significantly.
The last comment I want to make is one about section 9, which I gather deals with the control of smoking in specific environments. Although there are some specific areas in which smoking seems to be banned, it's not clear to me whether that means I and my family will be able to go into a restaurant in Thunder Bay and know we can sit down without being poisoned. The health effects of passive smoke are accumulating and I gather increasingly clear, and it's not clear to me whether I'm going to be protected in that environment. I don't know whether the common areas of shopping malls are going to be areas to which I can bring my kids safely, knowing they're going to be protected from the effects of passive smoke.
I wonder why it's not possible to just prohibit smoking in any place except those in which it is specifically permitted. Let's place the onus on the people who want to encourage or allow smoking to prove that it's going to be safe, rather than the other way around.
My experience as a family physician has really driven me to believe that the things that have affected people in their attempts to quit smoking are the societal changes in attitude. They're no longer feeling it's okay to stop in at somebody's house and light up a smoke, but ask the question, "Is it okay if I smoke here?" and, if it's a non-smoking house, out on to the deck they go. Those are the sorts of changes that make a difference for people, and I think making it less socially acceptable is really going to have a beneficial effect.
To conclude, it's a good bill, from what I can see. I really praise all the people who have worked really hard to bring it to fruition, and I encourage those people who believe in preventive health care in this province to continue to work to prevent this bill from being weakened, and possibly to strengthen it.
Ms Jenny Carter (Peterborough): Thank you for your constructive criticism of the bill. I think we're all agreed that the most important thing is to prevent people from starting to smoke, but I was wondering if you as a physician could tell us something about the difficulties of getting people to stop once they have started. Obviously, we're all aware of different strategies that people pursue to try to quit. Some of us who are not smokers wonder why these people don't get off this habit when they know it's so bad for them. Perhaps we don't understand just how hard it is. So I wonder if you can tell us what kind of prospects people who are maybe your patients have if they are smokers and want to get off it, what strategies they use and how many succeed.
Dr Roedde: I'm not an expert on the topic, certainly now that I do not practise primary care and I'm no longer involved in that area of practice, but in the time I did family practice, when people would come in for an annual health, I would ask them about it. I would talk to them about it. I would encourage them. I would ask them to go through the strategies: "Have you ever tried to quit? What things have you tried? What worked for you?" I'd talk about things that may motivate them to stop smoking.
Although there were a few successes, it took a tremendous amount of my time and energy, and patients' time and energy, with very few successes. It seemed to be incredibly difficult. When I was doing it, I believe I was following at the time the best strategies available. Although there are some successes in everybody's day, it just seems to me that the energy spent there would be far better spent at the front end. Obviously, things have to happen as part of the big picture, but it just seems incredibly frustrating to try to do it.
Ms Carter: Something like the nicotine patch, for example, is not really a breakthrough?
Dr Roedde: Personally, I doubt very much it's a breakthrough. As far as I'm aware, it hasn't been evaluated in comparison to other things that were around before, nicotine gum and so on and so forth. We're often driven by the latest and greatest, most convenient thing, rather than things that are clearly better than what we had before. There are strategies that are effective in getting a small percentage of people to quit. My experience even in emerg, with people who come in with the little patch and the nicotine on their fingers, suggests to me that it's not dramatically effective, although I'm not an expert on the literature.
Ms Carter: So the focus has to be on how to prevent people from starting, and you have given us some ideas about how we could strengthen the bill in that respect. What do you think are the main factors that cause youngsters to start smoking?
Dr Roedde: I'm not sure I can speak with any more wisdom than any parent. so, I reflect back to my own adolescence and to the kids I saw in practice and in emerg. Sometimes it's being different. Sometimes it's being part of a group. Sometimes it's saying to the rest of the guys: "I'm going to be different. I'm going to do it because I'm different and because you don't want me to do it."
Increasingly I'm seeing groups of young people today speaking out and taking stands about all sorts of things, about drugs, about smoking, about alcohol, about drinking and driving. Even within the youth of today, I see a lot of encouraging signs that people are not going with the big tide of peer pressure, and they're fighting against it.
I'm not an expert on it. All I can say is that it seems complex, and anything we do to make it more difficult to start, to make it more expensive to continue, to limit access, all those things are going to be effective. It's not going to make it go away, but it will be part of the big picture of making it not okay, in that group as well as in the groups of adults.
Ms Carter: If it could be uncool instead of cool, we'd be on our way.
The Chair: Dr Roedde, thank you for coming before the committee this morning. We appreciate it.
Mrs O'Neill: May I ask the parliamentary assistant a question? Mr O'Connor, would you be able to tell us whether there is some thinking about expanding the areas for non-smoking? The two that have been brought to my attention most frequently since the hearings began, the ones that came to us in Sudbury, and I've had written representation, are the common areas in seniors' housing, particularly public housing, and then the arenas. Can you tell us if there's any intent to expand that section of the bill?
Mr Larry O'Connor (Durham-York): The housing area could be problematic. We'd have to get some clearer definition and some help from Housing to deal with that. It's probably easier to deal with the arenas through this legislation.
LAKEHEAD WOMEN TEACHERS' ASSOCIATION
Ms Julie McKay: Good morning. My name is Julie McKay. I am a teacher and the president of the Lakehead Women Teachers' Association, which is one of 80 associations that form our larger provincial group, the Federation of Women Teachers' Associations of Ontario. We represent 42,000 elementary women teachers. In Thunder Bay locally, I represent 500 women teachers.
I thank you for the opportunity to present our concerns regarding the Tobacco Control Act, Bill 119.
The stand our organization takes is very clear in our provincial constitution, and I quote, "That the teaching of the prevention of smoking should be a component of the health curriculum in the primary division."
Smoking is dangerous to our health. This has been stated by the medical profession and also supported by the statistics from the Canadian Cancer Society. I'm here to ask that the community, parents, teachers, business and industry unite in a partnership with a common goal, that goal being our future. As educators, we can only do so much to combat the situation with smoking. Success depends on all aspects of society working together. This partnership must focus on our future as a community, a province and a country.
Our future is our youth, and our future will be as strong as is our youth. Smoking and its devastating effects cost many lives, many thousands of dollars, and promote neither health nor strength.
We compliment the Honourable Minister of Health, Ruth Grier, for bringing this bill forward, and we recognize the support and hard work put forward by Larry O'Connor and many other dedicated politicians.
We are in support of Bill 119, as it addresses our concerns. Bill 119 will prevent the exploitation of our children and youth: exploitation of our youth at their health expense, exploitation of our youth at their financial expense. It is not justifiable that children and young people have the pressures of advertising companies, specifically with the intent to get them to try smoking and then to get them hooked on smoking. Tobacco companies spend hundreds of thousands of dollars on marketing strategies and ads resulting in promotions that are directly aimed at young people.
Vending machines are made for easy access, especially by the underaged. Vending machines are unsupervised, they do not have a conscience, nor do they care or ask for the age of majority or proof of age. New York City does not have any cigarette vending machines, as quoted in the OCAT report, December 1993.
Selling cigarettes in health facilities of any type, pharmacies, health clubs, clinics, is a contradiction to the very existence of that facility, and the sale of this product should be prohibited there. It gives our children a mixed message.
Raising the age can help delay the process a bit, as young people usually start before the age of 20. If we prohibit and restrict smoking in public areas, we will be improving the quality of life for everyone, you and I.
Our interest is our future and our quality of life. We feel that Bill 119 is very important in addressing all of our concerns. As educators, as citizens, and as partners in our community, we support this bill. We will be paying very close attention to the procedures in the Legislature as Bill 119 is considered. Working together, we can make a difference. Our children deserve that consideration and the right to a healthy future. Our responsibility as citizens and adults in this country is to provide it.
Mrs Haslam: A number of us around the table are former teachers, and we share your concern for the young people.
It's nice to say, "Thank you, Ruth," and "Thank you, Larry O'Connor," but I must say that everyone around the table has worked very heard. Mr McGuinty brought in a private member's bill, and Mr Arnott from the Progressive Conservative Party, who's a former member of the committee, has done extensive work in his own community around it. On behalf of all the parties, I'd like to say there are many people here who are very keen on seeing this legislation be successful. It is for the young people.
We've been receiving statistics that say 3,000 young people a month start smoking in Ontario. I've checked those with everybody who has said that. I was talking this morning with someone who said that with the lowering of the taxes recently at the federal level, the accessibility in price being easier for young people, they are afraid somewhere between 4,000 and 6,000 new young people a month in Ontario will start smoking. This is a concern.
You mentioned strong words here and that's why I've zeroed in on them, because I'm wondering if this is the message we should be giving to our young people. In elementary schools, the message is easier in the health care idea, that smoking is bad for you. We get letters from young young people saying: "Thank you for coming and talking to us from the cancer society. I'll never smoke." But when we get to the secondary level, it seems to be much more difficult to get the message across to secondary school students.
I'm wondering if our message should be more the idea of: "You are being exploited by a marketing firm. You are being exploited to take the place of those people who have died using this product. You are being exploited to become hooked on a drug." Is that a stronger message we should be giving to our young people?
Ms McKay: I was bringing forward, as is our association, the idea that young people are taken advantage of. In the elementary, we can start at an earlier age level to put through the concept that it is not good for you. We still do have difficulty when we reach the intermediate grades, because there is peer pressure. Though we want to remove that, it is there. If the price of the cigarettes is at a level that they are accessible, they will try it. We all try something we can access. That certainly will move it, through that.
The exploitation is the advertising, the appeal of the cigarette, the stereotype or the image that is involved, just as in the commercials that used to be on the media that referred to alcohol, it was always something special to be able to take part in that. If we can work against that kind of advertising so that our children and our young people have the opportunity to be away from that pressure until perhaps a later age -- we have been given the statistics that they start smoking before 20, so if we had a legal age, that would probably curb a lot of the new beginners.
The Chair: Thank you very much for coming before the committee this morning.
Dr Stuart Holtby: Good morning, ladies and gentlemen. My name is Stuart Holtby. I am a medical doctor, a lung specialist practising in Thunder Bay. I am very grateful for the opportunity to speak to you. First off, I would like to offer you all my congratulations on working together to bring this legislation forward. I hope there will be continued cooperation in not only bringing this legislation through the Legislature but also speedily writing the regulations and implementing them.
The many organizations that support this act have provided you with solidly based, articulate arguments for all its provisions and also for extension of the act in a number of areas, including plain packaging, licensing and environmental tobacco smoke. I will not restate those arguments. Rather, I bring to you a message of support that you might not otherwise hear.
Like you, I spend much of my day listening to people, listening to them present their stories and their problems. Unlike you perhaps, most of the people I see have not seen any benefit or advantage from the tobacco industry. Indeed, most of the people I see have been hurt by the tobacco industry, savagely hurt by the tobacco industry.
Most of my patients are far beyond any remedy this legislation might offer, yet they are among the most fervent supporters of this. They speak to me with nearly one voice in support of this, and now I speak to you for them. I speak to you for the families they have left behind. I speak with the voices of the people who are your constituents, who are this province. I speak to you with the voices of those whose breath to be heard has been stolen for profit. I am speaking to you standing at their bedside. I am speaking to you standing on the graves of people who put you in office to make this land a better place.
Here is one of their messages entrusted to me to bring to you: "Keep our children from tobacco. Tobacco will enslave them, impoverish them, torture them; tobacco will kill them. Do not let that happen. Do not fill your pockets with their suffering. You, all of you, have the power to stop the tobacco industry. The people are behind you and with you to help you use that power. Do not falter. Do not forget."
The man who gave those words to me died in December of emphysema. I can think of no more compelling message for you to recall.
Dr H.S. Dhaliwal: My name is Dhaliwal. I'm a cancer physician and head of medical oncology at the Thunder Bay Regional Cancer Centre. I represent the OMA and the Thunder Bay Regional Cancer Centre, but above all I really speak to you in good faith on behalf of hundreds of silent patients who have succumbed to the ravages of disease that Dr Holtby has described. I echo his comments.
In the five minutes I have I'd like to make three points.
First, Bill 119, the Tobacco Control Act, in my opinion is easily the most important piece of health legislation in the preventive field ever introduced in Ontario. I choose these words carefully. I would like to congratulate the government and the members of the political parties in supporting this farsighted and courageous piece of legislation.
Second, I want to comment on some aspects of the legislation from the perspective of a cancer physician.
Third, I want to suggest changes to strengthen the bill, not to dilute it the way the vested interests are urging you to do, so that we send a clear message to what someone aptly termed "merchants of death" that their wily schemes will not deflect the government or the people of Ontario from the just path of limiting and eradicating tobacco.
Why do I regard this legislation as important? The answer is simple. The act, if applied effectively, will prevent more disease than I and my other cancer physician colleagues in Ontario are ever going to be able to cure over the rest of our lives. Please take note. Historically, the concept that one ounce of prevention is worth a pound of cure is well proven and beyond doubt, and you all know it. I do not need to reiterate that.
It was interesting for me to listen recently to the famous octogenarian professor Richard Doll, who lamented that his first paper linking cigarette smoke to lung cancer was published 52 years ago and that sadly, he says, the consumption of tobacco continues to increase. I could add, when will we ever learn? What does it take for us to learn? I spend much of my time fighting to alleviate the misery and suffering directly due to tobacco addiction. Many patients ask me, "Have we found the cause of cancer?" In frustration, sometimes I say facetiously: "Yes, we do know the cause of the commonest cancer. It's cigarettes." But they're always surprised by the answer a little. Most times I keep quiet; it's too late for them. Some will say, "Don't let this happen to someone else."
It's with this background that I really plead with you. I don't have the power to cure, but you have the power to prevent this slaughter of innocents. It really is a slow genocide, if you think about it. If the same number of Ontarians who died, 13,000 a year, and millions of others all over the world, died more vocally, there would be an uproar that we could not ignore. But silently, cancer kills, and we seem to be able to ignore, and the slowness blinds us into inaction.
Let me give you an example. If the panel could wave a magic wand and stop all smoking by dawn tomorrow, the so-called latent period of cancer means I will still be trying to treat cancer for the rest of my life, and so will Dr Holtby be treating the consequences of respiratory disease for the next 20 years. It is so important at this stage that we do not allow our path to be deflected and act quickly. Every day children are becoming addicted, and they cannot stop once they are addicted.
I urge the government not to start dismantling and emasculating this brave act at the behest of vested interests, of powerful organizations that are morally corrupt and ethically bankrupt but have tons of money to manipulate us all. They tell us that we should not have the legislation banning sale of cigarettes in pharmacies. If I told you that as a cancer physician, in order to make ends meet I also had to sell cigarettes, I wonder what your response would be to my testimony. It deserves the contempt that you should all pour on it.
The three measures I would advocate strongly:
First, a retailer licensing system. That's been proven to be effective in some other communities, and those data are available. It will allow close monitoring of vendors, encourage responsible behaviour and increase compliance with the law.
I'll give you an example. Coming from England, in the first few months, not being fully aware, I drove at the usual speed in England until my driving licence hung by a thread. I no longer speed.
Plain packaging is the second point I would urge the committee to recommend. Take the glamour out of cigarettes, please. The tobacco industry's own research in advertising proves that it increases sales, that there are multiple ways to glamorize the product, bypass the restrictions, target specific groups like the women with these slim cigarettes. Women have the highest rate of increase in cancer at this moment. Cigarette-caused lung cancer, as you know, now exceeds breast cancer.
In summary, as a citizen, father, and physician, I strongly applaud the introduction of this legislation. Someone compared it to the launching of a ship of hope. Those who care about human misery and suffering are aboard. It needs some extra sails to strengthen it. Please don't let the saboteurs hack away at the masts and drill holes below the waterline and sink it in the harbour. For God's sake, don't let them. If you succeed, the mothers, fathers, sons and daughters who will be spared the painful consequences of tobacco addiction will thank you for generations. Please pass this legislation and strengthen it. Thank you.
Mr McGuinty: Thank you very much for your very articulate, moving and compelling presentation. I have to ask you this, though. Why aren't we addressing and why haven't you addressed the big problem, which is that we have over the years developed as a society, as a country, a terrible dependency on the tobacco industry. This dependency is not like a tumour we could excise or a piece of fat on the outside of meat; it's marbled throughout.
Just to give you an example, as a result of the recent decrease in the tobacco tax, apparently that affects the consumer price index, which is partly a function of the price of a pack of cigarettes, which in turn affects the CPP payments. Some seniors have started to complain that CPP payments will not go up quickly enough because they're a function of the consumer price index, which is a function of the tobacco tax.
Why don't we attack the problem itself, which is the tobacco industry? I'm not sure how we'd go about doing this, but I'd really like to see a presenter come forward with a long-range plan. How do we phase the tobacco industry out?
Dr Holtby: Sir, you have that long-range plan in front of you.
Mr McGuinty: I can't see it.
Dr Holtby: If you lack the documents from OCAT to support what we need to do to cut away the generation of smokers coming, we will see that you get it in your office tomorrow, sir.
Mr McGuinty: No, I'm talking about the farmers, and we've got 100,000 retailers who are earning their living with this.
Dr Holtby: Sir, name one pharmacy that has gone out of business because it stopped selling tobacco. Name one place in this province where there has been clear evidence of a business closing or suffering because it has voluntarily chosen to give up tobacco. We are not talking about jobs here; we are talking about death. We are talking about a product that kills when used exactly as intended. The stakes in this game are extremely high.
I'll make just one last point: The revenue that your government administers generated by tobacco just covers the health cost of it -- in the past.
Dr Dhaliwal: Barely.
Dr Holtby: Barely. And now that the taxes have gone down, it will not cover the cost of health care. The money from the industry, the money from the taxes, just covers the cost.
Ladies and gentlemen, we have been through very difficult economic times, and I'm sure there has been harsh criticism of what the NDP has done economically in this area. There is a clear need to take the legislative steps now to stop the appeal of tobacco, to regulate the sale of tobacco. That's what we're talking about doing. That is the clear need. If we do those things, then in time the effect of the tobacco industry will wane and the economic necessity will wane.
The people who are addicted now will not stop smoking tomorrow. They're addicted. The guy who wrote those words smoked until he died.
Dr Dhaliwal: Society can be weaned. As you well know, there are many societies that exist without smoking at all. I come from one of those societies, and it isn't an absolute necessity. As you know, this is the first legislation we're effectively talking about in Ontario, yet hundreds of thousands of people have given up smoking, some 20% reduction. If you continue that trend by strengthening those measures, then you will wean society off, but it is as addictive as heroin. Would you use the same argument and say that because we depend on some of the revenues from heroin filtering, in illegal ways, into our society, we should continue that?
Mr McGuinty: Gentlemen, please don't be too quick to misinterpret me. First of all, you should understand that this legislation will, in all likelihood, receive unanimous support. My concern is with the big picture and the big mixed message, which is that now you've got to be 19, now you've got to be an adult, before you can get hooked. How do we get it away from the over 19-year-olds?
Dr Dhaliwal: You start getting hooked from the day you start experimenting with cigarettes, and I have known seven-year-olds experiment. That is why we urge control of access; just pure preaching will not do any good. Control of access is a vital part of that strategy.
Dr Holtby: You say, "Keep the big picture." Well, keep the big picture. Nineteen is a small detail. The longer you delay access, the fewer people will begin.
Mr Wiseman: One of my other pet peeves is that we calculate the consumer price index on a package of goods that should not be included, such as taxes and taxes on cigarettes and the purchase of cigarettes, something I think we need to look at.
Also, in terms of revenue, it's about $900 million the province receives. I would think the health care costs associated with paying for cancer and heart disease and other smoking-related illnesses -- when you go to a doctor, the first thing they ask you about any illness you're showing symptoms of is, "Do you smoke or drink?" The costs have got to be way, way beyond a billion dollars.
I think parents and health organizations should have the right to sue vendors or people who give cigarettes to young kids, as a means of enforcing.
Dr Holtby: If there's a fine system, you're going to have a problem. The police are not going to be keen on fining the poor corner store owner who gets duped into selling cigarettes to someone, but if all that's riding on it is his licence -- and I can tell you that right now, today, I have three Boy Scout troops interested in being the licence patrol.
With licensing, if you sell cigarettes to an underage person, you lose your licence, perhaps for a week. The second time you might lose it for ever. No one gets fined. It's easy to enforce. It's highly effective. Other areas that have done it have found it extremely successful.
Dr Dhaliwal: Apart from the costs, we must keep in mind the misery and the suffering. That is unquantifiable. That's what I see. I cannot measure it in pounds, in dollars, in cents.
Dr Holtby: We're not here because someone's paying us. We're not here as a lobbyist for some group. It costs me money to be here. My overhead's stacking up as I sit here. I've got work to do. I'm going from here to do work. Why do you think I'm here? I see the effects of this every day. I have people saying: "I can't stop. Why did I ever start?" You people can help people not start. For God's sake, do it.
The Chair: Gentlemen, thank you very much for coming here this morning.
Mr Ryan Fitzpatrick: My name is Ryan Fitzpatrick and I'm here today representing myself and my friends. Thank you for giving me this chance to speak in favour of the proposed legislation that will protect me and my friends from becoming addicted to cigarette smoking.
Cigarette smoking is not something our parents, teachers and doctors want us to do. They teach us to respect others, get good educations and live healthy lives. Why then would certain people make young people get hooked on something that will affect our good health and offend the people around us?
We all know that the legal age for smoking is 18. Do I look 18? I don't think so. I am 12 years old, yet I was able to purchase these cigarettes from many stores very, very easily. Now, buckle your seatbelts, hold your stomachs, put on those oxygen masks, because this is going to be a bumpy ride. These stores include: two very small corner stores, Esso gas stations, Suny's gas stations, Mike's Mart, the Great Canadian Superstore, Safeway and Shoppers Drug Mart.
Drugstores are places to buy medicine to make you get better. Why would they want to sell drugs that make you sick? Grocery stores are places to buy nutritious foods to keep you healthy. Why would they want to sell drugs to make you have bad health?
The clerks in these stores didn't feel any guilt whatsoever when they took my money. For instance, I walked into a gas station, Suny's Gas, and I said, "My dad's out in the car and he just asked me to pick up some cigarettes." He was talking on the phone. He didn't look at me or anything. He just threw down the cigarettes and took my money. He didn't ask any questions.
Then there are the vending machines. Nobody saw me, nobody cared. I just put in my quarters and pulled the knob. I easily got them from family restaurants, including Swiss Chalet, Casey's Restaurant etc, also the cigarette vending machines at recreation centres, such as local ski areas. Vending machines are a real treat for kids like me under 18 who want to start smoking.
The packages are designed to look nice so kids like me want to buy certain packages. For instance, the way I picked my cigarettes is I walked in and looked for the best-looking package -- like this. It's very nice looking. It's all nice and gold and looks rich. It makes me almost want to smoke them, maybe.
Bill 119 will help these problems.
(1) Give us kids a chance. Stop making it easy for us to become addicted to cigarette smoking. Don't let stores sell cigarettes to young people.
(2) Make it impossible for me to buy cigarettes at all stores. Put cigarettes in beer and liquor stores. It might even help half the population quit.
(3) Take away vending machines that will take anybody's money, regardless of age.
(4) Quit making designer packages that will make us want to buy certain brands. Plain packaging would be better, it would be definitely better.
Break the habit. It's not too late to break the bad habit of making it easy for young people to buy cigarettes. Help kids develop good habits. This new legislation is a healthy start. Thank you.
Mrs O'Neill: Thank you so much, Ryan. It's one of the best presentations we've had, because what you say is so authentic.
Would you say something about illegal cigarettes? Have you had that opportunity? You've had opportunity on the legal market. Has the contraband market approached you or are you aware of its presence in your circles in Thunder Bay?
Mr Fitzpatrick: I'm sorry, please rephrase that.
Mrs O'Neill: Has anyone approached you and offered you very cheap cigarettes, smuggled cigarettes?
Mr Fitzpatrick: No.
Mrs O'Neill: So that's not a problem in the area. Well, that's good news for us. Thank you so much for your presentation. We found it very meaningful.
Mr Carr: Thank you very much for a good presentation. Obviously, you did quite a bit of work.
I was interested in your thoughts with regard to the price of cigarettes. I take it that you got the money from somebody to do your purchases. We may take one step forward with this piece of legislation, but before the next budget this government will reduce the price of cigarettes, I suspect -- but not necessarily -- as the federal government has done, and Quebec. So we'll take one step forward and take one step back.
How much of an effect does the cost of cigarettes have on young people? You can do it very easily now, as you proved. This bill will make it tougher. How much, in kids your age, is cost a factor in buying them? Do you know from your friends' experience?
Mr Fitzpatrick: Tons of my friends smoke. They don't really mind the price. As long as they're seeing smoke come out of their mouths, they're just happy the way that is. They wouldn't care if they're taking most of their allowance and going down to the store; it's basically nothing.
Mr Carr: With the price of cigarettes, the allowances must be up a bit higher than they were in my day.
We've asked experts the reason kids are smoking. Maybe you could just give us your perspective. What do your friends tell you about why they are smoking?
Mr Fitzpatrick: They smoke because they think it's cool, just to see a pack like this in their pocket, to wave it around and see smoke come out of their mouths, just to sit around and be cool, I guess.
Mr Carr: A lot of the reason, I think, is that they want to look older. You don't need cigarettes. Anybody listening to your presentation would certainly think you're a lot older than 12 years old. You've done an excellent job. I've seen presenters who have done hundreds of these things and they haven't done as good a job as you. If you can take anything back to your friends, it's that it isn't the cigarettes that make you look older, it's the way you present yourself, and you've done an excellent job here today.
Mrs Haslam: Actually, when you're my age you don't want to look older. You can take that message back to the young women in your class.
Mr Wiseman: She doesn't smoke either.
Mrs Haslam: No, I don't smoke; I never have. But I used to be a teacher and I'm very interested in young people, very interested in how we can get the message out, and I ask those kinds of questions in this committee. It's really one of my strongest cares, the young people. Right now I have a 20-year-old and a 21-year-old, so it's like Mr Wiseman, with children coming up to the magic age of 12. He's scared to death, I'll tell you. He's scared to death because his young daughter is coming to the age of 10 and 11, and that's why he wants to sue the pants off anybody who gives his daughter cigarettes. That's why he's so concerned.
In my day you used to go out on the corner and it used to be that it wasn't cool. It was the troublemakers, with the slicked-back hair and the rolled-up sleeves -- now I'm aging myself -- but it wasn't as if they were the group I wanted to belong to. Has that changed now? Is it the perception of young people that it's the cool ones, the popular ones, who are smoking? I was under the impression that it had changed in the last few years, that you're cool if you don't smoke. Is that perception changing in school?
Mr Fitzpatrick: In my school, it is the popular kids who do smoke. They're not the slicked-back, bad people; they're any normal, good kid or kid you wouldn't even notice. There are girls in my class who smoke. You'd think boys would do it, but there are lots of people.
Mrs Haslam: That's the other detail that really bothers me, that the percentage of young girls smoking is higher than the percentage of young boys smoking. I have my own opinion, and it's a very feminist opinion, about the self-esteem of young women and why they smoke and why they hang around with boys who smoke, so don't get me started on that one.
The other question I have is around marketing. We've just had a person present who said that we're exploiting our youth, the marketing is exploiting our young people. When my daughter was going through high school, not elementary school, they looked at marketing. They came home and cut things out of magazines to say, "What kind of marketing tools, what age level were they gearing these to? Why was I so eager to buy this brand of jeans versus this brand?"
Is there any of that kind of class at your level? Would it make a difference if the message was: "You're being exploited, you're being used by a conglomerate that posted a $125-million profit for one quarter of its year"? Would that message get to you more than "It's cool"?
Mr Fitzpatrick: If Michael Jordan, say, or someone like that was advertising cigarettes, I think kids would buy them, but if someone like a 16-year-old person was advertising them, they'd think, "Oh, gross." You see in beer commercials 20-year-old women, all beautiful and everything, and they're all jumping around, all having parties, and you think it's pretty cool. But if you saw someone who wasn't, well --
Mrs Haslam: If you're more aware of that fact, as you are, if you're more aware of the effects of marketing certain products, would it change your perception of the need or the desire to smoke?
Mr Fitzpatrick: Yes.
Mrs Haslam: It would. You have survived peer pressure.
Mr Wiseman: So far.
Mrs Haslam: So far. That concerns me. I had a son who survived peer pressure, with a mother who didn't smoke and a father who said, "Don't smoke," until he was 19. I could cry that he didn't make it to 20. I congratulate you on surviving peer pressure. How were you able to do that?
Mr Fitzpatrick: It's sort of like saying: "Would you like to see me like this when I'm 20?" I'll be coming to Dr Holtby and be put in a hospital bed saying I'm all sick and everything. I wouldn't like that to happen to me. I hear all the stories he's told about people dying. It's just not worth it.
Mrs Haslam: I congratulate you and perhaps Mr Perley at the back from the association of non-smokers' rights would like to sign you up now for his organization. If this legislation is a step -- and it is a step. It's not perfect. I don't think we'll ever see a perfect world. I don't think any government will ever come up with perfect legislation. I think this is a really good step and I think he could use you in another five or six years. Good luck.
The Chair: Ryan, on behalf of all the members of the committee, we thank you for all the work you put into your presentation and for coming here this morning.
ONTARIO PUBLIC SCHOOL TEACHERS' FEDERATION, THUNDER BAY DISTRICT
Mr Jim Green: Good morning. I'm Jim Green, district president of the Ontario Public School Teachers' Federation. The federation represents approximately 30,000 educational professionals, and locally I represent approximately 500 educational professionals. I'm the official spokesman for the 500 and have the approval of the 30,000 to be here.
I didn't want to give you a written brief because you will get enough information with the facts and figures from other groups. I wanted you to be aware that teachers are concerned. We have worked long and hard to educate children about healthy lifestyles. Our group has gone so far as to pass specific motions at our annual meeting to direct teachers to attempt to reduce the incidence of smoking among children. We have debated quite heavily how to do this. We have lobbied to have schools made into smoke-free environments, and we're continually working to develop incentives and support programs to encourage smokers to restrict or quit smoking.
From personal experience, I believe the concept of preventing children from smoking before they reach 20 years of age is an excellent move. Most smokers I know started prior to being 20 years old, and I would be among them were it not for health problems in my youth. So I must commend the government for taking this initiative, and the other members here for searching out the information and supporting it.
We in the Lakehead Board of Education have a smoke-free policy. I notice there are still some students standing out on the curb smoking at some of the high schools. Perhaps making the possession of tobacco illegal will help some of the schools to deal with this issue.
Having been a former operator of vending machines, I understand the concern about free access. I'm not going to suggest that they're an evil item, but the control is difficult, and not having seen a satisfactory control, I believe this may be an appropriate move. If the city of New York can do it, I guess the province of Ontario can.
I just wanted to make very clear that as teachers, we're concerned for the students. We need all the support we can get, and we believe this legislation will provide support for the classroom teachers when they are bringing forward to the students healthy lifestyles, which exclude smoking.
The only really unfortunate part I see in this legislation is that it doesn't seem to address the issue of banning smoking in places where you can consume food. I sure would like to see restaurants all smoke-free. I patronize the two local restaurants I know of that are smoke-free. Part of the problem with restaurants is that if a neighbour doesn't ban smoking, others are forced to follow suit and not ban it for fear of losing business. If no one can do it, it will work for all.
I see this legislation as a good first step in dealing with youth, and I hope you will continue on with it and enhance it later to look after healthy lifestyles for the rest of us.
Mr O'Connor: To clarify, New York City doesn't have a total ban. It's very restrictive, but not a total ban.
One thing we have had some discussion about around the committee table was putting the onus on the young people. When Ryan was before us just a moment ago, the thought crossed my mind, should a person his age be the one we're going after? Should we have arrested him, busted the kid as he's leaving because he's been out there purchasing cigarettes to make a point? I don't know whether putting the onus on the young people who are the target of a very seductive advertising campaign -- of course, they're not allowed to advertise in this country, but it certainly does take place. What are your thoughts on that element?
Mr Green: I see the young people as the key, no question. We see it in the elementary, that students are smoking. Anything we can do to make it more difficult for them to access cigarettes and anything we can do to educate them about why they shouldn't access cigarettes will go hand in hand to help reduce the number of students who smoke. We believe we're doing all we can at the school level. This government initiative will give us some much-needed support, and in the long run it will pay off for all of us.
Mr Wiseman: Just a comment on Ryan's presentation. It seemed to me that what he was asking was for us as adults to protect him. While he was presenting a very mature and very well-thought-out presentation about why we should pass this legislation, there seemed to be an undertone that he's also saying that as adults and people who know this, for those who haven't matured to his understanding, we are really here to protect other young people from what is going on with the slick advertising and so on.
We've heard from other groups about peer pressure being an important issue, and we heard earlier from Dr Jim Morris, who used to be a principal, that in the 1960s or in the 1970s they would have peer groups go into the elementary school and discuss with the youngsters about not smoking. Is that still in existence, and if it isn't, do you know why it would have ended or it can't be re-established?
Mr Green: I'm not specifically aware of the program. I know in our system teachers are always looking for ways to get the message across, and I'm sure any peer messages they can bring, they do, but I'm not familiar with this one.
I do know the strength of peer pressure, though. In my own family, my son did not smoke as long as he was at home. When he went away, less than 20, he spent his two years in university rooming with people who did smoke, and that was enough influence to make him into a smoker. Anything that can be done, I think is wise.
The Vice-Chair (Mr Ron Eddy): Thank you for your presentation. We appreciate your coming before the committee.
Dr David Williams: I'd like to thank all the members of the committee for the opportunity to speak with you today. My role here is, well, more than threefold. I am the medical officer of health for the district of Thunder Bay. I'm the acting medical officer of health for the northwestern Ontario health unit. I'm also the vice-chair of the OMA section of public health physicians. I am also a father of four children, and I can speak about it from a personal perspective as well. So on all those opportunities, I would like to address the issues today.
As has already been mentioned by others, I'd like to congratulate the present government on its stand in bringing forward and placing this bill in the Legislature. I think it is critical at this time that we make a stand and move ahead on this issue. I'm very disappointed in the federal government's move to roll back the taxes and the costs that are there.
If I can use an analogy, since I'm speaking on public health issues, it's akin to having an outbreak of infectious hepatitis in a large camp and a decision's made to curtail hand-washing prior to eating because there have been squabbles in the line over the people cutting the washing and getting into the food line first. It solves one problem, but it creates a major epidemic in the long run.
I won't talk about all the issues of the act, so you don't have to worry about that, and I won't give you a whole collection of data and statistics. You have already received much of that in various formats. But I do want to speak on some issues.
One aspect I won't deal with is the accessibility. Ryan did a great job on presenting that. It is not a problem in northern Ontario. Accessibility is a free game, and there's no issue. The students have access any time, anywhere.
My one role is to speak on northern Ontario. What are the perspectives we face here? What is the epidemic in tobacco we face here, especially among our youth?
In the jurisdiction I cover, which is pretty well a third of the province, and the populations that are involved there, including the aboriginal population, we have some very disturbing statistics to put forward. One is that in our females aged 12 to 19, our average of smoking is 46% compared to the provincial average of 18%. Male and female combined aged 12 to 19 is 37% compared to the provincial average. In the low-income group, 47% of low-income people smoke compared to the provincial average of 33%.
In terms of some of the questions asked before regarding what the impact is of early smoking upon you, when you look at how many people in northwestern Ontario began smoking prior to the age of 18, it was disturbing to note that among the males in northern Ontario, 80% had started prior to the age of 18 compared to the provincial average of 67%. In the women, up till now, and no doubt it's going up all the time, 66% commenced before the age of 18 compared to 59% in the province as a whole.
It's important to note that with those children brought up in northwestern Ontario, the likelihood of having one or more people in the household who smoke is twice the provincial average. The accessibility to secondhand smoke is there all the time, not only in that sphere, but also, as alluded to by the previous speaker, wherever you go, the number of people smoking in public establishments is tremendously larger than in southern Ontario. I know that, because I came from southern Ontario three years ago. This is of great concern.
The other thing local data indicate is that among our grade 9 and 10 students -- and we'll show some data on that later, what we've done locally -- over 40% are already smoking by grade 9 or 10 in a significant form, as compared to 18% in the provincial average.
We have to ask ourselves, why is smoking worse in the north? Is peer pressure worse in the north than down south? Why are teens taking up the habit at an earlier rate and a higher rate than the provincial average?
Easier access has been noted already, and that is a great issue to overcome. Various methods are laid out in the bill that will deal with that, not strong enough perhaps.
There's greater exposure to secondhand smoke and environmental smoke from childhood and from infancy and prior to birth. You only have to watch what's happening around the area, and I'll cover that when I cover environmental tobacco smoke.
We lack initiatives in laying down bylaws throughout our areas, and I'll talk about that in the third point I'm going to raise.
There's very little impact on safety in the workplace, smoke-free environments. The act has made very little impact, and this is especially concerning with a number of summer students who work in these environments.
On that point, we have a very big problem in northern Ontario. It's a big problem across the province and in the country. I think Ontario can lead the way in dealing with a number of these issues, as laid out by the Premier's health council on prevention and promotion, and we should take those strides.
One of the main concerns I have in this area is dealing with environmental tobacco smoke. There are plenty of data out there, and I have a number of articles, even in the last year, indicating the impact this has on children who are passively taking up cigarette smoke, with the levels of the byproducts of nicotine in their urine samples. Also, with infants and the effect on the unborn child, that is there all the time. We have a large number of mothers who smoke in pregnancy, and especially with the younger teens the concern is that by the time you figure out you might be pregnant, you're already into your second trimester and a lot of the impact has already taken place.
The immensity of this problem in northern Ontario is that children like Ryan really have very little choice but to go into establishments and be exposed to this, whether it's a McDonald's -- which surprises you; it's a children's restaurant and it's inundated by smoke -- or most of the other restaurants around the area. As well, there are areas in schools where teachers are allowed to smoke in lounges. You say, "Well, that's maybe not a problem."
The problem in northern Ontario is that people want to be very efficient in their heat costs. Therefore, external air exchange is minimized. We often go in and have to investigate in our public health role CO2 contents in schools and public buildings and find to our surprise that someone has been overenthusiastic and cut back the exchange so it's less than 25%. This means any smoke in the area is circulated freely around to everyone to inhale all day long.
One only has to sympathize in looking at one or two children strapped in car seats in the back of private vehicles while two or three adults sit there and smoke for hours on end with the windows rolled up for hours and the heat system put on recirc, or in a taxicab we have to sit there, or the driver, and breathe this stuff hour after hour. Bingo halls are notorious. I don't know how you can see the cards sometimes. It's so thick you can cut it with a knife.
What does this mean for our children? This means children are exposed to enough smoke to make them already pre-addicted, I feel, and open to greater perception later on. Myself, I have an irritated airway and I have to use this from time to time, especially in a smoke-filled environment. When we're going along the highway -- and this is a problem with tourism -- sometimes you'll have to get your food and quickly go outside and eat in the car, because when you have over 60% to 70% of patrons in there smoking heavily, you can hardly breathe at times.
The act, while bringing about some rules limiting and asking for bylaws, I feel is lacking the teeth to move forward on that issue, both with the municipalities to deal with and also with local establishments. As the former speaker said, if I'm the only one on the street, it's very difficult, but if everybody else goes by the same rules, it's fair and it's fair game for everyone.
We have to deal with this very seriously in the province, that a lot of our children are being pre-addicted to tobacco and the influences of that and therefore are resulting in a whole new generation of future smokers coming up.
That leads into the third point, which is around bylaws. We did a survey of the bylaws around our whole area here and of all the municipalities. We have a lot of small ones, and they have to deal with a lot of local pressure. On most councils, a large percentage are smokers. Nevertheless, they have a strong desire to see some protection of their youth, and I know they are sincere in that.
The thing is, do you have the wherewithal to move the bylaws forward? Is there a model bylaw the province would put forward in the act to say, "Here's what we suggest all municipalities put forward and deal with, not only in the municipal buildings but also in restaurants and in public places such as shopping malls"? What kind of enforcement will be used so municipal councils will feel they have to take the initiative and deal with it and give them the freedom to move ahead on that?
Around the municipality, we did a survey. Some have some bylaws related to their municipal buildings but usually have a smoking room that most of the time, we found, is not adequately ventilated to the outside. None of them have public smoke-free bylaws in place, in both Thunder Bay and in northwestern Ontario. Some workplaces do have policies, but usually common areas such as cafeterias are literally smoke-filled. An exception is one of our pulp and paper mills in the Fort Frances area that has been more aggressive and leads the way in setting an example in that.
So we need stronger workplace bylaws, and in the act here a good model and example that will encourage municipalities to take the issue and move forward with a healthy public policy direction, as we've laid out in the province under the Premier's health council both in the present government and in the past government.
On that point, I'd like to ask that the committee move ahead and take leadership, as the province of Ontario can do and has the ability to do in spite of a lack of consistent direction on the federal side. We now have to deal with a greater epidemic. Just like discontinuing the hand-washing at the camp, we've got to move ahead with some more rules around preventive and promotional materials. Give us the teeth and public health line to lay in some rules and regulations around tobacco.
Mr Tony Martin (Sault Ste Marie): I don't think there's any doubt that the legislation in front of us today is going to pass. The question is what we will do to make it better.
What concerns me, as we sit here, is the same thing that concerns you: the bigger picture, the context within which we do this and the decision of the federal government and what that creates for Ontario, as we try to be good citizens, as we try to be in harmony with the groups you represent today in trying to reduce the consumption of tobacco products by pricing them at a level that makes them really not attractive.
Over the last couple of weeks I've been trying myself to figure out how we do this. Ultimately, we as a government will have to make a decision. We're pushed into a corner where, because of what the federal government has done and our neighbours in Quebec, we will have not only contraband tobacco coming in from the States now but from Quebec as well. Access, even though limited by what we are doing re this legislation, will actually become greater, because it's going to be everywhere. It'll be out there at every corner in every corner store and all those kinds of things.
What advice do you have for us? Do we cave in? Do we drop the price so we keep the contraband out but therefore make it in fact more palatable for people to smoke because it's cheaper? Or do we hold the line and somehow try to deal with the contraband in some other way? I have to tell you, I'm at a loss.
Dr Williams: My first reaction is to block the rollback and hang firm, as Ontario can do, and lead the example in that line. The difficulty is, as in the analogy I gave, if you don't have any other strong reinforcement to hang on to, it makes it very difficult.
Bill 119, that we're trying to introduce now, probably should have been there five years ago. We should have been taking stronger strides towards bringing that into line, to say there's more. The cost as one inconvenience is one thing, but there's the inconvenience that you can't smoke in a restaurant, you can't smoke in a public place; that you find smoking in general is a custom and a habit that's not applauded by the public at large and you're made aware of that.
Even now they'll ask you at times at a car dealer, "Do you smoke?" and a non-smoker's car is cheaper. Make it a rule, for example, that cars no longer come with cigarette ashtrays: That's an option you have to pay $500 or $700 for, or you get a CD player instead of a cigarette ashtray -- why is it standard? I don't know why it's standard any more -- and that the resale of your vehicle goes down.
It's the same if you're going to have a restaurant that has smoking. Put in such stringent rules around air quality status checks that you'll have to put in a very expensive ventilation system to keep the air purified, and in spite of the heating cost you'll have to recirculate 50% to 60% of your air outside, and a lot will find that a difficult thing to move forward on.
If you're going to offer tobacco in that type of environment, you're going to have to pay the cost of that. I think the people will have to bear that cost rather than the students and the children who are inundated by this problem all the time.
Because you're dealing with the rollback on the pricetag and that's going to be a very difficult issue to deal with, the contraband, the fact is that we have to have firmer ones that will decrease the accessibility and also at the same time decrease the convenience of having tobacco, to protect our children and unborn children coming up.
Mr McGuinty: I appreciated your comments and criticisms of the federal government rolling back the tax and the consequences that will have in the long-term plan to reduce smoking, particularly among our young people. I am very concerned about what the Ontario government is going to do in the face of that. I suspect it's simply a matter of time before they roll back taxes in this province. I hope that won't be the case, but that's my suspicion.
There's a great deal of smoking going on in northwestern Ontario. I'm trying to separate out the influence of tobacco companies' advertising and adults smoking. Do you know whether, if I've been raised by parents who smoke, relations who smoke, if I live in a community where it looks like, if you're an adult, you smoke -- of course kids, as you know, want to look older. They want that independence and that freedom. They're not really into the responsibilities, but they want to look older. One of the ways you can look older is to smoke. Can we separate out our milieu as distinct from the advertising? If there all kinds of people around us smoking, am I more likely to smoke? It seems I would.
Dr Williams: I think they do play in together, having seen the effects in southern Ontario, and here we're delayed a lot further. The media and the marketing techniques are there. If everybody around you is smoking and from the age of zero up you're probably inhaling the equivalent of one or two cigarettes a day in secondhand smoke, it starts to bring in pre-addiction, and when you're under stress in the future -- I am very concerned, and science will probably bear out in the time to come, that there is a pre-addiction taking place, and of course our youth are under a lot stress these days, and it's a stress reliever for a lot of people. Maybe we're unwilling to admit the fact that our children are already pre-addicted in this process because of their exposure in that way. The more you're exposed to that, the more you breathe it all day long, therefore the easier it is, when you start to try one or two cigarettes, to say, "This really does feel good," and you start to get back into it very easily, that you're more susceptible to addiction and pick up on that. I think the local milieu is very important in this as well.
Mr McGuinty: I'm interested in your use of the expression "pre-addicted." If I'm a child and I have inhaled a lot of secondhand smoke, is it possible that I have developed a real addiction in the sense of physical need, a craving, for cigarette smoke?
Dr Williams: That's my jargon. As we measure levels of cotinine in the urine of the children, we know they've been exposed to levels of nicotine. What effect does that have on brain development, on the various centres? We realize that tobacco is a real addiction. It's not, as some say, just a dirty habit. All you have to do in northern Ontario is watch people at 35-below having to get out there for a cigarette. Isn't this an addiction? You better believe it is. It's the same with the youth who are out there their shirtsleeves, out of the school, standing on the edge of the property 200 yards from the door of the building. You've got to be addicted, you've got to want it.
Ms Carter: You certainly made a strong case for northern Ontario having a higher problem than the provincial average. What effect do you think this federal tax rebatement is going to have on the availability of cheap cigarettes here and the problem it causes?
Dr Williams: Manitoba still is holding on, so I don't think across the border on that side will be the issue. There is still across the border on the American side. If the province rolls back the taxes accordingly, it will make it much more accessible. I indicated here the number of families that are low-income that are smoking. It seems we have a high percentage because our average level is not the same as it is in southern Ontario. I think that will be a main factor for those who were thinking of quitting. There have been a lot who've quit who say, "I just can't afford it any longer." That has really added teeth to the programs, whatever method you want to use. The same will happen with the youth with that rollback, because there's less of an incentive to try to quit because they need the money for those other things -- the date, whatever they want to go on.
We have to wrestle with the fact we may have to put in patch programs or whatever in high schools, because already you have to start a discontinuing program in grades 9, 10 and 11. It's a sad state of affairs, but we may have to seriously consider that.
Ms Carter: I was interested in your statement that environmental tobacco smoke can be addictive. I remember as a kid being in smoky rooms and feeling bad, having itchy eyes and a sore throat and a cough and so on because of it. Is there any scientific proof that it can actually encourage people to become smokers?
Dr Williams: No. It's difficult. How can you prove measurements of addictability even in the adult, except I have it in behaviour? The adult who is addicted has high levels of nicotine and the byproducts in the urine, and if you take the fact that an American study in the New England Journal late in fall 1993 found elevated levels of cotinine in those children with passive smoking, they've obviously been exposed to nicotine. How do you measure addictability? It's a very difficult thing to say, except maybe with a good prospective study, and that would take a bit more work: Of those who have been exposed to a lot of secondhand smoke, what is their uptake of smoking, more or less?
If you look at northern Ontario, do our children in the north have greater peer pressure than those down south? I doubt it. I think they have the same peer pressure, the same stresses, the same exposure to marketing. But they have a lot more exposure to secondhand smoke, by looking at the stats and data, than kids in southern Ontario. It may be relevant, but to say it's a hard scientific fact -- I don't think anyone has that kind of research methodology to prove that except by a prospective study. That would be good work to carry out.
Ms Carter: It's also part of a message that smoking is normal and this is what everybody does. Does that exposure of so many youngsters to environmental smoke have a measurable effect on general health levels, on the number of kids who are getting chest problems, or whatever?
Dr Williams: I've been trying to follow this along over the last two or three years. I've had complaints from many teachers wondering why there's an epidemic of these things showing up in the schools. They say it just seems to be escalating every year by leaps and bounds. I would like to do some studies to see what is the percentage and do some comparison over years.
Most of the paediatricians will comment that they don't know why they have so many children around who have very irritable airways that require, even after a cold or minor things -- I remember this as a kid myself, that before this was diagnosed, my cold would go on for almost three to four weeks and I'd have to have antibiotics every time. I now know that if I take my inhaler at the right time when I'm in a smoky environment, I don't have to resort to that. A lot of the children weren't aware of that in my day, and now they are.
There are a large number with asthmatic or asthmatic-like conditions who have very irritable airways. As result, it seems like every kid's walking around with some of these in the schools at times and Epipens are everywhere.
Ms Carter: I've heard the same thing in my own area, that large numbers of kids are using inhalers.
Dr Williams: I can't say it's purely due to smoking only, but I'm very concerned.
The Chair: Dr Williams, thank you very much for coming this morning and for your presentation.
Ms Jennifer Paxton: I am Jennifer Paxton, a 15-yearold grade 10 student at Sir Winston Churchill Collegiate and Vocational Institute in Thunder Bay. I'd like to thank all of the members of the standing committee for coming here today and hearing our arguments and our ideas on the passing of Bill 119. It takes everyone's time and effort to get it passed, and it's a large commitment. We need it to be accepted into society, because smoking stinks.
Although all aspects of Bill 119 are important, I feel strongly on two aspects as a teenager, because I have two parents who smoke and friends who smoke. I'd like to see them have a challenge put up against them, that they have a harder time getting tobacco. It's too easy for them to walk into a store and purchase tobacco products. I've discussed it with a few friends and even they find it too easy to walk into a store and just ask for a package of X brand smokes. They just get them, no problem.
The two aspects of the plan I'd like to talk about are the plain packaging and the licensing of stores to have more control over who is purchasing the tobacco.
The plain packaging: It's common knowledge that colour and looks sell a product, like jeans. If they look good, people will buy them. Cigarettes: If the packages are bright, the designs are good, people are going to buy them. They catch their eye; they buy them. Plain packaging should be regulated, because then it makes the packages look dull and dirty and people will decide they don't want to be seen walking around with the packages. They're more likely to keep them hidden or even not buy them because they don't catch their eye. They don't want to pay for something that looks dull.
As a teen, I see people going around flashing colourful packs of cigarettes, feeling they are cool and more popular because they smoke cigarettes. If it is made so that tobacco companies are forced to have dull-coloured packages with health warnings on all sides clearly visible, it will have a definite effect on the teens who are considering taking up this habit. They will see how ugly the packages are and it will make them less eager to be seen with them.
Younger children, when they go into the drugstores or the corner stores and stuff like that, see the small packages behind the counters and figure that since they see their friends and relatives walking around with them, if they've got them in their hands they'll be cool, they'll feel older, more responsible, whatever. If they're bright colours, they tend to see them more than if they were dull packages with no designs on them. It's just like pieces of cardboard. They don't want to buy them, no interest. It's kind of like hockey cards -- same effect -- in the packages. They'll soon realize how much of a social outcast smoking is and eventually they'll change their ways, I hope.
Enforcing the new plain packaging will result in more children deciding they'd rather not buy the cigarettes because of how ugly they appear compared to the eye-catching packs you see nowadays.
Smoking has an image of being fun; it makes you look popular. If smoking gets an image now, if the bill gets passed that plain packaging can be regulated, it'll just change the image totally.
Whenever you go to sporting events or hockey games you look around the arena and see advertisements for Player's Light, Rothmans, du Maurier all around the rink. That's giving the image to the people watching the hockey games and stuff like that that smoking is all right. If it's at a hockey game, that means the athletes will be smoking, and if younger children see the athletes smoking, they think it's all right for them. It'll make them stronger, better players of hockey, football, whatever sport it is they're watching.
If you look at the posters, the banners or whatever, they are the same colour as the packaging of the cigarettes; they are related. If the packages are plain-coloured, there will be no relation between the banners at the sporting events and the packages of cigarettes, making it harder for the younger children to determine which cigarettes, because there's no colour to relate them to.
The second point I would like to stress is the licensing of stores that sell tobacco products to minors. It is way too easy for students to go into a store and buy cigarettes. I've said that before, but it can't be stressed more. My sister's in grade 7, so she's 12 years old. She can easily walk into a store and request cigarettes. You saw Ryan today. He went into 10 stores and he managed to purchase eight packages from the 10 stores. It was so easy, he just walked in and asked for them. They didn't ask any questions at all.
Making it so that a store must be licensed to sell tobacco products would make their owners more reluctant to sell them. If when they are caught they must pay the consequences, ie, losing the privilege of handling tobacco products and therefore losing the profit of selling the product, that would be good because they would be more reluctant to sell to a minor without asking. I'd say a good idea would be asking for an age of majority card because then you automatically have proof of how old the person is. If they don't have it and the storekeeper is caught selling tobacco products to a minor under 19 years old, he can be charged or lose his privileges of selling it. If he does that, he is losing the great profit of selling tobacco even to those over 19 in the community. I feel they would recognize this and, instead of selling to a small minority of children under 19, instead of losing the profits from all of them, just lose the ones from the minors.
To summarize, it is too easy for teenagers to smoke -- young children, teenagers, all alike, it's just too easy. Tobacco is an addictive substance. At the young age children are beginning to smoke, they just look and see other people doing it and they figure, "They're doing it." They don't realize it's addictive when they start, but later on, after they are addicted, they cannot break away from it. They do not realize what they've done earlier. They're too young to make the decision for themselves.
If these issues are passed in Bill 119 and we limit the access to children under 19, minors, we limit their desire to smoke. We turn them off it. I have no will to smoke. I hope my friends will not start smoking. I'd like to see my parents quit smoking because it just -- it stinks. I'd like to convince them not to. I've tried, but they've been addicted to it since they were little and there's nothing I can do about it. I'd like to try stopping my friends from smoking if I have any say in it. If they ever say anything to me, I try to get them not to.
I guess that's it.
Mr Ron Eddy (Brant-Haldimand): Thank you, Jennifer, for coming before the committee with your views. It's really important that the members of the committee hear from students at our elementary and secondary schools on the tobacco issue and on the bill. The bill will do some things, and any suggestions you have to strengthen it are very important as well.
Across Ontario the availability of smuggled cigarettes is very apparent, to the extent that people buy them and sell them singly, we understand, in some school yards. There's also the problem that some tobacco manufacturers are making kiddie packs of, say, five cigarettes. The reason of course is they're much cheaper and they get people involved in smoking. Do you find those problems in the north as much? We know they are prevalent in parts of Ontario, but are they around in your area as well in schools?
Ms Paxton: I've never heard about any problems with smuggling around my school or anything like that. I know they'll purchase kiddie packs because they're cheaper than the regular larger packs. Quite a few students will buy them, or they'll split packs. They'll buy them in a group and split them up and divide the costs among themselves.
Mr Eddy: Do you feel strongly that the kiddie packs should be banned absolutely as well?
Ms Paxton: They should be banned because it just makes it easier to get them. It's cheaper; they still get cigarettes.
Mr Carr: Thank you very much for a great presentation. I was just wondering if you knew, among your friends, where they're buying. Are most of them buying them legally, illegally? How are they doing it?
Ms Paxton: I know of a few stores around the school and around the area that they can buy them from, or they get their older friends, older brothers and sisters to buy them for them.
Mr Carr: Is cost a factor to them? We heard young Ryan talk about how even at his young age they've got enough money. How much of a factor is the cost? They're fairly expensive and they're still able to do it. The cost is not a factor, I would say.
Ms Paxton: Some of my friends have jobs so they figure, okay, there's their money there. They buy smokes instead of gas for their car or whatever else they need. There are people I know who go around and bum cigarettes, to use that term. They go around asking people they don't know or friends they know for cigarettes or they buy them for quarters or stuff like that.
Mr Wiseman: I really appreciate hearing from you and from Ryan this morning and the other students we've heard, as this bill is directed at trying to prevent young people from smoking. In terms of peer pressure, what would be the single most important pressure that would cause somebody to smoke or to not smoke?
Ms Paxton: They see all their friends doing it. They think they're the only ones out, that they're not cool enough to hang around them, so they start smoking to try fitting in with the group.
Mr Wiseman: There has been some suggestion of an advertising campaign showing a big table with the owners of the tobacco companies laughing -- all the way to the bank, by the way, because the profits are huge -- and a message saying that young people are being duped and that they are being used to make huge profits for these companies, and of some powerful imagery, maybe even sitting around a coffin, laughing and celebrating their profits, with young people dying. We actually had presentations where somebody young, in their early 30s, who had been smoking for 23 years was dying of lung cancer. Do you think young people in your age group would respond to the fact that they're being used?
Ms Paxton: I think they would. It's their money that they're spending, and instead of spending it on cigarettes and getting these people to sit there and laugh at them, they can be using it on things they'd rather do like going to the movies and buying things they'd rather have than cigarettes, which only lead to death. They don't get anything from it besides sickness.
The Chair: Thanks very much for coming before the committee.
CANADIAN INSTITUTE OF PUBLIC HEALTH INSPECTORS, ONTARIO BRANCH
Mr Michael Reid: I'd like to take this opportunity to thank the committee and the government and the opposition parties for making this opportunity available for us from the north to make our presentations. I almost feel like I should be introducing myself as, "Hi. My name is Michael Reid and I'm an ex-smoker," which I am. I'm also a public health inspector with the Thunder Bay District Health Unit, and have been for 28 years. I am the Ontario branch president of the Canadian Institute of Public Health Inspectors. There are over 600 public health inspectors in the province, all of who are, as I point out, qualified to be named the inspector, if you will, named in the bill.
We do a variety of other things besides the role of provincial offences officers. A number of those are education, health promotion, and sanitation inspection in a variety of areas. A smaller part of our job, and I would like to stress this, is the role of the provincial offences officers. We certainly are more interested in, through education, having people do things the way they should be done rather than coming down on them with a heavy hand. I would also suggest that when this bill is made law, the educational aspect in dealing with those people who sell tobacco products is put foremost, before you come down with a heavy hand on them.
We also believe there's no reason for the province to create a new cadre of inspectors in the province, because we are already there. We have the background, we have the expertise to do the job. There will be costs, of course, because this would create an added workload to the health units and the public health inspectors now doing the job, but nowhere near what it would be if you had to gear up a new branch of inspectors or even, as the suggestion was made, turned it over to the Liquor Control Board of Ontario and had their inspectors do it. I think they have two inspectors for the whole of northwestern Ontario, which certainly would be inadequate for the job.
I would also suggest that the institute is in a position to bring public health inspectors in the province up to speed with the new act to have them ready to enforce this act. We have some expertise in this matter, inasmuch as we have dealt with the Ministry of Health as a cooperative partner in putting forward the Hazard Analysis Critical Control Point Protocols manual and have used the "train the trainer" aspect in passing that information along to public health inspectors throughout the province. We're also at present engaged in another joint venture with the ministry for a healthy environments mandatory program. So we are not without a certain amount of expertise in dealing with this whole matter of education as well as the enforcement aspect of the bill.
That's all I have to say at the moment.
Mr O'Connor: My question is around licensing. We've heard a number of presentations, especially in light of what the federal government has done. With the Liberal government lowering the taxes, we've heard more loudly and more vocally about the need for licensing. I just wondered if you have any experiences with licensing, because currently municipalities do have that ability and some have actually gone about putting that in. Have you had any experiences within that type of licensing system?
Mr Reid: Yes, we do. Certain municipalities do have bylaws that state that an establishment, whether a restaurant or whatever it happens to be, cannot get a new licence unless they have been inspected or have a letter from the health unit stating that there's no reason for them not to get their licence. There would be a control over that, and that assures the municipality and the health unit that these places have been looked into prior to a licence being approved. It's also a method of making people do what you want them to do, if you will, by withholding their licence, which means they can't operate, and which avoids court and that sort of thing.
Mr Jim Wilson (Simcoe West): As you point out, section 13 of the act says the minister "may appoint inspectors for the purposes of this act." It's been suggested to us that "may" should be changed to "shall." But you also point out, and I think it's an excellent comment, that the province shouldn't be setting out to create a new cadre of inspectors. To the best of your knowledge, have there been any discussions with the government about who these inspectors will be that are envisioned in Bill 119? Are you aware of any discussions in that regard?
Mr Reid: No, I'm not. In my comments, if I heard you right, I'm suggesting they don't have to. We can do it. In December, I wrote the Minister of Health suggesting that we were definitely for Bill 119 and that we were more than willing to step in and fulfil that role.
Mr Jim Wilson: Did you get any response from the Minister of Health to your letter?
Mr Reid: No, I haven't.
Mr Jim Wilson: Here's your opportunity. Perhaps the parliamentary assistant could tell us what the government envisions with respect to who the inspectors will be in this bill.
Mr O'Connor: It's my understanding that the Minister of Health already has gone on the record that we would be looking to the public health inspectors to carry out that role. I guess you've heard it again today. I appreciate what you have presented to us and anything you might want to add.
Mr Reid: I'm also saying that our institute has the expertise to be well involved in this, and the ministry probably is aware of that because of our involvement with it in the past in what we have done as well.
Mr McGuinty: To pursue this a little further, this will mean an increase in your workload, quite understandably, as you mentioned. What would that mean? You are responsible for a certain area?
Mr Reid: Yes, we are. I can read off a list of the various things we do, but we basically look after a certain amount of health promotion activities in terms of the Foodsafe program, rabies programs, communicable diseases. We run food handlers courses, as well as put in the HACCP protocols in inspections we do in the high- and medium-risk restaurants. We spend time on various committees, and we are fairly busy, but a lot of the times we go by, walk by and drive by, the places that sell tobacco, so it would be a matter of a little deviation to handle it.
But that's not in all cases, of course, because a lot of the health units are fairly busy. What with the social contract and the tough times, people have been laid off, and health units are stretched to the limit at the moment. As I say in my brief, there's no doubt that the government's going to have to put some money into it, but not anywhere near the amount of money it would have to put in if it wanted to start from scratch.
Mr McGuinty: How many people are employed in your unit and how many more would we have to hire to ensure they could carry out the provisions of Bill 119?
Mr Reid: We have six public health inspectors in Thunder Bay who cover Thunder Bay and area, and we have two health inspectors -- one lives in Geraldton and I live in Schreiber -- who look after an outlying area. I really couldn't say, until we get a finalized look at the bill and find out exactly what's going to be involved. I would think initially, if we do it the proper way and go out and do some educational work on it, that would take more time and more staff to do. I think that's an integral part of making sure that once the bill is enacted, it's put into force properly rather than just fanning out and nailing everybody.
The Chair: Thank you very much for coming before the committee today.
LAKEHEAD ELEMENTARY ADMINISTRATORS
The Chair: I call Laurie Margarit of the Lakehead elementary school administrators' association. Welcome to the committee. I can see there are two people here, if you would be good enough to introduce yourselves.
Ms Lise Haman: Neither one of us is Laurie. Laurie Margarit is in the audience. My name is Lise Haman, principal of Pine Street School, and this is Peggy Mason, principal of Claude Garton School, here in Thunder Bay. We represent the Lakehead Elementary Administrators.
The association is comprised of approximately 80 vice-principals and principals of elementary schools in the Lakehead Board of Education. We are committed to ensuring that our young people are educated and well informed to make wise decisions for their future.
In looking at the bill, the people it affects most are the young adolescents. Just as we plan our programs in schools based on the needs of the children and their stages of development, it's essential for us to take into consideration what the needs of the adolescents are and recognize what those are and ensure that the bill addresses that.
First of all, adolescents have a need to assert their individuality and their independence, to the point where they will defy rules. The other thing is that they are very insecure; they need to prove to themselves, prove to other people. In order to belong to groups, they'll experiment with drugs, with cigarettes and so on. They need to feel glamorous. The most important thing is that they feel they're invincible.
We're pleased to see Bill 119, and we applaud the government for leading the way across the country. The messages I believe Bill 119 is sending are strong and consistent with our mandate with regard to educating children about tobacco.
It's been proven in many studies that the partnership between parents and children has a very strong impact on the success of children. Therefore, we encourage parents to become involved in their children's schooling. It is also essential that the government, educators and health agencies become partners to make sure we can have an impact and influence young people in the province.
Therefore, we feel that the government's role in this particular case is legislation. We support the government in eliminating vending machines, and the message is strong; raising the legal age; prohibiting smoking in public places; prohibiting the sale of tobacco in health outlets, be it pharmacies or other agencies; and ensuring that the laws are very strong, have the strength of, for instance, the alcohol laws. Teenagers aren't allowed to drink before the age of 19, and we should have the same very strong laws with regard to tobacco.
Ms Peggy Mason: I thank you as well for the opportunity to speak. Among the adolescents that I deal with, there are often several who are addicted to tobacco by the time they reach grade 6 and will admit that to me as a principal when I talk to them about not smoking in the school yard. You get to see that these drugs reach students very early. A lot of it has to do with the influence of their peers and what goes on in the home.
We as educators have proven that by working with students in group situations that have discussions, that have activities where kids have to talk about the effects and hear what the other children think about smokers, it gives them a chance to work it through before they are faced with the choice about: "Do I try this? Do I take the chance to be hooked?"
The campaigns that have gone on in schools and in the media about drugs depict people that use drugs almost as losers, and they also show a lot of the physical damage that gets done. We need to tackle that part of the adolescent that believes they're invincible. I think they believe it till they're 25 or 26. We have to reach them so they know that down the road they're going to pay a high price for getting involved in smoking.
I don't think these materials -- we have some right now from the cancer society and the lung association that have been used in our schools, and many boards have developed their own. They need to be revitalized so they have the maximum effect. We need to have more group activities, and there just needs to be a few lessons that every single classroom in this province would receive. Some of the posters that get distributed to schools are excellent. When you see the beautiful young teenager turn into a withered lady, that hits girls right away, because they really want to feel that this isn't damaging them.
Some of the materials could be developed at a reasonable cost and could be directed at what goes on at the classroom level for teachers so they can work with students and have children work their way through this. It's not doing a lot of research projects; it's actually coming to terms with "what the effect on me will be."
The legislation that makes these drug sticks difficult to get will be helpful, but we also need to help kids make good decisions. Those students who have seen the reality through things that have happened in their family make the right choices. When they really come face to face with what happens to you if you become a long-term smoker, they don't touch those sticks. That's what we need to get out to students. They are smart and they are reasonable, and when they work through this together, I think we can have much more of an impact.
So I thank you for leading the way and working through this legislation. With messages that come from the media, from the government and from educators, I think we can do a better job of raising a generation of students that maybe is not hooked and lives a healthy lifestyle.
Mr Jim Wilson: Your observations about young people are consistent with what young people have told us themselves. In fact, we had a group of five or six young smokers appear before the committee a week ago. They essentially said what your observation is in the first part of your brief, that it's sort of a thing you have to go through, that yes, they are defiant and smoking is a trial-and-error thing and kids have to figure it out for themselves. They said: "It really doesn't matter if you raise the age to 19 or whatever or put $100,000 fines on retailers. We'll get the cigarettes and we'll smoke."
You mention the alcohol model and how we treat alcohol in our society. It seems to me that perhaps we should put some responsibility on young people themselves. There is a model in the United States where they have a licensing system but also the kids are fined $25 for being in the possession of cigarettes or smoking under a certain age. Do you think that would work?
I asked the young persons who appeared that day, and one felt it might work; the other ones weren't too sure. But they were very much aware of the laws with respect to alcohol. They knew they weren't to consume alcohol under the age of 19 or some of the other laws associated with that. What's your opinion on that? Would it go towards helping to eliminate them taking up the habit?
Ms Mason: The norm you were talking about, of students realizing it isn't acceptable and that's why the age is higher, I think that's a healthy norm: "It's not acceptable for you to be smoking, and that's why we have age restrictions."
As far as the fines and the law are concerned, I'm not sure. I don't know what the research shows about how it has affected the students in other places. I agree with what you're saying about them becoming responsible, and that's why I think we need to give them enough information that they can see what the effects are and make wise decisions, because if they tinker with it for too long while they're young, they're hooked, and some of them are hooked in a very short time. One grade 6 girl told me that it was just a few months, and she's having an awful time right now with the pressure of her friends and her own addiction. We've worked through some of that with her.
Mr Jim Wilson: It's quite sad. We consistently hear the stories of young people as young as grade 6 addicted to smoking. It's been an eye-opener for me, I must admit, because I recall kids trying cigarettes in grade 9 and grade 10, maybe grade 8, but I don't recall as low as grade 6. It's quite a shocker.
Can you give us a brief outline of what educational materials are available now in the schools?
Ms Mason: There are kits that the cancer society and the lung association have put out. They are packages that have some lesson plans in them, and posters. Our board has put together materials, and I'm sure many boards in Ontario have put together materials as part of the peer pressure programs, whatever the titles are, within their boards.
When Lise and I were talking about what we think might be helpful, focusing on the information we have available to us now, these materials are at least 15 years old, so things need to be revitalized and updated and made more powerful; also employing strategies that have students talk and discuss because the influence they have on each other you just cannot imagine -- it is so strong. If those kinds of activities were updated, the material would be much more effective.
Mr Jim Wilson: Is there a mandatory requirement to teach these materials in the schools, or just up to individual school boards?
Ms Mason: Individual school boards.
Ms Carter: I was very interested in the educational side of your presentation too. You already answered one question I had, which was, should we emphasize that smoking doesn't go with beautiful, attractive people, but goes with wizened, dried-up, withered, sick ones? You're obviously doing that. Do you also get across to kids the message that they're being exploited, being suckered, that somebody is out to take advantage of them at their expense?
Ms Mason: That's one of the features we'd incorporate into a new campaign. If there are teachers doing a good job of teaching students about media and how media can manipulate, which is part of the Ontario curriculum, I think that would be happening, but perhaps it's not directed towards just the topic of smoking. We could integrate that and make sure it focused on how you're being drawn in to smoke and who's really benefiting from all of this, that yes, you're being used.
Ms Carter: It's as though we never target anybody as being to blame, that we're just conducting campaigns in a vacuum and disregarding the fact that there are people out there who are deliberately out to hook kids on nicotine and make a profit out of that. There's nothing cool about being taken in and being suckered. I would have thought that, in addition to the fact of what it does to you, would also be very powerful. I hope you would use that.
Ms Mason: It might be difficult to put that into an advertising campaign, but it certainly could be part of the activities you have children explore: Just who is benefiting? How are they benefiting? How do powerful groups lobby? How do you get some of these decisions made by governments? They're very powerful lobbyists, and that's something the students don't realize.
The Chair: Thank you both very much for coming before the committee today.
Committee members, before we break for lunch, the parliamentary assistant wants to raise one issue for clarification.
Mr O'Connor: We've had, on occasion, some discussion around possession and the role of young people, and there are some legal implications about some of the choices and positions we have heard. I ask legal counsel Frank Williams to come to the microphone and give us a few of his pearls of legal wisdom.
Mr Frank Williams: I just want to make it clear that I'm not making any particular recommendations to the committee, but I thought this would be a good opportunity as several presenters and several members of the committee have raised the issue of possession by minors.
I'll just outline briefly how the Young Offenders Act and the Provincial Offences Act affects minors and in essence how the court sentences.
On the issue of sentencing, it's worth noting that community service is something the court does in lieu of sending somebody to prison. Community service as a first step in sentencing is not the way the courts work; it's in lieu of imprisonment. Likewise, imprisonment is in lieu of where somebody doesn't pay a fine, so it's a three-step process. So in terms of the suggestion that perhaps community service should be the punishment for a young person, although I admit in a philosophical vein that would be very laudable, that's not how the court works. Likewise, imprisonment would have to come as a first step before you'd have community service being offered as an option or an alternative to imprisonment.
Having said that, how does that work with the Provincial Offences Act and the Young Offenders Act? The Provincial Offences Act, first of all, prohibits the court from convicting anybody who's 12 years of age and under, so if a young person 11 or 12 was caught with cigarettes there's no punitive sanction the court could offer. It's prohibited from convicting a person under 12 years of age.
Between the ages of 12 and 16, the court cannot offer imprisonment as an alternative, say, to payment of a fine. If a young person refused to pay a fine, should that be the penalty in the statute, the court couldn't then say, "Let's put community service in place of imprisonment." There's a limit between 12 and 16, which leaves another age group of those older than 16 and those 19 and under. People that age would be treated the same as adults.
The complicating factor in all this is that you've got three different age ranges and each would be treated differently by the courts. I just want to put some perspective on that when you're considering what recommendations you want to make in this regard.
Mr McGuinty: We explored this on the committee which dealt with the bicycle helmet legislation. At the end of the day, the law was passed that does make it illegal not to wear a bicycle helmet at some time down the road. There is a minimum fine. If you're 13 and you're not wearing your helmet, you'll be subject to a minimum fine under the Provincial Offences Act, in the range of $70 or something like this.
Mr Williams: What I am suggesting is that you could fine somebody who's 13 and older but you couldn't impose a fine on somebody 12 and under. I'm not that familiar with the exact sections of that piece of legislation, but perhaps there's some way of having the parent pay the fine, I don't know.
Mr McGuinty: You make reference to imprisonment. I'm sure nobody here wants to throw a young person in jail for having tobacco products in their possession. If you are fined under the act and you can't pay the fine, what happens?
Mr Williams: Under what statute?
Mr McGuinty: The Provincial Offences Act.
Mr Williams: In respect to a young person? I don't know, to be quite honest with you. I don't know if there's any further consequence. I guess it ends there.
Mr McGuinty: There's been general movement -- I've read a few articles in the paper recently -- to get away from this idea of putting people in prison because they can't afford to pay their fines. Anyway, thank you.
Mrs O'Neill: I want to go to another part of the act while the legal counsel is here, or maybe the parliamentary assistant should answer this. I've had several questions about paragraph 1, section 9, regarding the exceptions or exemptions. Could someone help me understand just what that means or what kind of areas we're talking about? I would appreciate a clarification.
Mr O'Connor: This would be the area which would allow us to do some designations within health facilities.
Mrs O'Neill: Are health facilities the only area that part of the act would cover?
Mr O'Connor: If we move down to paragraph 9, that gives us the ability to prescribed other places.
Mrs O'Neill: Have we any ideas of the areas the government's going for that? Have you got a list in the back of your minds?
Mr O'Connor: Not at the present time, but any areas committee members would like to suggest -- and we've heard some recurring ones that are pretty obvious that people would like to see us move in. I'm open to listening to areas any committee member would suggest be included as we prepare to make the regulations later on this spring.
Mr Eddy: I'd like to ask about subsection 3(1): "No person shall sell or give tobacco to a person who is less than nineteen years old." There's no barrier to including a parent or a guardian in a family home, a parent who gives a child a cigarette? There'd be some very interesting situations, I'm sure.
Mr Williams: I agree with you, there's no barrier, but from a practical point of view, it would be very difficult to enforce in terms of a parent giving a child cigarettes at home. We're not going to have people breaking down doors to see if people are giving their children cigarettes. From a practical point of view, I don't know how that would work, but certainly in theory the law says you can't sell or give to somebody 19 years of age.
Mr Eddy: That includes parents?
Mr Williams: That's right.
The Chair: I remember an interesting case in Niagara Falls, I think it was -- this would be 15 years or so ago -- where a policeman walked by a house and saw a father giving an underage son a drink and the policeman went in and charged him. I can't recall what happened in the case, but it was as you described, somebody giving a person who was under age a drink, which was unlawful. It would be an interesting case.
Just before breaking for lunch, because we have to be back here at 1:30, there are several tables at Timbers that have been reserved for us. I also remind members to check out. You can either leave your bag at the desk or in Mr Arnott's room, whichever you prefer.
With that, we stand adjourned until 1:30.
The committee recessed from 1157 to 1330.
TOBACCO FREE THUNDER BAY
The Chair: Our first presenter this afternoon is the representative from the Thunder Bay tobacco free committee. Would she be good enough to come forward. I take it by a process of elimination that you are Sophie Wenzel.
Ms Sophie Wenzel: That's correct. Jean Juneau has to give his regrets today. He was unable to attend.
The Chair: A copy of your written brief has been circulated, so please go ahead once you're settled.
Ms Wenzel: I'd like to introduce myself. I'm Sophie Wenzel, and I'm the lung association representative for Tobacco Free Thunder Bay. Tobacco Free Thunder Bay is a regional coalition and it's made up of a number of organizations within the Thunder Bay district. We have our lung association, the Heart and Stroke Foundation, the Canadian Cancer Society, the Cancer Treatment Centre, the Addiction Research Foundation, the Thunder Bay District Health Unit, Ogden East End Community Health Centre and the RCMP. I'm not sure if I've left anybody out but they are listed on the cover page of the submission. We also do have individual representatives on the coalition as well.
As the name suggests, Tobacco Free Thunder Bay would like to see a ban on all tobacco products by the year 2000, but depending on the time lines, whenever it comes about, we would still be happy. We do realize we have to start somewhere and we have to applaud you for Bill 119. It's an excellent start to this. We applaud the government for introducing it and the opposition parties for supporting it this far, and for everybody being out here today to listen to the opinion of the public.
We've outlined a number of things that we'd like to see just as amendments and some additions to the legislation in the submission. Due to time restraints, I'm only going to talk about the packaging requirements, the plain packaging, the ban on kiddie packs and the licensing that we'd like to see included.
As you can see here, I have the packages that were obtained by our 12-year-old, Ryan Fitzpatrick, this morning. You can see they're all in different designs and different colours and they're very intriguing. If you look at them, I don't know if anybody from there can actually read what the health warnings say on here. If you can, could you please read them out, the exact wording. I'd be very interested to know.
You can see how the packaging is used as a tool, not only to advertise but also to hide the health warnings. If you had the plain packaging it would be very prominent, because they'd all be the generic white or the generic beige packaging and they'd have the same postscript for the titles, and then the warnings would stand out much more. That's one of the arguments why we would like to see plain packaging.
The other reasons are, more important, that the packages themselves are advertising. They're pulled out of pockets every day, they're set on tables every day by parents, by teachers, even sometimes you have athletes with them out there, and that's not giving the proper message to our children. So it would take away the advertising that the packages themselves have by including plain packaging.
As well, it would also stop the sponsorship that's being done by the tobacco industry, because if everybody has the same package, you won't be able to diversify between the brands.
Finally, it will help to diversify between the domestically sold and the smuggled cigarettes. Obviously, that is an issue right now. It would be a good source which would be even more prominent than a yellow band around it or the gold one. It isn't very prominent.
The other thing we'd like to see is a ban of the kiddie packs. We all know that kiddie packs, the 15 packs, have been targeted right to the children, because they don't have excessive amounts of money readily available to them. When I go out into schools and I make presentations to the children, when we're talking about quitting smoking, the first thing we ask them is: "You can save money by quitting smoking. How much is a pack of cigarettes today?" They always say $3 or $4. It's the older children out in the high schools who will say $7. This just shows you right there, when 90% of the children are saying $3 and $4, that's what they're purchasing, and that's because that's who they're targeted to.
We all know that the price of cigarettes and the consumption of cigarettes are inversely related. According to various studies, for an adult, the elasticity is negative 0.04, which means for a 10% increase in price, there's a 4% decrease in consumption. The estimated elasticity for children is negative 1.04, which means for a 10% increase in price, there is a 14% decrease in consumption. So it's very important that kiddie packs are banned.
In order to include this in the packaging requirements, it should be specified, for example, that the minimum number of cigarettes to be contained per package is 20 cigarettes. In that way, we will eliminate these kiddie packs that are targeted towards the young people. So we recommend that the banning of kiddie packs as well as plain packaging be specific requirements within section 5, packaging requirements.
The other thing we'd like to talk about, with the tobacco tax rollback that has happened recently, is licensing. We feel now with the rollback, it's really important that we do have licensing. What we would like to see with licensing is that each vendor who is to sell tobacco is required to purchase a licence. The licence would be suspended from the vendor each time he violates Bill 119. For subsequent violations, there's a longer suspension, and say after three or four violations, you could permanently revoke the licence.
The benefits of licensing would be that it would deter vendors from selling to people under 19 years of age, because not only would they lose their tobacco sales when they lose their licence, but they're also going to lose the spill-off sales such as the milk and the bread that people come into the store to buy when they happen to be stopping to buy their cigarettes.
Secondly, with a fee being charged for the licence, it would be self-financing. It wouldn't come out of taxpayers' money, it would already be there, the money from the licences. So you can use proper enforcement for it as well.
Thirdly, it would act as a record of who is selling tobacco. You would already have a record of who has licences, that is, who is selling the tobacco, and it may make your reporting a little bit easier.
Finally, with licensing, it would also keep away from a backlog in the court system.
Just a final comment I'd like to make is that enforcement is very important with the legislation. It's an excellent piece of legislation that you have introduced and supported. Now we need to hear from you what the enforcement system is going to be, because that's what will make or break a bill as well.
We had a couple that were here this morning and they just asked me if I would come up here and let you know that they have a granddaughter who they found out is smoking. One of the persons, the grandfather, is in a group called the short-of-breath group. He has either severe asthma or emphysema, the diseases such as emphysema that are related to smoking.
He said: "Will you please tell them that children think they're invincible. They need the government to tell them they can't smoke. When they're old enough to make the decision, that's fine, but when they're that age, their response to what's happening to older people is, 'Well, they're just old,' and they think they're invincible." They wanted us to pass that message on to you. That's the thinking they're getting from the children, and something should be done by the government. Thank you.
The Chair: Thanks very much. That sense of invincibility, as we know as we get older, we all recognize that we're not quite there. Thank you for your submission.
Mrs Haslam: I'd like to go back to the licensing idea, because the model that is now being suggested is fines. If you're caught selling to a minor, there is a fine process. If you're caught with two infractions or three infractions within a five-year period, you would lose your right to sell tobacco. Tobacco would not be allowed on your premises. You couldn't even store it in the basement of your store. It has to be totally off your premises.
The manufacturers would be informed in written form that they were not allowed to sell tobacco to your store, because you had been targeted as someone who had broken the law. You would have to post signs saying that you are not allowed to sell tobacco. The reason for that would be very clearly indicated right there for all of your customers to see that you had been caught selling to a minor. I wondered if you still felt, with that model, that licensing was preferable to what was being suggested in the legislation.
I think the concern is that for a lot of small businesses, it's very time-consuming to set up that type of practice. It's not quite so time-consuming, because there are already investigators out there who can automatically now go in and investigate. We could use the money to increase the number of people doing it, rather than putting all of that money and effort into reinventing the wheel for this particular issue.
Are you still in favour of, it isn't more stringent, but the different way of licensing that you have indicated here?
Ms Wenzel: I think I am in favour of the licensing. I feel if the person could permanently lose their licence, that's even more of a threat. We have children saying to us: "With the legislation, if you increase the age to 19, it's not going to make a difference. We'll just go into the stores when our friends are working." If they're risking losing that licence permanently, then they are going to make sure that the people selling the tobacco abide by it.
The Chair: Could I just ask you one question that has come up a couple of times: What evidence do you have, anecdotal or otherwise, about the smuggling problem here? Is it less up here than it is in areas to the south, or is it something that the young people talk about?
Ms Wenzel: I've heard situations where people do talk about smuggling products. I've also heard that what most people tend to do, especially the young persons, is they can go into a store and purchase cigarettes anyway, so why do they have to go to the black market for that. I think recently the RCMP did bust a tobacco smuggling group, so it does happen, but how prominent, we aren't sure.
The Chair: Thank you very much again for coming. I know you've been here through the day, and we appreciate it.
The Chair: I call on the representative from the Thunder Bay District Health Unit, Geraldton branch, Mr Simon Hoad.
Mr Simon Hoad: I'm going to just beg the committee's indulgence and throw even more paper at you. You have a report that I've given you which is a summary of the research study. Since there were a couple of questions this morning --
The Chair: I'm sorry. We need to get you on the mike for Hansard -- we can pass those out -- just so we get all of your words enshrined in Hansard. Welcome to the committee. We thank you for the supplementary information. Please go ahead and just explain again what you've provided.
Mr Hoad: As I was saying, catching the interest of members in your questions as you were responding to some of the presenters, there was some concern about numbers and what some of the local trends are. Although in my submission I've given you a précis, I thought I might as well give members of the committee the original document. I've marked with a yellow tab where some of the numbers are that compare Ontario numbers with northwestern Ontario and also northeastern Ontario. Then on the page before the tab, there's a chart that makes very clear youth access.
What I'm here to talk about is that youth access to tobacco and tobacco products is a northern issue. We find ourselves in the situation, after this recent research where grade 6 and grade 7 students were interviewed, both in Thunder Bay and out in the region, that we have significant numbers of young people who have said yes, they have been smoking for three months or more in the past year.
This was a case where we weren't using a very low threshold. We didn't say, "Did you smoke one cigarette in the last year?" We said, in effect, "Are you a regular user?" For all categories we are higher than the provincial average, and the significant and shocking feature is when we look at grades 9 and 10 in the communities in the district of Thunder Bay. We're looking in the communities along the north shore of Lake Superior or along the northern route: Beardmore, Geraldton, Longlac, Nakina, that type of thing. We are looking at 40% of these 9 and 10 students who are smoking.
We can tie that in with other research that was done in Minnesota, where they went back to high school students seven to nine years after they left school. Of these smokers who said, "Yes, I'm going to give up smoking soon," 75% are still smoking. We know that the vast majority of these smokers are unfortunately going to be confirmed in their habit and still smoking in their 20s.
On a question that one of the members asked earlier this morning around the success rate of smokers quitting, the good news is that the people who keep trying to quit eventually do quit, although it might take four or five attempts. However, there's a study in England that suggests that essentially 65% of regular smokers are never successful in totally leaving the tobacco habit. They quit for a time and they start again and they quit for a time.
In essence, they have been captured by the tobacco industry as children or as teens and they are there, that 65%, as regular smokers, to smoke till they die. There's both the good news that people do move off smoking but some really bad news in terms of the fact that significant numbers of these smokers who are starting, average age 11, in northwestern Ontario are already slaves to the tobacco industry.
That's why I feel very strongly that youth access is a northern issue, because of these larger numbers, and I think it follows from that there are some of implications when we look at Bill 119 and perhaps some directions that Bill 119 should move towards. I think what we have to do is have both a legislative approach and a proactive community approach. Clearly the schools can't do it on their own, legislation cannot do it on its own, but we all have our part to play to change the climate in which smoking behaviour happens for young people.
I think if we look at really restricting tobacco sales to minors, there are three ways that's going to make a difference. The first is, of course, that with the photo identification it's just going to be harder for them to get, but it has to have both legislation and enforcement, what the regulations are going to be. We can look at the example of Woodridge, Illinois, where they had both enforcement and education and there they were able to drop their adolescent use and experimentation by over 50%.
I would suggest that if we have the right regulations and the right clauses within Bill 119, we could look at those same types of changes with our own young people. For those young people who do become regular smokers, it's going to be harder for them to experiment, harder for them to confirm their regular smoking habit.
We also denormalize tobacco when we make very clear that it's not a legal product like all the others. I think as part of denormalizing tobacco, the emphasis in the bill to ban vending machines is excellent. This is absolutely needed.
If you look at that diagram which is the page before the yellow sticker, we asked the young people which of the four major areas where they were purchasing their cigarettes was the easiest for them. Surprise, surprise, 45% of the grade 6 students said vending machines. It's easy. It's anonymous. As long as they have the cash and they can reach high enough to put it in the slot, they can get their cigarettes. As they grow older and more confident, more sophisticated and essentially a little taller, then they broaden out to the other outlets in the community.
The repeal of the Minors Protection Act is, again, a good piece of housekeeping, absolutely essential. Teenagers have been making creative use of this loophole for obtaining cigarettes for years.
I want to make some points about the enforcement of the legislation. I think it's very clear that we have to have regulations that are easy to understand and are easily usable in the community. Part of that easy use: What about a role for the citizen, for the family, when they know that their youngster, their son or daughter, is buying from the corner store? To whom can they complain? How can they make sure that practice is stopped instantly?
I think we have a tremendous change that's going to happen with the federal dropping of the taxes, that Ontario as a province is going to find the pressure due to smuggling from the east irresistible, and so we're going to have a very different climate with many more young people purchasing cigarettes and using cigarettes. We have to prepare for it by having the strongest possible Bill 119 that's going to change some of the ground rules.
I think we should broaden the role of enforcement beyond the police. You've had the presentation about a potential role for the public health inspectors. In other settings, what about municipal bylaw inspectors or security guards in malls or other types of institutional settings? These are people who have a certain role and function at present and should be given part of the duty of enforcing the act.
I want to conclude by saying parents and community groups can be powerful allies for enforcing the legislation, so give the citizens levers in the law so that we can work together to ensure a healthy community.
I want to thank both the government and the opposition for the chance to comment on the legislation and I applaud the fact that we have a cross-party resolve to try and deal with this extremely serious problem of youth being hooked into the tobacco epidemic.
Mr Wiseman: Your last couple of comments hit upon something that I've been a little bit enthusiastically pushing, and that is the right of parents, the enforcement. I concur with you that we need to empower people to be able to participate in the process and to know that they're not powerless in the face of huge juggernauts like the tobacco companies.
I've been sort of touting an idea of allowing parents to have civil action against people who give away cigarettes to youth or who sell them to youth so that there wouldn't just be a fining process but there would be a real fear that I as an irate parent would come down and launch a lawsuit against you for hooking my child under the age of majority on cigarette smoking.
Mr Hoad: I haven't thought through all the implications of a civil suit, but on first thought I think there are some possibilities there in terms of being able to give parents and ordinary citizens a role. At the moment, we have essentially wide-open sales to young people. You had Ryan, age 12, here this morning. This absolutely has to change. As the price of cigarettes is going to go down in the middling near future, then we have to be even more prepared so that vendors know that they can only sell to someone who is 19 and has a photo ID that they're 19.
I wonder about, as part of that, the suggestions by some other people around the licensing system. If you had a licensing system of vendors, that gives you the option to say: "As a vendor you are selling a unique controlled product. You must be educated in the Tobacco Control Act and prove that you have knowledge of that before you can sell tobacco." I think there are a couple of different initiatives that we could use that will turn it back to the community and also make very clear to the vendors that this is not something that's the same as bubble gum.
Mr Wiseman: Your last comment here is, "Build in a feedback mechanism to the tobacco act," so that we can review it in the future. Could you maybe elaborate on that for us, please.
Mr Hoad: I think as legislators there are often times in which the best of possible advice and legal wording is brought together and then a year or two down the road people are quite surprised at how it actually works in the community. I think we should build in a feedback mechanism or build in a strong expectation that we're actually going to see if we're achieving the goals of the legislation, because if we're not achieving the goals, then let's have the courage and the foresight to say, "We're going to have a mechanism where we're going to back up, re-examine what we wanted to do and see if there is a slightly different way of getting there."
Mr Wiseman: Just as a final comment, to me the federal Liberal initiative on Quebec isn't really aimed at Quebec, it's aimed at Ontario, because the pressure now is building in eastern Ontario to force Ontario to lower its tobacco taxes. If Ontario goes, then it becomes very difficult for Manitoba to resist, and if Manitoba goes, then Saskatchewan and then Alberta. BC is at least separated by the mountains, but even then -- it seems to me that the goal wasn't really to get Quebec; the goal was to buy the election in Quebec for the Liberals. But to me, the pivotal point here is in Ontario.
I just wonder if you have any thoughts on any actions or any possibilities that Ontario could use to resist this tactic, because the pressure really is starting to build.
Mr Hoad: I don't see that there's anything that's very easy for Ontario to do as part of the federal system. In many ways the initiative no longer lies with Ontario; the initiative, unfortunately, lies with the smugglers and the price differential. There will be almost an inevitable working out of various individuals and organized groups pursuing that price advantage.
I've had a certain perspective. When I first left university, I was employed as a detached youth worker with the Addiction Research Foundation, wandering the streets of Thunder Bay at 2 o'clock in the morning as the chemical revolution was coming north from Toronto and eventually came up to Thunder Bay about two or three years after Yorkville. I've seen on sort of a street level when you have substances that are prescribed or somehow illegal, and of course you can still have tremendous amounts that are available for individuals with money. Unfortunately, there's a dynamic around smuggling that will be difficult to resist.
On a question or two raised by some other panel members around potentially criminalizing possession for young people under the age of 19, I myself would have some severe reservations on that. I think to a certain extent for some young people it would feed into some of the atmosphere of rebellion and independence. Twenty years ago, when marijuana and LSD were hot topics, part of a function of youth was specifically to rebel. We could end up making tobacco the forbidden fruit as opposed to just working successfully to acknowledge what a poison it is.
Mr McGuinty: Thank you for your presentation, Mr Hoad. I particularly liked your comments about how important it is to bring a comprehensive approach to the tobacco problem and not to underestimate the role that the community can play, parents can play, family can play, and I think not to overestimate the role too that government can play.
One of the interesting things we learned in Sudbury was that a group there had conducted a sting operation. That's the kind of idea that, if it was conducted on kind of an ad hoc basis without any announcement obviously that it was going to happen and you published the results as to who sold to somebody who was under 19 and who didn't type of thing -- of course, you'd want to check with a lawyer first before you get into that on a regular basis. But that's something that I think the community can do.
On the business of fining young people, I think it's important to distinguish -- I certainly wouldn't recommend that we criminalize it. It would just be a provincial offence, so there would be no criminal record associated with it, as there is right now with simple possession of marijuana, for instance.
But I think sometimes we underestimate our kids. I know sometimes we're reluctant to place any responsibility on them, but I think there comes a point -- I'm not sure whether that's 12 or 13 or 17 or 18, but at some point there's a certain element, I would think it's not going too far to say, of complicity to go to the counter, pretend you're older than 19 in order to get those cigarettes which you know you're not supposed to be getting. I'm just wondering if somehow we can't bring children in as part of the team in this struggle.
Mr Hoad: I think there certainly is a role for children and teens as part of the team, but I'd like to see it in a slightly different context. I think when you see that 50% of the people who we interviewed had started smoking by age 11, we'd be looking at significant numbers of those smokers clearly starting before the age of majority and real questions about responsibility and knowledge of what their action is. On a superficial level they could say, "Yes, smoking is harmful," but, on the other hand, as everyone concurs, "I'm going to live for ever," and they will, until one day they discover they're 30.
The way I think we can use young people and look at that responsibility, and within our own health unit we're pursuing the idea, is to look at saying: "Young people are going to experiment. They're going to spend a period of time being hooked. Let's cycle them through faster. Yes, you're going to be smoking by grade 6 or 7; let's get you out of it by grades 10, 11 and 12 and have peer teaching and have quit-smoking programs present in every high school." Within our own work plans over the next year or two we'd like to set up some models and explore this idea.
Another part, of course, is our social marketing, both in the schools and outside. This poster passed around grew out of some focus groups this past summer and the fact that we did have a little professional baseball team in Thunder Bay. We've just done an evaluation and we're busy looking at the numbers from that evaluation, so at every step we're trying to find out what young people think directly addressed their concerns and then test, did we achieve that?
There are ways in which we want to work directly with those young people and move them out of the habit as well as prevent them starting.
The Chair: Thank you very much, Mr Hoad, for coming to the committee and for the additional documentation that you've provided us.
Mr John Zgrych: I come before you as a registered respiratory therapist. I represent myself as a concerned health professional in our community.
In society there is a growing concern about today's youth and their future, and I share a common feeling with this. Being a registered respiratory therapist raised and making my career in Thunder Bay, I'm well aware of the effects of smoking and what it has done to the community. I work for a locally owned home health care company and, as a respiratory therapist, work primarily with adults around the age of 65 who suffer mainly from lung and cardiac disease.
Before I discuss my opinions I would like to thank the committee for an opportunity to help make a positive impact on our youth and the general health of people. I would also like to thank all the responsible people in government who put so much effort to make this day possible today.
I'm here before you with full support of Bill 119. I join a large number of non-profit organizations in supporting this bill that you are well aware of. This coalition represents a vast majority of people in Ontario, and those who do oppose it are mainly the tobacco industry and those who benefit from tobacco sales. I'd like to concentrate on the issues of young people smoking and the need for licensing.
My greatest concern is the sale of tobacco products to minors. The facts remain that tobacco is addictive, hazardous to our health and that it potentially can affect our lives for ever. This is not the type of product suitable for a child, nor is a child old enough to make a responsible, educated decision. Currently minors can obtain tobacco products easily without any problem. It is estimated annual sales to children are approximately 400 million in Canada.
In northern Ontario there is a higher percentage of younger people smoking than in any other part of Ontario. The Addiction Research Foundation states that 24% of students in grades 7 to 13 smoke. Between 1991 and 1993 smoking increased significantly from 6.1% to 9.4% in students in grade 7. It has been proven that people rarely begin to smoke beyond the age of 20. The average age of minors starting to smoke is 12 to 14 years. Health and Welfare Canada states that 90% of young smokers have started before the age of 17.
Present enforcement is not enough. It's not an effective deterrent for these retailers. Licensing is the only answer to deter these statistics. Ontario needs a retail licensing system in order to better control the number of new teenaged smokers who will be addicted to the tobacco, especially in light of the new tax cutbacks that have happened recently.
In 1992 80% of Ontarians agreed that government should pass legislation restricting access of children and young adolescents to tobacco products. As well, 75% supported a ban on vending machines and agreed that tobacco should only be sold through a licensed retailer; 64% of smokers supported this action, even though it may interfere with their ability to obtain and use tobacco products.
One would think that children who are turned down early, on their first attempts, are more likely to be discouraged from smoking. In the fight against young people obtaining tobacco one can only see the importance of a vending machine ban. Sales through vending machines supply a small portion of the total tobacco market but still remain an unsupervised outlet for all young children.
It is said that 16% of all illegal tobacco sales to minors are through vending machines. This small percentage will only increase with the licensing of retailers. There is no other product that is illegal for minors available through unsupervised vending machines, so why should cigarettes be? All vending machines must be banned, especially in light of the new recent rollback of taxes.
It is reported that 20% of preventable deaths among adults can be attributed to tobacco use. I would like to see more pressure on the industry rather than the end user. I'd like to give the young people an opportunity to make their own decision at a much greater age in their life. Thank you very much.
Mr McGuinty: Thank you very much, sir, for your presentation. No, I don't think there's any doubt whatsoever that we have to address the issue of vending machines, because obviously we've clamped down on retailers, and then kids I think quite naturally will look elsewhere where they can make their purchases without supervision.
Whenever you pass a law you want to make sure -- and it's my opinion in any event -- that you're doing so in kind of a moderate way to minimize the damage that you might otherwise cause. You want to ensure that the law works towards meeting your objective.
What I'm getting at here with respect to vending machines is, I'm wondering why we should be banning them in bars, for instance. I didn't have a chance to ask a presenter yet but I'm wondering how many grade-school kids, for instance, get their cigarettes in bars. Wouldn't you think we should be banning them in bars and, if so, why?
Mr Zgrych: I think, to be uniform across Ontario, a complete banning would be in order. If in fact a minor did obtain cigarettes through a vending machine in a licensed establishment, who would pay? Who's going to be to blame for this? Do you go after the owner of the establishment, the person in charge? You get into a problem of, if you're going to enforce this, there's a little bit of leeway there that you can get around it. I think that if you completely ban the act totally across Ontario, then it's uniform.
Mr McGuinty: My colleagues the Conservatives have proposed compensating. We have people in business now who've been playing by certain rules with respect to vending machines nd we're going to change the law on them. Fair enough, we're allowed to do that. Should we compensate them concerning money as a result of cigarette sales which to date have been legal? We're going to change that law. They tell us that it's impractical to convert the machines to other vending machine uses: chocolate bars, chips, these kinds of things.
Mr Zgrych: Personally, I think they shouldn't be compensated. I don't know what the figures are but I don't feel that makes or breaks their business. If it's in a licensed facility, alcohol would be their main money maker. I don't think I would go to a bar or friends of mine would go to a bar just because there's a cigarette vending machine in it.
Mr McGuinty: I'm talking about the people who make the machines and place them in different locations. I'm not talking about the bar owners as such.
Mr Zgrych: I'm not too sure what can happen on that.
Mr Martin: I want to thank you as well for coming before the committee. There has been some reference, today particularly, to the incidence of smoking, particularly among young people but other groups as well -- women were mentioned -- being greater in northern Ontario. Do you have any idea why that is? Is there anything that we should be doing differently re this legislation that could address that, for me, quite alarming revelation?
Mr Zgrych: I feel that in Thunder Bay and northern Ontario in general there are a lot of working-class people. Personally, I've worked in paper mills and that type of business and everybody smokes. If everybody sees everybody smoking, it rubs off on the next person, to the kids and to other family members. I'm not exactly sure why northern Ontario does have a high population of smokers but it is definitely there.
Mr Martin: If we follow that, then some review or moving more quickly to looking at and maybe doing something about it, the smoking-in-the-workplace piece of this whole package might be something that would address that particular issue.
Mr Zgrych: I think Thunder Bay would be a vital source of doing information studies on because it's such a unique area that you can only learn from it.
The Chair: Thanks very much for coming before the committee this afternoon. We appreciate it.
Ms Susan Loewen: My name is Susan Loewen. I am a pharmacist practising here in Thunder Bay. I have been a pharmacist in Ontario since April 1993, just last year. I have come to speak to you today to show my support for Bill 119, the Tobacco Control Act. I also speak on behalf of Janzen's Pharmacy, which is a tobacco-free pharmacy in Thunder Bay and has been since 1989. I do support all of Bill 119, but being a pharmacist I would like to show my support for the removal of all tobacco products from all pharmacies.
I consider myself a member of the health care team. As such, my job is to promote a healthy lifestyle and prevent disease. My job obviously also includes ensuring the safe and effective use of medicine, but that's not where it stops. This may seem naïve, but I don't understand how tobacco and pharmacies were ever mixed in the first place. It just doesn't seem to make sense.
I guess at one time tobacco was just another product that everyone sold, just like tissue or gum or a newspaper, but now for years we've known how dangerous this is and that it is the leading cause of preventable illness and death, so I don't understand why we still sell it. Just because we always have doesn't make it right and it doesn't mean we still should sell it.
To fix this, voluntary withdrawal was introduced, for pharmacists to remove it themselves from their shelves, and many pharmacists in Ontario have. In Thunder Bay there are three independent pharmacies that have a full front store, and two of those stores have removed it. There's only one that does have tobacco. There are also six other smaller clinic pharmacies in town that may not have a full front store, but they do not sell tobacco either.
Unfortunately, voluntary withdrawal didn't work 100%. I have an opinion as to why it didn't work 100%, and that is because if you are a pharmacist working in a national chain or a small local chain, you don't have the power to remove this product from your shelves even if you want to. I would say that if we did have the power to remove it ourselves, more would have.
When you really think about it, voluntary withdrawal for these large chains can't work because there is a tremendous amount of money at stake: 23% of all tobacco in Canada is bought in drugstores and, of that, one third is from Shoppers Drug Mart. So 8% of all the tobacco sold in Canada is from Shoppers Drug Mart. I don't know how much money that is, but I'm sure it's a lot and they're not going to give that up voluntarily as a business. It's purely a money matter.
I don't think we can make this a money issue because this is a public health issue and we have to show the public that we are health professionals and we won't sell a product that kills them. We have to set a role model. We have to be a positive influence, especially for the children, because otherwise it's a very mixed message when we say how bad tobacco is and yet we still sell it.
I would like to applaud the government for even proposing Bill 119 and to thank everyone who is showing support for pharmacists to help us remove this from our stores when we can't do it for ourselves.
Mrs Haslam: I'm interested in your figures, that 23% of tobacco sales are in pharmacies, a third in Shoppers Drug Mart. That's approximately 8%. Where did those figures come from?
Ms Loewen: I have a pamphlet with those figures in it.
Mrs Haslam: Do you know the name of the pamphlet?
Ms Loewen: I don't know the name. I have it with me, though. I can get it for you.
Mrs Haslam: I'd like to take a look at it in a couple of minutes. I have one quick question. You said there's one out of three independent pharmacies here in Thunder Bay that sells tobacco products. Is it located near this facility?
Ms Loewen: Near this facility right here?
Mrs Haslam: Yes.
Ms Loewen: It's in Westport, which is close to the mountain.
Mrs Haslam: The reason I'm asking is that I happened to go across to the mall and there was a drugstore there which wasn't a chain, it was more like an independent, and they sold tobacco on the edge there. It was just really very interesting because I could see all these signs that said you must be 18 to buy a lottery ticket. There were three signs that said, "No lottery tickets will be sold to anybody under the age of 18."
It took me the longest time to find the one sign in the corner on the right-hand side that said, "You must be 18 to buy cigarettes," but all of these signs were hanging on the cigarette counter that said, "You must be 18 to buy a lottery ticket." I found that very interesting. I wondered if it was that particular store that sold the tobacco or not. Those are my clarification questions for now. Thank you.
Mr Carr: Thank you very much for your presentation. I was anxious to know what you think will happen. I think you mentioned the 23% right now. What do you think will happen when this bill goes through? Are we going to see a shift to other places or are we going to see a decrease? What do you think is going to happen?
Ms Loewen: You'll see a shift because it will have to go somewhere else. You'll probably see a decrease. I don't know if it will be right away, but I think if the message goes out that pharmacists won't sell this product any more, some people are going to have to think twice about it. Maybe not the people who are established smokers, but children might think about it more if we don't sell it to them, that maybe there is something really wrong with this.
Mr Carr: Who do you see jumping in? Who's going to replace it, do you think?
Ms Loewen: Probably corner stores. That's what I would say. If it's not in a pharmacy, it's not as easily accessible, probably the corner stores.
Mr Carr: Okay, thank you. Good luck.
The Chair: Thank you for coming before the committee this afternoon and sharing your experience with us.
ONTARIO LUNG ASSOCIATION, THUNDER BAY REGION
Ms Kathryn Kaipio: I'm Kathryn Kaipio and I'm the executive director of the Ontario Lung Association, Thunder Bay region. My colleague is not here. He is the owner of one of three smoke-free bed-and-breakfast restaurants in Thunder Bay. He's also a member of the Non-Smokers' Rights Association. He's coming today, or he's trying to get here. He's out in rural Thunder Bay and there must have been a problem with roads or something, construction. He's coming here to speak to you on behalf of his children, so he just may make it. I hope he does before we're finished.
The Chair: We'll try to make sure we can get him up to the table when he comes in. But we welcome you, none the less, to the committee and we do have a copy of your written submission, so please go ahead.
Ms Kaipio: It's important that interest is given to my introduction in my written submission because it's important that you know who I represent. We're an organization that covers all of Ontario. However, here in Thunder Bay, this particular associate is solely funded by the contributions that come in from residents in the city. We don't receive government funds in this associate and we try very hard not to. We try to be as independent from government as possible when it comes to what we do in the community.
We have a very large geographic area, from Atikokan in the west to Marathon and Manitouwadge in the east, and yes, we do have a higher incidence of smoking in this area, along with a higher incidence of suicide and alcoholism and other socioeconomic problems which seem to be greater here in the north.
In 24 years, this associate in Thunder Bay has been working very hard at reducing the incidence of smoking in the north with smoking-prevention programs, working at a smoke-free spaces bylaw for the city and smoking cessation programs. We have a very, very excellent tool that is called the Lungs for Life school program and we have been teaching that in the schools for the last nine years. That's to teach children from kindergarten to grade 12 all about smoking, prevention of smoking and cessation of smoking.
I recently measured with a carbon monoxide analyser the lungs of a 12-year-old boy who was very small for his age -- he looked more like nine -- and his carbon monoxide reading was 80 parts per million. If a factory has a carbon monoxide reading in the ambient air of 40 parts per million, it's closed down by the occupational health and safety people. This boy had twice that amount in his lungs. This boy represents thousands of youngsters in the north who have ready access to tobacco.
We've been working hard on this problem. We've made it known to our donors, and so today I'm speaking for our donors, for the members, for the board of directors and the staff who make it a vocation rather than a career to work at this. I also speak on behalf of a group of 64 people who have severe lung disease. They call themselves the Short of Breath group. I would say 95% to 97% of them have emphysema and/or lung cancer and/or asthma due to smoking.
I counsel them in the warmer months. Because of their severe lung disease they can't come out in our cold winters. They get counselled on education and rehabilitation for their lung diseases from approximately March through October of every year. I see the ravages three quarters of the year, twice a month, with these people. I've been shocked at how limited many of their lives are simply because they can't breathe, and when you can't breathe, nothing else matters.
What we're trying to achieve here is to make sure that 40 years from now, our young people such as Ryan Fitzpatrick, who spoke to you today -- who, as you know, was able to access and purchase many packages of cigarettes -- aren't the people in the Short of Breath club when they're 40, 50, 60 and 70 years old. We're looking at a very long-range program for these young people.
I would really like to congratulate and thank this committee, the government and the members of the opposition party for working together on this health issue. We support you strongly and really appreciate the amount of work you've put in so far. I know that these hearings are tedious and I've been watching them from the beginning. I just want you to know that you're very much appreciated for this interest.
We strongly support the provisions laid out in Bill 119. We want controls tightened on sales to minors. We support the reduction of tobacco outlets, namely, vending machines that are used by over a third of young people. We want to see the cigarette ban enforced in pharmacies and we want to see the way paved for the elimination of tobacco. We want to see ads and sponsorships cancelled. We want to see smoking prohibited in designated places, including schools, and we want to strengthen noncompliance penalties.
We support all that Bill 119 outlines, but in addition to what Bill 119 states, I have four areas that I would strongly recommend you look at.
The lung association wants to amend the bill to require a retailer licensing system in order to better control the number of new teenage smokers who will be added to the tobacco market because of the tax reductions. My submission was done, in my mind at least, a couple of weeks ago. Then when we had the recent tax reduction I had to completely change my stance because I think you have to take another look at Bill 119 in light of this tax rollback. I don't think it's strong enough as it is. To amend the bill to include licensing is an absolute must.
We want you to immediately require plain packaging to decrease the attractiveness of cigarettes to young people, break the link with tobacco company sponsorship and advertising and help control smuggling by distinguishing the domestic package from the package destined for export. The federal government intends to study plain packaging. We want action now. Bill 119 already allows for it, and we want it specifically required by the bill.
Require that smoking be banned in all public places except where specifically exempted by regulation. This will be important because tax reductions lead to more smokers, which will in turn lead to more smoking in public places and more involuntary exposure of nonsmokers to secondhand smoke.
Immediately move to amend the Smoking in the Workplace Act in order to ban smoking in all workplaces in the province at the earliest possible convenience. I know you have to examine this bill, but I hope you will place that in order of priority at the top, because we have a very, very weak workplace act at the moment.
The lung association receives calls almost daily from employees who feel victimized by smoking that goes on in the workplace, and also really let down by the fact that there's such a weak workplace act that exists. So please do look at smoking in the workplace and strengthen that act.
Enforcement is the key, I think. When you look back at licensing, if you have retailers licensed, we must have enforcement. Without sufficient human and financial resources and the political will to use them in support of the provisions of the act, the legislation will be ineffective. To date, the provincial government has not indicated how it plans to enforce the act.
The lung association believes the government and the opposition parties want to ensure that the legislation is consistently applied, effectively enforced and is easily interpreted by all parties affected by the legislation. We recommend that at the earliest opportunity the government make public the details of its plans with respect to enforcement of the act.
I'd like to conclude by saying that as a member of the Ontario Campaign for Action on Tobacco, we strongly support everything that is said in the OCAT submission. We worked very hard to bring all this about, and as the lung association's submission does not encompass all that the OCAT submission does, please know that we support that wholeheartedly.
Bill 119, with the above amendments, is a prescription plan to give kids a chance, and I want to reiterate the fact that this is for children, not for smoking adults. It's for the protection of children who haven't started to smoke yet. Children are making the decision to smoke between the ages of 12 to 15 years old, and they're being seduced by advertising, by peer pressure, by image packaging, by examples set by parents, by the pharmacists, They're also being seduced by the fact that tobacco is accessible.
Of children between the ages of 12 and 15 years old who decide to smoke, 94% are going to continue smoking until adulthood. I want you to think about this just as I close. When a child between the ages of 12 and 15 years old makes the decision to start smoking, that is the only lifetime decision a person is going to make at 12 to 15 years old.
We don't make career decisions. We don't make hard decisions about which religious belief we're going to have. We don't make decisions about the mate we choose for the rest of our lives. We don't make decisions about almost all important things. But we're asking children between the ages of 12 and 15 years old to make decisions, when they're under the pressure of the tobacco industry and the poor example set by pharmacies and adults, and by government, to make a decision about the health they will enjoy, or not enjoy, for the rest of their lives.
On behalf of the lung association, Thunder Bay region, I urge you to remember through your work with this act that this is for children and for the protection of their health for a lifetime.
The Chair: Thank you, and we now welcome you, Mr Nobel, to the hearings. Would you perhaps like to add something from your own experience?
Mr David Nobel: Yes. First of all, I'd like to apologize for being late. I live 30 miles out of town and I tried to print all the briefs up. I had problems with my laser printer. I wasn't sure whether I should get the copies made or come in and try to get them made here. I did it this way and I'm very sorry that I did not arrive on time.
The Chair: That's all right.
Mr Nobel: I have a special interest in Bill 119 because I have two daughters, one a teenager and one a pre-teen. I'm very concerned about whether or not they are going to be tempted into starting to smoke. I believe the whole thrust of Bill 119 is towards preventing young people from starting to smoke. It's not directed against those who are already established smokers; it is designed to prevent new smokers from entering the marketplace. Therefore it is a vital bill, from my own personal interest and I'm sure the interest of many parents across Ontario.
I feel that what we have right now in Bill 119 is excellent legislation. It's something which will put Ontario in the forefront in North America and the whole world in terms of prevention of smoking and anti-smoking, anti-tobacco.
What we are missing in Bill 119 now, I think, most importantly, are two vital items. We do not have in place anything which addresses the issue of licensing and plain packaging, and there should be no mistake made. If you're really serious about combating among teenagers, it has to be approached as a total battle plan.
If you take two or three items, we have some good initiatives in here now. We have age of majority now. We have vending machines being banned. We have the termination of sale of tobacco in pharmacies. These are important strategies, but they have to work synergistically in order to be really effective. Otherwise, we'll see some benefit, but we'll see minimal benefit.
I think the two most important things lacking here are the licensing of retailers and plain packaging. This is based on extensive research which has been done in this field prior to today, over many years, according to studies done in the States, where in selected areas they have introduced really tough laws about regulating retailing of cigarettes. In other words, there's licensing and there are really stiff penalties put in place if you sell cigarettes to minors, which you're not supposed to do now but which is not enforced. It's just widely disregarded.
Where that is done, we see a dramatic drop in teenage smoking, up to 70%. It will not happen only through education, it will not happen only through banning vending machines, it will probably not happen to the degree we would like to see and to a significant degree with anything which is in Bill 119 now. It will have an effect. It will not have the dramatic effect that would have. That simply puts real teeth into what is the expressed desire of the legislation, and without it the legislation will not have the effect we would like to see.
The second issue is plain packaging. This is another vital issue. It's the issue I think you'll see the tobacco industry fight the most strongly on, with the most really dishonest types of arguments.
The bottom line on packaging is that the cigarette industry knows the packaging sells the cigarettes, and specially among teenagers. Studies that have been done here in Canada recently have shown that packaging has an enormous influence on teenagers who are thinking about smoking, because they're so impressionable and because image is so important. There's no brainwork involved here at all. It's all response to image.
When you take away the attraction of packaging -- and the packaging attraction is amped many times by tying in with corporate sponsorship, with the logos, with the symbols and the advertising effect of having that package coming out of pockets, thousands, millions of times a year across the country -- you remove a lot of the incentive of young people to get involved in smoking. It sounds simplistic, but it is nevertheless a fact.
Probably the key element, even more than licensing, to reducing teenage smoking, to preventing kids from smoking who would otherwise be attracted to cigarettes is to take away the attractive packaging. If you don't address that, in conjunction with the licensing, we're really taking a great deal of the wind out of the sails of this bill, and I urge you to include this in Bill 119. It is vitally important.
We also know that a majority of people in Ontario support this kind of legislation. There was an Environics poll that was done a number of years ago, two or three years ago, which showed rather conclusively that smokers and non-smokers together support the restriction of sale of cigarettes and tobacco products to minors, to teenagers. There is broad-based support.
I urge you to look at where the opposition to this bill comes from. We have an organization called the Committee of Independent Pharmacists. Where do they get their money? I think a lot of you are already aware of this. Where are their supporting financial statements? What kind of organization is it? Likewise the Smokers' Freedom Society: What is their membership? Has anybody here seen a list of their members? Have you seen a copy of the minutes of their meetings? Have you looked at their financial reports?
They have not been forthcoming on this, contrary to the practices of almost every group that is appearing before you to lobby for this bill. Most of the major health and social advocacy groups have open books, they have open membership; you know what they represent and you know who's funding them.
I put it to you that the tobacco industry is behind most of the most vocal and high-profile opposition to this bill. I put it to you that there is not significant opposition to this bill among ordinary Ontarians, which is not to say there are not independent retailers and vending machine operators who will suffer under these proposed measures.
But I feel and I think, if you look at this squarely, this is a necessary evil, that is, you cannot have social change this dramatic, social change which is trying to reflect an evolving consciousness about health and smoking, something which has been evolving since 1964 and the US Surgeon General report and much, much faster and at a much, much faster rate -- and we know how bad it is and how addictive it is now -- you cannot effect that kind of social change without somebody having to give somewhere.
We have an established, very, very profitable industry, and somewhere along the line the rights of merchants and the industry have to be balanced against the social responsibility of the government and the people of Ontario and their rights as well, the rights of ordinary citizens. This is not easy to do, but it has to be done, and I think even a lot of people who have a vested interest in this recognize this and are willing to make a lot of concessions to see it happen.
I hope my daughters never start smoking, but that is their choice. I can't prevent them if they want to, but I hope the legislation you're going to be putting in place, Bill 119, will be effective enough and strong enough that it will help them to choose not to smoke.
Mrs Haslam: I'm going to be very quick. On the last page of your submissions, there was something there and I wanted to clarification of it. I'm doing this in a very non-partisan way, but as a teacher-librarian, I like to know where things come from and where they were quoted from and where I can follow up on it.
You start on page 5 indicating your anger at "the Prime Minister's devastating decision to roll back tobacco taxes, which will lead to thousands more tobacco-related addicts, disease and death." Then on page 6 -- do you have this? This is the lung association, Thunder Bay region -- you commend Mr Rae, Mrs Grier and also Ms McLeod for her commitment and courage in light of the current pressure and controversy around the taxes.
Did she say something locally around this issue? I hadn't heard anything in the Toronto papers, and that's why I wanted to know if she has come out and I've missed it because it has been in the Thunder Bay papers that she wants us to stand firm on the tax issue. Could you clarify that for me?
Ms Kaipio: Yes, I'd be happy to do that. I haven't seen the paper or a television for the last couple of days. I've been raising money at a casino here for the lung association. So I can't say that she didn't. However, she called me in my office on Friday to tell me personally that she also is outraged with the rollback and that, yes, she supported the government of Ontario in trying to hold out. We understand how difficult it is, but she wants us to know that as of Friday, she supported it.
Mrs Haslam: That does help clarify where that information came from. Thank you.
Ms Kaipio: You're welcome.
Mr Martin: I noticed that you made reference in here again about how in the north we have a seemingly greater percentage of our children and women smoking when you compare it to the provincial average.
I have four children as well, living in Sault Ste Marie, and my image of the north is free and lots of fresh air and all that kind of thing. I guess it's just disturbing for me today to be hearing these kinds of things, because I assumed differently.
Again, you'd mentioned the workplace legislation and doing something about that. The previous speaker had said that probably was one of the main causes of these percentages being higher. Do you have anything else to say on that?
Ms Kaipio: I'm sorry I missed the first part of your question, but I assume what you're referring to is the north and the higher incidence of smoking here.
As far as youth is concerned, I think there's a problem the north has had for many, many years. I think it has always been here. We seem to lag behind social trends that are set in the rest of the province by at least two years. Where smoking education started to be popular, this part of Ontario didn't see it for two to five years. We're way behind the rest of the province.
I think that's one reason why there's a higher incidence; also because we're in very isolated communities here -- the long cold winters and so on. A lot of children aren't involved in sports. They come from lower-income families. They will, as they call it, "hang out in malls," and smoke and that's what they call their recreation.
As far as the workplace act goes, I think people are smoking more because they aren't kept from smoking at work and you're just going to see more of it. There's more environmental tobacco smoke because of it and the parents of these children are continuing to smoke. It's harder for them to quit.
If you had 100% ban on smoking in the workplace, you'd have people for seven to eight hours a day, with the exception of their lunch-hour perhaps, not smoking at all. You'd have a significant reduction of smoking among the parents of these children as well.
The Chair: Thank you both for coming before the committee. Mr Nobel, thank you for getting here and for the copies of your submission. We appreciate both of you being here today.
THUNDER BAY MEDICAL SOCIETY
The Chair: If I could then call the representative from the Thunder Bay Medical Society, Dr Belda. We have you down here as representing the Thunder Bay Medical Society, but I notice that the presentation you've submitted to us refers to the Ontario Campaign for Action on Tobacco Smoking.
Dr Antonio Belda: Yes, actually, my secretary has put the title. It should be a presentation from the Thunder Bay Medical Society.
The Chair: This is a presentation on behalf of the Thunder Bay Medical Society.
Dr Belda: That's correct.
The Chair: Thank you. Welcome to the committee and please go ahead.
Dr Belda: First of all, I want to thank you very much for coming 1,500 kilometres up north, the same distance from Toronto to Disneyland, but I think you may have some fun here too.
As a paediatrician and allergist, every day I witness the effect smoking has on children and their families. I am going to review the information that I have here and add some additional information that I hope will help you to make decisions when you are dealing with the law itself.
The frustration that we have is that most of the children, especially in northwestern Ontario, can easily get access to cigarette smoking. Actually, one of my patients, a 16-year-old girl who started smoking at the age of 9 -- I was amazed to hear her story, that it was very easy for her to start selling newspapers and get enough money to go to any corner store, saying that the cigarettes were for her parents, and they were sold with no question whatsoever.
Unfortunately, this was a cool thing for her to do at that time but now she's 16, she has bad asthma and she's badly addicted to the nicotine. We're dealing with a very bright and alert girl, very intelligent girl. She wanted to quit. She couldn't do sports that the other friends were doing and she couldn't quit. She was physically and psychologically addicted to the nicotine. It was really sad to see because she wanted to quit and she was asking for help.
We're not talking about somebody who doesn't know what she's doing. We have to consider that this is a powerful addiction. If we had the same kind of patient with a cocaine addiction, I'm sure you would look for different ways and you would consider a different problem, a different higher level. But unfortunately nowadays in our society we believe and we tolerate smoking because it's a legal product.
Unfortunately, if you look at the history of smoking, this legal product kills eight times more than car accidents, suicide, murder, AIDS, drug abuse, all of them combined. I'm sure you likely have seen this bar picture. This is the estimated annual number of preventable deaths in Ontario only, and this is the amount of deaths that can be prevented in Ontario, comparing with the alcohol, traffic accidents and all these things. The illicit drugs only kill 100. Cigarette smoking kills 13,500, but it's socially acceptable. These are factual data.
The other problem we have is that, unfortunately, our governments in a conscious way tolerate, support and advocate cigarette smoking because of the governments becoming very dependent on the taxes collected for the cigarette smoking. Unfortunately, because it's not going to influence the people immediately but in the long-term kind of investment, this is something that's put up and they say, "Well, that's a problem that's going to be dealt with by future generations."
If you will look at the ads in the 1940s -- and you have some photocopies there -- "More Doctors Smoke Camels Than Any Other Cigarette." This was socially acceptable in the 1940s. You see Ronald Reagan with one of his first lies, saying, "I Wish My Friends Merry Christmas with Chesterfield," and it was socially acceptable. Unfortunately, that's when the glamorous pressure on women that smoking was the thing to do started. It's sad to see that unfortunately cigarette smoking doesn't produce the effects immediately; it takes 20 years, 30 years, 40 years to start showing the effects.
If you can look at this loose sheet that you have about the incidence of cancer in women, this will really remove your tranquillity when you go to bed, thinking of the increase in the incidence of lung cancer in women since 1970. Thirty years after Ronald Reagan was telling you to smoke Chesterfield, finally you start seeing an enormous speed of the incidence of lung cancer and you can see it's almost touching the breast cancer that hasn't moved in incidence. But look at the speed of lung cancer going up.
Let me just tell you the end of this story. Last year, for the first time in world history, more women were dying from lung cancer than breast cancer. You have a strong moral responsibility to leave a legacy for future generations. You have to act now. This has to be beyond any kind of a political interest. As a human being, you have this moral obligation to do that.
It is really sad, the power of the advertisement. Those cigarette companies have been selling an image of deceit, targeting especially the young generation before what we call -- and you have heard many times -- the age of responsibility. We have to understand the age of responsibility actually comes after you already are addicted to cigarette smoking.
If you look at the advertisement of the young woman: "I always take the driver's seat. That way I'm never taken for a ride." Give the women independence; give the young generation, "If you always follow the straight and narrow, you'll never know what's around the corner." Be daring. If you find cancer around the corner, that's your problem. We've already got your money.
If you allow me to advertise this brand of cigarette, which I call Kancerette, which gives you power, freedom, excitement, pleasure, control, security, confidence, stability, experience, life; if I advertise these, I'm sure I'll go to jail for misleading advertisement. But we are not doing this. We are accepting the misleading advertisement of the tobacco companies. Legally, we allow them to lie to the young generation because we need their money and the taxes generated by cigarette smoking.
I think Ontario should remain the leader, blocking access to tobacco. We have to keep the prices of tobacco high. We have to license the retailers. We have to ban all the vending machines and we have to raise the age of purchase. If you could actually go a little further and try to get right now all the cigarettes in a plain package, I think we can identify who's smuggling cigarettes from Quebec, which is now going to be the new thing to do, and we can obviously pick up who is smuggling or close the border.
You should really do this so you can destroy all the image that the tobacco company has been building in the last 40 or 50 years. Please give the children a chance and act strongly now against cigarette smoking. Thank you.
The Chair: Thanks very much and thank you for the old ads as well. We've heard about those but I don't think we've seen them quite as graphically as you've brought them to us today. We'll begin questioning with Ms Carter.
Ms Carter: Thank you for your forceful presentation and, as the Chairman said, the ads, which certainly tell their own story. You state on page 3 that governments become dependent on the taxes collected from cigarette smoking. I guess in the old days when we didn't fund health care like we do now, and when also there weren't as many high-tech procedures which cost a lot of money, maybe that was true. But I think we heard earlier today that actually the cost of treating people with cigarette-induced disease now equals the amount that governments take in in taxes, or more.
Dr Belda: Actually, I think it costs much more than from the taxes we collect.
Ms Carter: In other words, if we could reduce smoking and lose the revenue for that reason, then governments would not be out of pocket.
Dr Belda: That's correct. I think that's a correct assumption. I have read some estimates, because estimates are the only thing we have, that the future cost to the health care is going to be more than the money that you collect.
Unfortunately, you may have a blind government which decides, "That is going to be for the next government to come, so I'm not really worried about it." I'm appalled and worried about the federal government making a decision to make it easier to smoke because it's going to solve a political problem that we are all aware of, but not seeing the consequence of social costs in future years.
Ms Carter: Of course, that's a lose-lose situation, because governments are going to be collecting less in revenue, but there's going to be more smoking because it's cheaper.
Dr Belda: And it's going to cost more money.
Ms Carter: Presumably the health costs are going to go up just as the revenue goes down. What would you do if you were the Ontario government in the face of the new situation created by the federal decision and the threat of cheap cigarettes coming in from Quebec?
Dr Belda: First of all, I think you must do the plain cigarette package to easily identify who's smuggling cigarettes. Second, you keep increasing the prices to make it less accessible.
Ms Carter: Can we do that in the circumstances?
Dr Belda: Third, you have to enforce the law. What you have seen in the last two weeks is a weak enforcement of the law, which is the beginning of the destruction of our whole society. You cannot allow this to happen under any circumstances.
I lived under a totalitarian government for 15 years in South America, and I know you can lose control of society if you don't abide by the law. You have to enforce it. You cannot let interest groups direct what the elected government's going to do. You have to enforce it, even if it means that there are going to be some people die. We have 13,000 dying from cigarette smoking.
Ms Carter: Another Oka?
Dr Belda: You don't want to have another Oka? That's totally irrelevant. If we have to have another one, let's have it.
Ms Carter: But in view of the legal reduction in prices in Quebec, what can Ontario do to stop those cigarettes coming here? How would we enforce that?
Dr Belda: Install severe fines and penalties for anybody who even smuggles through the province.
Mr Eddy: Thank you for your presentation. We appreciate your comments. I agree with you about the weak enforcement. There's been extremely weak enforcement in regard to smuggled or contraband cigarettes. Very, very weak. Secondly, there's been absolutely no enforcement, we've heard, on selling cigarettes to minors. It's non-existent, the enforcement, we hear.
You've talked about licensing. You probably know, of course, that in the act there are going to be what could be considered heavy fines for selling cigarettes, tobacco products, to people under the age of 19. Do you see that licensing should also be put in place along with that, or do you feel that very heavy fines will serve the purpose without the licensing?
The reason I'm asking that is, if you license so many outlets, like your corner stores, confectioneries, you're still going to have tremendous availability. So what do you think about fines versus licensing?
Dr Belda: The thing is, you have to have an enforcement mechanism.
Mr Eddy: Yes, sir.
Dr Belda: The problem is, if you put only fines without licensing, they may be willing to pay the fine and may even be actually sponsored by the tobacco companies: "I will pay your fines." But they will not have any incentive not to sell unless the licence is cancelled for ever. Now they will think twice before doing it. I'm sure the tobacco companies may be willing to subsidize the fees, because it's peanuts for them. I think they must go together, licence and fines.
Mr O'Connor: The bill itself has a statutory prohibition which would forbid people from selling if they are in contravention, which would be, I assume, what you're talking about in the licensing. Would you suggest that the prohibition remain in the bill?
Dr Belda: If they remove --
Mr O'Connor: If you are caught as a retailer selling cigarettes to a minor, then you'd be prohibited from selling cigarettes.
Dr Belda: That's correct.
Mr O'Connor: Is that acceptable?
Dr Belda: If I lose the licence, I cannot sell it.
Mr O'Connor: You don't even need to have a licence. What I'm saying is, in the legislation right now, if you are a retailer selling and you are caught selling to a minor, then there is a prohibition that won't allow you to sell it again. There are also successive fines, as well as putting signage in your retail establishment saying that you have been found in contravention of the law by selling tobacco products to a minor.
What do you think would have more impact? A licence on the wall that is gone, or a sign on the wall saying, "This person sold cigarettes to minors in contravention of the legislation," and then had to put it on the wall.
Dr Belda: If it works, I think that's good enough. But people like symbols and a licence is a symbol. If you remove that symbol, they may be psychologically affected more effectively.
Mr O'Connor: Interesting. Thank you.
The Chair: Thank you very much again for coming before the committee.
Ms Marcia Mableson: My name's Marcia Mableson and I'm a public health nurse with Thunder Bay District Health Unit. I work in the Nipigon branch. I was born and raised in Nipigon, small-town northern Ontario. I've been a public health nurse since 1981.
I'd like to thank the social development committee for giving the people of northwestern Ontario the opportunity to present their view on this bill.
What I'd like to do is just take you with me to small-town northern Ontario. I'd like to give you some insight into the extent of the tobacco problem in our small northern Ontario towns. To provide you with a balanced view, I have compiled anecdotes from public health nurses in five northern Ontario communities. I will be relaying them as my own experiences, but they are all true region-wide.
We begin with my return from Christmas holidays in London, Ontario. Not only are the potholes and narrow highway a challenge, it's impossible to find a restaurant with a no-smoking section. Everywhere I stop, grey, billowing cigarette smoke fills the air. My seven-year-old son, who has asthma, looks up at me and says, "I guess we eat in the car, right?"
Upon my return home the next day, I head off to work. On the way I stop at a local convenience store for a cup of coffee. Everyone has congregated at a stand-up coffee counter. The store is filled with smoke. As I join the queue at the till, I notice a couple of grade 8 girls walking out the door, unwrapping a pack of cigarettes as they head down the street to school. My son tells me these girls smoke across the street from the school during lunch break.
I head off to my office, which is located in the community hospital. As I approach the front door, I am greeted by a patient and his family who have seated themselves outside, next to an overflowing ash can. It doesn't matter how cold it is; they really need a smoke.
Later that same day I visit a senior kindergarten class to present a lesson on tobacco use prevention. The children are surprised to learn that secondhand smoke is dangerous. Half of them live with at least one parent who smokes. They ask me what to tell their parents about smoking. At recess I walk down to the staff room to join the teachers on their break. I go to the non-smoking staff room, but several teachers congregate in the designated smoking room just off the gymnasium. The smoking teachers are in full view of the students who spend their break in the gym.
Before lunch, I head off to the local day care and find the staff enjoying a morning break. They happily drink their coffees and smoke their cigarettes in a room open to the view of the preschoolers who play in the next room. These day care attendants are their role models.
I look forward to lunch that day; I'm meeting a friend I haven't seen in a long time. We arrange to meet at a local cafe. Everyone is hungry. The place is packed. There isn't a non-smoking section. We try to find a table in a corner away from the smoke, but there's no escape. The waitress lights a candle and says apologetically, "Maybe this will help." After lunch I join the slow-moving line at the till. Someone remarks that it's a good thing they have cigarettes in the vending machine right by the door. It's the fastest-moving line in the place.
In the afternoon I visit one of the many teenage mothers in the community. She's 17 and on welfare. Her premature baby is two weeks old. They live in a dark basement apartment which is poorly ventilated. She's trying to be hospitable, but I can see she's nervous. She lights up a cigarette and then jumps up to attend to her coughing baby who sleeps nearby in a swing. She opens the window a crack and says: "The doctor thinks the baby might have asthma. It runs in the family."
I finish off my afternoon with a phone call to a 60-year-old ex-smoker who needs help to pay her medical bills. She has diabetes and emphysema. She tells me she needs all the financial help she can get because her oxygen and medications cost her well over $300 a month. She expresses concern about her 40-year-old daughter who is a heavy smoker.
Next, I pick up my seven-year-old son from school. As I wait in the car, I notice the school principal huddling in the corner, stamping his feet to keep warm and having a cigarette.
On the way home I stop at the drugstore for a few items. As I walk through the door, I immediately catch a whiff of the cigarette smoke drifting from the back of the store. I catch a glimpse of an all-too-familiar and ironic sight: the local pharmacist puffing away behind the dispensary counter. This is life in a northern town.
That evening I return to work to teach prenatal classes. I am presenting a lifestyle class for first-trimester moms and dads. The class is well attended, approximately 12 couples. Their ages vary from 16 to 35. We talk about the effects of cigarette smoking on the unborn. The group is divided on the issue. A quick show of hands reveals that about one third don't smoke. One third say they've quit for the pregnancy but can't guarantee abstinence after the baby is born. The rest say they've tried and can't quit.
They say there's no way they could quit because their partner won't quit or they'd be too stressed out if they did. They say the stress of trying to quit would be harmful to the pregnancy, and in this town there are no support programs to help them break the habit.
When I finally get home to rest for the evening, I am shocked when I open the weekly paper. Right there in the middle of the page is an ad from a local arcade advertising the sale price on cigarettes. They boast about selling all brands, and I believe that ad is in your attachment.
I look forward to the weekend because my son will be playing in a Tom Thumb hockey tournament in a nearby town. The temperature is 40 degrees below and the rink isn't heated. After a half hour, I have to go into the lobby to thaw out but I don't know what's worse, the cold or the smoke. The snack bar and tables are filled by patrons. I figure at least half of those people are smoking. The rest of the lobby is filled with parents and spectators and it seems like half of them are smoking too.
I bump into a 14-year-old boy from the region who is smoking. I'm bold enough to ask him where he got the cigarettes. He tells me his parents gave them to him. He and his parents smoke together, he adds. He says it's their way of bonding.
That night my husband and I contemplate taking in a movie, but there's only one theatre and smoking is still allowed in the balcony. In this community, even going to a movie can put your health at risk.
I don't think I have to tell you what the problems are. By this point, you've heard it all before, and I'm equally confident that you've got a pretty good idea what to do about it. I'm not so naïve as to think we'll totally fix this situation with Bill 119. It's taken a long time to get this bad but we must make a start.
Our towns need help in controlling our sons' and daughters' access to cigarettes. We need help with implementing and enforcing strong and effective bylaws, bylaws that limit access and prohibit smoking in public places. We must protect our children from falling prey to the tobacco industry. We owe it to our children, the future of Canada.
The Chair: Thank you for what I must say is a unique presentation. We appreciate the way you approached that. I think it gets your message across very clearly. We'll begin the questions with Ms Haslam.
Mrs Haslam: I just want to say thank you also. I thought I'd heard it all before too until you came with this, as the Chairman said, very unique presentation. I really commend you on hitting us where it hurts, and that is where we live.
I don't think I've got any questions. I don't think the committee will believe I'm speechless. I've never been speechless before in my life but I really am because this is just such a devastating way to spend a day. It must be very difficult for you, in your position, to go through days like this. I imagine it's a compilation of days; I'd hope it is a compilation of different days.
Ms Mableson: Not all the time, no; some days are like that.
Mrs Haslam: Are there any success stories that you could share with us as an add-on to this type of typical northern small-town time?
Ms Mableson: I guess what comes to mind is the success that women in my age group are having in stopping smoking. We're not talking about women who are in a high-risk age group, the 12-to-19-year-olds. Those are the kids I'm really concerned about. Women in my age group are stopping smoking, but unfortunately most of them are well past the childbearing age. They've been through it and they can reflect and they know that they have to change their behaviour, but I'm worried about the young moms and I'm worried about the children.
Mrs Haslam: Do you think that limiting access to the areas where you may purchase smokes and looking at the cost of cigarettes are two of the strongest preventive strategies we could put in place?
Ms Mableson: I think that would be an effective start. I only know what I see and what I live. I hear kids talking. The other day when the new federal tax rollback came out I overheard two young kids talking and the little boy said: "Gee, this isn't going to be so tough any more. I don't have to spend all my allowance here." In Shoppers Drug Mart, standing in line, two young girls, one girl says to the other, "Didn't you know that they're cheaper now?" The other one says: "That's great. I can afford more."
Mrs Haslam: I was hoping we could end on a good note. Maybe there just aren't any good notes and it will make us work harder to be sure we can combat effectively what's happening.
The Chair: Parliamentary assistant.
Mr O'Connor: Thank you for your presentation. You do have a nice style in the way it's presented. The question I have for you would be, what role do you see the public health unit then playing in enforcement and education?
Ms Mableson: I think that the public health unit plays a very important role in education. As you probably know, it's a three-part approach: There has to be the education and the legislation and there has to be the enforcement, of which, by the way, there just isn't any where I live, and I'm sure that's true in most small northern towns. Enforcement, there is none right now. There isn't any.
Our tobacco use prevention program at the health unit is growing stronger all the time, and we work very hard in the schools to carry out a large percentage of that education. We use materials that are available through the Canadian Cancer Society, the lung association and other groups across the province and the country. There's no shortage of readily available, up-to-date information, and we really try to do our part in that area, I think.
Mr O'Connor: There's actually quite a bit of information through the different clearing houses and what not, but it's always taking a look at something new and fresh that might be coming out from one of the other communities in the province, and they may be tailoring it just a wee bit to the needs of your local community. Thank you.
The Chair: Thanks very much for coming before the committee this afternoon.
FORT WILLIAM COLLEGIATE INSTITUTE
The Chair: I'd like to call on Gillian Batay-Csorba from Fort William Collegiate Institute. Thank you for coming and joining us this afternoon. We've got a copy of your written presentation. Gillian, please go ahead with your submission.
Ms Gillian Batay-Csorba: I would like to start off by saying thank you for letting me speak in front of such a prestigious committee on behalf of Fort William Collegiate Institute.
Speaking on behalf of teenagers alike, it would be impossible to deny the fact that we are very impressionable, both with the things that we see and hear around us. On the advertising side of this, I think that the idea cigarette companies would like us to feel is what happens when you smoke. The high-class, worldly society of the smoker is very much an idea of what a high school student would like to feel. I can't say with any more disgust than I already have that this is not what happens.
When I was getting ready for this presentation I went to many different classes, and right now at the present time there's a group of grade 8s going to my school because there's an overloading at another school next to us, so we have grade 8 students. My principal and vice-principal gave me a chance to speak to them as well. The majority of those classes of 11- and 12-year-olds smoked. When I went to the grade 9 classes it was the same thing. In grades 10, 11, 12 and OAC it just got worse as it went up.
The majority of smokers, I feel from my research, are part of the younger generation, and I feel that the warnings on cigarette packages are inadequate to inform the youth of what actually happens when you smoke. To teenage girls especially, boys as well, it's very important in high school what you look like. If the cigarette packages let on that your fingers would be yellow, and your teeth and possibly your lips, that you would smell very awful and at one point you cough a lot and it becomes very hard to sustain cardiovascular endurance during aerobic activity, I don't think smoking would have such an appeal after that.
But instead they say, "Well, smoking could harm a pregnancy." Not too many high school students are pregnant at the moment and not too many of them are fathers, so that doesn't really hit them. You speak about lung cancer and emphysema: We're young right now and very ignorant, and I just don't think that has anything to do with us at the present time, so nothing that we could take into deep consideration.
Some people say that they will decide not to smoke and make it the healthy choice, but if you go to any restaurant or entertainment centre except for a designated few, you find it very difficult to find one with a non-smoking section. Even if you do, what says that the smoke isn't going to drift? Then you come to the point, "Well, it's not really my decision on whether or not I want to be healthy if everybody's going to be smoking around me and I'm just going to be inhaling it."
I'm not passing judgement on the people who do smoke. I'm just saying that maybe if everybody worked together to stop the future generation from smoking, we'd get somewhere. The only people who can save the smokers right now are themselves, but maybe we can extend the courtesy to the younger generation of giving them the decision on whether or not they want clear lungs.
Mrs Haslam: That's the most ingenious suggestion I've ever heard. You're absolutely right. We look at the ads and they scare us, you know. This ad for Virginia Slims just scares the bejabers out of me when I look at the young people and they're saying, "If you always follow the straight and narrow, you'll never know what's around the corner. Be decisive. Be fun. Be active," the ripped jeans, the whole bit. This is geared to you, and I'd love to put right under it, "Yes, you know cancer's around the corner." I agree with the gentleman who brought this.
But the idea of the Surgeon General's warning, "Smoking causes lung cancer, heart disease, emphysema and may complicate pregnancy," you're absolutely right and I love this. It's called truth in advertising. It says, "It will turn your teeth yellow, and your fingers, possibly your lips, and also you'll smell. After a certain period of time you'll find yourself coughing frequently." I think that's the best advertisement we could ever put on cigarettes for young people. Yes, "Kissing someone who smokes is like licking an ashtray." Why don't we get more truth in advertising? I think it's one of the best suggestions I've seen in a long time, and I just wanted to commend you for coming forward today. Thank you very much.
Let's be pessimistic. We're getting very pessimistic. Let's be pessimistic and they're not going to come forward with those kinds of things on packaging. They're not going to take your and my suggestions. Albeit we don't know why, they're just not going to listen to you and me. What else could we do for the young people? What else could we say to young people, what other message, since "You're going to die" doesn't seem to have that much effect on people? People think they'll live for ever at 16. It's only when they get to some of our ages that they start to worry about dying. What other message could we give the young people that would make it very clear it's not cool to smoke?
Ms Batay-Csorba: I've thought about that many, many times and I can't come up with any other reasons. I mean, if you tell a child --
Mrs Haslam: Young adult.
Ms Batay-Csorba: Yes. If you tell us that it's not socially acceptable to smoke, it provokes us to do it. We want to be socially unacceptable. But if you tell us that it makes our appearance look terrible, then it will. But if we can't get across the message on actual packages or in the magazines -- I mean Cosmo and Vogue and Seventeen and Sassy, every magazine you look at for a young lady tells you to be beautiful and thin and right next to it is a smoking ad with all these beautiful, thin women having all this fun that everybody would like to be enjoying -- I really have no other suggestions.
Mrs Haslam: It's very difficult.
Ms Batay-Csorba: Yes.
Mrs Haslam: You've obviously done a lot of thought on this, and I just want to say thank you very much. I really appreciate you coming and I know the rest of us are very pleased to have you here today. We're quite impressed with your ability to put your message across.
Ms Batay-Csorba: Thank you.
Mr Carr: Thank you very much also for coming in. A lot of the people who are your age and smoking, are they buying it legally or is a lot of it illegal? What would you say where most of them are getting them from?
Ms Batay-Csorba: Most of the people I talked to get it at the Indian store near Chippewa where they're sold for $5 for 25.
Mr Carr: So they're buying it on the cheap, the cheaper ones. What impact do you think, with the high cost -- and I guess some of the people around your age are working part-time. Is cost a factor in the decision to smoke or are they going to smoke regardless of the price, do you think?
Ms Batay-Csorba: I think, and from what the majority of people told me at my school, if somebody wants to smoke they're going to smoke. If they have to steal the money, if they have to steal the cigarettes, they're going to get them. Cost may matter somewhat, but to the majority it really doesn't.
Mr Carr: And with the changes with this bill, and it probably will go through, do you see a real decrease in the amount of young people starting to smoke?
Ms Batay-Csorba: No. In fact, just the opposite. I think more people are beginning to smoke right now.
Mr Carr: What about with the bill coming through? Do you think it will help, have much of an impact?
Ms Batay-Csorba: Honestly, I think everything that's happening with pharmacies and prices and everything like that, the age increase, I think it will help a per cent but I honestly say that it will be a small per cent. If somebody's going to want to smoke, they're going to smoke.
Mr Carr: Good luck.
The Chair: Thanks very much for coming down to the committee this afternoon. We appreciate it.
CANADIAN CANCER SOCIETY NORTHWEST ONTARIO REGION
The Chair: If I could next call on the representatives from the Canadian Cancer Society, northwestern region. Welcome to the committee. If you would be good enough just to introduce yourselves. We have a copy of your written submission and once you're settled please go ahead.
Ms Lynda Kvarda: Good afternoon. On behalf of the Canadian Cancer Society we would like to thank you for coming to Thunder Bay. We appreciate your taking the time to listen to our community's concerns about this important issue.
I would like to introduce Dr Geoff Davis. He is a medical practitioner in Thunder Bay and part of the medical affairs committee of the Ontario division of the Canadian Cancer Society.
My name is Lynda Kvarda. I'm a volunteer for the Canadian Cancer Society, I'm a nurse and I'm a mom of two teenagers. I work in a local hospital. I joined the Canadian Cancer Society five years ago because I felt there was a need to educate our young people against the hazards of tobacco.
In that time we of the health promotion committee developed and presented various anti-smoking programs in the schools across northwestern Ontario and to all the grades from primary to grade 10. I found it frustrating to note the statistics put out by the tobacco resource/action centre indicating a high incidence of children smoking in northwestern Ontario compared to the provincial average.
It's very disheartening for us as educators. Thunder Bay city itself I think is equivalent to the provincial average. It's the smaller communities outside of Thunder Bay that are higher. The study indicated 40% of grades 9 and 10 regionally are smoking.
I was delighted when the Ontario government put forth the proposed Bill 119 and I commend you on it. I feel education alone, however, is not enough but that enforced legislation to prevent young people from purchasing cigarettes is pertinent and necessary.
A study, which I'm sure you're aware of, of four northern California communities designed to examine the effects of community education and law enforcement intervention on illegal tobacco sales to minors concluded that education alone had a limited effect on reducing tobacco sales to minors. I have that report with me.
For example, the positive effects of education, combined with law enforcement, have been shown by an increased number of people wearing seatbelts and a decrease in drinking and driving because of the RIDE programs. Those are two examples.
In Bill 119, I am concerned about the phrase, "No person shall sell or give tobacco to a person who appears to be less than 19." "Appears" is too broad a term and allows retailers an excuse for not checking ID. All young people should be required to produce ID credentials which include age and a photo, the same credentials that are required in purchasing alcohol.
Several young girls I know who are 15 and 16 have no problem at all getting cigarettes. They get them from the corner store; 93% of kids who are smoking today get their cigarettes from the corner store, incidentally. Many young girls today look older than they actually are. I have a daughter at home who's 16 and looks 21.
I do know that they have trouble getting cigarettes at the 7 Eleven stores. They have a strict policy, and they abide by it, that they do not sell cigarettes to minors unless they have the appropriate credentials.
One of the most important interventions in preventing young people from smoking is plain packaging. A study funded by the Canadian Cancer Society found that packaging is an important status symbol for young people who smoke. Plain packaging does not give the same impact. It is also a deterrent for those who want to start. This should be included in the proposed bill.
The study was conducted with two of the most popular brands of cigarettes that kids smoke today, du Maurier and Player's. In part of the study the young people were given a list of adjectives to describe the people who smoke brand cigarettes compared to the people who would smoke plain package cigarettes if they were on the market. The buyers of the brand cigarettes were smart, fun, popular, outgoing; the plain package buyers were considered wimpy, goody-goodies and losers.
It was also noted that the buff-coloured plain packages were more undesirable than the white packages. The white packages were neat and clean and new looking; the buff-coloured packages were old and antiquated and deathlike looking.
Also in the study, the kids were asked what policies or interventions would prevent kids from smoking. They listed cost obviously. It's a good reason for eliminating kiddie packs, I think. The second was the lack of availability through restriction of sales and the third was plain packaging.
In conclusion, I would like to thank you again for coming. It is an important issue, one I feel very strongly about. Seeing someone dying of cancer of the lung or one of the associated diseases is very heartbreaking. It can be prevented and you can help. Thank you.
Dr Geoffrey Davis: Thank you, Mr Chairman and committee members. I'd like to further dwell on some of the points that Lynda has made, but also some of the specific suggestions that the cancer society has with respect to Bill 119. Furthermore, I would like to talk a little bit about the issue of chewing tobacco, which is one of the less talked about issues in terms of smoking itself.
I must say that I'd commend this government and this committee for looking, as they have, into Bill 119. I think it's a bill which supports health, not economics. It's a bill which looks to the future. It's a bill which is an insurance policy for our children, which is in itself a very unselfish thing.
I must say that it is with some regret that I'm talking to a provincial committee today, as I think that a lot of people would prefer to be speaking to a federal committee with the very backward step that they've taken in the last week. Just on my way over here, they're talking about all the stores in Hull having a great deal of difficulty keeping up with the supply of cigarettes and that the wholesalers are having to work overtime. We have a domino effect among our provinces, where now provinces are being split with the economic devastation that this federal government has imposed on us.
None the less, if I could speak more specifically to Bill 119, there are several areas, as you know, which we feel could be further enhanced. Lynda has spoken of the phrase "or on other reasonable grounds" in section 3(2) of the bill, an area that should be eliminated from this section, as it is too vague and allows too much latitude in the defence of a person who is dispensing cigarettes to minors.
In section 9, which deals with the places where smoking is prohibited, we feel that this should be expanded to include the grounds of schools and day nurseries etc.
Regarding packaging, Lynda has spoken about plain packaging and I would like to further mention this issue. If you read the study that was done on the image that tobacco products present when they are presented with the flashy packaging that is there, it's a very difficult study to do. If one reads the study, I think you'll find that it's a very well done prospective study that tried to address the issues in a very responsible fashion.
One of the interesting things that was discovered in their study was that if you looked at the younger teenaged children, they're more responsive to advertising and promotion of image products, whereas the older teenagers, even at that age, are less influenced by the packaging and are more influenced by the product that they perceive to be better.
Furthermore, on the packaging issue, Mr Chairman, I brought for you a small gift, if you will, to show you the image of packaging as I further discuss chewing tobacco. I don't know if many of you have ever indulged in the chewing tobacco habit, but you might be interested to see some of the types of packaging that are used.
The Chair: If it's all the same to you, you can keep the gift.
Dr Davis: This is a pack of chewing tobacco which the person over 18 in this province is now allowed to buy. This is the package that the eight-year-olds and 10-year-olds buy. It's called Big League Chew, same packaging, obviously marketed to indulge the children. If any of you parents are parts of sports organization, you may know of the incidence of tobacco chewing in athletes. The younger sports kid goes for this, because their coach will often chew the tobacco. This is another package of smokeless chewing tobacco. This is a package of chewing gum. It's obviously marketed to an early start program, and I think this legislation should look to expanding a ban on chewing tobacco altogether.
The incidence of chewing tobacco is relatively small in this province at the present time, but if you look in some of my abstracts, there are several articles which are referred to there. There's very little literature in Canada available about the incidence.
One of the articles talks about the incidence of college and varsity and intramural basketball players. Of 284 players, 25% indulge in chewing tobacco or smokeless tobacco products. The mean age was 15 for the initiation of all products.
In a larger study of 2,189 grade 1 through 12 students in Pennsylvania, approximately 20% of the subjects reported using snuff, while 16% were already using chew, and of that population 30% smoked.
If you look at the numbers that you've heard here today about our local population, you can pretty well extrapolate that and find that the incidence is very high of chewing tobacco use and will continue to rise within this province. I urge you to look further into the chewing tobacco issue.
With respect to kiddie packs, this legislation must prohibit the sale of kiddie packs as this is a very effective marketing tool targeted only at children in the lower socioeconomic groups to buy smaller quantities of cigarettes in an attempt to addict them at an earlier age.
Tobacco retail licensing is also an issue which you have heard about in previous presentations to this committee. I speak to it once again only to support the previous presentations about retail licensing. It is a more effective means of obtaining control on the sale of cigarettes in that it would provide income for the enforcement and inspection of the rules regarding the sale of tobacco products and, as well, would point out to the owner the added onus on their responsibility in selling the tobacco products.
Lastly, with respect to the issue of pharmacies, we support the ban on the use in pharmacies. However, in reading through Bill 119 -- I realize this will be dealt with in the regulations coming from 119 -- we feel the term "pharmacies" must be more clearly defined in terms of what constitutes a pharmacy. Certainly in this city, and I'm sure in many other cities, large supermarkets, superstores etc have pharmacies located within them. We would certainly support the ban on the sale of tobacco products in all of those institutions. However, it is not one which we find terribly well explained in the present status of Bill 119.
In conclusion, we'd like to thank this committee for listening to our submission. We believe Bill 119 can be further enhanced to improve the health of individuals. Collectively, by ensuring that this legislation is proclaimed and enforced, we are all fortunate to have an opportunity to alter harmful behaviour and to prevent illness and death caused by tobacco and to reduce the human and financial costs associated with tobacco consumption.
Thank you very much. Mr Chairman, are you sure you wouldn't like this? I might pass them around, if you like.
The Chair: Pass them around, yes. If you have any spare spittoons with you, that might be useful.
I want to just note as well for the record that you indicated at the back of your submission some abstracts on those publications. That is very helpful.
Mr McGuinty: Thank you very much for your presentation. I'm interested in learning a little bit more of the incidence of chewing tobacco use by young people. Are there any numbers on that and whether they're growing?
Dr Davis: I don't have any numbers on the incidence in Canada. Those facts that I spoke to talked about varsity teams. Particularly, it's a very popular item in the lower socioeconomic group and in the athletes. It's a popular and a growing area there. I think there are other reasons why it might be more enhancing to children too. It's obviously a lot easier to hide from your parents. It's small, it's compact, it's innovative, it's new, it fascinates the children. Much like cigarettes, it's a little bit disgusting when you first start, but if you continue to try, you can learn to enjoy it.
Mr McGuinty: In terms of the hit you get from this stuff compared to cigarettes, is it cheaper to buy this? If I'm a frugal-minded smoker and I'm merely concerned about price, can we drive people on to this stuff?
Dr Davis: I'm sorry. I can't hear your question with the fan directly above me.
Mr McGuinty: The physiological hit you get, is it comparable to cigarettes, first of all?
Dr Davis: I don't know exactly the answer to your question. But cigarettes, I am sure, would be a faster hit because of the fact that cigarettes go directly to your bloodstream through your lung; it takes about seven seconds. It's faster than intravenous heroin. Chewing tobacco is going to get absorbed through the mucosae of the mouth, so the hit or that pulsatile high that you get from cigarettes will be faster.
If you speak to people who chew tobacco, they say they get the same hit from it. As soon as you show them that pack -- I did show this package to a person yesterday who chewed tobacco. He says, "I wasn't going to chew tobacco all day today, now you've really got me going." That was his first comment.
Mr McGuinty: I had heard that the manufacturers actually in some cases put finely ground glass in chewing tobacco to act as an additional abrasive. Have you heard of that?
Dr Davis: No. I know that in certain Third World countries they use lye and other abrasive components that may be -- I don't know if that's in those products -- but it may be in other Third World countries they use different abrasives to help induce the impact.
The Chair: We're all going to be ill. Mr Wiseman.
Mr Wiseman: I'm asking you if you know, if you can clarify this, but I heard that the minor league sports baseball teams had the rule in place that they've banned chewing tobacco in and around the games that are being played in AAA ball or something like that and that they're trying to get rid of this chewing tobacco.
Dr Davis: I don't know about AAA ball leagues and things. I'm sure there are areas where it probably is banned. But as in the whole anti-smoking, anti-tobacco lobby, if you will, often it's the legislation that gives other organizations the clout to be able to say, "We have the support." From a legislative point of view, it's certainly the members of Parliament and the MPPs that one looks to for the leadership to say, "This is where you should go."
I am sure there probably are areas that have banned it, but again there are probably areas that wish they would ban it but it hasn't been able to come to fruition because of lack of legislation.
Mr Wiseman: Do you have any idea -- maybe you said this and I missed it -- of the percentages of people who actually use chewing tobacco? It's way down from what it used to be.
Dr Davis: But it's growing.
Mr Wiseman: It's growing again?
Dr Davis: It's growing rapidly in the United States. There are no studies that I know of in Canada, but the incidence in the United States has been growing very rapidly.
The Chair: Thank you both for coming. I think it's the first time we've talked in some detail about chewing tobacco, and that has been an eye-opener.
Mr O'Connor: Thank you for the information. Do you know of any Canadian statistics on smokeless tobacco?
Dr Davis: No. I keep getting asked for it. Almost all of the American statistics that you will read will start with, "There is insufficient research, this is a very underresearched area," etc.
Mr O'Connor: One in four varsity athletes: It just stands right out.
Dr Davis: I think that's pretty consistent across the country in the States. I can show you several other studies that will come with similar numbers. It's not a trivial preoccupation, and if you watch any baseball game, you can see where a lot of the influence is coming from.
The Chair: We want to thank you both for coming. I suspect, Dr Davis, you do a number of public presentations and I would be only too happy to give you back this wondrous gift that you have presented to me. Thank you both for coming. We appreciate it.
ONTARIO PHYSIOTHERAPY ASSOCIATION, NORTHWESTERN DISTRICT
Ms Diane Hiscox: I am representing the northwestern district of Ontario Physiotherapy Association today. I am also speaking on behalf of myself, so that's why you have two documents before you.
I don't have the stats, but just to comment on our previous speaker, I would like to share with you a personal experience about chewing tobacco. I didn't realize that would be an issue here today. My son went to school in Austria. He was a ski jumper. The children there were 15 and 16 years old, and he was telling me that they all chewed chewing tobacco. It was very popular, it was part of the sport, and I think they did it in school. I just thought I'd share that with you.
The first issue that I'm going to address is on behalf of the Ontario Physiotherapy Association. Just to give you a little bit of background about myself, I am a practising physiotherapist and I work on the pulmonary-respiratory service, so I'm very familiar with the clientele, the patients and the people who have suffered the ill effects of tobacco.
As a practising health care professional in the field of physiotherapy, we acknowledge and congratulate the government for its proactive approach to Bill 119. We respect and admire those individuals who've had the courage of their convictions and their values, thereby promoting the health and wellbeing of the young generation of our society.
We as citizens, as well as health care practitioners, have the responsibility to create an environment that promotes informed decisions on healthy lifestyles and behaviours. We support section 3 of Bill 119, which raises the age for the legal purchase of tobacco from 18 to 19.
As you are aware, Ontario's chief medical officer of health stated in his report in 1992 that people who reach the age of 20 as non-smokers are unlikely to become smokers. The addiction of the vast majority of smokers begins in teenage years. I might add at this point that a lot people I see in my practice started smoking at a young age. When I speak to them, they were not aware of the ill effects of smoking, or else they only associated them with cancer, not with being in the hospital, tied up to an oxygen line and losing their freedom.
According to Addiction Research Foundation statistics between 1977 and 1991, the percentage of young people trying tobacco for the first time before grade 9 dropped from 89% to 69%. However, that percentage increased from 69% to 75%. I do not need to tell you this; you've heard it today. But what I suggest you do is go to your local school yards, your junior highs, your high schools. Those of you who have teenagers, ask them how many of their friends are smoking, and I think you'll be a bit amazed, if you're not already.
We believe that tobacco sales in health care facilities, pharmacies, retail establishments linked to pharmacies and prescribed places should be prohibited. In agreement with the framework of the health promotion model, as presented by Jake Epp in 1986, Achieving Health for All, Bill 119 supports healthy environments and facilitation of self-care. Jake Epp's report embraces health promotion when discussing a new vision of health. It identifies prevention of illnesses as a national health challenge, stating that preventive measures can lead to a 50% reduction in the incidence of lung cancer and heart disease.
Health facilities and pharmacies that sell tobacco products are sending and giving mixed messages about the risks of tobacco. Indeed, these facilities should be part of the solution, not part of the problem. The document Achieving Health for All supports Bill 119. Now we must consider whether we will accept the challenge. We must walk the talk.
We strongly encourage the government to continue to pursue section 5 in that tobacco sold to the consumer retailer must be packaged in accordance with the regulations. This package is to bear both health warnings and other health information. The cancer society -- and you've heard all the research that it has given -- certainly indicates to us that the public policy to legislate plain packaging is part of a comprehensive plan to reduce tobacco use. By excluding plain packaging from such a plan, an important opportunity would be missed to effectively break a critical and powerful link that transfers the images portrayed via other promotional strategies to the user of cigarettes.
In summary, as health care practitioners, physiotherapists of the northwestern district of the Ontario Physiotherapy Association, we totally support Bill 119 to make the public cognizant and better-informed citizens about the risks of starting smoking, particularly at an early age.
I brought with me, if you wish to see it -- I'm sure you're familiar with it -- the report. This bill certainly supports that.
The next submission is a personal submission. I just want to illustrate to you the impact that smoking has.
I would like to describe to you a prominent citizen in our community who started smoking about 35 years ago. Those who are in my age group will be aware that in those days smoking was not considered a very dangerous thing to do; it was the in thing to do. The marketing wasn't as slick as it is today, but it was quite fashionable, without risk.
This person stopped smoking when his child was born -- that was about 13 years later -- but he did not give up his pipe. We were led to believe that pipe-smoking just caused cancer of the lips, so it was a treatable illness and we all bought into it. He pursued a career in neurosurgery. He came to Thunder Bay and was the only neurosurgeon. This man was a very dedicated neurosurgeon. He didn't miss one day of making rounds in a hospital in 27 months.
He was able to obtain a partner. They practised neurosurgery together and provided very good service to their patients. However, he practised in a smoke-filled office, part of it being that he contributed to it. He practised in a hospital where smoking was allowed in those days.
This man died 18 months ago of cancer of the lung. That means in Thunder Bay we have one neurosurgeon left. That means that when he takes holidays, for this community there is no coverage. A child could die of a head injury; a pregnant mom could get in trouble. There is no neurosurgeon between Kenora and Sault Ste Marie. For people who live in the north, that's fairly significant. If you're aware of the political situation with doctors, recruiting a neurosurgeon is not easy.
He also left four children and a wife. I am the wife. I've paid the price, the community has paid the price, of what cancer can do. I'm a physiotherapist; I bought into it. He was a neurosurgeon; he was addicted. That's the kind of impact that smoking has. You can talk about your stats, but when you have to deal with it, it becomes a very important issue. There's a lot of responsibility here in the decision that you are making.
I thank you for giving me the opportunity to share my feelings with you today. I hope I will have some impact on the decisions that you are forced to make. I know the decision will not be easy for you; there are many ethical issues here. But I think we have a responsibility to our children. People don't like to give rules to children. Children like structure. You find the happy children are in an environment where there are structures and there are limits set for them.
Thank you for allowing me to make my presentation today.
The Chair: Thank you for your submission -- I think everyone feels very strongly -- and in particular the personal submission that you made. As you say, so often we look at this issue in terms of data and statistics, all of which are important and meaningful, but we also have to remember the real people behind those statistics. Your presentation is all the more effective because of that, although we all share with you in wishing that you had never had to make that particular submission.
Ms Hiscox: Are there any questions? I'll entertain any questions.
The Chair: I think, quite frankly, your submission stands by itself. We want to thank you very much for coming here this afternoon.
The Chair: I now call on the next witness. Just to note for members of the committee, there are two: from Shoppers Drug Mart, Brenda Adams, and from Canadian Safeway Ltd, John Ginn. Welcome to the committee.
Ms Brenda Adams: My name is Brenda Adams and I'm pleased to have the opportunity to speak to you today. I'm sorry I don't have copies of my submission, but I will provide one to the committee within a few days. With me today is John Ginn, the manager of the Safeway store on Arthur Street here in Thunder Bay. His 50,000-square-foot store also has a pharmacy.
I would like to welcome you to Thunder Bay and I hope you enjoy your time here. We are very proud of our community and I hope you will get a chance to see some of the city. I also hope I will be able to bring to you a new perspective to some of the issues that you are addressing in this hearing. I know it has been a long day, so I will keep my remarks to the allotted time.
I wholeheartedly support the government in working towards a smoke-free society in Ontario. The steps you are initiating in Bill 119 will go a long way to ensure that young people do not start smoking and that the sale of tobacco is controlled. It is very clear that this government is concerned about the health care of Ontarians and this legislation reflects that concern.
There are a lot of good initiatives in this legislation. This government should be congratulated for the public policy direction. However, in the context of this issue, there is no place for a ban of sale of tobacco in pharmacies. It will not help the government achieve its broader goal of better health care and is unfairly punitive to pharmacists who presently choose to sell tobacco as part of their regular retail products.
Many of the presenters in these hearings tried to lump all the pharmacies into one format, typically that of a very traditional, old-fashioned pharmacy. In Thunder Bay we have many different types of pharmacies. We all have different types and shapes of pharmacies. We have a Zellers Pharmacy at the Intercity Plaza, a pharmacy in the Safeway supermarket, and the Canadian superstore that has a pharmacy as well.
I own and operate two Shoppers Drug Mart pharmacies. I think I can help you understand that all pharmacies are different and require different product offerings due to their format and to their dependence on physicians.
One of my pharmacies is a 6,000-square-foot store located in Centennial Square, and I sell tobacco at that location. Tobacco makes up 13% of my sales. My store is configured like many other Shoppers Drug Marts. We merchandise the tobacco in a 12-foot section at the front checkout. There is absolutely no other product that I can add that will only require 12 feet of space that will generate 13% of my sales.
Keep in mind that tobacco has an even greater contribution to sales than my entire cosmetics department and it's equivalent to my combined sales of paper products and confectionery, or to my total sales of over-the-counter medications which, I might add, are also sold by my non-pharmacy competitors.
This legislation is just the same as if you told me I could no longer sell cosmetics or paper products and confectionery or over-the-counter preparations. To me, as a retailer and as a business person, it is the same issue. These products are all departments within my store. You can see that I rely on tobacco for a large percentage of my sales, as well as the companion purchases that are made by customers who come in to buy tobacco.
My other pharmacy is totally different. It is in the Port Arthur medical clinic and we do not sell tobacco at that location. It occupies only about 2,000 square feet and there are approximately 40 doctors in the medical building. As a result, our business is almost exclusively prescriptions. We have a very small front-store business and no competitors in the immediate area. I do not need tobacco at that location to survive.
As a pharmacist and as a retailer, I can tell you these two stores are completely different for many different reasons: because of their size, their location, the competition that is around them and because of their proximity to doctors, and also based on their reliance on tobacco sales.
Many pharmacists who operate small medical centre pharmacies have appeared before this committee to proudly declare that they have dropped tobacco and have not suffered economically. Some may go on to recommend that all pharmacies should be prohibited from selling tobacco. It is no wonder that they have not suffered economically, but they should not unduly influence your decision. In essence, a pharmacy ban would give a small medical centre an even greater advantage over other pharmacies that are not located in the medical centre.
I have recently seen a copy of the Coopers and Lybrand study that was presented to you last week. I found it very interesting because it confirms what I'm saying, but also it demonstrates how important and fragile pharmacies in northern Ontario are. According to the study, over 2,700 full- and part-time jobs in Ontario will be lost, and from 120 to 140 pharmacies will close if they are prohibited from selling tobacco. In northern Ontario 196 pharmacy jobs will be lost and 10 community pharmacies will be closed.
It also details the impacts this will have on access to pharmacy services. In northern Ontario the potential market area without a single pharmacy would be over 43,000 square kilometres. I've been involved in many local pharmacy groups and I can tell you that we cannot afford to lose 10 community pharmacies in the north. There will definitely be whole communities that will no longer have a pharmacy service, especially in the north, as a result of this legislation. There are even some northern communities that are providing grants to pharmacists to come to set up pharmacies in their town. This legislation will definitely hurt these communities.
Just an aside -- nothing that's in my notes here today -- I really feel like I'm the bad guy here today, and I'm not. I'm a health care professional along with the rest of us. I'd really like to see tobacco non-existent. All I'm asking you is not to pick on pharmacies. If it's something that you want to legislate not to be sold, it should be made an illegal substance and not be available to anyone. To that I'd stand up and cheer, but I don't feel it's fair that I be singled out as one single retailer where tobacco should be banned. I'm in business like others.
At this time, I'd just like to pass it on to John to say a few words and then I'll say a little bit more.
Mr John Ginn: Thank you for allowing me to speak. Our regional manager was supposed to have made a presentation but couldn't make it, so I decided to come along with Brenda as I am very concerned with the clause that contains the pharmacy ban within Bill 119.
I won't take too much of your time. I only want to make a couple of key points. The pharmacy in my store is 1,500 square feet. That is only 3.5% of my total store. I have professional pharmacists on staff who have the dispensary under their supervision. They have nothing to do with the remainder of the store where the tobacco is sold. Those pharmacists serve their customers well and provide a valuable health care service to the shopping public who frequent our store.
If our company is forced to choose between the sale of tobacco and the pharmacy, that decision will be based on which is the largest contributor to the overall operations of the store. With the shrinking margins within pharmacy brought on by cutbacks to the Ontario drug benefit plan, I would have to guess the pharmacy would be the one to go. In my store that is five people; multiply that by the 151 non-traditional store formats in Ontario and you have a large number of unemployed people who won't be rehired by those stores to stock produce, meats and general merchandise etc. Thank you for letting me say my piece.
Ms Adams: I've also been following the federal tobacco legislation that relates to these hearings. The recent announcement by the federal government to a large extent is a mirror image of Bill 119. It seems that they have taken most of the provisions of Bill 119 into their own legislation. There is, however, one glaring difference, and that is the issue of sale of tobacco in pharmacies.
The federal government is completely silent on the issue of pharmacy sales. They recognize that there is nothing to be gained by a pharmacy ban and that it is discriminatory and likely unconstitutional to prohibit one type of retailer from selling a legal product.
I know you've heard presentations from the Ontario College of Pharmacists which state that it does not represent the business or economic interests of pharmacists, and it doesn't. As a professional issue, there is no argument with their position but this is as much a professional matter as it is an economic issue.
Simply put, I need tobacco to pay my rent, salaries and overheads to operate my business. If you legislate tobacco out of my drugstore you will force me to terminate at least four members of my staff at the Centennial mall location, and that's not an exaggeration. In fact, I was going to invite those four people here today and let you tell them that their termination would be a direct result of your legislation. My colleagues at the other three Shoppers stores here in Thunder Bay would also have to terminate people from their stores. Those terminated will be primarily women, part-time students and new Canadians. Surely this is not a group on which you wish to visit further hardship.
I know that you think you are doing the right thing, but are you doing the thing right? Will it reduce consumption? No, it won't. Ask yourselves: Will it result in job loss? Will it close down some pharmacies? Will it be discriminatory? Will it be unfair? If your answer to those questions is yes, then why are you doing it? Thank you again for your attention.
Mrs Haslam: I've been collecting a lot of data over the weeks on this issue and I find some of the things that are brought in very interesting. One of the people making a presentation reminded us that under the principles of ethical behaviour of the Canadian Pharmaceutical Association, a pharmacist shall not participate in any advertising or promotion program which might encourage misuse or abuse of drugs. As a pharmacist, you would be aware of that.
The other one I found really interesting under the code of ethics was that a pharmacist should never knowingly condone the dispensing, promoting or distributing of drugs which lack therapeutic value for the patient. I understand the concerns of some people who come before the committee who say, "I'm a pharmacist, I'm a health practitioner, but the bottom line is always how much profit I can make in my store."
Some of the other facts that we've had to deal with: Nicotine from an inhaled cigarette reaches the brain in seven seconds, and as a health practitioner, that should be something that does concern you. Tobacco is responsible for 20% of all deaths in Ontario in 1992, and as a health practitioner, I would think that would concern you.
We've had very many interesting people today. One was a 12-year-old boy from this area who brought in samples of cigarettes that he had bought and one of them came from Shoppers Drug Mart. That has to concern us when a 12-year-old is able to go into a facility and purchase cigarettes.
The gentleman before you I think made it a very clear case. It's something that I've been talking about over the extent of this time. This is a bill which shows foresight, as a piece of legislation which is about health and not economics, about saving people's lives and not protecting the incomes of individuals or corporations.
Some of the things that you mentioned -- 13% of your sales. The profit margin, though, is very low on the cigarettes. It's basically a cash flow in your business that is --
Ms Adams: It is a big cash flow.
Mrs Haslam: Because you don't pay for the cigarettes.
Ms Adams: Yes.
Mrs Haslam: You sell them, you get the money, it's a cash flow. So your profit margin on that particular product is fairly low.
Ms Adams: It still delivers a fairly good amount of profitability regardless, due to its volume.
Mrs Haslam: Right. We've had some people come in who have had 10% of their sales from tobacco, who have taken it out of the stores and have survived, have not laid off people, and I share that with you.
You said that there was some sale of other products and should we then ban other products in your store. I would just point out that cosmetics are not addictive; nicotine, and tobacco, is addictive. We have had health professionals come before us and say that it only takes two to three cigarettes and it is an addictive product. While I can agree that letting you sell certain products might not be to your benefit, I think in this case, we're looking at the benefit of young people and other people.
You mentioned the Coopers and Lybrand report. Did you get this from the Committee of Independent Pharmacists?
Ms Adams: Yes, I've seen a copy of the study and I looked it over.
Mrs Haslam: Are you aware that out of 1,400 pharmacies, they interviewed 13?
Ms Adams: I thought it was over 300. That's what I was led to believe.
Mrs Haslam: No, 13.
Ms Adams: I thought it was 13 in the independent --
Mrs Haslam: I'll let you check the report.
Ms Adams: -- and 300 --
Mrs Haslam: You mention that you're singled out. Actually, if you read the legislation and you look at it, you will find that we have not singled out pharmacies. What we've said is all health facilities. You are one of a group of health facilities.
Ms Adams: You've singled us out as retailers.
Mrs Haslam: No, we singled you out as a health facility perhaps, as a health facility that sells tobacco, but they also sell tobacco in hospitals, which we are now saying cannot be done, in hospitals where veterans are, in other institutions. As a health facility, you are one of many in this legislation.
Ms Adams: However, pharmacies are in a unique situation whereas pharmacies aren't what they used to be where they are only a health care facility. They have grown into large retail stores, just like, for example, Safeway that has a pharmacy within it.
Mrs Haslam: Yet you come before us in Toronto to look at the Regulated Health Professions Act. The pharmacists came to us and said: "We wish to be part of the regulated health professionals. We are not retailers; we are health professionals." I think that's where the crux of this legislation is. It's a health profession and we have to look at it as a health situation, not just a retail situation.
Ms Adams: I agree, and as I said, that is the one profession that does have that conflict of interest where we are health professionals when we are behind the counter but we also have to look after our business and our staff and there is the economic side to it, not to mention the fact of the companion sales we would lose. It wouldn't just be tobacco that's hit.
As I say, I wholeheartedly support the idea of making tobacco an illegal substance. I don't feel the clause banning it within the pharmacies alone or within health facilities alone will decrease the amount of tobacco consumption.
Mrs Haslam: I would tend to disagree. I may not disagree. What I know is that there are a number of stores in Sudbury that have reduced their sale and have not had an adverse effect. I know the College of Pharmacists, your governing body, has asked you to do this on a voluntary basis. When that didn't come, they came to us and said, "We need you to bring in this legislation."
I will end with one thing. Comments are often made that this will not help the government reach its goal, and there are many things that have been done in the last week or so that will prevent us, obviously, from reaching our goal in the year 2000 to reduce the number of smokes.
My comment would be: If removing one more access point for the sale of tobacco to young people -- and we've had many people come and say and they've done questionnaires and we do know young people can buy cigarettes in pharmacies, that it does happen, and it happens all too often to my way of thinking -- if we can remove one more access point and prevent just one more young person from starting smoking, believe me, I think that's worth it.
Ms Adams: Absolutely, and I really believe that in my store my staff are very well briefed on not selling tobacco to minors.
Mrs Haslam: How many Shoppers Drug Mart stores are in Thunder Bay?
Ms Adams: There are six total.
Mrs Haslam: So out of six, this afternoon Ryan was able to get into one of them and buy cigarettes.
Ms Adams: I'm speaking for my staff.
The Vice-Chair: Does that conclude your presentation?
Ms Adams: Yes.
The Vice-Chair: Thank you very much for coming before the committee with your presentation.
ONTARIO SECONDARY SCHOOL TEACHERS' FEDERATION, THUNDER BAY DIVISION
Mr Kevin Holloway: My name is Kevin Holloway and I am the president of Thunder Bay division of the Ontario Secondary School Teachers' Federation. I thank the committee and the hearing for allowing me to present this at a later date than originally scheduled. The package that I've presented, a little levity here, is in Valentine's Day red for you. My secretary wanted to make a heart out of it, but I didn't know how well that would go.
I've given you some background to the Thunder Bay division and the Ontario Secondary School Teachers' Federation, OSSTF for short. I do make a disclaimer that this document is not anywhere near an official policy statement by our provincial office. I'm not sure if they have one on the record at this time concerning Bill 119. But it is a collection of observations from educators in Thunder Bay and, as such, I hope you can use it in whatever way you wish.
To start off, I'd like to compliment the progress of this bill and I'm very pleased to support what you have done so far in the legislation. We would like to offer some suggestions.
The main purpose of OSSTF is to advance and promote the cause of education. We feel there is a connection between the health of our young people we work with and cigarette smoking or tobacco use, and as such we feel a need to speak out and state our opinion. Our opinion is that we should try to prevent in whatever way we can our youth from smoking tobacco products. We acknowledge that tobacco is a known killer, and it's our duty therefore to speak out.
In addition to that, there is an effect on part-time work habits. When students need money to finance their use of tobacco -- it could be called a tobacco addiction -- students often turn to part-time employment, which does then take them away from their time with their studies. This is not the only reason of course that students do part-time employment, but it does have a significant effect on their success.
We feel there is a connection between the health of individuals and their self-concept, and therefore their success in their studies. We want our youth to stop starting to smoke, and we need the legislation that you're proposing in order to help us do our job in the school.
Although we try our best, it is a fact that students do end up smoking on school property. We do our very best to patrol the different areas. We patrol the washrooms, we patrol the vestibules, we patrol the back doors and a variety of areas, hallways and stairwells, and occasionally we do catch students smoking.
What we end up having to do is more of a discipline matter rather than any health-associated matter. We feel that this legislation you're proposing will pretty well state that all of the student population should not be purchasing cigarettes because of the increased age and it will do a lot in helping us enforce the no-smoking-on-board-property rule.
An interesting aside: When the board of education -- I guess all across Ontario, but our board -- said there is a zero tolerance to smoking on board property for both students and employees, it forced people on to the sidewalks. I wish I could address that, but having students on sidewalks in front of the school or in the bus loading areas on the sidewalks is significant. In some cases, it's directly opposite elementary schools, so elementary schools see high school students smoking and a role model is created. I don't know how to address that, because we can't control what happens on public property. It's just an issue that I bring to your attention.
The school staff try their best to do all the different things. You heard from Brian McKinnon, our principals' and vice-principals' representative. We have programs in our phys ed classes to look at changing their attitudes towards non-smoking. However, students still do smoke.
We feel that restricting the number of retail outlets by preventing pharmacies and health care agencies from selling is a positive move, and of course the vending machines, which do not have a conscience. Vending machines sell to anybody.
We'd like you to suggest a few alternative things you may want to include in the legislation or future legislation. We feel that licensing retail outlets would be a way to have a definite control as to what those sales clerks and sales places would do. We feel that plain packaging would take away the connection of the image students have received through whatever advertising there is and from whatever role models in their lives. Plain paper packaging would be a definite suggestion that we can support wholeheartedly.
The banning of smoking in the public areas and removal of secondhand smoke really is very important, and the educational approach I think should go along with this approach of control. The advertisements we've seen recently on television are very, very good. We must work at countering the image that cigarette smoking is the in thing to do and that the only way to be accepted by your peers is to have a cigarette with them on the bus home or at parties and so on.
I think working together in an educational manner, with the correct kind of advertising, along with the restrictive manner your bill is proposing, is a way we can support, a joint thrust, educational and preventive. So we support what you have here and we'd like to leave this open for questions now.
The Vice-Chair: Thank you for your presentation. Are there any questions at this time by anyone?
Mr O'Connor: I appreciate your presentation. I know as a politician representing a constituency, quite often we'll get into the schools in our riding, and of course, this legislation being topical right now, quite a few of us are taking the opportunity to get in and talk to the kids. I guess part of the difficulty we have is that of course legislation alone can't do it. We have to involve the community and what not.
In the schools I guess part of the difficulty would be that quite often some of the teachers are smokers, so there's a challenge there again. I guess it's a double challenge. Trying to restrict the view of that is a problem, and not so much as it would be without this legislation in place, because it will be a total ban from the school and all property.
I just wondered if you had any thoughts you might have about how we approach the subject as we go into the schools to talk about it.
Mr Holloway: I'd like to comment on the concern about teachers smoking. When I started work with the Lakehead board back in the early 1970s, many people did smoke, and as we've moved through this era of understanding the effects of tobacco and having the restrictions on what we can do on board property, many, many teachers have stopped smoking. The actual executive I'm president of now in the past probably would have had three quarters, if not all, of the union officials heavy smokers. Now there are no smokers involved in OSSTF who are involved in our executive or division council, which is a fairly large body.
Times have changed. People are changing slowly. Of course there are some teachers who still do smoke. They are addicted to it, as many of the kids are addicted to it, but they are cutting back and they try their best to portray a healthy image to the students. Students do know, however, who smokes. Teachers have to have that same nicotine fix that students do, even though they're working against it.
I feel that part of the thing our boards of education could be asked to do is provide not only a punitive thing for students smoking, such as suspension or detention, but some kind of health care change in practice, something to help them stop smoking. I know teachers have the opportunity to take part in an employee assistance plan that has helped them, and there is nothing out there easily available to students. As well as saying it's bad and showing advertisements that it's not good for you, we should have plans in place, though I'm not sure where the funding comes from, that will help people stop smoking.
Mr O'Connor: I appreciate that. Cessation programs would be useful, and I'm glad to hear that there's something for the teachers themselves.
There's a booklet put out by the Ministry of Health called Talking it Out. It's a parents' guide to sitting down with the children to try to talk it out, because quite often when children reach that age where they'll start taking up the tobacco habit, they actually are at a difficult stage of life for communicating. Sometimes it isn't the best. I just wondered if you'd seen that documentation. I thought the document itself was fairly well laid out and I just wondered if you'd seen it or not.
Mr Holloway: No, I'm not aware of that package, but I'd have to become aware.
Mr O'Connor: Perhaps we need to circulate it a little bit better.
Mr Holloway: Yes.
The Vice-Chair: Any other questions? If not, thank you very much for making a presentation to the committee. That is the final presentation to the committee here in Thunder Bay, so the committee stands adjourned until 10 am tomorrow morning at Queen's Park.
The committee adjourned at 1631.