TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
ONTARIO PHARMACISTS' ASSOCIATION
MENTAL HEALTH RIGHTS COALITION
METROPOLITAN TORONTO HOMES FOR THE AGED ONTARIO ASSOCIATION OF RESIDENTS' COUNCILS
HAMILTON-WENTWORTH COUNCIL ON SMOKING AND HEALTH
CIGARETTE VENDING MACHINE OPERATORS AND DISTRIBUTORS, NIAGARA SECTION
CONTENTS
Thursday 24 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
Ontario Pharmacists' Association
John Connor, president
Wayne Marigold, member, executive committee
Gary Sands, manager, government and public affairs
Mental Health Rights Coalition
Marilyn Smith, outreach worker
Susan Roach, chair
Lisa Prinn; Robert Castle
Metropolitan Toronto Homes for the Aged
John Carrick, president, residents' council, Fudger House
Ontario Association of Residents' Councils
Mary Ellen Glover, executive director
Woburn Collegiate Institute
Gary Pennington, vice-principal
Hamilton-Wentworth Council on Smoking and Health
Dr Barbara Gowitzke, president
Anne Washington, chair, education committee
Cigarette Vending Machine Operators and Distributors, Niagara section
Ron Kane, representative
Raj Asser, representative
Kay Bourne
James Repace
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
Perruzza, Anthony (Downsview ND) for Ms Carter
Sterling, Norman W. (Carleton PC) for Mr Jim Wilson
Also taking part / Autres participants et participantes:
O'Connor, Larry, parliamentary assistant to Minister of Health
Williams, Frank, legal counsel, Ministry of Health
Clerk / Greffier: Arnott, Doug
Staff / Personnel:
Boucher, Joanne, research officer, Legislative Research Service
Gardner, Dr Bob, assistant director, Legislative Research Service
The committee met at 1006 in room 151.
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. Before inviting our first witnesses to make their presentation, before we end this morning I'm going to ask Bob Gardner to comment on some of the material that has been distributed. But we'll wait and do that at the end of the morning.
ONTARIO PHARMACISTS' ASSOCIATION
The Chair: Our first witnesses are from the Ontario Pharmacists' Association. Gentlemen, welcome to the committee. Please go ahead. We have half an hour.
Mr John Connor: Good morning, Mr Chairman. My name is John Connor. I'm president of the Ontario Pharmacists' Association. Maybe I could ask my two colleagues to introduce themselves.
Mr Wayne Marigold: My name is Wayne Marigold. I'm on the executive committee of the Ontario Pharmacists' Association.
Mr Gary Sands: I'm Gary Sands. I'm the manager of government and public affairs for the association.
Mr Connor: Mr Chairman, members of the standing committee on social development, I want to thank you on behalf of the Ontario Pharmacists' Association for allowing us this opportunity to speak to you on Bill 119.
Our association represents approximately 4,500 pharmacists, including independent pharmacists, chain drugstore pharmacists, hospital and industrial pharmacists. Under current provincial legislation, we are the official negotiating body with the government on matters pertaining to the Ontario drug benefit plan and represent pharmacy in a number of areas to the government.
At the outset let me state that the OPA is in support of the objectives of the government's anti-tobacco strategy as outlined in Bill 119. We cannot, however, support paragraph 4(2)8 of the bill that prohibits the sale of tobacco in a pharmacy.
The OPA supports the policy of voluntary cessation of the sale of tobacco products in pharmacies. This policy was supported by 62% of our members in a confidential referendum conducted by the OPA in the fall of 1992.
Our association has long been on record as supporting guidelines governing tobacco sales in pharmacies that include establishing all pharmacies as being smoke-free; prohibiting advertising, signage or any in-store displays promoting tobacco products; providing prominent display space for literature on the health hazards of tobacco use; and keeping tobacco products in a non-visible area that would require the customer to specifically request a tobacco product.
As well, in the past OPA has supported higher taxation on tobacco products, with a corresponding increase in funding for promotional and educational activities aimed at reducing tobacco use, particularly among young people, and stiffer penalties for selling to minors. But the provision of Bill 119 that would legislate the removal of tobacco, a legal product, from retail pharmacy conveys a lack of understanding about the current realities of pharmacy.
The retail, non-dispensary component of a drugstore is not only a separate and distinct entity from the dispensary but is absolutely critical to the viability of pharmacy. Neighbourhood apothecaries of the past would simply not survive, for example, in a major shopping centre in today's economy without the balance of front-store sales and the dispensary.
It is suggested that if many pharmacies do not sell tobacco yet stay in business, all pharmacies can survive without tobacco sales. This claim does not take into account various factors such as geographical location, the mix of prescription products with general merchandise in each store, hours of operation, the size of the store, the rent paid etc. This is particularly true in the context of existing government policies and initiatives taken with respect to pharmacy over the past three years.
For example, the professional fee of pharmacists paid under the ODB plan has been frozen by the government for the last three years. Last fall it was even rolled back under the provisions of Bill 48, notwithstanding the recommendations of two consecutive government-appointed mediators calling for an increase in the professional fee. The Ministry of Health has also continuously taken the position during negotiations with the OPA on the dispensing fee that it expects the retail "front shop" to subsidize the dispensary.
In the summer of 1992 the Ministry of Health delisted a number of ODB products from its formulary as eligible benefits. At the same time they implemented changes that substantially altered the level of reimbursement to pharmacists for many over-the-counter products. They did this by unilaterally deciding to stop reimbursing pharmacists for many OTC products on a professional fee basis which represents their professional services and expanding the list of products reimbursed on a retail markup basis. As noted in a letter on the reimbursement changes to Premier Rae in June 1992:
"As well, the ministry has advocated the removal of tobacco sales from pharmacies, arguing that the role of a pharmacist as a health professional takes precedence over their role as a retailer. We may even see legislation from the ministry in this area this fall. Now the ministry, when it suits their agenda and the product falls into the appropriate cost category, treats the pharmacist primarily as a retailer. The government can't have it both ways."
The dependence of pharmacy on the retail component has clearly been enhanced by the cumulative impact of these and other measures. This situation is becoming untenable for pharmacy and has taken a toll on the profession. The ripple effect is already being felt. Pharmacists may find it difficult to provide the appropriate level of care and counselling that we as a profession feel the public deserves.
While it is clear that the retail component of a drugstore is an integral part of the industry today, it is equally true that it is critical to its economic survival. To now propose a measure that will wipe out 10% to 15% of the revenue of the retail area will not only hurt pharmacy but will cost this province jobs, run the risk of pharmacy closings and weaken our presence in communities across Ontario as providers of an essential service and contributors to the local tax base.
The study undertaken by Coopers and Lybrand on the impact of Bill 119 on drugstores was presented to this committee earlier this month. It showed potential jobs losses in the range of 2,700 full- and part-time and a potential impact of over 100 store closings. That the government could contemplate enacting legislation that will deliberately result in job losses, particularly in a province that has been ravaged by the recession, seems incomprehensible, especially if we take into account that this pharmacy ban will not reduce tobacco consumption.
Surely at the time this legislation was reviewed by cabinet, an economic impact analysis or estimate was provided to the government. We would ask that this information be tabled with the committee.
The other reality this committee must address is that of the legal ramifications this legislation poses. To accept that the government has the legislative authority to decide what legal products can be sold or not sold by a particular retailer is setting a dangerous precedent.
The government seems convinced that by prohibiting the sale of tobacco in pharmacies, a message is being delivered to the public.
Our association has obtained a legal opinion on section 4 of the legislation, and we would submit to the committee that a strong argument can be made that section 4 of Bill 119 infringes on section 2(b) of the charter governing freedom of thought, belief, opinion and expression. As our counsel states, "Compelled expression is constitutionally offensive not because the government's message is false or because the individual disagrees with its contents, but because it is compelled." Therefore, we urge you to give the less intrusive measures in this bill a chance to work and amend the bill accordingly by removing the section pertaining to pharmacy.
I'd like to thank you at this point, and we would be happy to entertain questions.
Mrs Yvonne O'Neill (Ottawa-Rideau): Thank you very much, gentlemen. I find this brief very concise and to the point and right on. I don't have any questions for you, but I do want to ask the parliamentary assistant regarding the information that you have suggested must have been provided to cabinet, to verify that, and then ask that that information be tabled with this committee.
Mr Larry O'Connor (Durham-York): Thank you for the question. I don't know whether there was one provided to cabinet or not. Perhaps this august body might know if there is one and might want to share that with us. They've implied that there could be one.
Mrs O'Neill: I doubt that they have it, Mr O'Connor. I would really like to have you ask that question of your minister. I think it would really help the deliberations of this committee if we had that information.
Mr Gary Carr (Oakville South): On page 5, you talk about the legal ramifications of this legislation. If this legislation goes through as is, what's your intent in terms of legal challenges? What do you plan on doing?
Mr Connor: I'm not sure at this time. We've formulated a defence, if you will, so I'm really not sure I'm prepared to comment any further at this point.
Mr Carr: On the same page, you talk about the potential job losses, about the range of about 2,700 jobs, full- and part-time, that will be lost, and 100 stores closing. If this legislation goes through, that's what you see happening, that 2,700 people will be out of a job?
Mr Connor: Yes. I think what we're looking at there -- we make reference to a study. I think Coopers and Lybrand by most people's standards would be an acceptable standard for a survey having been conducted on this subject, and I think we would have to feel comfortable with what that survey has reflected.
Mr Carr: So you are comfortable with it?
Mr Connor: Yes.
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Mr Dalton McGuinty (Ottawa South): I want to ask you a couple of things, one relating to the legal opinion you've obtained and the other item relating to the seeming contradiction we have. As I'm sure you're very much aware, this particular provision of the bill related to the ban of tobacco products in pharmacies has been the source of great controversy. The college has asked for the ban, but your association says implicitly here that they really don't represent the majority of its members. Can you shed any further light on this? Can you tell us, for instance, that your survey is the most reliable?
Mr Connor: No, I don't think we could say that it's the most reliable. I think the point we want to stress in our brief, and certainly if I can re-emphasize it here, is that what we do want to communicate is the fact that we have a membership that has responded to a confidential survey. They have requested that it be their decision as to the decision to no longer sell. On an ongoing basis, as an association, we continue in our newsletter to post names of those stores that voluntarily decide no longer to sell tobacco products.
Mr McGuinty: Are you aware of any other survey that has been done by anybody else, apart from one of the partisan players, the politicians or even the government in this, but among pharmacists themselves, that would contradict this 62%? Has the college done one, for instance?
Mr Connor: I'm not aware of one and I'm not sure we want to compete; that's not our intention here. What we did is we simply asked our membership, so that was conducted within our own association. I would have to feel comfortable that it wasn't our intention to get into a debate over figures; it was simply our association looking for direction from the membership whom we represent.
Mr McGuinty: You've got 4,500 pharmacists, it says. How many more are there that you don't represent?
Mr Connor: I think all licensed pharmacists in the province would probably total about 8,100.
Mr McGuinty: This legal issue, I think you've raised a good point, and it's something that I raised on second reading of the bill. I don't think you need to be a lawyer to see that there may be a problem here. I think it's one thing to say you can take a legal product and restrict its sale to a specific retailer. "We're going to sell all our beer, you've got to go to the Beer Store. If you want your liquor, you've got to go to the LCBO." But I think it's quite another thing to say, "You can purchase this product everywhere except for this store." I think there's a problem there. You've raised it here.
I think it's important for us to look ahead and to see what could possibly happen down the road in this context. I'll just ask the parliamentary assistant, did the minister obtain a legal opinion from an expert in constitutional law regarding this issue so that when this bill goes ahead we're not setting ourselves up for an exercise which will benefit some of the lawyers of this province?
Mr O'Connor: Thank you for that question. We do have our legal counsel here with us. I'll ask Frank Williams if he might come forward to a microphone and attempt a response to that question.
Mr Frank Williams: Frank Williams, legal counsel, Ministry of Health. As I mentioned earlier in the technical briefing -- it seems like several months ago; it was only two or three weeks ago -- at that time I expressed the view that yes, we had obtained an opinion from the constitutional law branch and we feel that there is sufficient authority to go ahead with the bill as we've drafted it.
Mr McGuinty: Are you aware of the nature of that opinion? Is that in writing? Can we see that?
Mr Williams: I'm not at liberty to go beyond saying that yes, we have an opinion and we feel we have sufficient strength to go ahead with what we want to do.
Mr McGuinty: You can release that surely, Mr O'Connor?
Mr O'Connor: I'm not sure what we have on file.
Mr McGuinty: I'll make that request to you. Maybe you can get back to me.
Mr O'Connor: I'll undertake to take a look at it.
Mr McGuinty: We've got an opinion here.
Mr Williams: I would suggest to you that it would be a confidential solicitor-client privilege. That would not be the sort of thing that would be shared normally.
Mr McGuinty: But who's the client?
Mr Ron Eddy (Brant-Haldimand): Unless the minister decides.
The Chair: Mr Eddy, did you wish to comment?
Mr Eddy: Yes, I agree with that. But on the other hand, if the minister is in control, the minister could make that decision to release it, and it would be very helpful.
The Chair: Okay. I think the request has been made to the parliamentary assistant, and he will respond.
Mr O'Connor: Of course the minister is always in control, as the member has stated.
The Chair: Gentlemen, we thank you very much for the written submission and for coming before the committee this morning and for answering the questions.
MENTAL HEALTH RIGHTS COALITION
The Chair: I call on the representatives from the Mental Health Rights Coalition. Welcome. Introduce yourselves for the committee, then please go ahead.
Ms Marilyn Smith: I'm Marilyn Smith. I'm an outreach worker for the Mental Health Rights Coalition.
Ms Susan Roach: Susan Roach. I'm currently chair of the board of the Mental Health Rights Coalition.
The Chair: Just before you start, there was some difficulty with that mike, and I just want to make sure people can hear. If I suddenly stop you, it's not for something you've said, but just so we can make sure the volume is okay.
Ms Roach: It will be the first time in my life I've had to have volume added.
I would just like to start by introducing what the Mental Health Rights Coalition is. We are a group of consumer-survivors, who are designated under the Ministry of Health as individuals who have had care provided of a mental health nature. Specifically, I think we're here today to speak on behalf of those consumer-survivors who still are inpatients in a provincial psychiatric hospital or who may be in the future inpatients of a provincial psychiatric hospital.
In regard to that, we're addressing two primary issues. First is subsection 4(1) in regard to the fact that a provincial psychiatric hospital may be one of those locations which will be prohibited from selling tobacco products. Currently the institution we're involved with, the Hamilton Psychiatric Hospital, is selling tobacco products both in the patient canteen and also in the gift shop or tuck shop. The second item, subsection 9(1), is in regard to the availability of designated smoking areas for inpatients of the hospital.
I'm going to assume, not in judgement of anyone, that people may not know a lot about the running of the provincial psychiatric hospitals, at least to give you a very quick consumer perspective, which is that most of the patients at the Hamilton Psychiatric Hospital are inpatients as a result of being certified under the Mental Health Act, are being detained as not criminally responsible or are receiving forensic assessment under the Criminal Code of Canada.
In addition to that, individuals who are voluntary patients, at least initially, would be placed on what is sometimes referred to as a "locked end," which is an end that they cannot leave from the ward where they're receiving treatment, or they may be on a one-to-one with a nurse. They may be on ward privileges only, hospital or grounds privileges only.
If tobacco sales were removed from the hospital, you're looking at individuals who would not personally themselves be able to access at all tobacco for their own personal use. Compound that with the fact that a good number of patients, especially long-term patients, of which our system still has many, do not have visitors, don't have a regular support system from the community, someone who would be willing and able to provide the resource of coming in and bringing a pack of cigarettes for them.
I do not wish at any point to have this go to: "Well, should people smoke at all?" That's certainly not the argument that we're presenting, but rather the impact that these two elements of the legislation are going to have on the individuals who are currently inpatients of the hospital.
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Ms Smith: Within the walls of any institution, and specifically we're addressing the psychiatric institution, nicotine and tobacco products have had a significant value as a trading commodity. That is very much the case within the psychiatric facility. Our concerns are that if access is limited, the value of that commodity within the institution is going to be significantly raised.
I will talk a bit about the type of trading issues surrounding nicotine products at this time, with markedly better access to tobacco than there would be in the event that subsection 4(2) is a designated place for prohibition of sale.
I will refer to an article which was printed in the Hamilton Spectator, the May 5, 1992 edition, which references research done in Victoria, BC, citing that patients do offer themselves in a sexual manner for the trade of cigarettes. I might point out that it's a very limited number of cigarettes which these vulnerable people are willing to make that type of sacrifice for. That in itself, I hope, would strike any individual who had never given any thought to that matter as quite distressing and sad.
Again, given the impact of AIDS and its growing effect on our community, the issue of safe sex does fall into play. This research article indicates that the use of condoms is not frequently adhered to by patients. That's been in a circumstance where, again, there has been greater access to tobacco products. If it's going to be limited, patients may be engaging in that type of activity more frequently, thus raising significantly the chance of that health issue coming into greater play within the psychiatric facility.
Other issues of trade involve patients being manipulated into trading personal care items that they may have: clothing, radios, the like, things which they consider great luxuries. Many patients are living on a comfort allowance of $112 a month. Their access to luxury items, let alone cigarettes, is quite limited, and the prohibition of sales and the effects which I've briefly voiced are going to adversely affect them in the material sense.
Ms Roach: One of the other real, primary issues that we see potentially arising, in particular out of subsection 9(1) where we're talking about the limitation of designated smoking areas, is that currently at the hospital each ward has its own designated smoking area where patients, regardless of their privileges, basically from the time they wake up till the time they go to sleep, are able to access somewhere that they can smoke safely.
Maybe the other important part of this is that it's done safely for the benefit of others as well. If we talk about reducing the number of designated smoking areas, quite possibly to the extent that there's one area kind of serving the hospital as a whole, you're looking at a number of ramifications.
You're looking at people who can't get there because their privileges restrict them to a ward. You're talking about all patients, who, after the hospital shuts down at 9 pm, will suddenly not be able to access a smoking area. You're talking about increased stress on staff who try to police a situation around where smoking takes place.
You have an increased problem with the potential for fire because people who are undergoing a lot of stress are going to have a cigarette anyhow, even if they can't get to the safe area, maybe smoking inappropriately, say, in a bedroom. The risk of fire increases, which jeopardizes patients who are smokers, but it also jeopardizes non-smoking patients, staff and visitors at the hospital.
One seemingly small piece of legislation is going to have a large impact on a significant number of people and on a number of people who are already vulnerable and are going to be placed at greater risk.
Ms Smith: There has been clinical research done on the interrelationship between smoking and schizophrenia. I'm citing a study done by James Lohr and Kirsten Flynn which found that there is an indirect evidence that nicotine is important in maintaining the smoking behaviours of schizophrenics. That is so because of the effect of nicotine on dopamine, a brain chemical. They indicate that it is possible that nicotine may cause a decrease in negative schizophrenic symptoms.
We're not talking about the issues of dependency that a member of society not afflicted with a form of mental illness may face in relation to a nicotine addiction; we're talking about a condition quite aside from that which is impacted by nicotine. It is the belief of our organization that if you curtail access to the product itself or an area where people may legally consume that product, they're going to adversely suffer the effects of the illness for which they are in the facility to gain treatment for the purpose of exiting the facility, and that would be much to their detriment.
Ms Roach: We're kind of moving around here, but one of the other interesting things -- I don't know who follows the Hamilton media; I don't recognize anyone here from Hamilton -- is that Hamilton has had this real issue lately about elopements from our provincial psychiatric hospital. It's an issue that generated considerable community response, not too much of which was of a positive nature. The reason I'm pointing that out is that we had four individuals leave, the press picked it up, it was a major issue.
If we don't have cigarettes available at the hospital for purchase by patients who cannot leave the hospital, who do not have visitors who will bring them cigarettes, they are going to have one option. That one option is going to be to leave the hospital to purchase the cigarettes or potentially rely on a black market trade from someone who will bring them in, but they're going to pay an escalated price.
We're putting ourselves back into the corner of elopements, which is already problematic in our community. For a government which is concerned about black market trade, basically you're generating one at our hospital because people are going to have to rely on some other means to bring these cigarettes into them, and it's not going to be a fair exchange value that's going to result in that process.
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Ms Smith: On the issue of elopements, there are two matters. One is the effect that publication of the event would have had on the individuals who had taken leave of the hospital and the detailed information made public, and its impact, which would be adverse to that individual. One may question the issues of salience of printed information.
A secondary concern, and from the point of the provision of care a very fundamental concern, is that as individuals may be stepping outside the boundaries which have been afforded to them physically, be it leaving the grounds when they have grounds privileges, be it leaving the grounds when legally they are required to be there, nursing staff care providers are going to have to direct a great deal of their attention towards policing functions to monitor the presence of their patients.
That is going to detract from the time and attention they can devote towards their patients for the purposes of care. I would think that, in the long run, that's going to draw out hospital stays, negatively impact on that, and represent itself not as either a very therapeutic environment or a cost-effective one.
The Chair: I just want to be clear. I'm going to show my age again, as I have done through these hearings, but when you speak about elopement, you do not mean going off to get married but simply leaving the hospital grounds?
Ms Roach: Leaving against whatever privilege base they have, yes.
The Chair: Right. Mr Sterling and I need to be sure that we're clear on that. Thank you.
Mrs Karen Haslam (Perth): Are you passing around your wallet again, Mr Beer?
Ms Roach: Just to conclude, I would like to point out that I at least, speaking for myself, have been a patient of a provincial psychiatric hospital and have been in the position of always being fortunate enough of having family and friends visit, of always having some base of income and being able to afford to purchase cigarettes, but have always been very well visited by everyone else in the hospital because they don't have that same opportunity necessarily.
You watch within your own unit the level of anxiety increase, you watch the level of frustration increase, sometimes to a point where the person is then placed in a base of being in seclusion or needing additional medication in order to deal with everything that's going on at that particular moment. I'm not going to say that cigarettes alone are the cause. I think, in part, though it's the interplay of the two of them together, that when your coping skills are already minimized when you're ill, to cope with not having cigarettes available or be able to purchase them creates a very difficult situation for people.
We really struggled in our conclusion in terms of using the word "discriminate." In fact both Marilyn and I had an ongoing debate about this particular issue. I think we would like to believe, and I think we do believe, that it's not a malicious, "Well, we're kind of out to get the psychiatric population and this is one way of making their life miserable." I don't believe that's the issue.
I do believe, however, that the legislation has the result of being somewhat discriminatory in that a large number of people who will not access the product will not have a place to smoke, keeping in mind that a lot of psychiatric patients are in hospital for six, seven, eight months at stretch, that those occur repeatedly throughout their lives and that this is the one thing, albeit maybe not particularly healthy, that has always given them some satisfaction.
Mrs Haslam: On page 3 you talk about designated smoking areas. As a point of clarification, do you also have other common areas for people who choose not to smoke?
Ms Roach: Yes. Each ward actually has four areas, two smoking, two non-smoking.
Mrs Haslam: When you talk about exploitation of patients trading radios, clothing and food, I just wonder where the staff figure in on this, if they see it happening. What do the staff do in these instances when it seems to be detrimental to the mental health of the person, when it's not exactly what you'd like to see going on in a health facility? If it's that bad, how is it being countermanded presently and is there some way that staff can work on these issues? I don't see it as being just a tobacco issue is what I'm saying.
Ms Smith: No, it's not just a tobacco issue, but when an individual seeks treatment or is placed in a facility for treatment, that doesn't necessarily mean, in the common law, that they can't engage in acts of bartering, and it's not necessarily the role of a care giver to intervene in that type of a trade if there's a system that has been set up so that an unfair situation occurs for an individual.
Ms Roach: I think generally the hospital staff attempt to intervene. However, it depends on whether the person complains about it, and that's I think really where the crux of the argument is. We know, as other patients, other consumers, that it's happening. We know that it's like a radio for three cigarettes, because the person really wants cigarettes. Because the person got their cigarettes, they're generally not complaining about it, but you would have to question whether in all cases they really understood the impact of the decision they made.
Mrs Haslam: We're talking about one item in a system that is already operating and that's why I'm asking you. If it's going to go on, it is going to go on and the staff know it's going on, the presence or elimination of tobacco in that system is not something that you can control no matter what the legislation says because you will still continue to see these kinds of activities go on. That's my point.
Ms Smith: Our concern is, though, that it will elevate.
Mrs Haslam: Yes, I understand that, but it could be chocolate Milk Duds too.
Ms Roach: They don't have the same trading or commodity value.
Mrs Haslam: But they could have, if they were a similar product that everybody wanted. That's all I'm saying, that you're talking about a product, but that's neither here nor there for the system being in place continuing to be in place. I understand your concern about it, looking at the parameters of that system, but I fail to see the link with the --
Ms Smith: On the issue, I too have been a inpatient of a psychiatric facility and have been fortunate enough never to have found myself in a situation where I would be willing to engage in that type of activity. But when I became aware -- and it is women; I've not heard tell of a male engaging in sexual activity for the trade of a cigarette. That saddens me. I have not heard of anyone willing to sleep with someone for Milk Duds.
Mrs Haslam: It's not Milk Duds; it's just a product. That's it.
Ms Smith: I'm not meaning this to you lightly. Really, it saddens me, and that will happen for tobacco.
Mrs Haslam: Can I ask a quick question?
The Chair: Sorry, just about everybody wants a question here. I think we've only had one or two presentations around this specific issue and I just want to try to allow everyone to get in.
Mrs O'Neill: Thank you for a very powerful presentation. I think this is the second time this issue has been brought to the committee, but you are speaking at first hand, and I think that makes it very different. I'd like you to say a little bit more to us about the designated places and then I want to ask a question of the parliamentary assistant regarding this. You say that hospital shuts down at 9 pm. Does the designated smoking place, however, remain open? Would people still have access to that?
Ms Smith: As things are, and it's my understanding of the proposed legislation, subsection 18(1) confers upon the Lieutenant Governor the privilege to allow it to remain so. Patients have access to on-ward smoking areas after 9 o'clock.
Ms Roach: There essentially is one common area in the entire hospital that's kind of linked with the patient canteen and then there are the smoking areas on the individual patient wards, of which this hospital has eight.
As it stands now, yes, right until somebody goes to bed they can basically access the smoking area. The concern then is that if we're making some changes and some alterations in the accessibility to the wards, the worst-case scenario would be that it would be the one common area for the hospital and that people would need to go there. If you did that, the impact would be after 9 o'clock, when the ward shuts down.
I'm using probably the wrong term. It's not open to visitors. The door's locked; it's not the outgoing, ingoing flow. We're looking at the worst-case scenario which we wouldn't want to see happen. We tried to identify what some of the consequences of that would be and that the need really is to have some ongoing ward availability for people without privileges to leave the ward, that type of thing.
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Mrs O'Neill: Would your coalition be asking to have these areas ventilated to the outside?
Ms Roach: Certainly.
Mrs O'Neill: You haven't done that yet.
Ms Roach: I don't think there's anything beyond the availability, which is our concern right now. We think other things in regard to ventilated and properly set up should all still apply.
Mrs O'Neill: If I may ask the parliamentary assistant, is this a consideration regarding regulations, the exemption that's possible in this case?
Mr O'Connor: One of the purposes of going through a public hearing process for the presenters here is that in regard to the legislation as it's drafted and presented in the House, the members themselves in the Legislature of course may have some concerns, but they don't have the depth of knowledge that is out there in the community.
Part of the purpose -- I'm saying this for presenters as well -- is that you go out to the public and you draw on that expertise and hear what people have to say in their comments on the bill and then take a look at it. So the information that you have provided will give us some insight that we didn't have before.
It's my understanding that as the government went through this process a year ago within the ministry, we went through a public process before with the draft legislation. We heard from 240 different people in written submissions and 34 oral presentations. This does offer something that's a little bit different than what we've heard so far as well as what we've heard now. So to answer your question, this is important input as well and we'll consider it.
Mrs O'Neill: We consider it very important input.
Mr Norman W. Sterling (Carleton): Can I just ask you, where presently in psychiatric institutions are cigarettes normally sold to inpatients?
Ms Smith: In the case of the Hamilton Psychiatric Hospital, there is a coffee shop which is directly facing the front entrance to the hospital and there's a patient canteen located in a basement area. Something alongside of that, profits generated from sales made in both of those venues are redirected back towards patient activities and very often the moneys are utilized to provide outings, some types of pleasantry for the patients that are not otherwise afforded to them within the mandated budget of the facility.
Mr Sterling: I'm inclined to support your position and would be quite willing to amend or vote against this particular section of the bill which would exclude psychiatric institutions. What is the argument on the other side that might be presumed? I know that's not what you're here for, but is there another side to this or is it just a matter of lack of consultation?
Ms Roach: I think one of the contributing things, and it may fit what Ms Haslam was saying as well, is that one of the things that's always been dramatically overlooked with the psychiatric population is that yes, they do have a high level of smoking, so it does drive this kind of need and want. But I have never in all my years, which is 22 years in the psychiatric system, seen anyone attempt to provide a smoking cessation program for consumers taking into account their specific needs, driven by their own symptomology, the fact that when you only have $112 a month as a comfort allowance you don't have $70 to go out and join the Lung Association's quit-smoking program.
Part of this is, as much as anything else, I'm a smoker and I would love to see us working also towards helping people quit smoking. That's not something that's been looked at to date and it's not something that either the hospital or any outpatient psychiatric program has attempted to do.
Mr Sterling: All I can say is unless I hear something in between now and next Tuesday or Monday, in two weeks I'll be supporting your position and putting forward either an amendment or voting against this particular section on your behalf.
Ms Roach: Thank you, sir.
The Chair: Mr Owens and Mr McGuinty, and that will conclude the questions.
Mr Stephen Owens (Scarborough Centre): Thank you for your presentation. I was quite interested in the reference in the literature with respect to nicotine and its effect on dopamine levels in schizophrenics. Has this result been replicated in other studies?
Ms Smith: With the research briefs that I have been provided, no. I received a fairly limited bibliography of research devoted to that area, so that is the only study with that supportive conclusion that I have to access.
Mr Owens: I appreciate your comments with respect to smoking cessation programs. I don't think anybody on this committee or perhaps in the province can stand and say, "Smoking is the greatest thing since sliced bread and we should all do it," and of course as a government we're in a bit of a bizarre position with respect to known health effects versus revenue generation.
I think that in terms of the kinds of programming that you would see as being facility-appropriate, do you have any suggestions on the kinds of things that perhaps the Ministry of Health could be looking at with respect to cessation programs that could be designed around the kinds of needs that folks in your facility would have?
Ms Smith: Susan did make reference to things such as the availability of the patch. If I may refer to my own situation, I am quite aware of the negative physical ramifications that can arise from smoking. It does serve to calm and appease me during tense times and I don't know that there is anything that can be afforded to patients, with the exception possibly of upping people's sedative prescriptions and so forth, which might provide them with the same type of calming effect that nicotine does.
Mr Owens: In terms of sales to the public versus your residents, and again I don't think it's anyone's view on this committee that we want to add to problems already being experienced by inpatients, then in terms of the retail area, perhaps the front of the facility or the more public area, can you tell me what controls are currently there to prevent, say, the sale of smoking to minors, and what would you propose as a recommendation that sale for the purpose of public consumption be eliminated but then in terms of your residents that cigarettes be made available in some way through a retail service?
Ms Smith: Minor access to the facilities is quite limited. From time to time, adolescents may be admitted to the facility.
Mr Owens: But in terms of visitors --
Ms Roach: The hospital only admits people 18-plus; we don't admit under that. But I think in recognition of what you're saying, certainly staff are a relatively primary purchaser of the cigarettes at the hospital as well. I'm sure that something could be put into place that would say, "No, these are now for sale only in the patient canteen, and even if staff go in there, they're not negotiated for sale with staff." We may have a few annoyed staff for a while but I think that's easily implemented. There was another part of your question which I've --
Mr Owens: The access to the product.
Ms Smith: In all honesty, there are not a great many minors who frequent the facility to visit. Occasionally you see families coming with very young children. That's quite atypical.
Mr Owens: Presumably, they're not --
Ms Roach: We're still a somewhat stereotypical institution that doesn't draw a high visitor base.
But if I can just very quickly jump back to the part of the question about smoking cessation programs, do not attempt to implement them while the patient's in the hospital -- the stress is too high -- but try to implement them for almost immediately after their discharge so that they're being discharged and it's part and parcel of that follow-up, and a big part of that programming would have to address stress management even over and above any traditional quit-smoking program.
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Mr McGuinty: Thank you both very much for what I feel is a very important presentation. I don't think there's any doubt whatsoever that this particular provision we're talking about here is clearly discriminatory against psychiatric patients who are confined to hospital.
When I look at this act, it doesn't say anywhere here that its intention is to prohibit anybody from smoking. It doesn't even prohibit kids from smoking; it just says you can't sell to them. Effectively, if you read between the lines, what we're saying is, "Listen, if you're a psychiatric patient, if you're confined to grounds or to a ward or to the hospital itself, you can't leave the grounds, first of all, and second, nobody can come on the grounds to sell cigarettes to you." If that's not discrimination, I don't know what the heck is.
It's rather perverse when you compare it to our jail system. If I have committed an assault and severely beaten somebody deliberately and I'm confined to jail, I can buy my cigarettes there, but if I'm subject to an illness, something that's beyond my control, and I'm confined to an institution, I can't get cigarettes.
Let's not lose perspective about this stuff. We are talking about psychiatric illnesses. In the grand scheme of things, cigarette smoking pales in comparison to the complexity of a psychiatric illness, so let's not get carried away with the stuff. I hope to God the government is going to correct this so that psychiatric patients can buy cigarettes on the grounds and avoid all the problems inherent in not doing so.
The Chair: While we've gone somewhat over time, as was noted earlier, we have not had many discussions on this particular point and I think it was very helpful for the committee. Thank you both again for coming.
Ms Roach: We thank the committee for your time.
Ms Smith: Yes. Thank you for your time. We have a list of signatures from members in Cambridge in support.
The Chair: That's fine. If you'd give it to the clerk he'll be able to make copies for each of us.
LISA PRINN
ROBERT CASTLE
Ms Lisa Prinn: My name is Lisa Prinn. I'm from Sheridan College in Oakville.
Mr Robert Castle: My name is Rob Castle. I'm the general manager of the student centre at York University and the communications director of the Association of Managers in Canadian Campus, College and University Student Centres.
Ms Prinn: We have come to speak to you on behalf of the colleges and universities of Ontario, which represent nearly half a million students. First, we'd like to commend your efforts on Bill 119 so far, though we are here to ask that some modifications be considered concerning section 9, paragraph 2, which is under the title "Controls Relating to Smoking Tobacco."
Our concern is based on the fact that the bill presently states that there will be no smoking areas designated anywhere on post-secondary campuses. We wish it to be reworded to state that only the actual municipal buildings be affected. This would leave our student centres and surrounding land the freedom to designate smoking sections.
Student centres are built, owned and maintained by incorporated bodies through the use of student fees. As it is wholly the students' moneys concerned and they have requested representation of their views, a questionnaire was implemented and tabulated at Sheridan College, Oakville campus. The questionnaire was completed within a two-day period by 544 students at different venues throughout the institution.
The results indicated that 98.4% of Sheridan students are against Bill 119 as it presently stands, with the inclusion of their student centre and surrounding areas. Out of the 140 non-smokers who responded, 114 were in favour of keeping some sort of smoking area available to smokers, namely, the student centre.
Presently these facilities act as an outlet for student activities and licensed social events. Smoking and non-smoking students alike are concerned that support of these events will be drastically reduced as business is taken to off-campus establishments.
In compliance with the municipality's regulations and administrative bylaws, student centres are highly regulated for the safety of their students. If smoking areas cease to exist, students will likely proceed to off-campus establishments that do not offer as controlled an environment.
Post-secondary students have stated agreement with the intent of the bill's provision of tobacco to young persons. They understand the statistics concerning tobacco addiction in youth at a secondary school level. However, since the average age of post-secondary students is between 24 and 26 years old, the possibility of this bill preventing or reducing students' smoking addictions is unlikely.
The financial feasibility of maintaining this bill must also be considered. The amount of money required to enforce non-smoking on campus could become phenomenal, considering many post-secondary institutions are situated on large, diverse campuses consisting of many acres of land. Individuals who continue to smoke indoors will resort to doing so in washrooms and locked offices or classrooms to avoid being caught. This in turn infringes upon non-smokers' rights.
I would like to stress again that student centres are maintained and subsidized by revenues generated from their licensed events. The financial responsibilities related to the operation of students centres will be greatly affected by Bill 119, leading these establishments into financial difficulty, possibly bankruptcy.
Leaving you with this thought, I trust that your decision to redefine section 9, paragraph 2 which states, "a school, post-secondary educational institution or private vocational school" will be changed to accommodate the above-stated needs. One possible solution may be to exempt "post-secondary institution" from paragraph 2 and create a separate subsection.
I would like to thank you on behalf of the post-secondary students. If you look at the next page of this report, I have the results of the questionnaire that we did on campus. They're also right here if any of you would be interested in reading through them.
Mr Castle: I'd like to start off by thanking Ms Prinn for inviting me to share her limited time here before the committee this morning. I appear before the committee on behalf of the York University Student Centre and other student centres across the province regarding concerns over section 9, paragraph 2 of Bill 119.
Though we are generally supportive of the overall intent of the legislation, limiting use of tobacco by minors and limiting the sale of tobacco, the provisions of paragraph 2 would prove onerous to our operations and would not be in the interests of campus life. As you are aware, paragraph 2 would ban smoking at post-secondary institutions. As I understand it, officials of both the Ministry of Health and members of this committee have confirmed that this would mean a total ban on university and college properties.
Universities and colleges are very different creatures from public and vocational schools. There are many factors which speak to the need to deal with post-secondary educational institutions separately under the legislation. Most campuses are self-contained towns or cities within their respective municipalities. We generally have our own distinct cultures and rules which govern our unique communities. As well, university and college students are adults in the majority. Indeed, the average age of an undergraduate student at York University is 27.
York University has a campus population of 54,000 students, staff and faculty. If you will, we are a city with the population of Barrie, spread over 650 acres. As well, over 4,400 people make York their home in the campus residences. To service this community, there are over 30 on-campus restaurants and pubs. You can imagine that enforcement on a territory of the size and varied nature of York will be next to impossible. This holds true on campuses across the province.
The operations I represent, both at York and throughout Ontario, contain a large portion of the restaurant and bar services located on campuses. At the York student centre, we have a full-service restaurant and nightclub licensed for 700 as well as a food court with seven nationally branded commercial outlets with a capacity of close to 600.
Neither of these operations would be able to compete with off-campus locations that would not be subject to similar restrictions. If we were subject to stricter rules than our competitors, we would not, and forgive the cliché, be playing on a level playing field. There would be no equity.
The city of North York has recently implemented one of the toughest smoking bylaws in the region which, I believe, could stand as a model for municipalities in Ontario. We believe that respecting the North York bylaw respects the interests of all parties by striking a strict, but reasonable, balance between the smoking minority and the non-smoking majority.
The major difference, it seems, between the North York approach and the proposed legislation is that under the North York model similar businesses are treated similarly within the context of the wider community. We are simply requesting this regime of similar treatment continue to exist for on-campus business operators.
It is important for the committee to recognize that student centres are not funded from the public purse. Unlike academic facilities on campuses, our centres are generally funded through direct levies paid by students on top of their academic fees.
As an example, the York University Student Centre was built at a cost of $24 million, $21 million of which is paid directly by students. The CAW student centre at the University of Windsor was built at a cost of $10 million, $6 million of which is paid directly by students and the remainder by private donations.
These centres receive operating subsidies neither from university or college administrations nor from the province. We are freestanding operations which are supported by student fees and our business revenues.
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Excess revenues from the student centre operations are used directly to support activities for students. Though not identical at all campuses, these activities include support for multicultural groups, sexual harassment and abuse counselling, literacy programs, and other community services.
We attempt to provide our students with a healthy, positive environment where they can relax and enjoy themselves without having to leave campus. Adherence to paragraph 2 would in time reduce our client base significantly and would no doubt force the closure of many of these on-campus operations.
A major component of student life would be threatened by such a prohibition. If we drive students to off-campus operators, then the work we have done at universities and colleges across the province to encourage the development of responsible lifestyles may have been in vain.
The committee should also be aware of the impact paragraph 2 would have on our residence communities. Our campuses are home to thousands of students. Those who smoke within the confines of their own home might now be subject to fines.
Colleges and universities have tended to be at the forefront of the campaign to restrict smoking areas. Most campuses over the last five years have addressed the issue of smoking areas through representative committees. The resultant policies have often been more strict than the bylaws of local municipalities. We are now seeking a balance.
On behalf of student centres across the province, I am requesting an exemption from paragraph 2 for commercial food operators and licensed facilities on college and university campuses. These areas would continue to be governed by local bylaws.
Specifically, we would recommend that the term "post-secondary institution" be deleted from paragraph 2 and that a separate subsection in section 9 be added to read:
"No person shall smoke tobacco or hold lighted tobacco in any of the following places:
"A post-secondary educational institution, except an area within the institution which is exempted by municipal bylaw."
This amendment, based on similar language of the existing section 9, paragraph 1, would allow restaurant and licensed areas as well as residences to be governed by local regulation.
In closing, I would ask that members of the committee recognize the diversity of university and college campuses and further recognize the need for these communities to be dealt with separately under the legislation.
Mr Carr: Thank you both for your presentation. I was interested in knowing what percentage of the student population would be affected by this, and maybe you could talk about York and then Sheridan. I'm from Oakville, so I'm close by. What percentage, do you know, would it be at your institutions?
Mr Castle: That actually smoked?
Mr Carr: Yes.
Mr Castle: Very difficult to say. To my knowledge, there hasn't been a comprehensive survey that would be able to give us that sort of information.
Mr Carr: No ballpark figures?
Mr Castle: I would think that it would come close to mirroring the general population, so probably 30% to 40% of students would smoke and 60% to 70% would not. Quite naturally, in terms of the operations that we represent, as I mentioned, we represent bar operations and so forth on campus. A number of our patrons, probably a higher portion of our patrons, smoke than don't.
Mr Carr: I take it you don't have any numbers for Sheridan as well.
Ms Prinn: No, not really. We already got 10% of the students filling out these questionnaires and basically 90% of those wouldn't smoke. I'd probably say it's about 30% to 40% of the total population also.
Mr Carr: What do you see happening if this goes through and doesn't change? I like some of the ideas you put forward and appreciate the fact that you put it into amendment-type form. If this goes through as it is, what do you see happening when it's passed? What are the students talking about doing?
Mr Castle: I think there are a couple of issues; first, the issue of enforcement, and I recognize that under the legislation the owners and operators of these facilities are not required to enforce but merely to place signage. At our communities we tend to find that if signs go up and they're not enforced we get complaints, so we do have to address the issue of enforcement.
The university is spread over 650 acres. We have woods, we have marshes, we have creeks, we have trails. The idea of enforcing an outright ban is an impossibility. The resources of the university's security force -- we will have four to six officers on duty to patrol a small city, so their ability to enforce is very limited.
We will see a direct impact on those areas that we manage. The student centre, because of its business operations, will see a net loss of student customers to off-campus locations.
Mr Carr: What you seem to be saying is it's not going to work anyway. Even if the legislation comes through, it's not going to stop the smoking in your institution.
Mr Castle: I don't believe it's possible through this legislation to successfully have an outright ban on university and college campuses.
Mr Carr: Thank you. Good luck to both of you.
Mr Tony Martin (Sault Ste Marie): I'd have to say to Lisa that it was great for me personally to have had the opportunity to speak to your group when your provincial organization met in Sault Ste Marie a few weeks ago so that you might bring very forcefully to me your concerns around this.
As a matter of fact, it was interesting that of all the issues we discussed that day -- tuition fees, ancillary fees and all of that -- this is the one that, if you'll excuse the pun, created the most heat. We went on for a good 45 minutes, I'd say, on this. I certainly heard a lot and learned a lot in that and in fact brought back some of your concerns to the ministry. I think there is some consideration being given at the moment to how we might respond to some of your concerns.
Certainly the environment within colleges and universities has changed drastically over the last 10 to 15 years. I know when I was in university, the sum total of my smoking career was about two weeks when I thought that cigarette smoking would relieve my anxiety in a particular three-hour class where, after I had an hour, I was climbing the walls and I needed something and I saw people smoking all over the place and they seemed to be enjoying themselves. I thought I'd try that too, but I almost fell out of my chair and that was the end of that. In fact I even brought a pipe in.
This was back in the early 1970s. Pipe smoking, cigarette smoking was the norm at that time in classes. I know today that's an out for sure. I know the institutions that you represent have gone a long way to in fact put smoking areas in place that have the best possible ventilation systems and all of that.
I know the arguments that you made about the fact that the population in universities and colleges now is no longer the late teens and early 20s; it's the lifelong learning pieces kicking in and you have an awful pile of adults now attending university and college. This piece of legislation is particularly directed at kids and children. It leaves an area of grey that I think allows us to begin to maybe look at how we might be more accommodating.
The question I have for you is, at this point in time, what's the process in colleges and universities to determine what areas will be smoke-free and what areas won't?
Mr Castle: I think it varies from campus to campus. York some years ago, because we tend to find ourselves often at the forefront of the forefront on some issues, struck a campus-wide representative committee which was made up of faculty, staff and students. I think usually the process of most campuses is a consultative one, to work with interested parties, stakeholders, if you will, to determine how best to allocate areas within the facility where you can have smoking areas.
Under the current North York bylaw, which has sort of caught up to the York position and actually gone beyond where we were, academic buildings are now de facto smoke-free because, under the North York bylaw, you have to have separately enclosed and ventilated public spaces if you want them to be smoking areas.
The university is not in a financial position to take a student lounge, enclose it and spend the money to put in the ventilation systems, so by enforcing the North York bylaw, the only smoking areas now tend to be within the commercial areas. The limit of the areas within those commercial facilities is very strict, to a maximum of 40%.
Ms Prinn: This is true also in most colleges in Ontario right now just due to bylaws and the actual school administration. We don't sell tobacco on campus and we have to designate our own student centres as the only smoking areas. A lot of faculty members go outside to have a cigarette also. Classrooms and hallways -- there are no lounges within the municipal building itself.
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Mr Martin: Given that this time of life, college and university, for a lot of students still, the student particularly going from high school to university, is often a time of great anxiety and energy, I know of parents who have come to me and said they really liked this piece of legislation because where they tried at home to set a standard and an environment within which smoking was not acceptable, their student, their young man or woman, has gone off to university or college and come back a smoker.
Do you understand, though, given the particular circumstance that you present today, the underlying principle and attempt of this legislation, which is to cut back on smoking? Do you understand the damage that it causes to people and the great cost?
Ms Prinn: To that, if these younger people are feeling that pressure, they won't start smoking because there is an area on campus to smoke. They'll be smoking at parties or after school or hanging out with their new friends. If you look at the areas designated right now to smokers, it's very minimal. Our student centre only holds about 300 during the day, 300 people who can fit in there and smoke. If you look at the school's population and the amount of smokers, that's hardly anything and it's off to the side.
Mr Martin: What about those who go there who don't want to be exposed to the environmental smoke?
Mr McGuinty: Thank you for your presentation. I think again it highlights a shortcoming in the bill. On the face of it, the bill says that no person shall smoke in a post-secondary educational institution. I think it's logical to infer from that that means everywhere. Out on the sidewalk but on campus grounds you can't smoke, again keeping in mind that the intent of the bill is to make it harder for kids to start in the first place and also to some extent to control non-smokers inhaling secondhand smoke, to limit that problem. Would your proposed amendment here allow smoking in bars on the university?
Mr Castle: It would allow smoking within a designated area. Using again the North York model, they differentiate between enclosed public spaces and a restaurant facility. Within a restaurant facility you can have a maximum of 40% as a smoking area. The smoking area has to be contiguous seating area and you cannot require a non-smoker to walk through a smoking area in order to access a non-smoking space. So yes, there would be smoking allowed, but within a balance.
Mr McGuinty: Right. Lisa, you would be in agreement with this amendment for purposes of colleges?
Ms Prinn: Yes, I definitely would. I just believe there should be some area that the students could go to.
Mr McGuinty: I think you've raised some good points about the difficulties associated with enforcing university students, but compelling them not to smoke is I think getting into absurdities here.
Something I think you've got to recognize is that, as we've heard time and time again from expert presenters, tobacco is a highly addictive product, comparable with the addictive qualities of cocaine and heroin. You're not going to make people stop just because they happen to be going to university or college, and I think it's important to be realistic about that problem and to address it.
In fairness to the parliamentary assistant, I think he's indicated a couple of times now that it's not the intention to have this apply to residences on campus, which makes eminent good sense. We'll see if we can tighten up the rest, or loosen it up.
Mr O'Connor: Just to clarify some of the intention, the intention is that when young people, young adults, go on to post-secondary education, they have the right to that education in a smoke-free environment. You've clearly pointed out that having it defined the way it is raises your concerns that it goes beyond the parts of the campus that are designated for educational purposes.
I thank you for making that presentation to us. I'm sure you understand where we're coming from with this designation because it's all part of a comprehensive strategy. I appreciate your coming and sharing your view.
The Chair: Thank you both for coming before the committee this morning, for your presentation and for your recommendations.
METROPOLITAN TORONTO HOMES FOR THE AGED ONTARIO ASSOCIATION OF RESIDENTS' COUNCILS
Ms Mary Ellen Glover: I'm Mary Ellen Glover. I'm the executive director of the Ontario Association of Residents' Councils. Mr Carrick not only is president of the Fudger House residents' council, but he's one of our vice-presidents. He asked me to come along with him today just to add a few comments.
The Chair: You're both very much welcome, and please go ahead with your presentation.
Mr John Carrick: Thank you, Mr Chair. I also wish to make you aware that I'm a member of the Metro homes for the aged division, and I'm speaking on their behalf as well. I have their full support in my submission for your consideration.
In the past year all the homes for the aged have been dictated by the Minister of Health as to the smoking facilities in each of the homes. These have involved quite extensive renovations in all of the homes, to wit, having a designating smoking area. The homes have already achieved this goal in their renovations and they now have designated smoking areas within each area of each building.
As a matter of interest, these renovations at Fudger House alone, which is one of 28 homes for the aged in the city, amounted to over $60,000. This seems to be adequate for the residents to be able to follow their, should we say, unsatisfactory habits in so far as smoking within the buildings is concerned. I for one must admit that of my 75 years, I have smoked for 55 of those years, and I have no intention of stopping or changing at this point. That's just a side issue.
But one of our major concerns is that Fudger House is at the corner of Sherbourne and Wellesley in the downtown area. We have over 250 residents within our own home and, needless to say, they all are in excess of 65 years of age. Many of them are not as mobile as you and I, and in the matter of being able to obtain tobacco products, cigarettes, pipe tobacco or whatever, it places them in jeopardy in so far as they have to cross one of the major thoroughfares within the downtown area. Needless to say, it's extremely hazardous.
We have operated a gift shop where cigarettes and tobacco are available within the building. If this were to cease, we would be subjected to black marketeers coming into the building, and not only from the outside. Even our own residents would be given to the temptation to deal in the black market of providing cigarettes to those who cannot get out.
I feel this is a major hazard to the health and safety of the residents confined to the building itself. If I might go further, in my own case I think that if I were to quit smoking after 50 years, the frustrations and the anxieties and the stress in that would not be very conducive to a happy atmosphere within my own frame of mind. So much for that, the black market.
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Now, I do stress that the location of our home is such that we would certainly appreciate being able to provide this service: in the interests of safety and health to sell tobacco products to our own residents. True, we have volunteers coming in, but I would like to make the point that they not be included in the obtaining of cigarettes, nor should any visitors bring cigarettes into the home. We administer who should have and should not have access to these bad habits, and that's rigidly enforced within the home.
Before I turn the microphone over to my cohort, I would say that we have been in close association for a number of years, and she represents the homes for the aged all throughout the province. I would like to introduce my cohort to you, Mr Chairman: Mary Ellen Glover.
Ms Glover: Thank you, Mr Carrick. I won't keep you long, ladies and gentlemen. I just have a few comments to add to what Mr Carrick has said.
It is a great concern of our association that you intend to limit the sale of tobacco products in long-term care facilities, because we believe that, by doing this, you're contravening residents' rights. You have to keep in mind that the people who live in long-term facilities, as Mr Carrick pointed out, are generally very elderly and frail, and in a lot of instances they have few small pleasures left to them. Smoking is one of them.
Now, this generation doesn't consider smoking to be a pleasure, but people who are 80 and 85 do consider it to be a pleasure. They grew up in an era where it was not considered to be the health hazard or almost the crime that it is considered to be now. You also have to consider that most of these people are not concerned tremendously with shortening their lives, because they've all lived a good deal longer than we have.
One of the things you should take into account also is that, right across the province, most long-term care facilities have very effective smoking policies in place. They have designated smoking areas, and these smoking policies have generally been worked out in cooperation with the residents and the administration of the home. In all instances that I've encountered, even non-smoking residents feel that residents have the right to smoke.
I can tell you a couple of stories about the home that I have my office in, because they don't sell cigarette products in that home any more in the tuck shop. It's kind of sad, because every day I encounter a lady in the lobby who is bumming cigarettes because she has nowhere to get them. She has nobody to bring them in to her. She has no family. I guess she doesn't have very many friends. So that's how she spends her day: She goes around asking people if they would have a smoke.
I can add to what Mr Carrick said about banning the sale resulting in coercion of residents. I can honestly see staff saying, "Sure, I'll buy you a carton of cigarettes. You can have your" -- I don't know what a carton of cigarettes is now that the price has gone down: $25, let's say? "Sure, you can have your carton of cigarettes. You give me $30." As Mr Carrick said, I can also see residents doing that to other residents.
I can see you wanting to control the sale of tobacco products to minors, but you're not dealing with minors here. You're dealing with a population that doesn't have a lot of resources to get out and go to the corner store. As Mr Carrick pointed out, in some instances it might be quite dangerous for them to try to go to the corner store. You also have to think not just of the homes that are at the corner of Sherbourne and Wellesley but the homes that are out in the country somewhere where there is no corner store around.
I couldn't say for sure in terms of statistics, but I think that generally speaking the percentage of residents who smoke might be lower than the percentage of people in the general population who smoke, and this has probably come about simply because a lot of them have a very limited amount of money and they've had to give up smoking because they can't afford it. But I think you should give serious consideration to allowing the sale of tobacco products in long-term care facilities to residents.
Mrs O'Neill: We've had a very similar presentation from the veterans, and I've had a lot of correspondence from various homes for the aged on the issue.
I'd like you just to clarify for me, at the present time the homes for the aged are governed both by the directive that came from the Ministry of Health and then by the municipal bylaw in most instances. Is that correct?
Mr Carrick: We are subject to both of those regulations, those official bodies. This renovation I spoke of a short time ago was a directive from the Ministry of Health of Ontario, and all the homes have adhered to the renovations as required.
Mrs O'Neill: This does make this bill rather contradictory to a relatively new directive. I'm glad you brought that to our attention.
At the present time, are the homes for the aged that have a facility for sales limiting the sales to the residents?
Mr Carrick: Yes, that is the way it remains at the moment. We do not allow sales to outside persons and we don't have minors in the building anyway.
Mrs O'Neill: The designated smoking areas then are the only area in the facilities where there's smoking permitted? There's no smoking in the individual rooms, even if they're private rooms. Is that correct?
Mr Carrick: That is very correct, and that is governed by the Ministry of Health and the fire departments. We allow only the designated areas in which to smoke. Any other area, including the workplace of the staff, is limited.
Mrs Haslam: Just to reiterate that fact, you have non-smoking common areas?
Mr Carrick: Yes, we do as well.
Mrs Haslam: Some of the other products that people in long-term care facilities receive, chocolate bars and soaps and other sundries, where do they obtain those?
Mr Carrick: That is in the gift shop that each home maintains. They have all of those minor desires, and they do have quite a reasonable intake each month, which is turned back to the residents' funds themselves. While it is not a highly profitable organization, it is one that does benefit the residents themselves.
Mrs Haslam: I think the concern I'm beginning to see out of today is that everyone says this legislation's great except don't do it to the students' area, don't do it to long-term care facilities, don't do it to pharmacies, make an exemption in a psychiatric hospital. The next group I'm sure will come and say, "Make it an exemption in a regular hospital, because if you're on crutches, you can't get downstairs."
I think the concern is looking at the term "health facilities," and the idea of leaving the option for one or two leads to five and six exemptions. I think that's my concern when I hear, "This is a good bill, but add us to the exemption list." That's all I had to say.
Ms Glover: I think in looking at long-term care facilities, perhaps we should not be looking at them as health care facilities but as the home of the people who live there.
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Mrs Haslam: Would you consider the home then to be their rooms?
Ms Glover: No, I would consider the entire facility to be their home.
Mrs Haslam: We've also had a presentation from people who live in apartments, basically seniors' apartments, who came before us asking us as a provincial government to outlaw smoking in the lobby and in the common area downstairs because there are many seniors with asthmatic attacks. There are many seniors who are kept in their rooms because they cannot go downstairs through the lobby or through the lounge area where there is smoke. The other side of the argument was there versus this side of the argument.
Ms Glover: Smoking in long-term care facilities is very tightly controlled, as Mr Carrick said. There's very limited space for residents to smoke, and people who don't smoke and don't want to be exposed to smoke are --
Mrs Haslam: And what we're looking at is the sale of tobacco.
The Chair: Final question, Mr Eddy.
Mr Eddy: Thank you for your presentation and coming forward to the committee on behalf of all the residents or homes for the aged across this province, because it's very important. Unlike Ms Haslam, I am not afraid of the exemptions. You are adults using a legal product. You have the right to do that and you have the right to do it in your homes, and those are the homes for the aged. The forcing of the separated smoking areas is right and proper, because that keeps smoking from people who don't want to be involved in it and don't want to smoke. So it's right on.
It's still a democracy, and I very strongly say to you that if this province had done something about the contraband cigarettes instead of worrying about some of these things, we'd be in a lot better position today. But I want you to know I support your request. I'm not afraid of the exemptions.
Mr Carrick: May I make a closing note? I do appreciate your support, sir, but I do feel that having dictated along these lines that smoking is to be prohibited here, there and everywhere is certainly an infringement on my civil liberties and I feel it is contrary to our Canadian Charter of Rights if you would.
The Chair: Thank you both for coming before the committee this morning. We appreciate your presentation.
WOBURN COLLEGIATE INSTITUTE
The Chair: If I could then call on Mr Gary Pennington, vice-principal of Woburn Collegiate Institute. Welcome to the committee. Have some water. Once you're settled, please go ahead with your presentation.
Mr Gary Pennington: I guess I represent the other end of the spectrum to the previous speaker. I work with people I think the act is designed to help, from 12 to 20 years of age, very vulnerable years. Many of you are parents of teenagers. You know many teenagers have this idea that they're invulnerable. This morning I had a pregnant girl in my office who is all of 15 and is a smoker and knows nothing about these health issues, in talking to her.
I wanted to make the point as a vice-principal, on behalf of teachers, that this is a progressive piece of legislation. I want to encourage it and I want to commend the government for bringing it forward and I don't think it goes far enough.
In my 30 years of working with teenagers, I have seen a dramatic decline in the smoking by them. I work for an employer that has a workplace ban on smoking and has had for over five years. There are no problems with that. Just this morning I asked a smoking staff member how she had adapted to that. She says she goes for fitness walks to have her smoke, something she didn't do before. I thought, that's the kind of adaptation they did after the initial grumbling.
As you know, schools do a number of things educationally to pass on information increasingly coming out of the research establishment to people like this pregnant girl this morning. Some of the things we do, which you may or may not be aware of: We have public displays. Public health nurses come in two or three times a year and set up interactive displays that are quite popular with the teenagers. We have anti-smoking information in all health courses. We have smoke-free weeks in which we give out free carrot sticks in the cafeteria and put on contests, give it a fun aspect.
I think there's modelling by staff. There are 130 teachers on my school staff, and less than 5% smoke. They're not afraid to make that comment to students about the modelling and the importance of their leadership for young people.
Of course we don't have any sales in our cafeteria. One of the things that has changed in recent years is that we don't allow smoking at evening dances. That's something that has happened.
I'm aware as I walk up the front walk of my school, which rents out to public facilities in the evenings and weekends, it's littered with cigarettes and cigarette packages. It's a small point, but we've had our caretaking staff cut by 25% in the last year through the social contract and other cutbacks of funding, so the cleanup doesn't happen as fast. The chief caretaker has a real problem keeping the appearance and the tone that we want to promote in our high school, which we're very positive and proud of. There are lots of different spinoffs there.
I did want to say something about the workplace ban, which I'm in favour of. I think it works. The smokers have adapted to it, and there's been a dramatic decline.
One aspect of my presentation and research for today was that we checked with some of our grade 9 students about where they buy cigarettes. There is a retailer within a couple of hundred yards of our school, a convenience store, who will sell them cigarettes. We asked our foot patrol, assigned officers from the Metro police, to visit this man. He said, "I admit to doing it and I'm not going to stop." That was the end of that. One of the reasons he gave was: "I can't afford to do it. I don't have insurance, and they'll vandalize me if I don't sell to them."
We know they're getting access to it within close bounds of the school, but the designated smoking areas, which we tried in high schools, which I heard referred to by previous presenters, did not work for us.
I also worked at the faculty of education, which had a designated smoking room as of last fall and then eliminated it. I taught across the hall from it. It was an unpopular place to teach, because every time the door opened, you would smell this waft of smoke and chemicals coming into our room, so nobody wanted to take that classroom. That particular designated smoking area was a disaster for the young adults which I heard the students' association refer to. That has now been eliminated, and people adjust.
I think the climate of parents and students in high school who I work with every day is very positive to this pressure and support, education and enforcement balance that I think is happening. I want to commend you for the act. I don't think it goes far enough, but that's my perspective.
Mr Owens: Mr Pennington, thank you for your presentation this morning. While your collegiate is not in my riding, I represent the riding of Scarborough Centre and I subscribe to your views completely.
This hooey and hot air about civil rights and the right to smoke and all that other stuff that I've heard -- and this is my first day on committee -- I find quite disturbing, because we control other legal substances, like alcohol, like the right to drive. We control other aspects of social behaviour, so all of a sudden the right to smoke and the right to cause other people health problems is a little bit bizarre, in my thinking.
I think that clearly you're on the right track in terms of the education and enforcement issue, particularly with students in grade 9. You're absolutely right, they're at that prime age for peer pressure and all the other social pressures kids have, particularly now. I try to tell myself I'm not that far away from that age, but every year it gets farther away. There needs to be some level of support from the school system and from parents to ensure that they don't get involved in a habit that has been determined to be detrimental to their health. So while I don't have a question, I appreciate your presentation.
Mr Sterling: I was very much interested in your remarks. Having tried to ban smoking from all schools during the last Liberal administration and being unsuccessful in doing that, I'm glad they're doing something in this bill regarding smoking in all schools.
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You should know that the workplace legislation that we have in place in this province is not all that strong, and many of the advocates coming from my end would have liked to have seen this government strengthen the workplace legislation. It's also happening in some jurisdictions that I represent, the city of Kanata in eastern Ontario, that municipalities are seeking the right to stiffen the provincial laws which are in place. A lot of municipalities feel that the laws are weak in that regard.
You mentioned that you would like to see some additional measures taken. Have you any ideas in that regard? You say this bill doesn't go far enough as far as you're concerned. Do you have any other suggestions?
Mr Pennington: My understanding is that it doesn't deal with a workplace ban.
Mr Sterling: That's right.
Mr Pennington: That's why I want to give an example of working for any employer for five years who adjusted to that. Because there was an outcry initially that this wasn't going to work, it was unfair, undemocratic, all of the arguments we've heard. Five years later it's working extremely well, and staff members have told me it's an encouragement and support for them to stop.
As a vice-principal, I had to enforce this double standard of allowing staff members to smoke in the staff lounge, yet 50 yards away, students caught got an automatic two-day suspension. It was a double standard that kids will throw up to you very easily. Once that was brought in, it made it a lot easier, and I think that's one of the reasons smoking has fallen off in and around high schools.
The areas where they still smoke, just over the property in a public housing apartment parking lot, that's where they go and it's also the most vandalized area of the whole community. The students I deal with often have problems, either psychological or attendance or academic problems. I've been taking little, informal surveys as I talk to students every day in my office. Almost invariably those students are smokers.
I gave you that example this morning which happened at 9 o'clock. I'm talking to this girl, she is so vulnerable and her baby is so vulnerable to this ignorance that I just felt I had to say that this morning, that you're on the right track for this generation and the succeeding generation. As you can tell, I feel pretty strongly about this. I have a daughter who smokes, and that's a real concern to me as a parent.
Mrs Haslam: That's what I wanted to talk to you about, the message to youth, because it's a concern of mine. One of the things that I've been collecting over the process of this committee meeting just adds fuel to the fire, and I want to ask you a question. I have an 11-page document that lists the chemicals in cigarettes, 11 pages of chemicals, one of them being Varsol, one of them being toilet bowl cleaner formula.
We have seen advertisements -- in American magazines, I will admit -- but advertisements that say, "I always take the driver's seat. That's why I'm never taken for a ride," unless you're being taken for a ride by the tobacco manufacturers; or "If you always follow the straight and narrow, you'll never know what's around the corner." That's because what's around the corner is cancer.
I have a concern about this type of marketing and I came across some documents that showed that the tobacco manufacturers, in some of their marketing documents, had targeted young people. I wonder if that kind of information -- because young people hate to be used and they hate to be made fools of and they hate to be looked at and told, "You're being used by a media firm."
Would that kind of message be what assists us to reach the young people since the education of -- and you're right: "I'll live for ever. I'm 15. Don't talk to me about cancer of the lungs. Don't tell me about the man who lost his tongue. I'll live for ever." Is this kind of message more attuned: "Don't be a sucker, don't be used"? Is that the kind of message that education should be looking at now?
Mr Pennington: I think you're on the right track with that. When you say that, I think of the ads now running in the theatres, the commercials, which are Ontario government commercials. They are very powerful for teenagers, who tend to go to movie theatres, I think, in much greater percentages than the adults; at least, that's the impression I have. My daughter, who is 19 and a non-smoker, has commented on the power of those ads in dramatically speaking to them. From that little informal survey, I would say we're on the right track with that type of dramatic approach.
Mrs Haslam: If we're on the right track, would limiting the access to tobacco outlets be another goal we should be looking at?
Mr Pennington: I think so. Not that I'm a great expert on this, but I have the closest retailer to us saying, "I'm not going to stop. I admit to doing it."
Mrs Haslam: If he lost his right to sell tobacco?
Mr Pennington: I think that kind of enforcement seems to work in other areas of the culture. Why wouldn't it work in this part? A visit by a policeman had no effect, so I think yes, you have to look at that.
The Chair: Final question, Mr Eddy.
Mr Eddy: Thank you for a very strong presentation expressing your concern about smoking among our youths, because it is a very serious matter. There were a couple of things I wanted to follow up on, and I particularly note your point of non-enforcement of present laws. If we have more laws, new, stronger laws, we can only hope that there will indeed be strong enforcement; at least some enforcement. It's a shame there isn't.
I thought you said about the 15-year-old student that she did not know or realize the bad effects of smoking. Then you went on to say there were some demonstrations at the school about the effects of smoking. I was greatly disappointed in that statement. Surely she would be exposed to information about the bad effects.
The other thing I wanted to ask about, if you would, how far would you go with preventing smoking? Would you go as far as a complete ban on tobacco products, realizing, of course, that some people do smoke heavily and are addicted and there would have to be some system to allow for some smoking? Where would you limit tobacco smoking to? Homes only? How far would you go?
You've mentioned smoking in the workplace. I agree with you on that certainly. It's not strong enough and it's not being enforced, but how far would you go?
Mr Pennington: It's a good question. I don't have the answer.
Mr Eddy: I know where I would go, but I'm too strong on it.
Mr Pennington: One of the things we're operating in our schools these days from the Ministry of Education is a phased-in change over three years to our grade 9 curriculum. That seems to be an approach that I think has a lot of merit, a phased-in approach where you state the goal of where you want to move and you allow people time to adjust to it. The teaching profession is adjusting slowly and surely to what I think are progressive changes in the grade 9 curriculum.
So that phased-in approach has a lot, but I think the government needs to state clearly that we want to move towards a smoke-free society. A clear message of that and how you work in the timetable I think is up to your own wisdom and enforcement feasibility, but I think that clear message needs to come out for teens.
I don't know how that girl escapes, because there is one compulsory physical education course I'm sure she's taken. She's not a unintelligent girl, but she's wrapped up in trauma in her life. In questioning her I said, "Are you aware of any of the latest research coming out about the effect of smoking on foetuses, just noted in the paper this week?" She said: "No, sir. I don't know anything about that."
That's the kind of vulnerability that I think your legislation deals with. When I listened to all those previous presenters, I was thinking, "Wow, who's speaking for these vulnerable people?" It's great to hear from university students and old-age homes, but doggone it, teenagers are very vulnerable. But they will not admit their vulnerability.
I just think you're on the right track, and I'd like to see that as a statement come out of government, that we are moving towards a smoke-free society. There are lots of positive examples of how to do this. As I said, I've seen it in schools. Smoking did decline.
Mr O'Connor: I just wanted to add a clarification for the record. Perhaps some of the members may not be aware, Mr Eddy raised the issue of enforcement and, of course, that's something we're all very keenly aware of. The Minister of Health yesterday made a public statement that there will be $2.5 million put into the hiring of an additional 50 public health inspectors to deal with the enforcement. I just wanted to put that on the record.
Mr Pennington: But it has to have more backup, because we already sent an enforcement figure, and the retailer said: "So what? I'm not going to change."
Mr O'Connor: It's there.
The Chair: Mr Pennington, thank you for coming before the committee and for your presentation.
The committee is adjourned until 2 o'clock.
The committee recessed from 1200 to 1400.
HAMILTON-WENTWORTH COUNCIL ON SMOKING AND HEALTH
The Chair: Our first presenters this afternoon are representing the Hamilton-Wentworth Council on Smoking and Health, if they would be good enough to come forward and introduce themselves. It always sounds like we're about to start that old TV program, What's My Line? Somebody came in and you'd write your name on the board.
Mr Carr: Who remembers that show?
The Chair: You see, I keep demonstrating my age.
Mr Eddy: It was before my time.
Dr Barbara Gowitzke: Mr Chairman and members of the committee, we're grateful for the opportunity to be here today. My name is Dr Barbara Gowitzke. I'm the president of the Hamilton-Wentworth Council on Smoking and Health. Accompanying me is Mrs Anne Washington, who is the chair of our education committee for the Hamilton-Wentworth council and also the health education coordinator -- prevention, for the Lung Association Hamilton-Wentworth.
We have provided you with a brief, on page 2 of which is a summary of the major points, so that you can follow along.
Talking to the major point, the first and most important point I'd like to make is that there is a basic premise that it is important for the standing committee to accept. The standing committee needs to send a clear message to the Legislature by strongly supporting the Tobacco Control Act.
The Hamilton-Wentworth council believes that the committee can do that if each and every one of you accepts a basic premise; that is, if each and every one of you accepts the preponderance of research studies which have shown that tobacco is the leading cause of preventable death in Ontario. In fact, tobacco is the only legal consumer product that kills when used exactly as intended. The standing committee must also recognize the agonizing months and years of pain and suffering which precede these deaths. Financially speaking, the concomitant health care costs to the province are colossal.
With regard to the Tobacco Control Act, the Hamilton-Wentworth council supports and commends the government of Ontario for introducing this important piece of legislation. The council applauded the Ontario government's strong resistance to tax reduction and recognized that the federal government placed the province between a rock and a hard place. But now we have a major problem.
Bill 119 has many strong points and this council is particularly supportive of sections 4, 5, 6, 7, 9, 10, 11, 13 and 14. But in the light of recent events, it is now imperative that this bill be strengthened. Tax decreases mean increases in consumption, especially for young people, which is totally contrary to the spirit of Bill 119.
Our recommendations are as follows:
First, amend the bill to require a retailer licensing system. Do this either by licensing outlets as we know them today or by instituting an LTCBO, ie, Liquor and Tobacco Control Board of Ontario. The council favours the latter plan. Enforcement officers have shared experiences with us which suggest that only with small and limited numbers of retail outlets can we effectively control the sale of tobacco to minors.
Second, require generic cigarette packaging. In any comprehensive plan to address the tobacco epidemic, generic packages or at the least plain packages must be at the top of the list. Attractive and colourful packages give kids an enticing symbol which represents the critical passage from adolescence into the world of adult behaviour. Research shows that kids are turned off by plain packs. A recent study concluded that plain packaging would break or substantially weaken the link between the package and other promotions.
The most prominent way in which tobacco products are now promoted is through sponsorship of events like jazz festivals, tennis tournaments, fashion foundations and car races. By connecting advertising for such events with the colours and designs used on tobacco packages, the industry effectively promotes its product.
Third, adopt a reverse onus philosophy to legislation, such as that used in Finland. The legislation is based on the premise that all non-residential places are required to be smoke-free unless the contrary is indicated by "Smoking Permitted" signs. This blanket prohibition clearly enunciates a public health policy which condemns environmental smoke as a health hazard. Such an approach requires that applications for smoking-permitted venues would be made and only those meeting certain well-defined criteria would be granted.
Once again, in light of the recent tax reduction, it will be important to have a strong public places policy to protect the non-smokers. Let's face it: Tax reductions lead to more smokers, which will in turn lead to more smoking in public places and more involuntary exposure of non-smokers, and smokers too, to secondhand smoke.
ETS is the insidious disease. The smoker is the carrier. People exposed are often unaware of their exposure and the seriousness of the disease. It's rather like being exposed to radiation from the sun; you don't feel it or notice it until it is too late. I bring to your attention something I don't have in my brief from yesterday's paper. Canadian scientists yesterday reported finding evidence of cigarette smoke in foetal hair, the first biochemical proof that even the offspring of non-smoking mothers can be affected by passive cigarette smoke.
Fourth, and finally, create a smoke-free environment in all workplaces in the province. This is a critical need and should be done as soon as possible by adding a section to Bill 119 which would ban smoking in all workplaces. Just as a reminder, one person's public place is usually another person's workplace. At the moment, most Ontario municipalities have no such power to enact such legislation. It means that the only body in a position to control smoking in the workplace is the provincial government. This is needed now, particularly in light of the provincial target of smoke-free workplaces by 1995.
Finally, enforcement: It's key to Bill 119. All of the education and legislation attempts at federal, provincial and municipal levels still fall short unless there are some teeth in the system in the form of enforcement. I welcomed the minister's announcement the other day in Barrie.
In conclusion, the Hamilton-Wentworth council believes that incorporation of the above suggestions into the Tobacco Control Act will make this legislation one of the strongest in the country, will take some of the sting out of the reduced prices and will reinforce the comprehensive tobacco control program now being implemented by the provincial government. Equally important, passage of this act will underscore the government's commitment to preventive health care.
Now, if I may, I'd like to turn the attention to Mrs Anne Washington, who will speak on behalf of the Lung Association.
Mrs Anne Washington: Thank you, Barbara and members of the committee. I raise my glass to the province of Ontario for having moved as far as it has with tobacco legislation. Congratulations.
The Chair: We hope the water is good.
Mrs Washington: Indeed. I just want to set into a framework for you a little the reason why I'm here today. For the past eight years, my professional life has been entirely devoted to tobacco use prevention, cessation and public policy in the schools community and within the six municipalities of the Hamilton-Wentworth region. Rather than make a separate presentation from the Lung Association Hamilton-Wentworth, we agreed that we wanted to show our concern and our support of the work of the Hamilton-Wentworth Council on Smoking and Health. In that regard, I'm here today in support of the brief that Barbara has presented for you.
In Hamilton-Wentworth, we work as a team on the tobacco issues. We are a concerned team and why we're here today is to ask you to be a partner in this team so that we can improve the health and wellbeing of every member of the community of the Ontario province.
To give some sense of what it is that those with whom we are doing this bill feel about this, I bring today the voices and the concerns of our most precious resource: our children.
I have seen the addictions of an 18-year-old and a 15-year-old as they struggle with tobacco use. I have seen the frustrations of asthmatics who are caught in a situation where they no longer are able to breathe clean air because other people choose to smoke. I have heard the frustrations of people in workplaces who say, "We need to have stronger legislation so that we can bring in total bans."
Let us turn for a moment now, if we may, and let's just listen to those kids and see what they've got to say to you today. Would you roll that tape, please?
Video presentation.
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Mrs Washington: To support what those children, who are enriched students, say -- they wrote the words for that; it was not a put-on job -- I have brought these for you, if the clerk would distribute them, from that junior-level school. Also, a grade 11 student has taken the time to write you a two-page letter. His interests concern no smoking on school grounds and vending machines.
I have also brought along for you today a feeling from grade 1 students -- the mood out there is to do something about tobacco; grade 7 students; and a petition after a two-week series on tobacco use prevention and cessation from the students of a middle school. These students became so actively involved in this issue that they chose to write to you:
"We, the staff and students of Westview Middle School, would like the Ontario government to be responsible and to pass legislation that will protect the innocence of children from the insidious impact of this addictive drug, nicotine." The petition has been voluntarily signed by the students with the full knowledge of their parents. I'm going to ask Mr Larry O'Connor if he would submit this petition to the Minister of Health for us.
I've taken a few minutes to share some material with you that comes from the hearts of young children. What you are doing here today and what you will recommend to the government of Ontario is of vital importance. You have a part to play. All we can do is to give you some input and hope that you will listen. Thank you for your time.
The Chair: Thank you for your presentation. I think it's safe to say we have not had as unique a presentation with the young people as you've presented and we appreciate that. It struck me, just in terms of your brief, that the young people were in the drawing of course using the advertising, albeit they were working out their own name, but just the way in which that plays in the marketing and how significant that is for them. So it's sort of recording some of the things you were saying. We'll move to questions then. Mr Carr.
Mr Carr: Thank you very much for the presentation. How old were those children?
Mrs Washington: Those children were grades 4 and 5. They would have been 10 and 11, but they are enriched students.
Mr Carr: I was thinking the same because my son's in grade 6 and he's 11. He's also in enrichment classes, and they did look the same age.
With regard to the overall dealing with this whole issue, as you know, Bill 119 has taken a step in one direction, but within the last week or so we've probably taken a step backwards with the reduction in the price. How much of an impact do you think that will have in terms of what goes on? I suspect that with young people the cost is a big factor. I asked a couple of the young people up in Thunder Bay. They said they'd somehow find it regardless of the price. With the recent changes in the cost of tobacco, what do you see happening in terms of the usage among our young people?
Dr Gowitzke: We've both seen it; maybe both of us should comment. Just doing sort of an informal survey with some teachers in one of our schools in the east end, we've already had reports that it's a little bit like the forbidden fruit and they couldn't wait to get out of school the day that the prices went down to buy their cigarettes. Mrs Washington also has comments.
Mrs Washington: You'll notice if you look at the price sensitivity of children, which is two and a half times greater than that of adults, that definitely this is going to have an impact. James Dietrich, the grade 11 student, has taken great pains to draw your attention to what he has seen and what he feels about that issue. So, yes, it is having an impact. I have heard it in the schools where I have been and I have seen it even this morning, when students were purchasing cigarettes.
Mr Carr: It's my feeling that this bill, although a good intention to stop the issues, I think we're going to be behind overall because of the reduction. So we've taken one step forward and two steps back. What's your reaction? Is this just going to help nullify the increase, or are we going to be actually farther behind today than we were three months ago?
Mrs Washington: We've moved backwards but we mustn't be discouraged by that. What that tax rollback means is that Bill 119 has to be even more strengthened, particularly through plain packaging. We know very well that kids are influenced. How do I know? The cigarette that bears the lipstick traces bears the responsibility for children taking on this particular addictive substance. Plain packaging is vital to help combat that rollback on taxes.
Mr Carr: Good, thank you very much. Good luck with your fine work.
Mrs Haslam: I was reading the letter from the grade 11 student. You're correct: He is very clear in saying, "I've been buying them since I was 11 and nobody's asking my age." He feels the price is going to be a very strong enticement for young people. Everything is all connected in this legislation when you look at vendors who sell to minors. We're trying to find a way to stop that.
One of the ways we have looked at in this legislation is the model we've put forward regarding when a vendor is caught selling to a minor. If it's twice within a five-year period, they lose the privilege of selling tobacco. They must post a sign stating they've lost the privilege. The signage, to me, is a very important point in the business. The manufacturers and the providers of it are also made aware that that store can no longer sell tobacco plus, apparently, they cannot even have tobacco on their premises.
Having said that, having looked at those types of deterrents, plus the additional 50 inspectors that Minister Grier has just announced, my concern is holding up the legislation or putting in place a licensing system versus getting this type of system going very quickly as what is proposed in the legislation. Are you still in favour of going into a licensing versus this type of system, and why?
Dr Gowitzke: If I can respond, I'm still in favour of going to a licensing system. What you described is perhaps somewhat of a deterrent for some, but I guess -- the words that come to mind -- it's still "Mickey Mouse" as opposed to having some real teeth in the system. As you heard me say, we're really in favour of, if anything, limiting the number of tobacco vendors and taking it to the LCBO.
Mrs Haslam: That has been suggested. What do you see as the difference between losing the licence and losing the permission and signage, losing the right to sell tobacco? What do you see as the difference other than this system of licensing versus not licensing? What's the difference between you can't sell tobacco for six months and you must put a sign stating that versus you've lost your licence to sell tobacco for six months?
Dr Gowitzke: I guess they both come out with the same result, but 50 inspectors across the province of Ontario aren't going to catch them all.
Mrs Haslam: That's another concern about the expense of licensing versus this type of system. I myself would rather see the money go into enforcement.
Dr Gowitzke: Do you have a comment?
Mrs Washington: Yes. I think there is an obvious need here for massive education of retailers. That's one component. We haven't time to get into that.
I also see that licensing will to some degree be self-regulatory. One person who loses a licence will be a clear indication to others that if they continue to sell tobacco illegally, their licence will be removed. Whichever route you take, we need to do something very soon, because children are accessing those tobaccos.
Mr McGuinty: Thank you both for a very interesting presentation. I just want to comment briefly on the issue of the tax reduction. I think all of us had some serious reservations about that, but it's certainly my hope that the impact of that reduction will be to drive sales off the streets, out of car trunks, out of school yards, into stores. Hopefully, with Bill 119, it'll be impossible, first, for young people to acquire their cigarettes from retailers.
An idea that's been tossed around here from time to time is everybody's concerned about the mixed message when it comes to cigarettes. You've got adults smoking. We're telling kids that they can't smoke.
It's interesting, you gave us this chart here, the causes of preventable death. I've heard about that before but it's great to have it in chart form. Tobacco deaths far exceed what looks like all the others put together here: alcohol, suicide-related, traffic, falls, AIDS, drugs, poisoning, drowning, homicide, fire.
It's interesting, when it comes to alcohol, we tell our children it's illegal for them to drink. When it comes to a new law which is going to make bicycle helmets mandatory -- and I think we may have around 200 deaths a year in the entire province when kids are involved in fatal accidents, head injuries related to when they're riding their bicycles -- we're going to make it illegal for them to leave the house without their helmet.
I think there's a message involved in being able to tell kids that something is against the law, so I think we've got one end of it worked here. We're telling retailers, "Look, it's against the law," but we can't tell our kids, "You know, it's against the law for you to smoke." If I have a 14-year-old or 15-year-old who's smoking, I think, and some parents and teachers and medical people have told us this on the committee here, it would be nice if they could tell kids, "It's against the law." What do you think?
Dr Gowitzke: You've hit a very sensitive point with me, Mr McGuinty, because for some time now I've been concerned with the fact that with all the municipal and all the provincial legislation, or federal legislation for that matter, in the world that controls the vendors, you're still not going to do anything about those who actually possess tobacco.
In Hamilton-Wentworth, we've talked with our police services board about enforcement of the law with regard to possession and we're told by them that they have other more important things to do; murder, suicide, drugs and alcohol capture their attention. I guess it's for the reason that I mentioned in my brief. Those are more dramatic, you know, here today, gone tomorrow; it takes 30 years for tobacco to kill you.
But you've hit a very important and sensitive point as far as I'm concerned. Maybe some of those 50 health inspectors will do something about enforcement in that regard.
Mrs Washington: I think if I might make just a brief comment, from the background experience I have in the schools, this has to be a comprehensive approach. It has to happen at home, it has to happen in the schools, it has to be seen by the actions that our government takes. It's a health, it's a political, it's an economic issue, and everybody has to do their bit towards it. It's tremendous how far the Ontario government has come. I believe they're going to stand firm and I really believe they're going to go further.
Mr McGuinty: I'll look forward to that.
Mr O'Connor: I just wanted to put on the record my thanks for the day I had with this committee in Hamilton. I think with all the hard work that you're doing out there and the legislation and the approach -- the media have been good in keeping this as a forefront issue -- because there are so many people who die prematurely because of tobacco-related illnesses, I think we're going to go milestones. I want to thank you for your ongoing effort.
The Chair: Thank you for coming today.
CIGARETTE VENDING MACHINE OPERATORS AND DISTRIBUTORS, NIAGARA SECTION
The Chair: I call on Mr Ron Kane, Mr Raj Asser and Mr Bruno Monaco. Gentlemen, welcome.
Mr Ron Kane: We represent the Niagara section of the Cigarette Vending Machine Operators and Distributors. We've already had one casualty in the Niagara region. A cigarette distributing company has closed its operations in St Catharines. This is one less business contributing tax dollars. Some of the remaining operators will declare personal bankruptcy and lay off employees if Bill 119 is passed as proposed.
There are about 6,000 cigarette machines in Ontario. Tobacco manufacturers reported total revenue of $10 billion; $76 million of that amount was from machines in Canada; $29 million was generated through machines in Ontario. The province of Ontario earned $2.15 million in taxes in 1991. Less than 1% of all legal cigarette sales are from vending machines in Ontario.
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"If they're under age they're not betting legally -- but they're buying a legal product" Floyd Laughren said in January regarding Pro Line lottery tickets purchased by teenagers. Can we use the same quote on cigarettes? The government lottery machines are placed next to our cigarette vending machines with stickers, gold and black, which read, "Children under 18 not allowed to use this machine." If that is an acceptable monitoring system, can we use the same? We cigarette vending machine operators are selling a legal product plus paying PST and all the other taxes associated with it.
We're not in favour of teenagers smoking. We're here to convince you that the cigarette vending machines are not being used by children. "Over two thirds of smokers buy their own cigarettes...from corner stores. Other places where individuals reported buying...cigarettes" are "doughnut shops, gas stations, restaurants, pool hall, bakery and duty-free from the United States." From the Canadian Cancer Society, Effects of Plain Packaging on the Image of Tobacco Products Among Youth, page 11.
We support that. Andy Barrie of CFRB conducted a radio talk show with teenagers. It was an open-line phone-in show. Not one teenager present at the station or the ones who phoned in said that they used vending machines. All used corner stores. They walk in and get served with under-the-counter cigarettes. This has changed recently, but through nobody's fault.
The parliamentary secretary of this committee asked the question of the school children of York region on Thursday, February 3, 1994, if they or other children are using vending machines. One child said she did when her father asked her to get him a pack. The catchphrase here is that her father asked. Parents have some responsibility too.
All the research shows that cigarette vending machines are not children's enemies. We are being victimized. In a 15-minute script we cannot present audio-visual, but we suggest the committee get these from CBC radio and television, CTV and CITY. As the Minister of Health put it, when some of the retailers will not be selling the cigarettes over the counter, the children will start using vending machines, so ban the machines. There was no study done on the cigarette vending machines and their use by children. If a child cannot buy from a drugstore, is he going to look for a vending machine or is he going to go to the corner store that's open all hours and sell cigarettes substantially cheaper?
"Tobacco consumption will rise this year for the first time in a decade as smokers take advantage of cheaper cigarettes to puff harder, says a federal official."
Mr Anthony Perruzza (Downsview): Shame, shame.
Mr Kane: St Catharines Standard, December 21, 1993. Yes, it is a shame.
"Pierre Villeneuve, an aide to Health Minister Lucienne Robillard, said that almost all youths who now smoke buy their cigarettes on the black market." St Catharines Standard, February 2, 1994.
All the information we are getting is that the minors are smoking because of the easy access they have to the black market. Cigarette vending machines have been here long before this increase and there was a steady decline in smoking.
We ask you, elected members, why is the quote "small businesses are the backbone of our economy" not given any importance as soon as the elections are over? When the loonie was introduced we were put in the position of converting our coin mechanisms at approximately $750 per machine. We have not finished paying off these conversions.
The average age of our operators is in excess of 50 years. These operators will not be entitled to UI benefits, and by facing bankruptcy will not have the means to retrain or start other businesses. We have hundreds of thousands of dollars invested in our business. If we are out of business in three months what are we going to do with these machines?
What do we do after we go broke? Anyone out there looking for ex-business people? Maybe this government wants more on welfare. When the GST was proposed, the labour groups warned the government the GST will take the economy underground. We urge the NDP government not to pass Bill 119 as it is; otherwise the contraband business will flourish in Ontario.
The campaign is aimed at saving lives and cost to our health care system.
"Illness due to unemployment -- everything from stress-related headaches to heart troubles -- cost Canada's health care system at least $1 billion last year, a new study suggests.
"`Unemployment causes human suffering and places a heavy economic burden on the health care system,' said Dr Shah, co-author of the report and a member of the public health committee of the Ontario Medical Association."
All of our group are already suffering from the stress of our situation, as you can tell from my reading here, not knowing where our future lies, or more important, do we have any? This province has no control over most of the job losses and further burdens to the social programs. It does have a choice at this time in choosing not to put us out of business and on to the welfare rolls, as we have shown sufficient evidence that vending machines are no threat to the teenagers.
It is discriminatory to ban cigarette machines, because the government is allowing cigarette vendors to continue selling cigarettes. There has been no mention of compensation to families who have started and operated vending machine businesses, investing all their savings to sell a legal product. You are violating our constitutional rights, denying us the right to earn a living, at the same time allowing this legal product to be sold in corner stores.
"New York state passed a law in April that banned cigarette machines throughout the state -- with the exception of fully liquor-licensed establishments.... New York City went to court to keep the `25-feet rule.'" That means machines located inside licensed establishments of 25 feet. They lost that. That was reported in Vending Times, December 1993.
We recommend that you give legal responsibility to children and their parents, that government continue with its education programs and that you apply with force the existing laws. I was buying cigarettes when I was 10 and 12 years old in Toronto and no one ever questioned me and it was the law in fact then. It's never been enforced, at least not to my knowledge.
What steps are being taken by the Ontario government to prevent smuggling? For that matter, if you make the law 19, what's going to stop the other kids from selling the singles to the kids in the schools rather than the packages?
Will we be compensated? Why do pharmacists get one year to adjust their business and the cigarette machine operators three months? Thank you for your time. If you have any questions I'd like to help.
Mr Owens: Thank you for your presentation. You mention by way of example some of the US jurisprudence with respect to the amount of distance between I guess the front door and where a cigarette machine can be located. Are you aware of any Canadian jurisprudence on that issue?
Mr Kane: Not that I'm aware of.
Mr Owens: You ask the question specifically with respect to an adjustment period. Are you suggesting that if the ministry was amenable, you would agree to a one-year period to withdraw from the business?
Mr Kane: Would you agree to the disposing of your whole business in a one-year period? I don't think anyone would agree to that. I think the federal law has approached the thing from a reasonable standpoint. Cigarette machines are legal in licensed establishments according to the federal law as of February 8.
Mr Owens: In terms of the issue with respect to enforcement, we were clearly forced into a situation by the federal Liberal government, but I can assure you that what our Solicitor General was doing with the now deceased Conservative government was arguing strenuously for enforcement of anti-smuggling laws, which as you say currently exist. You shouldn't have been buying cigarettes at 12 any more than a 12-year-old at this point should be buying cigarettes, and enforcement is clearly an issue that we take quite seriously.
I'm sure the parliamentary assistant can wax poetic about the good things the ministry is proposing to do. The issue that I have some concern with is access to the product. Yes, it is a legal substance at this point, but as I said this morning, there are a number of substances and social things that the government regulates.
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This is my first day on the committee. I was given today an 11-page document with the numbers of chemicals that are in cigarettes, and I'm suggesting to you that while it may be a legal product, in fact some control is necessary in terms of trying to mitigate the kind of damage that we're seeing now because of the number of years that the people have been smoking, and what we're trying to do is stop that younger generation.
Mr Kane: May I interject here for just a second? You're suggesting that you don't want the younger children to smoke. I have kids of my own and I have grandchildren. I don't want them smoking. My kids don't smoke, although I did and I don't now, but that's beside the point.
The cigarette machines located where the federal law now has them are for the people who are supposed to be old enough to go into licensed establishments that are not available to teenagers. By limiting the cigarettes and having them available through corner stores or through whoever, young kids are still going to get them. It's going to be exactly the same as Prohibition, only they're going to be sold in schools by other kids that are old enough to buy them.
Mr Owens: So a restaurant like Denny's or another family-type restaurant which does serve alcohol --
Mr Kane: The law says 80% of the beverage sales have to be alcoholic beverages.
Mr Owens: But there's still, in terms of the type of family restaurant or establishment that would be in my riding, access by minors.
Mr Kane: Not in a licensed establishment, there isn't. The current federal law says they're allowed to be located in alcoholic-licensed establishments only, bars, not allowed to be located in other places, and we're well aware that the law was supposed to come out on July 1.
Mr Owens: If I could have a quick question or clarification form the parliamentary assistant: My information seems to be at odds with the opinion of the presenter. Can you clarify the difference with respect to the federal law and who it covers?
Mr O'Connor: Our legislation goes much farther than the federal legislation does; it goes only to age 18. We felt a way of monitoring it better and enforcing it better would be to put it to the age that we have for the age of majority for drinking, which is 19. They have an age-of-majority card that they can present.
When the federal government was drafting its legislation it had some difficulty in taking a look at Ontario because licensed premises include family restaurants. Therein lies the problem that we have here in Ontario: licensed premises. You referred to that young lady I asked a question of. Young people can go into licensed establishments because licensed establishments can mean a family restaurant.
Mr Owens: Golden Griddle, Steve's Pancakes.
Mr O'Connor: So the difficulty we've got here then is that from the many presentations we had we never did find from anyone a suggestion that would say, how can that vending machine find out how old the person dropping the loonies in is? That's the key here.
Mr Kane: I agree with you on that one, but you're talking family restaurants. The federal law says that the sales have to be 80% alcoholic beverages. Those aren't family restaurants; those are bars, and the law in Ontario says 19, so if they're in a bar under 19 they're in illegally.
Mrs Haslam: No, only in --
Mr O'Connor: That's why I say we have a problem here in Ontario, because a licensed premise is still accessible to a young person.
Mrs Haslam: That's right, because at 17 --
Mr O'Connor: I understand what you're saying, but the federal government's intention was well meaning and it doesn't apply to Ontario. We have a problem here in the province of Ontario that young people can still go into those establishments and have access to that vending machine that does not discriminate against how old that person might be. They may be going in to use the washroom, and quite often when they go past the washroom is when they pass that vending machine.
Mr Kane: Excuse me, but that's not true. The law in the province of Ontario under the Liquor Licence Act says that you have to be 19 to be in those premises. If you're not 19 years of age, you're in there illegally. I used to operate the Dalhousie Yacht Club, and we kicked children out of the bar area continually because it's illegal for them to be there. That happens to be the law.
Mr O'Connor: I guess to clear this up, because this really does concern me if that's the case, I'd ask legal counsel to come forward so we can get some legal advice on this, because that's the problem we've got here.
Mr Raj Asser: It seems that anybody under 18 can go into licensed premises with their parents.
Mr O'Connor: That's not what we're talking about.
Mr Asser: For the purpose of having a meal.
Mr O'Connor: They just can't drink.
The Chair: We'll ask the legal counsel to comment.
Mr Williams: The gentleman is correct. I think there's roughly half a dozen licensed premises in this province that have restrictions on their licence placed on their establishment by the Liquor Licence Board because of instances where they've served minors. Other than that handful of premises, in all premises in Ontario a person of any age can go into those premises. They're not allowed to be served liquor, but they're allowed to be on those premises.
Mr Kane: The law has changed since I operated a bar.
Mr O'Connor: No.
Mr Williams: That's been since at least five years ago, because I wrote the statute.
The Chair: I think perhaps we've identified an issue here and we'll follow up on that, but clearly there's a difference of opinion.
Mr McGuinty: You raised a very good issue relating to I guess the federal approach. I have a copy of the regulations here, just so everybody can understand what we're talking about here. They define a beverage place. You can't have a vending machine now under the new law, which is 16 days old. You can't have it anywhere in Canada except in a beverage place, and a beverage place means a bar, tavern or other similar beverage room where alcoholic beverages are consumed, da-da, da-da, da-da, da-da, and you've got to have 80% of your total annual gross revenues from the sale of liquor, alcoholic beverages. So we're not talking here about a place like Denny's. It wouldn't qualify. It's got to be a bar, a tavern or something of that nature.
I don't think there are many children going into bars or taverns. There sure as heck shouldn't be.
Mr Kane: I hope not.
Mr McGuinty: Yes. What we're going to do here is that in an effort -- and it's a noble intention no doubt -- to reduce the incidence of smoking in children, we're going to ban vending machines in bars. I think there should be something else we could do to keep kids out of bars, to keep kids out of taverns -- I think that's the real source of the problem here -- and allow you to operate your vending machines in those bars and in those taverns, under the restrictive guidelines they have in place here, which describe that it's situated a distance of not more than five metres from the innermost part of the entrance and it's got to be able to be directly monitored.
Mr Perruzza: You're saying vending machines are okay? Is that what you're saying?
The Chair: The question is directed to our witnesses.
Mr Perruzza: I wanted to know what he was saying.
Mr McGuinty: Just so Mr Perruzza understands, I think we could have vending machines in our bars and taverns, and I don't think our kids should be going into bars or taverns.
Mr Perruzza: You want to ban them from bars and taverns completely. That's what he's saying?
Mr Carr: I hate to break this to you, but I think, as you saw by the reaction from the members of the government side and the parliamentary assistant, that you're probably not going to get the changes. I believe that, as Mr McGuinty said, they're going to take one step to try to put you out of business and stop sales.
Yet over the last week or so or whatever it was, they probably did more to increase tobacco sales by reducing the taxes. Typical of socialists, they blame somebody else. It's never their fault. It's always the federal government's or somebody else's fault when things go wrong.
Mr Perruzza: Oh, you shouldn't just --
The Chair: Order, please. Mr Carr has the floor.
Mr Carr: Typical of these people, they're critical of the federal government. I wish they'd be as critical of their own government when they have the chance. You'd have more credibility, Mr Perruzza.
My question is, you've got a situation where you've now decreased taxes and yet they're going to put you out of business. I think reducing the taxes will encourage more people to smoke than putting you out of business will. Do you agree?
Mr Kane: Reducing taxes? It's going to encourage more kids to smoke, sure, because the 10-year-old with a quarter in his pocket, somebody's going to sell him a cigarette. That's what's going to happen. It's just the days of Prohibition, only it's tobacco now, that's all.
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Mr Carr: You may have mentioned this. In terms of economic impact, how large is your industry right now?
Mr Kane: There are approximately 6,000 machines in the province of Ontario. I know this doesn't agree with the figures of the federal government, and there's a real good reason it doesn't, because if you were reporting to Stats Canada and you sold a portion of your business off and you sent that in on the report, the next year you didn't get a report. Consequently, there are as many cigarette vending machine operators and private hotels etc that own their own machines that never reported to Stats Canada.
There are 6,000 machines at least, and it's going to cost a whole bunch of people their whole livelihood. It's that simple. You're going to put a lot of people out of business permanently, people who have put every cent they have into it, and giving them 90 days is criminal.
Mr Asser: I would like to bring your attention to a little article which says, "Mr Rae Seeks Payback for the Taxes He's Going to Lose," because the federal government brought the taxes down. I'm going to lose 70% of my business and I'm seeking a payback. If the government is going to put me out of business, it had better buy my cigarette machines and decorate Queen's Park with them, because I have nothing else to fall back on.
The Chair: Thank you for your presentation.
KAY BOURNE
Mrs Kay Bourne: Good afternoon. I'm representing just my husband and myself. We have a small business called Bourne Vending. We've had it for a few years. We have vending machines. I hope you don't lynch me.
Mr Carr: It's legal.
Mrs Bourne: It's legal, that's the point. Most of our machines are in licensed premises where children do not go in. They're bars and taverns. We do have a couple in private clubs, like the Moose, where I think the average age is 45 and over. We have one in a factory.
Where we have a couple in places where there are restaurants, would there be any objection if we put them, say, in the kitchen area? The servers have to get the ID of the person where they are going to be served alcoholic beverages. They could ask them for their ID before they get cigarettes. The servers usually go and get the cigarettes out of the vending machines. Would there be any objection to that? I can't see why there should be. Most of our machines, as I say, are in legal places.
About something I saw on TV, these commercials that are supposed to stop children from smoking: My grandchildren think they're ridiculous. I have 13 grandchildren, and not one of them smokes, and I have seven of them who are over the age of 19 and four more coming up this year who will be 19.
We haven't got any kind of pension plan except our RSPs. What are we supposed to do with the machines? What are we supposed to have for our business income? Has anybody got any suggestions here?
I'd like you to ask me some questions about it. I'm going to be short and right to the point. You've heard everything else from the other people.
Mr Sterling: Simply put, our party has stated that we think you should be compensated for your cigarette machines. If you're going to be put out of business by the government --
Mrs Bourne: Well, we would be.
Mr Sterling: -- then I think you should receive some compensation for your investment.
Mrs Bourne: I think maybe the provincial and the federal governments should get together on it if they're going to put us out of business. It shouldn't all be borne by one.
Mr Perruzza: How about all those people who work in a trade and all of a sudden find themselves out of work for years?
The Chair: Order, please. You will have your time for questioning.
Mr Carr: They get unemployment, Tony.
The Chair: Please. Mr Sterling has the floor.
Mrs Bourne: We don't get unemployment insurance.
Interjection.
The Chair: Order, please. Mr Perruzza, the way this committee functions is that each caucus has an opportunity to raise a question, and I would ask you not to interrupt. Mr Sterling has the floor, please.
Mr Perruzza: Yes, but he should stay away from crass political statements.
Mr Carr: You're saying that? Crass political you?
The Chair: Order, please.
Mr Sterling: I think there's a very, very important distinction between somebody who has invested their life savings in a business which has been heretofore legal, which you have done. I believe that if the government is going to say it's no longer legal to sell cigarettes from a vending machine, it should have some kind of compensation plan to buy you out at whatever the depreciated value of your machines might be.
I think that can be clearly distinguished from a person who loses their job, because a person who loses their job is not investing their life savings, hasn't put money up front, hasn't invested in a huge capital outlay on the premise that the laws were going to be all of a sudden radically changed for their lives.
Mrs Bourne: I understand.
Mr Sterling: I'm just saying that my party supports the position that you should be compensated, as we think the tobacco farmers should be and are compensated when they get out of growing tobacco.
Mrs Bourne: The only thing is, if you take the depreciated value of the machines, that's not going to do anything for our income, is it?
Mr Sterling: No, that's right, as we don't do anything for the income of people who no longer grow tobacco.
Mrs Bourne: I don't think that's very fair either. As you know, several of them have committed suicide because their farms have been lost.
Mr Sterling: Unfortunately, tobacco kills, and we have to deal with that in this government too.
Mrs Bourne: I wonder. There was a study done in British Columbia where they think a lot of the pollutants are coming from car exhausts. How about people who are in cars coming in, commuters, and going back every day? They're breathing in all these pollutants that must contain an awful lot of chemicals also. It's probably a combination of everything.
I don't agree with young people smoking. Don't get the idea I do. But we have a first generation of non-smokers in our own family, and at 70 I'm not going to go out and get another job.
Mr Perruzza: Very quickly, while I feel for what you're going through and I understand the difficulties that you'll experience, and there was a fellow just before you who maybe experienced the same kind of thing, I just want to pick up on a point that was made.
I represent a constituency where I've met with a good many people. I'll just relay the experience of one individual who invested about 22, 23 years of his life in a factory, learning how to make couches. I think he's 57 now. That man, as a result of federal legislation, free trade, saw his plant move away. They relocated in Buffalo, where they're making couches now. That individual has been unemployed for, oh, two and a half years.
He probably isn't going to find any employment, and I don't think there's much in the way of a pension until he gets to the ripe old age of 65, which is, what, seven, eight years away? He's not going to have a job. He invested his whole life in learning how to make couches, invested in his company, invested in his company dearly through his efforts, through his skills and through his want to produce.
Nobody's coming along and compensating him for his investment. He invested in a company. The government came along, changed the law and said, "Sorry, folks, we're going to have free trade." His plant moved away. His job moved away. He's out there. Is Mr Sterling standing up and saying, "We should compensate him for the eight years, nine years until he gets a pension"? That's not what we're saying.
To ban young people from every place in Ontario: That's the other kind of absurdity we've heard today as well. I just think this has all gone too far. While I regret very much what may happen to you as a result of your losing your vending machines and while I regret what may happen to the other fellow who just appeared before you, cigarettes are a bad thing. They not only kill the person who smokes, but they kill the people who are within the general area of the people who smoke.
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Mrs Bourne: Always?
Mr Perruzza: By and large. I think studies and all of the experts who have come and made representation to this committee seem to suggest --
Mrs Bourne: Yes, they seem to suggest.
Mr Perruzza: That's the ugly side of cigarettes. When you look at some of the --
The Chair: Just a question there, because we do need to move on.
Mr Perruzza: My question really had to do with the whole issue of compensation. If we should buy all of the previous person's vending machines and decorate Queen's Park, as his question was, and if, as Mr Sterling is suggesting in making a recommendation here today, you should be compensated, should we then not compensate just about everyone else, especially that whole generation of older workers who are near the age of retirement who lost their jobs as a direct result of free trade and who will never regain employment?
Mr Carr: How are we going to solve that?
The Chair: Order, please.
Mr Perruzza: Should we be compensating them as well? I want to take their logic one step further.
The Chair: The witness has --
Mr Perruzza: If you want to play politics, let's play politics.
Mr Carr: How are we going to solve that?
The Chair: Order. Mr Carr, please. Mr Perruzza has the floor. He's asked a question of the witness. Mrs Bourne, if you would be good enough to respond.
Mrs Bourne: This person that was going to lose their job, even though they had invested all those years, they probably have a company pension and they probably are going to get UIC.
Mr Perruzza: No.
Mrs Bourne: Why not? Severance pay?
Mr Perruzza: Their UIC lasts for a while and then they fall through the safety net.
Mrs Bourne: Will they not get a company pension or severance pay of any sort? I thought severance pay was mandatory.
Mr Perruzza: Not anything that has any real meaning. Many of these companies didn't have much to offer their people.
The Chair: We're going to move on.
Mr McGuinty: Mrs Bourne, thank you for your presentation and helping us to understand --
Mrs Bourne: Would you mind speaking a little louder, please? I'm a little deaf.
Mr McGuinty: Thank you very much for your presentation. You, like many other presenters who have come before you, help us to understand the implications of the bill on the front lines. This bill, like any other government bill, has got some good parts and some bad parts. By bad parts, I mean that some people are going to get hurt. The government feels that it is in the greater public good that this happen, that if a few people lose their jobs or lose some investments, there is a greater good at stake here and you become expendable. I think it's important for the government members to recognize that. That's what's happening.
You have been engaged in a legal practice. You have presumably been paying your taxes.
Mrs Bourne: Definitely.
Mr McGuinty: You may have raised a family on the earnings generated through this business, sent kids to school, put money in the church basket. I don't know. All of those things are legal and good and we have encouraged them in this society for a long, long time. Now we're changing the rules, and we're changing them abruptly. I think we have some obligation to minimize the impact, maybe by extending the time frame during which this business will be phased out. Maybe that's the minimum we could do.
Mrs Bourne: Are you still going to allow them to be sold in stores?
Mr McGuinty: Cigarettes? Yes.
Mrs Bourne: Then what's the difference with the vending machines if they're in a place where children can't get at them?
Mr McGuinty: I sit in opposition and I don't want to speak for the government on this, but I know why, and I think there's a good reason. The kids have access. We've got to minimize their access to vending machines.
Mrs Bourne: They can't get access if they're in a place where they can't get at them. When you go to a bar, the first thing they ask you for is your ID.
Mr McGuinty: I agree with you.
Mrs Bourne: If you go into a tavern, they ask you for your ID. If they're in a place where they serve food and they're where children can't get at them, nobody can get at them, only the servers, how are children going to get at them there? I've already asked some of the places I went to this morning to change the prices if they would put them in the kitchen where only the servers could get at them and ask for the ID, and they said yes, they would.
Mr Owens: Thank you for your presentation. In terms of the cigarette vending machine business, are you not currently seeing some level of diminishing returns?
Mrs Bourne: We did with the smugglers around, but now that it's starting to go down with the smuggling, our business has started to come up in the last week.
Mr Owens: The feds have passed legislation. Do you think that's going to impact on your business in a negative way?
Mrs Bourne: Which part do you mean?
Mr Owens: In terms of the location of vending machines.
Mrs Bourne: I don't think that will impact on it at all. I know they have to be 15 feet from the nearest entrance.
Mr Owens: Now, there are a lot of people on this committee and in the audience who are more knowledgeable about cigarette consumption in Canada these days, but my understanding is that consumption is going down. Is that not going to affect your business? If people simply cease to buy your product or buy the product from your machines, are you still expecting some level of compensation?
Mrs Bourne: Not if I could stay in business, no, because our business has not gone down that much before the smuggling started. I'm sure that when the smuggling has gone, we will sell just as many, because the people who go into bars and taverns are the ones who smoke.
Mr Owens: I just talked to a friend of mine at lunch break who bought a large king-size package of cigarettes for $2.78 from a local store. The last time I saw a price on a cigarette machine, they were like $6 or something.
Mrs Bourne: For a large package?
Mr Owens: No, for a small package.
Mrs Bourne: No, we used to charge $5.50, but that included GST, PST and compensation to the people who had this machine in. Those people have to be compensated for every package.
Mr Owens: I guess my question is, there are some business issues that are already going to affect your business and you're not going to be compensated for them, particularly if people stop smoking.
Mrs Bourne: If everybody stops smoking, yes, but I don't think you're going to find that happen. I was brought up in a household that smoked. My husband was. My children were. Nobody has any problems: respiratory, heart or any other way.
Mr Owens: I hope you stay for the next presentation.
Mrs Bourne: Okay.
The Chair: Mrs Bourne, thank you very much for coming to the committee this afternoon. We appreciate it.
Mrs Bourne: I hope it does something to help.
The Chair: Members of the committee, we're going to take a short recess. We have to just get a few things moved around here prior to the next presentation.
The committee recessed from 1507 to 1516.
JAMES REPACE
The Chair: Dr Repace, welcome to the committee. I think we've got all of our technological elements in place. Perhaps I might, just for those who are watching, identify who Dr Repace is. I will just read this out. I think members of the committee have it.
"James L. Repace is a physicist and policy analyst. He has lengthy experience at the US federal level in indoor air pollution research and science policy analysis for the assessment and control of the risks of indoor and outdoor air pollutants. He has published 38 papers on ETS in scientific journals.
"His work is discussed in both the 1984 and 1986 Surgeon General's reports, the 1992 US Environmental Protection Agency report on passive smoking and the 1992 position paper on ETS by the American Heart Association.
"His work for the US Department of Transportation has also been utilized for the assessment of the risks of ETS to passengers and crew of commercial aircraft.
"He has testified by invitation as an expert witness on passive smoking before the US Senate and the US House of Representatives. He also served on the Surgeon General's National Advisory Committee on Smoking and Health from 1987 to 1992 and he has filled the role of scientific adviser on ETS to the World Health Organization since 1987.
"As recognition of his work, he is the recipient of the Dr Luther L. Terry award from the United States Public Health Professional Association in 1988 and the US Surgeon General's Medallion for his work on environmental tobacco smoke."
Dr Repace, we're delighted that you could be here today. I know you have some slides and so on to go with your presentation, so please go ahead. At the conclusion, I'm sure there will be a number of questions.
Dr James Repace: Thank you, Chairman Beer and ladies and gentlemen of the standing committee. It's a very great pleasure to be here to share with you some 18 years of experience that I've had on the issue of environmental tobacco smoke.
I would like, in my slide presentation, to briefly summarize what I think are the important points about environmental tobacco smoke and indoor air pollution and the control of environmental tobacco smoke by various social policies and engineering solutions, and then to answer any questions that you might have.
Amplifying my oral testimony will be the draft of a paper that I submitted to the St Louis University Public Law Forum that has many of the slides that I will show you. I will just summarize orally what the important points are. Basically, public health professionals in the United States and abroad have come to a scientific consensus that environmental tobacco smoke is a class A or known human carcinogen. It has been judged to be a lung carcinogen. It very probably causes cancers other than lung cancers, although there are not enough studies at this point to be able to determine that definitively.
There are a very significant number of studies which suggest very strongly that environmental tobacco smoke is a cause of fatal heart disease, to a much greater magnitude than lung cancer. I'm going to focus mainly on the control of the lung cancer risks from environmental tobacco smoke.
This slide summarizes the agencies in the United States that have come to the conclusion that environmental tobacco smoke causes lung cancer and it constitutes every important federal public health agency that there is in the United States, so there really is a consensus at this point. The real issue is that tobacco smoke is a form of biomass combustion; it is like burning leaves; it is like burning wood; it is like burning coal or diesel fuel. It constitutes an incomplete form of combustion which releases many toxic and carcinogenic chemicals, somewhere between 4,000 and 5,000 chemicals, including 43 known carcinogens, many of them proven human carcinogens and the rest known animal carcinogens. So we are really filling our buildings full of highly carcinogenic vapours, which also are very toxic to other organ systems of the body.
If you look at the studies of active smoking and disease, you will find that there does not exist, to my knowledge, an organ system in the human body that remains undiseased in smokers; that is, they are prey to cancers of virtually every organ of the body at one time or another. So we're dealing with an enormously toxic substance.
The only people who seem to feel that tobacco smoke in the air is not a hazard to non-smokers are the tobacco people, and of course they have conducted a massive public relations campaign, I believe since the early 1980s, to try to convince the public that you would have to spend, for example, 100 hours in a smoky bar to inhale the nicotine equivalent of one cigarette, as if that were not a very significant risk. If we want public health information, we don't go to the tobacco industry; we go to the people who are paid to protect our public health.
So we can dispense with pseudoscience and I will talk briefly about the experiments which I performed in the Washington metropolitan area to take a look in the late 1970s and early 1980s as to exactly how much tobacco smoke was in the air, how it compared to air pollution from other sources and how it might be controlled. We used a device called a piezo balance -- that's this little yellow box here -- which is really a portable air pollution monitor. We carried it around to a variety of places where people were smoking or they were not smoking, indoors and outdoors, to sample the particles in the air, whether they were from tobacco smoke or anything else.
We sampled on the sidewalks of Washington, DC, obviously places where there was very little tobacco smoke, in vehicles on busy commuter highways in the Washington area, in the homes of non-smokers, in churches during communion ceremonies -- you can see there's a very high person-density here but no smoking -- and then we went indoors to places where people were smoking. This was the Capital Center sports arena in the Washington metropolitan area during a hockey game and even though smoking was discouraged, people smoked anyway because there was no law against it. If you look carefully, you can see the smoke hanging in the lights here. We also sampled in the homes of smokers during dinner parties, in offices, in lodge halls, in restaurants -- this is the Kennedy Center Roof Terrace cafeteria in Washington DC -- in bars, in nightclubs -- it's a little dark in this one -- at weddings, in waiting rooms, in bowling alleys, in bingo games, in dinner theatres and in dives.
This is what we found. This is a plot of air pollution on the vertical axis versus the volume density of cigarettes on the horizontal axis. What you can see is these data points that have letters attached to them are all the areas where people were smoking indoors. These few data points down here, 33 data points, were the measurements we made with this air pollution monitor in the outdoor air and indoors where people were not smoking. The levels ranged from about 20 to 60 micrograms per cubic metre of particles, and indoors where people were smoking, you can see that every standard that the US Environmental Protection Agency had for air pollution in the outdoor air was violated, and even this one up here, which is called the significant harm level, in a bingo game we have 1,140 micrograms per cubic metre indoors and 40 micrograms per cubic metre outdoors.
So you can see that these are really conditions where tobacco smoke, as smoked under typical conditions of ventilation and building occupancy -- this is what you get. You get a tremendous cloud of air pollution indoors which really cannot be controlled by ventilation and the reason it can't is because ventilation systems are designed for the removal of carbon dioxide from human metabolism and a replacement of fresh breathing air; they're not designed to remove a toxic and carcinogenic pollutant which is the result of biomass combustion.
If you take another look at this data, this again is a plot of the same data points, air pollution versus the density of cigarettes in the indoor air and now I have drawn in these dotted lines which show the air exchange rates in buildings. This is about half an air change an hour, which you get typically in very poorly ventilated spaces -- nightclubs, office buildings -- where they've shut the outside air dampers. This is the typical ventilation rate, seven air changes an hour, that you'll see in a well-ventilated restaurant that's operated according to code. The code in Canada is the same as it is in the United States. It's governed by the American Society of Heating, Refrigerating and Air-Conditioning Engineers, ASHRAE, which recommends building codes in North America.
You can see that, yes, the air pollution level does come down with increasing air exchange rate, but generally the places that have the higher air exchange rate are also the places that have the highest number of smokers. So it tends to counteract it, and you can see, even at seven air changes an hour in this nightclub, we're running between 300 and 400 micrograms per cubic metre and the US federal standard for inhalable particles is 50 micrograms per cubic metre. So you can see we're exceeding it by factors of five and six.
So ventilation, you can see, although it can lower the concentration of tobacco smoke indoors, cannot eliminate it. This is not a control measure for tobacco smoke. Although the tobacco industry has a very slick public relations campaign to try to convince the public that ventilation is the option for control of tobacco smoke, you can see that it is not. We'll return to this later. So you can see that we're dealing with a situation where, under typical conditions of building occupancy and ventilation, buildings are very polluted with biomass combustion products from tobacco. The question is really, what can one do about it?
The first thing that people tried was to put the smokers off in one corner of a room. Here's the State Department cafeteria in Washington, DC. This red bar is the smoking section and this shaded bar is the non-smoking section and this open bar here is outdoors. You can readily see that while the smoke level in the smoking section is higher than in the non-smoking section, the non-smoking section is not comparable to what it is outdoors, which it would be expected to be if there were nobody smoking. This is one of the things that we found: Indoor and outdoor levels were about the same when people were not smoking, but when people were smoking, they go up.
Here is a Denny's Restaurant, which is a large chain in the United States, and you can see again, even though the outdoor air levels are more polluted here because this is near a busy highway, it's still more polluted in the non-smoking section than it is out on the highway.
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Here's the Goddard Space Flight Center cafeteria, which is operated by NASA in Greenbelt, Maryland, in the Washington area. They had a 3-to-1 ratio between smoking and non-smoking, and you can see that the levels in the non-smoking area are much, much higher than outdoors.
So physically separating smokers from non-smokers indoors really doesn't work, and it's very easy to understand why it doesn't work. We really are not reducing the environmental tobacco smoke loading of the room if we put the smokers off in one corner. A few minutes after a cigarette is smoked, the smoke will diffuse throughout the whole room. You might not be exposed to the very highest concentrations which come off the burning end of the cigarette, but you're going to be exposed to the average concentration that the tobacco smoke makes in the room. So this is not a control measure for tobacco smoke.
Suppose we look at what we call the dilution solution to pollution. We separate the smokers in another room in the same building but on the same ventilation system. That doesn't work, for a very fundamental reason. Tobacco smoke generates huge clouds of air pollution in a very confined area. Even a typical large building is a relatively confined area compared to the number of cigarettes which are smoked every year in the building.
What I've got here is a plot of the lung cancer risk from smoking versus the number of square feet per smoker, assuming a 10-foot height for the building. The idea is, how many square feet of building space would you have to have per smoker to get an acceptable cancer risk? In risk assessment, we talk about the concept of acceptable risk or de minimis risk. We say there is such a thing as a trivial risk, which is generally comparable to the risk of being struck by lightning while walking down the street in a thunderstorm. We don't regulate that risk. That is about a one-in-a-million risk and it's generally thought to be inconsequential.
If we could lower the risk from tobacco smoke indoors by dilution to an acceptable level, that might be considered okay as a control measure. Unfortunately, and you can't really read the bottom line here, to get to one in a million -- this is a one-in-a-million lifetime risk, which risk assessment agencies like the Environmental Protection Agency, the Food and Drug Administration and OSHA might use as an acceptable risk -- you'd have to go to about a million square feet per smoker. That's bigger than most buildings. You can't dilute tobacco smoke down without having buildings of huge volumes with one smoker in them. So this is not a control measure for tobacco smoke.
Suppose we try to do it by ventilation, which is the tobacco industry's favourite control measure. They don't ever say how much ventilation you need to get an acceptable risk. What they tell you is that ASHRAE has recommended, for a moderate amount of smoking, 20 cubic feet per minute per occupant, which in metric units is 10 litres per second of ventilation air per occupant. That is not a ventilation standard which is designed to control cancer risk. It is designed to limit the odour from tobacco smoke indoors, and if you read the standard, it says so. However, the industry implies that this is a health standard. So here again you've got lung cancer risk as a function of ventilation rate in cubic feet per minute per occupant. Here's what the ASHRAE standard recommends. It's a risk of about two or three per thousand, which is a very, very high risk for cancer risk assessors. We would like to be able to lower that down to a one-in-a-million risk, which is this bottom line, but if we did that we would need something in the order of about 50,000 cubic feet per minute per occupant, which obviously would suck everybody out of the room. So ventilation is not a control measure for tobacco smoke. Even if you wanted to pay for that much ventilation, it wouldn't be practical.
I think we can summarize what the likely possible control measures are for environmental tobacco smoke. Clearly if people smoke outside of buildings, that's acceptable. It is not going to increase the risk to non-smokers if the smoker is not in the building at all. The smoke will diffuse in the outdoor air and be a de minimis risk level for the world, but not for the non-smokers in the building.
The other control measure which many people advocate and which can work if it is done well is a separately ventilated area which is directly exhausted to outside the building and under negative pressure with respect to the non-smoking areas of the building. Now, it can be done right. You can put an airlock in, you can ventilate the thing properly and you can make it work. But frankly, most people don't do it right and they don't make it work. Even when they try hard, they don't. Nevertheless, it is not an unreasonable control measure as a first step towards a total ban. This is what the US Environmental Protection Agency recommends as a control measure.
How does environmental tobacco smoke compare with other air pollutants? If you compare it to radon gas for non-smokers, you can see that we have about 5,000 deaths a year, plus or minus 2,500, in the United States from lung cancer alone from passive smoking, and it's probably about nine times that many from heart disease, so it's a very, very large number. If you look at radon alone, it's about 3,000 to 4,000 and if you look at all of the outdoor air pollutants regulated by the United States federal government -- asbestos, vinyl chloride, airborne radionuclides, outdoor nuclides, coke oven emissions from steel plants, benzine emissions from petrochemical plants and arsenic from copper smelters -- you will find that the total of those is less than about 90 deaths a year. So you can compare that with 5,000 deaths a year and you can realize that we're dealing with numbers which are 50 or 60 times higher for tobacco smoke than all of the regulated outdoor hazardous air pollutants combined. This is not a trivial environmental risk, and the numbers that we look at here for the United States are about 10% in Canada, based on a prorated population basis.
So we are dealing with a chemical that is really very hazardous. It's a class A, known human carcinogen. There are only about a dozen of those that we know are known human carcinogens, and this is one of them. Thank you.
Mr Owens: Thank you for an excellent presentation. Unfortunately, the person I really wanted to hear this presentation left before you spoke.
In terms of even the issue of smoking in the great outdoors, if you're sitting in an outdoor patio, is there a potential for a synergistic effect to take place between the properties in the cigarettes and the hydrocarbon emissions from passing vehicles?
Dr Repace: Yes, there is, although outdoors obviously there is no enclosed volume for the tobacco smoke to accumulate in. But that doesn't mean it can't impact on you. For example, outdoor air pollution is regulated from factory chimneys on the basis of the fact that the wind will blow it downwind on to you and it will cause some harm. Therefore, we try to limit the amount of factory emissions from chimneys.
Similarly, if someone is sitting outdoors, even though the smoke can't really accumulate, if that little plume from that cigarette impacts on you, it will certainly be able to cause harm. It is nowhere near as bad as it is indoors, and probably the main problem is that it's quite offensive to non-smokers; it's very irritating. For example, a lot of people have the experience, if they go to a beach and go downwind of a smoker, even at 100 yards away it can be very obnoxious because you don't expect to have that experience; you're expecting clean air off the sea and instead you're getting tobacco smoke up your nose. It's not going to give you cancer, but it's going to really annoy you.
Mr Owens: In terms of opposition that I've heard to the legislation, they talk about alcohol being more dangerous to people. Do you have an understanding of what the mortality rate is for alcohol vis-à-vis cigarettes?
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Dr Repace: I think that alcohol is probably considered one of the leading preventable causes of death in the world, and that's certainly true, but active smoking I think is greater than alcohol by a long shot. I don't know what the exact numbers are, but I think it goes this way: Active smoking is the worst preventable cause of death, alcohol is second, and passive smoking is third. We have about 50,000 deaths a year in the United States from passive smoking, so that would place it third in the hierarchy of preventable causes of death, and after alcohol. Alcohol is worse than passive smoking but not as bad as active smoking.
Mr Owens: So if we were really smart about this issue, we would make cigarettes illegal and not worry about vending machines and pharmacists. Clearly, from the presentation that you just finished giving, if anyone needs any further evidence that we're dealing with a known hazard, then I don't know what more evidence we need.
Dr Repace: That's certainly true. I think a lot of people would agree that banning cigarettes outright may not be a practical thing to do. We tried to ban alcohol outright in the United States and it didn't work. People who want to harm themselves always find a way to do it, and if you tried to ban every illegal substance, pretty soon we wouldn't have anything to work with any more. So banning cigarettes may not be a practical thing. It might be, from the public health point of view, a very desirable thing to do.
But certainly we can restrict the places where people are allowed to smoke, just as we restrict the places where people are allowed to drink. Drinking is perfectly legal in most countries of the world, but in almost every country of the world, it is illegal to drink and get behind the wheel of a car.
Mr Owens: So you don't buy the civil rights: "This is my constitutional right to be able to take up a cigarette."
Dr Repace: Not in a building. I would defend the right of the smoker to smoke outdoors or in any place where it's not going to harm anyone else, but I think it's a well-established principle of our civilization that society acts to control involuntary risks. We don't like to have risks imposed upon us against our will, and we ask that our society protect us from that. We are protected from drunk driving, and we should be protected from people smoking in buildings unless it's their own building, their own premises, and no one is being exposed involuntarily.
Mr Sterling: Thank you very much for your presentation. I think this is the second time I've had the pleasure of listening to your presentation. When was the last time you were in front of a committee here? The workplace legislation?
Dr Repace: It was a number of years ago. Yes, it was the smoking-in-the-workplace bill.
Mr Sterling: I appreciate having expert witnesses in to talk about these matters. Have you had an opportunity to look at Bill 119?
Dr Repace: Yes, I have.
Mr Sterling: I guess the most attractive part of this bill for me -- unfortunately, I don't think Bill 119 does nearly enough or really addresses the key and significant issues. One of them is the weak workplace smoking legislation which we have in this province and which I had really hoped this government would address but it hasn't addressed. I'll tell you, if we are lucky enough to be the next government, I will address that at that time.
The part I like about this legislation is the controls to smoking in some public places, because in this province we don't have uniform legislation. We have stricter controls than some of the larger municipalities, but some of the people in the smaller municipalities have no relief from secondhand smoke when they walk into a public place in their municipality. A lot of that relates to the ability of those municipalities to do something as sophisticated as this, because we have some very, very small administrations. Some townships are 200, 300 people.
Dr Repace: Right.
Mr Sterling: Section 9 of the act outlines a number of areas. There are eight different kinds of areas. You've done a lot of research in various different kinds of enclosed spaces. What would be your recommendations in expanding that list? There are eight specific ones and then the Lieutenant Governor in Council can by regulation put other ones in.
Dr Repace: Right. I would approach it, I think, a different way. I wouldn't expand the list to try to include every conceivable location that people can think of, because you can never think of them all. I would simply ban smoking in all public places and all workplaces and then I would allow exceptions to be made if the owner of the premises can demonstrate that he or she is adequately protecting the non-smokers in the building. In other words, they could be allowed, under certain circumstances, to establish separately ventilated areas under negative pressure according to the building code, which specifies how these things are to be built and installed, and if they can demonstrate to the satisfaction of the authorities that they don't leak tobacco smoke. I didn't touch on this, but you can now measure the nicotine in the air. If it's above a certain level, it's going to be an unacceptable risk, so you could actually enforce this kind of a standard. Otherwise, you're left with producing a laundry list of places where people can't smoke. It's better to establish non-smoking as the norm and smoking as the exception if you can demonstrate that it can be done safely.
Mr Sterling: The other area that I'd like to ask you about is I think you're quite familiar with our Smoking in the Workplace Act. How do you think that should be strengthened in terms of legislation that we presently have in place in Ontario?
Dr Repace: I think the workplace act says that you can have smoking in up to 25% of the floor area of an establishment in a workplace. As far as I can tell, it needn't even be a contiguous 25%, so you could have little areas all over the place. A moment's reflection will tell you that does not reduce the environmental tobacco smoke loading of the building at all. It's going to reduce the concentration of the smoke which goes from my cigarette past your nose, because it generally may be further away, but the average concentration of the smoke in the building is not reduced. There is no measure. You haven't increased ventilation, you haven't increased the volume of the building, you haven't reduced the amount of smoking, so the concentration in the building really doesn't change, and so the cancer risk doesn't change; the heart disease risk doesn't change. All you've done is maybe reduced the irritation a little bit.
It's a cosmetic approach. It's certainly a step in the right direction, but I would not call it a control measure for class A carcinogens, and that's what we are now dealing with. I'm not sure that when that act went into place it was widely understood that it was a class A carcinogen, but I think now there is no public health authority in the world that doesn't accept that. Now is perhaps the time to revisit it and to strengthen the Smoking in the Workplace Act. Whether this particular bill is a vehicle for doing that, I can't say, but it appears that you might be able to do that.
Mrs O'Neill: I think this has been very powerful testimony, as we had some pretty powerful testimony from our last presenter this morning. I'm just wondering if this committee is going to react to this by having our Chair write to the Minister of Labour telling of the experiences we've had on this committee and asking that the bill be reopened and strengthened. I think we've had enough evidence. Many, many times -- likely up to 20 times -- this issue has been mentioned in the course of our hearings. I think the least we can do is show that we as a committee want this bill reopened and studied by both Labour and Health.
Mr Martin: Just in response to that directive that just came from the Liberals, we've had people come in here and talk to us about the concerns they had. This becomes very much an ethical question. We know the information. Everybody knows that tobacco smoke's bad for you. Environmental tobacco smoke's even worse in some instances, depending on where you are. We've had groups come in looking for exemptions because their area has a particular nuance to it that makes it difficult and all this kind of thing. Whenever they come, the opposition is very supportive of that, and I have to say my heart goes out sometimes too, because you're tugged and you're pulled in different directions here.
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This morning we had a group of students come who said that they wanted their area exempted in some instances and for the most part the exemption would apply to closed-in areas for students, who claim they are more adult now than youth, at colleges and universities. Mr McGuinty was outside talking to the leaders of that group about how we might do something by way of exemption in this act, and I have to say that I did too. We can't suck and blow at the same time, and the question here is, and it's for all of us, where do we land? Do we really want the Ministry of Labour to come forward with some really restrictive regulations that will disturb and perturb a lot of our constituents? Certainly mine in Algoma Steel -- there are an awful pile of people there who still love to smoke and I'll tell you it will cause me some anxiety if it's known that I'm bringing that forward. It's a dilemma.
Mrs Haslam: Is this legislation a good first step? Are we on the right track with this legislation?
Dr Repace: To the extent that you want to do something, I think it is a good first step, but you have to ask yourselves whether it's an adequate measure. I would have to say that it could be greatly improved by really taking a much more positive attitude towards establishing non-smoking as the norm.
I can tell you, in the United States non-smoking is rapidly becoming the norm. In 60% of our workplaces now we basically have non-smokers either protected by bans or separately ventilated areas. This is mostly voluntary. There are only about 13 states that actually regulate smoking in the workplace. In the city of Los Angeles, which is, as you know, a very, very large city with a large number of restaurants, there is no smoking in any restaurant any more. In most of the small towns and cities in California, there is no smoking indoors any more in workplaces and in public buildings. The rest of the United States is rapidly moving in that direction. I think I can predict that the United States Occupational Safety and Health Administration is moving in that direction. They have announced a request for information and it is believed that they are drafting a rule now to control smoking in the workplace.
I can say that non-smoking really has to be established as the norm. Smoking is something that we all took for granted. Smoking permeated all of our buildings and it came to be regarded as natural, but it really is not. It really is biomass combustion in a confined space, and our buildings are not really designed for it. If people want to practise nicotine addiction, which is really what it is, that's fine and that's their right, but they shouldn't do it inside buildings where other people can be exposed.
Mr McGuinty: I have a couple of questions. First, if I can't smell cigarette smoke, does that mean I'm safe?
Dr Repace: No. It may mean that your nose has adapted to the odour of tobacco smoke. For example, in a large building many people believe that because there's, let's say, no smoking on their floor, but there might be smoking on another floor, even on a different ventilation system, they're unexposed. But research has shown, in terms of measuring nicotine concentrations, that this is not true. For example, in a high-rise building where there was smoking on the 32nd floor nicotine was measured on the 30th floor, which was on a different ventilation system.
That might seem strange, but give a moment's pause to how our buildings are constructed. They're pierced often by large elevator shafts which are really pistons moving up and down and creating overpressures and partial vacuums every time they move, so they're always sucking air from one part of the building and pushing it into another. We have stairwells where smoke can drift up. We have wind blowing on one side of the structure and creating a partial vacuum on the other. You've got chimney effects.
Over the course of the day, what happens on one part of even a very large building is going to be communicated to other parts of that building. We're going to breathe on the 32nd floor what might be generated on the first floor over the course of a day. You really can't get away from smoking in buildings. I can't overemphasize how much smoke is made by a single cigarette. It's just an enormous amount of air pollution. Our buildings' ventilation systems are not designed to cope with it. If we wanted to make them cope with it, we couldn't afford it.
Mr McGuinty: Tell me a bit more about -- because nobody's spoken to us about this before -- the toxicity of the tobacco, I guess, the byproducts as a result of combustion. Is that a function of additives or is just the natural product itself toxic?
Dr Repace: No, it's the natural product itself. If you burn something completely, an organic chemical, you're going to burn it into carbon dioxide and water vapour. If you burn it hot enough, you're going to make a little bit of nitrogen oxides. If you burn it incompletely, you're going to break the organic molecules down into smaller ones, and often they're very nasty things. They're toxic, they're carcinogenic and they can otherwise injure the body. That's really basically the problem, and that's true whether you're talking about tobacco or grass or leaves or coal or oil or gasoline. You're burning something incompletely and it's going to cause the products of incomplete combustion to form, and they're always nasty chemicals.
Mr McGuinty: You've had an opportunity, I gather, to appear before a number of committees, tribunals. You've met with movers and shakers in the anti-smoking movement throughout North America. Are there any other jurisdictions that have banned smoking in the workplace, for instance, outright, state-wise?
Dr Repace: The entire state?
Mr McGuinty: Yes.
Dr Repace: No, I don't believe so. I don't think there is a state-wide ban on smoking in all workplaces. There are certainly localities which do that, but I don't think at this point we have a state-wide ban.
Mr McGuinty: What are the classical reasons put up for not doing these kinds of things?
Dr Repace: I think the reasons that people put forward are generally economic or they're ones of inconvenience. Restaurateurs, for example, are fearful that if they ban smoking then people will go elsewhere to smoke, and that's been demonstrated to be not true. There's been solid research in the state of California that shows it really doesn't matter. People go to restaurants to eat, not to smoke. Generally, the arguments that have been put forward are very weak arguments, because they don't deal with the fundamental crux of the issue, that we have a class A carcinogen we're dealing with that needs to be controlled. That really takes primacy over every other argument. For example, if this hearing were about some substance called environmental tobacco smoke that the water treatment system wanted to put in the drinking water because they felt it would enhance its flavour, would there be any doubt? Would you allow environmental tobacco smoke to be baked into bread in the city of Toronto? I don't think so. Would you allow it to be put into Coca-Cola?
That really is the issue. You know, we have standards for the delivery of quality of outdoor air, of food and of drinking water. Unfortunately, we haven't as a society come to grips with standards of quality in the delivery of indoor air. That's really what this is all about. You don't put these kinds of standards into place without treading on economic interests, without treading on people's sensibilities, but really it's a public health issue.
It's like malaria control. It really needs to be done and this is the time to do it. We have enough information to do it. We have the political and social means to do it. There are certainly some areas of the population that are not prepared to go along with it. I think that is a matter of public education. Certainly one of the things that government can do is to bring the population along by educating it. There are established means for doing that, and this is certainly one of them.
Mr McGuinty: Just one final question, please: One of the problems we face here, as I'm sure you'll recognize, is that it's pretty darned cold up here in the winter. Are there any cities in the northern states which have banned smoking in the workplace, for instance?
Dr Repace: I really don't know. I am not completely up on who has banned smoking where. My main emphasis is on how you control tobacco smoke or how you can't control tobacco smoke and what it does to indoor air. On the political side, in the state of Minnesota they certainly have lots of restrictions. I would look there to see whether they have banned smoking in the workplace, but I'm not sure.
It was a specific issue in a hearing of the veterans administration hospital system when it went smoke-free. I happened to be an expert witness in the case of the veterans administration hospital system versus one of its labour unions. The issue was that all the divisions of the Department of Health and Human Services and allied systems that went smoke-free often did so without consulting all their unions. One of them raised this as a labour issue and the VA argued that it really was not subject to bargaining because it was a health issue.
One of the nurses for a psychiatric veterans' hospital came in and said: "Look, I'm 56 years old. I smoke. I've been smoking all my life. I would like to be able to continue smoking. I know it's going to kill me. I can't step outside to smoke because I work in a high-security facility. I can't leave my patients alone. It's going to be a terrible hardship." They went ahead and banned it anyway and all of the imagined problems that were going to come about because of this disappeared. What happens is that people quit smoking if they can't smoke, if they go outside and it's too cold. If they quit smoking, what happens? They live longer, and that's not such a bad punishment.
The Chair: Dr Repace, on behalf of the members of the committee, I want to thank you for being with us this afternoon, for your slides and for sharing your experience with us. We appreciate it.
Dr Repace: Thank you. It's been a great pleasure to be here.
Mrs O'Neill: I have just made a request. I thought there would be unanimous consent for that. I didn't hear it.
Secondly, I did ask for a definition of "pharmacy" and I did ask for a list of the programs that were available to those tobacco producers who wanted to leave the industry. I think they're fundamental. Today's the last day we're going to meet before we go into clause-by-clause. Are those things going to be forthcoming and do we have permission for you to write a letter to the Minister of Health and Minister of Labour?
The Chair: On the latter point, the Chair of course is in the hands of the members of the committee.
Mrs O'Neill: I'll make a motion that we send a letter and I would like it to be taken to a vote. I would ask for a recorded vote.
The Chair: Could you state your motion?
Mr Owens: I don't think anybody's disagreeing with it. I don't see the parliamentary assistant having serious -- so why don't we just say okay and let's move on.
The Chair: Just so I know what it is, then, that I'm doing, this would be a letter to the --
Mrs O'Neill: I would like you to state -- and maybe the clerk would be able to give the exact number or an estimate; mine is around 20 presenters. Some more explicitly than others have asked for this workplace act to be updated, to be opened again and that the Minister of Labour and the Minister of Health be so informed.
The Chair: Is it agreeable to the committee if, together with the clerk, I draft a letter and then show it to the two critics and the parliamentary assistant? If it is seen to be fine with them, then I would sign it and send it on behalf of the committee. Is that agreeable to everyone?
Mr Owens: Agreed.
Mrs O'Neill: Agreed.
The Chair: Fine. Then with respect to the letter to the Minister of Labour, I will go forward with that.
Now there were two other points of information.
Mr O'Connor: On the other information, would you like to receive that information before we get to clause-by-clause? I know you'd like it today; I don't have it with me today. But would you like to receive that before clause-by-clause or the very first day?
Mrs O'Neill: Very much so. That's why I made the request about a week ago, because I thought it might be possible to have it for today. I certainly think we need to have it before we begin clause-by-clause, yes.
Mr O'Connor: I appreciate that.
The Chair: Okay, so that will be done. We will reconvene on Monday, March 7.
The committee adjourned at 1605.