Monday 31 January 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

Ministry of Health

Hon Ruth Grier, minister

Larry O'Connor, parliamentary assistant to the minister

John Garcia, director, health promotion branch

Dr Richard Schabas, chief medical officer of health, Ontario

Brenda Mitchell, manager, tobacco strategy unit

Frank Williams, legal counsel

Physicians for a Smoke-Free Canada

Cathy Rudick, executive director

Dr Jack Micay, member

Dr Mark Taylor, president

Ontario Restaurant Association

Paul Oliver, president

Rachelle Solomon, manager, government affairs


*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:

Arnott, Ted (Wellington PC) for Mrs Cunningham

Haslam, Karen (Perth ND) for Ms Carter

Marchese, Rosario (Fort York ND) for Mr Rizzo

Wessenger, Paul (Simcoe Centre ND) for Mr Hope

White, Drummond (Durham Centre ND) for Mr Owens

Also taking part / Autres participants et participantes:

Sterling, Norman W. (Carleton PC)

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 1307 in room 151.


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

The Chair (Mr Charles Beer): Good afternoon, ladies and gentlemen. I call this session of the standing committee on social development to order. We are to begin today examining Bill 118, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others.

Our schedule this afternoon at the opening of the hearings will be to hear from the minister and to have a technical briefing on the bill. As you can see from the agenda, there are two organizations that will also be appearing this afternoon, the Physicians for a Smoke-Free Canada and the Ontario Restaurant Association.

With that, I invite the minister to make her opening presentation.


Hon Ruth Grier (Minister of Health): Thank you very much, Mr Chair. I'm glad to welcome the committee members. This is the first day of hearings and I guess the first hearings in the new year. I will, as you've said, be making the opening statement. My parliamentary assistant the member for Durham-York will be carrying the legislation in committee after that.

I have with me here at the front Brenda Mitchell, who is the manager of the tobacco strategy unit. Then the technical briefing that follows will be given by John Garcia, who's the director of the health promotion branch; Frank Williams, legal counsel; and Dr Richard Schabas, chief medical officer of health, who are all here at the moment.

It's Bill 119, which is the Tobacco Control Act. I think you said 118, Mr Chair.

The Chair: I'm sorry.

Hon Mrs Grier: I'm sure by the time all these hearings are over, it will be 119 firmly engraved in your memory.

It's a very important piece of legislation and we see it as a vital step towards our goal of a healthier society. I therefore welcome this opportunity to appear before the social development committee and make this opening statement.

I look forward very much to hearing the opinions of the members and the presenters on how to make this the best bill possible in order to reach Ontario's goal of becoming a smoke-free province.

The Tobacco Control Act is strong medicine. It contains tough provisions for tighter control over what we know to be a deadly and damaging substance, our society's leading cause of preventable death.

We know that tobacco costs Ontario over $3 billion a year in such things as health costs, lost productivity and fire damage.

Let there be no doubt about this government's intention with this bill. We are aiming for effective, far-reaching legislation that discourages people, and especially young people, from becoming addicted to a deadly habit.

During these proceedings you may hear from people who say the bill goes too far. To those people I want to say that the facts about smoking speak for themselves. Those facts argue for the toughest legislation we can produce.

Consider what we know about tobacco use in our society. One of every five adult deaths in this province can be linked to tobacco. That's more than 13,000 preventable premature deaths a year. The fact is that someone in Ontario dies from tobacco use every 40 minutes. The fact is that smoking is a major killer.

There is also convincing research to show that smoking not only harms smokers; it poses a significant risk to anyone exposed to secondhand or environmental tobacco smoke.

Thanks to higher prices and greater education and awareness, the number of people using tobacco has declined dramatically, from about 41% of Ontarians in 1966 to about 28% in 1990. That's good news.

But there is disturbing new evidence from the Addiction Research Foundation that among teens this downward trend is reversing. The foundation found in a recent study that for the past two years smoking among grade 7 students has increased from 6.1% to 9.4%. That's an increase of 50% and it's an alarming statistic. We believe it's linked to the enormous growth in smuggling and the fact that our children are getting their hands on $2-a-pack cigarettes.

Twenty-four per cent of Ontario students aged 12 to 19 now smoke. As anyone will tell you, smoking is perhaps the most difficult of all deadly addictions to break.

We must reach young people before they are seduced by this deadly habit. We must reach them with straightforward, factual information that persuades them to make a healthy choice.

We know that if young people do not begin smoking before the age of 20, the chances are good that they will never start, and if they never start, they are well on their way to a healthier life, as well as a life that is likely to be a lot longer.

With this legislation we will make it illegal to give or sell cigarettes to anyone under 19.

We will outlaw the sale of tobacco in pharmacies and other health facilities.

We will ban the sale of tobacco products from vending machines, a move that supplements the soon-to-be-proclaimed federal Tobacco Sales to Young Persons Act.

With Bill 119 we will require health warnings and other health information as part of tobacco packaging.

We will insist that tobacco retailers post health warnings and age limits on their premises.

We will closely monitor tobacco sales with mandatory reports from distributors and wholesalers.

We will ban smoking in designated public places.

Finally, we will provide effective enforcement mechanisms that include fines and bans on selling tobacco for merchants who break the law.

By preventing young people from taking up this deadly habit, we can give them a fighting chance against the many diseases caused by smoking and we can help them avoid other problems such as having babies with low birth weight.

You know about the links between smoking and various forms of cancer, but you also need to know that tobacco causes at least 80% of chronic lung disease such as emphysema and chronic bronchitis, and that tobacco is responsible for one third of premature deaths from heart disease.

Since 1970, the lung cancer rate in women has tripled, to the point where it is now a major epidemic. In fact, the Canadian Cancer Society estimates that this year more women will die from lung cancer than from breast cancer. This is all as a result of women starting to smoke 20 to 30 years ago.

How ironic that some of these women fell victim to the seductive messages of tobacco advertising. How tragic that they developed a fatal disease because they were told that smoking is a glamorous, sophisticated and essentially harmless pastime.

Anyone who has visited hospitals or cancer centres will tell you that there's nothing glamorous about lung cancer, that there's nothing sophisticated about premature death and that there's nothing harmless about a pastime that kills more than 13,000 of us every year.

Our government's comprehensive tobacco strategy will help us achieve our anti-smoking goals for the rest of this century.

By 1995 we want to make all schools, workplaces and public places smoke-free and to completely eliminate tobacco sales to minors. By the year 2000 we plan to cut tobacco sales in half, to reduce the percentage of teenagers who smoke to 10%, to reduce the percentage of adults who smoke to 15% and to eliminate smoking by pregnant women entirely.

I am very proud of our strategy and I'm proud that Ontario is leading the country in efforts against tobacco use. We have won international acclaim for our stand on smoking.

As members may know, Nova Scotia, Newfoundland, New Brunswick and British Columbia have recently passed their own tobacco legislation. As I have mentioned, new federal legislation will be coming into force later this year. But there's no question that Ontario is leading the way in this area. We have set our sights on tough targets and we are taking aim against a deadly foe.

In December, the ministry launched a powerful and provocative public education campaign against smoking. We are spending $3.15 million this year on a program to reach young children, teens and their parents with key anti-smoking messages and material. This program complements the efforts of health professionals and volunteers across the province who are also working to prevent smoking.

Our cinema ad which some of you may have seen over the holidays, the one known as Swimmers, began running in movie theatres across Ontario in December. It has been followed by equally powerful television spots. Other components of the campaign are now hitting newspapers, buses and subways as well as radio stations.

The response to this campaign has been strong and immediate. One mother called to tell us her teenaged daughter's two friends actually quit smoking after watching our ad on TV. In movie theatres, audiences have applauded and even cheered our commercial.

We recently launched the first part of our parent campaign with a booklet, Talk it Out. The booklet is designed to help parents discuss smoking with their children. After promoting the booklet in local newspapers for two days, the ministry received requests for some 7,300 copies of Talk it Out.

Throughout the committee process, I welcome and will respond to any issues and questions that are raised. During the second reading debate, there were concerns raised, especially around the sale of tobacco in pharmacies and the ban on vending machines.

Committee members should be aware that the Ontario College of Pharmacists, the professional regulatory body, asked the government to ban tobacco sales in pharmacies. The Canadian Pharmaceutical Association is also on record as opposing the sale of tobacco in pharmacies. Pharmacies are not just another retailer. Like doctors and nurses, pharmacists are health professionals and their stores are an important part of the health care system.

As for the issue of banning cigarette vending machines, the committee must be aware that the pending federal legislation will ban these machines everywhere except in licensed premises. Ontario's legislation simply extends this ban.

It is well known that some children get their cigarettes from unsupervised vending machines. Stricter control of tobacco sales to minors in retail stores will simply make the vending machines more attractive.

Nova Scotia also plans to ban cigarette vending machines and the machines are severely restricted in many places in the United States, including New York City, Minneapolis and the state of Utah.

This government can be proud of its educational efforts, which are backed with significant amounts of money. Today, we are seeking your support for our legislation.

Please bear in mind that we are meeting today in the context of rumours about rollbacks in federal tobacco taxation. This would be a surrender by Ottawa in the face of apparent inability to control smuggling. The federal proposal to lower taxes on tobacco would create an irreparable tragedy. Thousands of lives will go up in smoke.

My view is that we simply must not surrender. We know full well that high cigarette prices are the main deterrent in preventing children from smoking. Every 10% price increase reduces the number of young smokers by 17%. We also know that the major reason grade 7 children are smoking more is because they have access to smuggled, illicit cigarettes.


Cheap cigarettes will result in needless cancers, heart disease and low birth weight babies. This is too high a price to pay to appease Quebec's smuggling problem.

We therefore appeal to the federal government to reimpose something like the export tax on cigarettes and tobacco products. Remember, in just seven weeks putting the tax back on exports reduced exports by an estimated 60% in 1992.

For our part, we in Ontario expect to enforce more stringent anti-smuggling measures.

The Canadian Cancer Society tells us that tobacco exports have increased from one billion cigarettes in 1989 to nearly 15 billion in the first nine months of 1993. The Canadian Cancer Society report says Canadian manufacturers made nearly $100 million last year in this market. I am deeply shocked by the recent news reports alleging links between the industry and the smuggling trade. These allegations demand immediate investigation by the federal government. It's time to pull back the curtain and see who is really running this show.

I think we must also ask cigarette manufacturers and their shareholders to search their consciences. We need to ask them what additional measures they can take to deter smuggling. What can they do to make cigarettes less appealing to our children, and do they really want their children to smoke?

This committee has, in Bill 119, an opportunity to make a real difference, one that will bring more lasting benefits to this province than almost anything this Legislature has been asked to do.

I look forward to the cooperation of all members in securing the speedy passage of this bill so that we can take a giant step forward to a healthier Ontario.

I would like to conclude my remarks here today by quoting from a report by Dr Richard Schabas, Ontario's chief medical officer of health, who said:

"Tobacco-related diseases are this province's number one public health problem. The cost in human lives, quality of life and health care dollars is colossal. The circumstances call for nothing less than thorough and relentless action by all Ontarians."

Bill 119 is a vital step toward taking that action. Bill 119 puts it in our collective power to prevent death and disability for thousands of people in the years to come. By doing so, we will also be protecting our health care system for generations to come.

By passing this legislation, you will be earning the gratitude of your children and of their children and you will be helping Ontario set a standard that others will be eager to follow.

The Chair: Thank you very much, Minister, for the presentation. We are going to be receiving a technical briefing as well, but I would like to invite the two opposition critics, if they want to make comments now, to feel free to do so, or if they wish, to wait. Would you like to make some opening comments?

Mr Dalton McGuinty (Ottawa South): Yes, I would like to do that.

Minister, let me begin by congratulating both you and your government for bringing this bill forward. You will know that I have taken a personal interest in bringing measures forward. I brought forward a private member's bill, Bill 118, and I have an interest, of course, in particular in ensuring that we make it harder for our children to start smoking.

One of the things I learned in the course of my research for my bill was that the response was virtually unanimous if this question was asked: "Do we want our children to smoke?" I found that when I asked that of tobacco farmers, manufacturers, smokers, non-smokers, everyone agreed.

When we stray beyond that is when we get into areas of controversy. You mentioned a couple of areas of controversy yourself. One of those has to do with the ban on the sale of tobacco products in our pharmacies. It is my understanding that this will not reduce tobacco usage one iota. There are as I understand it some 2,200 drugstores in the province and 1,500 sell tobacco, but there are 120,000 other retail outlets which sell tobacco products.

My research, some of it anecdotal, led me to understand that the sale of tobacco products in pharmacies was, by and large, better supervised than it was in a local convenience store. The kids I spoke to generally didn't buy from a pharmacist.

The other issue related to this problem with the tobacco sale ban in pharmacies is that I believe there's a constitutional issue here and I look forward to hearing from some of the presenters in that regard. The issue there is whether it is constitutional to prohibit the sale of tobacco products in one retailer only. I think it is one thing to say, for instance, that we're going to sell all of our liquor products at the LCBO and our beer products at The Beer Store, but it's another thing to say that everybody can sell tobacco products except for these people. Another argument that could be made in a rather compelling way is that tobacco is a drug, and if we are to restrict its sale, it should be to drugstores.

The other thing we have to keep in mind is that it's 1994 in Ontario and there's a recession under way, and we have to worry about the economic impact of any kind of legislation we pass here at Queen's Park. Pharmacies are small businesses. They pay taxes, employ people, pay for heat and hydro, their phone, their rent. The concern I have, and I look forward to hearing from the presenters in this regard, is what kind of impact this will have on their businesses. Will we be putting people out of work? That's something we have to take into consideration.

The problem with tobacco is that it is a legal product. It has been around for a long time and it's terribly addictive. When we respond to the problem associated with the health care problems, we should do so with some understanding of the history of this product and of the industry that we have encouraged over the years to grow up behind it. We have generated significant revenues. We have profited from cigarette sales in this province for years and years. It's important to bear that in mind.

The federal government, as you indicated, Minister, has decided to deal with the vending machine problems by providing that they can only be used in licensed premises. I think you're quite right about addressing this issue of vending machines, because one of the things I found out is that if you don't clamp down on vending machines, kids who can't get them at the local store will get them at the vending machine. But I wonder if it isn't reaching too far by prohibiting those machines within licensed premises.

Again, we have over the years in a number of ways told the people here that they can feel free to smoke. It's becoming more difficult of late, of course, and I think rightly so, but there are a lot of people who enter these licensed premises and have a drink, and a lot of people who have a drink want to have a smoke. It's something we have to keep in mind and consider as we deal with this issue.

One of the concerns that was raised with me was that people put in their eight-hour days and at the end of the week they go out to a bar -- and we profit, of course, from the money they spend on the booze there -- and now we're telling them that they can't get their smokes at the bar. The concern that was raised was that now we're going to put them out in their cars. You can't get them inside the bar. You drink, you smoke; a lot of people tell you they go hand in hand. Now we're going to say, "Get out of the bar to go get your cigarettes, because you can't get them in here." We don't want to encourage somebody to get out there and drive after they've been drinking in order to go buy their cigarettes.

Those are some of the issues. We look forward to hearing from the presenters along the way here.

Minister, you raised this very important issue dealing with how the feds are going to react with respect to the black market sales of cigarettes, and it will be interesting to see how your government is going to respond. I don't envy your position; it's very difficult. I'm glad to see you are coming out strongly against decreasing the taxes. I hope your government will be able to hold the line in that regard.


I should mention that as my party's native affairs critic, I've also had the opportunity to visit the band at Akwesasne. You should know that the leadership there has been calling for more than five years now for the federal government to place a limitation on the number of cigarettes that are being routed and rerouted through the States back up here. Americans don't smoke Canadian cigarettes. The government has been woefully blind, as have our manufacturers, to the fact that we're sending a lot of cigarettes down there which are simply being rerouted back up here through the reserve and into the hands of willing smokers throughout the province.

Those are my comments for now. I have some questions for the technical briefing, and I'll leave it at that.

Mr Jim Wilson (Simcoe West): On behalf of my caucus colleagues and myself, I want to thank the minister for her comments this afternoon. I think it best at this time to yield the floor to my colleague Mr Norm Sterling, who has a long and distinguished career with respect to this issue. Mr Sterling wants to impart some wisdom to this committee, and I welcome his comments.

The Chair: Mr Sterling, we welcome you and your wisdom.

Mr Norman W. Sterling (Carleton): My wisdom hasn't been welcomed too many times. All of us here should realize that somewhere between 30 and 40 people are going to die in our province today prematurely by seven or eight or 10 years because they have been smoking. If we had heard today that there was an accident on Highway 401 where 35 people had perished, that would be front-page news in every daily in this province. Yet that's happening day after day, every day of the year.

In 1975, the World Health Organization recognized smoking as the single most advantageous health matter that governments could undertake to discourage. In other words, of all the health hazards we have in the world, if people stopped smoking, that would be the single most positive thing we could do.

In December 1985, long before this issue became a popular political issue, I introduced a bill in this Legislature that advocated controlling smoking in the workplace and in public places. Subsequent to that and during the last Liberal government, I introduced six or seven other private member's bills, including such measures as the licensing of vendors to sell cigarettes, allowing municipalities to make more extensive bylaws in controlling smoking in the workplace and a number of issues, some of which are covered in this particular bill.

Only in 1989 did the last government take some action and introduce legislation dealing with controlling smoking in the workplace. Quite frankly, I had hoped that the present government, when it came to this issue, would tighten up some of the looseness which surrounds that legislation, although I will admit, and I think as a result of that legislation, that smoking has been banned by many employers in their workplaces, notwithstanding the relative weakness of the existing legislation.

I am happy to see in Bill 119 that the province will be making some law surrounding smoking in public places. Heretofore, we have only had municipalities making various bylaws across this province, and therefore there is no consistency when one crosses the border from one municipality to the other municipality.

It's interesting that an issue like this can get embroiled in politics. I can remember introducing an amendment to the bill on controlling smoking in the workplace in 1989 under the former Liberal government. My amendment came down to the most basic concern I had about smoking in the workplace, and that was smoking in a nursery school. My final amendment was that we should not allow any smoking in a nursery school or day care centre, because young people, as you know, Madam Minister, have much less tolerance to secondhand smoke than adults because of their size.

The majority government of the day defeated that amendment. I knew then that even though this is an issue which coalesces everyone in terms of dealing with it -- I hope and I trust these hearings will be constructive and not come down to the petty politics that were practised in the Legislature that day.

I believe we around this table have a common goal of trying to discourage all people in Ontario from smoking, particularly our younger people. The question for Bill 119, of course, is whether it will achieve this end. Will it help in some way? Will all the measures outlined by you help in some way?

I believe that most of them will and therefore, as my caucus has indicated before, we support this legislation. But we must continue to look at each issue and say: "Will this really help? Is it unnecessary regulation? Will it be more costly? Can it indeed lead to the opposite result of what we are trying to achieve?"

One of the concerns on the front pages of the papers at the present time is the whole area of tobacco taxes. As a politician, both as a minister prior to 1985 and as an opposition member -- probably the only opposition member in this Legislature I know of who has ever stood up to a Treasurer and said, "Please increase taxes." I said that on the record a number of times during the latter part of the 1980s. I said, "Mr Treasurer, increase taxes on tobacco," because I was convinced and remain convinced that the higher the price of tobacco, the less likely consumers are to take up the habit, particularly our young people. I base that on some studies I believe were done in Michigan.

The question that political leaders have to face at the present time, both provincially and federally, because there is tobacco tax at both levels, is that as a result of the level of taxation we have reached at this point on tobacco and the relatively lower level of taxes in the United States, whether our young people are getting the cheaper tobacco now in greater numbers than those who are abiding by the law and buying Canadian cigarettes that have been properly taxed.

If we have created a situation in this country which we cannot enforce, then the political leaders are going to have to try to find some kind of solution if we cannot stop these illegal sales of tobacco. I hope that is not the answer, but we must be realistic because we are very, very concerned that our young children, young teenagers, are buying cigarettes out of the back of a truck adjacent to their school yards, which I have heard many stories of.

I think too that one thing that has not been addressed by our government -- and I'm going back prior to 1985 and to the next administration, the Liberal government and to the present government -- is dealing with our tobacco farmers, our tobacco producers, those people who make the cigarettes and the communities those tobacco farms support.

I have urged on many occasions in the Legislature that the government dedicate at least a portion of the tobacco taxes to buying these farmers out of producing tobacco. It is my belief that as long as we continue to have tobacco producers in our province, the large manufacturers will continue to use them as their political tool to continue their fight to keep smoking at the forefront and put forward the whole idea that we are benefitting from the producing of tobacco. Even if we could reduce our tobacco industry to producing tobacco for foreign markets, I don't buy that we should in Canada be exporting this dreadful addiction.


Therefore, I urge this government to consider in its budget dedicating part of the tax to buying out our tobacco farmers, to retraining our workers in the manufacturing sector who are producing tobacco products and to helping some of these communities readjust. It's long overdue, and as soon as we get rid of that basic part of our tobacco industry, we will no longer have the exploitation of these producers to put forward the tobacco manufacturers' cause.

We are concerned in our caucus about a number of matters dealing with this bill. Number one, of course, is whether the measures in here are really going to do some good. We look forward to actually improving the bill if we can discover through the witnesses whether there are other matters.

We are concerned about the provision restricting pharmacies from selling tobacco. I must say that it's not unanimous in our caucus. As you may know, we have had a number of opportunities in the Legislature to vote freely on various matters. I imagine, if there was an amendment that came forward in the Legislature during committee of the whole, you would find a variance within our caucus on this issue.

On the one hand, part of our caucus is saying that it's not necessary for us to intrude in this area as a government, that perhaps the pharmacies themselves, on their own moral grounds or on their own business practice grounds, should be making those kinds of decisions and government should not be involved in them. I have some attraction to that because I am concerned, as we go through the regulation of businesses, that we don't step in unnecessarily, as they have so many other restrictions that go around them.

On the other hand, I was the only MPP who sat with the pharmacists' group at the media studio here about a month ago, when it brought forward its view that it wanted it excluded from the pharmacies. I understand their college has approved this. But on the other hand, I don't know whether it's the college that should be putting forward something like that, whether we should be giving the college the power to restrict its own people, or whether it should be the government that should be doing that. I'm very concerned that we not step in when it's not necessary.

On the vending machines, it's my understanding that under the law which exists today, the government could virtually shut down vending machines, as the law stands. All it would take is for a person under age to operate that vending machine once and the owner of that vending machine could be charged. No government has ever taken this stand and in fact, I don't know that there has ever been a charge laid by any government over the sale of cigarettes to younger people from vending machines. Therefore, I really believe this could have been done without legislation if the minister had so desired.

It's a good step to do away with vending machines where they are accessible to young people, because of the uncontrolled nature of the sales transaction. I do think, however, that when government steps into a situation like this, compensation issues for those people who own vending machines should also be considered. If governments dramatically change the rules for a business, then there has to be some fairness in dealing with that business owner.

My colleagues and I look forward to a very constructive set of hearings. As I say, we will look forward to improving the legislation, trying to find accommodations to deal with all of these matters, and indeed strengthening it where we think stronger measures can be taken where results can be shown to be beneficial as a result of those measures.

Hon Mrs Grier: Let me respond very briefly, because I suspect that all the issues and questions that have been raised are ones that the committee is going to hear both sides on at great length in your hearings.

I did want to touch on a couple of remarks Mr McGuinty made about the better supervision of the sale of tobacco in pharmacies, just to say that there is really no evidence that in fact that is the case. The pharmacist as a health professional is frequently at the back of the store and the tobacco is sold at the counter at the front. I'm not aware that there is any intent or any effort made by the pharmacist to counsel those who come to purchase tobacco about the evils of so doing, so I don't quite accept that reason for not banning the sale in pharmacies.

The other point I wanted to make was with respect to bars. While the vending machines are banned, there is certainly no reason the cigarettes could not be sold from behind the bar. Our reason in looking at the federal legislation's ban on vending machines in licensed premises was that in Ontario, licensed premises are quite often family restaurants where the vending machine is in the lobby and then there's the door into the restaurant, so the accessibility to young people is very real. We didn't feel that even letting them remain in licensed premises was going to achieve our objectives.

As Mr Sterling has pointed out, it is very important that we have legislation that really achieves the objectives and that will work, so in response to him, let me say that I hope the debate will be constructive and I certainly am open to ideas about how we can make the legislation better, more enforceable and make sure it does achieve our objectives, particularly in light of the rumours about contemplated federal action.

I suspect that by the time you've finished your deliberations, we will know whether the federal government is going to move on reducing taxes. Should that be the case, it may well be that the committee will have some suggestions of changes to this legislation that would enable us to counteract the very damaging effect of that federal action. If we had to look at more stringent prohibitions or restrictions with respect to packaging or something that could help us counteract that effect, I would certainly be open to that kind of discussion.

I know you have a large number of presenters lined up to appear before you as you travel, and I also know that the member for Durham-York, who has taken a very active role in bringing us to this point on this legislation, has all the answers to all the questions that may be posed. I leave you in good hands.


Mr Jim Wilson: While the minister is with us, I reflect back to the press conference you held here in the building when launching this initiative, this legislation. You were asked the question whether or not you had any studies to indicate that banning the sale of tobacco products in pharmacies would decrease the number of people smoking, particularly young people. At that time, you admitted you had no studies. I wonder if the ministry has done any studies in the meantime to show that this initiative would actually have an effect in decreasing the number of people who smoke.

Hon Mrs Grier: The studies that have been done clearly indicate that a limitation on the number of outlets decreases the use of cigarettes, but whether pharmacies as opposed to limiting it in some other kind of establishment -- I'm not aware of completion of any of that work, but as part of the technical briefing, you may well be able to get more specific information on that from the officials.

Mr Jim Wilson: Unless something popped up over Christmas, your department doesn't have any studies to show that this particular initiative in this legislation will, as Mr Sterling pointed out, be beneficial to society as a whole.

My second question is, if the federal government were to lower the federal tax on tobacco products, are you recommending to your Treasurer that he increase the provincial tax and hence the net effect on taxation would be nil?

Hon Mrs Grier: The Minister of Finance is part of a committee that the federal government established between the government of Quebec, the government of Ontario and the federal government looking at measures to deal with the smuggling problems. Our position is very clear that we oppose the lowering of taxes. We have not had a conversation around what actions Ontario could take in the event that the federal government moved, because it is our very earnest hope, supported by a growing number of health groups all across the country, that that not take place. I was delighted to see the federal Minister of Health supporting that position recently, so it's a hypothetical, we hope, situation at this point.

Mr Jim Wilson: Can I flush you out a little bit more on your smuggling position? In the Legislature, you've consistently told us it was a federal matter, that the federal government had to deal with it. Now the federal government is letting us see some of its cards in a preliminary way with respect to the taxation matter. It's coming forward with a suggestion to the public, floating that idea anyway, and then all you say is that it's a terrible idea. Have you got any ideas of your own with respect to solving the smuggling problem?

Hon Mrs Grier: I'm sure you're aware of the submission the Canadian Cancer Society made to all governments with a whole list of proposals for better enforcement. The status of the proposals from the federal government appears to be somewhat unclear. When they first appeared, it was that this was a proposal. I think the Minister of Finance federally has now said no, that this has not been a concrete proposal put before the tripartite committee. I think we have to wait until that committee has finished its decisions and we know where the federal government is going before I could comment on it.

Mr Jim Wilson: It's been suggested to me that your government really doesn't particularly like pharmacists, and that's something that I think has shown through very clearly in a number of policies you've brought forward, in the past year in particular.

Along that line of thinking, it's been suggested by pharmacists that perhaps your government feels there are too many pharmacies in the province -- you haven't got any proof to show that it will improve the health of the population by banning the sale of tobacco products in pharmacies -- and that perhaps the intent of that section of the legislation is to just get rid of some pharmacies in the province because you think there are far too many.

We know you want to decrease access to certain parts of the health care system and to bring down costs. For instance, you've just said your belief is that if there's less access to tobacco products perhaps that will bring down consumption. Then I guess if there's less access to drugs for seniors, that may bring down consumption of prescription drugs by seniors. What do you have to say with respect to the charge that perhaps this particular section of the bill is really part of the greater plan to simply put some pharmacists out of business?

Hon Mrs Grier: What I have to say is that I find that absolute suggestion offensive. Any suggestion that we would be trying to deny people access to medications they require I categorically reject, as do I your suggestion that we do not support pharmacists.

In fact, the suggestion that pharmacists not be allowed to sell tobacco came from them as a self-regulating body through the Ontario College of Pharmacists and was largely a result of a large number of pharmacists, and I know you will hear from them, who have themselves decided to stop stocking tobacco products and who believe they would like, as small business, a level playing field with their competitors.

In fact, we regard pharmacists as health care professionals. All our efforts with respect to the health system have been to allow pharmacists to use more effectively their extensive training in the dispensing of pharmaceuticals. We talk to them about better methods of reimbursement for their pharmacological skills, as opposed to being paid merely for the dispensing of prescriptions. There is now no incentive for a pharmacist not to fill a prescription because he's only paid if he does fill one.

In working with the profession, we are looking at how they can truly fulfil their training and their role as health care professionals, as opposed to merely being dispensers of tobacco products. I know you will hear very strongly from them when they appear before this committee that they regard themselves as health care professionals and part of the health care system and wish to be able to function as such.

The Chair: We're going to take a brief three- to five-minute recess so we can set up a screen that's going to be used in the technical briefing. If people who are going to be doing that briefing could get their material and equipment ready, we'll take a five-minute recess.

The committee recessed from 1355 to 1402.

The Chair: We'll reconvene the standing committee on social development, and I'll get it right this time: We are examining Bill 119, not, as I had suggested earlier, another number.

Before beginning the technical briefing, I would ask our researcher, Bob Gardner -- there are just a few he has circulated -- to make a few comments.

Mr Bob Gardner: Members will know that we distributed a background package last week and we had a set of material in there on federal issues, much discussed by the minister and the critics today, of course.

We did another package, which was just put on your desk now, of articles over the weekend on the federal discussions from last week. Members will know that in some of the newspaper articles there was a reference to a new federal strategy paper. We spoke to ministry officials in Ottawa and no such paper has been formally released. We'll keep looking at that, of course, and get it for you as required. This is simply a number of articles from over the weekend on the issue.

The Chair: Thanks very much. We'll now move to the technical briefing. The parliamentary assistant is with us. I wonder if you would be good enough to introduce representatives from the ministry who are going to be with us, and then I'll turn it over to you.

Mr Larry O'Connor (Durham-York): Before us we have the chief medical officer of health for the province of Ontario, Richard Schabas. I suppose a lot of the committee members remember this report that was put out by the chief medical officer some time ago and I'm sure he's going to highlight that. It looks like a slide there before us from that report.

We also have Frank Williams here, from legal services, who will help us with legal advice through this process, and of course John Garcia, who is the director of the health promotion branch. I think we've got some very able people here to give us a very good briefing.

Mr John Garcia: We had planned the technical briefing in three parts. We thought we would begin first with an overview of tobacco use as a public health problem. Dr Richard Schabas, the chief medical officer of health, will present that briefing.

Then I will give a very short overview of the comprehensive tobacco strategy which is being implemented now by our ministry in conjunction with other ministries. The minister touched on many of the points I would make, so I'll keep that presentation quite brief.

This will be followed by a review of the bill. Brenda Mitchell, the manager of the tobacco strategy, is also here and she will take you through the bill clause by clause, provide a very brief description of what is included and a brief rationale for each clause. As Larry mentioned, Frank Williams, the deputy director of legal services in the ministry, will be happy to answer any questions on the legal side.

Dr Richard Schabas: I'm Dr Richard Schabas. I'm the chief medical officer of health for the province of Ontario and the director of the public health branch in the Ministry of Health. My role this afternoon is to very briefly review the issue of tobacco from a health standpoint.

As Mr O'Connor has already pointed out, there is the tobacco report, which is tab 23 in your binders, so I'd invite you all to review that. Some of the slides I'm going to show this afternoon are taken from that report. In addition, I released a report in 1992 dealing with adolescent health issues, which included tobacco. That's tab 24 in your binders.

Furthermore, my 1993 report, which looks like this, called Promoting Heart Health, also deals in some measure with tobacco. Unfortunately, the demand for this report has exceeded supply, so I don't have additional copies today, but I will make them available to the committee. Again, some of my slides today are borrowed from that report. I'd invite you to read those reports. They have a lot more detail than I'm going to go into today. I'm not going to repeat all the information that's in there.

What I'd like to spend my few minutes doing, though, is highlighting what I think are some of the really key points about tobacco use from a public health standpoint. In particular, I want to look at the magnitude of the problem, why it is we get so much more excited about tobacco than we do other health hazards. I want to focus in on why adolescents are such a key target group in the battle against tobacco. Then I'd like to draw some lessons from our experience in this province over the last 20 years to show where we have been making progress and also where we have not been making progress.

Let me begin by looking at the magnitude of this problem. It's easy to get a little cynical, because on an almost daily basis we're bombarded with information about health hazards. It's either chemicals or it's something we eat or perhaps it's sunlight, but on an almost daily basis, we learn about something new that's bad for us. I think there's a tendency sometimes to lump them all together as being equally important. From a public health standpoint, tobacco is important because it stands alone, far and away the most important identifiable health hazard we're faced with in this province, in this country.

This slide is meant to illustrate that. This is a graph which shows the number of deaths per year from tobacco use in Ontario compared to three other important causes of death: traffic accidents, suicide and AIDS.

The purpose of the graph is not to suggest that traffic accidents, suicides and AIDS are not important public health problems, as they most certainly are, but to demonstrate just how much more important tobacco use is. You've heard the numbers, more than 13,000 deaths per year. That's the equivalent of Niagara-on-the-Lake or Kirkland Lake. It's an almost unimaginably large number of people. Maybe one of the problems is that the numbers are so large that we've become somewhat immune to the real horror of what tobacco does to our population.

Furthermore, I'd like to emphasize that this is a graph that shows deaths, but deaths are really only the tip of the iceberg in terms of the health impact of tobacco, because where there are deaths there is also disease, there is also suffering, there is disability, there is also lost income. There are important costs here. There are health care costs. Tobacco-related disease is an important burden on our health care system and there are other costs of lost productivity estimated in total as being in the area of $3 billion per year in this province alone.

This rather grisly slide is meant to make the point that tobacco affects health in many different ways. These are some of the key diseases that are related to tobacco and they're in the proportion of the number of deaths that can be linked to tobacco use. I think the slide's important because there's generally good perception about the link between smoking and lung cancer and smoking and chronic lung disease. But what very few people realize is that the biggest impact of smoking on mortality, on deaths in this province, is not through either of those diseases, it's through heart disease. Smoking is an important contributor to ischemic heart disease, to heart attacks and the many deaths that are caused by that condition. Smoking is a major cause of that and, as the graph shows, that's where the biggest total impact occurs.


It's also spread through stroke. It contributes to other cancers, cancer of the larynx, cancer of the oesophagus, the stomach, the pancreas, the urinary bladder, to name a few.

What this slide doesn't include are other important health consequences. Careless smoking is the leading cause of house fires and deaths associated with house fires. It's the leading preventable cause of low birth weight infants in this province. The list goes on and on.

The point here is to understand the scope of the health impact of tobacco. If we relate it to our own lives, it's very easy for us all to identify how tobacco-related diseases of these kinds have touched the lives of everyone.

This is basically the same as the last one, so I'll skip over it.

This is, to my mind, the most striking graph, the most striking visual I've produced in any of my chief medical officer of health reports. This is a graph that illustrates the epidemic rise in deaths from lung cancer in women in Ontario from 1970 to 1990. The minister has already related the three-times increase, but I think it's only when you see it portrayed visually that you get some sense of the importance of the dramatic nature of this increase.

In fact, if we follow that line back 20 years earlier, we would realize that only 40 years ago, lung cancer was a very rare disease in women. By the early 1990s, it is approaching, and in some provinces in this country has exceeded, breast cancer as the leading cause of cancer death in women.

What's particularly tragic about this -- let me emphasize again we're not talking about disease rates here; we're talking about deaths -- is that this epidemic, and that's not a phrase a public health officer uses lightly, was predictable and preventable. We have had good scientific evidence since the early 1950s that smoking caused lung cancer.

From a scientific standpoint, the landmark report of the American Surgeon General in 1964 resolved that issue: Smoking causes lung cancer. We've known through the 1950s, the 1960s and into the 1970s that the smoking rates in women were increasing. So we knew, should have known, that this was going to happen, yet we allowed this tragedy to occur.

The second point I'd like to make from this graph, one which from a personal standpoint I found very important, is that when we look at lung cancer, which is the major cancer that's attributable to smoking, it's by far the leading cause of cancer deaths in this province. We all have this image somehow that when we get diseases, even serious diseases, we go into our health care system and our health care system has something to offer. We have magic bullets which are going to cure it. Somehow we're going to avoid the consequences of these diseases.

I can tell you that when I was a junior resident in this city studying medicine, it was the frustration I felt in dealing with patients with lung cancer, the inability of all the medical science I'd learned, of all the tools, all the drugs and various things we had at our disposal, the inability to do anything at all for the vast majority of people with lung cancer when we knew what the cause was, that lead to me going into a career in public health.

The sad, tragic fact is that the case fatality rate from lung cancer in this province -- that's the number of people who get the disease who subsequently die of this disease -- is almost 90%. Almost nine out of every 10 people diagnosed with lung cancer in Ontario will die from their disease, usually within two years of diagnosis.

Furthermore, in spite of a vast investment in research and health care expenditures, those numbers have not improved substantially in three decades. This is a problem that we can predict, that we can prevent. Tragically, we are not very effective at treating it.

Let me turn to the next issue, which relates to why adolescence is so critical. One of the characteristics of smoking behaviour is that people who become smokers almost always become smokers when they're teenagers. A number of surveys have looked at this question, and the estimates vary, but generally between 80% and 90% of adult smokers become smokers by the age of 18 to 20. Beyond the age of 20, very few individuals become smokers. In fact, some studies have shown that up to 50% of adult smokers began smoking by the age of 14.

One of the ironies of all of this is that many adolescents begin smoking because they regard it as an adult behaviour, when in fact the decision to become a smoker is quintessentially an adolescent behaviour. It's children who choose to smoke, not adults. Adult smokers, in fact, spend most of their energies trying to quit smoking.

When we take into account the highly addictive nature of tobacco, the fact that once you become addicted to tobacco it can be very difficult to break that addiction, I think it really allows us to focus our attention on this key age group, knowing that if we can deliver a generation of Ontarians to the age of 20 as non-smokers, we have every reason to expect they will remain non-smokers.

This graph is a good-news graph. What it shows is what has happened to adult smoking rates in Ontario between about 1968 and 1986. Subsequently, we could continue this on down and the rates have continued down, although at not quite such a dramatic rate. What it shows is that we've gone from a time in the late 1960s where almost 50%, almost one in every two adult males, in Ontario was a regular cigarette smoker down to about half that level among adult men. That is a dramatic and important accomplishment.

We can also see from this graph that rates in women have declined over that period of time. They've declined more slowly. In fact, smoking rates among men and women in Ontario are more or less equal right now. There's even some suggestion that women's rates may be creeping up ahead of male smoking rates.

But what this says to me is that smoking behaviour can change. I've said in previous speeches that we don't have to accept it as being like death and taxes. Smoking rates can change. In light of the minister's comments about tobacco taxation, I should say with tobacco it's a question of death or taxes, in which case I certainly would opt for the taxes.

This shows smoking rates among adolescents, among teenagers in Ontario, and again paints an optimistic picture to the extent that smoking rates have declined since the late 1970s, when more than one in every three adolescent males was a smoker, to our current rates which, again, if we followed these lines down to the present, are just a little above 20%. That's an important gain.

The bad news, though -- as you can see, the line became quite flat in the 1980s. We made great progress in the early 1980s, less progress in the late 1980s, and we now have the very disturbing evidence from the biennial Addiction Research Foundation survey which suggests that rates have stabilized and that in fact, at least in the very young teenagers, rates may indeed be increasing. I think that's a very strong warning to us that we have to redouble our efforts in this area.

This is another good-news slide. These are figures drawn from the Ontario Heart Health Survey and they show the proportion of Ontario adults by age group -- 18 through 34, 35 through 64, 65 to 74 -- who are never smokers. This is the proportion of a generation that are never smokers. As you can see, it's the youngest age group that has the highest rate of never having smoked. A little more than 50% of 18- to 34-year-olds in Ontario report that they have never been smokers. That's the good news.


The not-so-good news, and again this is drawn from the Ontario Heart Health Survey, which is kind of the flip side of that last slide, shows our smoking rates actually are highest in young people. The 18-to-34-year-old cohort, while it has the largest proportion who never smoke, also has the largest proportion of active smokers. That appears to be a paradox, but it's of course because there's dropout from the ranks of smokers as the cohort gets older.

People drop out for two reasons: First of all, they quit, and millions of people in this province have quit smoking. Also, they die, and that's particularly a factor in the older age groups. So clearly, this is not quite so positive and attractive a picture and let's us know that we have a lot of work ahead.

Finally, this is a slide which is drawn from my heart health report. It deals with more than smoking, but I'm going to ask you to focus your attention on the little campfire, the third from the right, which looks at smoking rates. What this slide does is illustrate one of the other sad facts of smoking in Ontario, that we have inadvertently created quite a marked social and educational gradient in smoking behaviour.

We've gone from a situation 40 or 50 years ago where smoking was primarily an addiction of the well-educated and well-to-do; two out of three doctors used to smoke Camels, according to one famous American ad. We've been very successful in reducing smoking rates among the well-educated and well-to-do, but far less successful among the less well-educated and less well-to-do.

This particular graph looks at educational levels, but similar graphs could be developed for income levels. What that smoking graph shows is that for Ontario adults with at least some post-secondary education the smoking rate is 13%, but for those Ontario adults with only up to secondary school education, the smoking rate is 30%. So clearly we've made gains, but those gains have not been evenly spread across society, and I don't think it's an overgeneralization to say that more and more tobacco use is becoming an addiction of poor women, whereas it used to be one of rich men.

That completes my slides. I'd just like to conclude my remarks by saying how pleased I am to be able to appear before this committee as an advocate for Bill 119, that it's a key component of the tobacco strategy of this government. There are other important components. You've heard about the television ads. I'd also like to remind you that we have a public health program in this province where we have activity and funding for each of Ontario's 42 boards of health to deliver a variety of services, including education, smoking cessation classes, workplace programs and public advocacy, and that in my reports I've called for a number of actions against tobacco. I'm very pleased to see that this legislation addresses some of them. Certainly education continues to be a priority, and the messages on tobacco packages are one component of that.

It's very important that we stop sending young people mixed messages about tobacco. It's one thing to teach them about the health problems of tobacco in their schools, but when they can go out the door and, yes, go to a drugstore, a place that we associate with somewhere you go to buy things that promote health and that treat illness, we're sending young people a very mixed message. I personally believe that's the real crux of the pharmacy issue.

Furthermore, the importance of reducing accessibility, it's well shown, for example, with alcohol, that accessibility is a factor in reducing alcohol use. There's every reason to believe that the same will be true for tobacco. Thank you.

Mr Jim Wilson: As critic, I'm very familiar with the work you've done with respect to this legislation and particularly with the reports you've produced, and they're excellent reports. You probably have one of the best illustrators working for you in the government of Ontario, on contract or otherwise.

I have a question with respect to your latter comments. You know my comments on second reading with respect to this legislation in the Legislature and my focusing on the section of the bill that deals with the prohibition of the sale of tobacco products in pharmacies.

It strikes me to ask whether the ministry or anyone has asked young people what their perception of a pharmacy is. It seems to me that adults view pharmacies far more as a place where you seek remedies to a health problem. A young person probably doesn't perceive a pharmacy that way. As a young person, when I was doing science projects, I perceived a pharmacy as a place where you would get poisons, as a place where you would actually have to go ask for things over the counter, my science teacher sending me up to get various concoctions. You know, when you were running the electrodes through little tin pans and that sort of thing, you would have to go get prohibited substances and have your parents sign for them over the counter.

I didn't really have any health problems and therefore never used a pharmacy for any other reason than some science projects, so my perception of a pharmacy would have been a place where I'd go to get prohibited substances, given that in my family we generally bought our shampoos and other health products in the grocery store and didn't go to the pharmacy. Now, I suppose, things have changed to some extent, where the loss leaders are often those general health care items like shampoos and tires and various other things that some pharmacies are into.

None the less, in a serious way, have you interviewed young people and asked what their perception of a pharmacy is, and, along that line, how many young people actually go to a pharmacy to purchase cigarettes?

Dr Schabas: I don't know; I can't answer those numbers. It's possible John Garcia can or our colleagues from the Addiction Research Foundation when they come to present to you. Those are very interesting perceptions of how people view pharmacies. I'm not sure I necessarily share them.

You've raised several times the issue of doing research. It's a little unclear to me how you could test the hypothesis of removing cigarettes from pharmacies without actually doing it, and in fact that's the way most public policy hypotheses are tested. But I think you're now raising another issue, perhaps to question young people about their perceptions of pharmacies. Again, I can't comment on that.

I can comment on the pharmacists' perception of pharmacies and the position taken, for example, by the Ontario College of Pharmacists. I'm quite prepared to defer to them in terms of what the perception of a pharmacy is. Their perception of a pharmacy is a place where you should not sell tobacco, for very much the reasons that I identified.

Mrs Karen Haslam (Perth): While Mr Wilson will be focusing on the selling of tobacco in pharmacies, I'd like to focus on young people and the health issues around this particular piece of legislation.

One of your charts looked at a decrease of the percentage of people smoking, and I wondered if you had any idea of whether that was in relation to a better education, to taxes, to the sickness involved, to a better marketing of it. I believe it was one on the women, and that really struck me.

Dr Schabas: There are two graphs I showed, one of Ontario adults, both men and women, and the decline. The other was for adolescents, which has also declined.

Mrs Haslam: I'll get to the adolescent ones later. The first one was the adults. You looked at 1968. There was a marked reduction. Is that in relation to taxes, education, sickness or better marketing of the problems?

Dr Schabas: To the best of anyone's knowledge, it's all of the above, the various interventions to deal with tobacco. First of all, they've not been introduced separately. We don't take one measure, stand back for five years and see what happens. A number of things have been going on over that 20-year period: obviously, better scientific information; better education; people became more aware of the health hazards; social attitudes changed, which I think is important; particularly in the 1980s pricing became an issue. There are all kinds of things, and I think it would be an impossible task to try to untangle what contributed to what.

I'd even go so far as to say that probably a number of those interventions were introduced without really good scientific proof that they were going to work. They were introduced more because it was felt necessary to do whatever we could about tobacco and because it seemed to make good sense. It's very hard to untangle which of those were the most effective, but my own judgement is that they probably all contributed.


Mrs Haslam: That takes me to your second chart, which was the percentage of adolescents who smoke. The progress in the early 1980s in that chart was phenomenal, which was really great, and then you said that now it seems to be flat-lined. Why was there not a continuation of a decline? Why suddenly in this time period was it flat-lined?

Dr Schabas: There are two or three issues I could point a finger at. Again, I can't say definitively what it was. Even among the adults the slope of the curve was sharper in the early 1980s. I think one of the things we did is we were effective at reaching the people whom it was easy to reach. Our main strategy up until the mid-1980s was purely an educational strategy. There are some people who are in a better position to respond to educational messages than others, and it worked for them. We kind of skimmed the cream off the top in terms of tobacco prevention.

I think we got into that problem, that we'd done the easy part and now are faced with the harder part. Particularly with young people in the last two or three years there is real concern that the real price of tobacco has been undermined by the smuggling, and that has played a role as well. We've heard about young people buying smuggled tobacco, something that should make us all very angry. That has been undermining some of the real health benefits which were felt earlier in the decade because of the real price increase associated with taxation.

Mr Rosario Marchese (Fort York): I have three questions but we may not have time; I'll ask two that are important to me. You said that in spite of the research we have done in three decades, very little has been shown by way of effective treatment of lung cancer.

Dr Schabas: That's right.

Mr Marchese: It raises interesting questions. My sense is that we have been probably spending a great deal of money in this field of lung research and I'm wondering, given the lack of effective treatment, whether we should be spending more money in that field as opposed to diverting all of our attention into prevention, reduction, as we're doing, and disusing as the answer.

Dr Schabas: I agree with the gist of your point. To be totally fair, there have been advances in the treatment of lung cancer in terms of palliative treatment. People with lung cancer now live longer, by and large, than they did, although most of that extension of life is measured in terms of months, not years. But yes, the point of my comments was to say that, if we look at what is ultimately the bottom line of the treatment of a deadly disease, which is, are we saving lives, the tragic facts are, as I said, that we've not made the progress that I think many of us perceive has been made.

We hardly go a week without reading of some new cancer breakthrough in the newspapers. Unfortunately, when you look at how they add up, at least in the treatment of lung cancer, the final results may not be what we perceive them to be. I agree entirely that, if we want to look at getting the best bang for our buck in terms of research and of health care investment, it's on the prevention side, because that whole graph, that whole epidemic, could have been and should have been prevented.

Mr Marchese: I raise this because it's obviously a question we need to ask in many other areas as well. It's the same ethical question we need to address with respect to where most of our health care dollars go. I heard a figure that 60% of our health care dollars go into the treatment of patients who are in hospitals from six months to one year. Perhaps it's an inflated figure.

These are the kinds of ethical questions we need to address as a society, as to where we spend our dollars, where we spend our research dollars vis-à-vis effective treatment of certain things. That's why I asked you for your opinion in terms of where this leads to.

Dr Schabas: These are important questions and I think probably a little beyond the scope of this discussion today, but I quite agree that, particularly as health care resources become scarcer, we have to make some hard and sometimes difficult decisions. But we owe it to our children, if no one else, to put our resources where they'll have the biggest benefit.

Mr Marchese: Another question comes to mind in terms of who we are able to reach with our educational programs. Quite clearly, education, class and reduction in smoking are all interrelated, and the ones we're not reaching are the ones who have lower literacy levels. It reminds me of the problem where in the 1900s, the wealthy used to eat the white bread and the working class was eating the fibrous bread, and of course in time the educated class realized there was a problem. So we reversed the situation, where the poor are now eating the white bread and the wealthy are eating the fibrous bread.

Dr Schabas: Ischemic heart disease, which is the leading cause of death in Ontario and is related to a number of lifestyle factors, including diet, physical activity and smoking, used to be a rich man's disease. It's not any more. We've completely reversed the social gradient, because it's been the well-educated and the well-to-do who have responded to our health promotion messages.

Mr Marchese: So the question for us is, how do we reach those youngsters who come from those particular income levels? Given that education is key and given that our messaging, however we are producing it, quite clearly is effective for those who are able to receive it, understand and then act on it, how do we reach those other young children who are going to have this problem?

Dr Schabas: I think you use the tools that work, and the lesson is that education alone is not enough. If education were the answer, then we wouldn't be meeting here today to talk about issues like accessibility, like changing social norms. But that's the key, and that's where I think this particular legislation is particularly strong.

Mr McGuinty: Dr Schabas, let me begin by congratulating you on the production of a great report. It's my personal philosophy that one of the jobs of government is to show people how they can better help themselves. Maybe we'll be seeing more and hopefully hearing more from you. You can become the Everett Koop of Ontario medical matters.

Have you got a figure in terms of the costs of the treatment annually for tobacco-related illness in the province?

Dr Schabas: There are estimates. I'm quoting from memory here. Dr Bernard Choi from the University of Toronto did a review a couple of years ago of the costs, and that's where the $3-billion-a-year figure comes from. I believe, and John or Brenda will correct me if I'm wrong here, that $1 billion of that roughly -- I'm talking in very rough, round figures -- was from direct costs of health care and about $2 billion was lost productivity.

Mr McGuinty: What can we do that we're not doing right now to help smokers stop smoking? I understand that idealistically the best way is to create a smoke-free generation. But what about those who are already hooked? What could we be doing that we're not doing?

Dr Schabas: I think there are a number of things we can do. Smoking cessation programs, although if you were to study them individually, you'd say that none of them worked, in fact the net effect of a number of them, particularly when people take them repetitively, is that for some people they do work.

The most important factor in smoking cessation is the will to quit. Personally, I believe the biggest factor there is social norms, that what we have to do is continue to reinforce the fact that smoking is just not a socially acceptable thing to do.

I know the clusters of people who gather outside government buildings started some four years when smoking was banned in government buildings, and one of the most striking things -- maybe somebody should do a research project on this, maybe we should have thought of this four years ago -- is to count how many there are or to count the butts that are out there, because it's certainly my perception that those numbers have declined and declined quite substantially. I think it's because the real benefit of that program was to make it socially unacceptable to be a smoker. That's a little bit of tough medicine for some people, but I think that's what works.

Also, pricing is important. Certainly tobacco smoking is not as price-sensitive a behaviour among adults as it is among adolescents, and we should remember that the real key to pricing as a strategy in taxation is its effect on adolescents, but there still is a curve for adults. Many individuals I've known personally or as patients have finally commented, and I don't know if this is just a rationalization on their part, "I quit smoking ultimately because I couldn't afford to do it any more."

So there are all those and undoubtedly others that I'm not thinking of.


Mr Ted Arnott (Wellington): Thank you, Dr Schabas, for all the work you're doing and all the work you will be doing over the next few months.

I'm interested in the issue of the reporting statistics for tobacco use among young people. We see different survey results and so on, and I'm wondering about the methodology that's used, simply based on the belief that a 12-year-old might not admit that he or she smokes. I'm wondering if perhaps these numbers aren't considerably understated.

Dr Schabas: Yes. There's no one set of numbers I presented that's perfect in itself for the reasons you pointed out, and also there's a difference in methodology. The Addiction Research Foundation questionnaire is based on, "Have you smoked in the last year?" whereas questions from the Ontario Health Survey or the Ontario Heart Health Survey looked at regular smoking. So there's a great deal of variation, but what is important are the trends those studies report.

For example, with 12-year-olds in the Addiction Research Foundation biennial study, there are problems. You've identified what the 12-year-olds really tell us, but what's important is to look at the trend in teenage smoking, because there's no reason why 12-year-olds now should be behaving differently, giving different information than 12-year-olds two years ago or four years ago.

Yes, it may underestimate smoking. It certainly, I think, would not overestimate smoking, and it's this latest change in the slope of the curve where it's flattened off and particularly among the grades 7 and 8 where we've now for the first time in 20 years seen an increase in smoking. I find that extremely alarming.

Mr Arnott: Do we discourage the use of tobacco in the schools for children, say, age 12?

Dr Schabas: The issue within the schools, yes. Smoking is banned in most boards of education in the province, although not in all of them, but the issue I think you're getting at is education of young people.

Indeed, the real focus of the public health program against tobacco use has been in schools and not just in the old-fashioned way of bringing out a black lung. That's what they did when I was in school and we all used to joke about it. It didn't have a big effect. It's using what's called the social influences model, which is basically to try to put smoking in its social context and to give children the defences and the skills to make intelligent decisions.

That's actually something that goes beyond smoking, because obviously they make the same decisions about sexuality and various other important health choices they make, but there's good evidence that those kinds of programs, in the context of general public policies discouraging smoking, can be quite effective.

Mr Ron Eddy (Brant-Haldimand): Don't you think that the measures proposed here are going to take too long to do what you feel should be done? Do you feel tobacco products should be banned, that we should face up to the issue and ban tobacco products?

It's something I could face, never having been a smoker of course, but we're going to be faced with more cigarette manufacturers in our country and in our province. Although I understand there's going to be a limit of sales to two cartons per person, I don't know what frequency that would be at the very reduced prices we're seeing in the underground economy.

In view of a tremendously large underground economy where anybody can buy any quantity of cigarettes at any time -- I realize we're not able to control, or do we try too hard to even control, crack cocaine or heroin or many other banned products. This doesn't seem to me to really be too effective. Is it too little, too late?

Dr Schabas: Clearly, from my remarks and from the position I hold, I would be delighted to see tobacco use disappear from the province tomorrow. It's a question, though, of introducing measures that are acceptable and will be effective. These things don't change overnight, and the concern would be that if we were to outlaw tobacco products, for example, with 1.5 million Ontario adults addicted to the substance, we would be inviting serious social and other kinds of problems.

I think we have to take the long-term view of this. This is a problem that has been with us in this kind of magnitude for 50 years. We've known about the health consequences, at least relating to lung cancer, for 40 years. I would be very satisfied if we could achieve the targets Ontario set out for itself -- 10% of adolescents, 15% of adults by the year 2000 -- and carry it on from there so that maybe by the time I'm ready to retire, we really will be looking at a smoke-free province.

The Chair: Thank you. We have other parts of the briefing to continue. We can come back to some of these issues, but perhaps we should go on with this.

Mr Garcia: I will give just a very brief overview of the tobacco strategy to comment on the economic cost issue briefly. The Ministry of Health views tobacco use and tobacco control to be a health issue: 13,000 premature deaths every year, one death every 45 minutes, 35 to 40 people every week are simply too many people who needlessly die from tobacco-induced diseases. So we've focused in the main on the health issue because it is such a major public health problem.

We know there's interest in cost information, and Richard did mention a study by Choi. We'd be pleased to provide a copy to the clerk if you'd like a copy of that. It's a bit dated now.

For 1988, about 4.75% of the entire Ministry of Health expenditures was due to the direct cost of physician services and hospital bed use attributable to tobacco-induced diseases. Applying that to the current year, the expenditures on tobacco will exceed revenues in the Ontario coffers from tobacco. So even the economic argument can be made at this point that it's a net drain on the Ontario government and Ontario society.

The minister has made a very firm commitment to tobacco control. She sees it as one of the strategic priorities of the ministry. As you know, all parties of the House have committed to a vision of health and health goals developed initially by the former Premier's Council on Health Strategy, the first line of which is: "We see an Ontario in which people live longer, in good health, and disease and disability are progressively reduced."

In order to achieve the vision credibly, we must pursue an ambitious agenda of tobacco control. The first goal, of course, is to shift emphasis to health promotion and disease prevention, and the tobacco control strategy is the cornerstone of our efforts in that area.

There's a single purpose for the tobacco strategy, and that is to reduce tobacco use. We have set out some fairly ambitious targets which have also been articulated by the Premier's council. They are by the year 1995 to increase to 100% the proportion of schools, workplaces and public places that are smoke-free and to eliminate tobacco sales to minors. We'll not achieve those objectives without this legislation. We also wish, by the year 2000, to reduce total tobacco sales by at least 50% and by at least 5% in each year during the 1990s. I think you'll agree that these are ambitious objectives.

We also wish, as Richard has indicated, to reduce tobacco use, that is, the prevalence of tobacco use among adolescents 12 to 19 years of age to 10% by that year, to reduce the proportion of men and women who smoke to 15% and to eliminate the use of tobacco products by pregnant women.

This is a complex problem, we all agree. There are no magic bullets and we need a comprehensive, integrated approach to effect the change towards these targets. We've put in place a number of planning mechanisms, including the creation of an interministerial committee on tobacco control, which is chaired by the chief medical officer of health.

It includes ministries -- Finance, Labour, Education, Municipal Affairs, and the list goes on and on -- all the ministries that are concerned with various aspects of the tobacco problem. We are planning together to determine how we may reach the objectives and targets of the strategy together as a government strategy.


We have also convened a steering committee of provincial partners in the strategy. I know you'll be hearing from many of those partners during the committee's hearings, including the major voluntary organizations -- the Canadian Cancer Society, the Lung Association and the Heart and Stroke Foundation -- as well as the resource centres that we've funded under this strategy. This will provide a mechanism for us to develop an integrated plan.

The legislation which is being discussed today is seen by those partners as an essential element of the strategy. As I mentioned, it is our judgement that the objectives will not be achieved without the legislation, particularly that related to the sale of tobacco to minors and the restrictions on smoking in public places.

The minister mentioned that we have introduced a hard-hitting mass media communications strategy, an investment of about $3 million this year, through the electronic media, including cinema advertisement and television ads directed to children, the use of radio spots, print ads in newspapers directed at children and supplementary material. All of this information will be available to the committee, of course.

We have made a commitment to develop educational resource materials and make these widely available through the school system and other mechanisms. The minister made grants during National Non-Smoking Week to our partners to develop and make these available province-wide. These are programs related to smoking cessation, for example, and increasing community awareness of the tobacco problem.

We've supported the establishment of four resource centres. We're a funding partner in the National Clearinghouse on Tobacco and Health, which is a focal point for information exchange and networking. We've just created a program training consultation centre which will provide support to the local public health system in the implementation of mandatory health programs and services guidelines related to tobacco use prevention. They will also be supporting voluntaries and implementing their aspects of the strategy and be supporting community health centres in their role in delivering smoking cessation programs and related community development activities.

We fund a group called the Smoking and Health Action Foundation. You'll recognize Mr Garfield Mahood's name, and he will be here. We're supporting him with various public education campaigns and community organization work, and the Council for a Tobacco-Free Ontario, which is the provincial interagency council on smoking and health that organizes National Non-Smoking Week and World No-Tobacco Day activities.

In order to ensure that our program is as effective as it can be, the ministry is providing financial contribution to the University of Toronto to establish an Ontario tobacco research unit. Roberta Ferrence, the principal investigator, is organizing a provincial network of scientists to assist us with research into what is the most effective intervention in the policy and program area, and she'll be able to speak to many of your questions. It also provides us with a mechanism to monitor and track progress towards the attainment of strategic objectives within the strategy, and there will be reports regularly from the resource centre as to how we do.

At the local level, Richard has already mentioned that public health is very active in tobacco control activities, supporting local interagency council activities. We've funded a demonstration project in Brant. I believe the Brant post-commit group is scheduled to be at your London meeting. They'll be able to tell you about their activities. We also plan to establish two more demonstration sites to implement the comprehensive integrated model to tobacco control at the local level.

The tobacco control strategy is the first comprehensive integrated prevention effort by the Ministry of Health. It is recognized by other provinces to be a model. We're very early in its implementation but we're hopeful that, if it's implemented in its entirety, including legislation, we'll be successful in achieving the targets we set out.

That's an overview of the strategy, and I'd be pleased to answer any questions.

Mr Jim Wilson: I don't have any questions, but I was wondering if I could get some information from the ministry in terms of all the various community groups or organizations funds with respect to the tobacco issue. Is there a list available or is it out in some report somewhere that I haven't seen?

Mr Garcia: There's actually a list included in your briefing binder, and we'd be happy to provide further information.

Mr Jim Wilson: Does that list include the annual grants to those organizations?

Mr Garcia: I don't believe it does. We could provide a list.

Mr Jim Wilson: Mr Chairman, for the record, I don't ask for that in any malicious way. I've just been asked that by constituents who get letters from these groups from time to time, from the pharmacists, saying, "How much money does the government give to these groups?" I think it's a fair question: How much money does the government give out in grants to these groups, and what are the groups?

The Chair: That information could be made available to the clerk and then subsequently to the members.

Mr Garcia: Sure. A very quick answer to that: We spend about $1 million on resource centres. Their recent grants for the development of education resource materials was slightly more than $600,000.

Mr Jim Wilson: That's just resource centres?

Mr Garcia: That's correct.

Mr Jim Wilson: That's not anti-smoking advocacy groups?

Mr Garcia: The Smoking and Health Action Foundation, for example, is one of the resource centres of the strategy.

Mr Jim Wilson: My question pertained to, in addition to the centres, the community groups that might receive grants from the Ministry of Health.

Mr Garcia: We could provide a list. We do this regularly.

The Chair: We'll have that circulated to the committee members. Any other specific questions for Mr Garcia? Otherwise, we'll move on and continue with the briefing.

Mr Jim Wilson: I just want to compliment this branch of the ministry. I was in the theatre a couple of weeks before Christmas when your Swimmers cinema ad did get a very large round of applause from the audience, and clearly spontaneous. It's an excellent ad campaign and I'd be interested, when you do the analysis of that, if that could be conveyed to the committee. I suspect some time will elapse before we see whether that's effective or not. We don't very often see the national anthem played, and when it's played people don't stand any more, but they sure responded to that particular ad.

Mr O'Connor: Moving along, as the committee members know, maybe not those viewing, we've had some discussion over the strategy up to this point, and of course last March there were presentations that took place. We heard from 240 people and 34 oral presentations. The member for Perth, of course, was there on the receiving end for quite a bit of it, as I was myself.

Brenda Mitchell was on the receiving end for a lot of that as well and helped us to develop the legislation. Now I'd ask her, as the manager of the tobacco strategy unit, if she would go through the legislation and just highlight the clauses in it, and then perhaps we can have some questions on that as well.

Ms Brenda Mitchell: You have a copy of Bill 119 in section 1 of the binder. I'll be following through this bill. For each section what I will do is briefly highlight what the section of the act does and give a brief rationale as to why it's included in the act.

I will start with section 2, which has to do with the application of the act. This would apply "to tobacco in any processed or unprocessed form that may be smoked, inhaled or chewed." We're trying to be comprehensive in terms of reaching the types of use of tobacco.

There is an important note that it "does not apply to products intended for nicotine replacement therapy." This is because the source of nicotine for aids for cessation, such as the nicotine in Nicorette gum or in the patch, comes from the tobacco leaf. That's why it does not apply to those aids.

Section 3 of the act prohibits the selling or giving of tobacco to a person who is less than 19 years old. The current law in Ontario is the age of 18, so this is an increase of one year. This age will effectively remove tobacco from high school students and will also treat it consistently with alcohol.

In order to aid with the enforcement of this age, there is a requirement in subsection 3(3) that unless the retail vendor knows that the person is of age, if the vendor suspects they may not be, it's their responsibility to ask for photo identification. The forms of identification would be specified in regulation. There would be an onus on the tobacco retailer to ensure that the person is of age, and that will help the retailer comply with the law.


In section 4 there is a prohibition on sale of tobacco in designated places, specifically on the sale in health facilities, and this does include the sale of tobacco in pharmacies.

Section 5 is on packaging requirements. There would be a requirement to meet regulations and that all tobacco sold must meet the regulations. We have identified in the notes provided in the committee book on this section that the regulations intended in this area have to do with controlling, at this point in time, package size, but of course we are interested in hearing comments on what other regulations there may be.

In addition, there would be a requirement that on the package there be health warnings and possibly other health information. It's being proposed at this time that the regulations on health warnings would bring the provincial law in line with the new federal law.

Under the Tobacco Products Control Act, which is federal legislation, health warnings are required on cigarette packages. There is a new regulation which will come into effect in September 1994, and Ontario would be looking at having a regulation that would duplicate the requirements. The federal Tobacco Products Control Act has been challenged by the tobacco industry and an appeal will be heard by the Supreme Court of Canada, it's anticipated, some time this year.

Section 6 has to do with signs required at the point of sale of tobacco. The content of the sign would include two things. One is pointing out the age restrictions on selling and giving tobacco, and the second would be a health warning.

Larry O'Connor mentioned that we had presentations made to us last March after we released a discussion paper on proposed legislation. Many of the groups who spoke to us emphasized the importance of embedding the age restriction in the health warning so it's clear why the age restriction exists.

Under the federal Tobacco Sales to Young Persons Act, there will be a requirement for signs at the point of sale of tobacco. They have put out their regulations. There were gazetted January 22, so we now know what they are. The federal regulations state that where the provinces are more restrictive in terms of having a higher age and also require signs at the point of sale, the Ontario sign would stand. That would be the signage required. They would waive the requirement for the federal sign itself. However, the federal regulation does specify where the signs would have to be posted. It's anticipated that that law will come into effect in July 1994.

Section 7 deals with vending machines and would prohibit the sale of tobacco from vending machines. There's also a requirement under the Tobacco Sales to Young Persons Act which would restrict vending machines to premises that are bars or taverns. In addition, they have identified that where the premise is one that can be accessed by a person under the age of 18, there are additional requirements. Again, according to the regulations that were gazetted on January 22, the vending machine would have to be under the supervision of and monitored by whoever was in charge of the establishment and would have to be a minimum of five metres from any entrance to the premise.

Section 8 of the act deals with reports from wholesalers and distributors. This would allow Ontario to collect information about who sells tobacco and also what tobacco is sold and where it is sold. This information is important to allow Ontario to enforce this act and its regulations and also for us to monitor how well we are doing with the implementation of the tobacco strategy, where the effectiveness is and where we need to take other kinds of action.

Section 9 of the act has to do with prohibitions on smoking in certain public places. There are eight specific types of premises identified, as well as saying under paragraph 9 "a prescribed place," which would allow further places to be specified in regulation.

You will see that the types of premises included here really fit into three categories. One is premises that are specifically for children, and this has to do with protecting children from exposure to tobacco smoke, a point Norm Sterling already spoke to this afternoon. The second has to do with restricting smoking in health facilities, and the third has to do with allowing people to go through their routine activities of life in a smoke-free environment.

Section 10 deals with no-smoking signs. It's important that where smoking is prohibited people are aware of that prohibition, and voluntary compliance will follow if they are aware.

Section 11 speaks to conflict with other legislation. This is placed in the act at this point to draw to people's attention the ability of municipalities to have more restrictive bylaws on smoking in public places. Certainly many municipalities already do have more restrictive bylaws; because we live and work in Toronto, I think we're very familiar with them. Bill 119 sets minimum standards for prohibitions on smoking in public places across the province, but certainly municipalities may go further and we wanted to make it clear that the most restrictive law would apply.

Section 12 of the act deals with traditional use of tobacco by aboriginal persons. We acknowledge that the traditional use of tobacco in the aboriginal culture and spiritual practices is different from other use of tobacco. Therefore, we are basically giving permission that tobacco being used in this way does not fall under some of the prohibitions in the act.

Section 13 deals with enforcement of the legislation, particularly to do with the rights of inspectors.

Sections 14, 15, 16 and 17 of the act deal with various levels of penalties that would come into play if someone is convicted. The offences labelled and specified here deal with fines, in addition to which there's an automatic prohibition that can come into play for tobacco retailers who have received two convictions; the terms of the automatic prohibition are outlined in section 15.

Sections 16 and 17 follow from that: Where a premise is under a prohibition of selling tobacco, it may not have tobacco on the premises, and there's right of seizure for that. Also, there must be a sign posted on the premises making it clear that the prohibition is in place. This will alert the community to the fact that tobacco is no longer available because they've been convicted for violations of the law.

That basically covers the content of the act.


Mrs Haslam: I wanted to ask a question around what Mr Sterling said earlier about the college being given more power to self-regulate the selling of tobacco. I wondered if any additional power at all was given to the college of physicians around that.

Also, Dr Schabas was talking about the long-term effects of the legislation. I wondered if any thought had been given to a tobacco control board similar to an LCBO, especially given that you said you shouldn't bring everything in at once. Would one of you like to comment on whether that is a possibility for the long term? Is that one of the visions you have in steps towards taking care of this problem? I understand that you can't jump in. I wondered if it was there as a dream for the long term, a hope or vision written down someplace.

Ms Mitchell: In terms of the pharmacy section, the way we dealt with this in legislation was something worked out with the college itself. We met with them and agreed that this was the best way to deal with it. Frank might like to speak to legal options of how to deal with that.

Mr Frank Williams: Generally speaking, colleges deal with issues of competency and with how professionals engage in the practise of their particular profession, so the college would be more interested in competency issues, I would think, than what particular pharmacists can and cannot sell. I suppose they could add an item as part of professional misconduct, selling tobacco products, but the college never gave us any direction that it wanted to go in that particular direction.

Ms Mitchell: In terms of the tobacco control board, we certainly looked at a number of options for dealing with the sale of tobacco. Is it possible for you to clarify what you think a tobacco control board would --

Mrs Haslam: I'm asking because Dr Schabas said we talked about bringing it all in at once and we talked about making decisions in an incremental way, and that this was a good time to bring in this type of legislation in an incremental way. I'm asking whether long-term you are still in favour of or have thought about bringing in a tobacco control board similar to an LCBO when you talk about the selling of this particular product. Maybe Dr Schabas could answer that, as I didn't get a chance to ask that question when he was here a minute ago. But you're dealing with regulations in this legislation and that's why I'm asking now.

Dr Schabas: I'll answer that question in a slightly circumspect manner, but I will try to answer it. Clearly, it's not included in the current legislation. It's something that's been discussed various times in the past, and it's the judgement of the minister of the government at the moment that it's not a measure that's acceptable or that we're ready for at this point in time.

But we also know in Ontario that the use of a liquor control board has been one of the tools we've used with some success in reducing levels of alcohol consumption and controlling consumption among underage young people and in certain situations. I would like to think it's the kind of issue we could revisit, because social attitudes about smoking have changed dramatically in the last decade. We now have measures of restriction of smoking in public places that would have been unimaginable 10 years ago. I very much suspect that five or 10 years from now, what is currently unimaginable or unacceptable will be very imaginable and I hope very acceptable.

Mrs Haslam: Are you of the opinion that this is not the time to bring in that measure? I suppose you would like to see it brought in. I'm just trying to look at the social norms now and whether you, in your position in public health, feel this isn't the time, or would you like to see us bring it in?

Dr Schabas: I'm not sure I'm the right one to make that judgement. As a public health officer, I will advocate for measures that will promote public health and, in this case, will reduce access to and consumption of tobacco. But it's really an issue for the Legislature and for the members of this committee to decide what is reasonable and practical at this point in time. That refers back to Mr Eddy's question earlier about what measures we are willing to accept, because we probably all share the long-term goal that we'd like to eliminate tobacco use.

Mr Garcia: One point I would make is that in deciding whether one would go in the future with a tobacco control board or an alternative licensing system, one needs to look at the policy objective that would be served by doing that. It's our interest to be able to prevent retailers who sell tobacco to minors from doing so in the future. We believe the sanctions that are included in the current legislation will be effective in doing that. I think it would be prudent to determine whether we're effective in achieving the compliance objectives we want. Maybe in the future there are other options that need to be considered; I wouldn't rule that out for the future. But at this point, we think we have an enforcement mechanism that will be effective in achieving the objective.

Mr Paul Wessenger (Simcoe Centre): My questions are probably going to be a little more technical. First of all, section 3 of the act, I assume there is an equivalent section in the Minors' Protection Act. Was the restriction there on selling or giving, or selling only, in the previous act?

Ms Mitchell: It's broader than just selling. The Minors' Protection Act states, "No person shall either directly or indirectly sell or give or furnish to a child under 18 years of age cigarettes, cigars or tobacco in any form."

Mr Wessenger: Why did we change the language? Do we feel this is plainer? Do we feel we're losing any legal rights by not using the language that was in the previous act?

Mr Williams: It's drafted by legislative counsel, so we deferred to their choice of language at this point. We're certainly open to suggestions. If the committee feels perhaps this doesn't go far enough, we're willing to consider changing it if necessary.

Mr Wessenger: The intention is not to in any way change the standard from the previous act to this act. Is that the intent?

Ms Mitchell: That's right. The intention is that it should not be narrowed in any way.

Mr Wessenger: The second question relates to section 5, which gives the power to make regulations with respect to packaging. I assume this would give the government the power to implement plain-packaging requirements if that were felt to be appropriate.

Ms Mitchell: If the government chose to follow that option, this gives the government broad scope to do what it feels necessary with packaging.

Mr Wessenger: Section 7 says, "No person shall permit a vending machine for selling or dispensing tobacco to be in a place that the person owns or occupies." Is the intention there to put a liability on both the owner of the premises and the occupant?

Ms Mitchell: Yes, it is.

Mr Wessenger: With respect to section 8, what is the purpose of requiring the wholesaler to make reports?

Ms Mitchell: When we identified that we wanted reports, we were looking for a system that would be fairly efficient and would not put a burden on the small businessman. We didn't want to put a burden on each tobacco retailer.

Mr Wessenger: Then you did consider requiring a report by each person at the retail level with respect to tobacco.

Ms Mitchell: It was something we looked at, yes.

Mr Wessenger: On the same basis as the packaging regulations, might it make sense to at least give under the legislation the power to require discretion reports from a retailer? It's just a suggestion.

Ms Mitchell: I suppose it could be considered, certainly.

Mr Wessenger: With respect to section 9, I have some concern. Is there a definition anywhere of "a retail establishment"?

Mr Williams: It would have whatever normal meaning it would have in normal parlance. Certainly case law would support what would normally be the interpretation of "a retail establishment," what you and I and everybody else considers a retail establishment. It doesn't have any special hidden meaning beyond its normal, everyday meaning.

Mr Wessenger: That was certainly my impression, but I look at that and then at some of the subsidiary definitions under section 9. We have, for instance, "a hairdressing establishment or barbershop." I would submit that in ordinary understanding that would fall under the category of a retail establishment. "A self-serve laundry" might also fall under that category. I'm suggesting that by having the two specifics set out as well as "retail establishment," we're leading to the difficulty of having a retail establishment being more narrowly construed.

Mr Williams: I think the intention was to at least zero in on those particular retail establishments about which perhaps there was some doubt as to whether they would fall under the definition, but it's also to make it abundantly clear that those were establishments in which we wanted to ensure that there was no smoking or selling taking place.


Mr Wessenger: Another question relating to where people may smoke: We seem to be very concerned about prohibiting the sale of tobacco in health establishments, and there seems to be an underlying premise that where numbers of consumers are in a common situation together, smoking of tobacco would be prohibited to prevent the ill effects of second hand smoke. Just a suggestion, but did you consider designating doctors' offices, for instance, as places where you shouldn't allow smoking? Certainly there are large numbers of people sitting in a doctor's office, and I'm just wondering if that's been considered.

Ms Mitchell: We've looked at quite a number of premises and certainly we've been advocated on that. I expect we will hear quite a bit about that in the next few weeks.

The Chair: Ms Haslam, you said you wanted a clarification on one point.

Mrs Haslam: It was something Brenda said on section 6. You were talking about the federal signs coming into a situation where the provincial signs are also in legislation, that the federal signage would be waived for Ontario signage. But then you said the federal says where it's to be hung. I wanted a clarification of who has jurisdiction. You're saying a provincial sign would have jurisdiction over a federal sign, but a federal sign would have jurisdiction over where it was hung?

Ms Mitchell: Sorry; let me clarify. There are two components to the federal regulation. One component specifies typeface, colour, borders, that type of thing, and the actual wording. If theirs says -- I can't remember exactly what it is -- that selling or giving to a person under the age of 18 is illegal, in the case of Ontario, because it's age 19 and we would also have health information, the content of the sign could be specified by Ontario.

The second part of their regulation deals with where the signs are posted. Essentially, they require that wherever tobacco is sold, the sign has to be located by the tobacco. If in a store there were many places where tobacco was sold, the signage would be required at each point. Ontario would specify what the content of the sign would be, but the posting requirement would be with the federal law.

Mrs Haslam: In other words, Ontario didn't put in any regulation about where it should be, relying only on the federal legislation for that particular issue.

Ms Mitchell: Ontario could specify where the sign is posted; in fact, depending on how we interpret the federal regulation, we may wish to clarify. It's simply that in the federal regulation they stated in terms of the content that if the province was more restrictive it would apply, but they made no statement about exempting in terms of where it was posted. Frank may wish to speak to that.

Mr Williams: There would be nothing to prevent the province from requiring signs in addition to those places the federal government would prescribe, for example, but there's been quite a bit of consultation back and forth between us and the federal government and the other provinces as well on both the content of the signs and where they're to be located.

Mr McGuinty: I have a few questions, but I'm not sure specifically to whom they should be addressed. I'll just put them out.

I think it would be unreasonable not to at least anticipate a constitutional challenge with respect to the ban on tobacco sales in pharmacies alone. Has the government obtained a legal opinion in that regard from anybody?

Mr Williams: I've had some contact with my counterparts at the constitutional branch of the Attorney General, and I'd make two comments. First, we don't look at pharmacists as retailers but as being another category of health professionals, so from that perspective we treat them the same as other health professionals. And certainly the courts have not looked at economic disability as being something that's a charter issue. Our view, from both our own legal branch and what I've heard from the Attorney General, is that there is no constitutional issue involved here.

Mr McGuinty: If one was launched, how would that affect the legislation in the interim? Would it apply, or would it be up in the air?

Mr Williams: My view is that a law is good until it's struck down by the courts, so I would assume the law would be valid until the courts struck it down.

Mr McGuinty: Dr Schabas raised the issue of a mixed message. I think a good argument can be made to that effect, but has that been grounded on any studies or research? I may be repeating the question raised by my colleague. Do kids perceive it as a mixed message? I'll tell you why I raise the question. I have four young kids, from seven to 12, and I know if I were to ask them what happens at the pharmacy, they'd say, "Well, that's the place where we get diapers and we get a hell of a good price on chips, and we get shampoo and soaps and cosmetics, and yeah, when we're sick Mummy will get a prescription there." It's seen as a combined retail and health care establishment, so I don't know if they'd see it as a mixed message as such.

Dr Schabas: Let me answer your question in several ways. First of all, there is research evidence that the mixing of the message is important. Things like the smoking behaviour of teachers, for example, have an important effect on the effectiveness of classroom teaching around tobacco, and the actual smoking behaviour of parents has an important effect on the smoking behaviour of children. There is ample reason, both intuitively and from a research standpoint, to recognize that consistency of message is important.

I don't know of any research that specifically addresses this issue of perception of pharmacies. I certainly believe the banning of tobacco sales in pharmacies will reduce tobacco use by young people, both through reducing the number of outlets and through sending a consistent social message, but I can't point to one piece of research that categorically proves that.

Mr Garcia: Perhaps I can add to that. We believe a ban on tobacco sales in pharmacies has a place in the context of a comprehensive strategy, and we believe it will have an impact on consumption. The college of course has made the argument on different grounds: that pharmacists shouldn't, in professional practice, be engaging in the distribution of a product that's hazardous and addictive and responsible for so many deaths. We're not dealing with confectionery here; it's a drug that kills people.

While the evidence is somewhat thin in terms of tobacco consumption per se and what the impacts may be, or even in terms of the reasons for the declines in consumption to date, there is reason to believe that the prohibition of tobacco sales from pharmacies will have some effect. It's part of the comprehensive approach.

The Addiction Research Foundation, which we consulted on this matter and which is aware of the impact of fewer outlets for alcoholic beverages, tells us there's reason to believe that restricting the number of outlets that sell tobacco products will have an impact on consumption. It's difficult to know what proportion of the total market is distributed through pharmacies. According to the committee of independent pharmacists it may be as low as 6%, or it may be as high as 25% by other groups, but it's still a significant amount of the market. We do not know what the impact will be. Maybe there will be a displacement to corner stores or maybe it will go into the underground economy; it's difficult to know exactly. But we believe it's part of a comprehensive strategy. This does not suggest that other approaches are not needed to deal with these other problems of smuggling and so forth.

Mr McGuinty: Section 9 talks about the prohibition of smoking in certain places and it makes reference, in paragraph 2, to "post-secondary educational institutions." I assume that means our colleges and universities. Does that mean there's a campus-wide ban on smoking?

Ms Mitchell: We're reviewing that ourselves right now to determine what the scope of the ban would be. In the point above, there's a prohibition on smoking in health facilities, and we're allowing an exemption. We're considering doing a similar kind of thing here, the idea behind that being that people should be able to go to colleges and universities and pursue their education and do that in a smoke-free environment. That's the intent.

Mr McGuinty: I'll tell you why I raise that. I'm the Colleges and Universities critic and it's been raised with me by students. The example put to me was, "If I'm a student and I have a room in a residence on campus and I'm in that room alone, am I allowed to smoke?" That's the question.

Ms Mitchell: I think it's a legitimate question to ask. In the point above, with health facilities, the allowance for an exemption was put in there because some health facilities are in fact people's residences. We could certainly look at an exemption for a residence on university campus.


Mr McGuinty: One final question: The bill seems to tie in nicely with what the feds are about to do, but you seem to go ahead of them with respect to an outright ban on vending machine sales. Why didn't you think the regulations the feds proposed, insisting that they be supervised, that they be located at least five metres away from the doorway -- I looked at the impact of similar legislation in some of the American states. The results there seem to be pretty good in terms of ensuring that young people didn't get access to cigarettes through vending machines. I'm just wondering why we didn't try that first.

Ms Mitchell: As a general comment about the difference between federal and provincial legislation, I think it's quite fair to say that the federal government and provinces in addition to Ontario are moving in the same direction; however, the provinces tend to provide a little more leadership than the federal government on this issue. For example, Nova Scotia has already banned vending machines. Similarly, if you look at age, the federal law is going to 18. Four provinces have now gone to 19 and Ontario would be the fifth. You could look at it as being that the federal government sets some minimum standards for this country and the provinces have the opportunity to go beyond that.

If you have some information that says that other things besides a ban on vending machines are very effective, we would be interested in seeing it. We've gathered quite a bit of evidence that shows there is no effective mechanism to ensure that minors do not have access to tobacco from vending machines, other than a ban.

Mr Williams: Another thing worth noting is that the federal legislation provides an exception for licensed premises. In most provinces other than Ontario, minors are not allowed into licensed premises, as you're probably aware, but in 1988 the laws in Ontario changed such that minors are now allowed into certain licensed premises: restaurants and the like. The intention of the federal legislation to prevent access of minors to vending machines would work in most provinces, but it wouldn't work in Ontario. This is another reason we've expanded the legislation the way you see it.

Mr McGuinty: The minister earlier mentioned that perhaps the people running these establishments could carry loose cigarettes: packages or cartons, whatever. But as you realize, cigarettes today have become a hot commodity, and a lot of people have now stopped carrying cigarettes because of the problems associated with theft and break-ins and that kind of thing. They are not prepared, at least in some cases, to carry cigarettes behind the bar.

Mrs Yvonne O'Neill (Ottawa-Rideau): I'd like to go back to section 9. There are two or three things I'd like some comments on. Subsection 2 says "a school." In many of the rural communities of Ontario, the school is the community centre. It also has wedding receptions, dances; it is the only place. Does that mean that a school is a school is a school all hours of the day, no matter what the function?

Ms Mitchell: That's correct.

Mrs O'Neill: And that will then have to become board policy across the province when this act is proclaimed, is that correct?

Ms Mitchell: The provincial law will be that smoking will be prohibited in schools, both in the buildings and on the grounds, at all times.

Mrs O'Neill: That's going to be quite interesting in some of the rural communities.

"A shelter or station used as part of a public transit system": In my community, many of the shelters are outside and very open; in fact, there are a lot of complaints, especially with the temperatures we've been having. We have a very, very small enclosure, and two sides of the building are not enclosed. And some of the transit shelters are not enclosed at all; they're strictly designated areas of the road. What does that mean?

Ms Mitchell: What we were looking to here as the model was the city of Toronto bylaw, which I think those of us who ride the TTC regularly are familiar with. We could talk to them about how they're applying it, but if something is clearly part of the TTC system or is in the glass transit shelter, which is a three-walled structure in Toronto, that is a transit shelter and that's how it's applied. If it's simply a TTC sign on a post in the road, then it's outside, and the law wouldn't apply.

Mrs O'Neill: I think those who are viewing this today in some other cities would have some difficulty with what you've just said, that you took the TTC model, because there are a lot of other forms of transit. We have to be sure that the law covers more than the city of Toronto. I'm sure you're going to have transit systems in the province asking questions about that, because the shelters are different and the transit systems are different in the way designated areas are included.

What does paragraph 9 mean: "a prescribed place"? In regulations, are you going to be stating other places than what is listed here? Is that what that means?

Ms Mitchell: "A prescribed place" would allow the government, through regulation, to add places at a future time. However, at this time we are not intending to have a regulation with additional premises at the time of proclamation.

Mrs O'Neill: So even though we're going into a set of hearings for four weeks, you're not going to add any places at this time.

Ms Mitchell: That's the intent, that we would not add places at this particular time. What we were looking at was that over a number of years, certainly if you look at the past 10 years, we've seen social attitudes change enormously in terms of where it's acceptable to smoke or not smoke. It's important that we have the flexibility in this act that we can change the regulation in the future to keep pace with social attitudes.

Mrs O'Neill: Paragraph 4 says, "those parts of the premises of financial institutions that are open to the public." Does that change the way the law is applied in those particular workplaces? That's what they are. Does that mean all the public areas come out of the designation of "workplace"?

Ms Mitchell: A public place is not part of a workplace. The Smoking in the Workplace Act would apply to the remainder of the workplace, but financial institutions are also workplaces that are affected by federal legislation. Because what we're trying to do is allow people to go through their daily activities in a smoke-free environment and because this section deals with smoking in public places, we're talking about part of a facility that's a public place, and smoking would be prohibited. Under the Smoking in the Workplace Act, they can differentiate between a public place and the workplace. The workplace would be the area the public doesn't access.

Mr Arnott: My first question deals with section 3, which indicates you can't smoke until you're 19. You indicated the rationale behind that is to take it out of the high schools, correct?

Ms Mitchell: That was one of the reasons.

Mr Arnott: I've been approached by a few constituents on this issue, and you've heard this too, I'm sure: "You're old enough to vote at 18, you're old enough to join the army at 18 and, if there's a war, to potentially die for your country, yet you're not allowed to smoke until you're 19." I wonder about that. I also wonder about whether it has the effect you're hoping to achieve. A lot of high school kids are still going to high school for five years: If you assume they go in at age 14, which most of them do, they're still in high school at 19, if they stay in the OAC program for five years. So you're not going to have the effect of taking it out of the high schools.


Ms Mitchell: There are people who will attend high school and who teach in high schools who certainly have the right to choose to smoke, and they may carry their personal cigarettes with them. We were trying to create an atmosphere in the schools where smoking is not acceptable. Basically, most high school students are indeed under the age of 19. My impression was that people are leaving high school earlier these days than they had been when I went to high school.

The other part of it is that in order to make the sale to minors really enforceable, we have to have photo ID that can be used and is readily available to anybody. If you are the retailer in a store and the onus is on you and you're going to say to this person, "Could I please see some identification that shows you're of age," this person may well have an age of majority card because that's the readily accessible piece of ID to show age. We do have to have something that's operational.

Mr Arnott: In section 9, you've got nine examples of places where smoking will now be prohibited as a result of provincial legislation. I'm trying to get an understanding of the rationale behind those that have been picked and those that have been excluded. You talk about public places, but I don't see community halls here, for example, community arenas, churches. The minister at our church used to smoke his pipe all the time, and that's still not on the list. Restaurants: You're excluding some and including others. I'm not being critical. I'm just trying to understand the rationale for what has been included versus what has been excluded, places that appear to be subject still to municipal regulation.

Ms Mitchell: One of the ways you could look at it is that there are some areas that are fairly clear-cut in terms of where you don't want the smoking to occur. I presume the minister did not smoke in the sanctuary but probably in the private offices.

Mr Arnott: That's correct.

Ms Mitchell: In places like churches and community halls and arenas and what not, people do have very mixed feelings about where the smoking should be permitted or not permitted, and it would get into that kind of definition. But certainly if the feeling were that there are other parts of the community, such as recreational centres, where smoking was not appropriate because it is a community centre, the committee could consider that.

Mr O'Connor: One thing I'd like to point out is that in many jurisdictions the legislation goes far beyond what we've got here as a list. Many municipalities are far more inclusive about areas that are prohibited, and we're going to hear that, no doubt, as we go through the public hearings. Section 11 addresses that, so that the municipalities that do have tougher bylaws and legislation will still have the impact they've legislated locally.

Mr Arnott: I agree, but as Mrs O'Neill pointed out earlier, if you have an example where the school is the only community hall and is used that way in a small municipality, and in an adjacent town there is a small arena and smoking is allowed based on the municipal bylaws, there's certainly an inequity there, a difference.

Mr Garcia: To perhaps clarify and add to the points Brenda made in response to Mrs O'Neill's question, the ministry is going to be listening very closely to the deliberations of the committee and taking political direction. We realize this is the process. I know you will be hearing quite a lot from health groups that the list is simply too short and they will be pressing for an extended list of public places to be included. What Brenda is trying to reflect to you at this time is that we do not have any plans to go beyond this at this point, but of course we're taking political direction.

Mr Jim Wilson: I'd like clarification on a couple of points. With section 4 you're banning the sale of tobacco in designated places -- hospitals, psychiatric facilities, nursing homes, homes for special care, charitable institutions, homes for the aged and rest homes, pharmacies of course, and retail establishments under prescribed circumstances -- and then in paragraph 1 of section 9 there is an exception for designated areas. Will residents of a psychiatric facility still be able to have a designated smoking area? Is that the intent?

Ms Mitchell: Under section 9, there could be an exemption for a designated smoking area in psychiatric facilities. That would be specified in regulation, and in the process of writing the regulation we would be in consultation with representatives of that community.

Mr Jim Wilson: The committee's been sent a rather extensive petition from Penetanguishene mental health institute essentially opposing the act as written, because its interpretation is that its patients will not be allowed to smoke. The residents there are quite upset about that. I think they make a very good point in their petition, which says they're under enough stress and a lot of them do smoke, and now to suddenly be thrown into an institution where you can't smoke might be more than some of them can take. You can't just tell us you're going to do that in the regulations. You must have made up your minds by now.

Ms Mitchell: The ministry is sympathetic to the issue of psychiatric patients and smoking. We know that smoking rates in psychiatric facilities are extremely high. We're trying to balance also that if you are a psychiatric patient, you should have the right to be a psychiatric patient in a smoke-free facility. In addition, you have to consider the amount of smoke you're exposed to if you're a worker in a psychiatric facility. We're certainly open to discussions with them in defining what the exemption would look like.

Mr Jim Wilson: Again under paragraph 4(2)9 that deals with retail establishments, I just want to clarify this: If you've got a large Zellers store that has a pharmaceutical counter at the back, can the Zellers store sell tobacco products at the front, as it currently does?

Ms Mitchell: Not if it's one premises. The Ontario College of Pharmacists and other organizations have made it very clear to us that they want a level playing field, that all pharmacies be treated the same. Therefore, whether the premise is a pharmacy or simply includes a pharmacy, the ban would apply.

Mr Jim Wilson: I wonder if the wording here catches the pharmacy in the mall with the smoke shop next door to it.

Ms Mitchell: If the smoke shop is next door and it clearly has its own entrance off the main mall and you can't go back and forth between the pharmacy and the smoke shop, then certainly the smoke shop can exist in the mall.

Mr Jim Wilson: I'm wondering about this laundry room business. If you've ever been to a laundry in a small town, it's very much a social gathering. In fact, I campaign in them because you meet a lot of people. Whom did you consult about this one? The medical officer of health has testified that a lot of poor people smoke, and they're probably using laundromats because they can't afford washers and dryers. In your fine chart, it could be $5,000 for being caught two or more times smoking in a laundromat. That's a bit ridiculous. Next you're going to say that because the Criminal Code calls cars a public place in terms of purposes of prostitution, you can't smoke in your car.

My colleague, in error, said you had a list of nine prohibited places. You have an infinite list of places here, because the ninth point is "a prescribed place," and given that you're not about to share with us all those other prescribed places, basically this is a slippery slope, as I see it. You're hitting laundromats, retail establishments. I can see it in schools and nurseries. Mrs O'Neill raised a very good point about public transit shelters. In my area, sometimes a tree is a public transit shelter. There's very often just a centre pole with a T over it for a little bit of shelter. We're not all living in Metro, thank God. A hairdressing establishment or a barbershop? Have you ever been to a barbershop?

Ms Mitchell: Yes, I have.

Mr Jim Wilson: I think you've gone a bit far in your list. I'm a little irate about excluding pharmacies. I know some municipalities have, but the reason we have municipalities is to reflect local values. They will decide whether barbershops in their particular area, after consultation with the local barbers, want to ban smoking, or whether the people in the laundromats, of which every town has one, want smoking banned. You're putting a blanket law in, and I'd like to know who the heck you consulted with respect to those places.


Mr O'Connor: A wonderful question, Mr Wilson. I don't know whether during National Non-Smoking Week you had an opportunity to talk to some of the young people, who were of course trying to keep from becoming addicted to this substance. When I asked the kids -- I always do -- where they get their cigarettes, they told me the usual places and then some others. Some are that they go into the laundromats and go through the ashtrays and grab great big butts. It sounds pretty gross, and it is pretty gross. These kids are going in there.

The key here is that we're trying to name public places. I don't know whether it was done intentionally, but we've identified a source children are getting cigarettes from after the fact. They've been half-used. It's pretty disgusting, but it's a fact. Restaurant ashtrays are another, and I'll be glad to hear what the restaurant association might have to say. This is what I heard, and I spoke to 10 classes between grade 5 and grade 8 last week or the week before, during National Non-Smoking Week.

The list names some spots, and no doubt as we go through the committee hearings we're going to hear from people who want to see that list extended beyond what we have. I think it's fairly inclusive right now. For a number of people, activities of their daily lives includes going to the laundromat; that's part of their weekly ritual so that they've got clean clothes, so it's pretty evident why it's there. We'll probably hear evidence that maybe it shouldn't be included, but I think they've included something that will affect the young people we're actually trying to address here.

Mr Jim Wilson: Are you contemplating allowing designated smoking areas in laundromats? It's damn cold outside, and if you go to the laundromat behind the Alliston IGA, you have to sit there for two or three hours while your laundry's being done. You might want a cigarette, and it was minus 18 degrees yesterday, a little bit cold. Would they be allowed if the owner were to designate an area under this act?

Ms Mitchell: There would be no allowance for a designated smoking area in a self-serve laundry. I can speak as somebody who does do laundry at a self-serve laundromat once or twice a week -- sorry, once or twice a month -- therefore I think it's reasonable for me to comment that I think I should be able to do my laundry in a smoke-free environment. I'd also like my clothes to come home smoke-free. Also, many of the mothers and fathers who do laundry in a laundromat take their kids along. There are a lot of children playing in there and I think they have the right to accompany their parents and be in a smoke-free environment.

Mr Jim Wilson: They clearly found the right person to write this act for them, but in the small town where I live a lot of people still smoke, and they smoke in laundromats. They think it's a right to smoke in laundromats. They'd have a different opinion on that.

I have another technical question. Subsection 13(14) talks about obstruction, and it's talking prior to that about the powers of inspectors. I was wondering about that wording, that a person cannot "refuse to answers questions on matters relevant to the inspection." I'll ask Frank. You probably knew the question was coming because it was raised in second reading debate by Mr McGuinty and myself.

Mr Williams: It's fairly standard.

Mr Jim Wilson: Is it? It seems self-incriminating.

Mr Williams: It's a standard provision. We consulted with the Attorney General on this. The Liquor Licence Act has similar provisions. In fact, this whole section reflects relatively recent developments on inspection, warrants, rights to enter premises that have been developed over the last few years with the Attorney General. It is consistent.

Mr Jim Wilson: Above that it talks about the right to counsel prior, I assume, to answering questions from the inspector. Is there any onus on the inspector to inform the person being questioned of his rights?

Mr Williams: To the best of my knowledge, you provide your identification and you have to comply with what the inspector requests.

Mr Jim Wilson: It says a person "is entitled to have counsel or another representative present during the questioning." Should there not be an onus that people be informed of that right?

Mr Williams: They're not being arrested and they're not being charged, so it's not exactly the same.

Mr Jim Wilson: It could lead to an arrest or charge, though.

Mr Williams: But there are other statutes that have similar provisions. The right to have counsel isn't necessarily provided under those statutes either, and I submit to you there's no difference.

Mr Jim Wilson: I'm not asking about the right to have counsel, but the right to be informed of your right to have counsel present. Did anyone ever think that maybe the other statutes aren't perfect either?

The Chair: On that note, the final question, Mr White.

Mr Drummond White (Durham Centre): Actually, a couple of questions, but they are brief and they are related to the sections in front of us, section 9 to start with. In many areas, in my own constituency as well, schools have designated smoking areas outside of the school building itself but certainly well within the school grounds. I'm concerned that many children -- children -- are smoking and that that activity is effectively being condoned by the school administration. These are people 13 and 14 years of age in high schools. Would paragraph 2 apply to an area on the school premises as well as within a building?

Ms Mitchell: The definition we're using is the definition for a school under the Education Act. That includes the building and the grounds, and therefore under this act smoking would not be permitted on the school property either. That would be a change.

Mr White: Anywhere on the school property it would not be permitted.

Ms Mitchell: Correct.

Mr White: Thank you. The second question, equally brief, is on subsection 15(4), where we're talking about automatic prohibition: "It is a defence to a charge under subsection (3) that the defendant had not received the notice at the time the offence was committed." Under other pieces of legislation, the issue has come up of: "When was I told I had broken the law, or when was I told about the fine? Was I properly served?" etc. I'm a little concerned about that because it might serve to lengthen and make arduous the process of enforcing the law. I'm wondering if that could have any correction on that concern.

Mr Williams: Certainly the way the section's worded now it implies that if you can show that you did not actually receive the notice, the section would not apply to you.

Mr White: But wouldn't the onus be on the sender of the notice to prove that the notice had been received?

Mr Williams: I would argue it would be actually the other way around. It would be up to the defendant to show they'd never received the notice.

Mr White: You're saying the onus would be on the defendant to say, "I did not receive that notice," and there would have to be some proof they had not done so.

Mr Williams: Yes. It says it's a defence to a charge that you didn't receive the notice, so it would be up to you to prove that.

Ms Mitchell: Just to clarify, I imagine what you're thinking is that if a retailer had a second conviction they would be knowledgeable that they had the second conviction and therefore would know that the prohibition, because it's automatic, would apply. But in addition, under clause 15(3)(b), "No wholesaler or distributor shall deliver tobacco to the place," and the wholesalers and distributors would need notification because they wouldn't automatically know a retailer had been convicted a second time.

Mr White: But the retailer wouldn't need that notification or another manager of the same store shouldn't need that notification.

Ms Mitchell: A fair question.

The Chair: With that, it's 4 o'clock and we do have two presenters. I know there are probably other questions, but ministry staff will be available as we go about our hearings. I'd like to thank you all for coming today and providing the presentation.



The Chair: I call our first presenters, Physicians for a Smoke-Free Canada, if they would be good enough to come forward, and if one of you would be equally kind to introduce everyone for the purposes of Hansard and also for those who are watching at home. Welcome to the committee. We have all received a copy of your brief and attachments, and we have half an hour.

Ms Cathy Rudick: Hello. My name is Cathy Rudick. I'm the executive director of Physicians for a Smoke-Free Canada. With me are Dr Mark Taylor, the president of Physicians for a Smoke-Free Canada, and Dr Jack Micay, a Toronto-area physician who's also a member of our organization.

I'm just going to give a brief introduction the background of Physicians for a Smoke-Free Canada. We're a national organization established in 1985 as a registered charitable organization. We're a unique organization of Canadian physicians dealing with a single major health issue and clearly focused goals. This allows us to act and react quickly and decisively to deal effectively with the number one cause of preventable disease and death in Canada: the tobacco epidemic.

We have 1,400 physician members across the country, and we provide leadership for our profession in efforts to combat the epidemic of tobacco-related or tobacco-caused diseases. We are funded primarily by our individual members, with occasional small donations from outside interests, and to date we have never received government funding.

I will now pass it along to Dr Micay to give a brief introduction about the importance of this legislation and the prevention of tobacco-caused illnesses in Ontario.

Dr Jack Micay: The reason so many physicians have joined Physicians for a Smoke-Free Canada are these grim facts which I'll briefly review. Tobacco kills, in Ontario alone, 13,000 people a year; that's over one fifth of all deaths in Ontario. It's the cause of 30% of all cancers of all kinds, not just lung cancer, 30% of all heart deaths are due to smoking, and 80% to 90% of all lung disease deaths are due to smoking. That is why I feel strongly about it and why the rest of my profession feels so strongly in support of this bill. I congratulate the government for presenting it and the opposition parties, hopefully, for supporting it.

The key to stopping this epidemic, and let's be honest and call it an epidemic, is to prevent children from coming on to the market, and to help smokers quit who want to quit. The first goal, in my view, is the more important one, and it's also the easier one. It's a very addictive substance. It's considered as addictive in clinical terms as heroin and cocaine, so it's a lot easier to prevent this addiction than to try to cure it.

This legislation is currently even more important because of what may be a pending drastic decrease in federal and maybe even provincial cigarette taxes. Price and taxes are the single most important factor in the decrease in smoking rates we've seen in Canada over the past 10 to 15 years.

Canada leads the world in this regard. We're looked on as a model by other countries, and this legislation before you today is also world precedent-setting and will send a signal around the world and will have repercussions around the world.

As I was saying, price is the biggest single factor, and if the price is going to be coming down dramatically, as there are indications it will be -- there's talk of the price of a carton of cigarettes coming down from $48 to $20 to $25 -- that is going to be an absolutely tremendous factor in bringing new smokers on to the market, and those new smokers are teenagers.

People don't start smoking after their teenage years -- it's very unusual -- and teenagers are the people who are the most price-sensitive. They have the least income and they're also the least addicted, so they're the people who are most influenced by price.

If the price is going to be coming down -- I hope it isn't, but it may well be -- restricting access becomes that much more important. That is one of the factors this bill addresses. We think this is critical in terms of saving hundreds of thousands of lives of young people.

Dr Mark Taylor: As Dr Micay has said, we're all very concerned about the impact of the potential tax decrease that may be coming up. Because of that, as you can imagine, the meagre resources of our organization have been very much tied up for the last week or so, doing what we can to fight this outrageous proposition, but we're going to do the best we can in making our presentation today.

We feel very strongly that tobacco does not belong in pharmacies. We support 100% the position of the Ontario College of Pharmacists, the governing body of the profession of pharmacy in Ontario, which has determined that tobacco should not be sold in pharmacies.

If pharmacies were retailers like any other, it would not be that critical to specifically prevent them from selling tobacco. However, for several reasons, pharmacies are not like other retailers. Pharmacists dispense medications which only they are allowed to sell. As fully trained health professionals, they are very much an integral part of our health care system. When a pharmacy advertises, it portrays itself as a health care facility, not a convenience store. We all see that these days with Shoppers Drug Mart ads on television, their health watch system. Shoppers Drug Mart is not advertising itself as a convenience store or a grocery store; it's advertising itself as a health care facility. In that regard, it's inconceivable that they should be allowed to continue to sell tobacco.

Many pharmacists have long felt that it is inappropriate for them to be selling tobacco. In 1977 the Canadian Pharmaceutical Association passed a resolution at its annual general meeting that the CPhA should "encourage pharmacists to discontinue the promotion of tobacco products." The Ontario College of Pharmacists regulates the profession of pharmacy under the authority of the Health Disciplines Act. For years the college has been trying to have the sale of tobacco industry products eliminated from all pharmacies. In October 1990 the college voted to work as quickly as possible towards the elimination of tobacco sales in pharmacies. In June 1991 the college recommended that the Minister of Health ban tobacco sales in pharmacies as of July 1, 1993. The college also recommended that in the interim, Ontario pharmacists should take steps to progressively reduce and eventually eliminate promotion and advertising of tobacco in pharmacy premises.

The idea to ban tobacco in pharmacies is not one that we thought up and it's not one the Ontario government thought up; it's the request of the governing body of the profession of pharmacy. Not to respond to that request would be tantamount to taking away the authority of that governing body. The governing body of the profession has asked the minister to do something, and without a very good reason not to do it, in our view, the minister should do what the profession has asked.

In order to determine the level of compliance with the Ontario College of Pharmacists' recommendations, Physicians for a Smoke-Free Canada, with the assistance of many health organizations across Ontario, has surveyed and conducted onsite inspections of a representative sample of pharmacies in Thunder Bay, Sudbury, Windsor, Hamilton, London, Toronto, Kingston and Ottawa during January 1994. In total, 385 pharmacies were surveyed, 40% of which have eliminated the sale of tobacco industry products. Interestingly, among Pharma Plus and Shoppers Drug Mart pharmacies only one location had ceased tobacco sales. All the others are independent pharmacies. So in those pharmacies which are truly independent in this province, a very large number have chosen not to sell tobacco. That's not be confused with another organization which calls itself Independent but seems to be anything but.

Early findings in our survey have shown that over 84% of tobacco-selling pharmacies were in violation of the recommendation that by January 1, 1992, back bar displays be eliminated. In addition, 28% of tobacco-selling pharmacies displayed tobacco sponsorship advertising. Again, Shoppers Drug Mart and Pharma Plus more readily violated sponsorship advertising restrictions than the independents which are continuing tobacco sales.

Continuation of tobacco sales in combination with the display of tobacco sponsorship promotional advertisements and promotional materials is of grave concern. Many pharmacies, especially among large chains, have extensive cosmetic counters. A very dangerous mixed message is sent to young women who are able to purchase tobacco along with health and beauty aids in an environment which readily advertises the Matinée Ltd Fashion Foundation, among others.


Some 23% of tobacco-selling pharmacies made tobacco industry products available from countertop self-serve units. Again, the large chains were more likely to make tobacco available without human intervention. Of the big chains, Big V has made the most progress towards the elimination of tobacco. Tobacco was not available from self-serve units and many had moved tobacco behind the counter to below-waist level. Three of 29 stores surveyed had removed tobacco entirely.

Those pharmacies that continue to sell tobacco products, particularly the chains, gave every indication that they had and would continue to ignore professional recommendations. Many education-based programs have been implemented over the years by various pharmacy bodies and yet the majority of pharmacies continue to sell tobacco. Clearly, a voluntary code for removal of tobacco industry products from pharmacy shelves will not result in compliance province-wide.

The college needs regulatory change to give it the teeth both for enforcement of the initial policy and for effective control over pharmacists, pharmacies and chains choosing to ignore the policy changes.

Those who argue against the elimination of tobacco sales in pharmacies claim that tobacco sales in pharmacies is natural and universal. Nothing could be further from the truth. Canada and the United States seem to be the only two countries in the world which permit the practice.

The code of ethics of the council of the Royal Pharmaceutical Society of Great Britain states that as of March 1987, members should not sell tobacco or tobacco products from registered pharmacy premises. To sell spitting or smokeless tobacco is considered professional misconduct. Similarly, tobacco cannot be sold in the pharmacies of Australia, Sweden, France, Belgium, Israel and Argentina, to name just a few.

To sell health and lifestyle products while selling tobacco is worse than hypocritical. For health professionals to be tacitly identifying tobacco as healthy gives tobacco an undeserved aura of safety. To identify cigarettes as products above reproach is absurd. There's an element of trust in the pharmacy business, as Shoppers Drug Mart executives have told us, and the trust is that a pharmacist is not going to put profit ahead of health and not going to promote addiction and death.

Ms Rudick: At this point, we'd like to counter some of the arguments that have been made by those in opposition to a ban on pharmacies. We'll begin with Dr Micay.

Dr Micay: One argument you'll hear is that tobacco is a legal product and that it's unfair to restrict sale of a legal product from some stores and not from others. There are various examples that can be cited of legal products that are restricted in sale. One that comes to mind is pharmaceutical products. Prescription pharmaceuticals are a legal product and they're restricted in sale, and that's to the benefit of the pharmacists: They're only available in pharmacies. Other examples I can think of are firearms, chemicals of different kinds and so on. Even tobacco is a restricted product right now, because it's restricted to people who are of age. It's illegal, supposedly, for somebody under the age of 18 to buy it. So I don't think that argument washes at all.

Dr Taylor: An argument which certainly has some merit is that if tobacco isn't sold in pharmacies, smokers will just go to other stores. There's no one on this panel, and certainly no one in our organization, who's under the illusion that eliminating tobacco sales from pharmacies will stop everyone from smoking.

However, it is well known that one of the best ways to begin the restriction on the sale of anything is to limit the number of places in which it can be purchased. If a smoker has to delay his purchase of tobacco for even 10 minutes -- he's at the pharmacy; he can't buy them there so he has to go across the street -- that 10-minute delay will result in a reduced consumption of tobacco even in and of itself.

The other problem is that a large number of people who are tobacco addicts have to go to pharmacies to purchase their medications to treat their chronic bronchitis or emphysema or lung cancer or heart disease or peripheral vascular disease or cancer of the pancreas or cancer of the bladder. When they go to the pharmacy to get their medications, they're desperately trying to quit smoking, and right in front of them, which they can't avoid, are great big displays of cigarettes. Eliminating those cigarettes would be eliminating one source of temptation for those addicts who are desperately trying to quit.

Dr Micay: Another argument you will hear from some pharmacists, a minority of pharmacists I would say, is that pharmacists are in the best possible position to give smoking cessation advice. I think that's pretty obviously self-serving, and I would say that you can't argue at the same time that you have to sell tobacco to stay in business and that you're going to be telling your customers not to smoke. I'm not impressed by that argument and I hope you're not.

Ms Rudick: I'd like to add an anecdote to that. When our volunteers were doing the onsite inspections, prior to going out to investigate the stores that continued to sell tobacco products we called the pharmacies to determine whether they sold. The phone number I gave everyone was a phone number for the pharmacy itself, and not once was someone offered smoking cessation advice when they phoned to find out the price of a pack of cigarettes. People were directed straight ahead to the front of the store to get the price of the product.

Dr Taylor: The argument I personally find most contradictory is that pharmacies depend on tobacco revenue to stay in business. They usually make that argument immediately after they say the pharmacists are in a good position to promote smoking cessation advice. On the one hand, they're telling us they must have the money from tobacco sales. On the other hand, they're telling us they discourage people from using the tobacco. Both of those cannot be true. No one is going to effectively discourage the consumption of a product on which their livelihood depends, so one of those is wrong.

The only literature I'm aware of on this topic was a survey done by the Canadian Pharmaceutical Association which found that of all those pharmacies that have voluntarily stopped selling tobacco, none have gone out of business because of the loss of revenue from tobacco and most of them suffered no loss of revenue at all.

Dr Micay: Another argument raised by the minority of pharmacists who continue to sell tobacco is that since tobacco's a dangerous drug, they're in the best position to control it. Again that strikes me as hypocritical and self-serving, and it really misses the point about tobacco.

Tobacco is harmful in even the smallest doses and it's lethal and it's addictive. When it's discovered that one of the prescription drugs being offered has lethal side-effects, it's taken off the shelves immediately by the drug companies and by the pharmacists. Why would they take away one poison and allow another poison, especially a poison that has no redeeming features? It's strictly a poison. It doesn't cure or treat any illness at all.

Dr Taylor: Pharmacists say they want a level playing field. I agree with that. There should be a level playing field, and the playing field that's level should be the playing field the governing body of the profession wants. The governing body of the profession of pharmacy in the province of Ontario wants the field level at zero tobacco sales, and that's where we should have it. Currently, all of those pharmacies in Ontario which have voluntarily stopped selling tobacco because of their own ethical concerns are now at a serious disadvantage. The field is not level for them. They're losing a tremendous amount of volume and business to those pharmacies which do sell tobacco. So let's level the playing field at a spot which is the ethical high ground and is also that ground demanded by the profession itself.

Ms Rudick: Tobacco sales in pharmacies should be completely banned. All efforts should be made to ensure that the pharmacy provision is enacted as expediently as possible. Tobacco-selling pharmacists have been well informed and provided with voluntary guidelines for removal of tobacco over an extended time frame. If the pharmacist chooses to be irresponsible and fails to follow the recommendations, based on an inaccurate assessment of the likelihood of continuing tobacco sales, they have only made a conscious decision to ignore the inevitable.

In addition, Physicians for a Smoke-Free Canada recommends that the definition of "pharmacy" be redefined to prevent direct exclusive access between pharmacies and retail areas devoted to tobacco sales. We propose the following definition:

"Premises in or in part of which prescriptions are compounded and dispensed for the public or drugs are sold by retail, as well as all contiguous retail space, whether under common ownership or otherwise, within the premises and whether used for the sale of health care products or otherwise."

Dr Taylor: We are open for questions now.


Mr Jim Wilson: At the outset, I agree with much of what you've said, but you've obviously spent a great deal of time talking about the banning of the sale of tobacco products in pharmacies. For the record, to be as clear as I can, I see it not as a health issue but as a retail freedom-to-do-business issue. You talked about a level playing field. I've not heard any pharmacist make the argument that they are reliant strictly upon the revenues from tobacco sales, but they are to a great degree reliant on the flow of tobacco customers who may come in and buy other products.

Having all of my life been part of a family retail establishment, I can tell you we sold gas for many years; we never made any money on the pumps out front, but it brought people and traffic flow in. We probably sold a lot of things that weren't particularly good for you, including tobacco, but it brought people into the store to buy other products. In fact, we always put the post office at the back of the store so that people had to walk through the store. We also put tobacco sales at the back of the store so they had to walk through the store, and they would pick up other things along the way. I guess that's my bias.

But you make some very good arguments, and obviously the government has agreed with most of those arguments. I'm a bit confused as critic, though, because the College of Pharmacists came here when we were dealing with the sexual abuse legislation and told us it did not want to be responsible for its retail employees at the front of the store if they were to say something sexually abusive. At that time they told us they were a retail establishment. Now they're telling us that the whole bloody store is a health care facility. You can't have it both ways, is what I told the college. In one act, you don't want to be responsible for the high school student or someone who's your cashier at the front of the store, but now you're telling -- and by the way, a lot of the people on the college are not retailers. They don't look at this as a business issue at all; they look at it as a health issue, as I'm sure you do.

I'm a little confused, having spent three years listening to all sides of this issue. You can't have it both ways. During the sexual abuse hearings, I took the stance that they were a retail establishment and that, unfortunately, they would be responsible for the clerk at the front of the store who may say something that has nothing to do with the pharmacy at the back of the store. That's the way that piece of legislation ended up. Call me stupid, but don't send me mixed messages, because I've got to respond to my constituents.

Dr Taylor: I'm in no position to explain the position of the Ontario College of Pharmacists on those two issues. You'll have to ask them. However, on the issue of bringing people into the store to buy other things, as I said, the only study I'm aware of having been done on this issue is the one by the Canadian Pharmaceutical Association. It looked at all those pharmacies which had voluntarily stopped sales, and of the 56 responding pharmacies that had eliminated tobacco, 59% had no loss in sales or an increase in sales, 13% had marginal losses and 7% had moderate losses, but all 20% claimed to have recouped their losses after, at most, two years. Two pharmacists out of the total 56 have had some significant losses which have not been recovered.

Dr Micay: It should be mentioned that tobacco is a low-margin product. The experience of pharmacists who have taken it off their shelves and replaced it with higher-margin products is their bottom line doesn't suffer at all.

Mr Marchese: First, I want to make clear that I support the prohibition of tobacco from pharmacies. I want to be convinced, however, about accessibility being a factor in the diminution of smoking, because I'm not entirely convinced. I liken that to another situation, with young people who have a compulsion to eat. When you prevent them from eating or tell them they shouldn't, it becomes worse: They tend to develop more of a psychological dependence on it or sneak food when you don't see them; they find a way to feed the habit or the compulsion. I'm wondering if the situation is similar to smoking. If people want to smoke or have become addicted, does restricting the availability of cigarettes diminish the desire to find that cigarette package somewhere else?

Dr Taylor: I think there are two issues. First, on the issue of children, the fewer outlets that sell tobacco, the easier they are to control. The smaller the number of outlets which sell it, the less likely children are able to obtain tobacco. I'm not making the accusation that pharmacies sell to children; most of the time pharmacies are better than most corner stores on that issue, that's for sure, but the fewer number of total outlets, the better in terms of total sales.

I agree with your arguments about when you're actively trying to discourage the consumption of an addict. What I'm talking about is helping those people who have already made the decision to quit. Not being able to buy tobacco in a pharmacy is not going to convince anyone that they should quit. I'm talking about those people who have decided they want to quit, go into the pharmacy and see the cigarettes right in front of them. It's extremely tempting, because tobacco is so profoundly addictive. It's those people that I'm concerned about in that particular argument.

Mr McGuinty: Let me congratulate you on your work. I'm sure we've all heard about you for some time in terms of the efforts you've been putting into this, I assume on a voluntary basis. You do good on behalf of your profession.

You raised some compelling arguments with respect to supporting the ban on pharmacies. Something one of the doctors said struck me: the way you categorized the opposition parties. I want to make sure you understand our position here. Our position as members of the opposition is to raise all the arguments that are out there, even the minority ones, even the ones that some of us don't want to hear. That's why we do that. It's important for people out there who are going to suffer adverse effects. The government is going to remove a right from pharmacists, and I think it's incumbent on it to show why that should be done.

There's something I could ask you specifically, though. Section 9 outlines a list of places where you won't be allowed to smoke. Somebody raised something earlier that I thought was a good point. Why couldn't we add physicians' offices to that list?

Dr Taylor: Absolutely.

Mr McGuinty: There's something else while we're on that point. Sometimes you have to do a lot of reading while you're waiting to see your physician, and a lot of those magazines contain ads for cigarettes. That's something to consider.

Dr Micay: That's a problem that has been noticed by doctors. A number of doctors don't allow such magazines. There's a group of doctors in the United States that makes stickers they give to their members to slap on top of those ads, which ridicule the ads or make fun of them.

Dr Taylor: Of course Canadian magazines don't have any tobacco ads; they just have ads for all the tobacco-sponsored events going on. If the Ontario government chose to ban advertising of tobacco sponsorship in magazines and to include American magazines in that ban, it would be wonderful and I would support it 100%.

The Chair: On that note, I regret we have to stop the questioning. Thank you all very much for coming before the committee today, both for your written and oral presentations.



The Chair: I call our last presenters for the day, the representatives from the Ontario Restaurant Association. Welcome to the committee. We have some healthy water and we're smoke-free.

Mr Paul Oliver: Good afternoon. I am Paul Oliver, president of the Ontario Restaurant Association. With me today is Rachelle Solomon, the association's manager of government affairs.

The Ontario Restaurant Association welcomes the opportunity to respond to Bill 119. As many of the issues raised in this legislation do not directly relate to the foodservices industry, the recommendations and comments put forward by the ORA will focus only on a few sections of Bill 119.

The Ontario Restaurant Association is a non-profit industry association which represents the restaurant and foodservice industry in Ontario. The association, which was founded in 1939, currently represents approximately 4,500 members representing thousands of foodservice establishments throughout Ontario. Our members are drawn from a wide range of establishments, both licensed and non-licensed, contract caterers, accommodation establishments, quick service restaurants and many other foodservice establishments.

The foodservice industry is a very diverse activity, feeding consumers in all circumstances ranging from fine dining to quick service establishments to factory cafeterias. In total, the industry includes what we would consider 11 distinctive characteristics.

The foodservice industry is dominated by small, independent operators who account for approximately 78% of the companies in the industry. Many operators within our industry, particularly the small, independent operators, are currently struggling to survive. Unfortunately, the cost of doing business in Ontario for the hospitality industry is increasing at an alarming rate, in particular the costs associated with the regulatory and compliance burdens placed on operators.

In January 1993, the ORA had its first opportunity to respond to the Ontario Ministry of Health's discussion paper on the planned legislation for the Ontario Tobacco Control Act. The ORA once again welcomes the opportunity to provide input, this time on Bill 119, the proposed legislation that was developed from the discussion paper.

Ms Rachelle Solomon: The first issue I'd like to talk about is the prohibition of smoking in designated places. We're very pleased that restaurants and bars have been exempted from prohibition of smoking in public places. The ORA believes that any changes to the foodservice establishment's smoking/non-smoking ratio should be left to the discretion of the operator and should be a reflection of customer demand.

The ORA believes that restaurant and foodservice establishments should not be viewed in the same context as public transit facilities or health care facilities, because the latter are mandatory entrance facilities, whereas in the case of restaurants a customer can make the decision about whether to enter.

Foodservice operators are very sensitive to making changes as a result of regulation or legislation; however, they are responsive to customer wants and needs. Some restaurants in Ontario have already converted to a 100% smoke-free environment as a reaction to the needs of their customer base. These operators have not been forced to change through regulations but have volunteered change, resulting in a progressive and positive response to the expectations of their individual customers.

The ORA feels that restaurants and bars should not be singled out as a culprit in the campaign against secondhand smoke. A much larger proportion of all smoking is done in the home. Children, senior citizens and pets are being placed at higher risk in their exposure to secondhand smoke in the home, because it is not as efficiently ventilated as a restaurant and because of the greater amounts of time spent in the home. A restaurant dining experience is a leisure activity that is purely voluntary.

We'd like to stress the importance of education rather than legislation in deterring smoking.

Our first recommendation is that the current exemptions for bars and restaurants in Bill 119 be maintained.

The second issue is controls relating to smoking tobacco. The ORA strongly opposes the section of the legislation which could ban smoking in restaurants. If the restriction on smoking is to be altered in the future, we believe it should be done through the legislative process, where there is political accountability and public input, and not through regulation. Therefore, we recommend the removal of section 9, paragraph 9, in which the government may prohibit tobacco smoking in a prescribed place.

With respect to municipal smoking restrictions in restaurants, we are concerned about the growing prevalence of municipal bylaws which place restrictions on smoking in restaurants. We believe that by allowing municipalities to make their own bylaws concerning smoking in public places, a patchwork of legislation is created which diminishes the effectiveness of the message, creates an administrative burden and creates competitive disadvantages. The ORA believes the provincial government should assume full responsibility for the regulation of smoking in restaurants and recommends that the provincial government work with the food service industry and municipal health officers to develop legislation which will set a provincial standard with respect to smoking which is applicable to all municipalities and is established as both a minimum and maximum for all municipalities in Ontario.

We also recommend the development of a working group comprised of government and industry representatives which would work together to develop a provincial standard with regard to smoking in restaurants and bars. We would be very pleased to be a member of a working group designed to achieve this end.

With respect to the prohibition of vending machines, we share the government's concern about the availability of tobacco products to minors through vending machines but believe a complete ban on vending machines goes beyond the government's stated objectives.

British Columbia recently introduced the Tobacco Product Amendment Act, which recommended that cigarette vending machines be permitted in premises where only adults are permitted. We see this as reasonable for Ontario since it would ensure that cigarettes are not being purchased by anyone below the age of majority. Therefore, we recommend that operators be permitted to place vending machines in age-controlled licensed establishments.

In terms of both operators and employees, we support the placement of cigarette vending machines in areas where the public is not permitted or in areas accessible only to restaurant employees, such as the kitchen area or back-of-the-house facilities. By permitting vending machines in non-public areas, it would allow for an element of control by the establishment to ensure that any customer who wishes to purchase cigarettes is of legal age to do so, as only waitpersons would have access to the vending machine. This would also help the security to the employee. Vending machines help to reduce the possibility of threats of physical violence by persons committing break-ins or robberies or having the intention to do so. They act as a deterrent against crime when compared to simply having cigarettes behind the bar. Therefore, we recommend that operators be permitted to place vending machines in areas not open to the public.

In conclusion, we appreciate having the opportunity to present our opinions on Bill 119. The initiatives under the province's tobacco strategy are progressive in that they augment current municipal initiatives and trends towards good health and a clean environment. The province should be congratulated for not taking a prohibitionist approach but for establishing reasonable guidelines that prevent Ontario youth from starting to smoke.

Mr Wessenger: The first question I have is with respect to your proposal concerning the provincial setting of standards in terms of smoking and non-smoking aspects of restaurants. Would you prefer a provincial standard as opposed to the varying municipal standards even if that meant a standard at the higher level, say at the high municipal level?

Mr Oliver: I think what you would need is further consultation between the industry, municipal health officials and the province. We would like to see a standard that's set as the maximum and minimum. We don't want to see it as the bottom and that municipalities can still randomly at will exceed that level. What we have now is situations where in one municipality it could be 30% non-smoking and right across the street it could be 50% non-smoking, so the operators have different playing fields. We're currently surveying our members on what is the most workable percentage for their establishments, but what we would like to see is that the whole responsibility for smoking in restaurants and setting that standard be taken over by the province and out of the hands of the municipalities.

Mr Wessenger: Basically, you'd favour that the whole matter to be dealt with at the provincial level as distinct from a municipal level.


Mr Oliver: Yes, because it will eliminate the competition. Also, for chain operators, if they've got 20 different locations in 20 different municipalities, they've got 20 different rules to follow. We think moving to a provincial standard would reduce resistance from the industry because of the competitive aspects and that you'd get a lot more industry support for it. Now we have municipalities where it's almost that this is the issue when their agenda is slow, that they move with this, and then the inequities in the system become very prevalent.

Mr Wessenger: The second question relates to the ventilation mechanism study I understand you've done. Have the recommendations of that study been implemented in any of the restaurants and do you have any idea of the cost aspect of it?

Mr Oliver: The cost aspect is certainly a major concern, because it varies between establishments. With a single, standalone, one-storey establishment, it's much easier to do it. We've distributed it widely within the industry and encouraged operators to adopt it. We've certainly encouraged people designing new restaurants to use it as a basis, because if they're starting from ground zero putting in a new ventilation system, modifications outlined in our study would be easily accommodated.

Mr Wessenger: Are there any special considerations? You're mentioning ventilation standards, that you believe they should be established. Do you think your study would be beneficial to other situations where people are smoking, situations other than restaurants?

Mr Oliver: There may be limited application; I'm not sure. We've based it on the restaurant industry, different air pressure in the smoking area versus the non-smoking area and following the air flow. My understanding is that most workplaces now have separate ventilated rooms, or a lot of them do. We're certainly willing to share it with anyone who's interested in it.

Mr McGuinty: Thank you for your presentation. I'm interested in your section dealing with the vending machines. The government seems to feel it would be impractical or unreasonable to expect that your members would be able to properly supervise a cigarette vending machine. I'm wondering how you respond to that.

Mr Oliver: In a lot of establishments, the control is there now for people purchasing beverage alcohol and other age-accessibility issues; we're talking about permitting them into licensed establishments, into an area supervised by an employee.

One reason we're concerned is that a lot of establishments use the vending machine as both a security and control mechanism. To keep a dozen boxes of cigarettes behind the bar certainly encourages some type of criminal activity, even just breaking into the establishment after it's closed to access that. The vending machine acts as a barrier to that, and it also means an employee does not have to deal with the product or does not have to handle it where they would be having a dozen different boxes under the bar. That's been raised as one of the major concerns operators have.

We think there are two ways to handle it in establishments that don't have age-controlled accessibility: that it would not be available to the public but would be accessible to the employee if someone wanted to purchase a box of cigarettes; and in an age-controlled establishment, it could be by the bar or accessible to the public provided there is an age mechanism in entering the establishment.

Mr McGuinty: How likely is it that someone under the age of 19, in an age-controlled licensed establishment, would have access to a cigarette vending machine?

Mr Oliver: We would see it as very limited, if not non-existent. For example, to enter a nightclub that's age-controlled, they would have shown their identification or had some screening process to enter the establishment. If they're going to put forward fake identification to get into the establishment, they're going to do anything to get it, whether going into a variety store -- that's not going to be a barrier to them.

Mr Arnott: Is it fair to say that the Ontario Restaurant Association supports the bill in principle as it is now?

Mr Oliver: We've commented on specific sections that impact the restaurant industry. We certainly support the fact that it hasn't put more smoking restrictions on the restaurant industry relative to consumer demands. Generally, the bill has fairly good support in terms of limiting the availability of tobacco products to young people. You'd never catch me arguing against that.

Mr Arnott: I'm also interested in section 9. You expressed concern about paragraph 9, which leaves open the possibility of the government arbitrarily adding restaurants to this list at some point in the future. I asked earlier what the rationale is or the thinking that was applied to generate the list as it exists. Hopefully, you'd get an indication of what the government's plans are in the future if you could understand its thinking.

I didn't really understand the answer, but perhaps you've given a fairly good explanation: that these are premises you can walk past, in theory, as opposed to others you have to enter. But I share your concern: I think we understand that this isn't the end of the line in terms of tobacco regulation, an issue that's been with us for 35 years, and new restrictions are applied every few years. I share your concern in that respect.

Mr Oliver: Certainly we don't see this as the end. We see tobacco legislation, restrictions on smoking and access to tobacco, evolving to reflect consumer preference or social changes. But if we're going to make major changes to where you can smoke or purchase the product, we think it should come back to the legislative process so people like the committee members here would have input, the public would have input. We wouldn't want to see these decisions being made in-ministry, where there isn't political accountability. We think hearings like this are very beneficial to the public policy process, and making major changes should come back here. It may take a few months longer to take it through the legislative process than doing the regulation, but we think it improves the process and improves the legislation itself.

Mr Arnott: And accountability as well. It's a valid point.

I have another question about your position on municipal restrictions. You suggest that there should be a province-wide standard applied as opposed to patchwork standards, municipality by municipality. Are there any jurisdictions you're aware of in the United States or in Canada that have either a state-wide or province-wide regulation of tobacco use?

Mr Oliver: I don't have a list offhand, but many of the states in the US are looking at it or have moved in that direction already. Our counterpart associations in the United States have endorsed that concept because it creates a level playing field for everyone, and it also addresses the needs and concerns of chain operators that are operating in multijurisdictions in Ontario.

Mr Arnott: There is an issue of local autonomy that would come into play there, and that would change if indeed what you're suggesting were --

Mr Oliver: That's one of the reasons we have suggested a multistakeholder group with municipal officials on it, so that they would have an input into developing that with the industry and with the Ontario Ministry of Health and the provincial government.

Mr Arnott: Another relevant point with respect to this discussion as it affects restaurants is that the owner or the manager of a restaurant has a direct interest in making sure that commonsense rules are applied with respect to smoking, because a non-smoker may very well not want to have smoke blown in their face during the course of enjoying a meal and might not come back if that happened. I think that's something the government has to consider as well, that self-regulation with respect to restaurants is very likely the best way to handle this issue.

Mr Oliver: If you survey restaurants, depending on which sector of the industry they're in, certainly we've seen a lot that go well beyond what the municipal legislation is. For example, Taco Bell introduced a 100% ban recently. Tim Horton Donuts has a target of 100 non-smoking stores before year-end. They're doing it because the consumers are telling them to do that, just as our industry brought in lighter meals during the 1980s because the consumer wanted a healthier choice, and our industry is moving that way.

As you say, the customer has the final say about whether they want to come back to our establishment or even want to arrive at the establishment. Customers don't hold back when they tell the operator their comments.


Mr Tony Martin (Sault Ste Marie): On a tangent to the health issue, which is primarily what this is about, I'd like to focus a bit on the economics of doing business as a restaurateur in today's world. For a time before I had this job I worked with teenagers in various forums, and smoking brought with it attendant difficulties in terms of burned carpets and a terrible mess that needs to be cleaned up and this kind of thing. Is there anything in this legislation that would give you some platform from which to go into a development in your industry that would be helpful re that kind of consideration and the cost it incurs?

Mr Oliver: Currently, operators can make the choice. If they want to put further restrictions on smoking to prevent that or introduce a complete ban, there's nothing that prevents them from doing that. The proposed legislation would not put a further restriction on an operator who wanted to do that. I don't think there's anything in the legislation that would help them address that issue, but I certainly don't see anything in there that would hinder them from addressing the issue themselves.

Mrs O'Neill: I want to go back to the vending machine and what you've said on the bottom of page 7. You have suggested to put the machine in a certain place. It wouldn't be the first place I'd think of, so you obviously must have a reason from looking at your industry and from consulting with restaurateurs. Could you say a little about why you have chosen that particular --

Mr Oliver: For putting it into bars and restaurants? Because there's an age control.

Mrs O'Neill: But at the bottom of page 7 you're talking about the actual location.

Mr Oliver: That was a separate proposal. A lot of establishments in the hospitality industry use the machine, and it's often the employee who accesses the machine because someone will ask for a certain type of cigarette or a pack and they will get the money from the customer and go and access it; they use it as a control management mechanism in the establishment. But it also eliminates the potential of having a whole bunch of cigarettes exposed that someone from outside the establishment could enter to try to seize. They use it as a mechanism because the owner-operator is the only person who has access to the machine, so it acts as a secondary barrier to a violent crime or some type of crime to access it. It's almost a management tool.

We're suggesting that operators should still be allowed to use it as a management tool. In this case, we're proposing that it be away from public access, in the kitchen or in the staff-only area, the same way as a dispenser for other products in the establishment should be allowed. Our reading of the act would suggest that even if it weren't available to the public and were in a secured area, you still could not have a vending machine. A lot of operators in our industry have purchased these machines, invested money in them and don't even have them available to the public now. We don't think further restrictions should be placed on those operators.

Mrs O'Neill: Have you had any response to this -- I don't know whether it's a problem or a solution -- from the government on this issue?

Mr Oliver: We are raising it here as part of the consultation process. We raised our views during the discussion paper process on vending machines and now we're putting forward what we think is a manageable recommendation.

Mrs Haslam: My question is along the same line. You state it would be put in back-of-house facilities or the kitchen area. Do your members generally agree with this, or do they have other options such as selling from behind the counter?

Second, what about underage people who work in the kitchen or who are servers? Not all restaurants hire 19-year-olds. I ought to know, because I've got two children who worked in restaurants for a time. When I go into a take-out restaurant to order, the people in the kitchen and back-of-house area are not older than 19; some are 18. That then begs the question of a friend saying, "Get me cigarettes from the vending machine at work." The access is still a problem from the youth point of view, which is what I'm very interested in.

Third, do you see a difference in handling this particular situation in the bars, taverns, those types of facilities, versus family restaurants or other facilities?

Mr Oliver: From the surveys we've done of members, very few of the family-style restaurants retail tobacco products and they're actually shrinking their smoking areas dramatically.

Mrs Haslam: So this wouldn't be a solution for them.

Mr Oliver: It hasn't been raised as a problem for those. It's the traditional licensed establishment, nightclub, tavern-style operation. Tobacco sales and children is a concern, but it's about the same concern you'd have that there's no age minimum in a variety store that sells cigarettes: You could have a 15-year-old in a variety store selling cigarettes. We think the chances of it happening would be the same in a restaurant as in a --

Mrs Haslam: But the vending machine doesn't ask for identification as a clerk in a convenience store must, by law. A vending machine does allow access without accountability.

Mr Oliver: Possibly, but I thought you were asking about the issue of an employee under the age of 19 accessing it themselves.

Mrs Haslam: That's correct.

Mr Oliver: The places we would see this happen would be in licensed establishments predominantly. It is the server, and in Ontario they have to be of a certain age to serve beverage alcohol. We think those regulations or restrictions can be placed on it to address those concerns.

Mrs Haslam: Versus selling across a counter.

Mr Oliver: Yes. We're not talking about this type of thing being applied in a Burger King or a McDonald's. They don't sell tobacco now and we don't anticipate they will in the future. It is the bar and nightclub type of establishments, which have a clientele over the age of 19 and have a workforce that's predominantly over 19.

Mrs Haslam: But do they see this as being better than across the counter, where there is more accountability? I'm concerned about accessibility and accountability for selling cigarettes to minors.

Mr Oliver: There's certainly a major concern about selling it over the counter, because we've seen a dramatic increase in violent crime pertaining to cigarette sales. To have a dozen cartons open behind the counter raises that issue and it raises a major concern on both the employee and operator sides. The chance of someone holding up a machine to get a hundred loonies out of it is very limited compared to someone holding up a bar operator. Also, selling tobacco, because of the cost of it now, for some establishments would make up as much as alcohol sales.

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

Before adjourning, members, two things: First, you have a copy of the agenda for the next several weeks, if you could check that over, particularly in terms of the other places we'll be: London, Sudbury, Thunder Bay and Ottawa. The other point is that we have requested of the House leaders that one of the four clause-by-clause days be changed to a hearing day. If we do that, we will be able to hear from everyone who requested to appear before the committee. The request we've made is that we sit on either Wednesday, February 23, or Thursday, February 24. As soon as we get word from the House leaders, I'll let you know. It would mean the week of March 7 would be three days for clause-by-clause instead of four.

Mrs O'Neill: When we have to come early to Toronto, for instance, when we go to Thunder Bay, will be given the exact time and flights of when we're going to be connecting?

The Chair: That information should have been sent to your office.

Mrs O'Neill: We have all the flights already?

The Chair: Yes. If there are any problems, by all means have your staff talk to the clerk.

Mrs Haslam: Is this room secure?

The Chair: No. Take your material with you.

The committee adjourned at 1700.