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TOBACCO AND HEALTH
FEDERAL LEGISLATION AND REGULATORY ACTION
HEALTH POLICIES AND PROGRAMS
Parliamentary Research Branch
Over the past several decades, North America has witnessed a revolution in attitudes to tobacco smoking. What was once considered a normal habit has become increasingly socially unacceptable. An ever-growing number of non-smokers are much less tolerant of smoking, and anti-tobacco health groups have become very vocal in their opposition to it. Governments and other organizations have become more receptive to lobbying efforts and are introducing bans and restrictions on smoking.
Since the 1960s, research has documented the health risks of tobacco smoking. Originally, the emphasis was on the danger to the smoker, but in recent years other concerns have arisen. Cumulative studies strongly suggest that non-smokers are at risk from inhaling environmental tobacco smoke (ETS). As well, an increase in youth smoking is becoming a focal point of government attention. Finally, international organizations have become more and more concerned with what the World Health Organization calls "the tobacco epidemic: a global public health emergency," and with the international perspective on tobacco abuse.
While most experts and governments accept the scientific and medical evidence of the dangers of tobacco smoke, changes do not come easily. Tobacco is a highly addictive product and many smokers find it difficult, and sometimes impossible, to stop using it. Manufacturers of tobacco products, who naturally minimize any tobacco-related health risks, are a powerful lobby group. Tobacco farmers can also be a strong regional interest. Government policies often reflect conflicting objectives since tobacco products bring significant tax revenues yet there is increasing concern about the rising costs of treating tobacco-related illnesses. Though higher taxes deter smoking, they can also lead to smuggling and other illegal activities.
In the past decade, governments have introduced a number of measures designed to reduce smoking. The federal government has enacted the Tobacco Products Control Act, the Non-smokers Health Act, and the Tobacco Sales to Young Persons Act. Most recently, Bill C-71 (now the Tobacco Act) received Royal Assent in 1997. As well, provincial and municipal governments are taking significant initiatives.
Parliamentary Research Branch
When Europeans first explored the New World, they found the Aboriginal inhabitants smoking tobacco leaves, and apparently deriving therapeutic benefits and pleasure from this activity. By the 17th century, European physicians were prescribing tobacco in various forms for medicinal purposes. Even after it was realized that these "cures" were ineffective, tobacco grew in popularity. In the 20th century, cigarettes and pipes came to be associated with sophistication, leisure and affluence; films and advertisements helped to popularize smoking and to develop its connotations of glamour. While smoking was traditionally associated with masculinity, in the past several decades advertisers began to court the female market successfully. Only recently, when its links with various health problems were discovered, did smoking begin to decline in popularity in western industrialized countries.
Reports linking cigarette smoking with cancer began to appear in the 1920s, but it was not until after World War II that deaths from lung cancer became so numerous that systematic follow-up studies were initiated. Researchers efforts to establish causation were constrained by the fact that the most serious ill-effects of cigarette smoking may take 10 years or more to appear. By the early 1960s, however, the risks of lung cancer were found to be substantially higher for cigarette smokers than for non-smokers, as were the risks of coronary disease and stroke. The accumulating evidence of the ill-effects of smoking was publicized by the Royal College of Physicians in London in 1962, Health and Welfare Canada in 1963, and the Surgeon General of the United States in 1964.
Over the past few decades, four separate concerns have driven the anti-tobacco lobby: the dangers of smoking for the smoker; the dangers of second-hand smoke for those who must live or work in the vicinity of tobacco smoking; costs of smoking-related illness to the public health system; and, increasingly, youth smoking and the resulting creation of a new generation of smoking-related diseases.
The health dangers of tobacco have become increasingly well known. For example, smoking can cause lung cancer and various lung diseases that seriously impair breathing, as well as other cancers and heart damage. Although the reported rates of smoking-attributable diseases and death can vary with the methodology used, a 1995 study published by Health Canada reported that the total number of smoking-related deaths in Canada in 1991 was 45,064 and suggested that the number of such deaths in the year 2000 would be 46,910.(1)
After research results confirming the negative effects of second-hand smoke became public, perceptions of smoking changed considerably. The social costs of illnesses caused by second-hand smoke and the lost work time from smoke-related ailments were publicized and there were a growing number of complaints to workers compensation boards and human rights commissions about smoke in the work environment. Smoking became increasingly viewed as socially unacceptable and many felt that it should be the object of government intervention and regulation as a serious health risk.
The research on the effects of passive smoking remains controversial, however; a 1995 Congressional Research Service Report pointed out that, though the Office of the Surgeon General and the Environmental Protection Agency believe evidence shows that exposure to passive smoke brings a small, but real, risk of lung cancer, this conclusion is questioned by industry, some researchers, and others.(2)
As the estimates of smoking-related deaths and illness rose, increasing attention was paid to the costs of smoking to society. In the United States, this led a number of state governments, as well as the Blue Cross and Blue Shield, to bring lawsuits against the tobacco companies in an attempt to recover the costs of public health care necessitated by cigarette smoking. At least one provincial government has enacted legislation allowing for similar action.(3)
As with most aspects of cigarette smoking, estimates of what it costs the public health care system vary widely. Health Canada, in a 1997 study,(4) found that in Canada 1991 costs attributable to smoking were: $2.5 billion for health care, $1.5 billion for residential care, $2 billion due to workers absenteeism, $80 million due to fires and $10.5 billion due to loss of future income as a result of premature death. However, as other commentators note, individuals contribute to the health system through taxes long before a smoking-related illness appears and premature deaths attributable to smoking will actually reduce some government expenditures that would otherwise be necessary.(5)
Increasingly, societal concern has focused on youth smoking, which is widely accepted to be rising, especially among teenage girls; research suggests that nicotine addiction becomes more difficult to break the earlier one starts smoking. The focus of anti-tobacco legislation has increasingly shifted to preventing teenage smoking through education, higher prices and restrictions on "life-style" advertising.
1670: New Frances Sovereign Council imposes duties on tobacco.
1676: New Frances residents are prohibited from smoking or carrying tobacco on the streets.
1739: Canada exports tobacco to France.
1858: Macdonald Tobacco is established in Montreal.
1878: House of Commons defeats resolution to abolish tobacco taxes.
1891: British Columbia prohibits the sale of tobacco to minors, followed by Ontario and Nova Scotia in 1891, New Brunswick in 1893, and Northwest Territories in 1896.
1906: Federal Department of Agriculture establishes the Tobacco Branch.
1908: The Tobacco Restraint Act makes it illegal to sell tobacco products to anyone under 16 years of age.
1912: Imperial Tobacco, established in 1908 through a merger of the American Tobacco Company and the Empire Tobacco Company, is incorporated.
1914: House of Commons Select Committee on Cigarette Evils conducts public hearings.
1927: First Canadian advertisement showing a woman smoking a cigarette appears in Montreal Gazette.
1950: Large-scale epidemiological studies showing a statistical association between lung cancer and smoking are published.
1952: Federal government reduces tobacco taxes in response to a rise in cigarette smuggling.
1954: Canadian Medical Association issues first public warning on the hazards of smoking.
1957: Ontario Flue-cured Tobacco Growers Marketing Board is established.
1961: Results published of major Health and Welfare study, initiated in 1954, on the effects of smoking on Canadian war veterans; 60% more deaths among cigarette smokers than non-smokers are reported, and an association is made between cigarette smoking and an increase in lung cancer and heart disease.
1962: Report of the Royal College of Physicians in London, England, provides research evidence of the harmful consequences of smoking.
1963: Federal Minister of Health and Welfare, Judy LaMarsh, drew attention to the link between cigarette smoking and lung cancer, coronary heart disease, and chronic bronchitis.
Canadian Tobacco Manufacturers Council is established.
1964: Report of the Advisory Committee to the United States Surgeon General concludes that lung cancer and chronic bronchitis are medical consequences of smoking.
Canadian tobacco industry adopts first voluntary code on marketing practices.
1965: Federal Department of National Health and Welfare commissions national survey on smoking.
1967: Federal Cabinet approves preparation of legislation to require statements of tar and nicotine levels on cigarette packages and in advertising; however, no bill is introduced.
1969: A report by the House of Commons Committee on Health, Welfare and Social Affairs (Isabelle Report) contained recommendations on restricting the advertising and promotion of tobacco products.
1970: In its first anti-smoking resolution, the World Health Assembly calls upon governments to act against smoking as an avoidable cause of death.
1971: The government introduces Bill C-248 to ban advertising of tobacco products; however, the bill is not debated. Instead, the tobacco industry and the government agree to voluntary guidelines.
1974: The Canadian Council on Smoking and Health and the Non-smokers Rights Association are founded.
1976: City of Ottawa passes first municipal bylaw restricting smoking in public places.
1978: Imasco acquires Shoppers Drug Mart.
1979: Nicotine gum is made available in Canada on a prescription basis.
1985: National Strategy to Reduce Tobacco Use is established with representation from federal, provincial and territorial governments and eight health organizations.
(1) Larry F. Ellison, Yan Mao and Laurie Gibbons, "Projected Smoking-attributable Mortality in Canada, 1991-2000," 16 Chronic Diseases in Canada (1995), at http://www.hc-sc.gc.ca/hpb/lcdc/publicat/cdic/cdic162/cd162c_e.html.(4) Murray J. Kaiserman, "The Cost of Smoking in Canada, 1991, 18 Chronic Diseases in Canada (1997)," at http://www.hc-sc.gc.ca/hpb/lcdc/publicat/cdic/cdic181/cd181c_e.html (5) Jane G. Gravelle and Dennis Zimmerman, "Cigarette Taxes to Fund Health Care Reform: An Economic Analysis," 8 March 1994, at http://www.forces.com/pages/crs-tax.htm.
Parliamentary Research Branch
Over the past 30 years, Canadians smoking habits have evolved in the general direction of fewer smokers and lower tobacco consumption. There are, however, still disparities in tobacco-use patterns between the sexes and among different age groups, regions of Canada, and socio-economic and cultural groups.
The cigarette market in Canada has shrunk considerably over the past 16 years. While in 1982 domestic tobacco sales reached a peak of 73.2 billion "cigarette equivalents,"(1) by 1997 the figure was 49.8 billion, or a decrease of 32%.
The drop in daily consumption of cigarette equivalents by Canadians aged 15 and over began in the mid-1970s, and has continued steadily ever since. Daily per capita consumption has fallen by 50%, from 11.5 cigarette equivalents in 1973 to 5.8 in 1997.
Until the early 1980s, the cigarette price index generally followed the same trend as the consumer price index, although the latter increased 60% faster than the cigarette price index between 1950 and 1980. Between 1981 and 1992, however, as a result of major excise taxes imposed on tobacco products (see "Taxation of Tobacco Products"), the cigarette price index shot up six times faster than the consumer price index. In 1993, faced with a growing tobacco-smuggling problem, Canadian governments drastically cut taxes on tobacco products, thereby lowering the cigarette price index by 37% for that year alone.
The most recent figures, from Statistics Canadas 1996-97 National Population Health Survey, indicate that 6.9 million Canadians (29% of the total population aged 15 and over) smoked cigarettes regularly or occasionally in 1996. This was a reduction from 1994-95, when the Survey found that this was the case for 31% of the total population aged 15 or over.
In 1996, more men than women smoked (31% and 26% respectively), and male smokers smoked more than female smokers. Although this difference between the sexes is significant, it is not as marked as it was in 1965, when 61% of men smoked compared to 38% of women. The difference in tobacco use between the sexes has been evening out gradually over the years, until in 1996-97 the proportion of girls aged 15 to 17 who smoked was actually higher than the proportion of boys in that age group who did so (29% vs. 22%).
Consumption patterns among both male and female smokers have changed little during the past 30 years. Over that time, the proportion of smokers who smoke more than 11 cigarettes a day has consistently hovered around 80% for males and 70% for females. According to the 1996-97 Survey, the figure was 80% among male smokers and 60% among female smokers.
In 1965, the percentage of the population who smoked varied between 42 and 45% in all Canadian provinces except Quebec, where the proportion was 51%. Starting in the mid-1970s, however, the proportion of smokers began to show regional differences. These can be grouped into three zones: the Atlantic Canada and Quebec, the Prairies, and British Columbia and Ontario. The 1996-97 Survey showed that 30 and 32% respectively of the population in Atlantic Canada and Quebec were smokers, 28% on the Prairies, and 20 and 25% respectively in British Columbia and Ontario.
The 1996-97 Survey also indicated that smoking rates are inversely proportional to levels of education. Of those who have never finished high school, 39% are smokers. This proportion drops gradually as the level of education rises (high school, college, university), to reach 16% among those with a university degree. There is a similar relationship between smoking rates and income levels (probably strongly correlated with levels of education). In the lowest income bracket, 42% smoke, compared to 20% of those in the highest income bracket.
Significant cultural differences emerge with respect to smoking. In 1994-95, 35% of Francophones smoked, 26% of Anglophones, and 15% of those from other cultural backgrounds. A study carried out by Health Canada in 1996-97 indicated that, while 32% of Canadians as a whole were smokers, the proportion jumped to 56% for members of First Nations, 57% for Metis and 72% for Inuit.
Source: Statistics Canada, Health Statistics Division, National Population Health Survey, Custom Tabulation,1
(1) A "cigarette equivalent" equals 1 gram for a cigarette and 2.5 grams for a cigar; this definition is consistent with the one used by the OECD (see OECD Health Data 1998).
Parliamentary Research Branch
Three companies control almost 100% of the Canadian tobacco manufacturing industry: Imperial Tobacco Limited; RJR-Macdonald Incorporated; and Rothmans, Benson & Hedges Incorporated. These companies are in turn owned by international conglomerates that are involved in the tobacco markets of most countries.
Imperial Tobacco Limited(2) has approximately two-thirds of the domestic cigarette market. Imperial is owned by Montreal-based Imasco, which in turn is controlled by the British-based tobacco conglomerate B.A.T. Industries (BAT). Imasco also controls Shoppers Drug Mart/Pharmaprix, Canada Trust, Genstar Development, and Fast Food Merchandisers (FFM). Imperial products include Canadas two largest-selling brands, du Maurier and Players. Brown and Williamson, one of the major tobacco companies in the United States, is also controlled by BAT.
Rothmans, Benson & Hedges Incorporated is the second largest tobacco firm in Canada, controlling about 20% of the market. Rothmans is mainly owned by Philip Morris, the largest tobacco firm in the United States, and by Rothmans International B.V., which is based in the Netherlands but controlled by the Rupert Family Trusts in South Africa. Rothmans produces Rothmans, Craven "A" and Benson and Hedges, among other brands.
RJR-Macdonald Incorporated controls about 12% of the Canadian market, and is owned by RJR-Nabisco. RJR-Nabisco is composed of R.J. Reynolds Tobacco, the second largest American tobacco firm, R.J. Reynolds International, and Nabisco, which controls such well known food products as Planters, Life Savers, Oreo, Ritz and Fleishmanns. The firms most popular product by far is the Export A line.
(1) More information can be found at the British Columbia Ministry of Health Site, at http://www.tobaccofacts.org. See also Rob Cunningham, Smoke and Mirrors: the Canadian Tobacco War, International Development Research Centre, 1996, p. 18-26.
Parliamentary Research Branch
In the case of tobacco products, the federal government applies both an excise duty(1) and an excise tax. Excise duties are imposed on a specific list of domestic products, the most important of which are spirits, beer, cigarettes and tobacco. The excise duty on cigarettes consists of a specific amount in dollars applied per thousand standard cigarettes (described as weighing not more than 1.361 kilogram or three pounds per thousand cigarettes). The excise duty is higher for cigarettes that contain more tobacco.(2)
Excise taxes are either a fixed dollar amount imposed on a specific quantity of goods or an ad valorem tax applied to a prescribed list of domestic and imported goods and certain specific taxes. These taxes are in addition to the general or retail sales taxes. The specific federal excise tax on tobacco products was indexed annually to reflect increases in the total consumer price index from 1 April 1981 to 1 September 1984. The automatic indexation of these tax rates was eliminated in May 1985 and replaced with legislated increases.
After 1984, cigarettes also became subject to the federal sales tax, the Manufacturer Sales Tax (MST). A 19% rate was imposed, instead of the then standard rate of 13.5%. In 1991, the Goods and Services Tax (GST) replaced the MST at the standard rate of 7%.
All provinces also apply their own particular commodity or excise taxes on tobacco products, usually in the form of a set amount per thousand cigarettes. With the exception of Prince Edward Island, Alberta, British Columbia, Yukon and the Northwest Territories, provinces impose retail sales taxes or value added taxes on tobacco products. Quebec, New Brunswick, Nova Scotia and Newfoundland include the GST when calculating the base for provincial taxes; Ontario, Manitoba and Saskatchewan do not.(3)
1987: Alberta, Saskatchewan, Manitoba and Nova Scotia raise their tobacco taxes.
1989: Substantial federal government increases on both cigarette and tobacco taxes are emulated by a number of provinces. The combined federal excise tax and excise duty on cigarettes rises on 1 April 1989 to $48.851 per thousand standard cigarettes from the $31.901 imposed on 11 February 1988, an increase of more than 53%. Combined manufactured tobacco taxes more than double, to $ 26.637, over the same period.(5)
1990: While federal taxes remain unchanged, nine provinces and territories increase their tax rates.
1991: The federal government and seven provinces raise their tobacco taxes, prompting concerns over cross border shopping, smuggling and theft. New Brunswick reduces its tobacco taxes and British Columbia abandons its twice-a-year inflation adjustment formula for such taxes. The federal government first implements and subsequently withdraws an export tax on tobacco manufacturers.
1992: Significant increase in tobacco smuggling activities, theft and robberies with violence involving tobacco products. Four provinces raise their tobacco taxes; it is estimated that federal and provincial tax revenues lost to tobacco smuggling amount to $2 billion a year.
1994: In an effort to curtail multi-billion-dollar trade in illegal cigarettes, the federal government reduces its excise tax by $5 per carton. The provinces are invited to match the federal reduction; any amount by which the provincial reduction exceeds the federal reduction will be matched dollar for dollar by the federal government (up to an additional $5.00). Provinces hardest hit by tobacco smuggling activity take up the offer: Quebec, New Brunswick, Ontario, Prince Edward Island, and Nova Scotia. The remainder of the provinces keep their tobacco tax structures unchanged. Other federal tax measures include the re-imposition of an $8 per carton tax on tobacco exports, a $200-million surtax on tobacco companies profits, and the introduction of various enforcement and education programs;(6)
1995: Barely a year after the federal and provincial tax cuts, Quebec raises its excise tax by a total $1.32 per carton and Prince Edward Island by $1 per carton. Nova Scotia removes the 11% sales taxes on tobacco products and increases its excise tax proportionately, leaving the overall tax burden unchanged. Tobacco smuggling activity drops substantially.
1996: he federal government raises its tobacco excise tax by $0.70 on 29 November, for cigarettes sold in Quebec, Ontario, New Brunswick and Nova Scotia. These provinces raise their own taxes by the same amount. Two weeks later, the federal government and Prince Edward Island both raise the tobacco excise tax by $0.70.
1998: In February, the federal government announces an increase of $0.60 per carton of 200 cigarettes for retail sale in Ontario, Quebec, Nova Scotia and Prince Edward Island and a $0.40 per carton for retail sale in New Brunswick. Comparable increases in provincial taxes on cigarettes will be implemented concurrently by provincial governments in these five provinces. Other measures include additional federal excise tax increases for cartons of tobacco sticks to be followed with concurrent excise tax increases by some provinces.(7)
Since 1982, the value of tobacco product shipments(9) has advanced annually at about 5%. The rise in the value of shipments results from regular increases in product prices. When adjusted for inflation, the value of shipments actually declines over the sample period as consumption of tobacco products and cigarettes continuously goes down. Public health concerns, pressure from anti-smoking advocacy groups, as well as government regulations on labelling and packaging and continuous rises in tobacco taxes have contributed to reducing consumer demand for tobacco products.
Canadian production of tobacco products is mainly aimed at domestic markets with little external competition. Exports usually stand at around 6% and imports around 3% of total value of shipments. This pattern changed in the late 1980s, however, when Canadian tobacco manufacturers started to export a growing share of production, mainly to U.S. markets, in an attempt to maintain levels of production in the face of accelerating domestic taxes on tobacco products and declining domestic sales.
The number of cigarettes exported, which had been below one billion until 1986, more than doubled in each of 1991 and 1992 and almost doubled again in 1993, reaching an unprecedented 17 billion cigarettes or 37% of total sales.
By 1993, expanding exports had increased the total amount of cigarettes sold for the first time since 1981. National sales totalled 48 billion cigarettes, a rise of 6% from the previous year. Regardless of the increase in sales, however, the value of tobacco shipments dropped to two billion dollars, 2% less than in 1992.
An unmeasured portion of these exports, however, returned to the Canadian domestic market as contraband, rather than being consumed in the country of destination. Total sales volume was little affected by the increases in exports, since these were offset by similar decreases in domestic sales.
In response to the increasing illegal trade in tobacco products and the resulting loss in tax revenues (estimated at $2 billion),(10) the federal government, in co-operation with those provinces hardest hit by tobacco smuggling, initiated in 1994 a series of measures for containing and reducing illegal trade in tobacco products. The measures included a substantial decrease in federal tobacco excise taxes, to be matched concurrently with cuts in provincial tobacco excise taxes, a levy on manufacturers tobacco exports and surtax on their profits, along with various legislative and regulatory measures to curtail illegal smuggling activities.
Following these measures, tobacco smuggling activities decreased substantially. The number of exported cigarettes fell from a record 17 million in 1993 to seven billion in 1994 and five billion in 1995. The value of exports fell more than $800 million in 1993 to under $200 million in 1994 and 1995.
In 1994, the year of the excise tax rollbacks, total sales rose to reach 53 billion cigarettes, 12% more than 1993, and the value of total shipments rose by 23% for a total value of $2.5 billion. After 1994, however, the industry resumed its pre-1990 pattern of modest increases in the value of shipments along with declining volumes of total sales and low exports.
Since 1994, the federal government and the eastern and central provinces have implemented a series of comparatively small increases in tobacco taxes which have not, to date, translated into any significant increases in reported tobacco smuggling.(11) However, according to RCMP testimony at the Senate Committee on Social Affairs, Science and Technology,(12) should tobacco taxes continue to rise, such activities can be expected to increase.
(1) Robin W. Boadway, and Harry M. Kitchen, Canadian Tax Policy, Canadian Tax Foundation, No. 63, 1980.
(2) J. Harvey Perry, Taxation in Canada, 5th Edition, Canadian Tax Paper No. 89, Canadian Tax Foundation, 1990.
(3) Non-smokers Rights Association (Canada), 17 February 1995.
(4) Tobacco in Canada, Canadian Tobacco Manufacturers Council, various issues.
(5) Finances of the Nation 1988-89, Canadian Tax Foundation, 1989.
(6) Finances of the Nation 1995, Canadian Tax Foundation, 1995.
(7) Department of Finance, Press Release, 13 February 1998.
(8) Statistics Canada, Beverage and Tobacco Products Industries, 1995, Catalogue No. 32-251 XPB.
(9) Value of product shipments are defined as "the summation of the value of shipments of goods produced by the establishment, receipts of custom and repair revenue, as well as the value of goods made under contract. Valuations are on a net basis; that is, they exclude discounts, returns, allowances, sales and excise taxes and duties and transportation charges made by common or contract carriers." Statistics Canada, Beverage and Tobacco Products Industries, 1995, Catalogue Number No. 32-251-XPB.
(10) Revenue Canada, PRESS33, National Action Plan to Combat Smuggling, 8 February 1994.
(11) Senate, Standing Committee on Social Affairs, Sciences and Technology, Proceedings, 2nd session, 35th Legislature, 18 March 1998, p.3.
(12) Ibid. p. 3.
Parliamentary Research Branch
Bill C-204, now the Non-smokers Health Act, was introduced in October 1986 as a Private Members bill by Lynne McDonald. Passed in 1988 and proclaimed in 1989, the Act regulated smoking in the workplace and on common carriers that were under federal jurisdiction.
On 4 February 1993, the Minister of National Health and Welfare introduced Bill C-111, the Tobacco Sales to Young Persons Act, in the House of Commons. The bill was quickly passed by the House of Commons and Senate, and received Royal Assent in March 1993. It was proclaimed in force in February 1994. This Act replaced the antiquated Tobacco Restraint Act, raised the minimum age for buying tobacco products from 16 to 18, and imposed fines of up to $50,000 on those selling tobacco to persons below that age. It also severely restricted the placement of cigarette vending machines. The Act received widespread support and positive reaction from politicians, the media, and even tobacco manufacturers, although small retailers and vending machine operators expressed reservations. In 1997, the Act was replaced by provisions of the new Tobacco Act.
In 1988, Bill C-51, later known as the Tobacco Products Control Act, was passed by Parliament and received Royal Assent. The Act provided the authority to ban all tobacco advertising; to impose restrictions on and gradually phase out promotional activities and sponsorship of events or persons by tobacco manufactures; and to require more explicit health warnings on tobacco product packages.
In June 1989, the Minister of Health and Welfare stated that no warnings linking tobacco use and addiction could be put on packages of cigarettes until the government had confirmed that such a relationship existed. The Royal Society of Canada was given $30,000 to study the relationship, and reported in October 1989 that tobacco was indeed addictive. From that date until the September 1995 Supreme Court of Canada decision in RJR-MacDonald, the federal government required tobacco manufacturers to place explicit health warnings on their packaging.
The Canadian Tobacco Manufacturers Council challenged the Tobacco Products Control Act in the courts as a violation of freedom of expression under the Canadian Charter of Rights and Freedoms. In 1991, the Quebec Superior Court ruled that the legislation intruded on provincial legislation and violated the tobacco companies right to freedom of expression. In January 1993, however, the Quebec Court of Appeal overturned this decision, holding that the ban on advertising was an appropriate response to the smoking problem, even in the absence of conclusive proof that the ban would reduce smoking.
The tobacco companies appealed the decision to the Supreme Court of Canada. They sought an exemption from compliance with the regulations until the Court had disposed of the appeal, but the Court, in March 1994, did not agree to this. In fact, as of September 1994, the government required even tougher and more prominent health warnings on cigarette packages. Nevertheless, in late September 1995, the Supreme Court released its decision in RJR-MacDonald, striking down all the challenged advertisement and promotion prohibitions except for the prohibition on the distribution of tobacco products without charge.
A majority of the Court held that the legislation was properly part of the federal legislative sphere; however, the Court also held, by a margin of five to four, that the prohibitions on advertisement and promotion were unconstitutional restrictions of freedom of expression, as guaranteed by the Charter. Although the Court approved the objective of the legislation, it found that the laws were more severe than had been proven necessary to meet Parliaments goal of reducing advertising-related consumption.
The critical flaw in the labelling law was the "unattributed" nature of the health warnings, which were seen as compelled expression imposed on the tobacco companies. The critical flaw in the advertising ban was that it included both "lifestyle" and purely informational advertising. The Court found that the latter was not an inducement to smoke, as it simply provided comparative brand information for existing smokers. The Court also found that a rational linkage between the use of logos on non-tobacco merchandise and tobacco consumption had not been proved.
The Court thought it possible that less severe laws, such as an advertising ban on only "lifestyle" advertising or on advertising targeting young persons, or mandatory health warnings attributed to the government or a related agency, might have been enough to achieve the objective of reducing advertising-related consumption. It was noted, moreover, that the government had refused to bring into evidence more than 500 documents requested by the tobacco companies, including at least one document pertaining to a study of alternative measures.
The Canadian Tobacco Manufacturers Association said that, in spite of the Supreme Court decision, it would continue to abide by the provisions of the Act for the time being. The federal Minister of Health stated that the Courts decision and the governments options were under study. Other interested groups argued either that the impugned legislation should be re-enacted and protected by the "notwithstanding" clause, or that tobacco advertisement and promotion should be prohibited under the federal Hazardous Products Act. The tobacco industry adopted a voluntary code of ethics relating to advertising; however, by early 1996 there were allegations that this code was unenforceable and was in fact being violated.
In December 1995, the Minister of Health released Tobacco Control: A Blueprint to Protect the Health of Canadians, which provided the general outlines of plans for new legislation to rebuild the governments strategy after the Supreme Courts decision in RJR-MacDonald. The reinstatement of health-related messages and information about toxic ingredients on tobacco product packaging, accompanied by a rule allowing for attribution of the messages, was described as an important first step According to the Blueprint, the governments intentions included:
Bill C-117, which addressed health and toxic contents warnings on tobacco product packaging, was introduced for first reading in December 1995. Bill C-117 and its replacement, Bill C-24, introduced in March 1996, would have amended the labelling provisions in the Tobacco Products Control Act that had been struck down by the Supreme Court of Canada in the RJR-MacDonald decision. Neither of these bills proceeded and in late 1996 they were replaced by Bill C-71, now the Tobacco Act.
Bill C-71, An Act to regulate the manufacture, sale, labelling and promotion of tobacco products, was introduced for first reading on 2 December 1996 and received Royal Assent on 25 April 1997. Known as the Tobacco Act, the legislation regulates tobacco labelling, tobacco product promotion, the composition of tobacco products, and young persons access to these. Tobacco product advertising, sponsorship, testimonials, points-of-sale display, and brand names on accessories are among the specific forms of promotion affected by this legislation. There was intense debate over the original proposed sponsorship restrictions and in its final form the legislation delayed their coming into force until 1 October 1998 or such earlier day as ordered by the Governor in Council. The legislation was quickly challenged by the tobacco companies on the grounds that parts of it are unconstitutional and contrary to the 1995 Supreme Court decision in RJR-MacDonald.
The Tobacco Act also replaced the Tobacco Sales to Young Persons Act. It prohibits the provision of tobacco products to persons under 18 years of age, prohibits the manufacture and sale of "kiddie packs," and limits self-service or automated distribution of tobacco products.
The most controversial aspect of Bill C-71 continued to be the restrictions on tobacco company sponsorship of artistic, cultural and sporting events. Under pressure from both the anti-tobacco health lobby and the artistic, cultural and sporting groups that benefit from large-scale tobacco company financing, the government delayed a final decision on the matter.
On 3 June 1998, Bill C-42, an Act to amend the Tobacco Act, was introduced in the House of Commons. The bill, which has only five clauses, would extend the transitional period for the introduction of tobacco sponsorship restrictions.
Under Bill C-42, sponsorships that existed as of 25 April 1997 would not be subject to any restrictions for two years. On-site sponsorship promotion could continue for the next three years, subject to some restrictions on promotional material furnished to the public. After this five-year period, the promotion of tobacco sponsorships would be totally prohibited. Health groups, who largely oppose any transitional provisions for tobacco sponsorships, have been somewhat comforted by the provision for ultimate prohibition.
The first two clauses of Bill C-42, as amended by the House of Commons Standing Committee on Health, would, effective 1 October 2003, replace sections 24 and 25 of the Tobacco Act with complete prohibitions on tobacco-related advertising arising from the sponsorship of artistic, cultural or sporting events or facilities.
At present, section 24 of the Tobacco Act allows the display of "a tobacco product-related brand element" to promote the sponsorship of a person, event or permanent facility by a tobacco company, subject to subsections (2) and (3) of section 24 and any regulations. Subsection 24(2) limits the display of tobacco brand information to the bottom 10% of any promotional material, and subsection 24(3) limits the publications in which, or the places where, such information can be displayed. Clause 1 of Bill C-42 would prohibit promoting tobacco company sponsorship of a person, event or permanent facility as of 1 October 2003.
At present, section 25 of the Tobacco Act states that, subject to the regulations, a tobacco product-related brand element, such as a brand name or logo, may appear on a permanent facility, such as a sports or cultural building, provided the name or logo is part of the name of the facility. Clause 2(1) of Bill C-42 would prohibit the display of a tobacco product-related brand element, or a tobacco manufacturers name, on a permanent facility if such a display would associate the brand element or name with a sports or cultural event or activity. However, under clause 2(2), the existing section 25 would until 1 October 2003 continue to apply to brand elements that appeared on a permanent facility on the day the proposed legislation came into force.
Clause 3 would repeal the regulation-making power referred to in the present clauses 24 and 25; this power would no longer be necessary because Bill C-42 would replace regulation by prohibition. Clause 5(1) provides that clause 3 would come into effect on 1 October 2003.
Clause 4 contains interim provisions for sponsorships that were actively in existence in Canada on the date of the passage of Bill C-71, 25 April 1997. The net effect would be that such sponsorships would be exempted from compliance with the Tobacco Act for two years, followed by a further three-year exemption for on-site promotion.
The existing subsections 24(2) and 24(3) of the Tobacco Act came into force as of 1 October 1998; however, for sponsorships that existed in Canada on 25 April 1997, and that had been active in the 15 months prior to that date, these subsections would not apply until 1 October 2000. Moreover, these two subsections would not apply to on-site promotions for five years, with the exception that subsection 24(2) would limit tobacco-related information to the bottom 10% of the material furnished to the public. People and entities participating in sponsored events would be equally exempted, whether or not they had previously been involved in tobacco product-related sponsorship.
Clause 5 provides the dates on which the various provisions would come into force, as described above.
Any new or reactivated sponsorships would be subject to the existing sections 24 and 25 of the Tobacco Act, which seriously limit the promotion of such sponsorship.
In February 1998, Senator Colin Kenny introduced Bill S-13, The Tobacco Industry Responsibility Act. The bill proposed creating a non-profit foundation, funded by a levy on tobacco products, to discourage smoking among young people; to foster a smooth transition away from dependence on tobacco industry funding for the arts, cultural, and sport communities; and to assist tobacco farmers to switch to other viable crops. At third reading, the bill was amended to remove the transitional provisions. Because the government had decided to defer the sponsorship ban for five years, it was no longer necessary to provide transitional support to the arts, cultural, and sport communities to compensate for lost sponsorships. In December 1998, Bill S-13 was ruled out of order in the House of Commons because it involved a tax and not a levy. Tax measures may be introduced only in the House of Commons, and not by a Senate bill.
Parliamentary Research Branch
At the federal level, efforts to control tobacco use involve many different federal departments and agencies, including those working on health, finance, agriculture and anti-smuggling endeavours. Measures employed include legislation, taxation, and public education.
This section focuses primarily on the actions of Health Canada and on its policies and programs aimed at tobacco-related research, education, prevention and cessation. Legislative and taxation efforts are described in separate units.
The federal governments roles in relation to health-oriented policies and tobacco use programs arose from both constitutional powers and historical and practical considerations. They encompass:
In 1994, the federal government announced a Tobacco Demand Reduction Strategy as part of its National Action Plan to Combat Smuggling in Canada. The strategy was to be funded by a health promotion surtax on profits from tobacco manufacturing. The amount allocated to the three-year initiative was to be about $60 million annually.
In 1996, the Tobacco Control Initiative was to allocate $50 million over five years for a comprehensive strategy combining research, policy and program development, public education, information dissemination and enforcement of legislation. An additional $50 million was pledged in the 1998 Speech from the Throne. The following sections describe federal support for anti-tobacco initiatives aimed at certain target groups, workplaces, product decisions, and health professionals.
Under the Tobacco Demand Reduction Strategy, efforts were made to develop prevention and cessation programs for groups with a higher prevalence of smoking or with a low responsiveness to previous programs. Priority groups included: youth, women, Francophones, Aboriginal people, certain ethnic and immigrant populations, the heavily addicted, and low income and low literacy groups. The current Tobacco Control Initiative continues to emphasize particular groups and the need for a multi-pronged approach.
Much of the federal action has been directed to the development and dissemination of research findings with respect to these groups. Since 1985, social marketing, particularly anti-tobacco advertising, has been a major part of federal government efforts to reduce tobacco use. In addition, Health Canada has designed the Community Action Initiatives Program (CAIP) to provide funding for projects supporting and encouraging the development and implementation of community-based anti-tobacco programs. Examples of federal initiatives for vulnerable groups are described below.
The 1994 Youth Smoking Survey provided information on young peoples attitudes to and knowledge of smoking.(1) Among other things, the survey found that 70% of 15 to 19 year olds cited peer influence as the most common reason for starting to smoke and that 85% of smokers and 83% of non-smokers consider tobacco company sponsorships on billboards and event promotions to be advertising. Detailed analysis of the results concluded that programs and policies should be directed to younger age groups of both sexes and should be supported by schools, youth organizations, and young peoples workplaces.(2)
One of the first of such programs aimed at youth was the "Break Free" campaign in place from 1987 to 1993.(3) Current efforts include the "Challenge to Youth" campaign whose advertisements aired in Cineplex Odeon theatres during summer 1997 and on television in winter 1998. A post-test analysis found that the "convincing value" of the ads was lower for boys than girls, for smokers than non-smokers, and for French audiences than English ones.(4)
Smoking cessation programs for teens were found to require several specific components. Thus, teens prefer programs that have high levels of success and offer methods that can be used on an individual basis, are affordable, and minimize the side effects of withdrawal. Health Canadas Quit-4-Life self-help kit can be used individually or in groups. A 1995 evaluation found that 77% of teens using the kit were able to reduce their cigarette consumption and about 20% had been able to quit for at least three months.(5)
A 1995 survey found that 25% of females smoked, compared to 29% of males. However, in the 15 to 19-year age group, the percentage for females was higher than that for males.(6)
The recognition that women and men start or stop smoking for different reasons led Health Canada in 1988 to support the first National Workshop on Women and Tobacco. This led to special programs for young girls and for pregnant and low-income women as well as to educational campaigns and cessation programs for women. In 1995, background work for another Women and Tobacco Workshop saw the publication of a framework for action that provided an overview of research, programs, public policy, and social marketing literature.(7)
Within the Tobacco Demand Reduction Strategy, both the Women and Tobacco Initiative and the Pre- and Post-Natal Tobacco Initiative developed special programs for adolescent and adult women. These included research on the design and delivery of effective tobacco cessation programming, a "Back Talk Guide" to help young women aged 12 to15 years to respond to media messages in an informed way, and development of booklets to be used by health care professionals when advising on the dangers of tobacco use during pregnancy.(8)
Data collected by Health Canada suggest that Francophones are a high-risk group in terms of smoking. A 1995 survey found that 36% of male Francophones in Canada smoke and 35% of female Francophones do so. This compares to the Canadian average of 29% for males and 25% for females over 15 years of age.(9)
Information collected by the Health Promotion and Programs Branch led to proposals for the development of programs with characteristics that appeal to Francophones. Some proposals focused on programs that are culturally sensitive and emphasize freedom of individual choice, that are visual and interactive, that propose replacing cigarettes with other pleasurable activities, and that involve professionals such as physicians, nurses and teachers.(10)
Responsibility for the delivery of programs and services to Aboriginal people is divided between the federal and the provincial/territorial governments according to whether recipients are status Indians, on or off reserve; non-status Indians; recognized or unrecognized Inuit; or Metis. Thus, the health of First Nations people on reserve and recognized Inuit people comes under the Medical Service Branch of Health Canada, while the Metis and other groups have access to federal programs for the general population.
Studies conducted by Health Canada reveal that smoking rates among Aboriginal people are much higher than among the Canadian population as a whole. A 1991 survey found that 56% of Indians, 57% of Metis and 72% of Inuit were currently smokers, compared to 32% of the overall Canadian population.(11) Additional information on smoking habits was gathered through the 1996 First Nations Youth Smoking Survey and through the regional health surveys carried out by First Nations organizations.
Efforts carried out under the Tobacco Demand Reduction Strategy to reduce these high smoking rates included tobacco prevention workshops run by the National First Nations and Inuit Working Group on the Non-Traditional Use of Tobacco, training Aboriginal community health workers, and designing a smoking prevention/cessation model for Aboriginal women called "Helping You Quit: A Smoking Cessation Guide for Aboriginal Women in Canada." Additional activities are expected under the Tobacco Control Initiative.
For Aboriginal people, tobacco has traditionally had a spiritual significance and has been used in ceremonies and for trading purposes. It has been suggested that acknowledgement of and support for the historical and spiritual context of tobacco use can provide a strong base for prevention and cessation programs. Programs must recognize, however, that Aboriginal Canadians are not a homogeneous group and that there are significant cultural differences in Indian Nations, Metis communities, and Inuit peoples.
Since the late 1980s, the federal government has developed various measures to discourage tobacco smoking in workplaces under its jurisdiction; that is, in industries or enterprises considered to be federal undertakings or businesses. The affected workers are primarily federal public servants and employees in such areas as interprovincial or international transportation, telecommunications, banking, and broadcasting.
The measures are linked primarily to the Non-smokers Health Act and its Regulations. Although the Act permits smoking in designated areas within workplaces, many federally regulated workplaces have developed policies to clarify the application of the legislation. The following sections provide a brief overview of some of these policies.
Treasury Board has developed a policy to assist departments in the application of the non-smoking legislation.(12) The policy applies to indoor or enclosed spaces under the employers control. Smoking rooms can be designated in consultation with the safety and health committee and can include motor vehicles, hospitality rooms, and a portion of any living accommodation or recreational facilities provided for employees.
Several additional concerns have arisen from the development and administration of this policy. For example, there is now more intensive smoking in areas seen as non-workplace, such as the areas around the entrances to the work site. Since commercially leased space for cafeterias is not considered to be under the employers control, workers in older buildings that have contracted cafeterias or adjoining restaurants continue to face heavy concentrations of smoke in these areas. Although departments may provide smoking cessation programs for employees, there is no obligation for them to do so and the serious problem of addiction can be overlooked.
Smoking is prohibited or limited on trains, airplanes and buses that operate interprovincially or internationally. For example, VIA trains prohibit smoking in the Quebec City-Windsor corridor and in all cars where meals are served. In trains outside this corridor, smoking is permitted only in designated sections and cars.
Attempts to control smoking on aircraft began shortly after the Non-smokers Health Act was introduced in the House of Commons. What started as a smoking ban during flights of two hours or less in 1987 had within a year been expanded to all North American flights. In 1994, Canada became the first country to ban smoking on both domestic and international flights over its territory. By 1998, all domestic and trans-border lounges prohibited smoking and Vancouver had become the first international lounge to do so.(13)
All buildings occupied by the House of Commons and the Senate (including all offices, lobbies, committee rooms, washrooms, freight entrances, etc.) are covered by the Non-smokers Health Act. So far, however, only the House of Commons has developed a policy for the application of the legislation.(14) The Senate has no policy and no internal person with monitoring responsibility, a situation that makes enforcement of the legislation more difficult.
The House of Commons policy covers issues such as signage, counselling, disciplinary action, and visitors compliance. It also notes that employees who smoke will not receive extended break periods and that smoking cessation programs are offered from time to time. By January 1996, after continued complaints, it was agreed that the Act would be more strictly enforced; the Manager of the Occupational Health, Wellness and Safety Division was authorized to report any alleged breaches to the Minister of Labour.
In 1990, in response to the federal Non-smokers Health Act, Correctional Services Canada developed a policy for its application within federal correctional institutions, which include penitentiaries, correctional residential centres, and psychiatric centres. The policy prohibits smoking by staff and offenders in all administrative areas, gymnasiums, dining rooms, kitchens and health centres.
In 1997, the Executive Committee of CSC agreed to continue work toward the goal of prohibiting smoking in all indoor and enclosed spaces.(15) Individual institutions were to have some discretion in designating smoking and non-smoking areas based on assessments of architectural design and consultations with warden, union and inmate representatives. Because many penitentiaries are built of solid stone and because almost 75% of inmates are smokers, particular problems arise with regard to ventilation and the location of smoking areas. Cellblocks and ranges meet the definition of "living accommodation" as defined by the Nonsmokers Health Regulations and can thus be designated as smoking rooms or areas. However, each institution is to take reasonable and practical measures to minimize the effects of tobacco smoke; for example, by grouping smokers together and ensuring airflow away from non-smokers.
Tobacco products are controlled primarily by the provisions of the Tobacco Act. However, there are several areas where the federal government has undertaken additional research initiatives for increasing understanding of how product packaging and product promotion affect the consumption of tobacco products.
In March 1994, following the suggestion of the Minister of Health, the House of Commons Standing Committee on Health began a study of plain or generic packaging of tobacco products. During the two months of hearings, the Committee members received evidence about the potential effects of plain packaging on tobacco consumption, on contraband and smuggled products, on the tobacco industry (manufacturing, growers, packagers, wholesalers, retailers) and on health costs. In their report, the Committee members concluded that legislating plain or generic packaging could be a reasonable step in the overall strategy for reducing tobacco consumption and called for the development of a legislative framework to proceed in this direction.(16)
In response to considerable questioning about the constitutional and trade implications of legislating requirements for plain packages in Canada, the Minister of Health subsequently commissioned a study by a panel of experts. Its report acknowledged the difficulty of proving conclusively that plain packaging would persuade smokers to quit or young people to defer consumption; however, it did conclude that there was substantive evidence that such packaging would reduce tobacco use.(17)
The federal government has support from provincial and territorial health ministers and international resolutions for requiring generic packages as one means of reducing tobacco smoking. It has not yet produced regulations on this issue, although it has legislative authority under the Tobacco Act to do so.
The focus on packaging includes labelling and in particular the requirement for labels to carry strong health messages and adequate toxic constituent information. Provisions in both the 1989 Tobacco Products Control Act and the 1997 Tobacco Act deal with these issues. However, as the Health Canada 1995 Blueprint document made clear, the existing provisions could be enhanced.(18) Research commissioned by the Office of Tobacco at Health Canada has focused on these areas; for example, a 1997 report by the Environics Research Group found significant public support for placing additional messages on packaging.(19) Expanding the list of toxic constituents from three (nicotine, tar, carbon monoxide) to include the more than 50 different chemical compounds, together with the addition of new messages, is expected to increase smokers and non-smokers knowledge of the product and ultimately to decrease consumption.
The provinces are the primary deliverers of health care through various health professionals. Such professionals can be very effective in counselling their clients against smoking. A 1995 survey by Health Canada indicated that 77% of current smokers had seen a doctor and 55% had seen a dentist within the previous year, suggesting that there had been opportunities for these health professionals to intervene.(20) Federal government action in delivering health care services to specific groups, financing health research, and supporting national approaches render it an active partner with the provinces and practitioners in advancing changes with respect to tobacco use.
The education of health professionals is important to this issue, as is their role in educating others about tobacco use. Health Canada, through its support of school-based health promotion, has identified a role for physicians in neighbourhood and community efforts to prevent and reduce tobacco use. For example, they can be volunteer speakers or advocates of adolescent cessation programs. Research funded by Health Canada suggests, however, that all health professionals, including physicians, are ill-prepared for these roles. A survey of professional faculties, funded by the Office of Tobacco Reduction Programs within the Health Promotion and Programs Branch and co-ordinated by the Physicians for a Smoke-Free Canada, found that few schools for medicine, nursing, pharmacy or psychology included information on counselling against smoking on their health education curricula.(21)
Much of the current emphasis on health practices has been directed at physicians. As part of the Tobacco Demand Reduction Strategy, Health Canada provided partial funding for a physician-directed publication called "Guide Your Patients to a Smoke Free Future," prepared by the Canadian Council on Smoking and Health (now called the Canadian Council on Tobacco Control).(22) "Mobilizing Physicians for Clinical Tobacco Intervention" is a joint effort involving the Canadian Medical Association and Physicians for a Smoke-Free Canada.(23)
Federally funded research is credited with increasing knowledge about how health professionals can influence tobacco use. For example, a departmental survey of about 3,817 physicians revealed that only 32% of Canadas family physicians were aware that they could bill most provincial or territorial health plans for providing smoking-cessation advice to patients not diagnosed as having a smoking-related illness.(24)
(1) Health Canada, 1994 Youth Smoking Survey, Cycle 1, Ottawa, 1996.
(2) T. Stephens and M. Morin (eds.), Youth Smoking Survey: Technical Report, Supply and Services Canada, Ottawa, 1996, Chapter 9.
(3) James Mintz, et al., "Social Advertising and Tobacco Demand Reduction in Canada" in Social Marketing: Theoretical and Practical Perspectives, M.E.Goldberg et al. (eds.), London, 1997, at: www.hc-gc.ca, October 1998.
(4) Health Canada (Prepared by Les Études de Marché Createc), Quantitative Post-Test of "Challenge to Youth" TV Campaign, Ottawa, April 1998.
(6) Health Canada, Survey on Smoking in Canada, Cycle 4, Ottawa, 1995.
(7) Health Canada, Women and Tobacco: A Framework for Action, Ottawa, April 1995.
(8) Health Canada, Women and Tobacco, Fact Sheet prepared for the Canada-U.S.A. Womens Health Forum, Ottawa, 1996.
(9) Health Canada, Survey on Smoking in Canada, Cycle 4, Ottawa, 1995.
(11) T. Stephens, Smoking among Aboriginal People in Canada, Supply and Services, Ottawa, 1994.
(13) Information was obtained from websites for VIA and Canadian Airlines, September 1998.
(14) House of Commons, Smoking Policy, 24 May 1990 and memo re: Enforcement of the Non-smokers Health Act, 11 December 1995.
(15) Correctional Services Canada, "Communiqué for Members of the CSC National Implementation Committee on Smoking Re: EXCOM Smoking Policy Decisions," 1997, 3-page unpublished document.
(16) House of Commons, Standing Committee on Health, Toward Zero Consumption: Generic Packaging of Tobacco Products, Ottawa, June 1994.
(17) Expert Panel, When Packages Cant Speak: Possible Impacts of Plain and Generic Packaging of Tobacco Products, Ottawa, Health Canada, March 1995.
(18) Health Canada, Tobacco Control: A Blueprint to Protect the Health of Canadians, Supply and Services, Ottawa, 1995, p. 33-34.
(19) Environs Research Group, "Public Attitudes Toward Toxic Constituents and Health Warning Labelling on Cigarette Packaging Qualitative Research Report," 1997.
(20) Health Canada, Survey on Smoking in Canada, Cycle 4, June 1995.
(21) Roger Thomas, "A Survey of the Training of Canadian Health Professionals to Counsel against Smoking," Chronic Diseases in Canada, 18(3), 1997.
(23) "CMA Pushes for Tougher Tobacco Legislation," CMA News, 6(3), 1996, p.3.
(24) Patrick Sullivan and Anita Kothari, "Right to Bill May Affect Amount of Tobacco Counselling by MDs," Canadian Medical Association Journal, 156(2), 15 January 1997, p. .241-243.
Parliamentary Research Branch
According to the World Health Organization (WHO), if current smoking habits persist, about 500 million people now alive, or about 9% of the worlds population, will die as a result of tobacco use. In 1995, about 3.1 million people were estimated to have died from tobacco-induced diseases; that figure is expected to rise to 10 million deaths per year by the 2020s or early 2030s, with 70% of those deaths occurring in developing countries.(1) In October 1998, Dr. Gro Harlem Brundtland, Director-General of WHO, announced the development of an International Framework Convention to cover key aspects of tobacco control that cross national boundaries.
The United States has been particularly influential in introducing tobacco control legislation and dealing with tobacco-related litigation because of its size, its position as the home base of the major tobacco manufacturing companies, and the nature of its legal system. Aggressive lawsuits in that country have sought damages for illnesses or death allegedly caused by smoking, and some courts have awarded large settlements.
Moreover, in March 1996, the Liggett group, one of the five major U.S. tobacco companies, settled out of court on a number of pending anti-tobacco lawsuits. In March 1997, it concluded a settlement with various states whereby the company was insulated from tobacco litigation in return for an admission that cigarettes are addictive and for its co-operation in implicating other tobacco companies.
On 20 June 1997, the tobacco companies reached a provisional settlement on lawsuits brought by 40 states. The tobacco companies would have paid $365.8 billion to the states over 25 years in return for broad protection from liability suits. Most of the money would have been spent on anti-smoking campaigns, and to repay state Medicaid money spent on the treatment of smoking-related illnesses. The settlement, however, required the approval of Congress, which attempted instead to impose its own agreement by legislation; this attempt collapsed in June 1998.
In late July 1998, nine states (California, Colorado, Massachusetts, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania and Washington) resumed talks with the tobacco industry to see if a national settlement could be salvaged; however, as of the end of the summer, little progress had been made.
Meanwhile, four other states had settled their lawsuits individually for a total of over $35 billion: Mississippi ($3.6 billion) in July 1997, Florida ($11 billion) in August 1997, Texas ($14 billion) in January 1998, and Minnesota ($6.6 billion) in August of 1998. The various settlements work out to between approximately $725 and $1,400 per capita, with the provisional national settlement involving approximately $1,350 per capita (before legal costs are deducted).(3)
1954: Industry faces first liability lawsuit by lung cancer victim alleging negligence and breach of warranty. Suit dropped 13 years later.
1964: Surgeon General releases reports concluding that smoking causes lung cancer.
1965: Federal Cigarette Labelling and Advertising Act requires Surgeon Generals warnings on cigarette packs.
1972: Officials rule all airlines must create non-smoking sections.
1980: Surgeon General reports that smoking is major threat to womens health.
1981: Insurers begin offering discounts on life insurance to non-smokers.
1988: President Reagan bans smoking on short domestic airline flights. Surgeon General reports that nicotine is an addictive drug.
1990: Smoking banned on interstate buses and all domestic airline flights of six hours or less.
1992: Nicotine patches introduced.
1994: Case filed by Diane Castana, whose husband died of lung cancer, grows into largest potential class action lawsuit in history by including millions of smokers.
Executives of seven largest U.S. tobacco companies swear in congressional testimony that nicotine is not addictive and deny manipulating nicotine levels in cigarettes.
Brown & Williamson documents show that tobacco executives had discovered the risks of smoking before the Surgeon General did so.
Mississippi files first of state lawsuits seeking to recoup the cost of smokers Medicaid bills from the tobacco companies.
1996: Liggett Group, the smallest of the major tobacco companies, settles claims with the attorneys general of five states, and promises to help them in claims against other companies.
Court strikes down class action status of Castana case, calling it too unwieldy to cover all states. Lawyers begin filing class action suits in dozens of states instead.
1997: Liggett concludes settlement with states whereby the company is insulated from tobacco litigation in return for admitting cigarettes are addictive and implicating other tobacco companies.
(1) For further information, see "Tobacco Free Initiative", WHO web site, at http://www.who.int/toh/ accessed June 1999.