Public Hearings on the Public Health (Standardised
Packaging of Tobacco) Bill 2013
Opening Statement
Dr Anthony O’Regan,
President the Irish Thoracic Society
Consultant Physician, Galway University Hospital
6th February 2014
Priory House, 19 Priory Hall, Stillorgan, Co Dublin Tel 01 2835252 Fax 01 2835251
Email info@irishthoracicsociety.com Web www.irishthoracicsociety.com
President Dr Anthony O’Regan Vice President Dr Jacqueline Rendall Past President Dr Edward McKone
Treasurer Dr Ross Morgan Secretary Dr Aidan O’Brien Assistant Secretary Dr Dubhfeasa Slattery
Charity No. CHY17510 Company Registration No. 462103
1. Introduction
Good Morning Mr Chairman and Members of the Committee. Thank you for
inviting us here today to share our views on The Public Health (Standardised
Packaging of Tobacco) Bill 2013.
Over 5200 people die in Ireland each year from tobacco related disease1. The
Irish Thoracic Society represents respiratory healthcare professionals
throughout Ireland – our members include physicians, thoracic surgeons,
clinical nurse specialists, scientists, and physiotherapists. Every day of our
working lives our members meet patients who are seriously ill and dying
because of tobacco – this includes smokers and ex -smokers as well as nonsmokers who have been exposed to high levels of tobacco smoke in their home
or work environment. Lung conditions such as COPD and lung cancer are
painful, debilitating and often fatal. They are also preventable and the most
powerful form of prevention is ensuring that young people never take up their
first cigarette. That is why this legislation is so important - it represents a
major step towards the government’s vision of a tobacco free Ireland by 2025,
it builds on previous initiatives and will put Ireland to the forefront of global
health protection.
2. Tobacco and Lung Disease in Ireland
This legislation is vital for respiratory health in Ireland. We have high rates of
lung disease compared to the European average. In Ireland lung diseases
account for 20% of all deaths, it is the 3rd most common reason for acute
hospital admission, and is the most common reason to visit a GP. 2
Smoking is the major preventable cause of respiratory illness. Lung disease
accounts for over 60% of the 5,200 deaths from smoking annually in this
country. Specifically each year in Ireland 15003 people die from COPD (giving us
one of the highest death rates for the disease in Europe) and 17004 people die
from lung cancer. Smoking causes over 85% of these diseases. Smoking has
also been shown to exacerbate many other lung diseases including asthma,
pulmonary fibrosis, cystic fibrosis, and even tuberculosis. Taken with its role in
non-respiratory diseases, including cardiovascular disease, other cancers, and
osteoporosis, tobacco kills 1 out of every 2 smokers.
3. Smoking and Lung disease in specific population groups.
Tobacco use is among the biggest causes of health inequalities. Smoking rates
are higher in disadvantaged groups and communities, and this is where the
burden of tobacco related disease is highest. Tobacco accounts for up to half
the difference in life expectancy between the richest and the poorest groups in
our society. 5 Not surprisingly these differences are strikingly reflected in the
prevalence and outcomes of respiratory disease. For instance the mortality
rates for lung cancer and COPD are over two-fold higher in the lowest
socioeconomic class. 2
Another significant trend is the increasing prevalence of smoking related lung
disease in women. It is apparent that from the 1970s onward that the tobacco
industry targeted advertising at women. The fallout from increased smoking in
women is now apparent. In COPD there is a convergence of deaths and
hospital in-patient discharges for men and women that mirrors the trends in
female smoking rates.6 In lung cancer there is a 0 .5% increase in female
mortality each year and lung cancer is now the main cause of cancer death in
women outnumbering breast cancer deaths by 6%. 4 Lung cancer incidence and
mortality in Irish women is amongst the highest in Europe.
4. The tobacco time lag
Smoking causes damage to the lungs long before it results in clinically
symptomatic disease. Although the majority of people diagnosed with smoking
related lung conditions are of middle or older age, most will have started
smoking in adolescence or early adulthood. In fact 80% of smokers start and
become addicted before the age of eighteen.7 This illustrates the importance of
early interventions to reduce smoking rates among our teenagers and young
adults to ensure healthier life expectancy for our population into the future.
We know that legislation works. Over the last decade Ireland has made great
strides in the ‘denormalisation’ of smoking thanks to the workplace ban, the
ban on advertising and on point of sale display. The success of these initiatives
is best illustrated by the reduction in smoking in both children - from 21% in
1998 to 12% in 2010, and in adults - from 31% in 1998 to 24% in 2010. We
must continue on this path and indeed accelerate our efforts to ensure that
today’s generation of children and teenagers do not become tomorrow’s COPD
and lung cancer patients. The introduction of standardised packaging together
with graphic images represents a significant step in achieving this goal.
5. Standardised packaging works
It is clear that marketing works. It has worked on behalf of the tobacco
industry to the detriment of the lives of 100s of thousands of Irish men and
women throughout the 20th and into the 21st century. We now have an
opportunity to remove the last vestige of marketing power that the tobacco
industry holds and we must grab it with both hands.
Australia introduced standardised packaging 1 year ago. While it will take time
to fully measure the effects of this policy, preliminary evidence shows that
compared with smokers who are still using branded packs, the plain pack
smokers are over 66% more likely to think their cigarettes are of poorer quality
and less satisfying, and 81% more likely to think about quitting on a daily
basis.8 Plain packaging has also been shown to reduce pack and product
appeal; increase impact of health warnings; and to reduce confusion about
product harm that can result from branded packs.9 Most importantly, research
indicates that standardised packaging will reduce the appeal of tobacco
products to young people, who are the primary target for tobacco industry
marketing.10. The campaign in Australia waged by the Tobacco industry
challenging this policy is clear evidence of the perceived impact of branding on
target populations by these companies.
6. Conclusion
In conclusion, the Irish Thoracic Society would like to commend the
government for its commitment to the introduction of standardised packaging
and all parties for their support of this policy. This again places Ireland as a
leader in the global battle to protect public health from the effects of tobacco.
In particular it puts Ireland to the forefront in the implementation of our legal
obligations under the UN treaty – The World Health Organisation’s Framework
Convention on tobacco Control. By setting an example to other European
countries the benefits of this legislation will not be confined to our shores
alone.
In order to ensure that this and future generations of Irish children, particularly
those from underprivileged areas, can look forward to long healthy lives free of
tobacco related illness, we urge the speedy adoption of this legislation by the
Houses of the Oireachtas.
Department of Health (2013). Tobacco Free Ireland
2 INHALE Report, Irish Thoracic Society 2008
3
National Clinical Programme for COPD
4
Cancer in Ireland 2013: Annual report of the National Cancer Registry. National Cancer Registry Ireland.
5
http://ash.org.uk/files/documents/ASH_82.pdf
6
O’Farrell A, De La Harpe D, Johnson H, Bennett K. Trends in COPD mortality and in-patient
7
Office for Tobacco Control (Nov. 2006). Children, Youth and Tobacco: Behaviour, Perceptions and Attitudes.
8
Wakefield M et al (2013); Introduction effects of the Australia plain packaging policy on adult smokers: a
cross-sectional study; BMJ Open 2013-003175
9
Moodie C, Stead M, Bauld L, McNeill A, Angus K, Hinds K, Kwan I, Thomas J, Hastings G, O’Mara-Eves A (2012)
Plain tobacco packaging: a systematic review. London: Public Health Research Consortium.
10
Ignite Research (2013) ‘The impact of tobacco branding and standardised packaging on young people’.
Commissioned by the Irish Heart Foundation and the Irish Cancer Society