Good morning. My name is Doris Grinspun, and I am the Executive Director of the Registered Nurses’ Association of Ontario (RNAO). With me today is Rob Milling, Director of RNAO’s Policy department. RNAO is the professional association for registered nurses who practise in all roles and sectors in Ontario. Our mandate is to advocate for healthy public policy and for the role of registered nurses in enhancing the health of Ontarians.
RNAO was proud to represent Ontario’s nurses on the vitally important Tobacco Strategy Advisory Group (TSAG), a panel of health experts established to advise the government on a five-year plan to build on the successes of the Smoke-Free Ontario strategy.
Our final report called for a comprehensive tobacco strategy that reduces both demand for tobacco products, including preventing young people from getting addicted, and the supply of legal and unregulated tobacco products. We recommended practical and achievable outcomes that will lead to our shared vision of a tobacco-free Ontario.
Tobacco use is a well-known and totally avoidable cause of illness and death, killing 13,000 Ontarians per year and resulting in 1.93 billion dollars per year in direct health system costs, not to mention the cost in lost productivity estimated at 5.8 billion dollars. Smokers and non-smokers face significant health risks. The good news is that Ontario has made progress in reducing smoking rates. Smoking prevalence dropped from 23 per cent in 1999 to 15 per cent in 2009. The progress is attributable to a range of steps taken by government to reduce the scourge of smoking. These steps include:
the Smoke Free Ontario Act, which we praise as one of the toughest in North America
the ban on smoking in cars when children are present
the ban on displays of tobacco
support for smoking cessation, including support at the Ontario and federal levels for RNAO’s best practice guideline on smoking cessation
The bad news is that progress is levelling off, and has levelled off since 2005. In fact, preliminary figures for 2010 show a marginal increase in smoking from 15 per cent to 16 per cent. We know that the tobacco industry is working hard to expand its consumer base, and government must maintain its commitment to tobacco control and work even harder to protect public health.
We are encouraged by the April 21st announcements of enhanced support for smoking cessation, prevention of youth smoking and access to nicotine replacement therapies through primary care providers such as nurse practitioner-led clinics.
Bill 186 addresses one huge barrier to lowering smoking rates: the ready availability of cheaper contraband tobacco. It is well known that demand for tobacco is very sensitive to price, and raising its price through taxes is an effective way of deterring would-be smokers. The presence of illegal tobacco makes it more difficult for government to impose health-saving taxes.
The Bill lands chiefly on the side of regulation and enforcement against contraband tobacco. Consistent with one of our advisory group’s recommendations to go beyond cigarettes to encompass all tobacco use, the Bill itself would tighten regulation of tobacco in its raw leaf form by requiring producers, processors, dealers, importers and exporters to obtain registration certificates; this could allow more effective enforcement by reducing diversion of raw tobacco to unlicensed manufacturers. This is a step towards the advisory group’s recommendation to use that regulation to reduce the production of tobacco.
Bill 186 would impose labelling on fine cut forms, in the way that cigarettes must currently be labelled. This would combine with extension of authority of enforcement officers to seize illegal unmarked tobacco products. The TSAG report also includes labelling and enforcement as tools in its suite of tools to raise tobacco prices and dissuade use of contraband tobacco. In the future we look forward to the government adopting the advisory group’s recommendations on minimum retail prices and tobacco tax hikes. We also called for a dialogue with First Nations leadership and communities on contraband tobacco, and we hope that Section 13.5 of the amended Act would facilitate those discussions, which First Nations representatives say have not yet happened.
Taken together, Bill 186 and the April 21st announcements address a number of key recommendations of the advisory group’s report. They steer tobacco control in Ontario a significant distance in the right direction. For that reason, we join other health organizations in calling on all parties to quickly pass Bill 186.
During the coming election and beyond, Ontario’s nurses will work with all parties to achieve an even stronger commitment to a vision and plan to virtually eliminate smoking from the province. We will not rest until that day.
At the same time, RNAO urges all parties to address the social injustice that is spawning much of the tobacco smuggling: the deplorable economic and social circumstances that exist in far too many Aboriginal communities. The sad reality is that tobacco smuggling is an economic option in the absence of better alternatives. What community would freely choose an industry that contributes to smoking prevalence double of that for the rest of Ontarians? Ontario has a poverty reduction program, and top priority must be placed on addressing poverty in aboriginal communities. This is something that must be negotiated with aboriginal communities, respecting all traditional rights, and mindful of equity considerations both in Aboriginal communities and outside of them as well.
Contraband tobacco may be a significant health threat on and off Aboriginal communities, but it is also a warning sign pointing to deep-seated and challenging inequities. Solving them will not be easy, but it behooves us as a province to urgently devote the time and resources to right those historical inequities.
In closing, we urge the committee members to pass the Bill as a good step towards addressing contraband tobacco and getting tobacco control more solidly on the rails. We look forward to working with all parties in building a comprehensive tobacco reduction plan as outlined by the Tobacco Action Strategy Group. Thank you again for giving us the opportunity to present the views of registered nurses.