STANDING COMMITTEE ON SOCIAL DEVELOPMENT
TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
CANADIAN PHARMACEUTICAL ASSOCIATION
CANADIAN TOBACCO MANUFACTURERS' COUNCIL
NATIONAL CAMPAIGN FOR ACTION ON TOBACCO
SOMERSET WEST COMMUNITY HEALTH CENTRE
KARYL JAANUSSON
DAVID J. WALKER
NATIONAL ASSOCIATION OF TOBACCO AND CONFECTIONERY DISTRIBUTORS
LUNG ASSOCIATION, OTTAWA-CARLETON REGION
OTTAWA-CARLETON HEALTH DEPARTMENT
CONTENTS
Thursday 17 February 1994
Tobacco Control Act, 1993, Bill 119, Mrs Grier / Loi de 1993 sur la réglementation de l'usage du tabac, projet de loi 119, Mme Grier
Canadian Pharmaceutical Association
Ernest Stefanson, past president
Leroy Favang, executive director
Nghia Truong
Canadian Tobacco Manufacturers' Council
Robert Parker, president
National Campaign for Action on Tobacco
Janice Forsythe, spokesperson
Robert Cunningham, counsel
Ruth St Louis
Somerset West Community Health Centre
Sherryl Smith, health promotion coordinator
Sean Graham
Rosemary Robertson
Kate McCarthy
Adrienne Turnbull
Karyl Jaanusson; David Walker
National Association of Tobacco and Confectionery Distributors
Mr Luc Dumulong, executive vice-president
Non-Smokers for Clean Air
Ed Napke, member
Jinny Slyfield, president
Tom Johnson
Lung Association, Ottawa-Carleton region
Greg Penney, member
Trisha Chelton, volunteer
Nagla Acouri; Lorne McEwen
Ottawa-Carleton health department
Richard Cantin, Ottawa-Carleton health committee
Dr Edward Ellis, associate medical officer of health
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
*Chair / Président: Beer, Charles (York-Mackenzie L)
*Vice-Chair / Vice-Président: Eddy, Ron (Brant-Haldimand L)
Carter, Jenny (Peterborough ND)
Cunningham, Dianne (London North/-Nord PC)
Hope, Randy R. (Chatham-Kent ND)
*Martin, Tony (Sault Ste Marie ND)
*McGuinty, Dalton (Ottawa South/-Sud L)
*O'Connor, Larry (Durham-York ND)
*O'Neill, Yvonne (Ottawa-Rideau L)
Owens, Stephen (Scarborough Centre ND)
*Rizzo, Tony (Oakwood ND)
*Wilson, Jim (Simcoe West/-Ouest PC)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Dadamo, George (Windsor-Sandwich ND) for Ms Carter
Haslam, Karen (Perth ND) for Mr Hope
Sterling, Norman W. (Carleton PC) for Mrs Cunningham
Winninger, David (London South/-Sud ND) for Mr Owens
Also taking part / Autres participants et participantes:
O'Connor, Larry, parliamentary assistant to Minister of Health
Clerk / Greffier: Arnott, Doug
Staff / Personnel:
Boucher, Joanne, research officer, Legislative Research Service
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
THURSDAY 17 FEBRUARY 1994
The committee met at 0900 in the Westin Hotel, Ottawa.
TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
Consideration of Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others / Projet de loi 119, Loi visant à empêcher la fourniture de tabac aux jeunes et à en réglementer la vente et l'usage par les autres.
CANADIAN PHARMACEUTICAL ASSOCIATION
The Chair (Mr Charles Beer): Good morning, ladies and gentlemen. Our first witnesses this morning are representing the Canadian Pharmaceutical Association. Welcome to the committee. We have half an hour.
Mr Ernest Stefanson: Thank you very much. I'd like to introduce myself first. I'm a community pharmacist from Gimli, Manitoba. I'm the past president of the Canadian Pharmaceutical Association and former chairman of our PACT$ committee, which stands for Pharmacists Against Cigarette and Tobacco Sales, and I'm currently giving lectures on one of CPhA's programs called Butting Out For Life, which is a smoking cessation counselling program to teach pharmacists how to counsel their patients to quit smoking.
Mr Leroy Favang: My name is Leroy Favang. I'm executive director of the pharmaceutical association. You have received our briefs. Our intention is to speak to the brief through some verbal comments and then when we're finished if there are any questions that you might have, we would be very pleased to respond to them.
First a few words about who we are. The Canadian Pharmaceutical Association is the national voluntary association for pharmacists. We represent over 10,000 pharmacists from sea to sea, and that includes pharmacists in all areas of practice, whether they be in community practice, hospital practice, industrial practice. That also includes a number of organizations. We represent the chain drugstore pharmacists as well as the independent pharmacists, so it's the full spectrum. In many respects then, we would be referred to as the umbrella organization for the professional pharmacists.
Since the 1970s, we've been involved in the policy question of the sale of tobacco products in pharmacies. We've always pushed forward the position that tobacco sales are incompatible with the professional image of pharmacy, realizing that the profession was divided on the issue. But we really felt that our main concern or our main raison d'être is health. So the growing health concerns of the public have overridden any kind of apprehensions we might have about the economic implications of the removal of tobacco products in pharmacies.
We recognize that the profession is divided on this particular issue, but as the national pharmacy association, we believe that the majority of members do in fact support the removal of tobacco products from pharmacies. So we stand firmly behind the principle and firmly behind Bill 119. We commend the government of Ontario for supporting the bill and also commend the opposition for their support and careful consideration of the bill and for agreeing to the bill in principle at second reading.
Mr Stefanson: Canadians visit their pharmacies because they need medications that can improve the quality of their lives. How inconsistent it is to see a patient walk out of a pharmacy with a carton of cigarettes in one hand and medications in the other. The irony is that tobacco, when taken as directed, will lead to death in many of its habitual users and that medications are taken to improve the health and wellbeing of the individual. It is because of this inconsistency that we believe that pharmacy should be out of the tobacco business.
The effectiveness of some medications can be reduced by smoking. As a pharmacist who does not sell tobacco, I have greater credibility to counsel my patients on these perils.
Mr Favang: In February 1986, an independent survey was done on the program which we were conducting at that time called the Stand Up and Be Counted program. This was a joint program between ourselves and the federal government department of Health and Welfare.
The program urged pharmacists to voluntarily give up the sale of tobacco products. The characteristics of that program back in 1986 were that there were three levels of participation.
The first level was those pharmacists who really agreed to distribute within their pharmacy educational material on the problems, the perils, of tobacco smoking and the difficulties associated with that and the implications on their health. The second level were those pharmacies which still continued to sell tobacco products but would not promote or advertise them in the pharmacy. The third and highest level, of course, were those pharmacists who agreed to voluntarily give up the sale of tobacco products. So you can see where we're gradually weaning people towards that end objective.
After the program was over, we had this independent study to determine the effectiveness of the program and, really, whether it was worthwhile. According to their findings, they said that the customer support for the Stand Up and Be Counted program was very favourable. In fact the higher the level of participation of the pharmacist in the program, the greater the customer support for that particular pharmacy.
It was apparent even back then that the removal of tobacco products from pharmacy gave pharmacists a sense of public approval. This was really very important to the profession, because as the gatekeeper for medicines in Canada -- pharmacists improve the health of nations -- they felt that it was important not to be caught up with the stigma of the sale of tobacco product, which is the number one leading cause of death in Canada.
We believe the passing of this bill and the removal of tobacco products from pharmacies pays dividends to pharmacists many times over. It not only increases their understanding and image with the public that pharmacists' first role is the health of the patient, but it also improves the pharmacists' own sense of self-esteem and that they're working in that direction. The public support for this provides the dividends which will overcome any of the economic implications that are associated with this.
Mr Stefanson: The Stand Up and Be Counted program was followed by a program that we called PACT$, which stands for Pharmacists Against Cigarette and Tobacco Sales. This was an initiative by our association to encourage and assist pharmacies to discontinue tobacco sales by providing them with a how-to kit.
This program was reasonably successful, albeit with independent pharmacies. The kit provided pharmacists with the public relations materials to help them realize community support for their actions and provide alternative product lines to substitute for their tobacco. Our association also dedicated an issue of our association journal to the tobacco issue.
A survey conducted in 1988-89 revealed that despite the resources channelled in this area by CPhA, only 12.7% of pharmacies that replied to the survey did not sell tobacco. Ladies and gentlemen, this is not a record to be proud of, but it's a record that you, through the work of this committee, have a chance to reverse.
Subsequent to the PACT$ program, a survey was undertaken by the association in the spring of 1991 that focused on those pharmacies that had been identified by CPhA as being tobacco-free. The purpose of this survey was to identify practical alternatives which would maintain customer loyalties and offset lost revenues in those pharmacies that stopped selling tobacco products.
The survey revealed that almost 69% of the stores which reported a ratio of tobacco to total sales indicated that cigarette sales were less than 10% of their total sales, and half the stores reported that there had been no changes in their sales or that their sales had actually improved. Over 50% of the stores reporting on customer traffic indicated no change or an improvement in the number of customers in the store. Several actually commented that their average sales increased during that period of cessation of tobacco sales.
The conclusions drawn from the survey were that pharmacists determined that ceasing tobacco sales generally provided positive results in the long run. In our handout we have some further statistics that you may wish to look at.
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To you, members of this committee, this may merely be a list of statistics, but to me, Ernest Stefanson, a pharmacist from Gimli, it means much more. I am statistics in action. In 1985 I decided to stop selling tobacco in my community pharmacy. This year, almost a decade later, I have reached my 25th anniversary in my pharmacy. It has survived and thrived despite the removal of tobacco, and I believe that both my customers and I have benefited from this decision.
Like the Canadian Pharmaceutical Association, the Ontario College of Pharmacy and the legislators of Bill 119, I chose to take a proactive, front-runner role on what is considered as not only a pharmacy issue but a public health issue. Our association recognizes the potential financial impact that cessation of tobacco sales may have for its members but believes that a transition period is essential to permit the orderly planning for a successful tobacco-free conversion by substituting other product lines and thereby reducing the potential negative financial impact.
Government must also realize that the profession of pharmacy is under considerable economic pressure from other sources; namely, the Ontario drug benefit formulary reductions, a recessionary climate and Bill 81. It is critical that government be sensitive to the compound effects of these influences. For example, if Bill 81, a piece of legislation now presumed dead, resurfaces in some other form in 1994, the combined effects on our members might be devastating.
To request the profession to accept a clawback of $30 million on the professional fee in addition to the loss of revenues from cessation of tobacco sales might be a double blow which some of our members would feel seriously. For these pharmacists, being squeezed at both ends may indeed become a question of survival. But let me restate firmly and clearly that the sale of these products is incompatible with the role of the pharmacist as a health care provider. For this reason, CPhA supports those provisions outlined in the legislation that prohibit pharmacy tobacco sales.
Mr Favang: Because tobacco is a public health issue, I'd now like to make some comments that will not be on the bill, which are not really covered in the bill itself.
We feel, as part of the larger health community that has examined the Ontario Tobacco Control Act, there are a number of areas in which the bill could be tightened up, enhanced and made more effective from a public health measure. These would include the banning of chewing tobacco, snuff; the banning of the kiddie packs, the smaller sizes, which we believe could be done through packaging regulations; banning the advertising and promotion of tobacco products either directly or indirectly through tobacco industry promotional corporations; and beefing up Ontario's workplace smoking legislation.
We also understand that the standing committee has received a submission from the Ontario Campaign for Action on Tobacco, OCAT. We make specific reference here to the recommendations on the advantages of plain packaging and we support those recommendations.
Mr Stefanson: In conclusion, I will mention that I have a 16-year-old daughter, Sigrid. Like any parent, I want a healthy and happy life for her. As well, I want her to be able to respect me and what I do and what all pharmacists like me do. We work hard in an honourable profession that has such capacity to serve the public. What message does it send to Sigrid and other kids like her to see a man or a woman in a white coat dispensing tobacco? Thank you. That concludes our presentation.
The Chair: Thank you for your presentation and also for the documentation you have sent to us. We'll begin the questioning with Mr Winninger.
Mr David Winninger (London South): As you may know, we've heard a litany of complaints from pharmacists accusing the government of discriminating against their retail operations. Perhaps the most extreme proponent of this view appeared yesterday. That was Mr Graham Stebbings of the Throop Group. This, in a nutshell, is what Mr Stebbings had to say:
"There is only one legitimate and acceptable survey and that is the one conducted by the Ontario Pharmacists' Association, which represents the economic interests of all 8,000 pharmacists practising in this province. That survey found 62% in favour of continuing the regime of having the decision to sell tobacco a voluntary one."
To wrap up, he says:
"All other surveys presented to you do not have the sanction or the legitimacy of the Ontario Pharmacists' Association. Not even the Canadian Pharmacists' Association survey is accurate; it was conducted with a small sample and it's not Ontario-based."
Could you comment on that?
Mr Favang: I certainly don't intend to comment on the OPA survey, but certainly in the framing of any survey question how the question is worded can have a very major impact on the answers that you get in that. I would suggest you look at the actual question and how it was worded in order to draw conclusions on the results of that survey.
Mr Winninger: I see.
Mr Favang: We stand behind our survey comments.
Mr Dalton McGuinty (Ottawa South): Gentlemen, thank you very much for your presentation. Let me begin by commending the work that you have done and your predecessors have done on behalf of your Canadian Pharmaceutical Association to remove tobacco from Canadian pharmacies.
One of the issues that concerns me personally is whether we should be doing that or you should be doing that -- the government is in that certainly. As a personal preference I would far prefer that pharmacists work this out among themselves. I gather that you have concluded that you have gone as far as you can, practically speaking, in terms of encouraging your members. Am I correct?
Mr Stefanson: Yes, you are.
Mr McGuinty: Tell me, nationally, are tobacco sales permitted in pharmacies in all of the provinces?
Mr Stefanson: Yes, they are. It's very similar to Ontario that tobacco is sold. As you well know, this is just a North American phenomenon. People who come from Europe and other countries are just astounded that pharmacies in Canada and the United States sell tobacco. They find it very strange.
Mr McGuinty: Right. On page 9 you have a definition of a pharmacy. I think that's important for us to consider as members of the committee. Just so I can get your position on this, it becomes somewhat more complex when we're dealing with larger retail operations where the dispensary in relationship to the overall operation is quite small or perhaps even located on another floor or a number of floors away from the location where they're selling cigarettes.
Under the terms of your definition -- for instance, in town here at the Bay, I think on the fourth floor there is a dispensary and on the first floor they're selling cigarettes. Would it be your intention in that case that, "Look, guys, you've got to pick one or the other"?
Mr Stefanson: Yes, certainly I think we agree with the way that the bill is worded presently and it does look after that. As we all know, people will just look for any kind of loophole and they will have myriad ways to circumvent the intent of the legislation. So I really commend the legislation, as it is written, to address those concerns.
Mr Norman W. Sterling (Carleton): Thank you very much for coming to the committee to express your concerns over the bill. I, like Mr McGuinty, have some concerns about the government getting involved in this, but I guess the part that I dislike the most about this debate over pharmacies and selling tobacco or not selling tobacco is that it seems to be a pharmacy issue.
No one has argued very strenuously in this room that by not selling tobacco in pharmacies the consumption is going to fall. As a legislator that's my primary concern. Quite frankly, outside of the pharmacy trade I don't know whether anybody really cares whether you sell tobacco or you don't sell tobacco. It might be important for your children in terms of your interpersonal relationship and that kind of thing, but I really don't know.
When I walk on the street and I ask people who are not embroiled in this thing they shrug their shoulders and say, "What are you guys talking about?" I guess I'm concerned that we're spinning our wheels here talking about this and we're not lowering the consumption.
Mr Stefanson: I personally think that getting rid of tobacco out of pharmacies is not going to make a major impact on consumption in Canada. I agree with you there, but I think it goes beyond that. It's the image that a pharmacy portrays. People go to a pharmacy to purchase their health care needs, and it's just so incongruous to be selling tobacco where you're also selling your health care requirements.
I think also it sends a very negative message to the young people of Canada. When we're talking the tobacco issue really we have to focus on the young people, because people in the 20s and beyond, very few of those start smoking. People start smoking when they're kids. Pharmacists are a relatively respected profession, and I think this really does send the wrong message that this professional group is also selling tobacco.
0920
Mr Favang: If I may, I think you're right. It's not going to have any impact upon the sales, but the symbolic aspect -- by selling it in a health outlet the person who smokes or who might wish to smoke can rationalize that clearly the health hazards are minimal, because why would a health outlet sell the product?
It's that inconsistency which reinforces to the person who wants to rationalize it that it is not a noxious or habituating product. So from that symbolic point of view I think it's really quite important to the public to clearly enunciate the public health measures.
Mr Jim Wilson (Simcoe West): Thank you, gentlemen, for your presentation. Just on this note about public perception, though, because I think maybe pharmacists have more of a perception of being health care facilities than what the public does, I've argued that most people we've talked to on that don't perceive particularly the large pharmacies as health care facilities.
The Environics poll that was released by one of the anti-smoking groups last week or earlier this week indicates the same thing: 66% of those surveyed felt that pharmacies are retail outlets and only 24% felt that they were health care retail outlets or health care facilities.
In fact, cannot the reverse argument be made? I'm sure you've been through this a thousand times in your careers. It's not too many years ago when I was in my teens and doing science projects at high school. The only time I ever went to a pharmacy was to get a prohibited substance, something I couldn't get at the local hardware store. So cannot a logical argument be made that perhaps we should be banning it in every other retail sector and moving it behind the counter in pharmacies, moving tobacco products there?
Mr Favang: I don't know if you've read this morning's Globe and Mail --
Mr Jim Wilson: I'm trying to get through it here. There are several cigarette articles.
Mr Favang: There is an editorial on that particular concept. I don't think society is really ready for a move in that direction, because to ban the sale of it from all outlets other than a pharmacy, you're really stating from a societal point of view that it is a hazardous, habituating product and the only reason for its sale is to get the person off the product.
Society would then be saying that there's no legitimacy in the sale and all efforts must be geared towards discontinuing smoking. If society as a whole agreed to that, then I think this concept has validity, but until there is support for that and recognition of that by society as a whole that kind of action would not be really successful, I don't think.
Mrs Yvonne O'Neill (Ottawa-Rideau): Gentlemen, we had some pretty graphic videos the other day about the smokeless tobacco, and you have it in your brief, although you didn't mention it. Would you tell us a little bit about where you see that product in Canada now and do you see it growing, the provision of this? We do seem to feel that it is attractive to both children and athletes and the role model that's connected between those two.
Mr Favang: Yes, that's right. It's the role model which is really I think resulting in this having more public acceptance by the youth. That, in some respects, might even be a more hazardous tobacco product than the other, but it's a relative measure.
Again it comes back to, how firmly does society want to regulate these products? I don't think society has really grappled with this. This might well be the tip of the iceberg or the watershed product by which we could establish firmer kinds of controls, but unless there's a social will that we have to mobilize all of our efforts to discontinue not the sale but the consumption of these products, then we will still continue to debate that issue.
Mrs O'Neill: Have you any ideas for us on this kind of product and nipping it in the bud, so to speak?
Mr Favang: If you feel that this is the product that we have to control sincerely from a health point of view and tighten it up, pharmacies are the place where you can expect that kind of delivery. If it's a regulated product, then you can hold pharmacists accountable for the sale of that regulated product under the conditions specified in the regulations, whereas you can't expect that of other retailers. So the mechanism is there; it's established.
Mrs O'Neill: So you're suggesting that this product should be sold only in pharmacies.
Mr Favang: If you agree that there's no legitimate use for the product and it should not be sold, anybody who buys it should be tried to be talked out of it, so there's no legitimate use for that product at all and the sole reason of restricting its sale would be to discontinue its use or consumption. If that's what you want, that can be done that way.
The Chair: The final question, parliamentary assistant.
Mr Larry O'Connor (Durham-York): Thank you for your presentation. I'm sorry, your name?
Mr Stefanson: Ernest Stefanson.
Mr O'Connor: Did you say you came from Gimli?
Mr Stefanson: Gimli, Manitoba, yes.
Mr O'Connor: That's where the CNR has its training school.
Mr Stefanson: That's right.
Mr O'Connor: I used to work on the Canadian National Railways as a conductor yard foreman. It seemed to me that there were an awful lot of hoggers, as we called them, engineers who used spitting tobacco. I just wondered then, in pharmacies out west, is that something that is another market, kind of a niche? It seemed to me when I was working in the railway a lot of these people chewed it. Just what are your thoughts on that?
Mr Stefanson: In our particular area it's not a major problem. It's really disheartening, though: In northern communities, especially a lot of the native communities, chewing tobacco is really on the upswing, especially among the young kids. It's a problem that they are having a hard time grappling with because it's not the obvious smell that you can detect from a child. I know it's a problem in our area that has been very difficult to handle and unfortunately is on the increase.
Mr O'Connor: When the Addiction Research Foundation made a presentation to this committee and was asked the question about reducing the number of outlets, for example, if taking it out of pharmacies would have an impact on the sales, they said yes, any reduction in the number of outlets would. Somebody might well want to correct me here, but they said even if it's just a delay sometimes in the length of time somebody goes out and purchases it from someone else.
I guess the most compelling argument I've heard so far was from a pharmacist who came forward and said they've been working with some consumers and talking to them around cessation. They got their patch and everything, went up to the front checkout and, as they were leaving, there were all those cigarette packages staring them in the face and they decided they were going to buy the cigarettes. I guess it's kind of a contradiction, because you don't pay for everything when you go back to the pharmacy and you walk out and there they are.
We could see two pharmacists right out here in this mall: Shoppers Drug Mart selling tobacco, the other one tobacco-free. Both of them look like they're thriving businesses, both of them seem to be operating viably, so I think there is a role that pharmacy can provide, which is tobacco-free.
The Chair: Gentlemen, we thank you both very much for coming before the committee this morning.
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NGHIA TRUONG
Mr Nghia Truong: Ladies and gentlemen of the committee, good morning, and first a big welcome to our home town. You're right here in our backyard. I think probably it's wise for us to welcome you. For those who follow the lunar calendar, the Chinese and the Vietnamese among other people, we would like to wish you a happy new year. This is the year of the dog, and apparently it's very lucky if you're in the year of the dog. So we wish the government and this committee luck in all your deliberations.
I appeared before you two weeks ago as a cofounder of a group called Pharmacists in Support of Bill 119. Today I'm speaking to you as an independent pharmacist from the Ottawa area. Let me give you a brief history of my business. After that, I would like to expand for a few minutes on the falsehoods and the fallacies that you have been listening to for the last two weeks and present to you my personal observations regarding Bill 119 and its implications. Hopefully, we will have the time for you to ask me questions, and I'll try my best to answer the questions.
My company operates two pharmacies, one in the village of Merrickville and the other one here in Ottawa. Until 1992 this company had four pharmacies, two of them selling cigarettes. We took them out in 1987 and we didn't go bankrupt. As a matter of fact, when we sold to the present owners, we got a premium price. I will expand on that in a few minutes to get you off the myth that when you take tobacco out you lose your shirt.
My background is in chemical engineering from the States, and I have a doctorate in pharmacy from the University of Paris. I have been licensed to practise in Ontario since 1972. I have practised in France both as a community pharmacist and as an industrial pharmacist, and here in Canada I have worked in industrial pharmacy and for the last 20 years in community pharmacy.
I think I told you two weeks ago that I was quite amazed when I came to Canada to find out that in drugstores we can buy everything from soups to nuts, including tobacco. That was really a stopping point for me, and I have a lot of difficulty when I go back to the University of Paris -- I'm a guest lecturer once in a while -- and try to explain the pharmacy business in North America. This is always a sticking point.
I have a problem with the professors and my colleagues in France and in Europe that, "How could a health professional like you" -- meaning here in North America -- "carry a product which is deadly?" I have to find a lot of excuses, but it doesn't work. You can say a lot about economics, but the question remains that you are first a health professional. To paraphrase one of my professors, who by the way has already passed away, tobacco is a cancer. It's a cancer stick if you sell tobacco. You become a death merchant. Do you realize that?
But anyway, those are just rhetorical things. I would like to take this time to congratulate the government for bringing forward this bill and this committee for taking the time to go through it clause by clause and, in the final thing, for supporting this bill.
A few days ago, and even yesterday, the CEO of Shoppers Drug Mart and one pharmacist sitting on the council of the Ontario College of Pharmacists, in an effort to discredit the Ontario College of Pharmacists council for accepting the task force recommendations, stated that: "You should know that of the elected members who supported that resolution all but three were subsequently defeated in the elections that took place during...1991. They were voted out of office."
Let me please set the record straight, because I was part of that election. I think you should know by now that I was the one who got the resolution on tobacco, and I had to face the electorate, which is normal. Two things we have to remember: As a member on the council of a self-governing body, you may be elected by your peers in your district to go to the council in Toronto, but you are there not to represent the interests of your fellow pharmacists; you are there to represent the public interest of the province. Many of the councillors have forgotten that; they just forget, in due time, for whatever reasons.
Let's get back to that election. There were 16 elected seats to be voted on. There were five changes only, and they were all pro tobacco. One got in by acclamation in district 2 and four by election: district 1, which is where I belong; district 9, in the Niagara Falls area; district 12, in the Kitchener area; and district 14, in Sudbury and North Bay. So there were only five changes out of 16, not 13 out of 16. I don't know where he got those figures. I don't know whether they tried to trick the committee or what, but I hope that they got the matter straight.
Many of my colleagues and organizations have come to this committee, even in writing, to advance the proposition that tobacco removal should be voluntary. I think you have heard all the arguments. Very simply, voluntary doesn't work; we have seen that with the Canadian Pharmaceutical Association survey. Even at the college, after 10 years we knew it didn't work.
So we have to make a decision. It's a very difficult decision, but when you are elected to make a decision, you have to make tough decisions for the public interest, not for your members. I wish the committee to understand that. That's why the college took the position and asked the government back in 1991 to bring forward this type of legislation, because it is very paradoxical and incompatible for a health practitioner to carry a product which causes death.
"Tobacco is a legal product. Why shouldn't you let me sell it like other retailers?" But ladies and gentlemen, pharmacists are not just retailers, they're health care professionals. They're given the privilege to have a drugstore, meaning to be the custodian of prescription drugs, and the monopoly to sell drugs. With privilege, they must accept responsibility. They must not send a mixed message to the public, particularly to younger people who look upon the pharmacist as a person they mostly trust.
0940
I'm going to give you now my reasons and my personal observations of why tobacco should be eliminated from pharmacies. During my practice for the last 20 years, I have seen so many tragedies in my patients and I don't have to go over all the rhetoric about that.
For me there was always a conflict of what I was doing and what I was educated to do, meaning to promote health and prevent disease. That struggle ended one late evening shift when I worked in Kemptville. The emergency department called me and asked me to stay late to fill a prescription for a patient. "She needs it for her breathing problem." So we went through the whole thing. On her way out, she asked me to bring a carton of cigarettes. That was the straw which broke the camel's back. I could not look myself in the mirror any more. I had been telling my wife for so long that we had to do something about it because I have to live with my conscience.
So we took it out in all our stores. I don't have the liberty to release the figures because I have sold those stores to other owners, but I have had the blessing to give you some pictures. We took it out in 1987 on the first day of our new year, meaning of our fiscal year in 1988. We did not lose any revenue. We have increased our revenue by 10%. I can tell you how. The moment we did it, we got so much praise and support from our clients, from our patients and we had more new business than we can anticipate, but for me it's the message I have to give out, particularly to younger people.
I have been asked many times to go to schools to give little talks about healthy living and all those things. If all those young people came to my store and saw the tobacco I sell, they'd really be confused. On the one hand, they learn from their parents, we hope, and from the teachers that tobacco is bad, and go to Nghia Truong's pharmacy down there and get all those things there. Who would they believe, really? Right there, I drive a wedge between the parents and the teachers and everything.
In Ottawa-Carleton, the latest figures is 70% of pharmacies in this area are tobacco-free and very few, none of them, have closed the doors or have major layoffs.
What I'm going to tell may be very provocative, but I'm going to tell you from the heart. I have seen many victims of smoking. The figures of 13,000 every year -- 100 in Ottawa, for instance, in each of our ridings -- die every year, but those 13,000 people who die do not take their problems with them to the graves. This is where I'm being very provocative to you. They leave behind the physical, the emotional sufferings and the financial toll to their loved ones.
The Chair: Take your time.
Mr Truong: I went through those feelings six years ago when my father died of lung cancer. The man was six feet tall, and when he died he weighed 80 pounds. So I can really sympathize with Mrs Fraser, who came to you on the second day, when her late husband told her he wished he had never started smoking. My father used to say that. But we had warned him even before he had lung cancer, "If you smoke two packs a day, you're playing with trouble." Those things will never leave you.
This is why we, as leaders in our field, and you, as politicians, have to make every effort so that the children, our children, do not have ready access to tobacco products. With the problem we had last week of the decrease in tax, this bill must be strengthened.
I respectfully suggest to you that we need to have licensing systems on retailers for better control of sales; we need the plain or generic packaging to decrease the appeal of cigarette smoking to younger people; and we should enforce a smoking ban in all public places. We need the political will in this province to take those measures to protect our children. The ones who have already died, as I said, are gone. We have to protect our future.
I want to thank the following people who have helped me and who have really encouraged me in this thing, but before I do that, I would like this committee to appreciate the many pharmacists who came before you here or in their surveys, which I will share with you. They support this bill in a leap of faith to show to the government and to everybody that pharmacists are very serious in this debate and we're taking the side of the public health and the public interest rather than an economic point of view.
I strongly request this committee to explain to the minister the wish of pharmacists not to be further punished by measures in the ODB program which we have suffered in the last two years so that pharmacy as a profession remains viable for us to keep on providing good care to residents of Ontario, because our detractors will say: "You're crazy enough to go with this bill. You're losing your shirt and they're going to punish you more. Are you a whipping boy of the government?" No, we are doing this for the public of Ontario.
I want to thank Mrs O'Neill -- she has really supported me and encouraged me -- Mr Dalton McGuinty, Mr Hans Daigeler, Mr Chiarelli and Norm Sterling, who gave me a lot of advice, and Ms Gigantes for her support.
I would like to share with you two things. We have sent to every pharmacist in Ontario a survey, and in that survey we asked one question: "I agree in principle with the no tobacco sales in pharmacies provision of Bill 119, the tobacco act. Agree or disagree?" If you agree, you can become members of our association.
As of yesterday, we have had 715 surveys returned to us: 499 signed members for our group; 104 support that provision but did not sign their names. So we have 603, or 84%, of the returns in favour of the ban of tobacco; 112, or 16% only, are against the tobacco ban. You can see the figures are there, ladies and gentlemen. I have included a letter from one of the pharmacists who wrote to us. Of course we have also received a lot of insulting letters, but that's part of the game.
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I also gave you a copy of the pharmacies in the Ottawa area which do not sell tobacco, and in the last page I got myself the pictures of the two rogues there. If you have kids who can't sleep, you can show those two pictures and they scare the heck out of them. I put those pictures there just to say do it. Do Bill 119. Not for those two guys, but do it, please, for my two daughters, because many years down the road from now, they will ask me: "When you were the president of the college, what did you do? Why didn't you do it? You had the chance to do it." So this is a very personal plea to you for my daughters and for all the children in this province.
Mr George Dadamo (Windsor-Sandwich): Thank you for your presentation. By the way, in 1979 my own father died from lung cancer from many, many years of smoking. He came from an environment and grew up in Europe where doctors said to him then that it's okay to smoke. They didn't know, and we grew up of course with smoke everywhere. He smoked in the car, smoked in the house. We don't know what those effects will be on his children in the years to come.
I sort of joined up late in this committee and I did a little bit of reading before coming on, but the line of questioning I have is I think basically simplistic and I haven't swayed from some of the questions I've gotten in the last few days. Do pharmacists not take an oath or something along those lines that stresses clearly that you're dispensing medicine and you're trying to make people healthy, in that cigarettes you sell at the front of the counter are sort of an afterthought?
Mr Truong: Mr Dadamo, it is a very good question you ask, because there's a code of ethics of the College of Pharmacists which says something in that line. Back in 1991 we were tempted to use the code to enforce it, just like the Quebec Order of Pharmacists tried to do, but our legal counsel have advised us not to do it. It would not be able to stand up in court because you cannot use a code of ethics to pursue a member. That's why we ask for legislation. As the college we can do a lot of things, but we need some teeth to be able to enforce it.
Mr Dadamo: In my estimation, it seems clear that people will come into your pharmacy to buy medicinal, they'll come in for other products, but cigarettes are not the main attraction. Correct? Pharmacies have said to us clearly that if they drop cigarettes, it's not going to mean the fall of the empire and the store is going to close; the actual sales or the profits that come in at the end of the day are fairly low, so why do it? Why do you do it?
Mr Truong: I think probably most of the pharmacists and most retailers are afraid of the unknown. They say, "If I take tobacco out, I might lose all the accompanying sales." This is what they try to show you in the Coopers and Lybrand study.
But you have answered the question. For many of us who take tobacco out and who do it in a certain way -- because you have to replace those. As a health professional you have many things: you have sports medicine, you have nutrition, you have homeopathy, so many new products. It's up to each operator to find the niche that his or her pharmacy is in.
Even Ms Stenzler, the CEO of Pharma Plus, has said that those pharmacies who did it did it in their own time. Why didn't they do it? The college has given them notice since 1991 that this is going to happen. They're waiting for the last minute to do it.
Mr Dadamo: Congratulations on your work. Thank you.
Mr McGuinty: Nghia, I want to start by first of all congratulating you for all of the work you've done in advancing this cause. I don't think anybody could doubt the sincerity and the sense of commitment you bring to this. You probably recognize that a great deal of the debate which has taken place in this committee centres around the issue you first brought forward as president of the college, so you should be happy to know you've caused us a lot of trouble.
Some would have us believe that this is all black or all white and that those who have some difficulties with the idea of pharmacists selling tobacco are somehow pro death. It would be wonderful if life was that simple, but it's just not.
I think the issue for me personally is whether pharmacists should remove tobacco from their stores or whether government should remove it for pharmacists. That's giving us a great deal of difficulty and we'll have to give that extensive consideration.
Has the college ever asked the government to do anything of this sort before? Do you anticipate it doing anything again in the future? Do you have concerns about this as a precedent? There's obviously some controversy, and it's been very difficult for us. I think it would be unwise for us to conclude that there's consensus regarding this issue among pharmacists.
Is there a concern that somehow you're setting a precedent, that this time you're asking the government to do something for you? You're taking a side. You happen to agree with the government this time. What about next time? What if another group of pharmacists come forward and they decide they want something done with which you cannot agree? How do you answer that?
Mr Truong: Let me try to answer those two or three concerns that you have. The voluntary approach is the best way, if we can convince everybody to do it.
Mr Jim Wilson: Then it's not voluntary.
Mr Truong: You know, during my presidency, when I had to go all over the province to explain to my colleague pharmacists, I always stood up and said: "We want a voluntary approach. It's great. It has been 20 years though, guys, that we asked you this. So when are you going to stop it?"
I give them an analogy: "Let's say it was the time the GST was coming in. Let's say that Brian Mulroney goes there and tells you guys, `Let's have a voluntary GST for the good of the country. If you want to do it, fine. If you don't want to take time to do it, fine too.' What do you think?" That was 1991, when the GST was there.
Voluntary things are great on paper. Philosophically, great. But when it touches the bottom line, it doesn't work. I know in North America we live in a democracy. You have to listen to your people. But there's a point in time that as a leader of a group or a community or an association, for the benefit of the public, you have to make a stand and you have to take a stand for the good of the public. I know it's very controversial, but if nobody does it, we will be smoking until the end of the day.
Your question is, tobacco is the first thing. The college or another group will come and knock at your doors next time. You have to understand, Dalton, what the College of Pharmacists is. The College of Pharmacists is a branch, really, of the government, almost an illegitimate child of the government, even though we deal at arm's length. But if the government asks the college to jump, we have to ask how high.
The college doesn't go and knock at the door of the government to ask for things like that. It has to come from within the membership, the councillors, the ones who are there to represent the public -- not the way some of my friends think they are to represent the profession. They are confusing again. If they talk like that, they should belong to the Ontario Pharmacists' Association. They are not there at the college to represent the interests of their colleagues.
If the college, in its wisdom, asks the government to pass legislation, it's for the good of the public. Now, you may say sometimes, "What's next, if the college asks for some type of legislation which is different?" I think probably you have to give them the wisdom and the intelligence to come and ask the government, and of course the legislators, something which they can buy, really.
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Mr Sterling: I'm really happy you're here, Nghia. You know I've been involved in this whole fight against smoking, or the results of smoking, for seven or eight years. I started in 1985, and we've talked about it I don't know how many times over that period of time.
You may have heard me talking to the previous presenter about I'm not sure the public is involved in this debate as much as the pharmacy profession, but I do know of your hard work over that long time and I know how hard a worker you are in your business, along with your wife and your family, and I respect that gratefully.
I want to tell you the effect that someone of your stature can have on a member like myself. My tendency on this one would be to not be in favour of this, but you certainly give me much more than sober second thought on this issue. That's how much I respect you.
Mr Truong: Thank you, Norm.
The Chair: Thank you for coming to the committee and sharing your thoughts with us. We appreciate it.
CANADIAN TOBACCO MANUFACTURERS' COUNCIL
Mr Robert Parker: Good morning, ladies and gentlemen. My name is Rob Parker. I'm here on behalf of my client, the Canadian Tobacco Manufacturers' Council, CTMC, for whom I act as president. Members of the association are the three major Canadian tobacco manufacturers: Imperial Tobacco Ltd; Rothmans, Benson and Hedges Inc; and RJR-Macdonald Inc. Our brief, I think, is in front of you. I will summarize the main points.
First, the tobacco industry supports the goal of eliminating tobacco sales to minors and therefore the principal purpose of this bill. We have been members for some time of a coalition active in this area. Samples of the 1992-93 material distributed by that coalition are included with the brief. Given changes in the law, including those contemplated in this bill, the material will require updating before it can be reissued later this year.
Second, along with other members of that coalition, we would urge the Ontario and other governments in Canada to find consensus on a common age of majority for tobacco purchase purposes. The existing legal ages of 16, 18 and 19, depending on jurisdiction, will, we believe, inevitably lead to confusion among both the public and retailers.
Third, while it is obviously being debated outside the context of this bill, the bill itself does not address what we believe to be one of the largest sources of tobacco for young people, the contraband market. We do not see how sales to young persons can be successfully eliminated when contraband continues and grows. In fact, to the extent that it narrows legal channels of distribution, and only to that extent, by banning sales in pharmacies and banning vending machines, the bill would in fact expand opportunities for illicit distribution.
Fourth, section 5 of the bill deals with packaging and health warnings. The drafting there appears to us to go beyond anything now contemplated by the provincial government in that it establishes legislative authority for a parallel second warning system in addition to the federal one, even though the provincial government, as far as we know, is not now contemplating that. This is therefore a delegation of power by the Legislature to the current or future lieutenant governors in council, permitting a major new regulatory action without future involvement of members of the Legislature.
Fifth and finally, we believe that the authority to regulate in some places is too general. Under paragraph 9, for example, "a prescribed place" is included without further definition in the list of places where smoking will be prohibited. That would permit, we believe, current or future cabinets in Ontario, without further public debate or legislative reference, to ban smoking entirely in Ontario in all public and private places, including private homes, and that would appear to go considerably beyond the stated purposes of the bill.
That concludes my summary of our submission and I'd be happy to try and answer any questions.
Mrs Karen Haslam (Perth): I'll ask you a couple of questions that I hope have a very brief answer and then I'm going to look at something in your submission. Do you believe that tobacco smoking causes lung cancer?
Mr Parker: I believe that consumption of tobacco is statistically associated with a long list of health ill-effects. These have been clearly documented in a huge volume of scientific studies. If the purpose of the question is exploration of the details of that, I'm not a qualified witness.
Mrs Haslam: No, I was merely asking for a short answer. Lung cancer has tripled in women. It's a concern of mine, and I know that this is it.
Do you believe we should be preventing our young people from starting this habit?
Mr Parker: Yes.
Mrs Haslam: Given that, I'd like to look at your submission, because you've brought forward some very technical aspects and I'm sure the committee does appreciate that.
Your very first point in your submission, though, says, "CTMC supports the goal of eliminating the sale of tobacco products to young persons." However, you talk about aiming your programs at encouraging retailers rather than looking at the tobacco industry.
The reason I'm concerned is that I have in front of me a "Compilation of Excerpts from Court Testimony and Exhibits from the Tobacco Industry Challenge to the Tobacco Products Control Act." What concerns me is documentation such as this: "Young smokers represent the major opportunity group for the cigarette industry; we should therefore determine their attitude to smoking and health and how this might change over time." That came from Matinée Marketing Plans.
This was Fiscal '88 Overall Marketing Objectives: "Re-establish clear, distinct images for ITL brands, with particular emphasis on relevance to younger smokers. Shift resources substantially in favour of avenues that allow for the expression and reinforcement of these image characteristics.
"If the last 10 years have taught us anything, it is that the industry is dominated by the companies who respond most effectively to the needs of younger smokers. Our efforts on these brands will remain on maintaining their relevance to smokers in these younger groups...." That also comes from RJR-Macdonald.
"Advertising implications: Export should continue to appeal to younger males who are sports oriented, drink beer, enjoy popular music, are most comfortable in blue jeans and T-shirts...." You are successful. My son started smoking at 19.
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The one that worries me the most is your media planning process. What you do is select magazines which deliver the largest target group for each brand individually. For Player's Filter, in English and French in men, your target group is 12 to 17 years old. In Player's Light, English and French, your target group for men and women is 12 to 24 years old; du Maurier, women and men, 12 to 34 years old.
I'm very concerned about that, because that is well below any of the legal ages that you said were across Canada. I'm concerned because we see ads like this come out for Virginia Slims. Given that you said you're in support of eliminating the sale of tobacco products to young persons, given that your marketing plan goes for 12-year-olds, I feel that your neck would be a little red in the contradiction of both of those types of comments.
Mr Parker: Ms Haslam, I don't see any contradiction in it. I wonder if you could tell us the source of the specific quote that identified 12- to 17-year-olds?
Mrs Haslam: This came from exhibit ITL-13, Fiscal '80, Media Plans, an Imperial Tobacco document.
Mr Parker: Who prepared it?
Mrs Haslam: This came from a compilation of court testimony and exhibits.
Mr Parker: Yes, but was it written by Imperial Tobacco?
Mrs Haslam: It was a compilation of things -- I believe it was, yes. Outline the target groups for each brand in 1980.
Mr Parker: Well, all I can tell you is that I don't believe that is an Imperial Tobacco document. It came from a very complicated and lengthy court case. I think you're quoting excerpts from a paper prepared by a professor at the University of British Columbia.
Certainly people begin smoking at younger ages. Once they get into their 30s, there's very little incidence of starting to smoke. So reference to younger smokers should not be taken as meaning smokers under the age of 18. All that I can tell you is that since 1989, there is no advertising done by any of the Canadian manufacturers, because the Tobacco Products Control Act forbids it.
Even if advertising still existed, the industry's position -- and there was a great deal of evidence in the same court case on this point -- is that advertising does not promote a decision to smoke. It is aimed at brand choice. Those two decisions are quite distinct and different from all of the research that the companies have done historically. I know of no reputable market research firm or advertising research in Canada that would support the proposition that advertising triggers the decision to use the product. That's a complicated --
Mrs Haslam: But marketing does target an age group. You do look for a type of lifestyle, an age group, a young person looking at certain --
Mr Parker: That is not a Canadian company and that is not a Canadian advertisement.
Mrs Haslam: My concern is, though, that the targeting and the marketing is, even in Canada I feel, geared to younger people. That does concern us.
Mr Parker: I would think it would. It concerns the companies as well. We believe that the choice to smoke is an adult one. It should be a choice made only by people over the legal age to smoke. The only way we believe that can be controlled is by both voluntary compliance by retailers and by informed and effective enforcement. That's why we support this bill.
Mrs Haslam: I agree with the enforcement.
Mr McGuinty: Thank you, Mr Parker, for taking the time out to come and speak to us today. Are any of the members of the council manufacturing smokeless tobacco?
Mr Parker: No, I don't believe -- snuff you're talking about?
Mr McGuinty: Snuff or chewing tobacco.
Mr Parker: As far as I know, none of our manufacturers manufactures that or imports it. It's a very small segment of the market. There is some imported from the United States. I'm not 100% certain, but I'm virtually certain.
Mr McGuinty: Right. Do you know if there has been any discussion or consideration given to beginning to manufacture it here in Canada?
Mr Parker: No, I do not. A point I should make is that the association represents the membership on common, non-competitive matters such as appearances in a forum like this and dealings with government on a variety of issues, as well as the media. Choice of a particular product -- in the same category would be introduction of a new brand -- would not be something that we would be informed about.
Mr McGuinty: How would the council respond to this government banning smokeless tobacco sales in this province?
Mr Parker: I can't answer the question because I haven't asked it of my members. A ban of an entire range of product -- I guess the first question would be what the purpose of it is. If it would be included in the general ban of sales to young people then we would certainly support that. In fact, I assume it is included under the drafting of the bill.
Mr McGuinty: Yes.
Mr Parker: I would be happy to consult with the members if you'd like a response, but I simply haven't raised it and they haven't raised it with me.
Mr McGuinty: I would appreciate a response on that. It appears that, on the face of it, there would be no immediate economic impact on the members, since they're not in the business.
Mr Parker: That's correct, if they're not in the business of manufacturing it.
Mr McGuinty: I wanted to ask you a bit about packaging. I'm sure you're very familiar with this, but a number of presenters have argued that the package itself is a powerful form of advertising and that it's not covered by the federal legislation; that it ought to be addressed; that in the eyes of young people, a cigarette package is an accessory in much the same way as an article of clothing might be, earrings, a belt or the latest running shoes; that it's a powerful motivator for young people to get the package, get the cigarettes. How do you respond to that?
Mr Parker: I've read a lot of the material produced on this point. I certainly haven't read all of it. I think the fundamental position of the industry is that it continues to confuse two quite separate decisions. One is a decision to smoke, the second one is a decision as to which brand will be smoked, which tends to change a couple of times during the first few years of somebody smoking.
We have simply seen no evidence, and the companies having sold these products for close to a century in at least one case, they have extensive experience in this area. They find no relationship between those two decisions: First, they choose to smoke, then they decide which brand. The first choice of brand is much more likely to be something that is smoked by their peers, smoked by their parents, smoked by an older sibling, simply because it happens to be available.
The package design, therefore, as a promoter of the smoking habit, is not a relationship that we regard as proved in any aspect. It's worth pointing out that the Chabot case before the Quebec Superior Court -- Mrs Haslam quoted I think some extracts from testimony that was heard at that time -- heard a large volume of material on the connection between advertising and package design and the decision to smoke.
The judge's conclusion was that all of that evidence was of no probative value and it was not considered as part of his final decision. When he was reversed by the Quebec Court of Appeal it was done on legal grounds, not on an evidentiary basis, and that was let stand.
Mr McGuinty: I have one final question for you: What reaction could we anticipate from the council in the event that this government enacted legislation to require generic packaging for cigarettes sold in this province?
Mr Parker: Plain packaging?
Mr McGuinty: Yes.
Mr Parker: No such proposal has been presented to the council so I'm speculating in some cases in this answer. Plain packaging would remove the only device by which the manufacturers can compete among themselves, which is the package design. It becomes a very moot point over what the choice is between one brand and another if the package designs, as a matter of law, are virtually identical.
There are a number of legal questions that enter into such a decision. I think it is safe to say that the industry would object and would argue very strongly that it's a misplaced initiative. Beyond that, until there is a formal proposal, it's difficult to comment.
Mr Jim Wilson: Thank you, Mr Parker, for your presentation. I note with interest your comments. I know you're a former member of Parliament.
It is a point we've made also that the government is seeking very widespread regulatory authority here and that crucial public health questions and the manner in which tobacco products will be dealt with and smoking in public places, in the future, simply will be done in secret in cabinet and not referenced to the Legislature. However, you may want to appreciate that over three years of this government, we have got used to their way of doing business.
Particularly in the future, I think the public increasingly doesn't want smoking in public places. In fact those would be good questions to put before future legislators, but the government has decided to do it through cabinet process.
I did want to ask you a question. We've never really had, to my recollection over the last couple of weeks, the legal question that currently is before the Quebec courts. I believe it's the Quebec Court of Appeal. Is it with respect to labelling or packaging? Could you give us a summary of what the question is before the court?
Mr Parker: Two of the three companies launched court action on the constitutionality of the Tobacco Products Control Act, in particular its provisions banning advertising. That case has now been heard at the Superior Court level in Quebec and by the Quebec Court of Appeal. The Quebec Court of Appeal, as I indicated, reversed the lower court's decision on two points. It's quite a complicated case. Leave to appeal to the Supreme Court of Canada has been granted. That case will be heard, we expect, some time this year, although no date has been set.
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It is under that act that the package warning label regulations -- which are now themselves in a state of flux because they are changing -- a new regime will be in place by September of this year which requires redesign of all of the packages and a new set of eight warnings, two colour combinations to appear, larger than the current ones.
The companies asked the Supreme Court to stay that change until the court had heard the overall action because in effect the ground is shifting under the companies' feet. If the court, for example, hears the action and decides that the act is indeed unconstitutional, they will have changed all of the packaging, at a very considerable cost, under an act which would no longer have validity.
The court has not responded on that application for stay and the case itself, as I said, has yet to be scheduled but it will be heard.
Mr Sterling: Could I just ask a brief one on that: Has the Court of Appeal of Quebec basically said that the federal government then has the packaging control, or the right to make laws in that regard? Was that the question they're determining, whether it's provincial or federal jurisdiction?
Mr Parker: I'm out of my depth on this, Mr Sterling. I'm not a lawyer, period, and especially not a constitutional lawyer.
There were, I think, two separate grounds. The companies' cases, first of all, varied somewhat. The essence of it was the constitutionality of a ban on advertising; in other words, freedom of commercial expression under the Charter of Rights. There are related issues to that.
The first judge found that not to be justified; the second court found it was justified for a number of reasons relating to constitutional interpretation rather than, as I said, on the advertising evidence. That whole thing, of course, is to be reheard. Essentially, we now have two judges who have found in favour of the industry, two judges who found in favour of the government and it's to be heard by the Supreme Court.
Mr Winninger: In your presentation, you suggest that the solution to contraband tobacco is reducing taxes and increased enforcement. Both of those have an enormous cost to this provincial government. At the same time you admit the wealth of scientific data that relate tobacco-related diseases to the consumption of tobacco.
I'm just wondering, since I believe you're a business person, how you justify this position and how you would suggest that our government pay for the enormous cost of health care related to tobacco consumption if we reduce taxes and increase money spent on enforcement. It certainly won't be the consumer who pays for that; it certainly doesn't appear that the tobacco manufacturers will be paying for that health care. Who then bears that cost?
Mr Parker: Society generally bears the cost of the health care system out of consolidated revenue funds in all governments. That's always been the case. There is a considerable debate about the heightened health costs based on consumption of tobacco. Claims have been made that the costs to the public purse of those health effects significantly exceed the revenues to governments from smoking, which are very substantial.
As I'm sure you're aware, the Ontario government itself, and alone, for several years, has profited from tobacco taxes to the level of about twice the entire industry level of profits. The same is true of all governments collectively; the figure is 10 times or better, probably closer to 15.
There was a study written, I think two years ago, by a former chairman of the Economic Council of Canada which examined the proposition that it was justified to charge higher tax prices on tobacco because of the health impact cost. There are two responses, one of which he studied. The first one is whether or not that allegation was in fact true. The conclusions of his study were that contrary to those claims, smokers constituted a massive $3-billion- to $4-billion-a-year subsidy to non-smokers. The study is available; I'd be happy to provide it to you.
The one thing he did not address, and it's the other part of the argument, is whether lifestyle choices should be subject to differential health premiums. Tobacco is a legal product. It does carry health risks that are statistically associated with it. So do a lot of other choices that people can make in society. The question is whether behaviour should lead to differential premiums.
If it's true for tobacco, should it also be true for those who eat diets with high levels of cholesterol? Should it be true for skiers or hang-gliders? To be faintly ridiculous about it, should it be true for people who take public transportation to work, which is demonstrably and statistically safer than private transportation? Now, that's a philosophical argument that I think has to be addressed if governments wish to pursue this course of inquiry.
Mr O'Connor: Thank you for taking the time to come before this committee. As committee members will certainly correct me, we do have the information about the court challenges. It's in our binders, so we know about the history of the challenges through the courts.
It was interesting that through our discussions, we've certainly had a lot of presentations and a lot of people suggesting that we should go to a plain-packaging format. I guess part of the reason is that -- I'll use the example when we were in Sudbury. Someone came before us and gave us this.
Of course, it's a drugstore, and we've heard those arguments, and that's not what this is about, but down here below -- of course, it's for the jazz festival, du Maurier, and it's bright red, which of course is associated with that advertising that takes place millions of times every day in Canada with the package coming in and out of the pocket, which we hear isn't advertising and which, of course, is in compliance with the federal legislation that says no person shall advertise but for promotional purposes.
I guess this is why we're hearing so many people come before us saying that plain packages are essential. The intention of the legislators for the government of Canada, representing all the 40,000 who die prematurely from tobacco-related illnesses and the families and everything else, and the huge cost that it has on the economy for the illnesses and everything else is that this here -- they put that legislation in to ban advertising because of that. They did it for all those people, and yet this here seems to undermine it. They've got that part in their legislation.
I just wondered what is your thought around not advertising for the tobacco company, but sponsorship.
Mr Parker: I was not a member of the Legislature of Canada at the time that bill was passed, nor was I associated with the industry. But I read the Hansards that connected with the passage of the bill.
Advertising was to be banned. The Minister of National Health and Welfare of the day, Mr Epp, introduced an amendment to the bill, which would permit sponsorship of charitable, cultural and sporting events by the companies and promotion of that sponsorship, the kind of thing you're referring to in the picture.
That provision was supported by all parties in the House. In fact, I think there were only one or two dissenting votes at the time. The purpose was obviously to allow the organizations that benefit from the sponsorship to receive that support and, secondly, to permit the companies to notify the public that they in fact were in fact supporting them. The amount spent last year on that kind of activity collectively in grants to the organizations involved was in the neighbourhood of $50 million. It's up a little bit from two years before. We have done a paper which is available to you if the committee would like to see it. It goes back to early 1992 on that entire area.
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I think the nub of the question goes back to whether or not advertising or promotion or marketing -- there are lots of names for it, but whether a display of the name or a display of the package or a display of an advertisement in fact promotes the decision to smoke or a choice of brands. We simply have seen no evidence that it does. There are jurisdictions in the world where wide-open advertising is permitted, billboards the size of football fields and so on in Hong Kong, where the smoking rate is significantly lower than in Canada, in fact has fallen faster than it has in Canada. There are jurisdictions in the world where there is no advertising whatsoever where the smoking rate is significantly higher than it is in Canada. It's a connection that we believe does not exist.
I understand the sincere desire of people involved in this debate to eliminate or reduce smoking. We sympathize with it obviously in the case of young people below the age of majority. We think it is not a decision that people of that age should be making, and the only way to do it is to eliminate the contraband market and take the enforcement steps, many of which are in this bill, in the legal market. The advertising or promotion connection to the decision to smoke, I would simply tell you, in our view does not exist.
The Chair: Mr Parker, thank you for coming before the committee today and for your presentation.
Mr Parker: Mr Chairman, thank you for your time and for your questions.
Mr McGuinty, you asked for a comment on the industry's view on a ban on smokeless tobacco and whether I had any other document --
Mr Tony Rizzo (Oakwood): The report you were talking about.
The Chair: Yes, it would be useful to have that.
Mr Parker: That's the Raynauld Vidal on health costs. I'll provide both.
NATIONAL CAMPAIGN FOR ACTION ON TOBACCO
Ms Janice Forsythe: Good morning. Bonjour, tout le monde. Merci, Monsieur le Président. I'm Janice Forsythe and I'm executive director of the Canadian Council on Smoking and Health. I am here today on behalf of the National Campaign for Action on Tobacco, which is a coalition of organizations that are interested in reducing tobacco use in Canada and that work mostly on the advocacy side of the issue. The organizations in the steering committee are the Canadian Cancer Society, the Heart and Stroke Foundation of Canada, the Lung Association, Non-Smokers' Rights Association, Physicians for a Smoke-Free Canada as well as the Canadian Council on Smoking and Health. We act as convener of that coalition.
Some of our counterparts at the Ontario level may also have submitted and presented to this committee, but I want to emphasize that we are not here to supersede anything that they have said, only to enhance their positions.
I'd like to thank you for listening to us today and congratulate Ontario for the position it has taken on this terrible public health problem. You are certainly leaders across the country, and we're very pleased to see all-party support for this very important bill.
We've heard some people say that there are no studies showing that the ban on the sale of tobacco in pharmacies will have any impact on reducing consumption. We beg to differ; this is not the case. Rob Cunningham, next to me here, is a lawyer working right now on a contract basis with the National Campaign for Action on Tobacco. He's a lawyer and an MBA graduate of the University of Western Ontario, and in his studies over the many years that he's been working on tobacco control issues he has take a very close look at this. His findings were published in the Canadian Pharmaceutical Journal and we've asked Rob to make a presentation based on his personal views as were indicated in the article. I'll now turn the floor over to Rob.
Mr Robert Cunningham: Thank you. I will be making a number of comments on other aspects of the bill briefly at the end, but I'd like to address this principal issue with respect to pharmacy. Let me first say that when I undertook this examination, my conclusion was not such that I was able to prove scientifically that consumption would decrease if the sale of tobacco was banned in pharmacies. That would be difficult or perhaps impossible to do. But what I did do was look at the available evidence and reasons, and my conclusion is that I personally have no doubt that there would be a decrease in consumption. A different question is how much that decrease would be, and that's something that I didn't examine in the article.
There are seven reasons that I would like to list fairly briefly, if I could, as to why there would be a decrease in consumption. You may have heard some of them previously.
One is price competition. You take away Shoppers Drug Mart and its loss-leader activity, its putting tobacco on sale: This has an impact of lowering the price among other retailers in the community. They want to make sure that they maintain their tobacco sales and the complementary sales that go with it.
If this happened and the price competition was such that there would be a 5% decrease in price within a community, that has, based on all the empirical research, about a 2% increase in overall smoking, and we've heard about this relationship in the tobacco tax debate.
The second reason: You ban the sale of tobacco from pharmacies and you get rid of a lot of advertising and promotion, inducements to smoke. Notwithstanding Mr Parker's position that advertising has no impact on primary demand, my view and the view of professors in my faculty of business administration who study marketing have said it's absolute garbage. A lot of jurisdictions in increasing numbers around the world are banning tobacco advertising precisely because they feel the impact has to be something that's addressed.
You have in most Shoppers Drug Marts and other pharmacies sponsorship advertising. You have huge displays. Now, these are inducements that the tobacco companies actively have their sales representatives encourage.
I'd just like to quote something from an Imperial Tobacco document. It's a confidential document that was produced in a court case, Matinée Marketing Plans 1971, and each copy is individually numbered. They wanted to make sure at the time that there was a very tight restriction. With respect to Matinée, this brand was targeted as one for women and positioned to be safer for health. So one of the things they wanted to do in the marketing plan and I'll quote: "Therefore we should put a certain amount of emphasis on vending machines, keeping in mind that Matinée could appear with an ad on vending machines in hospitals and health centres."
So back in 1971, when tobacco was more commonly sold to hospitals, they had this brand that they wanted to have perceived by smokers as being safer for health, so they wanted to have it positioned in hospitals and health centres. You've heard lots of individuals make representations about how the message of pharmacy as a health facility and tobacco is incompatible. The tobacco industry recognizes that link in confidential documents.
Third reason: You get rid of the sale of tobacco from pharmacies and you may have more health promotion messages. Right now a tobacco sales representative is going to object for sure if some pharmacist is going to have, above the tobacco display, "Smoking causes lung cancer; quit smoking, save money," or whatever other message there may be to discourage smoking. They may also object to the alternative nicotine products, such as Nicorette chewing gum, which we see have increasing promotions in pharmacies.
I mentioned this health promotion possibility to one chain drugstore pharmacist here in Ottawa a number of years ago, prior to the publication of this article, and what he said to me was, "We can't appear to do anything against tobacco." That's quite a statement and it shows how financial implications -- and I refer to that quotation in the article -- can have an impact on non-business decisions.
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The fourth reason: Reduced distribution. You reduce the number of outlets, you reduce convenience for the consumer and you'll reduce consumption. The Addiction Research Foundation -- I've quoted from some of their previous research in the area of alcohol in the article, and I understand from Mr O'Connor's comments this morning that they've already made a presentation of how, in their view, reduced distribution would lead to reduced consumption.
The fifth reason is that fewer distribution outlets facilitate enforcement. It makes it easier, with fewer outlets, whether they're pharmacies or vending machines, to control the sale of tobacco to minors. We've heard pharmacists say, "We don't sell tobacco to minors; we train our staff." In the written material there are a few clippings: Shoppers Drug Mart was convicted of selling tobacco to minors, an item that Mr Sterling raised in the Legislature the day of the conviction. There's also the summary of a survey done at about the same time where 25 out of 30 Shoppers Drug Mart stores surveyed in Ottawa and Toronto on a compliance check sold tobacco to minors. Of the 25 stores that sold, 21 had signs up saying that they wouldn't sell to people under 18. We also have laws with respect to tobacco advertising and there's been a litany of complaints by health organizations that these aren't being complied with.
Shoppers Drug Mart, we know their relationship. They have a large, large number of tobacco promotions of various kinds within most of their stores, although less in the store that's in the Rideau Centre that some of you may have been in, in your stay in Ottawa.
I wrote to Mr David Bloom, chairman and chief executive officer of Shoppers Drug Mart. I'm a lawyer. I pointed specifically to various provisions of the act that were being violated unequivocally, a registered letter asking for an explanation from Shoppers Drug Mart. I got no reply. That letter was written November 12, 1993.
The sixth reason is of course the relationship with Imasco. They own Shoppers Drug Mart. If Shoppers Drug Mart was no longer able to sell tobacco, the attractiveness of owning Shoppers Drug Mart would be substantially reduced. The synergy, the vertical integration of owning a tobacco retailer, perhaps the largest tobacco retailer in Canada, would be lost. If Imasco severed that relationship you may have new independence in Shoppers Drug Mart, producing a new attitude to tobacco control, an attitude substantially different from the one that we have at this point in time.
The seventh and final reason is that the ban on tobacco sales in pharmacies would result in an educational message to the public: "Hey, this is serious. You can't sell tobacco in pharmacies." That sends a message and may contribute, with other factors, to the decisions with respect to smoking initiation or cessation.
At the same time it'll have an impact on decision-makers at the local level: "Hey, yes, smoking. We should really tighten up our bylaws. This is serious business." So it can have an influence in stimulating interest in advancing other laws which would also have an impact in reducing tobacco consumption.
The Committee of Independent Pharmacists had a report produced by Coopers and Lybrand. I've only had an opportunity to give a cursory examination of this document, but based on my training I reject the conclusions, partly based on the methodology and partly based on the failed material that was considered. Only 13 independent pharmacists were interviewed, and these were all independent pharmacists who sold tobacco. Statistical significance is something that's missing. They didn't interview pharmacists who had stopped selling tobacco and what the impact was on jobs for them.
They did mention, "We want money to stay in our communities and so on and so on," but they didn't mention that 100% of the profit of the chain company, Shoppers Drug Mart, goes to Imasco; 40% of that profit goes to their parent company in Great Britain, BAT Industries. So where is that money staying in our community? That money is leaving the country.
If I may, I'd like to reiterate my support for plain packaging. If there's anything that this committee or the government of Ontario could do other than tobacco taxation to have the maximum impact on tobacco consumption within our community and with our young people, it would be plain packaging. I'll pass around a little plain package that I've prepared. There are different models of plain packaging which you may have already seen before the committee. That's one such way. The brand name is found in small print on the end.
There were a couple of questions that have come up, one with respect to the new federal law, the Tobacco Sales to Young Persons Act. That was proclaimed in force last Tuesday. Its regulations are law today. So most vending machines in Ontario are illegal and have to be removed, as of last week. That's already in place and the only vending machines that are left are the ones not covered by the federal law. With respect to a question that came up from Mr McGuinty with respect to smokeless tobacco, I can confirm Mr Parker's understanding that there is no smokeless tobacco produced in Canada; it's all imported. So there wouldn't be that economic impact if the committee made a decision in that area, which I would support.
With respect to the case in Quebec, I've also written an article with respect to the constitutionality of the ban on tobacco advertising prior to the case being argued. I vigorously supported the constitutionality and, my having seen the evidence, some of which was cited this morning, some of which I cited and, contrary to what Mr Parker said, some of which was cited by the Quebec Court of Appeal, that level of court did cite some evidence that was not cited by the judge at the trial level in supporting their decision that the law was constitutional.
I'm very confident, and so are health organizations, that once we get through the system, there will be a very strong decision from the Supreme Court that the ban on tobacco advertising is constitutional, especially with some recent decisions that were not available at the time the Quebec Superior Court made its decision. There have been some more recent decisions on commercial expression that really give a signal that the tobacco advertising ban is going to survive very successfully.
One thing that was also decided this week was that five national health organizations were granted permission by Mr Justice John Major to participate in the hearing of that case as intervenors. So the health perspective will have added presence at the Supreme Court, not just the Attorney General of Canada. The intervenor status was opposed by the tobacco industry, as it was at the lower courts. The health organizations did not participate in the trial at the Quebec Superior Court. That may have a further impact.
In the document that you have, I've made some comments with respect to enforcement. Some of them are technical and detailed and legal, but I would commend them to your consideration. If I may highlight one and say we're having this real problem at the federal level with tobacco companies and compliance with the ban on tobacco advertising, there have been occasions where the federal government has said: "This is illegal. Stop this particular type of activity." The tobacco companies say: "No. We think it's legal. If you don't like it, take us to court." But then when we get to court, they say, "It's unconstitutional," and we have to wait through the legal hurdle as well.
What I would like to see the committee consider is something we find in the Ontario Business Practices Act where it's possible to have a cease-and-desist order to order corporations to have compliance. They can appeal this order, but in the meantime they must comply. Given the past behaviour of the tobacco companies, who fight like the dickens with respect to any measure that can have an impact on their profit, this type of added enforcement provision could be of tremendous benefit, particularly when we recognize that we would like to have laws that we can enforce successfully.
That concludes my oral comments. We'd be pleased to answer any questions the committee may have.
Mr O'Connor: Thank you for your presentation. Noting that you're part of the national action campaign, I wonder, given that the federal government has proclaimed its legislation, and noting we've been around the province and we've seen these vending machines in lobbies and what not, do you know what kind of action the federal government might be taking to get these out of these places? Because they are obviously now against the law.
Ms Forsythe: The health groups met last evening with federal Minister Marleau and we have been assured that they are stepping up the negotiations with the provinces on the enforcement mechanism to be put in place for the Tobacco Sales to Young Persons Act. They have added 300 investigation officers, so there are some wheels that are in motion, but we don't have a definitive plan at this stage.
The Chair: Am I not right that there was a date on the federal bill? Wasn't it July 1?
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Mr Robert Cunningham: They had been expected to proclaim the bill so that it would be in force, but because of the tobacco tax matter they felt they had to proclaim it on an earlier occasion.
The Chair: But is there a specific date?
Mr Robert Cunningham: In the legislation, no. It was to come into effect on a date designated by the governor in council.
Mr Sterling: Nice to see you again, Rob. I don't know how long it is since we talked last. I saw you sitting out here and I didn't, until you came up and I saw your name and I started reading about you -- it clicked, I guess, that it's four or five years, and I don't know if I ever did thank you for writing that nice letter in the Star or in the Globe and Mail about how wonderful the member from Carleton was on this issue.
Mrs Haslam: Who was the member then?
Mr Sterling: Actually, I don't know if I was the member for Carleton at that time. Anyway, I appreciate your coming here.
I was interested in your last point about the right of a government to stay or to stop the sale of tobacco or to have an interim decision of the government, while it's being tested in front of the courts, remain the law of the day in effect. I guess I'm a little concerned about doing that in light of the present scepticism towards our politicians. I wondered, is it a fair comparison between what we do under the business practices legislation and what you're suggesting here? Are there any problems with that?
I'm very reluctant, quite frankly, to say to any government -- maybe that's because I'm in opposition at this time -- "You can legislate whichever way you want," and even in the face of the Constitution it may tempt legislators to step beyond their bounds and then say: "All we'll do is we'll stop it for two or three years. We'll put up a tremendous fight in the courts and legislate where we really don't properly have jurisdiction." I guess it's sort of a two-edged sword, looking at it from a point of opposition politics in terms of not agreeing with whatever the government -- now, I would agree with what you're saying here on this issue, but I wouldn't agree necessarily with other steps.
Mr Robert Cunningham: Sure. I recognize the concern as a legitimate one. The Business Practices Act has different tiers of options. First of all, they give the responsibility to a director. It's not at a political level. We see this type of responsibility at the federal level: for example, the director of investigation and research for the competition bureau. It sort of has some quasi-independence. That's one thing.
They also have different things: They can have an order for compliance and then it can be appealed. They can have another level where they can say order and comply, pending an appeal. So it would only be in a more serious situation where you'd go to that step.
The tobacco companies would still have the option that they would even seek an injunction to avoid compliance. If there are still constitutional issues that remain outstanding, they may do that, but the constitutional issues are going to be resolved. We're going to see them at the federal level. They're going to be resolved soon, and then it's not merely constitutional issues but compliance. So they would have mechanisms through the Divisional Court in Ontario to challenge that. But once you've gone through that a couple of times and the courts say, "That's fine," and in fact, the courts do say that and I expect they would, then I think the courts would be permitting as directed.
Mr Sterling: When you were a law student, several of you laid some private information against Shoppers City, I think it was, for selling to minors. I've suggested to various different groups in terms of the vending machine issue that basically most vending machines in Ontario, and in Canada, I guess -- Ontario in particular because I know -- were illegally selling cigarettes to minors. They have been for the last five or six years. I suggested to the heart and lung people or whoever to go through the same process you did when you were a student at the University of Toronto, and they seemed to be reluctant to undertake that kind of process.
If a 14-year-old went up, put money in a cigarette vending machine and took the cigarettes out, the owner of that vending machine, as I understand the law, could be charged with selling cigarettes to the minor.
Mr Robert Cunningham: I have the same understanding. I think a lot of people who don't have legal training, some people, are intimidated by the legal process and if they were to initiate something --
Mr McGuinty: It's not the process; it's the bills.
Mr Robert Cunningham: That's a further consideration. So that may be a deterrent for a large number of people who would like to see compliance. I would support a provision that simply gets rid of vending machines so that you don't have to go through this more time- and cost-consuming stuff.
Mrs Haslam: I'd like to thank you for your presentation. It's been one of the most precise, most concise, most technical advising reports we've had and I really appreciate that. I think the ministry appreciates the information from you regarding enforcement because I think we all agree that enforcement will make or break where we're going with this legislation. That's been part of a previous legislation, that there hasn't been an effective enforcement component, which I think was part of the thinking when we brought the legislation forward from the ministry, to look at the costs involved in any enforcement mechanism.
I believe that's why the model was brought forth, such as it is, regarding ticketing versus licensing. It's my understanding that licensing could be very costly both to small business people and to the ministry, upwards of $1,000 per business. So the other way of looking at it was to look at ticketing and put that money into enforcement, rather than bringing in a piece of legislation that's costly and have no money left for enforcement. So I really thank you for those suggestions around the enforcement.
What I'd be interested to know is if you could expand a bit on one of your reasons when you talked about the drugstores. We've had Zellers and other mart people come and say, "We can get around this. We can put it as an owner-owned entity within a larger building, and that kind of a problem for us," building walls and things like that. Others have come forward and said, "If Zellers has to make a choice between tobacco and the pharmacy, we feel the pharmacy will be let go."
I've always wondered, wouldn't that focus more business to pharmacies? If Zellers no longer does prescriptions, wouldn't that go into the Shoppers Drug Mart, if Imasco decides to go with the drugstore in their sign instead of the tobacco at the front of the store? Wouldn't that be a more focused business to the real pharmacist so that when pharmacies come to us and say, "We're concerned," wouldn't there be a flow of business if this came about? You mentioned something about Imasco making a decision. I wondered if you would expand on that, if you had any thoughts on that.
Mr Robert Cunningham: I would agree with what seems to be the premise of your question that, yes, if Zellers was no longer selling pharmaceutical products, customers would have to go, for this purchase that they need to make, to pharmacies that aren't selling tobacco. These other pharmacies would then benefit from some of the traffic sales that are no longer going to places like Zellers.
Mrs Haslam: Would that counteract to some extent the flow of traffic next door to the confectioner for the tobacco, that at least they're increasing the flow of people into their store for pharmacy?
Mr Robert Cunningham: Would it counter it to some extent? Yes.
If I may, with respect to your comments on statutory prohibitions, I would really urge the committee to ensure that on the first conviction there is a short statutory prohibition period. This is what the Legislature in Nova Scotia has done and I believe the Legislature in Newfoundland. In Nova Scotia, it's seven days, and a longer period of time for subsequent offences. Here, we need the second offence. So that really gives a retailer a break: "Okay, I'll wait till I'm caught and then I'll really try and comply." In the meantime, they may have sold several hundred cigarettes to minors. So that's one point I really urge the committee to consider.
Mrs Haslam: Thank you, Mr Cunningham. Again, I really do appreciate your presentation.
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The Chair: Final question, Mr McGuinty. Dare we finish with a lawyer?
Mr McGuinty: Thank you, Mr Chair. I may be a lawyer, but I assure you I'm not a QC.
I want to thank you both for your presentation. Mr Cunningham, I admire -- what would I call it? -- your ingenuity in your law school days in terms of bringing that matter before the courts and conducting that survey.
I want to get your legal opinion on a couple of things. First of all, what legal obstacles can we anticipate if we incorporate a generic packaging component in Bill 119?
Mr Robert Cunningham: First of all, Mr Parker didn't give a very complete answer on how tobacco manufacturers may respond. They may respond with a constitutional challenge. I think it would be easier for a court to conclude that plain packaging is constitutional than a ban on tobacco advertising. There are two reasons: One, I made a presentation at the National Conference on Tobacco and Health and I had 17 reasons why plain packaging would have an impact on tobacco consumption. I'm presently writing an article on that which will give you more detail.
But smuggling, it's clear that if you could have a distinct package like this, anything that doesn't look like that doesn't belong. That makes it a lot easier for enforcement in smuggling. There's no doubt there will be an impact. Given the importance of the contraband issue to a number of areas -- I mean, you don't have to get to the question of whether it will have an impact on young people smoking.
Having said that, there is an increasing amount of evidence in Canada, in New Zealand and in other places of how generic packaging can have a tremendous impact. So you may have a challenge; we'll have to see what the manufacturers do. But I have no hesitation to predict the outcome would be successful for the government.
Mrs Haslam: Where can we reach you when we want to hire you?
The Chair: This is not supposed to be a business hearing. Thank you both very much for coming forward and for your submission. We appreciate it.
RUTH ST LOUIS
The Chair: I call on Ms Ruth St Louis of the Pro-Medical Pharmacy. Bienvenue. Welcome to the committee. We have a copy of your written submission.
Ms Ruth St Louis: Good morning. I wasn't sure how this worked, if I had to hand it in earlier, so I'm glad someone came and asked me for it.
I'm an independent pharmacy owner who's worked as a dispensing pharmacist since I graduated in 1978, continually the whole time, except for two very brief maternity leaves. I opened Pro-Medical Pharmacy in 1986. It's located in a medium-sized dispensary in a medical building here in Ottawa. Pro-Medical has never sold cigarettes and never will. Given the size of the pharmacy, it was an easy decision, but there was no way I was going to ever have tobacco in my store, no matter what size it was going to be.
I strongly support the ban on the sale of tobacco in pharmacies. What made me decide to come was that before the hearings, all I heard were the loud voices of the opposition, which were pharmacy representatives saying how they were going to lose their shirt and all this stuff and that they were the best people to counsel about tobacco. I felt that most of these pharmacists were really not the front-line people; they were mostly the non-dispensing, administrative pharmacists. Having been in the field for so long and seeing the patients coming in with these tobacco-related illnesses, I felt there was just no question that tobacco shouldn't be in pharmacies. You can't in one corner sell tobacco and in the other corner fill the prescriptions for all the problems caused by it. To me, it's quite clear.
As health care professionals, of course our primary objective is to improve health and quality of life. To me, that choice was made when I chose the profession of pharmacy. Now that it's 1994, there's no doubt as to the hazards and everything associated with tobacco use. My big question is, how can something that has so many limitations on where it can be used find itself in a pharmacy, which is a pro-health facility? To me, it's always been quite clear.
I find it's a real shame that it has had to come to legislation, but I'm really grateful that it has. I think it will help a lot of the pharmacists out there who do work for companies that really are the decision-makers as to what is sold in the store. They're the ones dealing with the people on a day-to-day basis, but they really don't have a say as to what comes and goes in there.
I think with the legislation going through, it will eliminate the conflict once and for all, and the mixed message. I feel that it will send a stronger message to the people who say, "If they're available in pharmacies, they can't be that bad." Those people will start taking the health risks really seriously and decide what to do.
I really think restriction leads to more awareness. I know it's worked in our building. We worked for quite a while trying to make our whole building a smoke-free environment, because we had a small restaurant in there and it was the only place in the building that allowed smoking. He did decide to sell the odd tobacco. They're gone now and it's amazing how many employees who do smoke have come for help to quit or have quit. So I feel that a message really can be a mute message but it's there and people really do act upon it.
I don't have much more to say, except that, in closing, the fact that my store was a tobacco-free pharmacy attracted a lot of people to me initially. I'm surrounded by chains and people were coming because they wanted an alternative to, as one lady frankly put it, "those tobacco pharmacies." That's what she labelled them as.
But there's this one particular lady I'll always remember. She came into the store for the very first time. Friends had told her that we didn't sell tobacco. She said she'd just lost her husband within the last month and she wanted all her prescriptions transferred to us because she didn't want to set foot in this pharmacy where she'd been for years and years.
She found that there was no way she could go there after they had sold her husband the tobacco that had killed him and then profited from the prescriptions that he needed as a consequence. I didn't know what to say to her. I just shook my head. You wonder, why is this still happening? Something's got to change.
Thank you for the opportunity of coming here.
Mr McGuinty: Ms St Louis, thank you very much for taking the time to come down and speak to us. I know where you are. My constituency office is on Kilborn Avenue, in fact.
We've had some presentations from people with considerably larger operations than yours. I'm just wondering what you felt about that when we get into stores like Zellers, or even we had the example, I guess this is the most extreme example, where the pharmacy is on the fourth floor and the cigarette sales are on the first floor in a large department store.
Ms St Louis: Where would that kind of store exist?
Mr McGuinty: The Bay. I haven't been following it that closely, but it's apparent to me that having a pharmacy on location is a marketing ploy. It's a draw to bring people in there, so we're seeing them in non-traditional settings, I guess. I'm just wondering what your feelings are about those non-traditional pharmacies.
Ms St Louis: I didn't realize there was a facility that large that had them so separate. I don't know. I basically feel that you have to make a choice. It's either prescriptions or tobacco. If tobacco is so lucrative to you, to anyone, then choose tobacco. To me, they're just two very different things, and they don't go together. It's like saying some person who sells insurance can go and tamper with your car just so he can raise your premiums. To me, it's basically the same thing. It's pretty cut and dried, in my mind.
I feel for these places, but a lot of pharmacies have voluntarily withdrawn cigarettes. I think they've benefited by it in the long run. I really feel that the pharmacists who are talking, especially from the large chains, are really the voices of non-pharmacists, basically. These people haven't dispensed in a long time. They really are cut off from the health issues. If they're voicing the concerns of Imasco, they're not pharmacists at all. So to me it's cut and dried. It's too bad, especially for the building that has a pharmacy on one floor and tobacco on another, but they're minorities.
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What's nice about Ontario is there are still a lot of independent pharmacies. I grew up in PEI, and when I was young, it was all independents. Then the chains came in, and now there's basically only Zellers and Shoppers Drug Mart. Everybody else is gone. So there's really no alternative; people only see day after day -- you know, you walk in, you go by the tobacco, then you go get your prescription. When you walk out, you go by it again.
Mr McGuinty: I think you make a very compelling argument. One of the difficulties we face is that if we just consider the non-traditional pharmacies, I think there are many cases in which the people who call the shots there will opt for cigarette sales, and those pharmacists that are employed at Zellers or the Bay or K mart or Loblaws, whatever, are going to be put out of work. They can't be re-employed, obviously, within those operations, stocking shelves or whatever.
Ms St Louis: If they have a client base, they can easily open on their own. I'm not sure how it's set up with Zellers, but I think the pharmacy itself is owned and operated by an individual, so you can usually find a location not that far away, especially if you have a business already set up, outside of these places.
Mr McGuinty: All right. Thank you.
Mr O'Connor: Thank you for your presentation and for coming before us. We've certainly heard a lot of arguments on both sides of this issue, and of course it's tied in with a bunch of other health facilities that are included in that portion of the legislation.
I come from a small town, and we still have a small community pharmacy that everyone goes to. I remember Mike Sheridan, who retired there. A new person came in, a young pharmacist. She does a terrific job, and everyone still goes back there. She's redesigned it a little bit and made it, I guess, kind of more modern-looking. But it's a terrific community pharmacy, and it's someplace where people can go in and talk to the pharmacist and have some comfort there.
I guess some of the dilemma in the way people have been putting it is that we've had, actually, representatives of the college come before us who said that, "The pharmacists that I speak up for don't want us to be banned from selling tobacco products." Mr Nghia Truong was here this morning and said it so eloquently, that the college of pharmacy is here to represent the consumers, the people who may have a problem at some point in time with the way they've been handled by the pharmacist. I guess the conflict we find ourselves in here then is that we've actually had people from the college who have come before us and said that, and the pharmacists from my area, and it's really kind of disheartening.
I see some young people coming in here. We've had a number of young people come before us, and we've had some pharmacy students come before us. You could see within them that they are going to go out there and practise pharmacy as health care professionals.
Ms St Louis: But that may not last.
Mr O'Connor: Well, maybe it will now.
Ms St Louis: Well, it will now. My first job was Shoppers in Summerside. I worked there a year before I moved to Ontario. A lot of the corporate head office didn't come to PEI that much. I think there was one store in Charlottetown and one store in Summerside, so they didn't bother us too much. We were pretty adamant about a lot of things, but tobacco was still up there in the front. At that time, I don't think a lot of us really took the issue seriously. It was 1978, 1979. But you become aware of how corporate head offices just kind of pull the strings. A lot of times the pharmacist owns that dispensary, but the rest of the store is basically out of his hands.
So to me, I feel that a lot of those decisions are not made by that person in the back seeing those people; it's the people who have access to the front of the store. It's two separate things within the same store.
The reason I came here today is I want to represent the pharmacists who do the dispensing. A lot of us are busy out there making a living, because there are so many issues to deal with right now that a lot of us can't come in here. I was going to drop everything -- family, business -- and just come and make my voice heard to kind of offset those loud ones that we've been hearing so much.
Mr O'Connor: Good. Thank you for doing that.
The Chair: Thank you very much for coming down to the committee this morning. We appreciate it.
SOMERSET WEST COMMUNITY HEALTH CENTRE
The Chair: I call on the Somerset West Community Health Centre, Ms Sherryl Smith. Welcome.
Ms Sherryl Smith: Thank you very much, Mr Beer. I have three young people from our community here today: Kate McCarthy, Rosemary Robertson and Sean Graham. These children are 8 and 11 respectively.
I am the health promotion coordinator at Somerset West Community Health Centre, which is located here in Ottawa. It's a very urban, multicultural community. As a health educator for the last eight years I've really focused a lot of my attention on helping low-income women quit smoking, and I've seen the struggles that most of them have gone through. All of these children's parents smoke. I've watched women who are poor and are struggling with many economic issues in their lives and a lot of social and environmental stresses as well try to kick the habit, and more recently I've decided that although we can't forsake their needs we have to also look at the issue of prevention, so we've been really working much more at looking at preventive efforts. That's why we're here.
Most of the women I've helped to quit during their intake process have admitted that they started smoking between the ages of 12 and 13, so this is really very critical legislation and we applaud the government for having gotten it this far against some very strong opposition, well-organized opposition, and given the state of affairs with the taxation issue, we also think it's very important that you hang tough.
We certainly support the legislation as it is written in its entirety. There are a couple of issues that we would like to either reinforce or amend.
Reinforce the issue of plain packaging. Certainly there's tremendous evidence to show that that is a very strong deterrent for young people taking up smoking. The other issue we would like to see is some kind of very strictly enforced policing system. Licensing would be the ideal, but if licensing isn't feasible then certainly some very strongly enforced legislation with some real teeth to it because we know that the current legislation doesn't do very much good.
The opinions that I'm giving are on the basis of community meetings that we've had around the issue of tobacco access for young children. One mother who was involved in these discussions suggested that a lot of people repackage their smuggled cigarettes, so the packaging is somewhat of a deterrent for the young people, but if we're really dealing with the smuggling issue, perhaps changing the colour of the filter tips might be another way of distinguishing the cigarettes.
So we got some very concrete suggestions and we've had some discussions with these young folks here as well and they've also come up with some interesting suggestions and some interesting stories that I'd like you to hear them tell.
Sean, do you want to start with your good suggestion?
Mr Sean Graham: I said that maybe you should put ingredients on the box of cigarettes so when people read them they would look at them and think that they're really bad and can poison them. If they don't read it they can like put a little chart on the wall and show them the ingredients in it.
Ms Smith: Do you want to tell your story about your friend?
Ms Rosemary Robertson: I had a friend; she was at a store about cigarettes. She tried to buy cigarettes and the store manager said no. Then he said, "Well, you have to give me a gold ring and then I'll give you cigarettes." Then she walked out with the cigarettes and that's it.
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Ms Kate McCarthy: My best friend has a friend who's only 13. She's really tall for her age. She walked into a store and she said, "Can I have some cigarettes?" She was only 13 and they thought she was about 18, 19. They just let her have as many cigarettes as she wanted, and she was only 13.
Ms Smith: I'd just like to finish. You'll see that in the attachments there's a poem written. It's a wonderful poem that was written by a young woman who participated in one of our cessation programs. This was sort of her inspiration, so I just draw your attention to that poem. I think it's terrific.
The Chair: Just to identify it, that's the one Nick O'Teen?
Ms Smith: Nick O'Teen. I think it says it all so well. It says it all.
The Chair: Would you like to read it?
Ms Smith: Sure.
"Someone we've known for a long time. I can still remember when I first met Nick -- I thought he was so cool. All my friends hung out with him, and so I thought I would too. At first, I'd get really choked up when he was around -- just like a teenage crush. But as time went on, I really got hooked on him.
"They say love is blind, and I loved Nick. All I could see was good in everything he did when we were together. When I was sad, he comforted me. When I was angry, he helped me calm down. When I was tired, he gave me a lift. I never felt lonely when Nick was nearby. Everyone told me that Nick was bad for me. I never listened.
"It took a long time for me to see the truth. Finally, now, I can say that I know Nick for what he really is: a lying, cheating, good-for-nothing CREEP.
"He took all my extra cash -- even when I had no extra cash. He took advantage of my trust, and got me addicted to poisons. He makes me sick! He stinks! And anyone hanging out with him stinks too! He tried to rob me of my future, but I didn't let him. I told him to BUTT out of my life.
"It may be hard to get on without Nick, but not nearly as hard on me as it was to have him around!
"So, I'm here today to say goodbye to Nick. So long, it's been bad to know you.
"Ashes to ashes, butts to dust.
"Goodbye Nick O'Teen. Rest in pieces."
This was a poem that she wrote the day she was quitting smoking. We've used it in our programs as sort of a eulogy, you might say, when the day comes for women to quit smoking.
Interjection.
Ms Smith: This was written by a participant in one of our programs, Mary Elliot.
Mrs Haslam: Sean, it was interesting for you to bring that up because we were talking about truth in advertising. We had a young person, a little older than you, come forward and say that instead of saying, "Smoking is hazardous to your health," what we should be saying is: "Smoking makes your face get wrinkles. Smoking makes your teeth turn yellow. Smoking makes you stink. You smell if you smoke."
I think you've hit on a another good idea because we have 11 pages here of the ingredients of cigarettes, so it would be an awfully large package if we made the tobacco manufacturer put all the ingredients in tobacco. One of them is varsol, the chemical formula for Varsol, and the chemical formula for toilet bowl cleaner. Do you think that would be worth putting down: "These cigarettes could clean your toilet if you used them in a certain quantity"?
Do you really feel that type of advertisement would help young people? What age should we be aiming it at? You're 11 and statistically you're at a very vulnerable age now to start smoking. But there is still 11 to 19 and maybe even 20; there are another 10 years above you where you're at jeopardy of starting smoking. What could we say to you in the next 10 years that would make you stick to your guns and not start smoking?
Mr Graham: I'm not really sure about it.
Mrs Haslam: That's fine. That's an adequate answer and it's certainly something that we understand, that it is difficult for you at your age. It's difficult for us at our age to find that one message or the two messages or the education component or the enforcement component or the plain packaging component. Maybe we're looking for a simple answer when the answer is all of the above. Thank you very much, Sean.
Ms Smith: Do any of you others want to answer it? No?
Mrs O'Neill: Thank you so much, Ms Smith, for coming in and bringing your children. I feel quite strongly that cessation programs will have to be a very strong component of the implementation of Bill 119 although very little has been said about them in these hearings. We know that smoking is addictive and that has been said quite often.
Can you tell us a little bit about the cessation programs that you've been involved in? We've heard about them being part of high school credit programs. We've heard about them being part of workplace programs where people will be given actually time out of the workday without any loss of pay. Can you tell us anything about the kinds of things you've done that would be successful? This poem seems to be very poignant. You must have some success stories, just looking at that poem.
Ms Smith: Actually, this story started about seven or eight years ago when I myself was trying to quit smoking. I was in a privileged position to be able to buy the service to help support me through that process. I was at that point working with a group of very low-income mothers who, when they heard that I was trying to quit smoking, indicated their own need to quit. When I started doing some research about programs they had access to that were affordable, there were none. I decided at that point to try to develop a program that was appropriate to these women and also very affordable.
That process took about five years and the program has been written up as a facilitator's manual. It has been printed and distributed across Ontario, is now being reprinted and translated and will be distributed through the Addiction Research Foundation.
The reason this program is effective is because we're not dealing exclusively with the addiction. We're really looking at some of the underlying socioenvironmental factors that once people are hooked they feel that tobacco products, the nicotine and the other chemicals that are in cigarettes -- they become dependent on those both psychologically and chemically. It's the psychological addiction that is often the hardest one to really break.
A lot of these women have very stressful lives and are dealing with incredible pressures to survive. Tobacco is one thing they have control over. It's a power. It's a control issue for many of these women who are on social assistance and who often don't have any other controls in their lives, so holding on to their cigarettes is very important. We know that women smoke for reasons that are different than men. They smoke because of stress factors in their lives that often they can't deal with another way, or they don't think they can.
Our programs really look at those underlying fundamental issues and teach people how to cope, how to deal with stress, look at self-esteem issues, look at a whole bunch of different factors that are influencing people's need to find solace in an addictive substance. That's the approach that we use in the program.
Mrs O'Neill: Thank you for your perseverance and your ingenuity.
Ms Smith: We had some support. I think the Ontario tobacco strategy is timely, and certainly this population is a very needy population. One of the largest groups of new smokers is young women. Poor women and poor people are the ones who are still very addicted to the product. There haven't been a lot of resources made available to support their need to quit.
My experience over the last eight years as a health educator is that 80% or 90% of people want to quit. If you ask them, they want to quit, but it's how to quit that's the problem. I'm here because I'm committed to that group but I'm also here because I don't want to see any of these kids in any of our cessation programs 10 years down the road.
Mrs O'Neill: And yet their mothers are very strong role models.
Ms Smith: Yes.
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Mr O'Connor: Thank you for coming today. Thank you for your presentation. You're a long way from voting age and this is a unique opportunity that we do have in a democracy like we have here in Canada and Ontario, that you can come before a committee of the Legislature and have a chance to have some real input into legislation before it happens.
Another opportunity I want to offer you right now is that -- I'm the parliamentary assistant to the Minister of Health. I speak to Ruth Grier quite often. In fact, tonight I'm going to be sitting down and talking about some of what we've been doing in some of the committee hearings.
There's an ad campaign that's under way. You may have seen the ads, this Joanne ad, where this young girl goes into the bathroom and smokes a cigarette and that computer does that thing to her face. Of course, it's induced by that cigarette that kills over 13,000 Ontarians a year. If you had a chance to tell Mrs Grier what you think of that ad campaign -- here's your opportunity. I'll let you say something to Mrs Grier and I'll take it to her tonight.
Ms McCarthy: I think it's pretty neat for some people, adolescents, who are thinking about starting smoking and when they see that commercial, they sort of get a bit scared and they will think about stopping smoking. That's what I think.
Mr O'Connor: All right, thanks. Adrienne, did you have anything you wanted to add, or Rosemary or Sean? Did you want to say anything to Mrs Grier?
Mr Graham: The part with the chemicals, we can name a few most common chemicals, not all of them. Like, some of them you can say over whatever number it is and here's some of them: You can put mercury and arsenic.
Ms Smith: Mr Chair, I'd like to also introduce to you Adrienne Turnbull. We were scheduled originally for 11:30 and she's come out of school and I'd like her to have a chance to speak, if you wouldn't mind.
The Chair: Certainly.
Ms Adrienne Turnbull: I'm not too sure exactly what has been happening but I'd like to say that as a high school student, I find that there's a lot of smoking around. I don't exactly enjoy it much and I tend to avoid it but I notice that essentially the thing that will really stop students is if you -- well, essentially what won't stop it is making the buying age different because they'll find someone else to buy them for them. Licensing will probably work, though. I think it's probably a very good idea because there are quite a few students in the --
The Chair: Thank you. I'm sorry to end it. We're a little ahead of ourselves. You weren't here at the beginning, but we also appreciate your coming down. Ms Smith, thank you for having the students come here and talking to us about tobacco. We appreciate it.
KARYL JAANUSSON
DAVID J. WALKER
Ms Karyl Jaanusson: We'd like to thank you for inviting us to share our views on Bill 119 today. My name is Karyl Jaanusson. My colleague is David Walker. We are both employees of Pharma Plus Drugmart in Ottawa. We each have had over 20 years experience as pharmacists and many of those as managers. We are on the agenda as Pharma Plus Drugmart with our names underneath it; we'd like to make it clear that we are here not has representatives of our company, but more as community pharmacists just speaking for ourselves.
Our purpose is to explain our position on Bill 119 and the proposed Ontario tobacco act, and our reasons behind that position. Our presentation will be brief, as we're sure you've heard many arguments over the last few weeks.
We are presenting together as our stores are similar in size, sales and trading area. Our stores are over 6,500 square feet and are like mini-department stores with four distinct selling areas: the prescription department, or the pharmacy, the cosmetics, general merchandise, and the tobacco area. Between us, we employ about 70 people, 25 of whom are full-time employees.
Bill 119 has caused us to split ourselves into our two halves, professionals and retailers. As health care professionals, we certainly support most of the objectives advanced by the Ministry of Health in Bill 119. As managers, however, of retail stores, we object to the proposed ban of tobacco sales by drug stores. I will be presenting our professional side; Mr Walker, our retail side.
As health professionals and personally, we agree that smoking is both a health and environmental danger. We agree with these objectives of Bill 119: to discourage smoking in children and adolescents, to decrease public exposure to secondhand smoke and to reduce the overall use of tobacco.
As pharmacists, the majority of our day is spent dispensing prescriptions, discussing medication with physicians and counselling consumers on the use, benefits and potential side-effects of both prescription and over-the-counter medication. Support staff such as pharmacy assistants do the technical jobs, such as counting, pouring, mixing, typing labels. Many times, after discussion with the consumer, we will suggest no drug therapy at all, for which advice we are not reimbursed.
The pharmacy in our stores today represents about 10% of our selling area, 25% to 30% of the store gross profit and almost 50% of the total store salaries. Profit in the pharmacy is generated through the dispensing fee or professional fee which is added to the cost of the medication to make the price of the prescription.
The pharmacy profit margin has fallen almost 20% in the past decade and 1% in the last year. The reason: the social contract and other efforts by the government to reduce the cost of the Ontario drug benefit program. The fee, which is frozen at $6.47 since June 1990, was further cut back in September 1993, to $5.86. Several drugs have been delisted from the drug benefit formulary.
Other drug plans are following drug benefit's lead and are pressuring us to reduce our fees. It is not uncommon for a prescription to cost $100 for a month of medication. Of that $100, $94.14 is paid to the manufacturer or wholesaler for the cost of the drug. The balance is our profit. So the cost of drugs is increasing; the fee is decreasing. The pharmacy profit is being eroded.
Should our stores be pharmacy only, especially those stores with a high percentage of drug benefit prescriptions, we couldn't possibly survive. Support staff, such as pharmacy technicians, would have to be eliminated to cut down in overhead and the pharmacists would then be reduced to doing the technical aspects again and we wouldn't be free to speak to our customers.
Thus, with the economic squeeze being put on pharmacy today, we depend more than ever on our front-store sales to help us survive so the consumer has a dependable, knowledgeable, inexpensive professional available for medical advice at a time and place convenient for them. I'd like to ask Mr Walker to continue with the retail part of our presentation.
Mr David Walker: From our position as being retailers, we feel that this proposed legislation will be damaging to the profitability of our stores and, inevitably, there will be some job loss. The front shop accounts for about 70% to 75% of our total sales and it's these sales that help the dispensaries to operate in the professional manner which we both would like to see continue.
The component of these sales, which traditionally were tobacco, were about 10%, although recent activities with regard to black market smuggling and the federal move on taxation have changed this figure somewhat.
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Our margin on tobacco is relatively low, but it has been a generator. Most customers who buy tobacco also add on to their purchases by buying personal care products, OTC products and the like. Under this scenario, if there was no tobacco, then there would be no reason for many of these customers to come into our stores, and I think this scenario points out that there would be a financial impact on our stores.
As an aside, we would suggest that the government of Ontario move to bring back into pharmacies all the medical-type products that currently are freely available in all sorts of outlets such as grocery stores so that proper services would be available for counselling the patients if needed.
We want it clearly understood that, as health care professionals, we absolutely and totally support the move towards reducing tobacco use in Ontario. In fact, personally, if Ontario became a tobacco-free society tomorrow, I would be extremely happy. However, we feel that this bill will not have that desired effect of reducing the smoking but, in fact, will allow greater uncontrolled access to tobacco since it will still be freely available through the gas station, corner stores, grocery stores etc.
If the government of Ontario is serious about reducing tobacco use in Ontario, and we believe it is, then we suggest the bill should be amended. The government should make tobacco a controlled substance. We do not believe anyone denies that tobacco can be and is addictive, and we suggest that government and society should be moving in a direction that acknowledges the drug type of properties that tobacco use has. In fact, with the previous presentation, the reading of that poem Nick O'Teen, I think, highlights the destructive effects of nicotine.
We'd suggest that there should be a massive campaign to exercise the public that tobacco use is in fact a type of drug use. The outlet for supply of tobacco products should be a multipurpose facility with anti-smoking products as well as counselling services available. We do not -- and I repeat, do not -- suggest that this facility would be a drugstore.
The distribution of tobacco products through a tobacco control board, similar to the LCBO, would be the fairest and most consistent way of regulating supply, but also of treating retailers equally. However, this would necessitate the government giving all retailers a time period of five, seven, 10 years to adjust their operating procedures, lease renegotiations, replace lost products and adjust staffing through natural attrition.
In conclusion, we would just thank the committee for the opportunity of voicing our opinions and concerns.
Mr Tony Martin (Sault Ste Marie): It was again a good presentation of the way that you proceed with this whole issue.
For me this has been a really interesting, challenging, troubling discussion that we've been having for the last number of weeks. I guess the only word I can use to sort of describe in any way -- I suppose there are others -- is almost a schizophrenic happening where you have professional pharmacists very sincerely believing two different things here.
We have retailers who come in and share with us two perspectives on this. Some say, "We don't lose money"; others say "We do lose money," and it's almost like the devil playing with us. I've listened to one group of presenters tell me that and run by me all the facts and figures that tell me this is a deadly business to be in and 13,000 people are dying across the province every year. Then we have other people coming and tell us that, "Well, yes, that may be true, but still it's a legal substance and we need to sell it to make money." It just doesn't jibe. You have, in your own instance, Pharma Plus stores which are selling it and Pharma Plus stores which have decided not to sell it. How do you personally deal with that?
You sit at the table here, actually presenting to me the retail side and the professional side. How do you personally deal with that tug that must be inside of your head around the question of this being such a deadly substance -- 13,000 people a year dying as a result of smoking -- and yet it's a legal substance and we continue to sell it because it produces a profit?
Ms Jaanusson: It has always been a problem with myself as a professional in the fact that drugstores sell cigarettes, but it's been a traditional product in community drugstores, especially those of larger volume, ever since I can remember. Personally, I've never sold a cigarette. Cigarettes are at one end of the store and I'm at the other. Although I manage the whole store, I have nothing to do with cigarettes.
I don't agree with smoking and, as David said, I'd be very happy to see a smoke-free Ontario. I guess my objection would be the fact that we're being pointed out because people see us as a health facility where in effect we're partly health facility but generally just a convenience store to many people, like a grocery store or the corner store where people can go and not only pick up their cigarettes but they can pick up their aspirin, their Alka Seltzer and a lot of things that are of a drug nature which I don't think should be sold in those stores, but they are.
I would agree; as a professional I don't agree with cigarettes and I think they should be eliminated. I just think it's a bit discriminatory to pick all drugstores.
Mr Walker: I would concur with what was said. I would also point out that as part of the traditional drugstore economy, tobacco was used partially from the government's side also when it negotiated fees and things to say: "Well, don't worry if this fee's not good enough. You'll make it up out front." Now if at this point then you pull, suddenly, a portion of what has been part of the economy of operating a drugstore, then I think you have a potential and major effect.
But the more important thing is, by pulling it out of a drugstore, I personally don't believe you're going to reduce the usage of tobacco significantly, because you're not making it less available. It's still in all the other outlets.
Mr Ron Eddy (Brant-Haldimand): Thank you for your presentation. We've been presented with information where many pharmacists have made the decision to eliminate tobacco products from their locations and they're success stories. They say that although they may have experienced a reduction in sales because of that when they eliminated tobacco for a while, then things picked up and they were complimented by many people who agreed with them eliminating tobacco. It's a real success story and there are many of those. In addition, we have a list here of 64 pharmacies in this area who have eliminated tobacco.
I appreciate your mentioning the contraband, the smuggled cigarette situation and hopefully measures being taken will help to curtail that, if not eliminate it. I certainly hope so and I know many others do. But in view of the success stories and in view of the declining sale of tobacco products -- maybe you're experiencing that -- what do you think about the success stories that this committee's been told on many, many occasions since we've been sitting?
Mr Walker: I don't know personally all the people you're referring to. I would say, however, that their decision to discontinue was probably made by themselves, that this is appropriate point to do it. This legislation is proposing saying, "Everyone stop supplying tobacco."
Mr Eddy: I don't think we've been told by anyone that anybody who stopped selling cigarettes decided to go out of business. It seems to be a plus rather than a loss.
Mr Walker: As a business person, a business person would not make a decision to discontinue a product if he knew it would bankrupt him. So the people who discontinued did so because maybe that was not a large or significant portion of their business or whatever. I really can't answer for those people.
I think we've made it clear that neither of us smoke. We don't believe in smoking. We're not even saying that tobacco should be in a drugstore per se. What we're saying is that if you want to reduce tobacco consumption, then move towards a controlled supply but don't leave it in gas stations and whatever, because that doesn't go towards the ends of reducing it.
Ms Jaanusson: Also, I'd like to add that in our particular cases we're in malls where there's a lot of competition. There's Zellers very close by my store; there are grocery stores. If we didn't sell cigarettes a lot of our customers would go to those stores to pick up the cigarettes there, and those stores are now carrying a lot of the products that we traditionally have carried, like health and beauty aids and even some cosmetics in small amounts, that I think we would really lose the companion sales for those.
Mrs Haslam: I've been listening very carefully and as I understand it -- you talk about profitability -- you say that 75% of your profitability comes from front-of-the-store products and 10% of the 75% comes from tobacco sales, so that lessens the profitability out of 100% of tobacco. I question whether a store would go bankrupt on 10% of three quarters by removing one product. I seriously question that.
As Mr Eddy has said, time after time we've had companies and stores come to us and say: "Yes, it was a little difficult. There's little profitability in tobacco. It is a cash-flow situation for the store. We replaced it with a more profitable product, so we replaced it with something that makes us more profit, not just the cash-flow item of it. We replaced it with something that still brings people into our store." So I would question that comment in particular.
Number two, you talk about an appropriate point, some people having an appropriate point for removing the tobacco when in reality the Ontario College of Pharmacists has given notice since early 1989, 1990 -- task force continued to say that pharmacies should be removing tobacco. So in the last four years there should have been some downgrading and there should have been within the last four years an appropriate point for stores to remove those products from their store.
I think you bring it to the forefront. It ultimately is a matter of an argument saying that the presumption is that the financial benefit supersedes the health benefits, and I think this committee has to look at the health benefits. I just ask you to make a comment.
Mr Walker: If we're talking four years or whatever, you must remember there are lease negotiations where rates are fixed over 10 years or whatever. However, the committee's concern is with health, and I think we've made it clear that our concern would be with health.
I'm personally not arguing that tobacco should be in the drugstore. What I'm saying is that the legislation, as proposed, does not have the desired effect of reducing tobacco consumption, and I think that would be the argument I would be using.
Mrs Haslam: If we reduce just one person's consumption and if we prevent just one child from starting -- and we've had certainly proposals before us showing in that Brantford 28% of the high school students buy from drugstores. We had a 12-year-old in Thunder Bay buy from a Shoppers Drug Mart and Pharma Plus. So if that one child stops smoking, I think we have to consider that as a viable goal.
Mr Walker: I would concede that if one child stops, that's great, but if you can stop more than one, in fact hundreds, by having your supply controlled through proper outlets, and I would suggest gas stations and corner stores as being the supplier is not the right way to go -- so taking it out of drugstores as one area is just discriminating. Make it a controlled substance if it's that dangerous, you know, and put it in a controlled outlet and provide the anti-smoking support services and all and, as I said, not in a drugstore.
Mrs Haslam: I agree. Enforcement is a major component of this piece of legislation. Thank you very much.
The Chair: May I, on behalf of the committee, thank you both for coming here this morning. We appreciate it.
Members of the committee, that concludes our sitting for this morning. We begin at 1:30 this afternoon here.
The committee recessed from 1154 to 1334.
NATIONAL ASSOCIATION OF TOBACCO AND CONFECTIONERY DISTRIBUTORS
The Chair: Good afternoon, ladies and gentlemen. Our first witness this afternoon is from the National Association of Tobacco and Confectionery Distributors, Mr Luc Dumulong, executive vice-president. Welcome.
Mr Luc Dumulong: Thank you. First of all, I would like to thank the standing committee for giving us the opportunity to present our views on the proposed law. I guess I could start by telling you what the association is all about and who we are and who we represent.
We are wholesale distributors of tobacco and confectionery products throughout Canada. We are the middleman, if you will, between the suppliers and the retailers. Our members serve 60% of all retail outlets in Canada, so we're pretty vast. Of course, the goal of the association is to foster better communication and a good flow of products, be it confectionery or tobacco, between manufacturers and retailers, and of course representing the interests of the wholesale members.
On our presentation per se, I guess I could start by looking at the minimum age requirement. In the light of the fast-evolving situation these days in respect of tobacco and tobacco legislation and taxation and so forth, in our opinion we should have a universal minimum age. We, of course, are against youths smoking and we think that smoking should be a decision made by adults. We commend the effort of the Ontario government to curb accessibility of the product for youths.
This being said, if we start having different age requirements by different jurisdictions it might get confusing, especially in this portion of the province where we have a different age requirement now, and we have an age requirement throughout Canada that is universal, if I may say. So I guess our point of view on that would be of one age across Canada.
Vending machines: Of course, our members do distribute tobacco products through vending machines. We have to realize that over the past few years the legitimate distribution network of tobacco products has been experiencing a significant decrease in its sales, but at the same time this decrease in sales wasn't reflected in the consumption level that we see in the population, for obvious reasons.
Obviously, we have a huge contraband problem on our hands now and we're losing control of the tobacco industry. We know the manufacturers are making a lot of money on that. They have been making a lot of money recently, but we, the small operators, privately owned distributors and retailers, the clients of our members, are really hurting also. We see again what's happening here in Ontario and in Quebec: 40% of the total market here in Ontario is controlled by organized crime where you don't get any taxes and we don't get any business.
That being said, if we ban vending machines totally, what we'll do I guess is we'll only shrink the legal distribution network of this legal product, giving even more incentive to the consumer, who might not get the chance to buy the product of their own choice easily enough, to turn towards the illegal market again, fuelling even more this huge problem on our hands.
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If we reduce points of sale, that's what is going to happen. We're going to fuel this contraband network again. I don't think it's very good for our society as a whole when we see that more and more it is socially acceptable to circumvent the law because of legislation that isn't in tune with what the population is inclined to accept. If we shrink this legal distribution network even more, and I have to stress this fact because we have this big problem now, of course we'll lose, because of this contraband, tax revenue for the government and we'll lose jobs at the wholesale distributing level as well as the retail level.
In pharmacies, the same thing applies. That won't achieve the goal of discouraging people from smoking because they'll be able to walk across the street or to the next-door store and buy their cigarettes. I think here again the same logic applies: Reducing points of sale will encourage even more people to turn towards the illegal market. The demand is there and if it's not supplied by legal means, it will be by opportunistic, organized crime means. What do we do with small and remote pharmacies that sometimes depend on the sale of tobacco products to stay in business? Are they going to have to close down? I'm sure all these arguments have been presented before, but it's important to stress that. The banning of tobacco sales in pharmacies also raises serious concerns as far as we, the wholesale distributers, are concerned, because this measure in a way represents a first step on the part of the government to take control of the distribution of tobacco products in this province. I think this should raise a flag for us, definitely, because here again if we start selling cigarettes in liquor stores, by shrinking this distribution network, we're going to have those opportunistic guys going across the border and making tons of money: $1.6 billion in 1993 that the illegal contraband network netted. It's a lot of money they're looking at there.
There's a need for the product and if it's not supplied by legal means, it will be by illegal means. I wonder if laws that would like to have people quit smoking or entice them to quit smoking really work. If people decide to quit smoking, they just quit. I guess the role of the government in that respect would be one of education. As long as we educate the public, it's the only way. I don't think coercing people will achieve a very positive response in many of them. We hear that more and more these days: "I'll do what I want. I don't like to be told what to do by the government, especially with a legal product."
Our recommendation would be, to start, a unified legal age for buying tobacco products. In terms of vending machines, although there's an accessibility problem to that special market, without totally banning vending machines, I guess we could leave those machines in a restricted area where we have a licensed establishment where accessibility is already restricted. I don't think that we need to ban vending machines totally. In terms of pharmacies, the decision should be left to the owner. Basically, that's it.
Mr Jim Wilson: Thank you, sir, for your presentation. I don't have any questions, other than to ask you how many members you have in the association. I guess secondly -- I do have a question -- do you know of any other provinces that have had the discussion about banning the sale of tobacco products in pharmacies? In particular, because I notice your address is in Quebec, has the Quebec government thought about that?
Mr Dumulong: I guess in light of what they've been deciding with taxation, as a PR move in a way, they said they were going to consider maybe banning sales in pharmacies, but I don't think we're there yet in Quebec. I know that in Ontario this dossier is much more advanced and the political will behind this proposal is much stronger in Ontario than it is in Quebec. Taking this into consideration, I don't think Quebec will go ahead. They might take this position as a medium, maybe, to appease the ever-powerful anti-smoking lobby in Ontario.
Mr Jim Wilson: How many members are in your association?
Mr Dumulong: We have 86 members from BC to Newfoundland. Maybe you can say, "Jeez, 86 members are not that many," but 86 members cover 60% of retail outlets in Canada. We have big members, and smaller of course. We have independent and we have corporate.
Mr Jim Wilson: Do you know how many actual stores you would supply to?
Mr Dumulong: I don't have the actual numbers. I just have a percentage. Within our membership, it's very touchy to start telling these things, because in a way in association business you have competitors that are together under the same umbrella. They can get really touchy at one point in time in terms of their yearly sales and all these things. These are problems I have to work with in my membership. That's why we only can work with the percentages.
Mr Sterling: I have just a very brief question. Can you give us some idea of how much of your sales would represent sales in chewing tobacco and whether or not that's increasing at this time?
Mr Dumulong: Chewing tobacco is very marginal. It's by region. The more west you go, the more chewing tobacco you'll find. But all in all, it's a very small amount.
Mr Sterling: Is it increasing in Ontario or Quebec, or do you know?
Mr Dumulong: Chewing tobacco? I don't think it is increasing. Smoking is increasing. We all know that. I don't think I have to explain that. In terms of chewing tobacco, I don't think that it is. It's pretty stable.
Mrs Haslam: The National Association of Tobacco and Confectionery Distributors: What else do you distribute?
Mr Dumulong: Well, candy --
Mrs Haslam: That's what I was asking. Confectionery is candies, and tobacco?
Mr Dumulong: We also distribute what we call "small wares," the little articles that you find around cashiers: pens, things to hold your hair and all these things. Historically, our members were specifically distributing tobacco and confectionery, but with the evolution of the market, of course they would have to carry more lines of products and things like that.
Mrs Haslam: I just find it incongruous, tobacco and confectionery. The two of them together give me an uneasy feeling, when I talk about candy on the one hand and tobacco on the other.
Could I go into your report now? You talk about smaller and remote community pharmacies that rely on the sale of tobacco products. We have not found that in these hearings.
Mr Dumulong: No?
Mrs Haslam: They do not rely on tobacco if they are a pharmacy. It ranges between 5% and 10% of their sales. It's a good cash flow product at the front of the store when they pay for cigarettes versus when they come into the store and they're a turnover. But we've also had many come in and say that they've survived without it. So I would question your idea that they rely, because that's not what we're hearing. But I want to ask you specifically about a couple of things.
You talk about "authorities...take control of the distribution of tobacco products." Do you not agree that governments should be taking control of this product?
Mr Dumulong: I totally disagree with that.
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Mrs Haslam: Okay. On the minimum age requirement, are you aware that we are not the only province? There's New Brunswick, Nova Scotia, British Columbia, Newfoundland and Ontario, so out of the provinces, you're looking at five. You're looking at half the provinces with the same age. The reason we brought it in in Ontario as this suggestion was because of an age-of-majority card and proper identification. It's not a matter per se of only the age. We could have made it 20; we could have made it 21. What we do feel is important is that we have to have some viable and approved sense of identification. In Ontario, with an age-of-majority card, that would coincide with the age of 19. So when you talk about "18 to 19 will create confusion," I disagree again because half the provinces in Canada are at 19.
It was interesting that you brought that one forth. It was very similar to the previous legal presentation from the tobacco manufacturing council and it was a very interesting legal type of presentation.
My last question is around organized-crime-led tobacco.
Mr Dumulong: I'm sorry?
Mrs Haslam: Organized-crime-led tobacco. What makes you say that by reducing the number -- it's not what you're saying; it's that you've included its being "offered by organized-crime-led tobacco contraband." I'd like to know where you got your statistics around the organized crime in the operation of tobacco contraband.
Mr Dumulong: They control it. I think it's a known fact.
Mrs Haslam: That's what I'm asking. Where did you get your information?
Mr Dumulong: Just to give you an example why organized crime is involved in that, you can buy a semi-trailer of cigarettes in Indian reserves in the States, if I may, at $612,000 Canadian, resell it at $27 with their well-organized distribution network in Canada. That means $2.025 million minus that $612,000. That's $1.4 million profit. There's 24 passing --
Mrs Haslam: That's my question. You're talking about organized crime. Are you saying that the bands which are selling tobacco are organized-crime-led?
Mr Dumulong: I never talk about the Indians.
Mrs Haslam: That's what I'm asking. Where did you get your information about organized crime?
Mr Dumulong: I guess we should not put everybody in the same boat here. There are some elements of native people who are involved in that. We all know that; it's a known fact. But this being said, I don't think we should put everyone in the same basket, saying that all Indians are in that same boat and that all Indians are corrupted by organized crime. But we all know --
Mrs Haslam: So you see a major growth in the contraband as coming from organized crime?
Mr Dumulong: They are controlling the --
Mrs Haslam: And where did you get that idea?
Mr Jim Wilson: The RCMP commissioner's letter to the PM.
Mrs Haslam: That's what I'm asking.
Mr Jim Wilson: Inkster's letter to the Prime Minister states that.
Mr Dumulong: We always hear from the police authorities, and it's well documented in the Sûreté du Québec and the OPP that it is led by organized crime. I guess if you read the newspaper as much as I do, I don't have to go into that. We know that it's organized crime.
The Chair: Thank you very much for coming to the committee this afternoon. We appreciate it.
NON-SMOKERS FOR CLEAN AIR
Dr Ed Napke: I'm Dr Ed Napke and I've been involved with Non-Smokers for Clean Air for some 20-odd years. Our association receives no grants or benefits other than the fees we have from members. Most of the members have had some illnesses from smoke, secondary or otherwise.
Ms Jinny Slyfield: I'm Jinny Slyfield, president of Non-Smokers for Clean Air.
Dr Napke: The small, typed article is what I'm reading from. It says, "Without Prejudice," and it was written by Dorothy Vallillee, who is a senior in one of the seniors' residences here in town. Several other seniors were supposed to come, but feeling intimidated, have not shown up. They may by 2:30, but up to now they haven't. So I'll just read this. I have not edited it; it's as Dorothy Vallillee has written it.
Before I go further, there is a perspective I'd like to bring out, which is that "tobacco smoke" is a misnomer. You have to picture it as a poison gas with known toxic effects both for normal people and for people who are sensitive to smoke. So there are two kinds of responses to smoke: normal people, who can tolerate it except for the smell and things of that nature, and then there are people who are sensitive or hyper-sensitive, which will bring on a reaction as soon as they're in the vicinity of smoke.
The other thing that has to be kept in mind is that although the perpetrator of smoke may have left the room, the gas is still there. Think of this as a poison gas, and though the perpetrator has gone, the smoke is still there until something filters it out, if at all.
"Ladies and gentlemen:
"For the sick, infirm and elderly of senior citizen residences in the city of Ottawa, this presentation to you is a matter of life and death.
"We are here on behalf of some residents to present to you their issues on the status of their declining health. They are confident their health would improve if secondhand smoke were eliminated from these buildings.
"They tell us that their quality of life was not taken into consideration when you were establishing the current smoking regulations.
"We are more aware now of the carcinogenic dangers of secondhand smoke in our environment. The `fatal' statistics were given to us by the provincial and federal governments (departments of health) who have spent millions, perhaps billions, of our tax money on tobacco research. Were their studies in vain? Their suggestions and recommendations have gone unheeded by another ministry, Housing, who govern and regulate the buildings in which we live and breathe our air -- for better or for worse! Are these ministries cooperating with one another or working against one another?
"In our twilight years, the message we are getting is, `Nobody really cares about our health problems or our quality of life.' Something is radically wrong. We plead with all of you to listen to and to help us -- time is not on our side.
"Attendance at some activities has dropped off from a once active social life. We can no longer tolerate the leftover secondhand smoke which has contaminated our games room, lounge and permeated into our kitchen. The smoke odours have penetrated our fabric-covered furniture and the carpets.
"We must not forget the residents who are on continuous oxygen. They cannot walk freely about their own home just in case someone has `lit up'; thus, we the majority of residents must remain isolated in our units. You are all aware of the psychological effects of isolation which in our case is forced because of secondhand smoke. Could this be elder abuse? Criteria designated by Health and Welfare state that this is so. If a detailed medication survey was taken in this building, the realization of medication for lung, arteriosclerotic heart disease, asthma etc would be outstanding to all of you. So why add fuel to the fire? An ounce of prevention is still worth a pound of cure.
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"Turn this old, old saying into cash and the amount is enormous. Therefore, your present regulations on secondhand smoke is definitely contributing to the escalation of our health care system and affecting our quality of life.
"There is no doubt in our minds that the cost of this medication could be reduced if secondhand smoke could be controlled by the Ministry of Housing.
"We came here to seek your help when we made the decision that we do care enough about our suffering neighbours to reach out for help on their behalf. Timidity and vulnerability prevent them from approaching you or anyone else. It has not been easy for us to be involved, since this smoking issue has created notable disunity in our buildings.
"The Ministry of Housing has been aware of this disunity, hostility, animosity, antipathy and defiance of suggestions issued by housing authorities. It is very, very sad to experience the feelings of ambivalence and apathy which have overtaken residents this past year -- mostly attributed to the smoking regulations. They cannot understand the justification of this issue dragging on and on. This attitude does not give them any hope that one day they may enjoy the same freedom you have in your workplaces. We all have rights, that is true, but no one has a right to make others ill at any time, or anywhere, or at any expense.
"Please make our building safer by the bottom line of this issue: No smoking anywhere except in your unit.
"We thank you for this opportunity to speak with you. We are willing to discuss this issue any time and anywhere at your convenience. It is a matter of life and death. Please listen to our plea. Thank you.
"Sincerely yours,
"Dorothy Vallillee,
"On behalf of some residents of seniors' housing in the province of Ontario. Without prejudice."
Ms Slyfield: Non-Smokers for Clean Air is a group of volunteers who are either directly affected by tobacco smoke or very much aware of the danger of environmental tobacco smoke for non-smokers. We have several physicians in our group.
First of all, we want to congratulate the government for its recognition of the need for protection from tobacco use, and we welcome the opportunity to speak to you today. Our presentation will be limited to one topic, that of the serious need for legislation to regulate smoking in common areas of apartment buildings, especially those occupied by senior citizens. Apparently, no level of government now has the authority to provide this protection. This is a very serious health and lifestyle issue, and we urge the Minister of Health to amend Bill 119 to include this badly needed legislation.
We became involved with the issue of smoking in seniors' buildings because seniors asked us for help. These were people who had made a simple request: "Please establish and enforce regulations against smoking in common areas of our buildings." They did this through their tenants' association. As you heard, they encountered amazing resentment and many of their initial supporters backed away through fear of personal reprisals.
Most of us had believed that seniors were either covered by existing legislation or we would be concerned enough about the health of other seniors so that they would not be subjected to environmental tobacco smoke. It seems that seniors are the one large segment of our population which has been totally ignored, this although seniors suffer more respiratory distress and heart trouble than the general population.
The argument that smoking seniors deserve special exemption from smoking legislation is blatantly unfair to non-smoking seniors. These buildings are home to all. The lounges are for the use of all. If they're filled with tobacco smoke they contain at least 43 substances known to cause cancer in humans and animals.
We asked for help from the Ottawa-Carleton Council on Smoking and Health, of which we are a member, and the regional health department. Together with representatives from several seniors' buildings, we approached the Ottawa-Carleton Regional Housing Authority to ask for a policy. We asked that all lounges be designated non-smoking so that all residents can enjoy their use.
Housing takes the view that all such issues must be settled by tenants at tenants' meetings. While this is perfect in theory, the reality is that the sick and the frail elderly cannot attend these meetings because of tobacco smoke. Also, many tenants are simply unaware of the danger of environmental tobacco smoke.
The additional problem is fear. There have been several incidents of physical and verbal abuse, vandalism and racial insults, all directed at those tenants who requested non-smoking lounges. Many tenants who originally signed petitions later asked that their names be removed for fear of retribution. Many seniors are now prisoners in their own apartments.
Personal tolerance levels vary greatly. My own health and lifestyle have been affected by exposure to environmental tobacco smoke, so now I experience physical symptoms after a very short time.
At the request of residents I visited lounges in two buildings in Ottawa. In the first one, no one was smoking because the exercise class was in session. Incredibly, even this small concession, to prohibit smoking during an exercise class, had to be fought for. After two minutes in each lounge I experienced allergic symptoms, just as many tenants do. My eyes watered and began to sting, my nose stuffed up and I began to cough. I had to leave before I developed a headache.
There is no way I could have attended an exercise class in those rooms. However, the seniors concerned enough about their health to exercise were constantly exposed to this environmental tobacco smoke residue. Many seniors who suffer from asthma and heart disease simply cannot attend exercise classes or any social, religious or administrative function in these lounges.
It was shortly after my visit that carbon monoxide tests were performed and levels were found to be "low." Air testing is absolutely useless if it measures only carbon monoxide. There are 43 other death-dealing substances. Fans and air cleaners do not eliminate these particles. A quotation from the Heart and Stroke Foundation states, "Shared ventilation systems would require the force of a small gale, about 226 air changes per hour, to effectively eliminate the environmental tobacco smoke from a typical indoor work area where smoking is permitted."
Voluntary compliance does not work. It did not work in the workplace, when non-smoking employees were expected to speak up against a roomful of smokers, it did not work in public places, public transportation or retail stores, and it does not work in seniors' buildings.
Smoking is a health issue. It is not a question of numbers of smokers versus non-smokers in a particular area. Health professionals all agree that all non-smokers must be protected. At the moment, the residents of seniors' buildings are not.
We support those seniors who have had the courage to continue in their efforts to protect themselves from tobacco smoke. We advocate that smoking be prohibited immediately in all common areas in seniors' apartment buildings. It is our hope that eventually several floors in every apartment building will be declared non-smoking and that several apartment buildings in each city will be designated totally smoke-free.
This is a health issue. Non-smokers need the protection of legislation. We strongly urge this committee to recommend that it be included as part of Bill 119.
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The Chair: Thank you for the presentation as well as the letter. I think this issue may have been raised before but certainly not in as directly focused a way and as specifically. We'll begin the questioning with Ms O'Neill.
Mrs O'Neill: We did have this brought to us, actually, by an actual resident in Sudbury, a very poignant presentation, a very personal one, and certainly in my role as a member of provincial parliament, I've had quite a few representations from residents.
The bottom line is that I think we need to get other ministries involved in Bill 119. Have you, through your organization, contacted the Honourable Elaine Ziemba, who is the Minister of Citizenship and is responsible for seniors' issues?
Ms Slyfield: We have not contacted that minister but we have contacted the Minister of Housing.
Mrs O'Neill: What kind of a response have you received from the Minister of Housing?
Ms Slyfield: Not very sympathetic.
Mrs O'Neill: At the moment you're thinking only of the housing that is provided by the province, that is, the non-profit seniors' residences that fall under the various municipalities, and in cooperation with the municipalities, the housing authorities?
Ms Slyfield: We have to start somewhere and we've had the most representation from those. But we also have had calls from people who are living in other apartment buildings.
Mrs O'Neill: Do you have the support of the municipal officials?
Ms Slyfield: Yes, the regional health committee.
Mrs O'Neill: Would they be making representations on your behalf to these various ministries?
Ms Slyfield: Yes, we are working with them and they are going ahead with some plans.
Mrs O'Neill: I would strongly suggest that you write to both of those ministers --
Ms Slyfield: All right.
Mrs O'Neill: -- and I think it would be wonderful if you could have a letter from RMOC that also accompanied and had the same purpose as your letter --
Ms Slyfield: All right.
Mrs O'Neill: -- because this is not going to fit into Bill 119, although it is an issue that we have had brought before us on more than one occasion in more than one city. I think it's an issue that does demand attention.
Ms Slyfield: Thank you very much for your help.
Mr Sterling: Actually, it doesn't surprise me that the government is not very sympathetic to what you want. It seems that this government and the previous Liberal government as well, I might add, have continued to restrict the rights of people to pick the kind of accommodation they want to live in. You no longer can have an apartment for seniors only, people who don't want to live in an apartment where there are children. You can't go to an apartment that doesn't have pets. The whole concept of allowing people the right to choose their community, be it a building, a floor, I don't think is acceptable to this government in terms of its philosophy.
Ms Slyfield: What can we do about it?
Mr Sterling: Change the government.
Mrs Haslam: I think that does call for a comment, because we've all tried to be so non-partisan. Welcome to the committee, Mr Sterling.
I think there are choices out there where you can live. It's just that what he's talking about is government-funded housing and they open it to everyone. They are not exclusive; they are inclusive.
I understand the concerns of some seniors who have a concern over this, but I think there are two ways of looking at that. I think that as a government we look at the inclusivity of the support of people who live in government supported or subsidized housing, looking at it being more inclusive than excluding people from that subsidy. I'll just throw that out.
We can't really discuss this specific issue, because as Ms O'Neill has indicated, it does fall under Housing. It is a difficult situation to deal with when we're dealing with common areas, and maybe the municipality would have to look at a type of bylaw. I'd ask the PA to maybe do a clarification on that issue about municipality versus this legislation, looking at that type of thing.
I'd like to go to one quick question. Would there be an addition to some of the places that we are looking at in banning smoking that you, representing possibly a seniors population, would like to see added to what is already present in Bill 119?
Ms Slyfield: The main thing that we would like to see is the addition of their homes, the places where they live, because that's where they spend most of their time.
Mrs Haslam: Are you asking that the bill say that in an apartment building we then legislate that a common area in every apartment building be smoke-free?
Ms Slyfield: I'd like to see that very much.
Mr O'Connor: I appreciate your comments and your very well-written presentation. To try to get out of the partisan atmosphere that somehow we've gone into, I could see why the Minister of Housing would suggest that this should be dealt with locally, because the Minister of Housing is trying to really start to create a dialogue in different housing atmospheres, especially in buildings, that it's planning together, working together with everybody. I can see the unique problems that you're pointing out here, and I really do appreciate that.
I have a question for you and then I'll make a commitment for you, as I have on another occasion. Ottawa has got some of the best municipal bylaws, I think, in the country. I don't believe there is anywhere in a municipal bylaw, right across the country, that what you're asking to be included is included. I don't know whether you might know what the reason is; maybe that's something I'm going to have to look into.
Just before you answer that, what I have done in another, more specific area that was pointed out to us as a problem is that I've undertaken to write to the Minister of Culture, Tourism and Recreation. In this case, I'll undertake on your behalf to write to both the Minister of Citizenship and minister responsible for seniors' issues and the Minister of Housing to try to see what we can work out for this certain issue.
You've obviously worked hard with the folks from the Ottawa council, and I just wondered if you could maybe help us understand why that might not have been dealt with there, knowing that it's some of the best municipal bylaw legislation in the country.
Mr Jim Wilson: You're passing the buck.
Mr O'Connor: I'm not passing the buck here.
Mr Jim Wilson: Sure you are. Your legislation allows you to do what these people want. What are you going to do, is all I want to know.
The Chair: Order. The question has been asked. Let the witnesses reply.
Ms Slyfield: This cannot be dealt with by a municipal government. It has to be dealt with at the provincial level. One avenue that apparently is open is to ask the province for enabling legislation, which apparently takes two years. Some of these seniors aren't going to last that long. It might be in place when we're all ready to go into the seniors homes; we don't know.
It has to come through the province, and if this region asks for it and we get it within two, three or four years, then it applies to only this region. If Sudbury wants it, Sudbury has to apply. That's why we're asking the province to look at it for the whole province.
Mr O'Connor: I'll undertake to look into the possibility of putting this in there and contact those two other ministries. In a non-partisan atmosphere, as we have here, I want to thank the Tories and the Liberals for all the work they've done on this in the past, and the action that the federal Liberals have done as well.
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The Chair: Did you wish to make a comment?
Dr Napke: Let's get above politics. It's very hard to go above politics. Yes, it's very hard, but I will take the balloon and go up much higher.
This is a matter of health in a group of people who in themselves find that they have been dispossessed of the rights and quality of life, and they are not aggressive people. It takes an awful lot of courage. We're younger; well, some of us are younger. I belong to the category. The vast majority, and particularly a large number of women, are timid. With an aggressive individual lighting up a cigarette and saying, "These are our rights," they back off, and then they can go back into their rooms. So they are isolated. They are living out there but they can't participate in the functions of the place.
The others say, "Well, you can come down." They don't understand that there are some people who within minutes become ill. They don't understand that because it is not the common norm. There are people who become ill. They think they fake it or something but it's not true.
This is the dilemma. They cannot speak up at these meetings for their shared rights, because everybody has rights. Smoking is legal, so there's a right to smoke, but it's where. The problem, as I said before, is that this is a gas and after you leave a room, the gas remains. If you come in, it's going to cost a fortune to try and get that out and there's no need. You should have an area, just like in the workplace, where there is no smoking. The smoker can come in and participate, the non-smoker can come in and participate, and then they can take their smoking to wherever else they want to do it, in their own units.
These people, seniors, which we will all hopefully become, we change in our aggressiveness and our demand for rights, and if you already have an illness, chest or otherwise, it makes it even worse, and why fight it? It's a different ball of wax defending their rights. Any health regulation dealing with smoke or otherwise should take into consideration the specific group called seniors.
The Chair: You have both made that issue very clear to the committee and I know it is very frustrating at times when it would appear a solution is possible and yet it doesn't come to hand. Your testimony today has certainly made everyone here very much aware of it and I think we all recognize we've got to find a way to solve it in a way that isn't going to take three or four years. Thank you both for coming to the committee.
Dr Napke: Can I add just one point on how serious this is, smokers versus non-smokers, in these buildings? I know of one person, and there are others, who had to leave the place and move into another spot. We had people who said they signed a petition and then asked for their names to be taken off because of real or imaginary or what have you feelings.
The Chair: Thank you for coming and thank Mrs Vallillee for her letter as well.
TOM JOHNSON
The Chair: I call Mr Tom Johnson from the Canadian Cancer Society. Good afternoon, Mr Johnson.
Mr Tom Johnson: Let me say that I'm very nervous.
The Chair: Don't be nervous.
Mr Tom Johnson: I'm not sure who the good guys and the bad guys are, who should be wearing white, who should be wearing black.
The Chair: There are no bad guys in this room. This is just a group of people who have been sitting for a long time and every now and then they get a little tired, but they're actually good folks. So just pretend you're sitting down and having a discussion with your colleagues.
Mr Tom Johnson: My role in life is marketing. I'm a marketing consultant. I first want to apologize for the copies. My photocopier broke down, so consequently you've got streaks on your paper. I hope to use my experience to address at least one or two of the issues later on.
My role in life as it relates to this committee is that I work for the Canadian Cancer Society as a volunteer, as does my wife. My wife does volunteer rides for cancer patients. She administers that. I'm also part of the local committee here on the Ottawa-Carleton Council on Smoking and Health, and I've been involved in a couple of bylaws in the area.
I live in Kanata and about two years ago I got involved in the generation of a smoking bylaw. Kanata, at the time, didn't have a bylaw, Ottawa had a pretty decent one and Nepean was just about to release its recent bylaw. So what I'm hoping to bring today is a perspective on what I had to go through to get that through, the kind of obstacles I saw, and at the end of the day when the bylaw was successful, what the results were.
This is a much more complicated subject area than I ever imagined when I first looked at the issues you people would be dealing with, so I tried to focus in on one area that I could bring a specific focus to, and that's why I'm going to talk about my experience with this bylaw. What I find interesting is that you've seen the same kinds of things that I saw when I was doing this in microcosm in Kanata, which are the excuses, the reasons for why we can't do a strong bylaw. All of them are valid, all of them have support, but at the end of the day, they all disappear once the law's in place.
I went through my notes when I did Kanata's bylaw and I've just taken out some of the statements that came out of a document from the bylaw office here in Kanata. One is: "Enforceability of such a bylaw is a problem, is an issue. Concerns stem from the politically active nature of the general population of Kanata as an excuse for why we shouldn't put in this kind of bylaw." Another one, "So restrictive as to cause the source of someone's livelihood to unnecessarily suffer." Has anybody heard that before?
Interjections.
Mr Tom Johnson: Okay. "The regulation of bus shelters would need to be done across the region and by sheer numbers would be unwieldy," was another reason we shouldn't put in aspects of the bylaw. "The major centres in the region would be inconsistent in their smoking regulations," was an excuse for not making it a stronger bylaw. A delaying tactic was, "Petition the regional municipality of Ottawa-Carleton to make application on behalf of the regional municipalities."
We went through three heavy-duty council meetings to put some teeth into our bylaw. When drafting the bylaw for Kanata, we built on what we'd seen in Ottawa and what we'd seen in Nepean to come up with the best bylaw we could possibly get for Kanata. At the end of the day, after all the noise and the negative barriers that were put in front of us in getting this bylaw in place, the bylaw actually had three parts: a public part, a workplace part and a vending machine part.
We were successful in getting the public part into place, and we got nothing but positive feedback from the press. Enforceability of the bylaw was not an issue at all. All the issues that had been brought up beforehand disappeared once the law was in place.
Ultimately, the thing I drew out as the most positive press piece that I got here locally in Ottawa was that we have a "Cheers and Jeers" column. Kanata is well-known for its obnoxious bylaws, and under the "Cheers and Jeers," the thumbs-up was that we'd finally put in a bylaw that was progressive, that changed the world.
That's part of why I'm here and I believe why a number of you people have gone into politics: We believe we can change our corner of the universe. I wanted to change my corner of the universe, and part of that was starting in the city and looking at what I could do to get something in place.
We talk about the voluntary part of the local community doing things. We looked at the local restaurants to see what the voluntary rate of no-smoking areas was in restaurants in Kanata, and it was 14% at the time. We now have a bylaw in place that starts at 50% and is a progressive bylaw that over a number of years goes up to 70%. At the end of the day, the restaurant people loved the bylaw, because among other things I personally can look like the bad guy and they can be the good guy implementing this bylaw. That can be an effective tool for you when you're looking at implementing this.
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There are a lot of us out there who have put an awful lot of energy into this process of researching the area, finding out what the problem is with smoking and health and then presenting this and pushing it and pushing it and pushing it. One of the biggest problems we've found in doing the municipal thing is that there's just an incredible amount of bureaucracy to get this done.
If I look at Kanata as a specific example, it took a year from the day the council decided that there should be a bylaw before we showed up. Nothing had been done. We presented a bylaw and it took three heavy-duty council meetings and then it got implemented about four or five months later.
We still don't have a workplace bylaw. The reason we don't have a workplace bylaw is because we need enabling legislation.
We looked at how we could get enabling legislation for that. To ask our solicitors to do that and do the presentation would've been an expensive proposition when we're trying to keep a zero growth in taxes, so we passed it on to the regional municipality here which felt it could do it region-wide instead of just on an individual municipality basis. It's been about a year since I requested that from the regional municipality. I've asked just about every couple of months: Where are we at?
There are all sorts of reasons and good reasons why the solicitor hasn't done it yet and so on, but at the end of the day, it didn't get done. Each municipality has to do this to get its workplace legislation in. Our latest estimate, now that it's actually been passed on from the regional government to the province, is that if we're looking at about a two-year delay before this actually gets implemented, before it comes up in front of you people to give us enabling legislation here, obviously that's not the good way to do it. In this particular case, timeliness is just so important.
We were talking about statistics the other day and I was talking to Dr Ellis of the regional health unit here and he looked at how many people die in this region from smoke-related diseases. I tried to bring it back home to your particular riding. If I look at the ridings in this area, in Dalton's riding, there are going to be 100 people who die this year from smoke-related diseases who we have no doubt about. On top of that, there are the other people who are the marginals. I have a neighbour who died last year of a lung-related cancer. Lung cancer is really strongly related to smoking. It's virtually a causal relationship now. She wasn't a smoker; her husband was. She just left a one-year-old baby behind. This is a timely thing. This has to be done now, not years from now.
I know the workplace bylaw isn't on the books now, but I strongly ask you, if you don't put a bylaw in or a law in to cover the whole area, then do something about giving us the ability to do it. Give us blanket enabling legislation or something. Give us the tools and we'll do it, but it's got to be done now. People are dying today.
By the way, one of the major benefits of putting these bylaws in in a progressive stage was -- what we saw was that Ottawa had a nice good bylaw that it did an awful lot of missionary work on and Nepean built on that and Kanata built on that.
I recently did a presentation to the West Carleton council and when I told them that our version of the bylaw was progressive from 50% to 70%, she asked me, "What are the statistics in terms of smokers and non-smokers?" In the Ottawa region, 23% are smokers. So she asked me, "Why would we want to do 50%?" It's a pretty classical situation we get in terms of bargaining and so on. The reason we did that was to accommodate the smokers. I just don't believe that any more. West Carleton is looking for either 80% or 100% in its bylaw that's coming up shortly. We've got to stop being in this role of always accommodating the smoker. It's a very small percentage of the population now. The big percentage of the population are people like me who want to go to the restaurants.
One of my neighbours is the mayor of Kanata. She doesn't go to any of the local restaurants because she has asthma. She can't go there because of the smoking, period; it doesn't matter whether it's 10% or 15% or 50%, like we currently have.
What do we do about this? When I looked at what you people had done over the last few weeks in your work, I finally came down to, I think, a common denominator. You can call it good guys, bad guys. There's a group of us looking at the health aspects and there's a group looking at the profit aspects; I would go one step further and say the greed aspect. If we look at the white suits and black suits, it's pretty easy to see which has got the higher ideals.
If I look in terms of accommodating the business aspects of smoking -- you've seen all these statistics and I'm not here to present the statistics because the cancer society has already given you those in terms of health aspects; it has given you the statistics in terms of what really happens to pharmacies -- we don't have to believe any more that the pharmacies are going to go bankrupt next week if there's a law like this in place. It's just not going to happen. I think you've got enough anecdotal information to support that. We haven't seen a single case where the pharmacies have voluntarily stopped selling cigarettes and it has affected their business in a way that they haven't recouped it in two years. It just hasn't happened. You've got Imasco doing presentations to you suggesting that their profit is the main reason we should accommodate the pharmacies.
When I look at the three areas that I believe are important in terms of reducing access to cigarettes or the promotion of cigarettes, I've come up with my version of the universe, which is the access to cigarettes, the allure of cigarettes and the social aspect. I have a nine-year-old son and a seven-year-old daughter and I want to enhance their environment in the future such that they don't end up trying tobacco products. You've already seen cases where children have gone into the stores to buy cigarettes. We've got to limit the access to these children. The pharmacies are a good start.
I personally think you have to go one step farther and look at licensing tobacco. When we looked at licensing vending machines in Kanata, we used Nepean as an example. Nepean considered its licensing program a cash cow. I believe firmly that if you did look at the licensing issue, it would be self-paying. It's not going to be a cash drain to you and it will definitely make these people think twice about making cigarettes accessible to children. The pharmacies represent 25% of the sale of tobacco, as I understand it.
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On the allure side, I'm going to give you a quick example of the allure of the cigarette packaging. I'm from the marketing side of the planet. The packages are designed to be appealing to kids. Last week, I was at Mont Cascades skiing and I was just about to get on the chair-lift, and there were two young ladies in front of me and a young man who was operating the T-bar. He took a package of cigarettes that was behind him on a shelf and put them in a spot over near the apparatus. It seemed clear to me he was displaying -- he wasn't going to open the package and start to light the cigarette; he was moving it to impress the ladies with this package.
It struck me that there's the problem. In my business, we were just looking at marketing a product and as one of the ways of marketing that product, we were going to do mouse pads, because the mouse pads advertising that company are always visible on that guy's desk top. What a bright way of marketing. I'll tell you that the cigarettes are exactly the same thing. You've got to change the packaging of the cigarettes to stop their advertising. That's the way they advertise.
One other point in terms of the three areas that I saw in terms of reducing access or promotion of cigarettes is to reduce the social support for it. We've got to start making cigarettes dissociated with things like bingo halls, bingo parlours and bowling alleys. Two obvious ones: We've got to dissociate it from the pharmacies. You've got to separate that out. The other area: Ultimately, you've got to separate it out from eating. It shouldn't be associated with restaurants; it shouldn't be associated with grocery stores. If we do those kinds of things, we make it more of a miserable thing to find the cigarettes and associate it with just cigarettes and not with eating, not with pharmacies, not with drugs and other things.
Mrs O'Neill: Could you just tell us some of the public places that your bylaw covers in Kanata?
Mr Tom Johnson: We banned it completely from all recreational areas --
Mrs O'Neill: So that's the wading pool.
Mr Tom Johnson: Yes -- any municipal offices, anything owned by the municipality; in fact, we went one step farther and anything we rent out to other people. You can rent the facilities, but you still can't smoke in them except for --
Mrs O'Neill: Is there an arena involved?
Mr Tom Johnson: The arenas actually were before, but we included the Palladium; it's not built yet, but that's part of it as well. In the shopping malls, we restricted it to the eating areas, unfortunately, and that's a compromise. It's interesting, the press afterwards -- the eating areas became the focal point for smoking and one of the local vendors was selling women's clothes nearby and this owner was a smoker. He's asked the city to do something about it because his clothes all stink of smoke.
This was another point that I haven't put in here, but in both the councils I dealt with, Kanata and West Carleton, each council had at least one smoker on the council. They were completely for a progressive law, especially as it relates to making cigarettes difficult to access for kids. I'm kind of surprised that they limited this group to not have smokers, because they're also advocates of this, believe it or not.
Mr Dadamo: It's become crystal clear in all this that we have to take cigarettes away from the young people and hope they won't start. Is there anything your society does with the high schools or the grade schools in this area, anything on a curriculum basis that would better instruct kids on the health hazards?
Mr Tom Johnson: Education doesn't work, or it works very minimally. You have to be progressive in the laws and make them strong. We've been fighting a battle recently with keeping the cigarette smoking off -- we can ban it from the schools and then the teachers go out and smoke in their cars out in the parking lot. What kind of image does that give to the students? Yes, we're working heavily, but it's got to be more than just education for students, because the staff just don't support it.
The Chair: Thank you very much for coming before the committee this afternoon and for your presentation.
LUNG ASSOCIATION, OTTAWA-CARLETON REGION
The Chair: If I could next call on Mr Greg Penney of the Lung Association of Ottawa-Carleton. Mr Penney is accompanied by Trisha Chelton. Welcome to you both.
Mr Greg Penney: Actually, we'll start with Ms Chelton and I'll be moral support. I'll speak after.
Ms Trisha Chelton: My name is Trisha Chelton. I am 19 years old. I am a non-smoker and I have never, ever had a puff of any cigarette ever in my life. One of the reasons now why I don't smoke is that I have severe asthma. When I have a severe asthma attack, I have to use a machine with a mask and medications to help me breathe. These sometimes are worsened even when I'm around secondhand smoke. I get so that I'm coughing and wheezing and gasping for air and I just can't breathe.
When I used to live with my parents, I got a lot of secondhand smoke from my mom, because she smokes, and then those symptoms would arise. After I moved out, I lived in a smoke-free environment, and now I notice that when I'm around smokers my symptoms are even worse in that my throat gets really sore and I find it hard to swallow.
I came to speak because I think I have the same right as everyone else to breathe clean air and I notice that sometimes my rights aren't enforced. Two main examples of this are that when I go into a bus shelter, say, to wait for the bus, and the sign that says "No Smoking" is clearly placed, there are still smokers who think they should smoke in the bus shelters and some who even block the area where the clean air is coming in. They look at me like I'm strange when I say, "Why don't you just look at the sign and smoke outside, please."
Another main example I have problems with is certain restaurants. There's one restaurant I go to a lot. At different times it's quite smoke-free, but other times I can't go during certain hours because I know a lot of people who will be there are smoking and I won't be able to breathe if I go there. One exception I have just found is a Tim Horton's on Bank Street. It says right out in front of it "Smoke-Free."
I like going there because there are no smokers. I even asked them a couple of days ago when I was there -- it was suggested I ask them -- if they've lost any business because of it, and they said the first week or so they did but now they find they've got a new set of clients, people who don't smoke. They're quite happy with that. So I would encourage all restaurants to take on their example.
Since I've told a lot of people about my asthma, especially those who smoke, I have had two really good friends of mine stop smoking completely because they were worried that they too could get something wrong with them and I've had another friend who's cut back on half of his cigarette smoking. He asked me to say that because he thinks it's an important thing too.
A main question a lot of people might ask me is whether I am biased for non-smoking because I have asthma. The answer to that is that I have only had asthma since I was 13. Before then, I still couldn't stand smoking and anything like that. Since I was yea high, about five or six, I've always been saying to my mom: "Why are you smoking? Please stop. You're going to get sick."
Since I've gone on this quest, I have also noticed a lot of problems at school with kids who smoke. I haven't mentioned this. I go to Gloucester High School, and we have a population of about 1,800 students. It's a fairly big population. So when I started asking people, "Do you smoke?" and things like that, it was very easy for me to come up with at least 40 kids who smoked because of the high population.
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I even thought it might be neat if I went to one of my classes with some of my questions about smoking. I went to a marketing class -- I have a marketing class that I take -- and I asked students who smoke there how many of them and how easy it is for them to get cigarettes on different days. I was very, very surprised and not very happy to find out that even though there's a law that states that you have to be 18 before you can buy cigarettes, at least 95% of them can go to a convenience store and get cigarettes. I looked at them very surprised, and they said, "Oh, yeah," and they named all these convenience stores they go to and they have no problem at all in getting it.
These people seem to believe they're 18 just because they're tall or just because they're acting a certain way or dressing a certain way or wearing their hair a certain way. Some of them do ask them, "Are you 18?" but the kids say to them, "Oh, yes, I'm 18," and they don't ask for proof or anything like that. It's really easy for them to get cigarettes.
I asked one of them why they do this and they said that they really like smoking. I asked them how they got started and they said peer pressure. I asked even what age a lot of them started. Some of them, I was surprised to hear, start when they're 13 years old. That's really awful.
One of them brought up a point. They asked me to mention this, because I told them I was coming here today. One of them wonders why it is legal for them to smoke at age 16, but they have to be 18 before they can buy cigarettes. I'm a little confused by that point. They asked me to mention that, because that bothers them.
Another thing we talked about was the recent advertisements by the Ministry of Health. There is one ad they have with this young girl who is smoking in a washroom. She's got red hair and she's really pretty. It shows her starting to light up and then, by the end of her lighting up, she's old and sick and has emphysema. Everyone agreed that they liked that ad. Everyone could relate to that girl because she's like us, a teenager, and this is what could happen. So we like that ad.
But there's another ad they have where they have all these swimmers and they're going to jump into this pool that has all kinds of toxins and what not. The first time I saw it, it was really over my head. I couldn't understand why this would have anything to do with not smoking and things like that. When I asked the kids in my class about this, they said that it actually made them want to smoke when they saw this ad. They didn't understand why they'd have an advertisement that would do this to them.
I know a consideration is making more ads and trying to get more people to stop smoking this way, and I think a main point is that it's better to make it more like the first example of the girl we can all relate to who smokes and this is what happens to her, rather than a confusing ad.
Another thing I agree with is this idea of having plain packaging for cigarettes, simply because I know a lot of kids who started, not just because of the way the cigarette packaging is, but it was certainly a main consideration, just to see the different colours and things that made it look attractive to them. If we make it plain and we take away that idea, then it won't seem as interesting to them.
Another thing I agree with is totally banning vending machines for cigarettes, simply because obviously they're not always supervised, so you can't see how old the kid is when they're getting their cigarettes. That's just saying to them, "Okay, you can't buy one maybe somewhere like a convenience store or wherever else, but just buy it in a vending machine where no one's looking and you can still get your cigarettes."
Even the people in my class disagreed with having those vending machines and agreed, maybe right away -- it won't be May that they're totally nowhere at all, but at least make them in places where teenagers can't get access to them, like bars and things like that, because then at least you can watch who's getting them and who's not.
Another thing I have is that I think most pharmacies, if not all pharmacies, should ban it completely, because, I don't know, when I go into a pharmacy it's usually because I'm sick somehow, like I've got a cold or I need medicine for some reason. When I go to a pharmacy, I don't like to see something that could make me sick, because the idea of going to a pharmacy is mostly to get better, not to have something to make you sick.
There is one pharmacy I go to a lot, on Nelson Street, and it is totally smoke-free. They ban all tobacco products, and that's one of the reasons why I started going there sometimes.
I'd just like to end by saying that my idea for coming up here was to promote a smoke-free Canada. Nothing would make me happier as a teenager than to see no one ever smoke, because that makes a lot of people sick and I just don't agree with it. Thanks.
The Chair: Thank you for coming forward with such a personal story and viewpoint. We really appreciate that. Did you want to just add to that?
Mr Penney: Yes, I just have a couple of very quick comments. The biggest thing from the Lung Association point of view is that we've got to stop sending the contradictory message to our children. In response to what was said before, I think education is a very big part of our society. We don't spend all our lives in school learning nothing.
We have a Lungs are for Life program which is geared to various grades in the public school system. We work very hard with this program. At the younger grades it's used to teach the children how important the health of their lungs is to them and their environment. As we go to the older grades we're a little more blunt with what smoking does to them. That program isn't the end-all and be-all, but when those children leave that classroom and go out, they have to stop seeing the contradictory message that is out there in the public that smoking is "cool." They see the older children, the older teens, smoking. They're standing around with the packages and playing with them.
Plain packaging? Definitely. Licensing? Definitely. Statutory prohibition doesn't work. I'm in my mid-20s. I grew up through the 1980s with the alcohol before we got really strict and the drunk driving and all that. Statutory prohibition does not work, folks. We know that. We've got to enforce it properly, and the only way to make someone realize that their business is in jeopardy if they don't follow the law is to have them licensed and they can lose that part. It's self-funding. We know that.
I know it's a tough situation, but we've got to deal with these issues and quit sending the message to our children that what I see out in the public is all right but I'm being told something else by my parents or I'm being told something different in school. We've got to stop that.
Mr McGuinty: Thank you both for your presentation. Trisha, I appreciated your comments about the advertisements. In fact you were giving the same kind of critique we've heard elsewhere. I can't recall exactly. I agree with you. The one where they jump in the pool is rather attractive to watch, but it's abstract and the meaning doesn't come home in the same way as the other one did, I thought, with the young lady in front of the mirror. I thought that was very effective.
One of the things we've kicked around is this idea that when it comes to alcohol, you can't have alcohol in the school, and not only because it's against school rules; it's against the law. But you can have cigarettes. If you're sitting on the curb and you're 16 and the police officer comes by and you're smoking and your friend's drinking, the police officer is not going to talk to you and is not going to confiscate your cigarettes, he's not going to fine you. But he can do all of that to your friend. But we know that the damage that's caused by cigarettes far outweighs the damage that's caused by drinking and abuse of alcohol in this province.
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Shortly it's going to become illegal for you to ride your bicycle without a helmet. We're talking about only, I think, something in the neighbourhood of 100 fatalities a year in this province. But we're talking about 13,000 deaths a year. We're going to fine you if you haven't got the helmet on and we're going to fine you at 14 years old. What should we be doing with cigarettes and fines? Do you think that there's an opportunity there we're missing?
Ms Chelton: Yes, I think that they should be made just like the alcohol. Maybe we should set up a law that says it's totally illegal for any kid to even smoke. They should be fined as well, maybe the same as alcohol. That's a good example, because it does just as much and more damage when you smoke. One's really as bad as the other; therefore, they should probably be kept the same.
Mrs Haslam: Very quickly, because we are a half an hour behind, and I do appreciate the Chair allowing me this quick question, you're in marketing class. You asked them questions and you made comments on the ads. I'd like you to make a quick comment on, looking at some marketing issues, do you discuss this in class about being manipulated or used by tobacco manufacturing advertisements? If you did, would it make a difference in using that product?
Ms Chelton: We only discussed the cigarette thing once. I was just bringing it up because I wanted some opinions on that. We all basically just follow the same idea, that we don't agree with any smoking and we don't like anyone else to. We do agree that non-smoking associations and advertisements should use us in saying that no one should use it and this is a bad idea.
Mrs Haslam: Excellent point. Thank you.
The Chair: Thank you both very much for coming to the committee this afternoon. We really appreciate it.
NAGLA ACOURI
LORNE MCEWEN
The Chair: I call on Ms Nagla Acouri, owner and pharmacist of the Crystal Beach Pharmacy. Welcome.
Ms Nagla Acouri: First of all, I wish to thank you all for giving me the chance to explain why I still carry tobacco in my store. Although I heard the previous presentations, especially the gentlemen from the cancer society saying that to be controlled they have to be eliminated from pharmacies, I can tell you one thing: In my pharmacy we never ever sell to minors.
My store is only 1,000 square feet. I'm at the back in the dispensary. I can see very easily the front cash where the tobacco is sold, and if I see anyone who looks underage, I go personally and I ask for an identification. They know now not to come to me, but that doesn't solve the problem. They're going to the convenience store next to me and they're getting it.
Hours I work in my store: I've been in this location in Crystal Beach for 12 years. I started this store from scratch to serve a community of 2,000 people who live in this area. I have always been involved in the community. When this tobacco issue came up, I passed papers to my customers and I asked them their opinion: Would they still keep coming to me and trusting me for my professional advice and the same service I give them, or would they prefer me to stop selling tobacco?
I can tell you that I got a response of 90% that this was something totally up to me and that it did not affect their relation with me as a pharmacist because they know how much I work and that I am devoted to my profession. That does not make me less professional than any other pharmacist who is not selling tobacco.
I worked seven days a week, 10 hours a day, for seven years. I hardly had holidays. After that, when they started opening the malls on Sundays, I had to close because I had no business. Thank God, now I have Sundays off. I still work six days a week, 10 hours a day. It is very tough for me to get one pharmacist and pay him $30 an hour to replace me, to spend time with my kids. I've worked through my pregnancies to the last day.
The percentage of sales in my store --
The Chair: It's all right. Just take your time.
Ms Acouri: I'm sorry.
The Chair: It's all right.
Ms Acouri: I have two boys, 9 and 11. My third kid is my store. The percentage of sales of tobacco is 30%, prescriptions 40%, the rest over the counter. I don't smoke, none of my family smokes at all. I have come from a country where we don't sell cigarettes in drugstores, but on the other hand we do not sell all kinds of drugs in grocery stores.
I've worked in Europe, I've worked in England, I've visited Turkey, and it was the same principle: If you want medicine, you go to the pharmacy, you don't go to the grocery store. If the government has any suggestions and would do anything to stop those big grocery chains from selling all kinds of our front counter -- I can name you 100 products. It's no problem. They don't need a pharmacy for over-the-counter drugs.
I'm going to tell you a very interesting incident. One of my patients on a Sunday had her little kid who had a cough, so she walked to the grocery store, which carries all my front store and asked him if he had a cough medicine. He gave her Magnolax, which we all know is a laxative. She took it back home and, just reading the label, she didn't use it. She looked for my name in the directory book and called me at home. I said: "Don't give it to her. This is a laxative. I'll be coming to the store in about an hour or so and I'll give you the medicine."
I had another customer who was addicted to Listerine, the alcohol in Listerine. I saw the rate he was buying the Listerine. There was no way he was using it as a gargle. He had to be washing the floors with it. I talked to his mother and she told me that he is addicted, that he drinks it.
Now, if I didn't talk to this person -- and I had to approach him a very special way so I didn't hurt him. I told him that this is wrong and this is harmful and everything. I took him as a friend and he told me, "If you were not so honest with me, I really can get that in K mart and Loblaws and everywhere, you know, in the front store." I said: "I know that but I want you to promise me that for your health you're not going to buy it, not for anything. It's not good for you and it's not right what you're doing."
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What I do in my store to try to control the sale of tobacco, and what I suggest, opposite to maybe what everybody else suggests, which is, pull out the tobacco from pharmacies, give it to the grocery store, which doesn't care a bit if you are asthmatic or sick or dying -- he's not going to check with you for anything and he doesn't care.
When I have a patient who's asthmatic or has any kind of illness and I see him going to the counter to buy tobacco, I leave my counter and go around and talk to him and tell him, "What's the big idea of you buying four inhalers and Theo-Dur, and this and that, and you're coming to smoke?" I said: "You wouldn't need all that if you just quit smoking. Have a strong will. I'm ready to help you. We'll start with the Nicorette gum and then you ask your doctor. If you feel comfortable, you can start lowering the amount of cigarettes you're smoking and then go to the nicotine gum, then go to the patches, and if you can't afford it, I am ready to eliminate my dispensing fee."
Would you honestly tell me, will the grocery store, a convenience store or a bar, like the young lady was saying, care who buys tobacco? I don't think so.
I'm not saying that it is good for your health, but we are in a free country. That doesn't mean that everybody can do whatever he wants. He can do whatever does not hurt society. This is the way I was brought up. I was welcomed in this country and I've always worked hard to show my appreciation of this country accepting me.
I hand out pamphlets. I have a big sign on the cigarette counter to say that you are shortening your life expectancy smoking, and if you need help, please call your pharmacist or come to the back. I'm the only one who works there, so they can't mistake me. Everybody knows me. If I'm not there, it means I'm dead. I have to be there.
How does tobacco help me in my business? I cannot lecture everybody to be perfect. Let's admit it: Everybody has a weak point. Somebody smokes and we tell him not to smoke. But he's hurting himself. You advise him. I've advised some patients and they told me: "We're tired of that. It is none of your business. We will smoke. We know it's going to kill us. But my grandfather smoked till he was 90. He never died." That's what they told me. I said, "Well, it is my duty to tell you and, of course, sir, you have the freedom of choice."
Why are you not worried about people being alcoholics, driving while they're drunk, killing other people? Drugs -- I see it in the plaza, right in front of my eyes. I know who in the next building is trafficking in drugs. I called the police more than once. Do you think they did anything about it? There is no proof. I think this is a lot more harming to our society than selling tobacco in pharmacies.
On the opposite, believe me, if you restrict the sale of tobacco to pharmacies and tobacco stores, because that is their livelihood, you can't just tell them: "Go close. We're not going to let you sell tobacco." Then you would have control over it. But if you want to convince me that Loblaws and IGA and the grocery store and the convenience store are going to worry about who's buying, they don't care. They hire kids of 16 and 17 to work for them and they go and sleep. The more sales they make the better.
For me, it is a source of income, but I'm not desperate for it. If I sell less, I'm going to buy less and so on. But the idea is, if some people want to smoke, they come into the store. I looked into the ribbon. I've been considering pulling the tobacco for four years. Believe me, I've tried everything. I put a dollar store in my store now; I have a section. The post office was in the grocery store and went bankrupt. So the community recommended my business as a responsible and solid business and the post office gave me the post office for no money.
I said, "God, thank heaven; that's going to do it." Do you know how much I make from the post office? I lose $500. I have a full-time employee who gets paid. The employee has to be there from 10 am to 8 pm. His salary comes to $1,000 a month. The highest commission I ever made in parcels and things, you name it, is $132 during Christmas. I sold $4,000 worth of stamps, which gave me a commission of $400, plus $132. I made $532, minus $1,000; I lost $500.
But I am still keeping it because I said maybe -- I took it last June -- maybe it will get better, maybe I'll think of something else besides the post office. Then I can give up this tobacco. Not because my customers are bugging me -- I have to tell you, they respect me and they are proud of me. One of them is here. Later on I'm going to tell you --
The Chair: Ms Acouri, I apologize that we have a limited amount of time. I know there are a couple of questions. We've gone over the 15 minutes, and I wonder if you could just bring your comments together.
Ms Acouri: Sorry, okay. What also makes me carry on selling cigarettes is all the pressure and the reductions that the government has put upon us. I have never seen in any place in the world a dignified profession like a pharmacist who has to hang his fee on the wall, $9.49 or $8.49 or $11.99. I don't think this is very dignified, but anyway that's the rule. While dentists and lawyers are not asked to do that, we are asked to do that.
The government decided lately to cut our dispensing fee from $6.46. They thought that was too much. Retroactively, you're going to get paid $5.68. They didn't even ask us. If I dispense any over-the-counter medication for seniors, I don't get paid a dispensing fee; not only that, not even an upcharge.
I gave a senior 500 tablets of Tylenol, which cost me $5.80: $1 to enter it in the computer, 20 cents for a vial, and time of the pharmacist, and the government paid me $5. That's just one example of how I'm losing money. The papers that I got from Pro Pharm lately showed that I have lost between $400 to $500 every quarter of the dispensing fee that the government has cut me off.
Now, the government cut off my dispensing fee; I take the tobacco out; the grocery store sells all my front store; I am losing on the post office. Could you tell me honestly, what is the solution? What can I do? What can I sell? I don't think I'm going to make a bakery in the pharmacy. That's the only thing that's not in the strip plaza. That's the next thing I might do. You never know.
I feel sorry as a pharmacist, educated, all the years I spent to study, to come now and be compared to grocery stores. Then there is the competition. We have enough competition with the big chains, the Canadian chains, never mind going and getting into our giving the pharmacy business to Loblaws, which makes the dispensing fee 99 cents, Wal-Mart from the States, Jean Coutu from Quebec. How can I compete with these people? I can't.
To show you how much I really care for my customers -- before that, one second.
The Chair: Could this just be your last point? I'm afraid we're under --
Ms Acouri: Just two more minutes, please.
The Chair: Okay.
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Ms Acouri: Is tobacco a legal product or illegal? If it is a legal product, then I as a small store with 1,000 square feet should not be discriminated against, and allow K mart because he has a pharmacy here and he has his tobacco here -- I can't do that; I don't have the space. So it should be fair, all the same.
The other thing is, if it's illegal and such a poisonous thing that the people think it is hazardous, why don't we be brave enough and ban the whole industry? Why don't we do that? Be honest with ourselves, ban the whole industry. Make Canada smoke-free. Then fine, no problem.
The only example I have to show you how I care about my customers is Mr Lorne McEwen, who is one of my patients. He's had problems with asthma and heart. He has been smoking for years. I've been bugging him for about five years to quit smoking --
Mr Lorne McEwen: Oh, more than that.
Ms Acouri: I sent him to doctors to do a test on his lungs and they told him he only had 20% usage of his lungs left and he still wouldn't listen, until lately he quit smoking. So there is an example. If Mr McEwen was buying his cigarettes from a bar or a convenience store, would he care if he quits or dies of emphysema or whatever? I don't think so.
Anyway, I want you to understand that I do appreciate you giving me the time. We're not bad guys, we're not bad pharmacists and we really don't think that everybody who goes and buys the tobacco from the pharmacists is getting cancer from us, that we are the reason. About six of my family have died and none them died of cancer, and a lot of my patients. Thank you very much.
The Chair: Thank you very much. I'm sorry, I don't mean to be a bad guy either in cutting you off, but unfortunately we face some time constraints. I think we have time for one quick question.
Mr McEwen: Could I say a word?
The Chair: I wonder if we could just pose the question and perhaps that could work into the answer. We really are awfully tight on our time. Ms Haslam.
Mrs Haslam: I really appreciate it, Mr Chair, and I'll be very brief.
I want to commend you for your diligence. You ask for ID, your professional attitude, the sign, the questionnaire to your people. But you're the first one who's come to this committee who says you actually leave the counter to counsel people. Most of the pharmacists who've come say, "I counsel when I'm asked." Unfortunately, there are others who don't make your effort. What we're seeing is that tobacco is a mixed message to our young people when they see it as an item in a store.
I was interested in your talk about the customer base. Your customers respect you, and it's not about the selling of tobacco. They would still come to you without the tobacco in the store, and I think that's something we have to look at.
I understand your concern about larger grocery stores versus a smaller store, and that's a fact of business. What this committee is looking at is health and the health of young people. I wondered if you would agree that we have to control the product more, and do you see the possibility of putting it into a tobacco control store versus leaving it open?
Ms Acouri: Well, I don't have the space.
Mrs Haslam: No, into like a liquor control board.
Ms Acouri: Yes. If you do that, that's fine. But if you take it from me and give it to the grocery store next to me --
Mrs Haslam: No, we don't give it. What we're asking is that anyplace with a pharmacy in it would not be allowed to sell it.
Ms Acouri: Well, I wouldn't have a choice. If you have the law, I have to abide by the law.
Mrs Haslam: That's right. Okay.
The Chair: Thank you very much. I'm sorry that we have the time problem, but we will have to move on.
OTTAWA-CARLETON HEALTH DEPARTMENT
The Chair: I call on the Ottawa-Carleton health department. Gentlemen, welcome to the committee. I believe we have Mr Edward Ellis and Monsieur Richard Cantin with us, c'est ça? It's Dr Ellis, I'm sorry.
Mr Richard Cantin: Actually, I've been demoted since the last time. I had an honorary doctorate when I was in Toronto to speak to you as the vice-president of ALOHA, the Association of Local Official Health Agencies (Ontario).
Dr Edward Ellis: Good afternoon. I'm one of the associate medical officers of health at the Ottawa-Carleton health department. I'm also speaking this afternoon on behalf of Dr Corriveau, who's the MOH for Renfrew and District Health Unit.
Because tobacco use reduction is one of our two department priorities, we have several staff working on the issue -- protection, prevention and cessation -- and included in your folders are examples of some of our educational material. Our health department is also a co-sponsor and home of the Ontario Tobacco Program Training and Consultation Centre, which is funded by the Ministry of Health.
I thank all of you for coming to Ottawa, the NDP government for introducing the bill, all parties for giving quick second reading and, in particular, the strong support all of you have given to individual sections of the bill.
Why is this bill so important to us? Well, we think it's one of the most important public health pieces of legislation that has gone to the provincial Parliament. Here in Ottawa, we have basically the equivalent of a jumbo jet crash every six months. That's how many people are dying of tobacco-related disease. We think that some of that is preventable, and this bill will go a long way to doing that. Also, because tobacco prices are falling, we think that the elements in this bill are very important to help offset that.
We fully support everything that is in the bill. However, I would like to ask seven questions, some of which relate to things that are not in the bill.
First is the issue of plain packaging. Is this the time to introduce it, or should we wait for some more research? We would say that the time has come. You've probably received information already about the Canadian Cancer Society study, which was in Ontario. That backs up studies done elsewhere in the world.
You've heard the other arguments for the advantages of plain packaging. It seems to us there are too many good reasons to delay. We have to try what shows good promise of working, and I encourage Ontario to take the lead in the world and do this. You've got 10 million people; it's a good chance to find out what happens.
Second: Are health warnings enough to post at the point of sale? We don't think they are. We would like to see a telephone number on there, a toll-free number where people can call for information on cessation or protection or prevention.
We also think the regulations under this act should require that 25% of the space on any tobacco sponsorship advertising for the arts, fashion, sports, whatever, should be set aside for health warnings. Let's face it: This advertising is really trying to sell a brand of cigarettes, so it's only fair that it should also warn about their effects. If the province doesn't have the authority to do this, we suggest that you pressure the federal government to do that, or preferably to ban sponsorship advertising altogether.
Third: Will enforcement of this legislation be practical and affordable? Not yet. The people who are going to enforce this legislation, and by that I mean the public health inspectors, municipal bylaw enforcement officers, the police and others, need to know who retails tobacco in order to check for proper signage and to know where to monitor for underage sales.
If you think it's easy to list all the places that sell cigarettes, consider how long it would take you or me to list the over 800 retailers in the city of Ottawa alone who sell cigarettes if we had to check business by business. It seems to me to be a waste of our salaries, frankly, to be doing that.
I think there are two alternatives: one is a licensing system, or requiring tobacco distributors to provide a list of all retail points. Under the regulations section here, that could be done.
I prefer the first option of licensing, because it also raises revenue to pay for monitoring and enforcement. Ontario has a record deficit. Tax revenues are decreasing from cigarette sales. Without earmarked funds, this new act will not be enforced without affecting other vital activities.
We know locally that a retail licence fee of $200 a year covers costs for enforcement. It will not be a financial hardship to the retailer. It represents the profits from selling one and a half packs a day.
We recommend that the province either license directly, do it through the liquor control board or request all municipalities to license, using the power they already have under the Municipal Act. They can use the licence revenue to pay for bylaw enforcement officers who could help enforce provisions of the act.
Fourth: Is the list of public places in section 9 adequate? Not yet, if we're really serious about reducing involuntary exposure to ETS by 1995.
In Ontario up to 25% of the population has a health condition such as allergies, asthma, angina or lung disease aggravated by ETS. These people aren't necessarily worried that they're going to die in 20 years from a heart attack or lung cancer, though in point of fact we do have 100 people a year in Ottawa-Carleton who are non-smokers and are dying from lung cancer and heart disease because of exposure to ETS. What's concerning people now is the fact that it bothers them when they go into the areas with the smoke. It can impede their use of public facilities.
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Then there are pregnant women. If you look at the ultrasound of a foetus, when the mother inhales ETS the lung movements are suspended for up to two hours. We don't know whether or not that is causing permanent damage, but it sure isn't comforting to see. Part of our education program is basically, "Don't smoke around a pregnant woman." Well, what about the pregnant woman who's going into a public place? She deserves some protection too.
Finally, there are thousands of Ontarians who are trying to quit. They're on the patch or they've just started the process of quitting and the last thing they need is to smell the smoke and get the temptation to light up once again.
We think that Bill 119 should, at the very least, offer people a choice. When they walk into a restaurant, which the restaurant association says we still do on the average of three times a week, at least half the seats should be non-smoking. Shopping malls should be non-smoking except for up to half of food premises seats.
Any parent with an asthmatic child, including my own, can tell you that hockey arenas, in the lobby or the crush space, are dynamite and they should be smoke-free. Bowling alleys can be 50% non-smoking. Bingos can be 30% non-smoking and they will survive. We know that because we have done it here and it has worked.
We've done it through municipal bylaws. The problem with municipal bylaws is that you've got over 800 municipal councils in this province and they're not going to act fast enough to have smoke-free public places by 1995. It'll just take too long without provincial legislation.
We have strict provincial occupational health legislation to prevent far fewer cancer deaths from uncommon toxins, so why should ETS, which is a proven carcinogen, be an exception? We ask you to please give people a choice when they're concerned about ETS and they want to avoid it.
Fifth: How can we achieve the 1995 provincial goal for smoke-free workplaces when this flagship piece of legislation is completely silent on the matter? We think the provincial government should ensure that smoking is not allowed in the workplace except in smoking lounges that are separately ventilated to the exterior. This is the case in the city of Ottawa, where it's working, but we only have it here because the city went after enabling legislation.
We recommend that the Minister of Labour introduce amendments to the Smoking in the Workplace Act this year or that the Municipal Act be amended to allow municipalities to pass workplace bylaws without having to go to Queen's Park every time for enabling legislation.
Sixth: Why do drugstores sell cigarettes? Well, you've heard this over and over. What I want to add to it is that locally it really isn't to stay in business. As of this week, 74% of our independent and small-chain pharmacies in Ottawa-Carleton do not sell cigarettes. That's 80, and that's up from 30 in 1989. Among the 37 Shoppers Drug Marts and Pharma Plus stores in the region, 36 are still selling. We do have one Pharma Plus here in the Rideau Centre that's not selling. I commend them and I wish them every commercial success.
We think if the independents can survive without selling tobacco, then certainly the big chains can. But then, of course, the only logical reason to sell cigarettes in a drugstore is to make money. I think it's time to listen to the child who said, "If cigarettes are as bad as you say they are, the government would not allow them to be sold in drugstores."
Seventh and final: We'd love to start working on the regulations, please, the day after royal assent. They have to be written and implemented quickly to see results. Our health department offers its full assistance and support in whatever way it can in the drafting.
I thank you very much and I turn over to Monsieur Cantin.
Mr Cantin: Thank you, Dr Ellis. Those of you who heard me speak in Toronto, wearing my other hat as vice-president of ALOHA, remember my example of my dad who couldn't skate the length of a skating rink but can now, at 83, skate the full length of the canal. I invite you to take the full length of the canal to see how long that is. He's 83 years old today.
My points will touch more the political side of things and maybe the parental side of things. Dr Ellis has already mentioned that the workplace has to be included in this Bill 119, and the reason it has to be included is that you'll have a situation like in the regional municipality of Ottawa-Carleton with 11 municipalities. All you need is one to buck the trend and you destroy everything that everybody else is doing. You've got to have a province-wide act that does it. Enabling legislation is partially getting there, but I think the province-wide act is doing it.
There's a strong feeling, and it was expressed last week when Evelyn Gigantes received a copy of my letter addressed to Premier Rae dealing with the taxation issue: An elderly lady approached her and said: "Why do I have to stay in my bedroom in the senior citizens' apartment because I can't take the smoke when all the common areas are taken up by the smokers? Why aren't they regulated?" Maybe we need to have a regulation that'll protect the seniors in their own homes.
We feel strongly, and Ottawa-Carleton I believe is a leader in Ontario, that there should be no sale of tobacco in transit operations. I know the TTC would be hit pretty hard if we were to do that because at every entrance to the subway there's at least one smoke shop. But here in Ottawa-Carleton we put our principles in front of money, in front of profit, and we outlawed that possibility within our system. I would like to see something like that in the legislation as well.
Again, when you have multiple jurisdictions it's difficult to enact something without upsetting the applecart around here. As of Tuesday, Place d'Orléans shopping mall, which is one of our large regional malls, voluntarily went smoke-free. Seven out of 10 customer comment cards that they had received in the last six months stated very clearly: "I am disturbed by the smoke in your hallways. I cannot take it. It's either you get rid of the smoke or you get rid of me as a customer." As of Tuesday 15 February they're smoke-free except for a small area in the food court. That's a positive step from a private individual. They don't think they're going to lose any money over this deal.
Lastly, I feel strongly that something should be done about the selling of cigarettes in schools. I know some of you are concerned about smuggling in schools. I feel there should be some legislation that in educational facilities, if the administration of the school is aware that something is happening, such as this one, it should be held accountable the same way as a company is in terms of fines.
I think it's just awful that you can walk into a cafeteria in a high school in my neighbourhood and see teachers buying cigarettes from the black market and the principal knows about it. He's been told more than once. So we need to do something about it. I know you're pressed for time. If you have any questions, we're both available.
The Chair: We do have some questions. I hope you'll understand that some members have a problem around a flight. So those of us who don't have that problem are going to ask you questions; those who have to get to that flight are not leaving because of anything you have said or done.
Mr Cantin: I realize that.
The Chair: Sometimes life gets that way. I just thought, to help those who are going to have to struggle through the traffic, if there is anyone who's got to go, if he or she has a question we could start, and then those of us who don't have to head off can continue. We'll start with Ms O'Neill.
Mrs O'Neill: This tobacco infoline is in existence, correct? You're the first person who has brought that forward as an idea. Could you tell us what happens when people call this number?
Dr Ellis: There is sometimes a recording at the beginning, so if you are a teenager and you want to get the Quit for Life compact-disc-type kit, which is basically the cessation kit for teenagers, you jump over to another line that tells you how to get it, because we had a blitz on that in promoting it and a lot of calls were coming in about that.
Otherwise it goes through to a public health nurse or someone else, a health promoter, who basically answers your question. The questions coming in can be "How can I stop?" or "What courses are available, group programs, self-help guides?" It could be a question about "Is smoking allowed here and there?" It can be "What can I do to organize a prevention program?" and so forth.
We run it for the whole region. It could be run for the province. It could be a 1-800 number. When the call comes in it could just automatically be fed out to a local health unit, I think.
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Mrs O'Neill: Is it heavily used, would you say?
Dr Ellis: Yes. It varies of course by what's happening in the media. During National Non-Smoking Week it was very heavily used. I think on Weedless Wednesday there were several hundred calls. I don't have the exact number month by month, but we have basically two staff dedicated to it just to handle this region.
Mrs Haslam: One quick question: Under your tobacco-free pharmacies there are four K marts, there is a Loblaws, there is a Zellers, there is a Woolco. Does that mean they have already made the choice not to carry tobacco because they have a pharmacy on their premises?
Mrs O'Neill: They're leaders in Ottawa-Carleton.
Mrs Haslam: I don't doubt that. I just need to know if that's the case.
Mr Cantin: Maybe I could respond to part of that. Not only have you got that but you've got the biggest chain in Quebec that is now in Ontario. I was telling some of the other members --
Mrs Haslam: Jean Coutu.
Mr Cantin: Jean Coutu. If you look at number 23, here's a case in fact where this person was an independent dispensary, went into a chain, had no choice but to sell tobacco but refused to display it, hid it under counters. When I refused to cut the ribbon for him and told him I was no longer a customer after nine years of being a customer of his, he became very concerned. He approached the president of the chain, explained the situation and said, "Listen, I've got to have dispensation," which they gave him.
Mrs Haslam: "Dispensation" is an interesting word to use.
Mr Cantin: It was in his contract.
Mrs Haslam: I see there's a Coutu number 19 pharmacy selling tobacco but I do think that's very interesting that we do have stores like the K marts, like the Zellers, which have already made the choice to stick with pharmacy. I think that's great.
Dr Ellis: I should add that when we did our survey, if a pharmacy was independently owned, rented its own cash register but occupied the premises of the larger store, we considered it as a tobacco-free pharmacy because they were two separate businesses.
We would as a health department, however, support the proposal that either tobacco sales or pharmacy sales have to stop in a situation where there is one business nested inside the other. For our survey, because they were two separate businesses, we considered them tobacco-free.
Mrs Haslam: That changes it.
Dr Ellis: Yes, it does.
Mr McGuinty: Thank you both for coming in with your presentation. I really am pleased with the concept they have of providing assistance to smokers, because Bill 119 does not address problems that smokers encounter. That wasn't its intention. I think society has tacitly if not approved, at least tolerated smoking over the years. As we all know, it's highly addictive and now these people are in trouble. So I really like that idea.
One of the things we heard up in Sudbury, I think it was, the school principal came in to speak with us. I spoke with him outside after in the corridor and he said he found it rather perverse at this school that there had been a smoking cessation program offered on the school premises for teachers but not for students. They developed their own program, offered during school hours, for smoking students. He maintained that an important component in that program was to get the smoking students involved in setting it up.
I'm just wondering if that's something you'd like to comment on, and it's something that we might be able to do further.
Dr Ellis: I think it's very important. The Ontario Health Survey showed that half of teenagers who smoke have tried to quit in the last year. The problem is that most smokers have to try four or five times before they're finally successful. We have run a number of stop-smoking programs in local high schools, quit-and-win contests. You name it, we've tried it, and we have plans to do even more.
You basically need a school board that says: "This is important. We're willing to take class time for it." You need teachers and principals who think it's important. It helps to have ex-smokers come in who have a good rapport with the kids to work with the teacher doing it. One of the things we would hope to do locally in the future is to have money available for an honorarium to the people who come in and work with the teachers and so forth to run these classes.
The most successful one I've ever read about is where a shop teacher and the students at a local high school decided they were going to do it together. The one-year cessation rate was 60%, 70%, which is phenomenal, because they idolized this guy and he had stopped and they were going to do it.
The Chair: That, I think, is one of the things that's been troubling as we've gone around listening to testimony from some of the young people who have said in effect that education hasn't had much impact, and the example that Dalton mentions that came up in Sudbury: trying to find, from the experience of educators and people such as yourselves in the various health units, what reaches young people. How do you reach them with a program that will have an impact? I think what you've just said is very instructive in that regard.
Just as a last question, have you found there's a barrier that you hit in terms of reaching young people? Is there an age where you're sort of saying, look, if we have to deal with, I don't know, a 17- or 18-year-old who's been smoking for three or four years, you just can't get through, that if they're going to stop, that will come later through other things? What can you tell us about that problem?
Dr Ellis: Well, virtually every teenager who starts to smoke figures: "I'm not going to become addicted. I can stop whenever I want to." They know they're not going to drop dead from lung cancer and probably not from a heart attack in the next few years. Then when they decide to stop, and usually it's because the price is out of hand or something else is happening in their life, they find it's difficult. If they're really motivated to stop at that point, and especially if they've tried once or twice before, then it's obviously easier to get them into a group or whatever.
If they enjoy it and if they're not under a lot of pressure to stop, then I think they're probably going to continue until they either get in a workplace where they realize they just can't go two hours without a cigarette so they might as well stop -- a lot of people have done that.
That's one of the major advantages of workplace legislation, besides the protection from ETS. We saw that in the federal government: They went from a 29% smoking rate to 24% in one year flat just because for a lot of people thinking, "I should stop, I should stop," suddenly this became a reason to do it: "I can't go two hours between breaks."
But getting back to the youth, unless something comes up, it seems like it's not until they're in their 30s or 40s and they start to come to grips with their own mortality and, "It's time for me to get my body in order." So we see that with the adult programs there's a real crush in the 30s and 40s coming in.
Mrs Haslam: I just had a suggestion. We just had a presentation from Nagla Acouri and the Crystal Beach Pharmacy saying, "My customers are loyal to me." Obviously she was a dedicated pharmacist who left her pharmacist area to go and counsel her people, and even though at 30% of her sales she said, "I won't lose cigarettes, because my customers are loyal to me and I'm a good pharmacist," what you should be using her for is going out and talking to other pharmacists and saying, "This is the job we do as pharmacists." What a spokesperson she would be for the dedication that pharmacists need in their positions.
Mr Cantin: Yet --
Mrs Haslam: Yet she has tobacco.
Mr Cantin: She still sells cigarettes to the person she gives medication to for asthma. I find that a little hard to take.
Mrs Haslam: Yes, but she also said that 90% of her people were more loyal to her than to the tobacco sales that she offered.
Mr Cantin: Well, if that were the case, I would submit the case of one Jean Coutu pharmacist who quit the sale of tobacco and tripled his sales in two years.
Mrs Haslam: Good idea.
Mr Cantin: I'd like to make a final comment, if I may, Mr Chairman, because I forgot to mention it. I heard the tobacco council this morning, Mr Parker I think it was, make a suggestion that it's wrong to tax people because they've got a different lifestyle. He was saying, should we tax the automobile driver more than the person who uses the public transit because they're doing things? Well, they are taxed. They pay more insurance. They pay more taxes through the use of fuel.
Life insurance companies certainly realize that the life expectancy of a smoker is shorter, so the premiums are higher and the house insurance for a non-smoker is a lot lower as well. So yes, there are people other than governments who do tax other lifestyles or benefit people who don't abuse it themselves.
The Chair: Thank you. Mr McGuinty, you had a final question?
Mr McGuinty: Yes. I hadn't asked it before, and I'd heard some talk about this, so I want to get confirmation, Dr Ellis. What kind of recovery does a smoker have? Can they see a complete physiological recovery, or do we get to the point of diminishing returns, like if you smoke for 10 years you get 80% recovery for 20 years? How does it work?
Dr Ellis: You get benefits from stopping regardless of how long you've been smoking in the past. Obviously, if you've been smoking for 50 years, you can't completely eliminate the chance of lung cancer in the future. It's going to take 10 or 20 years to get back to a normal risk level. But just in terms of lung functioning, the effect on the heart -- let's face it, most of us die of heart attacks, not lung cancer. That's a tremendous impact of smoking. Those things are reversed very quickly. It's a real benefit to your heart to stop, and to your lungs.
The Chair: Thank you. In closing, it has been very interesting to all members of the committee that we've had a number of presentations from the various public health units, however described, and also from your provincial association. I know I've been struck, and I believe other members have, by not only the evidence you have brought before us around smoking, but also just about the number of programs that you have developed and are putting in place in the community.
I think, if nothing else, the record of these hearings in terms of what exists in 1994 in Ontario has been extremely instructive. As the last witnesses of the day, I want to thank you for carrying on that tradition, and we really appreciate the fact that you and your colleagues around the province have come before us.
Mr Cantin: If you're speaking to Premier Rae, tell him to read my letter from last Friday with regard to holding tough on taxation. Just because Jean Chrétien made a major mistake doesn't mean he has to repeat it.
The Chair: With that, we stand adjourned.
The committee adjourned at 1552.