Proceedings of the Standing Senate Committee on
Energy, the Environment and Natural Resources

Issue 15 - Evidence

The Standing Senate Committee on Energy, the Environment and Natural Resources, to which was referred Bill S-20, to enable and assist the Canadian tobacco industry in attaining its objective of preventing the use of tobacco products by young persons in Canada, met this day at 6:45 p.m. to give consideration to the bill.

Senator Mira Spivak (Chairman) in the Chair.

[English]

The Chairman: Today we will resume our discussion and our review of Bill S-20. Our first panel of witnesses includes Mary Jane Ashley from the University of Toronto and Garfield Mahood from the Non-Smokers' Rights Association.

Please proceed.

Dr. Mary Jane Ashley, Professor, Department of Public Health Sciences, Faculty of Medicine, University of Toronto: Thank you for giving me the opportunity to speak to you concerning Bill S-20. The importance of this legislation cannot be overstated. Its passage will mark one more crucial step towards putting into place a truly comprehensive approach to tobacco control in Canada -- an approach that is long overdue and urgently needed.

You have heard from others about the devastating and far-reaching health consequences caused by the use of tobacco industry products. Many of these health effects have been widely known for years, except of course by the tobacco industry. Yet, with few exceptions, the response of governments to this commercial epidemic has, for the most part, been business as usual.

The passage of Bill S-20, along with the bill on health warnings, now in its final stages in the House of Commons, should signal the beginning of a new era in tobacco control at the federal level. It will be an era in which the health of Canadians takes precedence over the commercial interests of a powerful and predatory multinational industry whose main product, the cigarette, is addictive and toxic when used exactly as intended by the manufacturer and kills one half of its long-term users, many of whom are in the prime of life.

I am a medical doctor and have spent my entire career in the field of public health. For the last 25 years, I have been a faculty member at the University of Toronto where I have taught medical students and graduate students who are preparing to take up various public health positions across Canada. In my role as an academic, I conduct research and have been involved in research on tobacco and tobacco control for two decades. I am currently a principle investigator in the Ontario Tobacco Research Unit.

Last year, I chaired an expert panel that reported to the Minister of Health for Ontario concerning the approach that is needed at the provincial level to control the tobacco epidemic in this province. The panel readily concluded that tobacco is Ontario's number one preventable health problem. Tobacco kills 12,000 Ontarians each year -- four times more than die from motor vehicle accidents, suicide, homicide, and AIDS combined.

The treatment of diseases caused by tobacco requires more than 1 million hospital days each year. Health expenditures caused by tobacco exceed $1.1 billion annually. Additional tobacco-related costs to the Ontario economy are $2.6 billion per year in lost productivity.

Tobacco is responsible for 25 per cent of all fatal cancers suffered by Ontarians, making it one reason for the current crisis in cancer care in the province. Lung cancer now exceeds breast cancer as the number one cause of cancer deaths in Ontario women. In some, the impact of the use of tobacco industry products, in both economic and health terms, is nothing less than catastrophic.

The panel also found ample evidence that current tobacco control efforts in Ontario are not effective. Smoking rates among young people continue to climb. Data from the ongoing biannual surveys of schools, conducted by the Centre for Addiction and Mental Health -- formerly the Addiction Research Foundation -- that were reported in the June 13, 2000, issue of the Canadian Medical Association Journal, show that, in 1999, 28 per cent of Ontario students used tobacco. That is up from 22 per cent in 1991. Those current rates are similar to rates reported in the early 1980s.

Furthermore, little progress has been made in the 1990s in curtailing smoking among adults. Essentially, smoking rates among adults have plateaued with more than 25 per cent overall of the adult population using tobacco products, primarily cigarettes. The rates are higher in young adults, about one-third of whom are current smokers.

Many Ontarians continue to be exposed regularly to second-hand smoke at work and in public places. More than 400,000 children are exposed every day in their homes to second-hand smoke.

The panel also found that many of the elements that would comprise an effective tobacco control program are not in place. One crucial element concerns the cost of cigarettes. There is ample research evidence that price affects consumption and, in particular, consumption by young people. However, today, cigarettes are cheaper in Ontario than they are in any other jurisdiction in North America, including the tobacco growing states of the United States.

Other crucial policy elements are also weak or missing. For example, there is no effective province-wide legislation to protect workers from second-hand smoke in the workplace. We now know that such legislation, when enforced, not only protects non-smokers but is an important aid in assisting smokers, the majority of whom want either to quit or to cut down. It is no wonder that the tobacco industry fights so hard against such legislation.

Spending on tobacco control in Ontario, although increased by $10 million following the submission of our report, is still far below that required for effective programming. According to the experiences of other successful programs, and in keeping with the guidelines developed by the Centers for Disease Control in the United States, current spending on tobacco control in Ontario, at about $19 million in the current fiscal year, is far short of the estimated $90 million, or about $8 per capita, required for effective comprehensive tobacco control.

In preparing our report to the minister, my colleagues and I reviewed and assessed the scientific evidence on what would constitute an effective public health approach to tobacco. I hope that you have our report in front of you. It is entitled "Actions Will Speak Louder Than Words: Getting Serious about Tobacco Control in Ontario." It is in both French and English.

The panel recommended government action in nine areas: tobacco prices; public education; marketing, including packaging, labelling and information disclosure; retail outlets; smoke-free spaces; supports for smoking secession; finance and infrastructure; research monitoring and evaluation; and cost recovery litigation. In all, there are 29 specific recommendations. These recommendations can be found in the executive summary at the beginning of the report on pages iv and v, and they are discussed in detail in the body of the report.

Most important, the panel's review of the evidence convinced us that only a comprehensive approach will be effective in decreasing the use of tobacco industry products in Ontario, thereby diminishing the public health disaster with which we are faced. The piecemeal approach that has characterized tobacco control in most jurisdictions in Canada will not work.

In coming to that conclusion, we relied heavily on the experiences of California, Massachusetts, and Oregon, where the evidence clearly shows that comprehensive tobacco control programs are effective. You will be hearing about the programs in California and Massachusetts this evening. Their experiences demonstrate that comprehensive programs can be mounted, that they will decrease rates of smoking, and that with diligence and effort they can be sustained.

Effective, comprehensive tobacco control is possible here, too, and for the sake of all Canadians, the young and the not-so-young, it must be accomplished. The passage of Bill S-20 will demonstrate that there is political will at the federal level to act now in order to ensure an important component of a comprehensive program. Among other things, the passage of Bill S-20 would enable effective mass media programs to reduce smoking among young people to be put in place and sustained. Soon you will hear about the remarkable success of just such a program in Florida. It has been done there and it can be done here.

We chose the title of our report, "Actions Will Speak Louder Than Words," carefully. In undertaking our work, we realized that we were yet one more of a series of panels and other groups that, over two decades, have clearly documented the devastating health and economic burden that Ontario incurs from the use of tobacco industry products. These same groups have recommended actions that needed to be taken by the provincial government. However, with few exceptions, the rhetoric of successive provincial governments about the importance of counteracting the tobacco products epidemic has not been matched by actions.

I implore you, honourable senators, in your capacity at the federal level, to take action now to protect the health and lives of Canadians. Pass Bill S-20.

Mr. Garfield Mahood, Executive Director, Non-Smokers' Rights Association: Honourable senators, the Non-Smokers' Rights Association is a non-profit health advocacy organization with offices in Toronto, Ottawa and Montreal.

Professor Ashley has pointed out the importance of a comprehensive plan. I wish to comment on something she stressed, which is the importance of avoiding a piecemeal approach. Before getting into that, there are two or three pleasantries I want to get out of the way.

I wish to compliment the Senate, and this committee in particular, for once again putting the tobacco issue at the top of the national political agenda. That happened with Bill S-13 and it is happening again with this bill. You deserve credit for putting it on the front pages and giving an opportunity for a national debate on this issue, something that is not coming from the House.

Second, our organization wishes to compliment one particular senator for the scholarship that he has brought to this issue. The Honourable Senator Colin Kenny is the only legislator that we know of in this country who has looked into this issue with the degree of scholarship that he has. I want to note that for the record. We feel very strongly about the leadership you are showing on this issue.

Finally, some of my colleagues have asked me to look at the track record on tobacco. Many of the things that I have found come from the scholarship of Rob Cunningham of the Canadian Cancer Society.

Having said all of that, a comprehensive plan is critical. I include five components in that comprehensive plan. First, we have to keep kids out of the market. Governments have historically focused on preventing supply of tobacco to kids. The problem is that if you do not affect the demand side of the equation, cutting off the supply will not work. You can shut down 95 per cent of the outlets and the kids will find the other 5 per cent, or they will get them through friends. You must reduce demand, and that is why this bill is so important. In that way, we will have a chance to cut the tobacco industry's access to our kids.

The second thing is moving toward informed consent. Attempts have been made in the past to improve the information in the system, but the problem has been that at the same time as doing that, which is laudable, governments have not moved to get the disinformation out of the system. You can improve cigarette warnings, and I compliment the government for that, but on billboards throughout the country we see Player's associated with athletics pursued by healthy young men, which is a desirable thing to do. That negates the effect of the warnings. In focus groups, kids say that if it is as bad as we say it is, those billboards would not be allowed all over the country. When you ask kids what those billboards are, they do not say that they are sponsorship ads or ads for racing events. Kids will respond first that they are tobacco ads. When the researcher asks whether the billboards advertize anything else, the kids say that they may be advertizing racing. However, the first thing they think of is tobacco. We have been very negligent in not taking the disinformation out of the system.

The third element of a comprehensive plan is protecting non-smokers from environmental tobacco smoke and from fires caused by cigarettes. Another element is product modification. It is critical to get into harm reduction for smokers through product modification. Finally, smoking cessation is critical. We have to help people get out of the market. When you cover those elements, you have a comprehensive plan.

The problem is that there are 15 or 20 different components in a comprehensive plan, and governments implement only one or two at a time. It takes five or six years to do it. To implement the full comprehensive plan, you might spend half century to get to your objectives. People wonder why it does not work. That is the background against which we look at the track record.

I wish to compliment the government for some of the things it has done, which have been very effective, quite positive. In the decade from 1982 to 1992, they increased tobacco taxation to world levels. Believe it or not, we had world precedent-setting declines in prevalence during that period. The government deserves some kudos for that.

The passage of the Tobacco Products Control Act in 1988 was world precedent-setting legislation. It banned tobacco advertising, and allowed for strong new warnings. The government deserves praise for that.

The Non-smokers' Health Act, the private member's bill, was a landmark. Taking smoking out of aircraft and out of Crown corporations and banks, again, was precedent-setting and important.

The introduction of the tobacco package warning system that is on cigarette packages, although now there voluntarily, was a world precedent for warnings at the time. The Tobacco Act, adopted when the Tobacco Products Control Act failed, was, and is, an excellent piece of legislation, although it has some problems.

In 1999, there was the federal lawsuit to recover money for what is alleged to be one of the biggest frauds in Canadian business history. We think that serious criminal behaviour was involved also. That was very important because it made Canadians look at this industry through far more critical glasses.

The world precedent-setting tobacco package warning system just brought out is extremely important. This will travel around the world, and the government deserves praise for that.

The government has done work on the international Framework Convention on Tobacco Control. I have talked to people internationally and they are praising the Canadians for the leadership that was shown on that. I heard that praise in a major way when I did a press conference with some of my American colleagues with respect to that.

All of these things are very good. However, there has been a massive failure to deal with a number of issues. There has been a failure to close the sponsorship loopholes that created this kind of a problem. There was, and continues to be, a failure to lay charges against the people who were aiding, abetting and profiting from the proceeds of crime related to the smuggling. We have not had criminal charges placed, yet the Americans have managed to achieve convictions in criminal courts for precisely that kind of activity.

The introduction and repeal of the export tax was a downer. Tobacco tax rollbacks were probably the biggest failure in the history of tobacco control in this country. The clawback of the Tobacco Demand Reduction Strategy money in 1995, where they gave money for tobacco control and then they cut it out, is the kind of thing that this legislation could fix.

The suppression of the Laboratory Centre for Disease Control study is something many of you may not have heard about. That was an impact assessment of the tobacco tax rollbacks. In other words, what kind of illness and death would you expect if you cut tobacco taxes through the rollbacks, if you cut tobacco taxes to meet U.S. levels to stop the smuggling? You never saw that report at the time. It was suppressed, but it predicted that the tobacco tax rollbacks would cause over 40,000 deaths from the increase in smoking among adolescents during 1994 to 1995. In other words, there would be the equivalent impact of 40 tainted blood affairs in that one decision. That was not very pleasant.

The speaker of the House killed Bill S-13, and the failure to replace that was another major failure of this government to respond to the tobacco epidemic. Of course, we still have not seen the record of the caucus committee that was promised in order to spell out how that problem would be fixed.

I want to say that there has been a failure to fund tobacco control. That is what this is all about.

They tried to integrate the different departments in Health Canada. They had space picked out where they could put policy together with the health protection branch. They were going to bring it all together, which had been recommended by other experts. They did not have enough money to get the space. They had the space selected, and there was no money. They have no money now. The money problems are serious.

A de-normalization policy was set, which covers all the events that we follow. De-normalization is the attempt to focus on industry behaviour and to reverse, in effect, what has been done for five decades. For five decades, the tobacco industry has tried to attach legitimacy to its products and to its activities. At every point, it has tried to undermine the health messages by having people believe that its behaviour and products are normal in the marketplace. De-normalization attempts to reverse the process that has been happening for decades. It is critical. Health Canada arrived at that policy, but now Health Canada officials tell me privately that they cannot operationalize the policy.

That is another reason why this bill is important. It takes that de-normalization process and establishes it at arms' length from government. Other people can do that, as you will see later on tonight.

I will end there, but I will say there are two or three historical barriers that are mentioned in my speaking notes. If anyone wants to ask me questions with respect to the particular things that have caused the barriers and caused the problems to repeat themselves over time, I would be pleased to answer those questions. In the meantime, I am honoured to be here to say a few words.

Senator Taylor: Dr. Ashley, I was made curious when reading through the submissions. You have noted that the provinces should ban the sale of chewing tobacco and snuff. That is usually an adult form of taking in nicotine. It is the youth that you are trying to stop. I know it is a messy habit, but what was the reasoning behind your recommendation? Are chewing tobacco and snuff the worst things? I cannot think of anything worse.

Dr. Ashley: It is a very small part of the market in Ontario. It is not part of the local production market in Ontario. There would be very little economic impact.

However, that was not the main reason for making the recommendation. The main reason was that the tobacco companies sell flavoured snuff and chewing tobacco that is aimed at the young market. The use of those products can often be a gateway product to the use of regular cigarettes. We were thinking primarily of the youth market, and the potential for getting kids hooked.

Senator Taylor: Converting them to cigarettes?

Dr. Ashley: Yes. It is detailed in the body of the report when you get to that recommendation.

Senator Taylor: I remember trying chewing tobacco when I was about 13. I have not tried it again, it was so horrible. I was wondering who you were attempting to convince with that.

Nicotine replacement therapy is available in the self-serve areas of pharmacies. I like that. Does that mean that you would give nicotine replacement free? Is that one of the recommendations?

Dr. Ashley: That was to make it available without prescription and readily available to people who are seeking this particular aid in smoking cessation, which we know is effective.

Senator Taylor: Would they still pay?

Dr. Ashley: Yes.

Senator Taylor: Have you thought that people should be able to get nicotine gum free? I know you said you would be giving it free on airlines to keep people from going into a rage from nicotine withdrawal.

Dr. Ashley: It was certainly discussed. We decided not to recommend it at this point. It may well be something that is recommended in the goodness of time. I believe that in Scotland at the present time a bill is being heard that will, indeed, allow people who want to quit smoking to get these products free of charge for a period of time.

Senator Taylor: As an aside, someone I know who has decided to quit smoking told me that the cost of nicotine patches goes up at the same rate as tobacco. There does not seem to be a tie-in except that someone is trying to benefit. I was wondering about giving them out free.

Senator Kenny: Mr. Mahood, could you describe the 1995 clawback for the benefit of the committee?

Mr. Mahood: When the taxes were rolled back in 1994, one of the programs introduced in order to mitigate the effects of half-price cigarettes in most of Canada was the Tobacco Demand Reduction Strategy, and a fund of $180 million was set up to be spent over three years to try to dampen the problems caused by institutionalized half-price cigarettes. Midway through the program the government clawed back half of the money that was left and gutted the program. Of course, at the end of the three years, it was terminated.

One of the things that witnesses keep repeating -- and it is certainly a premise that is at the foundation of this legislation -- is the fact that you need the proper and adequate amount of money that is sustainable. There is no way that you can set up a program and expect to see results in 18 months. As one government confidential report that I received said, the staff had literally only hours to prepare the plan. After they have hours to prepare the plan, they are then expected to score big time and have a successful program 18 months from the start. That is simply unreasonable. It was a money grab, and public health took a huge hit as a result.

Senator Kenny: Mr. Mahood, could you describe for the committee the effect of Bill C-42? Do you think ultimately it will be effective?

Mr. Mahood: I will not comment too much on that, other than to say that I have serious concerns about whether or not it will be effective.

Senator Kenny: When you say you will not comment on it too much, is that because you do not believe it will be put into force or because you believe that the bill is flawed?

Mr. Mahood: We are worried about whether or not it will come into force. We continue to have that kind of concern.

Senator Kenny: Could you describe for the benefit of the committee the funding problems faced by groups in the community that are currently trying to deal with tobacco issues?

Mr. Mahood: Like this government-funded group?

Senator Kenny: Like that government-funded group, yes.

Mr. Mahood: When I speak internationally, as I occasionally do, one of the compliments I pay to my own country is the fact that there has been sufficient leadership here that tobacco control groups receive financial support from the government. Governments know that they will not achieve their public-policy objectives without having a vigorous national debate. They also know that they must level the playing field between a multi-billion dollar industry and public health. Therefore, funding has been directed at organizations that can raise the tobacco issue on the national agenda.

The problem is that, with the department running out of money, some of us have literally waited three months because some of the grant applications have not been processed simply because the money is not there. They are seriously short of funds in that department. There are some good people over there; they try to do the best they can with little money, and occasionally people get heard. There are good projects that could be funded, projects that would reduce morbidity and mortality, would keep kids off the market, and they simply cannot be implemented because the funding is not there.

Senator Kenny: The department was recently reorganized to provide more focus on tobacco. Can you give us an assessment of whether the reorganization is working?

Mr. Mahood: A few things were promised as part of the reorganization, and one of them was an oversight committee. Another was the appointment of adequate senior staff to implement the program and, of course, bring all the various interests together in order to make an effective team. The absence of money has simply prevented that. I do not know what more to say. The absence of adequate funding has forestalled the benefits of that kind of activity from taking place. There is no point in having an oversight committee if you have no program to review.

Senator Kenny: Can you speculate for the committee as to why we have not seen a return to pre-1994 taxation levels in the five eastern provinces?

Mr. Mahood: I would be interested in other views, but I think it has been an absence of political will. There has been a certain buy-in to the belief that the smuggling would return. I know that the issue of smuggling has been raised by people from the tobacco industry. A candid assessment might be something like this: What are the chances of tobacco smuggling returning when the very people who fuelled and supplied the smuggling market before are under criminal investigation? As has been reported in the press, the criminal investigation continues; that is public knowledge. I do not think they will get involved in activity when they are under that kind of spotlight.

The second thing, of course, is that the prices for tobacco are in fact higher. We have the lowest prices for tobacco on the continent right here in Ontario. We do not believe this, but the industry claims that the price differential fuels the smuggling. In this case, the price differential is favouring Canada raising the prices.

Finally, the threat has always been that they will simply manufacture the product, or the product will be manufactured elsewhere and shipped into Canada. That might have worked when the Canadian companies were benefiting from that before, but now, because of the spotlight on the industry, the exposure of their behaviour and the fact they are facing massive lawsuits, we believe that they will not set up the manufacturing facilities out of the country. Someone else must. If someone else does it, the Canadian companies do not profit. They have an economic incentive to ensure that it does not happen.

For those three major reasons, and there may be more, I think there is a snowball's chance in hell of smuggling returning with the $15 per carton price increase, which is the figure that has been mentioned.

Senator Wilson: Dr. Ashley, the bill proposes that at least one young person have a seat on the foundation board. My assessment of putting one young person on anything is that they get ploughed under fairly quickly. Is there a problem in suggesting that two be appointed?

Dr. Ashley: I have no problem with that. I think we can learn a lot from what young people have to tell us about their perceptions of the problem and their perceptions of what works and what does not work.

Senator Wilson: I think they need a bit of a critical mass to be heard.

Mr. Mahood: I support there being more young people on an advisory board. If there were a group of young people on an advisory committee, for example, you could actually put the group to a more effective purpose. If there were a number from different groups in society working together, you would have something even more effective.

Dr. Ashley: Minister Rock already has a youth advisory committee that he has called together at least once to advise him on tobacco issues. It is my understanding that on that youth advisory committee there are youth from all across Canada. Youth from every province and territory are represented. I had the privilege of talking to the young man from Ontario who is on the committee. He happens to be a student at the University of Toronto. He is a very bright and articulate young man. I cannot imagine moving ahead with programs aimed at youth without having advice from people of that age group.

Senator Wilson: I support the idea of the advisory board. However, I have been on too many myself and not at the decision-making level to buy that completely. That is why I ask about there being two young persons on the board, as well as the advisory board, which is something that I support.

Dr. Ashley, in the executive summary of your report, under "Public Education," you say the Ontario government should "Implement comprehensive school-based prevention programs." Would the elements of that differ at all from the ones that have been outlined?

Dr. Ashley: We believe that there is a role for school prevention programs, including education, but also including policy elements and cessation programs in the schools, which are often ignored. I do not care what you do, school programs by themselves will not work without the supporting structures in the general policy arena and in the community at large.

Senator Christensen: The other day we had representatives from the tobacco industry before us. We were trying to ascertain what steps they took so as not to attract youth to their advertising programs. They said that they really did not know what they would do. They said that since they were not aiming at youth they did not really think they would have to take anything out. What is your assessment of their advertising? Do you feel there are things in the advertising that are attractive to youth?

Mr. Mahood: You will have to help me more, senator, because I do not quite understand your question.

Senator Christensen: What do you feel about the advertising now?

Mr. Mahood: Are you referring to sponsorship advertising?

Senator Christensen: Yes. Do you feel it is attractive to youth?

Mr. Mahood: Absolutely. There was an international study funded by the Robert Wood Johnson Foundation, in which I believe Dr. Ashley took part. The study was done by the University of Toronto's Centre for Health Promotion and the University of Illinois. I believe the study has been submitted for publication to one of the major journals. They asked kids about their reactions to the kind of ads to which you refer, senator. For instance, scrambling the Player's name, they showed the participants in the study a group of sponsorship ads. They asked what the ads were for. The kids identified, first, that they were tobacco advertisements. On a second round of questioning they identified that they might be event advertisements. Kids see these as tobacco advertisements, which means that they see them as legitimizing tobacco industry products. They see healthy models engaged in macho activities. We believe these types of ads work better for the industry than traditional brand ads. I think there is research to back us up.

In traditional brand advertising, the industry would not use live models associated with athletic activities. With sponsorship advertising, they are able to do now what they could not do for traditional brand advertising in the 1970s and 1980s. The will of Parliament in 1988 was that these sponsorship ads should end. Some 12 years later, we still have them. It is a disgrace.

Senator Christensen: Do you think the passage of Bill S-20 would be able to counteract some of that?

Mr. Mahood: Yes, without question. You will see later some terrific award-winning media work done in California, Massachusetts and Florida that exposes the industry's behaviour. Kids do not like to be ripped off. One of the reasons kids smoke is because of rebellion. Parents, teachers and health educators tell kids not to smoke. However, they rebel and smoke. If you come along and identify that the tobacco industry is the authority that is causing all of this to happen, you can transfer some of the rebellion. That is where an effective mass media campaign comes in. However, it is but one component. If you identify the industry's behaviour and expose it to kids, then you can definitely counter some of this stuff.

Senator Taylor: I understand that most of the smuggling would still take place in spite of what you say because we are allowed to export so many cigarettes per year without paying tax on them. Therefore, those cigarettes would go across the border and come back without tax. What do you say to the idea that we should tax cigarettes as we do alcohol right at the factory? Therefore, no cigarettes could be exported tax free.

Mr. Mahood: I am not the expert in my organization with respect to tobacco taxation. I would be glad to have Rob Cunningham or someone else get back to you with an answer.

My understanding is that the export tax, of course, is critical when there is a price differential that creates an incentive to smuggle. With tobacco $15 per carton more expensive in the United States at the present time and with us having the lowest levels of taxation on the continent in some of our jurisdictions, I cannot believe that there would be an incentive to smuggle.

With respect to the export tax, very clearly there are ways to make that a positive deterrent to smuggling, but I will get my people to contact Senator Taylor and give you more complete answers.

Senator Taylor: I appreciate that. I notice most of the programs in the U.S. are state programs. We have trouble because each province you have listed here has different taxing rules, different rules on nicotine. Are we barking up the wrong tree by trying to put a federal act in instead of provincial acts? The states are doing it in the United States. The provinces are the ones involved with different rules. Is it legitimate to try to do it on a national scale?

Dr. Ashley: I certainly think the federal government has a very important role to play in Canada in health matters of various kinds. There is no reason why it should shy away from the tobacco arena and leave it entirely to the provinces.

I am not a constitutional expert, but I do believe the federal government can set standards for programs and can create incentives for various programs and so forth. Clearly, the provinces need to do programs themselves, but there is a role for the federal government and there is a role for a program that all Canadians will have access to that will be effective.

The Chairman: Thank you both for appearing. Mr. Mahood, I wonder if you could stay for a bit. I understand you are very familiar with the panel coming up next. Perhaps you could give us a few words of explanation.

Dr. Ashley, thank you so much for coming here. We shall read the report. I did have some questions, but perhaps I will be able to ask you privately about what is happening with this report.

I should like to say that if we have any further questions, I hope we may communicate with you and ask you to respond.

I should like to ask the next panel to come to the table. We have, from the American Legacy Foundation, Chuck Wolf; from California, Greg Oliva; and from the Massachusetts Department of Public Health, Greg Connolly. Gentlemen, we are most appreciative that you have come all this way. We look forward to hearing what you have to say. Before you begin, I should like to ask Mr. Mahood if he would make an introduction.

Mr. Mahood: Thank you, senators. I should like to introduce Greg Oliva. I will just say, by way of introduction, that Mr. Oliva is involved in policy with the Department of Health Services for the State of California. California has been the granddaddy of the significant groundbreaking campaigns in tobacco control in the United States.

I might add a note of appreciation. California has been of tremendous assistance to Canadians. They have offered their services continuously to us to help us understand what is going on there. They have given us the award-winning "Debbie" ad that you saw that was shown on television. That was a California ad, which they graciously gave us to use in this country. They have done many wonderful things and it is a pleasure to have Greg Oliva with us to talk about their campaign.

Mr. Gregory P. Oliva, Chief, Program Planning and Policy Development, Tobacco Control Section, California: I am extremely honoured to testify on behalf of Bill S-20 tonight. Through the superlative vision of Senator Kenny, your great country has the opportunity to craft an effective landmark tobacco control program, instead of putting together a program that is politically expedient.

In the brief time that I have before you today, I will discuss the California Tobacco Control Program's recipe for success. Just as with any recipe, this one has ingredients. When used appropriately, you get a great meal. When used inappropriately, you not only go hungry but you also waste the resources that could have created a great meal.

Before I go any further, I should like to make one disclaimer. I am here today as an individual citizen and not as a representative of the California Tobacco Control Program. However, what makes me knowledgeable about the California experience is that I am currently the chief of program planning and policy development for the Tobacco Control Program in California.

In 1988, California voters determined that a 25-cent tax should be placed on each pack of cigarettes to fund health care programs and tobacco education and research programs. Twenty per cent of those funds collected go toward tobacco education efforts in both community and school settings. Those funds created our program.

In California, we employ a social-norm-change approach to indirectly influence current and potential future tobacco users by creating a social milieu and legal climate in which tobacco becomes less desirable, less acceptable, and less accessible. This environment is created by two forces working synergistically with each other. One, there is a well-funded and aggressive state-wide media campaign that serves to shape the issue of tobacco use, secondhand smoke, and tobacco industry deception. Two, we have locally funded programs that utilize community-based organizations and concerned citizens to develop grassroots efforts to reduce the use of tobacco through awareness, education campaigns, and local policy development.

The success of the California Tobacco Control Program speaks convincingly. We have spent $1 billion during our 10-year existence and that $1 billion has been spent well. We hold the second lowest adult prevalence and consumption in the United States. We are second only to Utah, which is a relatively small state in the United States, predominantly inhabited by Mormons, whose religious followings do not allow the use of tobacco. We are also the only state to witness a 50 per cent decline in consumption, from 112.6 packs in 1989 to 61.3 packs in 1999.

Also, reducing youth prevalence in California has been a success story, especially of late. Current classroom-based survey results from monitoring the future data, which is collected through the University of Michigan, indicate that California youth smoking rates are declining at rates higher than the rest of the United States. In addition, preliminary findings from the telephone-based California Youth Tobacco Survey indicate an approximately 37 per cent decline in youth tobacco prevalence from 1998 to 1999. That is in youth ages 12 to 17.

Finally, since 1995, millions of Californians have been protected from second-hand smoke in the workplace. No other public health intervention has been so widely discussed and has protected so many Californians from second-hand smoke morbidity and mortality.

While we have spent a great deal of money, it has actually saved us money. We know that for every dollar we spend on our program, we save $10 in direct and indirect medical costs. That data comes from the University of California at San Francisco, from a researcher named Dorothy Rice, who countless times in public forums has stated that these estimates are in and of themselves very conservative and that the savings are probably far greater.

Where do we see some of the cost savings? The rates for lung and bronchus cancer mortality after just 10 years of the California Tobacco Control Program have begun to fall and at greater rates than the rest of the United States. Heart attacks and strokes are also falling.

The program has made revolutionary changes in how tobacco use is viewed in California and has made revolutionary changes in the health and well-being of literally all Californians.

How does a revolution happen? Let us go back to the recipe for success. What are the ingredients? The most important are the following: one, committed individuals at both the state and local levels; two, aggressive interventions that yield social norm and policy change; three, limited political interference; and four, a significant and continuous funding base. These ingredients act in a dose-response relationship. The more we see of them, the better the outcome. The less we see of them, the worse the outcome.

The first ingredient is people. You cannot accomplish the revolution without the troops. In California, we have had and still possess an extraordinary army of tobacco-control soldiers. Margaret Mead said:

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.

No statement could be more worthy of the people who have made California's efforts so notable. Winston Churchill's reference to the Royal Air Force during World War II is also fitting: "Never was so much owed by so many to so few."

The second ingredient is aggressive intervention. You have to choose a strategy and stick with it. In California, we employ a social-norm-change strategy where we have indirectly influenced current and potential future tobacco users by creating a social milieu and a legal climate in which tobacco becomes less desirable, less acceptable and less accessible. That overall strategy feeds into our three priority areas: one, reducing the availability of tobacco products to youth; two, reducing the exposure of second-hand smoke; and three, countering pro-tobacco influences in the community.

Each one of those priority areas yields the opportunity for the program to create policy changes at both the local and state levels. The greatest example of social norm and policy change is smoke-free workplaces. If you make enclosed workplaces smoke-free, do you the following: one, you limit the places where smokers can smoke; two, you create social cues upon which smokers begin to accept the norm of non-smoking environments; three, you gently motivate smokers to consider quitting; and four, you protect the health of countless other individuals who do not smoke.

The implications are far wider than merely choosing to fund individual cessation programs. As recent data suggests, smoke-free environments in California are a strong cessation program in and of themselves. I would add that our intention in all of this is to create a supportive environment for smokers so that they can quit and so that they are not treated as outcasts for their addiction.

The third ingredient is limited political interference. I must once again make my disclaimer that I am here as an individual citizen and not as a specific representative of the California Tobacco Control Program. Having said that, political interference is intrinsic to implementing a tobacco control program. Whether it be through government or a private foundation, the system you create must provide sufficient financial and programmatic protection so that you may move forward with your goals.

For three years prior to 1995, Republican governor Pete Wilson diverted funds from their legal destination, the California Tobacco Control Program, to an illegal yet needy destination, medical care programs. Riding on the momentum from the aggressive launch of our program, we still achieved the lowest adult prevalence in 1995 -- approximately 16 per cent.

However, in the time it took to retrieve the diverted funds, adult prevalence rose to over 18 per cent, where it has roughly stayed since. In addition, we were only able to retrieve the funds through litigation pursued by the tobacco control constituency in California. The best friend of the tobacco control program, short of no political interference, is a strong, fearless constituency.

After the constituency won the lawsuit, the administration clamped down on the programmatic aspect of our effort like a bulldog. Tobacco control had won the battle but lost some of its autonomy in the process. In addition, while the program has traditionally been allocated sufficient funds to run an effective media campaign, we are burdened by a media approval process that does not allow us to run an aggressive campaign.

This administrative interference plays into the hands of the tobacco industry. Each day that we do not place hard-hitting ads on the air or in print is another day that the tobacco industry can play up their own public relations campaign. When we do not counter the new-found good corporate citizenship image, our silence infers acquiescence.

Although it is no panacea, Bill S-20 allows for a system where the chef can actually cook and not debate the recipe ingredients, cooking temperature or even whether to cook at all.

The fourth ingredient is a significant and continuous funding base. When compared to other states, California's tobacco control budget must look quite large. It is large, but it absolutely must be large given the fight we are in. Other health programs battle infections, virus and diseases. In our line of work, the infection, virus and disease is the tobacco industry and one shot or one pill will not cure it.

In order to be effective against the tobacco industry, we need to maintain an aggressive and continual state-wide media campaign. We need to maintain programs within our local health departments, programs run by community-based organizations, and evaluation efforts. This is all within the context of the most populous state in the country -- approximately 33 million people. It is one of the largest states in the country in terms of land mass, one of the most ethnically diverse places on the planet and, finally, a state with a high mix of large, urban cities, medium-sized cities and small, rural cities. Reaching that amount of population in that geographic expanse with that many cultures and that many different political sub-units requires a significant and continual expenditure of funds.

Each year, we request what is known as multi-year spending authority. Because our funding comes from a tax, the revenues fluctuate. If we are being successful, we actually expect revenue to go down. Multi-year spending authority allows us the flexibility to account for fluctuations in tax revenue and maintain a constant and seamless level of funding for our program. When we are told no to multi-year spending authority, that highlights more interference that disrupts the flow of our program.

Because we have witnessed fluctuations in revenue, at times we have had to decrease the funds that go to existing programs and, further, not fund new agencies that actually had passing scores in our peer review process. That is not an effective way to run a program when your enemy has unlimited financial resources, is not afraid to use those resources, and has little or no scrutiny on how they market their product. You have to maintain a consistent presence on the airwaves and in the communities if you are to be effective in reducing the burden of tobacco.

I applaud Bill S-20 for its per capita allotment to this effort and for acknowledging the Centers for Disease Control's best practices recommendations to come to that funding level of $12 per capita. While our population size is somewhat similar, our program is merely one state. Your program will be national and it will be of tantamount importance to establish programs and efforts across your large country if you expect to create significant change.

I also applaud Bill C-20 for its intention to establish not only sizeable funding but stable funding. You cannot expect to reduce prevalence and consumption or prevent youth from taking up tobacco if you do not have a continual presence on the airwaves and in the communities.

In summary, California has had its share of successes in tobacco control. However, how far could our revolution have gone had we not had historically to deal with political interference? How far could our revolution have gone had we had the financial resources that were equivalent to the CDC's best practices recommendations for a state the size of California? How far could our revolution have gone had we had stable funding, year in and year out, so that we did not have to cut programs and did not have to face insufficient dollars to fund new agencies?

I will continue to work to make the California program the best it can be under the existing barriers, because I believe in the cause and because the politics of the day leave me with little other choice.

Senators, at the dawn of the new millennium, you have a choice and you can answer my question. I hope the answer will come from Canada in the form of Senator Colin Kenny's Bill C-20.

At this time, I have four commercials to show you. I believe they are cued up. These are relatively successful ads that we have run in California. They were all focus-tested. The ones I will show you address the delegitimization of the tobacco industry and also the harmful effects of the tobacco industry. They also address the harmful effects of tobacco use, both graphically and also at the heartstrings.

[Video presentation.]

Dr. Greg Connolly, Director, Massachusetts Department of Public Health, Tobacco Control Program: Honourable senators, I have been to Canada on a number of occasions. I came here 12 years ago when prices of cigarettes were twice those of Massachusetts. Today I see Canadian tourists in Boston buying cigarettes.

I came and saw an advertising ban that set a world standard for those of us who work at WHO. Hong Kong and Thailand have copied Canada. Landmark warnings in Poland today mirror what Canada has done. I find it amusing to be coming from Massachusetts to tell you what you should do. I have looked to Canada for leadership. However, I should like to describe just briefly our campaign and what we have done and why you should invest serious dollars to curb tobacco use.

Our state spent $58 million last year to curb smoking in a population of about six million people. In Canadian dollars, that would be $15 per capita -- higher than what is being recommended here. Even that figure is lower than what Vermont, Maine or Mississippi is spending.

I would argue that, in funding, one must think about well-funded campaigns. The more money you put in, the more you get for your buck. The campaigns must be sustained over time. One cannot put money in because you cut taxes then take the money out two years later, because that causes enormous disruption.

Campaigns must be comprehensive, addressing issues of price, clean indoor air, enforcement, aggressive mass media and cessation.

What do we do with our $58 million? We spend about $16 million on media. Media is not a solution. It really frames the debate. Then we commit another $30 million to local communities, to boards of health, which are responsible for enforcing and ensuring that kids are not sold tobacco products illegally.

We promote clean indoor air. By and large, one cannot smoke in our restaurants in Massachusetts. One cannot smoke at Fenway Park, the Patriot Stadium or the shopping malls. It is pretty much passé. However, it is through advertising that we changed social norms.

We provide any smoker in our state who wants to have counselling for smoking cessation free counselling through a network of hospitals and health centres, plus free nicotine replacement therapy. In our state, we fought to ensure that any woman who was at risk of breast cancer had a screening. We did that. We now ensure that any smoker at risk of lung cancer can get the equivalent of that. Given the policies on drugs in Canada, we probably would like to come up to Canada to buy the nicotine replacement therapy -- it would save our state a lot of money.

We have comprehensive education in schools that links the policy in the school to what is going on at the community level. That campaign is not soft and mushy. It is not a bunch of kids going in and putting posters in a gym. Those are hard, real services. The same way you buy hard, real services for your maternal and child health programs, substance abuse programs and the infectious disease programs. Those are hard, substantive programs.

The programs are highly popular. If you ask residents in the state what is the one thing government is doing right, the tobacco control program comes up very high up on the calendar.

The programs are highly effective. They work. We put 10 per cent of all dollars into evaluation to ensure that we can show elected officials that they do work, that they do give results. They pay for themselves and they save lives.

What has been our success since we established the campaign in 1993? There has been a 35 per cent reduction in overall sales -- four times the national average. That means $1 billion this year that would have been spent on tobacco products by our consumers is now being spent for our goods and services, including trips to Quebec, Halifax, Toronto and Montreal.

Among kids, we have a 30 per cent decline in middle school figures. We have just achieved that in the past two years. There is a 20 per cent decline in high school students. With the exception of California and Florida, our kids' rates nationally are either going up or not changing.

For pregnant women, Massachusetts' demographics are very similar to those of the eastern provinces. There is no question that we are more akin to the eastern provinces than we are to California or Florida, and that is not to disparage our fellow states. We share similar smoking prevalence rates. We reduced our smoking among pregnant women from 26 per cent to 13 per cent. I will be in Nova Scotia next week, where the rates are still around 25 per cent. In Newfoundland, they are higher than that. The same is true in rural areas of New Brunswick, in Quebec and in other communities.

We have shown that if you fund the programs to do education, you can get those rates down. The nice part is that, by knocking the rate down from 26 per cent to 13 per cent, we paid far half the program. Not because we prevented a lung cancer case from being treated 20 years from now, but because we prevented 400 babies from going into hospitals for treatment of smoking-related diseases because of maternal smoking, and we saved an estimated $18 million from that alone.

Among our adult smokers, daily consumption fell from 20 cigarettes per day to about 14 per day. We went from a prevalence rate of 22 per cent to 18 per cent. It may not sound like a lot, but if you have 1 million smokers, that is 200,000 people who do not smoke. Keep in mind that one out of two of those individuals would have died 14 years before their time from a smoking-related disease. We saved 100,000 premature deaths.

If we had developed a cure for lung cancer in 1993 and had inoculated all the people who smoked, we would not have saved 100,000 lives. It is really a cure for lung cancer.

Our daily smoking rate is 14 per cent. That is one of the lowest rates in the developed world. The same is true for California. You are seeing extremely low rates because these programs are effective and they work.

I should like to show you a couple of our ads. Our tone may be different from that of California, but from it you can see there is a mix of strategies we can use.

[Video Presentation.]

Mr. Connolly: Marie puts a face on the reason we are in this room. In our country, the tobacco industry has said, "Yes, smoking causes lung cancer now," but what have they done?

I go to the annual meeting of Philip Morris as a private citizen each year. Philip Morris owns 40 per cent of the Rothmans company in this country, and, as well, Japan Tobacco Inc. They say, "We are a small part of America. We are community people. We donate money to the arts. We take care of affirmative action issues. We are an economic dynamo. We are just like any other company in America." I get up and say, "Mr. Chairman, I had to walk through a metal detector to get inside this community today. Mr. Chairman, when ABC News says you manipulate nicotine, what do you do to our conscience? You sue it for $10 billion. You take soft money and you lavish it on our political system so that common people are not given access to their democracy."

When our FDA tried to regulate tobacco product as drugs, or our EPA, second-hand smoke, they sued. Canada is different though. I am sorry, I am not in the United States. I am probably out of turn. However, who sued British Columbia two years ago when they tried to get the additive list out to the residents of British Columbia? Who sued when you banned advertising? Where did the lawyers come from? Who is involved in smuggling cases? Oh, but Canada is different. Your tobacco industry is different. You treat them differently than we treat them in the United States of America.

I talked, when I started my presentation, about common people fighting a vicious foe. That was in jest of course. But, how we beat big tobacco companies is by common people standing up to big tobacco companies. We have the cure for lung cancer. All have need to do is buy it. It is cheap compared to what you spend for health care in this nation.

On this continent today, 1,500 people will be killed by smoking. They will be replaced by 4,500 Canadian and America children. If you ask Philip Morris, "Is that your problem?" he will say, "No, it is not our problem." Well, as my grandmother always taught me, "Make it their problem."

Mr. Mahood: Honourable senators, I am pleased to introduce Chuck Wolf. He is the driving force behind the successful Florida campaign. He will tell you the origins of the funding for that campaign and, more recently, from the American Legacy Foundation, which was set up as a result of the master settlement and the legal settlement between the state attorneys general and the United States tobacco industry. He has an enormous amount of experience in working and developing these ads. He has also been a friend of Canada. He has been here to do workshops with Health Canada, and on every occasion when requested he has helped us out. It is a real pleasure to have him here today.

Mr. Chuck Wolf, Executive Vice-President and Chief Operating Officer, American Legacy Foundation: Honourable senators, I have had a unique opportunity to build the two newest anti-tobacco programs in the United States: the program for the State of Florida and the national program at American Legacy Foundation. The Florida tobacco control program was created by a legal settlement.

My experience is in business, not in government. I worked for the governor of Florida at the time of Florida's tobacco settlement. I was asked by him to build a program, which meant travelling to California, Massachusetts and other places in the world, to learn what the best practices were -- to do exactly what you are doing today. The goal was to find out from those policies and practices what we could do.

We did not have the benefit of the CDC best practices at time. If we had, it would have saved me a lot of work. That is not to say that I would not have listened to my colleagues, but I would have been able, first, to get the accurate amount of funding to build a good program. Second, we would have saved a lot of time in learning all the great things that have been done throughout the country.

Florida's program is rather spectacular in its effort to reduce youth tobacco use. To get started, it concentrated on youth tobacco use. The American Legacy Foundation has done the same thing. As you have heard, the American Legacy Foundation was created by the master settlement agreement. It receives funding in excess of $330 million per year for a national anti-tobacco campaign, which is primarily a media campaign, because community and education programs are done by the individual states.

The Chairman: Could explain what the master settlement agreement is?

Mr. Wolf: All 50 states sued the tobacco industry. Four of those states settled separately, Florida being one of them. Some 46 others settled en masse. Thus, there is one master settlement agreement for 46 states against the tobacco industry in the United States. That includes the four major tobacco companies, as well as many subsequent smaller manufacturers of tobacco products. It has many restrictions. Each state receives a certain amount of money. It will amount to $246 billion being paid to the states over 25 years. A small portion of that money was used to create a national foundation to do anti-tobacco work.

I was in the Florida program for about 15 months. We built that program and then moved to the American Legacy Foundation. I have just left that foundation, after spending the first 13 months getting it up and started.

I will offer you some perspectives on how to get these programs up and running, how to use best practices to do it and how you can be proud of it in a rather short period of time.

Having come out of the field of business, I used business models to develop both these programs. I will give you some perspective on how it was accomplished. No good business succeeds without strong leadership. To allow leadership to happen means you cannot be micromanaged or nanomanaged. In the Florida program, a board of directors was created. I enjoyed the earlier question about how many youth you should have on your advisory group because the board of directors in the Florida program is all youth. There are no adults developing the theme or the tone of the anti-tobacco program in Florida. When you hear the results, you will see what that can do for you.

Some 70 young people create a board of directors with a 10-member executive council. They made the decisions on how to spend the $150 million. I am sure all of you are thinking, "That is nuts. We would never do something like that." In fact, it took a lot of work by the governor of Florida to get the Florida legislature to allow such a thing to happen. Again, when you hear the results, I think you will be surprised to see that it actually works.

Florida's program is developed into five program areas. I will not spend a lot of time on marketing because you have seen some ads already. Although it is something I love to talk about, I would like to spend more time talking about the education programs and community partnerships that are developed. This meant going out and developing education programs that these young people enjoyed, believed in and thought would work. This really meant developing messages that were not, "You get black lung. Your arteries get clogged and you will get sick." Most 14- or 15-year-olds do not spend a lot of time thinking about their long-term health. They are thinking about being cool, being fun and being rebellious. They developed some new things that dealt with how the industry gets their friends to use products. In their math problems, they use these kind of questions: How many packs does it take to be addicted? How much profit does the tobacco industry earn? If you divide the profit by all the shareholders in the tobacco companies, how much money is each shareholder earning? If you divide that by how much money the CEO of that tobacco company earned, how much money did he earn on the number of people who died that year from using the tobacco product? It is fascinating way to look at the tobacco issue. However, by developing it that way and by being unique, which is what the young people wanted to do, they have had tremendous success.

Community partnerships and programming meant that no minority group was left out. Everyone was at the table in spending this money. In fact, in many of Florida's counties, the minority constituencies are the majority of young people at the table deciding what concerts to have, how to deliver messages and how to do cool community events when schools are out.

The marketing is effective. Florida's anti-tobacco program created a brand called "Truth." It is without a doubt the most well-known youth brand in the state of Florida right now. Within a six-month period, there was a 92 per cent knowledge corrected awareness number. That is better than Nike, Burger King, McDonald's, Coca-Cola or Pepsi ever had on a product launch. It is phenomenal what young people can do when they are allowed to develop these messages.

The business model I spoke of had strong leadership. This meant allowing the program to go out there and flourish. It had accountability, meaning you had evaluation and research, but you did not second-guess every step along the way. If a company's board of directors was never to allow the management they hired to do the work they were hired to do, they would never get anything done. That is why boards of director do not meet every day; they usually meet quarterly or twice a year to make policy decisions for the company. They allow staff to get the work done.

In the integration of a company's efforts, you as a board do not want to see management wasting money. You do not want to see them developing one program that is competing with another program. The key to successful anti-tobacco programs is that they are integrated. You do not have people competing. When you agree on a theme, whether second-hand smoke, social norm change or industry manipulation, you allow that theme to flourish. You follow it. You agree to that direction and allow the leadership of the organization to put it out there.

It has to have sufficient funding. Just like a good business, they have convinced someone of their business plan. They have adequate funding and are allowed to keep it sustained if they are making progress. They must not be second-guessed. You heard others talk about the idea that non-sustainable funding means they are spending all their time coming back for more funding. If the bank is there for a business every month saying, "We do not like what you are doing this month," then the business is spending all its time convincing the bank instead of getting their work done. Not having sustained funding is an interruption in being able to reduce the number of youth smokers.

Finally, in any good business model you must acknowledge and be responsive to your competition. In this case, we know who our competition is. They are very forward and happy to advertise their product as best they can. You know who the competition is. You have to be able to answer the competition. You have to be able to move quickly. You have to respond to their latest moves.

Today, they are very strong in the 18- to 24-college-age category. Why is that important if you are worried about under-18 tobacco use? Because almost everyone under the age of 18 looks up to those who are 18 to 24 as role models. If you cannot affect that role model vision, just like if you cannot affect knowledge and information to parents, then you will not be able to affect youth tobacco use and reduce it.

I have told you about Florida's program and the many efforts in it. The American Legacy Foundation is copying many of these efforts to build the first national anti-tobacco media effort in the states.

In less than two years, Florida's tobacco use among middle school students, who are 12, 13 and 14, has declined by 54 per cent. Among high school students 15 to 18 years of age, in the same time period, there has been a 25 per cent decline in tobacco use. That include all tobacco products, such as cigarettes, chew, pipe, and bidis. In the state of Florida, 16 per cent of tobacco users had already started using these products before they were in grade 6. The significant work has to happen at young ages. You already know that 80 per cent of your tobacco use in this country begins before the age of 16. The tobacco industry knows that as well. If you are a good marketer and a good business person, you will concentrate on from where you will get your market share. You will never defeat continuous addiction in your country if you do not concentrate on this age group.

Concentrating on the age group does not mean it is only a youth program. Youth should be allowed the opportunity and be empowered to develop and deliver the message, but parents, other adults, college-age students have to be integrated into this effort as well.

I am hoping I will elicit some questions from you on how you empower young people to develop programs and messages. I will leave behind some tapes and ads on Florida's work. I know you have some of that already. I do not want to shortchange the media efforts because I believe they are important. However, I think my colleagues have covered that as well.

Senator Christensen: How do you set up your program to get youth involved in the way that you do, having them literally running the program? What is the age of those youth?

Mr. Wolf: The board of directors in Florida, called Students Working Against Tobacco, are high-school age students. There are in middle school and high school, but they are primarily 14 and older. They are all under 18.

Senator Christensen: They are the board of directors?

Mr. Wolf: Yes, and they have an executive council of 10, which they elect among themselves, that meets on a more regular basis. The larger group meets twice a year. In fact, they are meeting right now. There is a summit going on in Florida of 1,000 youth. They do that once a year. They elect a board of 70, and then 10 members.

There are two things to remember in recruiting youth. One is that they have to self-select. You cannot just go to the school principal and say, "Give me your brightest and best." You need tobacco users as well as non-users as part of this effort. You should not exclude a student who smokes from being part of the effort. By doing that, everyone feels included and they really have authority and power.

The other thing is not to second-guess them. You will find that there is a tendency to say, "You can have this much power, but when you make a decision we do not like, we will stop you." That will be the death of any effort. If you give them some authority, some responsibility to deliver a message, and then say, "You know what, I am sorry, but the government has now decided we do not want you to do that," or "That is too risky for us to be involved in," it will be the kiss of death.

The other, very difficult part of this, to be honest, is that it is very hard for adults to let go. The idea that you would give youth any responsibility for leading such an effort would mean, in the minds of many adults, that they have to give up that responsibility, whether it is power over money or over responsibility or decision-making. That is where you have to start, to be frank. You have to convince the adults that this is a good thing to do. You can convince them by writing it into your legislation or you can convince them by just saying, "We are going to beat you over the head until you get it."

Either way, it is very important thing. You have to get the adults to understand that youth empowerment is the key to it, and then you have to give the youth real responsibility.

Senator Christensen: What sort of support staff is there in the Legacy Foundation?

Mr. Wolf: The Legacy Foundation has rather minimal staff right now. A year ago, they built up to about 28. They will reach about 50. The Legacy Foundation is different, in that they are not delivering on-the-ground programming because they are making grants to states to do that. The states will have the majority of the staff, the grant recipients.

In the Florida program, there was a core staff of about 30, but there was a staff person in every county to deal with these youth groups that were formed in each county as well. There are 67 counties in Florida, so you could count 97 staff members, if you added everyone in the county who was a staff person under a grant recipient.

Senator Christensen: Is the Legacy Foundation created under any legislation?

Mr. Wolf: No, it was created in the legal settlement.

Senator Christensen: It is a non-for-profit organization?

Mr. Wolf: Yes.

Senator Christensen: Are there any legal implications in having youth involved who are under the legal age?

Mr. Wolf: The Legacy Foundation has one youth member of their board, but they are making grants to states and requiring in those grants that young people be at the table and leading those efforts. They are called youth empowerment grants to the states. They expect to make, I believe, $25 to $50 million worth of grants in the first year, or a commitment to that in the first year. The Legacy Foundation board, as a result of the settlement, must have two governors, two attorneys general, and two state legislators serve on it. It had some statutory limitations.

Senator Christensen: In addition to the youth?

Mr. Wolf: Right. The youth was not called for in the settlement. That came later. Actually, there is a clause in the master settlement agreement that calls for a child psychology expert and they decided that the person to fill that would be a 19 year-old college student.

Senator Christensen: Who is the chairman of the board?

Mr. Wolf: The chairman of the board right now is Mr. Chris Gregoir, the Attorney General of the State of Washington. Her term ends shortly; there will soon be a new chair.

Senator Christensen: Is it possible that one of the youth might be elected?

Mr. Wolf: That is possible, if the other members of the board so voted. The youth is a full voting member.

Senator Finnerty: I found your presentation fascinating. I hope we can catch up to you very soon.

Do the youth have focus groups? What kind of training do they have to do this?

Mr. Wolf: Just decide on their own?

Senator Finnerty: Yes, it just comes out of where?

Mr. Wolf: This is where it gets interesting. We say to empower young people; however, some people are frightened that that might mean that the youth will run off and do what they want. In reality, they ask for a lot of guidance, and training, and for many experts to come in, not dissimilar to legislative committees who ask for experts to come in and talk about how something is done. You will find that young people will say, "You know, we need advertising experts in the room. We would like teaching experts in the room, educational experts, to help us talk about these educational programs."

Companies like Scholastic, which is a big educational publisher, brought experts in to help the youth develop new work and that kind of thing.

With respect to skills for leading meetings, doing public speaking, debating the tobacco companies, they had a representative from Brown & Williamson Tobacco come to one of their events. 60 Minutes covered the exchange between the youth and the representative from Brown & Williamson Tobacco.

They asked for and got a lot of support. The youth considered us as staff to do what they wanted. When they asked for a train to go all over the state -- they called it the Truth Train -- it was our job to run out and get them a train, secure the tracks, paint the train for them and allow them to deliver their messages.

We really treated them as our board. We were their staff. They asked for training and they got it, just like members of a board would want to be brought up to speed on their organizations.

Senator Cochrane: One thing that is impressive this evening is the amount of coordination between our group and the American group. This says something about our objective, trying to prevent youth from taking up this bad habit. I am so pleased we are sharing the information; it is one of the fields where we ought to be sharing information. Perhaps we should have been sharing more information about other things, as well. I commend you all and I hope it continues.

My question is this: In what way do you prevent youth from smoking?

Mr. Connolly: There is no silver bullet. It is a comprehensive campaign that reaches young people by changing -- this is the strategy we are taking -- the social norms for the larger society. You raise the price. You forbid smoking in public places. Adults are not smoking so they are not role models for young people. There is education in the schools, aggressive mass media, and enforcement of the law against selling tobacco products to minors.

I call it the four Ds. We deglamorize the behaviour in the eyes of young people by getting rid of advertising and doing counter-advertising. We denormalize the behaviour by promoting clean indoor air. We delegitimatize the tobacco industry by exposing them for what they do, so that young people will rebel against them and not someone else. Finally, we try to denicotize the product through FDA regulation. We lost that in our Supreme Court.

There is no silver bullet. You go after the larger society and you do it with a comprehensive, well-funded, sustained program. You cannot get kids not to smoke by implementing small programs, ones that will not be there for the long term. You have to spend money on it. You have to put money against the issue. You have to take risks. If you fail on one strategy, you must have the wherewithal to continue, to learn from your mistakes and go forward with other strategies.

We had a great meeting last year, which Senator Kenny attended, in Cape Cod with the eastern provinces and with the New England states. It was a very rich experience. Many people in New England cannot spell the word Parliament. For them to understand the whole different approach to tobacco control was great. We share similar populations. The prevalence rates are similar between the New England states. For us, it was a wonderful experience. We will meet in Saint John next year, 2001, with the New England states and the eastern provinces.

Mr. Wolf: Will there be snow then? They get to go to Cape Cod, and I have to go to Ottawa in January. That is great.

Mr. Oliva: I agree with everything that Mr. Connolly said. In addressing the social norms, I think you will find that, in families where adults smoke, there is a much greater risk or chance of the youth actually taking up smoking. Therefore, addressing the adult role-modelling of that behaviour is very important.

Mr. Connolly also mentioned price. In one of my comments, I had mentioned that between 1999 and 1998 we saw about a 37 per cent decline in youth smoking, ages 12 to 17. On January 1, 1999, we had a new 50-cent tax go into effect in California, so there are obviously some price-sensitivity issues around tobacco with youth. Whether that caused the 37 per cent decline, I do not specifically know. Did it contribute to it? I would imagine it did.

Senator Cochrane: Given everything we know today from various sources about what smoking can do to you, how do smoking rates among young people in the state of California compare with the rates in other states, where fewer resources are available to put on these campaigns and ads?

Mr. Oliva: As I said earlier, the rates in California are in many instances significantly lower than other states. As per the handout you have on current monitoring and future data, the rates are not only lower, but also the decline of acceleration is even more significant in California than in other states. The continuous and stable funding source that we have in California has had a presence in changing the perceptions of youth towards tobacco. I think that is essential. Many states do not have that presence, although it is beginning now to build up, with some of the states allocating money toward tobacco-use prevention from their master settlement funding -- that is, for those states that at least have the vision to allocate dollars to tobacco control; not every state has done that.

Mr. Connolly: From 1993 to 1998, in Massachusetts, smoking among 12- to 17-year-olds went down 22 per cent. Our neighbouring state of Rhode Island spent no money and no resources for that same period. Their rates went up 30 per cent. It is a beautiful natural experiment. We have two populations next door to each other, one where there is nothing going on and another where there is something going on.

Senator Cochrane: You have done comparative studies, then.

Mr. Connolly: Yes. The populations are similar. Prices are higher in Massachusetts, with much more aggressive campaigns. Spending $15 Canadian per capita, it worked.

Senator Banks: I apologize for having been late and not having heard the rest of your presentation. The part I did hear was terrific. I do not know whether we will be able to get down to including any mechanics in whatever legislation might result from this. I do not know whether we will include a specific program in the legislation, per se.

You said that you did not go to the principals in the schools and ask for the best and brightest. How did you recruit, select, call out the members of your youth groups, and to what extent were they involved directly in the creative aspect of the programs that you use?

Mr. Wolf: We found young people through a variety of sources. We are doing the same thing in 10 days. A national youth tobacco summit will be held in Seattle, Washington. There will be 1,000 young people, using a similar process as what I am about to describe.

We used the Internet. Our Florida Web site is called wholetruth.com. The national Web site is called thetruth.com. Those Web sites are very actively visited by young people and give them a chance to self-recruit if they are interested in being involved.

Of the 1,000 or so kids who will come to Seattle, about 40 per cent of them were recruited by tobacco control advocates in their state. They were recruited for diverse reasons. Either their parents had some connection with tobacco-related illness or they have some interest because of person tobacco use. One hundred were chosen because, when we originally kicked things off and got Legacy started, we got two kids out of every state, from all walks of life. The other 50 per cent were chosen by going to places where kids hang out. We handed out Truth gear, hats, t-shirts, and giving them an opportunity to write a script, having them look at commercials or act in commercials.

Currently, there is a series of ads in the United States called Web letters. These are ads filmed in kids' living rooms with a Web cam on top of their computer shooting at them as they speak into it, filming them, and they are responding to messages on the Internet bulletin board.

At the same time, we are very cautious about what we call the digital divide, which is those places where there is no Internet access and where young people do not have some of these same resources. Special efforts were made to visit these communities and find young people. For instance, we have native American populations in some states with very high tobacco use. In many cases, that is religious or spiritually based, and in many places it is historically based. It did not matter because they were all interested in the issues.

We found a number of young people who, given the opportunity to have real input and real power, took the chance. They are coming to Seattle. In the case of Florida, it meant hanging out at the beach. It meant hanging out at water parks.

Senator Banks: I will do that part.

Mr. Wolf: I would love to see who you recruit.

The opportunities are immense for finding some really interesting people when you go out there and talk to these kids on their skate boards or in the woods hunting or whatever it is they are up to that weekend or in the afternoons after school. You have to be open to it. You have to not be opposed to talking to the kids with the funny hair. You have to be very welcoming and encouraging and let young people know they are part of it and can be in it.

Florida had great success with it. Legacy has had tremendous success. We are now trying to export that to 25 more states with these grants, to see if it can be replicated in more places. I think it really means being open to it where they are.

The Chairman: What is your concept of the Truth thing? How did you brand it? Why is that so catchy to kids? Why is that so cool?

Mr. Wolf: I can piggyback an answer to that at the same time that I try to answer the second part of your question, which was whether young people were involved in the original creative aspects. The answer is, yes, they were involved in the original creative aspects, and they came up with the brand name Truth. There have been Truth campaigns in other states, but frankly our kids were not aware of that. They went through tonnes of different brand names, from rage to Truth to get real to 86 tobacco industry. You name it. The brand names they chose were all over the map. Some were really cute and catchy. They went after names they really liked, and ended up with Truth. It was a long discussion with a lot debate and a lot of voting back and forth.

Their concept was to just put the "truth" out there, to tell the truth about what this product really does instead of what the tobacco industry says it does. The tobacco industry, in the minds of youth, looks like they are selling a product that is cool, sexy and rebellious. Instead, they wanted to tell the truth about what the product does. It kills one third of people who use it. In our country, 89 per cent of each person who starts using tobacco is under the age of 18. It has 100 more poisons in it than rat poison. The tobacco industry has an allowance of $15 million per day.

You name it. They came up with all kinds of great ways to put the message out there, the "Truth", as they call it.

There has been a Truth campaign in Massachusetts and in Utah, but the branded effort started in Florida, and the young people came up with it by being involved in the very beginning.

The Chairman: Now everyone recognizes that Truth is the tobacco thing.

Senator Taylor: Thank you for your very interesting presentation.

Mr. Connolly: I testified five times in 1996 before the other Senate and the other committees in support of what was called the McCain bill. It was a great piece of legislation but big tobacco came in and killed it. I hope the testimony tonight will result in this nation doing something that our Senate failed to do just three years ago.

Senator Taylor: The big tobacco companies were in last week. We had to subpoena them, but when they came, two of the three said they would support the bill. The third indicated some reservations. There is an old saying, that one must be wary of anyone bearing gifts, but we will wait and see.

Mr. Oliva mentioned that 20 per cent of the funds collected in California go to education. Did I hear correctly? Where does the other 80 per cent go?

Mr. Oliva: It goes mostly to medical care. There is a 25-cent tax on each pack of cigarettes; 20 per cent of that 25 cents goes towards our effort, to the health education account.

Senator Taylor: The other 80 per cent goes to help people in hospitals with emphysema or whatever?

Mr. Oliva: It can go to maternal and child health programs.

Senator Taylor: I thought that perhaps it was like our government up here; they just steal it.

Mr. Oliva: No, but that did happen, though.

Senator Taylor: The research you mentioned refers to heart and lung disease caused by tobacco. Is there any research -- or am I just dreaming in technicolour -- that indicates that after someone quits smoking other diseases come along? Smoking, for example, is known to suppress weight gain. Does the diabetes rate go up amongst people who quit smoking?

Mr. Oliva: Something will get us all, but I know of no such research.

Senator Taylor: Smoking is often used as a weight-control measure by young female smokers, is it not? I wondered whether those who do quit smoking find a substitute, or do they experience weight gain? Were you able to convince them that at a higher weight they are just as beautiful?

Mr. Oliva: We would always promote quitting smoking as the best thing you can do for your health. While some adolescent females may use it for weight control, stopping smoking and participating in an exercise program and eating a healthy diet are the best things you can do.

Mr. Connolly: Nicotine alone may be a therapeutic aid in Parkinson's disease and short-term memory loss. There may be some benefits. It is not unexpected that nicotine will be used in therapeutic form, pill form or whatever, in the future, possibly to treat certain disorders. The problem is that the dirtiest source of nicotine is a cigarette. To get the nicotine into your body, you must consume 4,000 other chemicals through your lungs. Probably the most stupid way to ingest it is through burning tobacco leaves.

In the future, therapeutic nicotine use would be appropriate as long as it is regulated as a drug. Our Senate tried to do that and we lost. It will probably be back in our Senate.

I cannot stress enough that what you do here sets the standard in the United States. What you have done on warning labels came to the attention of members of our Senate, before Senator McCain and before Henry Waxman. I think we will see a bill in our Senate next year after the elections.

I cannot stress this enough. We failed to do what you are doing right now. Our Senate failed because big tobacco shut them down. They came and supported the Earl McCain bill. I would watch very closely the promises you heard last week.

I just cannot stress enough that you must get this legislation, not just for the sake of the United States, but for the sake of Thailand, Poland, Estonia, Argentina -- the whole world watches what Canada does in tobacco control. You must re-assert your leadership, as you have done, and ensure that this bill gets through.

Senator Adams: We do not live in Florida. We live in a totally different climate. I have been to Florida a couple of times, and I did enjoy the weather. Up north, where I am from, there was snow piled in the fire exit of my hotel last weekend. In the wintertime, we have few daylight hours; right now, when we visit on the weekends, we have 24 hours of daylight. It is different.

I always tell Senator Kenny that even if this bill passes, there will be a different approach by the people up North toward the idea that cigarettes are bad for you. In the small communities up North, twice as many people smoke as in the rest of Canada, because there is not much to do there. We do not have skateboarding or surfing and things like that in our communities. In the wintertime, it is very cold and it is very difficult to get outside.

I would like to find out a bit more. You say that you teach about smoking in the schools. What sort of oversight do you have over the teachers and principals as they are presenting this in the classroom? How does the system work?

Mr. Wolf: To address the education part of the question, you asked how we get into the schools and what the regulations are. In Florida, we could not go in and mandate some kind of new educational program for the schools. We could not say, "You must teach tobacco."

What we did was infuse tobacco educational materials in things they already had to teach. Whether it was math, social studies, science or reading, subjects that were already being taught, we gave them material that had tobacco information in it. Teachers always like to get new and fresh stuff for their kids and for themselves, frankly. If they get something new, it makes it more interesting to teach as well.

For first-, second- and third-graders, everyone got a book, The Berenstein Bears Sinister Smoke Ring. That is what was used to teach reading. It was another reading aid. In math, in fourth, fifth and sixth grades, word problems were provided. In science, they got something called Science, Tobacco and You, which meant that tobacco was a whole new infused curriculum or lesson plan when teaching other parts of their curriculum. In social studies, when they were teaching civics, they got special books and pamphlets and magazines on how the McCain bill got killed in the U.S. Congress and how the tobacco industry lobbies for their point of view.

That is a way to infuse the curriculum. It could not be mandated. Teachers had to want to do it. If they want to do it, it gets used in the classroom.

The other thing to remember is that these were ideas developed by young people, so that they were relevant to them.

The other part of your question dealt with something we spent a lot of time worrying about and much time working on in Florida, namely, culturally specific programming and how interventions can reach all kinds of different communities. There is probably no one better at this than California, given the variety of the population in California. In Florida, specific Latino programs were developed. That does not mean just an advertisement in Spanish, it means culturally specific programming. In the Latino community, tobacco was used in a different way by parents. There are smaller native populations in Florida than there are in California, but we do have some Seminoles, and other tribes that use tobacco products for religious purposes. It is revered in those places as something that is used for a purpose. That carries on in a young person's mind, that it is all right to use the product for internal ingestion, which is not the way it is used for religious purposes among those tribes. In the African-American community, rates are already tremendously lower than anywhere else. However, when you subdivid that community and look at one part of it versus another, you find that the Caribbean islanders who are dark skinned used tobacco products a lot more than the traditional African-American population. You have to be specific in language use related to Caribbean populations as well.

The key is empowering all of them to come to the table and to develop programs that are good for their communities. Just as you bring young people in to develop programs for them, you must bring in these other populations to develop their own programs.

Mr. Connolly: I will make a public admission. About 10 years ago, I did a piece with CBC Marketplace on chewing tobacco, which is very popular with the Inuit. At the same time, I was working with major league baseball, counselling baseball players in Florida on how to quit smoking. They asked me during spring training, "Would you be interested in flying to Yellowknife, or would you rather go down to Florida to speak with the Blue Jays?"

In schools, you must think about comprehensive programs that are part of a well-funded curriculum in the school that mirrors what is on TV. You saw that young woman with emphysema. We did an 18-minute program about her life and how it was compromised. We showed that tape in the schools. She then toured. They saw her on TV and they saw her speaking at the schools. What they saw on TV, they also heard in the classroom. We totally banned smoking by anyone on any school property in our state. If you go to a football or a soccer game, I do not care who you are, you cannot smoke. We offer smoking secession services for any child in the school. We have trained nurses in whom we have put resources. These programs cost money -- they require resources -- but it is that comprehensive approach that really works with school children. I must agree with Ms Ashley's earlier remarks that the curriculum alone without linking it to that larger environment will probably not be as effective as you want.

The use of smokeless tobacco is also a major problem with our native American populations. It is a special problem among the Inuit in this nation that should be addressed. I have worked closely with a health educator in Yellowknife. About 30 to 40 per cent of the kids there are using smokeless tobacco. When they make smokeless tobacco in the U.S. they use a wax paraffin. It will then sit on the shelf in a remote community for three months. During the time, the chemicals will interact with the paraffin. We were measuring levels of nitrosamines from Yellowknife that were four times greater -- and, these are very dangerous chemicals -- than you would see in Toronto, where the tobacco is very fresh. You have to examine the product and you have to deal with that.

I worked with native Americans in Alaska where six-year-old native children would be given oral tobacco by their grandmothers. They would be hooked at age six. They would go from age 6 to 12 having been dependent on nicotine, that is, the time when they were learning. They would have had to have been dosing themselves with the chemical when they were seven, eight or nine, just to deal with living in a village, boredom and stress. What are you teaching a child when you are giving a seven year old a psycho-active drug to deal with their every day existence?

Senator Adams: I remember kids six or seven years old sniffing chemicals. Even up in the Arctic, we have 100 channels on TV. Most of the people in my community are addicted to watching hockey games, racing cars and other sports. Racing cars is more dangerous than the ingestion of nitrosamines in cigarettes. What channel do you use to advertise your message? Most of our young people and even our elders stay at home, watching TV and smoking. The other day, we heard in another committee that a 10-second commercial costs about $10 million to produce. A 30-second commercial probably costs about $30 million. What is the best way to air a commercial? What is the best TV company to use to air a commercial?

Mr. Connolly: As I said to Senator Kenny, we will be filming a very famous Canadian female soccer player in Boston on July 3. We will spend some money for that, plus we will also use a Japanese soccer player. It will be an international video. If this Senate appropriates the funds, as I said to Senator Kenny, we will match any money that you put in to get this very famous female soccer player.

We find that people do not get it about lung cancer. Everyone in this nation is at risk of breast cancer. They know how to do an examination, and they know the risk factors. Every male at risk of prostate cancer is having a PSA if they think they are personally at risk. However, when you talk about lung cancer, the public does not get it. If you ask the smoker, "What is my risk?" He says, "It is a little bigger than that of a non-smoker," when in fact the risk is forty-fold.

We have done some aggressive, hard hitting ads that talk, in a very emotional and hard-hitting way, about the enormous personal risk, in order to shock smokers. When an elder who smokes sees these ads, they are pained. They hurt. It makes them think twice about it. They think about loss and how the kids will handle it if they leave the family. They think about the painful loss. Many people who smoke think, "I will die. That is fine. After you die, there is no pain, period." But you can communicate with them and say, "You will not die. You will get lung cancer and then you will have to go through chemotherapy. Your husband will take your hair off and put it over here. You will then be strapped down to a table with radiation being shot through your head." We actually have an ad that portrays that: "If you are lucky, you will die in a year." You have to communicate those messages to people. You have to buy the advertising on prime time, when people are watching. It does not cost $30 million, but it does cost in the millions. That is what you have to do. People have been numbed by tobacco advertising and by thinking, "I will never get lung cancer. It is not a real disease. It is not like breast or prostate cancer." We do not have a prostate cancer lobby out there renting auto cars and saying, "Don't wipe out prostate cancer but get your PSA." We don't have a breast cancer lobby saying, "Don't do the annual exam. Don't worry about fat or estrogen," but we do have a tobacco lobby, that is alive and well in both the Parliament and the Senate, that is trying to kill bills like this -- maybe very quietly, while maybe ostensibly supporting it. That is why you need comprehensive, well-funded legislation such as what is before you.

Mr. Mahood: In both the "conscience ad" and the "Debbie ad," two of the ads that were part of the flight of ads that ran in Canada, there was only enough money to run them on stations where opinion leaders would see them. That was a decision that we supported. However, most Canadians did not see those ads because there was no money to show them anywhere else. They had a very short flight of six weeks. They only had $3 million to put these on the air waves. The Province of Ontario -- just one province -- spent over $50 million on one of their advertising campaigns. To put it into perspective, that is what we have experienced in Canada in recent years because of the lack of money.

Mr. Oliva: Mr. Wolf mentioned the ethnic concerns and how California has been somewhat of a leader in addressing those. I should provide some background for Senator Adams' sake in addressing this issue.

The story of addressing ethnic populations in California has been an interesting one. When the California program first began, we had priority areas that specifically addressed ethnic populations, but we moved away from that. We wanted to focus more on addressing the social norm strategy and the three priority areas: Reducing youth access, eliminating exposure to second-hand smoke; and countering pro-tobacco influences. Those are the hallmarks that we have been working on for many years now.

We do not ignore ethnic populations in California and we actually spend a significant amount of money to address them. We probably do not spend as much as we should, but we are limited in our funds.

We fund four ethnic networks. These are state-wide projects that address the Hispanic-Latino community, the African-American community, the Asian-Pacific Islander community and the American Indian community. The goal of these projects is to develop specific campaigns that address these populations and also build the capacity of ethnic organizations throughout the state so that they can apply for our funds in our competitive bid processes. They have been somewhat successful in doing that.

To address the media issues, we also fund one large state-wide media agency. However, under that, there are three agencies that we fund to address Hispanic-Latino media, Asian-Pacific Islander media, and African-American media. We do not address American Indian media because, unfortunately, it is difficult to reach that population.

Those are some of the efforts that we have undertaken to address ethnic populations. I wish we could do more, and we should do more. In the last several years, we have looked at the lists of organizations that we fund and we are finding that, through time, we are losing some of those organizations that address ethnic populations.

Last year, we funded a specific request for applications that only targeted ethnic populations. We had done that earlier in our existence and we went away from that. We made it a priority to go back to that and fund that request for applications in the order of about $5 to $7 million. We funded about 10 to 12 new projects. We need to keep that going.

When you look at the way the tobacco industry is marketing, with their Virginia Slims campaign in the states, the "find your voice," it is heavily targeting women of colour.

Senator Sibbeston: Mr. Chairman, I was slated to leave a couple hours ago, but I have been mesmerized to a certain extent by the witnesses here tonight. Their testimony is very impressive.

Is it simply a matter of convincing governments, much like you have come before us and convinced us of the worthiness of undertaking these approaches and also demonstrating the results and giving us examples of the type of ads you use? I am surprised that governments do not undertake these programs when you can show them how effective the programs can be.

Are you people the leading edge or the leading groups in terms of the United States? Is this the start of a nation-wide movement against tobacco and the harmful effects it has on people?

In Canada, we are faced with such high medical costs. The government provides health care. There is even a debate as to whether governments can afford the kind of medicare we have. Considering the numbers of people who are affected by smoke every year, do you not think that governments should respond and recognize that, unless they spend money, they will not get results like this? Are governments in Canada missing something, or is it just a new thing that will eventually come to Canada?

Mr. Wolf: This is not a new thing. There was a period when Canada was leading many folks in the anti-tobacco work. There was a period in the U.S. where Minnesota was actually the leading state in anti-tobacco work, in the mid-1980s. Then they had some budget reallocations.

As Mr. Oliva explained, in California, the governor took money out of the program and then he had to be sued before the money was put back in. Then this reallocation or misappropriation of funds caused these programs to have a see-saw effect which means you do not get the long-term generational benefit. What you are after is generation after generation becoming less and less addicted to tobacco.

You asked the question about how governments could be ignoring the problem. I have heard numbers as high as $10 billion a year spent in this country on the effects of tobacco, what tobacco does to you. This bill has $300 million plus allocated for such a program. The idea that you would not spend $300 million to try to reduce $10 billion in business would just be laughed at. Of course you would spend or invest it. Businesses are doing it every year. Often times it means layoffs, but they will pay those employees for the rest of their lives up to the $300 million if it meant they had a $10 billion savings. Anyone in business would make that investment.

Why does government not make that investment? You will have to answer the question in your particular government's case. Frankly, many times it is a lack of leadership. We know there is a significant amount of influence. We know that this industry is accepted as a legitimate industry in political circles. That acceptance of legitimacy makes it harder to change. Whether it is just that they are the guys down the street, or they are putting monies into the campaign coffers, who knows. Whatever it is, they have bought legitimacy by their immense wealth. That is a hard thing to overcome.

Finally, why do governments ignore the situation? I do not know. You have an inoculation available to you. Any doctor who knew you had this inoculation and did not use it, would be accused of malpractice. Any doctor who did not use something for a patient when they knew they had it available to them would be sued by the patient if the patient later found out that the doctor knew all along that there was an inoculation available but the doctor chose not to do it. You are in the same situation.

How much more evidence or proof do you need than the half a dozen to a dozen states south of you that have proven it works? To not follow that and not care about the generations that are coming up addicted to tobacco would be tantamount to malpractice in medical terms.

Mr. Connolly: California started in 1988, we started in 1993. It took us four or five years to put it all together and to learn from it. Our learning experience is relatively new.

We can come here, but it took us five years to get the data to say that it does work. California and Massachusetts have shown that you cannot monkey around with the smoking issue. You must be serious about it. We are talking about $15 per capita. Otherwise, do not bother going after it.

Government has always thought that, "We can throw a few dollars here against smoking." We pour money into AIDS, maternal health and substance abuse. We have learned that money must be poured into smoking, too.

I have been to 26 state legislatures in the past year where they have the big cheques from big tobacco. By and large, the legislators say, "These programs do not work. They are soft and mushy. It is a waste of time." It is really a personal decision. Government should not climb into someone's family and tell them how to behave. It is another big bureaucracy and we do not want any more bureaucracies. We have enough government programs.

However, in talking to them, you say, "Wait a second, these are real hard services." When we try to prevent a kid from buying cigarettes illegally, it costs money. When we provide counselling for someone, it costs money. These are hard services that also work. Our data are better than that for the AIDS program. We have done a better job. That is not to say AIDS is not a plague, but we have the numbers to show that we have saved lives. In doing it, we have seen a big shift, among most of the states now, where they are committing serious money. In some states we are not seeing progress but, by and large, I would say we are seeing the states move ahead.

It is a no-brainer. I tell the legislators in America: "That is why we pay you guys the big bucks. We give you the big salaries to make these tough decisions." They look at me and say, "You are right."

Mr. Oliva: It is a great question and I am glad you asked it. Much of what I would have said has already been said, but I would not make the assumption that, because California has a program which has been going on for 12 years and which is located within the state health department, which is the government, that the success is as a result of government action. Were it not for the people of California and for the constituency that was interested in reducing the burden of tobacco use in California much further back than 1988, when we had that ballot initiative, we would still not have a tobacco control program today. We would never have had a tax levied by the legislature. Prior to Proposition 99 in 1988, the tax on cigarettes was 10 cents per pack. If we had never had the initial ballot initiative that resulted in the 25 cent tax, we would still have a 10 cent tax on tobacco products. While the program is located in government now, it was the people who made it happen.

Mr. Mahood: Senator, your question is very good: Why do we not have this when it makes so much sense? One of the fantasies that I have noticed that governments at the federal level have indulged in for a couple of decades is the belief that somehow you can deal with the tobacco epidemic while, at the same time, maintain a healthy industry. Somehow, we must better at explain that the situation is like the one faced by the armaments industry at the end of Second World War. When the war comes to a conclusion, you do not look around to figure out how to save jobs in the armaments industry. You make the adjustments and get on to other things.

Similarly, the tobacco industry people do not seem to understand that you cannot always have this "jobs-over-lives" thing in the equation. There will be dislocation, but in the end you will end up with more jobs. When we tried to get the precedent-setting warnings through, they were almost scuttled by a concern about some printing contracts being moved in the United States. The fact is that there will be problems in dealing with this. The tobacco industry takes a lot of money and creates very few jobs. As people leave the tobacco market, or do not join it in the first place, if you transfer the equivalent amount of money spent on tobacco to other purchases, you end up creating more jobs because the other purchases are from industries that are more labour intense. That is the first thing.

The second thing is that the justice block has been a big problem in this country with our tobacco control programs. Ever since the tobacco industry sued in 1988, it has slowed down virtually all of our programs and, in some cases, brought them to a conclusion. The government simply will not do anything as long as they are in litigation. What we must understand is that the tobacco industry will always be litigating. We have been litigating with the tobacco industry since 1988. This bill solves that problem because it gets the program outside of government, where the government cannot slow it down because it is engaged in litigation.

There is a whole bunch of problems or blocks that this kind of legislation -- because it would create an arm's length foundation -- would solve.

Senator Sibbeston: The witnesses are relating their experiences at the state level where they have done all their work. It makes me wonder, in attacking the problem, whether you need to be at that level, whether the proper path in our country would be in the provinces where they are closer to the community and closer to people. Do you have any opinions as to what we are trying to do in Canada on a national basis? Since we are trying to attack the problem on a national basis, do you think we would likely be less successful? Need you be in the provinces to begin these attacks?

Mr. Wolf: An analogy that we borrowed from business would relate to the grocery store chain. You would not allow a national grocery store chain to have a store in Calgary that ignored everything you were buying, ignored all the best practices you had developed, and went out and found all their own produce. However, you would allow that store to tailor some of the offering to its community, if there were specific things that sold more often in that store. It is like car dealerships. Ford would not say, "We will produce a different car in B.C. from the one we will produce in Ottawa," but they might say, "We might put more of the blue cars in B.C. where they are more popular and more white ones in Ottawa," allowing them to be tailored.

If we had our druthers and we could all be integrated into one big program, believe me, we would choose integration because of the benefits of economies of scale, of being able to buy media regionally, of being able to buy it nationally, and of being able to produce educational materials on a much broader scale. The cost of publishing educational material in one province or one state is considerably higher than doing it for the entire country.

While we have all been involved in the development of state-wide programs, the Legacy Foundation has also had the benefit of developing a national program in the United States. Their economies of scale for national media campaign are much better than any individual state -- even the largest state, California -- will ever experience. The idea that you have a chance to hit a home run here on an integrated program for your entire country is one we would salivate over. You have a great opportunity.

Mr. Connolly: I would reinforce that. We had a bill in our Senate two years ago, the McCain bill, that was going to put $2.5 billion into a national campaign which would be given as grants to states. The tobacco industry killed that. We all wanted that. We did not want individual state programs. Our fear now is that Massachusetts will have one ad campaign, Maine a different one, and Vermont a different one. It will be chaotic and inefficient. It will not be a comprehensive campaign. Kentucky has twice the smoking rate of Massachusetts, yet they are in the same country. They have triple the number of low-birth-weight babies from smoking than Massachusetts, and they are in the same country.

That is what the tobacco industry wants.

Having said that, however, I would like to see a national campaign with strong grants to the provinces, so that all provinces, regardless of what local decisions are made, have resources. The acronym I use -- I love it -- is "KILLS: Keep it local and loud, stupid." That is where you get the best change.

However, you have to get the national resources to the local level to really make it work. We would much rather have a national campaign. It would be of much higher quality than what some of the states would do. It would cover everyone. In a sense, it is similar to what we had with civil rights in the United States 30 or 40 years ago. We had great civil rights protection in the State of New York and horrible stuff in Alabama. That is what we are seeing with the tobacco industry playing off our tobacco states.

Senator Banks: This is a crass, boring question, but it used to be the case that a media buy in California was approximately the same cost as a media buy in Canada. I do not know if that is still true, but assume it is. Mr. Oliva, in hard dollars, how much do you spend on media buys? I am assuming you get some PSA activity. When you are buying the prime-time broadcast placements that you were talking about, for example, what do you spend, on all media, if you know the numbers off the top of your head?

Mr. Oliva: For the state-wide media campaign, we do not look for PSAs. It is all paid advertising. Our local programs that have much less money will go the PSA route and the ad will come on at two o'clock in the morning. That is not what the state-wide media campaign is all about, rather, it is about getting out there and being on television.

Senator Banks: Could you give a ballpark figure?

Mr. Oliva: Was the question related to what we spend each year, or what we have spent to date?

Senator Banks: Annually. I am sorry to ask such a specific question. Do you want to get back to us?

Mr. Oliva: I could, but I would guess probably $10 million to $15 million.

Mr. Wolf: The contract that is being bid in California is for the next year $40 million, and then $25 million each year thereafter. There is a big difference. Remember, that is just media. You have many other marketing expenses in that as well.

Mr. Connolly: Massachusetts has a population of 6 million. Let us say that five times that is the Canadian population. We spend $16 million a year for total advertising and production, so that is approximately $90 million a year U.S. It would be higher. Of the straight media we buy out of that $16 million, the actual purchased TV time is about $8 million. We get a 50 per cent bonus rate because we are doing the work. If you are going to get our ads, video is 50 per cent free, so Canada is probably $55 million just on straight media. Probably another $90 million for campaigns. We probably have what the CBC would recommend. That is not the level of a McDonald's, but it is probably close to a Burger King or a Taco Bell.

In our media campaign we did research which showed that kids who saw the media -- we tracked them from 1993 to 1998 -- were 50 per cent less likely to take up smoking than kids who did not see the media. That was the TV piece. That is true even with exposure to billboards or printouts. Therefore, we showed, at least with kids, the younger cohort exposure to media reduced the likelihood of smoking by about 50 per cent.

Senator Cochrane: Do you have any idea about the amount of money that the tobacco industry spends on promotion and advertising in the State of California?

Mr. Oliva: That is $1.5 million a day.

Mr. Connolly: Based on the Federal Trade Commission reports, the tobacco industry spends $5.2 billion a year on advertising and promotions. Based on the number of cigarette packs we consume in Massachusetts, that comes out to $129 million a year just in our state. We are spending $16 million versus their $129 million, about nine to one. I think you can do it with nine to one.

Senator Cochrane: That is 6 million people?

Mr. Connolly: That is 6 million people spending $129 million a year. Canada has probably banned more forms of advertising than we have, but that is what is being reported. Our tobacco industry has agreed to sign the settlement with the States, and we are taking the billboards down because we do not want kids exposed to advertising. What do they do? They take the money off the billboards and they put it in magazines read by kids.

Mr. Oliva: They probably spend about $500 million in California a year, I believe.

Senator Colin Kenny (Acting Chairman) in the Chair.

The Acting Chairman: As acting chairman, I would like to exercise my prerogative and ask just one question of each of you.

This committee has a bill before it, which you have had an opportunity to study. In the event that we are successful and it becomes law, do you believe it could achieve the same results or similar results as you have achieved in your states?

Mr. Wolf: Based on the way I have read the bill, you will do better than we have done. You will have the opportunity to be independent, you will have the opportunity to have integration, and you will have the opportunity to include local interaction. It might increase the number of youth involved, but other than that I think you could do very well, and probably better than some of our states have done.

Mr. Connolly: Given the similar demographics of a state like Massachusetts with at least the eastern provinces, there is no question in my mind that you would not see the same results.

Mr. Oliva: If you look at populations between California and Canada, which are relatively similar, you would have much more funding than we ever did, and I think probably a much more united front. I believe it could be very successful, especially since you will be having a base of experience from many different large jurisdictions in the United States that have already done this. You have a solid template around which to build a strong program, which we did not have in California. We had nothing, and we were able to do what we have done.

I should not say "nothing." There were some smatterings of theory and other efforts that had gone on, but with what you are armed with, in terms of information from previous efforts, you should be very successful.

The Deputy Chairman: Thank you. I should like, on behalf the committee, to thank you gentlemen for travelling so far and for providing us with such an intriguing insight into tobacco control in the United States. You are a remarkable group.

The committee adjourned.