---

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

Issue 2 - Evidence, April 23, 2001 (morning)

---

VANCOUVER, Monday, April 23, 2001

The Standing Senate Committee on Energy, the Environment and Natural Resources, to which was referred Bill S-15, 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 8:30 a.m. to give consideration to the bill.

Senator Nicholas W. Taylor (Chairman) in the Chair.

[English]

The Chairman: Honourable senators, we are meeting today in Vancouver to consider two issues. The first is Bill S-15, proposed the Tobacco Youth Protection Act, and the second relates to energy issues, past and future. This morning, our focus will be on Bill S-15.

I would like to take a few moments to explain the process the committee will follow. Our witness will begin with a short presentation. Following the presentation there will be a question-and-answer period, as strictly between the senators and the witness. One hopes it will be the senators who are asking the questions and the witnesses who will be giving the answers. Sometimes we get it reversed and it does not work quite that well.

Over the next few days, we will be hearing from Canadians in Calgary, Edmonton, Toronto and Montreal. The goal of these hearings is to obtain a sense of the views held by Canadians on the issues as appraised by this bill.

I would note that prior to the last federal election the committee studied a previous version of the bill; and in 1998 another Senate committee studied a bill dealing with broadly similar issues. Our work will be built on this prior knowledge.

Once the committee has completed its hearings, we will proceed to clause-by-clause consideration of the bill. We will send the bill to the House of Commons for first reading. If the Senate sends the bill to the House of Commons for its consideration, at second reading the House will be sent the bill to the appropriate committee for consideration. If the bill passes in the House of Commons, then it will receive Royal Assent and become law.

Before we begin, I wish to inform you that earphones are available and that translation in English and French is available.

When we break at noon, I would invite senators and/or witnesses and members of the public to visit an exhibit in the Port of Vancouver Room, which is just across the foyer.

Before I do that, I would ask Barbara Kaminsky, who is well-known in anti-tobacco circles, to stand up and let herself be recognized. Ms Kaminsky is the Executive Director of the Canadian Cancer Society.

Ms Kaminsky. It really was not necessary to wear Liberal red today, but you are just as welcome.

Senator Kenny: We appreciate it, though.

The Chairman: Our first witness this morning is Dr. Gerald Bonham.

Thank you very much for joining us today, Dr. Bonham. We met many years ago, when you were in Calgary.

I wonder if you would begin by telling us a little bit about yourself, before you get into the heart of your presentation.

Dr. Gerald Bonham, Health Consultant, the Canadian Cancer Society: Honourable senators, it is a very great privilege to have the opportunity this morning to address this issue. I have been a great admirer of the Senate work on this subject. I am also great fan of Senator Kenny, who has been indefatigable on the subject.

My present role is to coordinate the campaign for Bill S-15 on behalf of the Cancer Society here in British Columbia. In the past, I served for 12 years as the Medical Officer of Health of the city we are meeting in this morning. I also held that position in City of Calgary. I have also held the position of senior ADM in the B.C. Ministry of Health, and have held professorial positions at the University of Toronto and the University of Calgary.

Of most importance, however, to the subject we are here to talk about today, is my work in northern British Columbia, work that has given me keen insight into the difficulties of trying to carry out an educational program in non-urban areas, and that is very pertinent to this subject.

Before I get into the substance of my presentation, I wish to make a point. When I was first the Medical Officer of Health in Vancouver, I had a parallel experience to the one before you today. There had been an outbreak of rubella or German measles about every six years, and it left in its trail - for pregnant women, very badly damaged children. This was a serious problem. When that cycle was just about ready to repeat itself, a vaccine was suddenly available, but the province would not pay for it. So I went to the local school board, to city council and to the voluntary health agencies. A political party leader even donated $1,000. We got enough money assembled to put in place a city-wide vaccination program. By this time, the minister was somewhat embarrassed, so he came up with a solution, what you might call a half-baked solution. He would fund the program, and we were to give half-doses. It so happened that, thanks to science, the half-baked solution was not solution at all, that it would not prove useful. The minister had to go for the full dose.

With respect to the tobacco issue, we have a quarter-baked solution, and that is not a good prospect. There is no science behind the kind of money that was promised by Allan Rock and Mr. Martin in their announcement a couple of weeks ago. There are not signs telling us that that would do the job. We have to take this opportunity with Bill S-15 before us to do the job right. There is no lack of money flowing in from tobacco products in the form of taxes, levies and all the rest. It is not a question of there being no resources to do this thing properly.

One of my colleagues said to me, "Well, if this allocation of $100 million annually does not work, we can go back and get more money." The problem with that is that since 1994 there has been a huge increase in teen smoking, from almost 20 per cent to 29, maybe 30 per cent, of teens smoking. And this has been after a couple of decades of slow progress to get it down to the 20 per cent that we had in 1994.

The reduction of tobacco taxes in 1994 appears to have been the trigger. Cheaper tobacco became available to children, which led to an upsurge in teen smoking. As well, there was no effective anti-tobacco program in place at the time.

In fact, I sat around the table of the National Strategy to Reduce Tobacco Use in Canada - which was a federal-provincial-NGO organization - and we actually were tested with the new TV ads coming out of Health Canada. Those ads were Mickey Mouse, because the people that put them together did not want to offend the minister of the day. This speaks to the argument for arm's-length administration that is built into Bill S-15. It is vital to have the ability to make mistakes, experiment and get the thing right, and not keep repeating old ineffective programs.

In the government announcement, there was no mention of evaluation, which is critical, and evaluation research does not come cheap. A small allocation overall, part of which goes to evaluation, is not sufficient. The allocation must be adequate, which Bill S-15 promises. Of course, Bill S-15 is in line with the only study in North America of effective anti-tobacco programming, which was the report of the Centers for Disease Control in Atlanta. You can see how thick that report is. It is very thorough and it recommends the $9 to $24 range that has been mentioned frequently. Bill S-15 is in the $12 range, the lower end.

The last thing I really want to address is the fact that I have heard from a lot of sources that this is overkill, that we could not even spend that kind of money if we had it. People tend to underestimate the difficulty of putting something together in this large country of ours, the second largest land mass on earth.

Last winter, I worked temporarily as medical officer in northwestern British Columbia. They were recruiting, so I filled in for a time. I can tell you that the difficulties of trying to carry out an education program in those northern areas are enormous. One needs either a floatplane or a helicopter, or something, because at times there is no road access into some of those areas. Some of the highest rates of tobacco use among young people in Canada are in the native community, which are among the hardest to access to carry out an effective campaign. The problem will not be solved by television ads. It takes a lot more than that. It takes a very detailed, comprehensive approach, to do the job well.

With those remarks, I will throw it back to you. I wish you success. I hope you can persuade the MPs in this country to get on with it and do the thing right.

The Chairman: Thank you very much, Dr. Bonham.

Senator Spivak: A number of questions come to mind. First, what is the situation here in Vancouver, in terms of the ban on smoking.

Perhaps, a new provincial government will be elected here, shortly.

Senator Banks: Maybe.

Senator Spivak: I said "perhaps." What would be the attitude of a new administration? I am rolling all these questions in at once. What about the royal commission Roy Romanow is heading up? There is so much attention being paid to the acute care system. What about public health? Are you thinking of a public health component?

My questions are not really related to Bill S-15, because we are very familiar with it. They are more general in nature.

Why does prevention and public health have such a low priority, in terms of some of these inquiries and so forth? I understand that the problems are horrendous in terms of the system as it operates, but prevention and public is part of it.

Dr. Bonham: You have asked half-a-dozen wonderful questions, and please prod me if I miss out on some of them. I will start with your last question: Why is public health such a low priority?

It takes a certain mindset to appreciate the importance of public health and prevention, because the payoff is not immediate. If the state of health care is such that an individual cannot get past the emergency room into a proper hospital program, that is considered to be a crisis. Given that, it is difficult to talk to kids about something that could happen to them in 15, 25 or 30 years down the road. There is no urgency apparent. They also do not appreciate the effectiveness of prevention.

We have eradicated many health problems in Canada over the years through preventive measures. We do not have the nutritional deficiency diseases, the classical scurvy and rickets that we had at the turn of the century. Some of my pediatric colleagues persuaded the government of the day back in the 1960s to adopt safe-packaging rules and, as a result, fatal childhood poisonings to kids under five has dropped like a rocket. We forget these stories.

We know that tobacco use can be brought down to a very, very low level. I took a study leave in Finland, where they were pioneers in banning advertising - their programs were focused on the kids - and while there I did not see one child or young person smoking. So it can be done, and prevention is the way to go.

Smoking cessation is also very effective. We tend to write that off. An individual is not necessarily a smoker for life. A lot can be done to reduce smoking rates even among smokers themselves.

With respect to Vancouver, a year ago the Workers' Compensation Board blanket ban on smoking in all workplaces was struck down by the courts because of a shortfall in consultation. They went back to the drawing boards, and they have come back with a program that will kick in in September. The program includes a provision for separately ventilated smoking chambers. Also, experience elsewhere has shown that these things are not all that practical. It may be a political safety valve on the regulation, but, in practice, unless the tobacco companies rush in with hundreds of millions of dollars to pay for these things, I do not think we are going to see people willingly going into a glass chamber filled with smoke and being cut off from the main area of the restaurant. When the Workers' Compensation Board regulation was turfed, the local bylaws were activated, resulting in no smoking in Vancouver restaurants.

In the capital region, in Victoria, there is no smoking in bars or restaurants. Recently, a $20,000 fine was levied for allowing smoking in a bar there.

However, the local bylaw approach is not considered to be the favoured way, and we are looking forward to September. There is always the risk with a new government that it may not be as committed to this as the previous government. However, the Workers' Compensation Board is independent of government, and I think it would be very difficult politically to overturn something like that. It is paid for by the employers and the employees.

Now, you asked other questions.

Senator Spivak: Just about whether you think Roy Romanow's royal commission will pay any attention to prevention and public health.

Dr. Bonham: I am always disappointed at the lack of attention to health when health care is on the table. I have looked at the Alliance Party's health program, and there is nothing about prevention in that one. I am writing a letter to see if that can be brought on the table.

Likewise, there was a royal commission in Alberta, when I was working in Calgary, on health. The prevention agenda had to be forced onto that commission, but it did happen. They finally came around. It takes a conscious effort to make sure that people do not equate health with health care. In fact, I remarked that the people who lived the longest were the people of Iceland, until they got their own medical school.

Senator Spivak: Well, I know it can be done. Just one short comment. I worked in the social policy field at the time when prevention, the mental health model, was all the rage. I wrote a paper on that. After I left, a person, who is now living in Vancouver, succeeded in establishing the first mother and child health department in the Manitoba Department of Health, so it can be done.

Dr. Bonham: It sure can.

The Chairman: Dr. Bonham, you mentioned Finland. Dr. Ivan Illich, who is a great philosopher, did a study that shows that, in Saskatchewan, when the doctor strike was on, when they wanted to put in medicare, deaths dropped per thousand and that people were much healthier when they did not have it. Now, mind you that is a small window.

Senator Kenny: Dr. Bonham, could you describe to the committee what difference you would see here in British Columbia if Bill S-15 became law?

Dr. Bonham: Well, we are in a privileged position, with our teen smoking rate down at around 20 per cent, which is much lower than the national average. There has been a much stronger tradition in British Columbia to go after smoking. Consequently, British Columbia has the lowest lung cancer rates and the lowest lung cancer death rates in the country. A lot of hard work has been done, over several decades. Nobody is satisfied with a 20 per cent teen smoking rate. We know that that is the only statistic that really matters, because the teen smoking rate becomes the adult smoking rate, which becomes the ultimate rate of lung cancer, chest diseases and an increase in heart disease.

If we had a strong program funded by Bill S-15 level money, it would not surprise me if we could get that teen smoking rate down to 5 per cent - which is about where they were in Finland when I was there.

It was interesting. The attitude their was to write off the smoking, drinking, middle-aged and older population, and to put all their money into maternal and child health. And I must say that the sheer appearance of the children was a joy.

In fact, my original intention was to go to Sweden for my study leave. However, when the people there discovered that my interest was in the maternal and child health area, they said, "Do not bother with us. Go to Finland. They are doing a far better job." It was true; they were doing a superb job. And they were content with their lack of resources. They were content to see that healthy population work its way through ultimately into middle and old age. In the meantime, they were not going to squander money on these difficult middle-aged people that had smoked all their lives.

Senator Kenny: Could you talk to us about evaluation? What sort of projects or how extensive is evaluation in the province? Are all the projects evaluated?

Dr. Bonham: No, evaluation is usually the first casualty of a program. Everybody pays lip service to it. People do token evaluations, participation rates and stuff like that, but hard outcomes are just not being done. One of the best features of Bill S-15 is that evaluation is recognized and that about 10 per cent of the money should go there - which is about right. I have seen programs, and have been part of some, where they have put 3 per cent of the budget into evaluation, and it is not worth doing.

Senator Adams: I am from the North. I have seen many young people start smoking. You mentioned that you have been in a northern community around the B.C. area. I have seen the photos and messages on cigarette packages, the images of cancer of the mouth, the warnings of lung cancer. People say it is ugly. There was one about a young lady whose brain was gone. The people in the community say it is too ugly.

There are also television commercial, warning of the dangers of the cigarette smoking. Just like in the south, some of our people get up to 100 television channels. They do not watch the commercials. Most people want movies, which do not have commercials, and they rent them and watch them on their VCRs. Even with all the warnings, people still smoke.

Dr. Bonham: I am a great believer in doing everything and not putting all your eggs in one basket, like television ads and so forth.

The real benefit of the new warnings on the packages with all our ugly images is to take away from the attractiveness of the cigarette pack itself. The cigarette industry has known for a long time that the package is their biggest form of advertising - the attractive colours, the good printing, the appealing finish.

There were studies in New Zealand into plain packaging, preferably an unpleasant brown colour - and I will not go into details - that found that the kids had less interest in carrying around a pack that was unappealing. So I think the disfiguring pictures in and of themselves are probably not that effective, except to destroy the overall appeal of the package itself.

As far as the movies are concerned, we are privileged to have Mr. Bonfilio with us this morning, and I know he has had some direct involvement with the movie industry. You can ask him about that.

To remark about, again, on my visit to Finland, the children of my mentor there came running in one night and said, "Dad, dad, come and see this old movie. They're smoking." They had effectively put a stop to their own movies showing people smoking.

There is a lot of dangerous role modelling. Seeing popular movie stars smoking has a very significant appeal. Let's not forget the endorsements by athletes and other popular people, in the old days. I hope those days are over. There are many, many subtle areas here, and we have to be aware of them all and do them all.

Senator Adams: Just one more, Mr. Chairman. Families should be concerned about their kids. In some of the communities, the elders smoke. They do not understand how addictive nicotine is. Elders and family members should be aware of this.

Bill S-15 is concerned about youth, which is good. Once addicted to nicotine, it is very difficult to stop smoking. There has to be more awareness on the part of adult family members that once someone starts smoking it is very difficult to stop.

Would you agree?

Dr. Bonham: Well, the nicotine is what drives the whole business of tobacco use, and the tobacco companies have known this all along. They went through a long period of denial.

As far as youth smoking is concerned, it is complicated, and this is where we need a lot more behavioural research. It needs to be much more adequately gone into than has been the case so far. Certainly, peer pressure is an element.

What was good about the announcement by Mr. Martin and Mr. Rock was the correction of some of the tax issues around cigarettes, and we certainly need to applaud them for that. However, the cheapest cigarettes in North America are in Ontario. In other words, there is still more room, and the $1.50-per-carton levy that Bill S-15 is calling for is a good place to start. That will not drive Canadian tobacco prices above the U.S. levels. The U.S. prices are much higher than those in Canada.

The Chairman: Before I go to Senator Lawson, I would like to address something you said about packaging. Half a century ago, when I used to smoke, I bought Sweet Caporals. There was almost nothing on the front of those packages, just a little crest in the corner. I used to use the packages to keep notes.

Senator Lawson: Nice to see you again, Dr. Bonham. You have been on the frontlines of so many battles for health issues in this province and in this city; I am surprised you are not more battle-scarred. It is probably because you do not smoke. Anyway, it is nice to see you.

The issue I want to talk to you is second-hand smoke and smoking in restaurants. As you know, we were dealing with that issue here in the Lower Mainland. Some businesspeople said to us, "If you ban smoking here but it is allowed in the neighbouring city, it will hurt business, and we cannot compete." As a matter of fact, we have a restaurant operator here who simply sets aside so many dollars a month to cover any fines related to smoking. He would rather do that than deal with the loss of business he would face if his clientele went elsewhere, where smoking was on banned. So, we are faced with that kind of problem. There is some merit to those arguments.

I know that Senator Kenny has been following very closely the California statistics on youth smoking. I spend a lot of time in California. Their aggressive position is noticeable. With respect to smoking in restaurants, the concern over second-hand smoke, they simply ban it everywhere. Has it hurt the restaurant business? Well, if you go to Palm Desert or Palm Springs, for instance, it is apparent that business has not been hurt at all. You have to stand in line to get a reservation. There is even one restaurant in Santa Monica that has an unlisted number. That is how difficult it is to get a reservation.

Therefore, if you apply a firm policy, do it province-wide or state-wide, it seems to have the desired affect and it does not hurt business. Is that not something we should also take into consideration?

Dr. Bonham: Yes. Everybody has recognized in B.C. that the Workers' Compensation Board approach, which is applicable to every corner workplace in the province, is the best way to go. And those very arguments were raised, particularly in the Greater Vancouver Area, that neighbouring municipalities might not have the same restriction and clients could just walk across the street to another restaurant. However, in practice, that unevenness has not really been the problem.

Just over a year ago, during the first round of the Workers' Compensation Board approach, a "snitch line" was put in place. I live in Ladner, towards the Tsawwassen Ferries, and I visited all the bars and snitched on the ones that were allowing smoking.

And interestingly, when the courts overturned the WCB program, the bars did not go back to smoking. For one thing, their staff would not let them. They had become accustomed to a better working environment. That is the same thing, in effect, that happened with the airline industry. The airline industry staff started the whole thing, resulting in a worldwide smoking ban on airplanes. The trouble with the food and beverage industry is that the workforce tends to be unstable. Wages are poor and people come in and out of that workforce. There is usually not a union in the picture to help them protest. But I think the first round of experience in B.C. was very encouraging.

Senator Lawson: You mentioned the airlines. There is no smoking allowed in airports; however, to leave or enter an airport, one has to walk through a wall of smoke, because everyone is smoking outside the buildings. The same thing in true on Parliament Hill. At the entrance to the Senate, people are standing out in the cold smoking, but they are all standing right at the doorway, so you have to get through the wall of smoke. We have to find a way to deal with that. I do not know whether smoking rooms would serve the purpose, or how we should deal with it.

Dr. Bonham: There is a smoking room paid for by Philip Morris, I believe, in the Vancouver Airport.

Senator Lawson: Back to California for a moment. I noticed while I was there a very aggressive radio campaign, a huge concentration, as well as a television campaign. I must say that I was taken aback to hear some of the kids talk about that campaign: "Did you hear that ad on the radio and what they are talking about, what smoking does to you?" The ads are very dramatic, very effective in what getting the message out.

I have shown my friend Senator Kenny some of the ads from the Desert Sun. There is a picture of someone reporting to the president of a major tobacco company, and the person says, "Women smoking deaths have doubled." The president looks up and says, "Finally the focus is off us targeting kids." That is an example of the dramatic approach taken in California.

I think it is very effective. Would you agree?

Dr. Bonham: Yes. There was a cartoon in one of northwestern newspapers when this argument was going on more than a year ago. The cartoon pictured a swimming pool, and in the far corner there was a sign that read, "Peeing section" - referring, of course, to the pool. It made the point very nicely that if you smoke, you are going to affect everybody within a wide range.

Senator St. Germain: Doctor, your good reputation precedes you. Why not ban tobacco? Why do we not have the courage of our convictions and ban smoking, if it is as bad as we say it is? Other things are banned.

Senator Banks: Yes, that is effective.

Senator Spivak: It should be under the Hazardous Products Act.

Dr. Bonham: As a new product, tobacco would not see the light of day. It would never get approval as a new product. We have too long a tradition in the world of availability of tobacco and I think banning it would be impractical. I honestly think there would be so much smuggled and under-the-counter stuff going on that it would drive us all crazy. I am sympathetic to regulatory approaches to health matters, but this is where I think we draw the line. Prohibition did not work, although I do not think they can stuff cigarettes into car tires as easily as they could whiskey.

Senator St. Germain: What is your reaction to the argument that smokers should bear the medical costs of smoking-related problems? Politicians talk of wanting to do things, but then they do not have the courage of their convictions to go all the way. It is like the gun registry. I think we should ban guns. A total ban on guns might have the effect of reducing the level of societal violence.

Therefore, I ask you: What is your reaction to the suggestion that smokers should pay their own medical bills?

Dr. Bonham: I think you would have an epidemic of lying. Let me just relate one quick anecdote. When I worked in Calgary, I received a call from a physician who told me that he had a patient whose blood carbon monoxide levels were off the scale. He asked me if we had the equipment to check out the patient's home. The physicians suggested that the patient might have a faulty furnace, or a similar problem. We checked out everything. Finally, after five or six visits to the physician, the patient admitted to being a four-pack-a-day smoker. The patient had not been without to share that information with his doctor. Smokers are smoking are going to suffer enough, in terms of their own health and misery. An additional financial overlay may not be necessary.

Senator Spivak: I have a supplementary. At one time, we were trying to get tobacco listed as a hazardous product.

Dr. Bonham: Yes.

Senator Spivak: That would be a great step forward.

Dr. Bonham: I agree with that. I think it is within the realm of the feasible.

Senator St. Germain: What is your reaction to legalized marijuana, the smoking of marijuana? I believe there is a correlation between youth smoking and the illegal use of marijuana.

Dr. Bonham: The marijuana question is very complicated because there is not as much research in terms of its health consequences as there is on tobacco. I would rather not see marijuana legalized, unless there is very clear evidence of its safety.

Senator St. Germain: My last question relates to the native community. I have worked extensively in this area in the three years or so. As you know, this is a complex area. I gather there are native aboriginal peoples in Finland.

We have virtually destroyed our native populations in this country. In Canada, every government since 1867, and previously, has virtually destroyed these people. They have been ghettoized. No one has had the courage to do anything the problems in that community, until the arrival of this new chief, Chief Matthew Coon Come. He is a breath of fresh air. Thank God he has got the courage to stand up and cite the problems.

I happen to have a Métis background. I grew up in a community of abject poverty, where there was no light at the end of the tunnel. I saw where smoking was a replacement. I saw the social acceptance it received. At the time, there were no drugs, but there was excessive use of alcohol in those communities. It seemed to be an offsetting situation.

If you have worked in these communities, what is your reaction to this? Can this be dealt with effectively?

Dr. Bonham: Two things in response to that question. The first is that tax-free cigarettes have been provided at the rate of something like 15 packs a week for everybody over 15 on native reserves. No one could have consumed all those cigarettes, which led to shipping the stuff out at midnight, and that did not help them.

As far as the native people are concerned, there has to be an indigenous program, if it is going to work at all. Some of the native reserves have gone dry, as we know, at least in the North. As a result of some successes, there is the suggestion that if the native people can work it out for themselves there might be some chance of improvement.

I see your point, though, about it being a substitute for other miseries. It would obviously be an easier problem if the economic situation in the native communities were improved.

The Chairman: There was a reference to smoking in communities where there is abject poverty, smoking being the source of escape, a type of relaxation. Where does this all fit, in terms of youth rebellion, which we know is a reality? How much youth smoking is related to youth rebellion?

In other words, if parents tell their kids not to smoke and society decries smoking, will the effect of that be to push kids toward smoking, psychologically speaking, doing exactly what they are told not to do?

Dr. Bonham: Well, I have two answers to that. Anti-smoking programs that have utilized student leaders have been fairly effective; in other words, exactly what you are saying, that rebelling against their peers is not attractive to them.

The other thing is that the experience in the U.S., and Mr. Bonfilio can give you more information about this, is clearly that if the tobacco companies' exploitation of children is clarified kids will rebel against the tobacco companies rather than their parents, and those have been very, very effective approaches.

Some of the tobacco executives, in determining what was reasonable anti-tobacco-use education for youth, were concerned about the effect of demonizing the tobacco companies, and with their own money. We have to be conscious of that possibility, that they will kick up and protest if their money is used to demonize them, but maybe that is the only way to effect a positive outcome with the kids - having them react to something other than their own parents.

Senator Banks: Dr. Bonham, I am a smoker, so I am perhaps the most assiduous supporter of this bill; I know firsthand about that addiction. It is perhaps the most difficult of all addictions.

Senator Lawson, I just want to tell you where the "smoking room" is in the Senate. It is the loading dock out back. There is less of a gauntlet at the loading dock, which is where my colleagues and I go. There are many places left for us.

I want to get crass, if I can, Dr. Bonham. You have been in this fight for a long time and you are on the ground here. You know the difficulty, politically and otherwise, this bill will face - once the Senate passes it, which it will - when it gets to the House of Commons. I wonder if you would tell us what your personal view is, if you have been able to form one so far, in respect of the attitude towards this bill of members of the House of Commons in this province.

Dr. Bonham: I have personally talked to a number of MPs, and the one argument that is very well supported is the argument that our programming with the kids has got to be adequate. They are like the Finns: I think they would sell off the middle-aged people quite cheerfully. However, when it comes to the kids being targeted for advertising as they have been, the sponsorship advertising and so forth, the matter is a different one.

I worked with an Alliance MP who was very positive on this issue, in spite of the fact that he said, "We have a kind of civil libertarian streak in our political philosophy; nevertheless, the tobacco issue can be separated out and they can see support for it." As well, the Tobacco Act, when it came before the House of Commons, was actually moved by a Reform MP at the time.

Senator Banks: And stay out.

Dr. Bonham: This could be an opportunity for all-party support. The problem, I guess, is Liberal MPs. If the government were to take a hard view, that their option is the one that has to be supported throughout caucus - but that has not happened, as I understand it. There is reason to hope that many of the Liberal MPs will support this proposed legislation.

With respect to the Bloc, there is some sensitivity on their part about Imperial Tobacco being based in Montreal. The Bloc does not want any negative consequences. There may be a sense that there is some resistance to the bill on the part of the Bloc, but I have no information on that.

I just want to mention one thing. Sponsorship advertising has been quite misunderstood. Replacement money for sponsorship funds provided by the tobacco company is not unrealistic if you have a big enough pool. What you are doing is exploiting these same events for a non-smoking message. I visited with the State of Victoria people in Melbourne, and that is the approach they took. They said, "We are just co-opting them into our non-smoking program." The events that were previously sponsored by tobacco companies were a golden opportunity for them to get the non-smoking thing through.

Another interesting thing I learned is this. The figure $80 million is the one we hear as the amount the tobacco companies in Canada spent on sponsorship. I do not know the figure for the State of Victoria, but when the foundation there, the arm's-length foundation that we respect so much, got hold of this they found that only half that amount was needed. The tobacco companies spent half supporting the event and half promoting their logo. So, right away, if there is no cause to support the company logo, the sponsorship amount is reduced. We should not be afraid of it.

Senator Banks: One last question. We were all flabbergasted in the meeting of this committee last year when the president of Imperial Tobacco said, "Yes, cigarette smoking causes cancer" - which was a remarkable. Second, when the presidents of the three main tobacco companies in Canada made their opening presentation, we were all loaded for bear, presuming that there would be a huge resistance. Instead, they were 100 per cent in favour of the bill - not only were they in favour of it and not going to oppose it, they intended to actively and avidly support it. And they have been as good as their word. They have spent hundreds of thousands of dollars to urge people to urge their members of the House of Commons to support this bill.

What is your impression of the motives behind that?

Dr. Bonham: If you have seen the Philip Morris direct advertising to children in the U.S., you can appreciate what is going on up here. By portraying it as an adult pleasure that you can choose to buy into, the message is powerful in its aim to dangle forbidden fruit. And this is the risk in the present situation.

I think one of the three tobacco companies, the counterpart to Philip Morris, was sort of holding back saying, "We might want to do our own advertising." Well, just take a look at the Philip Morris ads that come over the border and you will see how powerful the message is in its potential to increase children smoking. We have to be careful about this.

With respect to no participation in the foundation, if this passes, every precaution should be taken to sanitize the thing. Perhaps a ban on their advertising, even when it appears to be favourable to our cause, would really be a sustainable idea.

Senator Banks: Should we ban their advertising in newspapers urging people to write their Members of Parliament to support this bill?

Dr. Bonham: There is a fine line here. If they go into U.S.-style Philip Morris advertising, telling kids not to smoke, I think we should prohibit it outright. Telling people to talk to their MPs is part of the political process that we have to respect, and we may not find that that is worth going after.

The Chairman: Thank you, Dr. Bonham.

I thought I might mention, for your information and for the information of those in the audience, that the three tobacco company presidents to whom I earlier referred refused to appear the year before and they refused to appear last year. I signed a subpoena telling them either to appear or to face the consequences of much complaining by many of the politicians that were worried about campaign donations, and so on, on both sides and in the other chamber.

We were not only surprised when they decided not to fight us anymore, after I signed the subpoena, but surprised to have them come on side. So I think it is interesting that you say they might be taking the attitude that smoking is an adult pleasure. In effect, that is a reverse form of advertising.

Once again, thank you for your appearance here today. Obviously, you are your own best advertisement for looking after one's health. You are looking very well, indeed. Perhaps the next time you are before us, you will direct us to your fountain of youth!

Our next witness is Dr. David Bonfilio, past president of the California Cancer Society. Dr. Bonfilio has been involved with tobacco control since 1988 at the local, state and federal levels, sometimes in an advocacy role, sometimes in a coalition role.

Thank you for coming to see us today. You might wish to take a few minutes to flesh out your career a little more than I have just done.

Mr. David E. Bonfilio, Past Chair, American Cancer Society, California Division, Inc.: Honourable senators, I have been a volunteer for the American Cancer Society since 1985. I have been involved in tobacco-control work since 1988. I was a banker for 27 years. I am now a management consultant.

Tobacco work to me has been important. I was a smoker. I quit after our second daughter was born, because my wife told me she did not want me smoking around our daughter. Hence, I fully understand the addictive nature of the substance.

Before I talk about some of the challenges and some of the successes that we have had in California, I wanted to give the committee some background about the chronology of what has occurred in California.

In 1988, we passed Proposition 99, a $0.25 tax on tobacco products. In 1994, we defeated Proposition 188, which was an attempt by the tobacco industry to pre-empt local laws over state laws. In 1994, we passed Assembly Bill 13, which established smoke-free workplaces - and I will talk a little bit more about that in a minute. In 1994, the health community sued the governor and the legislature, and I will explain why that occurred.

In 1996, we fought to restore the funding of Proposition 99 and its programs. In 1998, bars became smoke-free. Also, in 1998, we passed Proposition 10, which increased the tobacco tax by $0.50. And in 2000, we defeated Proposition 28, which was an attempt by the tobacco industry to overturn Proposition 10.

In 1988, the smoking prevalence among adults in California was 22.8 per cent. By 1999, it was 18 per cent. In 1999, 61.5 per cent of all smokers in California attempted to quit. Smoking rates are declining for all age groups in ethnicities except for 18 to 24 year olds. Smoking prevalence among youth was down to 6.9 per cent in 1999. Among youth, all ethnicities are reporting declines.

Lung cancer rates, for the period 1988 to 1996, declined 14.4 per cent in California, compared to a decline of 4 per cent for the rest of the United States. Unfortunately, women's rates are continuing to increase in California, as they are across the United States, but at a slower rate than in the rest country.

The California Department of Health Services, Tobacco Control Section, in a October 1998 report, said the following:

The California experience demonstrates that a comprehen sive approach designed to change social norms has a much greater impact than a frontal attack designed to market cessation services directly to tobacco users. The goal of this "social norm change" approach is to indirectly influence current and future potential tobacco users by creating a social milieu and legal climate in which tobacco becomes less desirable, less acceptable, and less accessible.

Thoughts, values, mores, and actions of individuals are tempered by their community.

Let me give you an example of how this has worked in California. In 1990, the city of Lodi, which is located in the central valley of California, halfway between Stockton and Sacramento, passed the first clean indoor air ordinance. By 1993, 120 local ordinances had been passed statewide. In 1994, the legislature passed Assembly Bill 13 to create a statewide clean air provision for all workplaces, but with a provision to delay the smoking ban in gaming clubs and bars for two years. The tobacco industry then succeeded in getting a single one-year extension on this ban, but on January 1, 1998, all workplaces in California became smoke-free.

Now communities are reacting. And this goes to the earlier comment about having to walk through a wall of smoke to get in and out of the Senate buildings. Now communities are reacting to that very issue - their citizens being exposed to the second-hand smoking they encounter coming in and out of places of business, in ATM lines and the like. Communities are drafting local ordinances to prohibit smoking within so many feet of building entrances. The tobacco industry, I will say, fights this effort on all levels all the time.

In 1998, there was an error made by the health community in crafting Proposition 99. This goes to some of the good things I see in Bill S-15. In Proposition 99, we had a provision that allowed for a 4/5 vote of the legislature to allocate the revenue. Additionally, tobacco-control efforts were placed under the Department of Health Services, the head of which is a political appointee. This has led to several problems.

In 1994, the health community was forced to sue the governor and the legislature for diverting funds from tobacco control to general health care. The tobacco industry was behind this move, and they did it in a very smart way. The California medical association and the hospital association were on one side, saying, "Well, this is good. We are still taking care of health." The voluntary health organization was on the other side, saying, "We are not taking care of tobacco control." The courts found in favour of the health community in one suit and against us in another. However, the public ill created by this forced the governor to reallocate the money back into tobacco-control efforts. It also helped that our economic climate was improving at the same time. There was additional revenue coming in, so we did not have the fight with the California medical association and the hospital association that we thought we would have.

However, in the suit that the courts found in our favour, the money was placed in escrow. It was only this year that that money was released from escrow and placed back into use.

The Chairman: How long was that?

Mr. Bonfilio: It took three years to get that money back in. We spent two years fighting each other instead of fighting the tobacco industry - which is exactly what the tobacco industry wanted to do.

We have had both a Democratic and a Republican governor who have micro-managed our media campaign, delaying and/or disapproving release of both new and effective older ads.

The Tobacco Education and Research Oversight Committee, which was established by Proposition 99, is advisory and has been forced to fight for effective programs in both administrations.

Another problem in the original legislation was a two-year review clause. Every other year, we must rally forces to speak to the legislature to reallocate the funds. Of course, that gives the tobacco industry another opportunity to drive a wedge between the politicians and the health community.

In 1998, Proposition 10 established the Children and Families Commissions at the state and local level. The legislature and the local boards of supervisors had to pass legislation establishing these commissions. These policy makers, as well as the governor, appoint the commissions, but it is there that their control ends. At both the state and local levels, the revenue cannot be co-mingled with the general fund. The commissions have full authority to expend the funds as they see fit, without approval of the policy makers.

I currently serve as the Chair of the Marin County Children and Families Commission. It has been an interesting two years explaining to our local politicians, particularly the bureaucrats, how this is supposed to work. The model is working and has been a catalyst for making some very innovative changes and for shoring up some programs in danger of being defunded.

Bill S-15 establishes the proposed Canadian tobacco youth protection foundation, whose members will be appointed by the Minister of Health. This is similar to Proposition 10. From what I have read, the foundation will be independent of the government - again, similar to Proposition 10. This will give the foundation greater control and more freedom from parliament politics.

I applaud the writers of the bill for including a seat for a young person. Young people have a different outlook on messages from adults. Peer-to-peer messaging can be very effective.

I also understand that the Minister of Health, Mr. Rock, recently announced increased funding for tobacco control to $110 million per year. I also understand this increase is only for five years and that it will be used to fund government-controlled programs. To be effective, tobacco-control programs must be sustained over time. Twelve years of funding tobacco-control programs in California has led to the gains we enjoy. Even momentary lapses have led to backsliding.

In 1988, the tobacco industry spent $8.24 billion in the United States, or $22.5 million per day, on advertising and promotion. In California, the tobacco industry is outspending tobacco-control programs by more than 10 to 1. California in 1999/2000 fiscal year spent $2.52 per capita on tobacco control, well below the Centers for Disease Control target of $5.12 to $13.71 per capita for our state.

Based upon the CDC target for best practices, California should spend an additional $105 million per year. The health community has been unsuccessful in obtaining the current governor's approval to increase this budget significantly. Again, the writers of Bill S-15 are to be congratulated for establishing and funding the foundation independent of the government.

In spite of what I have said, the California program is cost-effective. Savings from the California tobacco-control program between 1990 and 1998 amounted to an estimated $8.4 billion in smoking-attributed direct and indirect costs. In avoided direct medical costs alone, the program saved an estimated $3 billion, or $3.62 for $1 we spent.

One of the hallmarks of the tobacco-control program in California has been the successful establishment of ethnic networks. Senator St. Germain, this goes to one of your comments earlier. Research shows that the tobacco industry has targeted communities of colour and those of lower socio-economic status. One of the networks that has worked very hard to overcome tobacco is the American Indian Network. As you are aware, many American Indian tribes have sovereign nation status, which can mean that local, state and federal laws may not apply to them. Tobacco has traditionally played an important part in Indian ceremonies, but this network still reports success. There are more reported smoke-free workplaces, although there is little evidence of written policy. It is just in place. Education is welcome, but we have the same problem that you have in your country; that is, many of these communities are remote physically and may have reduced infrastructure. The progress that has been made has been against the commercial use of tobacco, not the ceremonial use, and the American Indian Network has been very careful to make that distinction.

We have learned a great deal in California. First and probably the most important is the need for a comprehensive program. Media is flashy, many people see it, but without reinforcement it does not work.

Let me turn to strategies that work. Countering pro-tobacco influences leads to the following: it causes people to question industry motives, and smokers and non-smokers rally alike; it holds the industry accountable; youth and adults both rebel against industry manipulation; it supports local policy activities; and it continues the process of norm change.

Strategies about second-hand smoke that work will result in the following outcomes: educate the people about the hazards and they will act to protect themselves; turns public apathy into action; mobilizes communities; gives non-smokers a voice; cessation becomes an outcome, people quit to protect their families; and it results in social norm change.

I will now focus on youth learning strategies that did not work in California. They ignored long-term health benefits or effects. They ignored short-term health effects. They ignored short-term cosmetic effects. The idea that smoking is not cool to the opposite sex did not work. And just saying smoking is not cool did not work.

Youth learning strategies that have worked in California include the following: tobacco industry manipulation; nicotine addiction - the kids do not want to become addicted; second-hand smoke is more dangerous than you think; and impactful personal stories. With respect to the personal stories, it does not make a difference whether they are told by a peer or an older person. As long as youth know that the stories are not being told by an actor, that a real person is relating a personal story, they react to the stories.

One of the original ads featured a woman by the name of Debbie. At the beginning of the ad, we just see her face. She is talking about smoking. She has had a laryngotomy, so is struggling with talking. She is talking about how addictive smoking is and what it has cost her, her life. At the end of the commercial, we see her inhale nicotine through the stoma in her throat. That ad is very effective with the teenagers.

There is a new ad with Debbie. Debbie has not fared well over the last few years. She is looking much older. She is having extreme difficulty with saliva buildup in her mouth. She is swallowing almost every other word. She is talking about addiction and about the tobacco industry manipulating her. The upshot is that her seven-year-old niece told her that she did not want her to die, which caused Debbie to stop smoking - not the addiction, not the tobacco industry.

Some conclusions from California. A comprehensive program is most effective. Media and local programs must be coordinated and well funded. If you want kids not to smoke, you need to get the adults to change their habits. Anti-industry and second-hand smoke strategies are effective. Empower the local communities to advocate. Be culturally sensitive and use the power of those communities. Oversight and accountability are key to success. Provide strong leadership and allow program flexibility.

Senator St. Germain: Mr. Bonfilio, you look very healthy. My question relates to your health program. Among my colleagues and I, and in the general public as well, there are many discussions about health care in Canada versus the U.S. I think you have a very health society.

Having said that, you talk about an $8-billion reduction in costs with respect to smoking-related health problems. Canada has a purely socialized system, 100 per cent medicare. How does this measure with respect to your system? Could you elaborate on that, please.

I run every day, and have for 30 years. I do not know whether, as a result, I will live any longer, but it will seem longer because of the torture I have put myself through. I do this to improve my health.

Today in Canada and in the U.S., obesity is a major problem with our young people. It leads to diabetes and many other health problems.

So, my question relates to the health programs in your country, whether there are increased rates for smokers and better rates for non-smokers.

Mr. Bonfilio: We have significant problems with our health care system in California and in the United States. We have a high percentage of uninsured people, both in California and in the United States, because we do not have health care that covers everybody.

We went to an experiment of managed health care, which was an attempt to keep the costs under control. Those costs were creeping up. Well, they are no longer creeping; they are galloping. We are facing issues of not being able to retain health care workers. Both doctors and nurses are leaving the profession because of managed care. Yes, we have seen increases. We have seen tremendous increases.

The numbers that I was quoting you come from the Tobacco Control Section of the Department of Health Services in California. They are comparing the smoking population to the non-smoking population to come up with these costs.

Senator St. Germain: It is a concern to hear you say that you have problems. We too have problems in our system.

I guess my biggest concern is how far can we go in legislating against things like smoking versus what we should be doing to improve our own health vis-à-vis preventative actions - dietary actions, exercise actions, and what have you. I was once a smoker. When I quit smoking, I was smoking three packs a day.

The Chairman: How many miles were you running when you were smoking?

Senator St. Germain: I was not even walking; I was driving. I did not have time to run because I was too busy smoking. Many times I have considered smoking a cigar on the golf course; however, I stop myself simply because I think it might interfere with the other activity.

Has there ever been any correlation between exercise and what have you in the program; do you know?

Mr. Bonfilio: You cannot ignore one without looking at the other. Tobacco causes a third of cancers. Poor nutrition and lack of exercise cause another third. We are talking there about 60 per cent of cancers, which means that we are talking about a lifestyle change. So, in California, we have been able to make smoking an unacceptable behaviour.

In terms of legislating it, what you really need to do, and that is why I use the example of the city of Lodi, is to start at the community level and work up. What this foundation can do is educate the people about the dangers, about second-hand smoke, about industry manipulation, about addiction, and then work with the coalitions to get the local communities to say, "We want this."

That is the process that took place in California. Smoke-free workplaces did not start at the state level. The state legislature was afraid to touch it because of the tobacco industry influence. It was the local communities that said, "We want this."

Now we are looking at banning smoke around building entrances. We are looking at conditional use permits for retail operations that sell tobacco. We are looking at licensing for tobacco. And this is coming from the local level. This is not coming from the state level.

Senator Banks: I have two questions, Mr. Bonfilio. You mentioned that the CDC in Atlanta recommended for California a per capita annual expenditure of between $5, $12 and $13, I think something like that.

Mr. Bonfilio: Yes.

Senator Banks: I would just like you to confirm that and tell me whether you know if there is a difference from state to state, for whatever reason there might be, in that recommended level of spending. I am asking the question because we have heard different numbers from different places as having been recommended by the Centers for Disease Control.

My second question relates to the personal stories you talked about. You said the personal accounts worked with young people in California. Did those stories not sometimes include things you said did not work, like the message that smoking is uncool and the question of addiction, for example? It seems to me that the personal stories must at times have referred to or touched upon those things that you said did not work. That is the least important question.

The first one I would like to hear about is the numbers, the dollars, what should we be spending? Does it vary from state to state?

Mr. Bonfilio: Yes. It varies from state to state because each state is at a different stage with respect to tobacco-control efforts. We just allocated $500 million per year for four years to tobacco-control efforts, from the Master Settlement Agreement, which is more than either the State of Louisiana or the State of Mississippi spends. So we are a huge spectrum.

Senator Banks: That is only $2?

Mr. Bonfilio: For my county, that is on top of the $2.50 we are already spending. So with the Master Settlement Agreement in California, the state gets 50 per cent of the money, the counties get the other 50 per cent of the money. When we first got into this, the governor would not sue the tobacco industries. We have had better luck at the local level than at the state level, getting those monies into tobacco control.

The Centers for Disease Control come up with best practice targets, and those are those dollar amounts figures. There is a chart that lays it out state-by-state, for the type of population.

To answer your second question about the personal stories, the stories really do not talk about smoking not being cool. They indirectly touch on health affects. There is one about an older gentleman, probably in his 70s. He talks about his wife nagging him about quitting smoking, and then he says, "It is my life but she is the one who died from second-hand smoke." Again, the kids react very powerfully to that. There, the reference is health affects is indirect. He just talks about having killed his wife.

Senator Banks: So it is the anecdotal stuff that works?

Mr. Bonfilio: Exactly, and neither Debbie nor this gentleman is an actor. They are real people. When the kids look at it, they think about their grandparents or their neighbour, who may be a smoker. So, yes, indirectly, it does talk about those things. However, if you directly talk about those things, you will turn the kids off.

Senator Banks: You have had a problem with too much government control over the allocation and of the content of the program itself. Do you see any potential for problems, at the other end of the stick, in having a completely independent body, one that is free of any influence, either from the government or the health community? Is there a danger in that?

Mr. Bonfilio: There could be a danger in that, but as we are learning with the Proposition 10 commissions statewide, we have enough people watching what we are doing and holding us accountable in the court of public opinion that the leash is very short. In Marin County, several watch dog groups are monitoring every single step we take. They are very vocal members of the community. They go to the press, they go to the board of supervisors, any chance they get, if they see us straying from our stated mission.

In terms of Proposition 10, we work with the government. We work with the Department of Health on these programs, but we are saying to them that we do not want to be strapped down by their bureaucratic way of doing things. We want to see what really works out there in the community and not have to worry about political pressures. The tobacco industry is one of the largest contributors to political campaigns. It is important to be independent from government.

Senator Banks: You have just described he reason that this bill is coming from the Senate of Canada and not from the House of Commons.

Senator Spivak: I am very interested in the strategies that you have talked about to achieve the goal. Americans are very good at strategy. The political system there gets people involved, in the sense of working for what they want. I will come back to that in a minute.

However, I want to talk about what I think is the key problem here. In my opinion, the problem here the across-the-board lack of corporate responsibility. For example, McDonald's could make their products completely healthy; they choose not to. The companies that are responsible for air pollution could do something about that problem, but many do not. Some have, of course.

I want to address the issue of the movie industry. Everywhere in movies now we see cigarettes. How did that come about, when at one point there were no cigarettes in movies?

My second question is this: What tactics did you use to achieve all those propositions? Did you use straight political tactics? Was it coalition politics?

Mr. Bonfilio: I will address the issue of the entertainment industry first. There has been a huge influence by the tobacco industry in the entertainment industry. However, through Proposition 99 and through the health coalitions in California, we have been talking to the industry. They have not shut us down. They are interested in talking to us. There are some producers and directors who are very interested in this problem, Chris Columbus being one, Zemeckis being another. They are concerned about the problem.

One of the issues from the standpoint of the industry standpoint is "artistic freedom." However, we are quick to point out that the prevalence of smoking in movies outweighs the rate of smoking in the rest of the population. So we are still working on that. Another concern is the 18- to 24-year-old age group. A lot of movies portray this age group as smokers.

Senator Spivak: Yes, and music videos.

Mr. Bonfilio: Exactly.

Senator Spivak: It is an advertising vehicle for the tobacco companies and it means money in the hands of producers. The cost of producing a movie these days is in the range of $100 million, not $10 million. The tobacco companies must be must be paying a lot of money to have their products used on screen - not only the tobacco companies, but other giants, like Coca Cola, et cetera. How are you combating that, or are you, apart from talking to them?

Mr. Bonfilio: Yes. Talking to them is about all we can do. We are limited because we have only Proposition 99 funding; there is a limited pot of money. The tobacco industry, as I pointed out, outspends us 10 to 1 in California, and they know how to do it.

I have here with me this tabloid-type newspaper, the Monday edition. In here, there is an ad to win a $20,000 trip to New York City. The ad was placed by a tobacco company. This is enticing. You are required to be at least 19 and a smoker to enter the contest.

Senator Spivak: What about campaign finance reform? Will that help, if it really comes about? I forget what the tobacco industry gives to the Democrats, but they give the Republicans a lot of money. That is the problem. It is like the David and Goliath story.

The Chairman: Just in case you think it is one-sided, I can assure you the that the Liberals, Conservatives and the Alliance all do quite well by tobacco companies also.

Senator Spivak: Well, I did not know that, but okay.

Mr. Bonfilio: The issue of campaign reform, based upon what I have read, would help out, and with respect to all industries. In that way, any one industry will not dominate, as has been the case with the tobacco industry of late.

I think you asked another question, senator.

Senator Spivak: About how you got the propositions. Do you use political strategies or is it mostly coalition politics? Our first bill on this subject, what came to be known as the Tobacco Products Act, came about as a result of coalition politics - the Cancer Society, nurses, et cetera - against a government that did not want to introduce it.

Mr. Bonfilio: Exactly. We do use coalition politics. It is very important in California. I worked on the predecessor to Proposition 10, which was a coalition between Lung, Cancer, the CMA, the hospital association and managed care. We were trying to craft the initiative, to get it onto the ballot, hoping that the managed care industry would support it financially, because it does cost money to get these things onto the ballot. Unfortunately, that effort fell apart because the health community was concerned about competing initiatives that it thought were going to appear on the ballot. So, for political reasons, the managed care industry had to back out.

Rob Reiner picked it up. When we first met Rob Reiner, he was a political neophyte. He did not believe what we were telling him, about how personal the tobacco industry was going to make it, how much they were going to spend versus how much we were going to spend, and the dirty politics. By the final weekend of the campaign, he was understanding it all too well.

So when we first start out, we use coalition politics, but eventually we do have to hire political consultants. We need to play the political game, and we have learned over the years.

Senator Spivak: Speaking of coalition politics, if you linked up with all of these so-called "radicals" who are talking about no logo, brands, corporate responsibility, would that not help your case? Are you linked with them, or are you thinking about it?

Mr. Bonfilio: We do have those radicals in California. Some of them are known to you here.

Senator Banks: Radicals in California?

The Chairman: I think they were up visiting us in Quebec.

Mr. Bonfilio: Yes.

Senator Spivak: I say "radicals," because I think they are the tough-minded people in our society. The others are tender-minded.

Mr. Bonfilio: Very much so. We walk the tightrope. One of the things we did with Pete Wilson, the former Governor of California, is shame him into action, and it worked. That was done by the more radical members of the coalition; they pushed us into this. The rest of us were worried about the other things we would have to deal with the governor on, and how that would affect our relationship, but since he was so stubborn, we went along with it, and it worked.

It really got his attention. When the American Cancer Society signed onto that ad, he actually called our CEO, the volunteer chairman of the board and the volunteer president, who were at a meeting in New York, to complain to them personally. The chairman of the board told me that when she picked up the phone and realized it was Pete Wilson on the other end of the line, going on and on and on, she could not believe it. So, sometimes we have to do that.

Senator Lawson: We have a tendency to overlook the importance of California, until we realize that the population of California and Canada are very similar, so you have much to bring to us.

You said you were a former banker. My bank manager was telling me last week that he had a lady client who said to him, "I want a $50,000 home improvement loan." He responded, "You and your husband have lots of collateral. We can take care of that." When he was writing out the cheque, he said, "By the way, what are you going to do with this $50,000-home-improvement loan? Are you going to redo the kitchen, add a sun room?" She said, "No, we are going to get a divorce." I suppose the moral of the story is that one should look beyond the words, to the real message, rather than the words you are hearing.

You gave us such graphic details about the Debbie ads. When I saw it for the first time, I was with a family with pre-teen and teenage children. One parent smoked, the other did not. The children were literally repulsed by the ad. They said, "Oh, my God, that could be you, dad, that could be you. " And he said, "Well, it is not going to be me; I am going to quit." The impact of that ad was dramatic. That is how important that it was. They are very effective ads.

I read that the population in California will soon be more than 50 per cent ethnic, Hispanics and so on. Are any of these ads being done in Spanish? How are you dealing with the language question?

Mr. Bonfilio: We are a state without a majority. There is no majority. The white population is under 50 per cent of the state, so that is reality today and it has been a creeping reality for us for quite some time. I talked about the Native American Network. We also have a Hispanic network, an African-American network, and an Asian-Pacific Islander network. We do ads in a multitude of languages. There is a Spanish radio station, which is quite popular throughout California, I think most of the United States, and we run ads in Spanish on that station because we know it has the audience. We run print ads in a variety of languages. And we recruit people of those communities to work in those communities.

The coalition I belong to in Marin County has a variety of folks from different organizations, Catholic Charities being one. The representative from Catholic Charities is a Vietnamese woman. All of her work takes place in the Vietnamese community in Marin County. People react to people like themselves.

Senator Lawson: A final question. Senator St. Germain raised the issue of legalizing marijuana with Dr. Bonham. There is an election campaign going on in this province currently. Of course, one of the parties is the Marijuana Party.

They say that legalizing marijuana would do a number of things. First, they say, it would decrease consumption by young people because small groups would sit around sharing one cigarette - love and sharing would be the by-product.

Do you accept the logic of that?

Mr. Bonfilio: You are talking to a resident of a state that has legalized medical marijuana. All the state law enforcement agents are scratching their heads. It put us in direct violation of federal law. We have seen an unfortunate side-effect of medical marijuana. In some of our communities, kids are turning to marijuana versus tobacco. They are saying, "If it is okay for medical use, it must be an okay substitute." As a result, we are seeing a larger problem, with increased marijuana use among young people.

We would like to get the research done, find out if there is anything to these anecdotal stories about it being of use in medical situations, as well as investigate the health risks of sustained marijuana use over time.

The Chairman: Is marijuana a substitute? In other words, does an individual who takes up marijuana smoking suddenly quit smoking cigarettes? Or are they two different things?

Mr. Bonfilio: We are seeing them as two different things. Kids are picking up marijuana versus picking up tobacco.

Senator Lawson: Is there a correlation between marijuana use and harder drugs? At least some of my friends in the police department say that getting into marijuana is the first step in the road to harder drugs.

Mr. Bonfilio: There is evidence to prove that that might be the case. I worked with a woman on the Proposition 10 commission who works with pregnant mothers who are substance abusers. She has found that they can give up tobacco while they are pregnant. Others will breast feed for a longer period because they understand the health risks of tobacco to their child. However, they have a harder time with alcohol and hard drugs during that same time period.

Senator Kenny: Mr. Bonfilio, I was not entirely certain about your answer to Senator Banks regarding the Atlanta Centers for Disease Control funding formula. Correct me if I am wrong, but all the figures you were giving us were U.S. dollars obviously. Second, my impression is that the formula is arrived at, first, in terms of population, second, in terms of population density, third, in terms of the diversity of the population and, finally, in terms of the rate of smoking within the community. As a result, a series of formulas has been generated that will vary quite significantly.

For example, the population in Rhode Island and Iowa might be the same but because people live further apart in Iowa and are more homogenous fewer dollars will flow to Iowa than Rhode Island. Are we on the same page?

Mr. Bonfilio: That is correct.

Senator Kenny: Could you elaborate for us the payback issue that you talked about. I am particularly interested in the paybacks you saw in California for dollars spent on tobacco control.

Mr. Bonfilio: We had evidence it was happening almost immediately. It was not too many years into the program that people started reporting less of these types of diseases. For example, there was a dramatic decrease over an eight-year period in lung cancer rates. We saw paybacks almost immediately.

With respect to women and lung cancer rates, women took up smoking a lot later than men, as a general population, and began to quit a lot later than the male population. In California, the rate of increase of lung cancer among the female population is growing at a slower rate than it is for the rest of the United States.

We saw immediate health benefits.

Senator Kenny: Did I understand you correctly to say that for every $1 you were spent on tobacco control you saw a reduction of $3.62 in tobacco-related health costs?

Mr. Bonfilio: In direct tobacco-related health costs, yes.

Senator Kenny: On the topic of political interference, you mentioned that there was interference from both sides. Can you give us more examples of the sort of interference that took place?

Mr. Bonfilio: Governor Wilson would not allow us to run the Debbie ad. When Gray Davis came in, he sat on that ad for almost a year.

Senator Kenny: Just I understand, is any tobacco grown in California?

Mr. Bonfilio: No.

Senator Kenny: Are cigarettes manufactured in California?

Mr. Bonfilio: No.

Senator Kenny: What is the correlation between cigarette companies and politicians in California?

Mr. Bonfilio: Money - both sides of the aisle.

Senator Kenny: Can you describe to us the procedure that is used in California to provide for evaluation? How does it start? When is an evaluator chosen? How are the evaluations made public?

Mr. Bonfilio: In Proposition 99 and in all subsequent measures, evaluation has been a very important element. We were fortunate, when we wrote Proposition 99 - and this is one of the things we definitely did right - to insist on evaluation. There has to be an evaluation piece from day one. The evaluators were chosen by the Department of Health Services but with the TEROC, the Tobacco Education Research Oversight Committee, looking over their shoulders at who these evaluators were going to be.

Our friend, Dr. Stan Glantz - from UCSF - is one of the more vocal members in the tobacco-control movement. He was watching every move the government made in choosing the evaluators. We continue to choose evaluators for different programs, depending upon the sophistication of the program. It is an ongoing process, but it has been from day one typically, in the case of Proposition 99, by the government, but they are using the University of California system, which is pretty independent of the political system.

On Proposition 10, we are allowed to choose our own evaluators, and so we are choosing evaluators both at the local level and at the state level, and they are being chosen by the commissions themselves.

Senator Adams: It is not uncommon to see kids standing outside school smoking during recess or after school. Is there any law in California prohibiting one kid from giving another kid a cigarette?

Mr. Bonfilio: What you are talking about is a problem. Kids have a tendency to get cigarettes either from their families - outright from a family member or stealing them out of purses or pockets - or from friends. Most of the school districts have prohibited smoking on campuses to help defeat that. Unfortunately, with most high schools, we have an open campus policy. Thereby, the kids can leave the school property at lunchtime and get their nicotine fix off campus. It is a problem and that is how the kids are getting their tobacco.

I was talking to the coalition earlier about the increase in smoking among 18- to 24-year-olds. Much of the reason for that is that the tobacco industry is focusing on bars. Even though it is illegal to smoke in the bars, the industry is sponsoring tobacco nights in bars in urban areas and around college campuses. The kids go to these bars, where there is live music, contests, prizes, and big bowls of cigarette products for anybody who wants them. And even though 21 is the drinking age in California, all of us who have gone through that phase know how easy it is to get false ID. So the young kids are going to these bars and picking up tobacco there.

The Chairman: One thing that has bothered me somewhat through the years is the tax write-off associated with advertising costs. Whether the product being advertised is a car, beans or woodwork, the company gets a tax write-off. I realize this is a federal issue, but has any work been done in California vis-à-vis disallowing the tobacco companies to write-off advertising?

It seems to me that Washington is subsidizing the tobacco companies, by allowing the write-off, to subvert the youth of California, under the system that you have now. Has anybody moved on that?

Mr. Bonfilio: That goes to the Bill of Rights and free speech, and even though what you are talking about is part of the Tax Code, it is also about free speech. It would be difficult, if not impossible, to make any changes like that.

In the Master Settlement Agreement, the tobacco industry did agree to certain advertising restraints. We are keeping an eye on them to make sure they comply with those constraints.

If we were to ban advertising as a tax write-off, it would affect all businesses. It is too slippery a slope to go down.

The Chairman: I am not suggesting prohibiting the right to advertise. My question is this: Why allow it as a deduction? There are many things that are not allowed as a tax deduction. For example, you cannot take your wife and kids to Hawaii for Christmas and write that off. The tax people make decisions about what is a deductible and what is not. A change could be made to ensure that all advertising is not deductible. Why could this not be done in the name of health?

Has anybody approached the tobacco companies, for example, to say: "Look, we cannot stop you from advertising a product that is obviously detrimental to health; however, we sure can stop you from using it as a tax deduction"?

Mr. Bonfilio: It will be interesting, vis-à-vis FDA regulation, to see whether that will become an issue. If it does become regulated by the FDA, there may be some advertising issues that go along with that.

Senator Banks: Mr. Bonfilio, I am hopeful that you have had a chance to read Bill S-15. I do not know if you have, but my parting question to you is this: How are we doing? Is it a good bill? Does it get around some, all, a few or not a sufficient number of the problems that you have already experienced in California?

Mr. Bonfilio: Yes, I have read the bill and I think it is well written. There is enough latitude within the bill I think for you to overcome many of the objections. The fact that the foundation is going to be independent of the government is very important. The fact that one of the seats is going to be held by a young person is very important. The fact that the foundation will exist in perpetuity unless it decides to shut itself down is good. These are all good points. It is definitely a step in the right direction.

Senator Banks: Could it be better? And, if so, how?

Mr. Bonfilio: I would need to understand better your way of governing and some of the customs up here to be able to answer that question.

Senator Lawson: Hardly a day or week goes by without something being written on air rage. They talk about all the reasons for it and so on. I was surprised to read recently the suggestion that one of the major causes of air rage was smokers being deprived from smoking on long-distance flights, that the rage is more of an addictive reaction.

I probably should have asked this of Dr. Bonham, but has your group done any studies or seen any material on this that might indicate that that is a problem?

Mr. Bonfilio: I have not seen anything. There was an air-rage story involving two women, twins, on a flight from San Francisco to Singapore last week. Apparently, the problem resulted from a combination of alcohol and the fact that the women were caught sneaking into the restroom to smoke. However, I have not seen a study on that, no, and I am not aware of a study being done on that.

The Chairman: On behalf of the committee, thank you very much, Mr. Bonfilio. We appreciate you taking the time to come up from California to be with us today.

Our next witness is Mr. Scott McDonald.

Thank you very much for meeting with us, Mr. McDonald. We look forward to your presentation.

Perhaps you could begin by telling us a little bit about your background.

Mr. Scott McDonald, Executive Director, British Columbia Lung Association: I have been with the British Columbia Lung Association since the early 1970s. I graduated from Ryerson Polytechnical University, where I studied journalism, and then worked for a short time in the publishing world. Then, to my luck, I was transferred to Vancouver in the early 1970s.

I began to work for the B.C. TB Christmas Seal Society, which was the name of the Lung Association in those days. I worked in public affairs. I left, for a couple of years, to do media relations with Canada Post. I then went back to the Lung Association, which had changed its name in the meantime. I have been executive director since 1981. I have been around for a while.

My original plan was to talk to you in a fairly formal way. However, I am happy to see that you take such a casual tone with your witnesses. With your permission, I think that is the approach I would like to take.

I have a lot of numbers here. You have probably already seen a lot of numbers, and you will see more in your travels across the country. I can probably just satisfy the need to give you some numbers by saying that smoking is a terrible problem. The Lung Association began its life at the turn of the century as the Society for the Prevention of Tuberculosis and Other Forms of Consumption.

At the time, people did not die from smoking-related illnesses because tuberculosis probably killed them first. The odd person died from the flu or pneumonia, or from other problems. Worldwide, more people will die from tuberculosis this year than in any other year in history. Although I am not sure about this, I am fairly confident in saying that more people will die from tobacco-related illnesses this year than in any other year in history. Back then, the TB Society was concerned about tuberculosis; it is now preoccupied with tobacco-related illnesses.

The Lung Association is also involved in many other lung health issues, from air quality to asthma, proper use of antibiotics, and issues about education, the flu, and nutrition.

Today, many of the elderly persons with chronic obstructive pulmonary disease, COPD, are victims of tobacco use in their younger years. Whereas tuberculosis affects both the young and the old, the ravages of tobacco use do not really show up for many years, in most cases. This is unfortunate because lung cancer cure rates have not improved much over the past 50 years. The same is true of emphysema and chronic obstructive pulmonary disease.

Lung cancer is one of the deadliest cancers, and remains such. The survivability of a diagnosis of lung cancer really has not changed since the 1950s. It is a terrible disease, and in most cases 75 or 80 per cent of people with that diagnosis have been smokers. The numbers are similar with respect to emphysema - more than 80 per cent of its victims have been smokers.

It is not uncommon for a young person to say, "Well, I'll quit when I want to" or "I'll quit when I start to cough." Unfortunately, it will probably be too late.

Those people who ultimately end up dragging around an oxygen bottle commonly have been smokers for 30 or 35 years. Emphysema, which was once more common to males, is more commonly being diagnosed in females in their mid-50s. Some of these patients live long lives, but their lives are made quite difficult by the presence of that disease.

In days gone by, there were spittoons everywhere, to permit expectoration by those who chewed tobacco or those who had tuberculosis. For a long time, it was considered the right of tobacco users to spit. We also know that tuberculosis was commonly spread by spitting. Eventually, however, the disappearance of spittoons and the prohibition of spitting in public places eventually came to pass. There were "no-spitting" signs and signs that warned of fines for spitting. Nevertheless, politicians were initially very reluctant to even think about introducing legislation that would prohibit such a thing. I see an analogy there with tobacco today.

There was a time, not long ago, when people would smoke at Senate hearings like this one, or the hearings we watched television, the Mafia hearings and the McCarthy hearings. It seems such a foreign concept today. However, back then, no one would have thought of preventing Joe Valachi or Senator McCarthy or Richard Nixon from smoking in the Senate chamber in the 1950s.

Here we are, today, in a hotel where there are more non-smoking rooms than smoking rooms. The only place you can smoke in this hotel today is in your own room, and it must be a designated smoking room on designated smoking floor.

These concepts are no longer foreign to us. I am not sure about the rest of the country, but in British Columbia non-smokers expect not to be offended by second-hand smoke in public places. And in British Columbia, as well as in the rest of the country, non-smokers outnumber smokers substantially.

There used to be sanatoriums for the containment of tuberculosis patients, who were sent there to serve their time or to wait out a cure, if that was the case. People with tuberculosis were looked upon as pariah. No one wanted anything to do with them. There is an analogy with sanatoriums and smoking rooms. Notwithstanding, of course, the development of tuberculosis was often not a matter of choice. The same is not true of smokers, who obviously make the choice to smoke.

Let me turn to the topic of the arts community and its portrayal of actors smoking in films, using tobacco, to add that artistic cachet, that risk-taking theme. It used to be considered attractive to have tuberculosis; that consumptive look was sought after.

Virtually all of the best-known artists, sculptors, poets, writers had tuberculosis. Many died from tuberculosis. There was a certain cachet, as I said, about tuberculosis.

As we know, many youth are influenced by the arts community, the actors they admire. Many youth dream of becoming actors, of being famous. If an actor they admire smokes, they also may choose to smoke. So there is no doubt that there is an issue there.

It used to be that if the parent in a household got tuberculosis so did the kids. We can draw an analogy with respect to tobacco use today. If one or both parents smoke, there is an extremely good chance that their kids will make the choice to become a smoker too.

I have digressed from my presentation. I especially wanted to speak to our support of the bill.

The British Columbia Lung Association is a member partner of the Canadian Lung Association. I am sure you will hear presentations from other lung associations as you travel across the country in the next two weeks. We have a very close and valuable relationship with the British Columbia and Yukon Division of the Canadian Cancer Society and the Heart and Stroke Foundation of B.C. and Yukon. We work closely with them; in fact, we have formed an organization called the Clean Air Coalition. It is a sole-purpose organization, whose purpose is to create awareness and support for smoke-free public places, in particular, to support the Workers' Compensation Board regulations that will come into effect in September, after having been negated last year on a technical issue. We are very pleased to be able to work with the Heart and Stroke Foundation and the Cancer Society. I know that other lung associations across the country also work with their respective provincial partners as well. I think I can safely speak on behalf of the three major health agencies in the country, certainly the Canadian Lung Association, in expressing my support for this bill.

There is a comprehensive tobacco strategy being developed in British Columbia that is particular to British Columbia. Again, the organization has a commitment to clean air and to educate people about tobacco and the use of tobacco.

As I was sitting here earlier, I was actually wondering why these hearings are even necessary. If the tobacco industry supports it and the people are for it, there is nothing left to do.

Before I close, let me just tell you something here. There are about 130,000 supporters of our organization in the province. They show their support by making a financial contribution to the Canadian Lung Association's various campaigns, of which the Christmas Seal campaign is probably the best known. We surveyed about 10,000 of our donors to ask them what work we should be doing with their donated dollars. We received about 800 replies. The highest ranked response, about 70 per cent of them, indicated that the most important thing we could do is educate young people to head them off from becoming tobacco users. That is something we do quite vigorously, but so much more can be done.

Young people are choosing to use tobacco for a variety of reasons. Much could be achieved with the formation of the foundation proposed in Bill S-15, and the funding available to it.

I will end just here. I am prepared to answer any questions you might have.

The Chairman: I will ask you the same question I asked of Mr. Bonfilio. He was primarily concerned with state issues. I think you probably wonder into the federal field from time to time. Has there been any research into trying to stop the advertising deduction of tobacco companies from their income tax?

Mr. McDonald: I am not aware of that, although there have been activities related to advertising tobacco. A number of organizations, however, are involved in the issue of tobacco advertising so it would not surprise to find out that that had been one of their approaches. I am not aware of it though.

Senator Banks: Have you been active in urging the members of your organization to urge their members of the Commons to support this bill?

You raised an interesting question a few minutes ago. You asked: Since the tobacco companies are for it and the Senate is for it and the people seem to be for it, who is against it? I think you know the political realities that provide the answer to that question. There is resistance to this bill and it is in the House of Commons. Are you making, can you make, will you make, can you dragoon your people into even doing more to urge their members of Parliament to support it?

As you know, those who sit in the House of Commons are susceptible to political pressure. As such, the likelihood of this bill, once it passes the Senate, which it will, finding success in the Commons will depend to a very large degree on constituent pressure upon members of the Commons - and I guess I am asking for help. Are you dragooning your members into doing that?

Mr. McDonald: Yes, we absolutely are, but possibly not with the vigour that might be necessary, and I look for advice on how much vigour is necessary. We are definitely committed to reducing tobacco use among young people. The older people who are suffering today were young people who once make the decision to smoke.

I have three teenagers, a 16-year-old and two 14-year-olds, so I have a bit of a selfish interest in this as well.

Our organization, as I mentioned earlier, also has concerns around asthma, air quality and a variety of other things. We are limited to the activities we can undertake by the public support we get. We are supported entirely by charitable donations, by individuals, and as such have other things on our plate. However, this, at the present time, is the most important thing before us.

Obviously, the issue has peaked, in terms of consideration by your committee. We have written letters to all the Members of Parliament from this province. As well, we - the Heart Foundation, the Cancer Society and the Lung Association - either have or will be visiting, I think I am right in saying, every Member of Parliament in this province to express our support for this proposed legislation. We have certainly written a lot of letters - although I am not sure how effective letters are. However, the short answer is, yes, we have taken some steps.

Senator Banks: Every little bit helps. You have asked for some direction on how much is required. I think part of the answer to that can be derived from the fact that a version of this bill has previously failed in the House of Commons. It was passed by the Senate and it failed in the House of Commons, so that is the answer.

Would you just take a moment to tell us though, since we are here and since this committee is concerned with many aspects of the ecology and the environment, what other facets of the question of clean air, having to do perhaps with industrial emissions, et cetera, are of particular concern to British Columbians?

Mr. McDonald: Well, on the broad topic of clean air - and I will stay away from indoor air. We are all aware of the damage that is done by tobacco in public places and the very important regulation that will be relaunched this September with respect to the protection of workers, clean air in a public place.

On the broader topic, a lot of British Columbians heat their homes with wood. Today, gas prices are off the meter and electrical prices are off the meter.

The Chairman: You cannot get rid of your wood.

Mr. McDonald: We cannot get rid of wood. There are mountains of wood all over the place. There is wood that is not commercially viable that works well in the wood stove or the fireplace. Often, people who heat their homes with wood are thinking green and think that by not using natural gas or oil they are being green. However, often they burn green wood, or have a stove that is too big or too small for the space they are trying to heat, or think they are being green by burning garbage. They think they are being green by burning treated wood or painted wood or other things. Many of these actions, which cause air pollution, result from lack of education.

In the 1980s, about 112, 000 British Columbia homeowners used wood as their sole heating source. That is a lot people. Someone who lives in Dawson Creek or Fort St. John might burn six or seven or eight cords of wood; someone living in Vancouver, of course, would not burn as much wood. Nevertheless, we you are talking millions of cords of wood.

As well, 70 per cent of British Columbia homes have a solid-fuel-burning device, that is, a fireplace or a stove of some kind. There are about 1.3 million homes in British Columbia, so we are talking about 1 million homes in British Columbia that have a solid-fuel-burning device.

It is important, therefore, to educate people about the wise use of wood stoves and fireplaces - which might include not using them.

There is also the issue of the automobile, the number one polluter in this province. Most of the population is in the Lower Mainland, and there are a lot of cars. The pollution from these automobiles blows up the Fraser Valley, having its most dramatic effect in the upper valley.

What we have to do is improve mass transit and make it easier to get around the Lower Mainland. There is a lot of criticism here right now about the transit system, about its poor functioning. Mass transit has to function well here in the Lower Mainland. After all, it has to move half the province's population around, to and from work and school.

There are many other issues as well, including fuel formulations, sulphur content, MMT inclusion in fuel.

Personal use of a motor vehicle and use of energy in home heating are probably the two major areas where people can really make a difference.

Senator Kenny: Mr. McDonald, I am going to put you on the spot a bit; if you want to beg off on any of these questions, feel free.

On April 5, the government made a series of announcements. I would like to get your reaction to the different components of the announcements, and I will run through them for you.

First of all, Mr. Martin raised the excise tax on cigarettes by $4 a carton. Good idea or bad idea?

Mr. McDonald: There is no doubt that there is a relationship between cost and the choice to smoke. Tax will influence that.

There is research on percentage increases in the cost of a carton of cigarettes and the effect of that on people's consumption of tobacco products, so good choice.

Senator Kenny: The second component of Mr. Martin's announcement was to introduce a $10-per-carton tax on the 3 per cent of Canadian cigarettes that had previously been exported duty free. Good idea or bad idea?

Mr. McDonald: I am not sure of the implications of that. Again, probably any increase in the cost of tobacco products will have a positive effect, either in another country or somewhere down the line, the effect being that people may either stop smoking or reduce consumption.

Senator Kenny: If I told you that the RCMP had advised us that 85 to 95 per cent of the cigarettes that were being exported were coming back into the country - they were exported duty free - is the $10-a-carton tax a good idea or a bad idea?

Mr. McDonald: I can recall a time, and I am sure you can, when low-cost cigarettes were being sold in parking lots in downtown Toronto. Those cigarettes followed that route - across the Rainbow Bridge or the Thousand Islands Bridge. I am not certain how those cigarettes got out and back again, but if a government policy exists that leads to smuggling, reduced costs and increased consumption, then it is a bad idea.

Senator Kenny: Duty free stores now are not getting their cigarettes duty free. There is a tax being imposed on cigarettes at those stores. Good idea or bad idea?

Mr. McDonald: I would have to think it is a good idea.

Senator Kenny: Mr. Rock announced recently that roughly $98 million a year for the next five years, or $3 per capita, would be devoted towards tobacco control. Contrast that with Bill S-15 at $12 per capita. What is your choice?

Mr. McDonald: A couple of issues there. I have had dealings with government. We know their decisions can sway with the wind. Although $98 million for tobacco education is a lot of money, the use of those funds is subject to government involvement. To me, Bill S-15, which would create the proposed foundation and involve, I think, four times the money on an annual basis, seems to be a better idea.

I am grateful for the funds committed by the government, but I think those should not be the only funds.

Senator Kenny: In 1994, do you recall the Prime Minister announcing that Canada was going to see the most effective anti-tobacco campaign in the history of the Western world?

Mr. McDonald: I do not recall that specifically, but I have heard quite a few comments made like that.

Senator Kenny: And do you recall how long that program lasted for?

Mr. McDonald: I do not think we really saw much vigorous activity, certainly not world-leading activity.

Senator Kenny: Would I be refreshing your memory if I suggested that that anti-tobacco program was cut back in 1996 when the government instituted across-the-board belt tightening?

Mr. McDonald: I would believe you.

Senator Kenny: The funds that were announced on April 5 all go into the Department of Health Canada. Do you believe there is adequate transparency there? Do you have a clear understanding of how Health Canada is spending its tobacco-control funding?

Mr. McDonald: I do not. As I said earlier, I have had some difficulty working with government to access funds, how they were allocated within government departments.

Do not get me wrong, we have had some excellent working relationships with Health Canada, and we look forward to continued excellent relationships with them in the fields of tuberculosis, tobacco, flu awareness, use of antibiotics, and a variety of other programs; but it has not been as transparent as I might like, no.

Senator Kenny: What is your understanding of the evaluation process of programs within Health Canada? Have you had access to any evaluation of the programs that Health Canada has run?

Mr. McDonald: I have not, no.

Senator Kenny: Do you have any knowledge that they have evaluated any of their programs?

Mr. McDonald: I do not.

Senator Kenny: When the announcement was made, there was a suggestion that the government's objective was a 20 per cent reduction in youth smoking over the next decade. If the current rate is 28 per cent, that would mean that they are aiming for 21 per cent in 2011. What is your view on that as a target for youth smoking for the federal government?

Mr. McDonald: I do not think that is very ambitious. I would like to see a more ambitious goal than that.

Senator Kenny: The funding for this program comes entirely from the Consolidated Revenue Fund, which means that it is being paid for by all taxpayers. The funding for Bill S-15 comes from cigarette companies and, hence, cigarette smokers. What is your preference?

Mr. McDonald: In the Clean Air Coalition surveys of public attitudes about providing smoke-free places in public places, restaurants, bars and so on, most smokers support smoke-free places. Most smokers want to quit. Dr. Bonham this morning talked about the number of people who want to quit. Most smokers want to quit smoking, and they support activities, as all Canadians do, to prevent young people from taking up the habit. So I think it makes more sense that the smoker funds the foundation that would educate young people.

Senator Spivak: I just have one question. There is an election campaign going on here right now. How does the platform differ with each party in terms of the issues we have been talking about? Do you have some idea? I think there are about five parties running, right?

Mr. McDonald: I am not sure how many parties. It is at least five.

Senator Spivak: There is also the Marijuana Party of Canada and the Green Party, but they are not going to get into power.

Senator St. Germain: Oh, oh.

Senator Spivak: Okay.

Mr. McDonald: Using the office of the Clean Air Coalition, which is a fairly modest operation but has the enthusiastic support of the Heart, Lung and Cancer Societies, we have just sent out a survey to every candidate in every party in the province. I actually have it here with me, I believe. I will not read all the questions, but here is an example. "If elected, will you support the implementation of a fully funded comprehensive tobacco reduction strategy in B.C.?"

Senator Spivak: Good.

Mr. McDonald: "Legal actions are now underway against the tobacco companies. If elected, would you support this legal action against tobacco companies?" With respect to the Workers' Compensation Board, the following: "If elected, will you support the implementation of this vital health measure?" And, finally: "Will you be a leading example in directing your campaign manager and others associated with your campaign to not accept contributions from the tobacco industry?

Senator Spivak: So you think they are going to answer that ingeniously.

I guess the governing party is in the process of agreeing to it, but you have not had any of the opposition parties in their platforms deal with this issue as of yet, is that correct?

Mr. McDonald: I am not totally up to date on that, but I know that individuals from the coalition go to all candidates' meetings and so on raising the issue of their positions on tobacco. I am not sure that any of the parties has stated a position on tobacco, other than the current government. I know we have had much contact with the opposition as it exists today; I do not think so much with the other parties.

Senator Lawson: I enjoyed your presentation. I see you were born in Saskatoon, Saskatchewan. I was born in Spy Hill, Saskatchewan, so we have something in common.

The reason I mention Saskatoon is that there was a group of ladies from England who were on a Via Rail trip coming across Canada, and the train stopped in Saskatoon. One of the ladies went out on the step and said to the station master or the station agent, "What place is this? " He said, "Saskatoon, Saskatchewan." She went back to her group, she said, "Oh, how quaint, they do not speak English here."

Anyway, following on Senator Bank's comment about contacting your MP.

The Chairman: There is one Saskatchewan person in the audience anyhow!

Senator Lawson: Two.

On the topic of contacting your Member of Parliament, a couple of political facts of life. This is a bill sponsored by Senator Kenny, who is a Liberal. The bill is going to go before the House of Commons, which has a Liberal majority. You would think it would be approved. Ain't necessarily so.

I sit as an independent, and as such am not subject to party discipline. Let me give you a bit more of a direct response than perhaps Senator Banks was able to give to you.

It may come as a surprise to you that there are egos in Parliament. There are even egos amongst cabinet ministers, as surprising as that may be. Now what worries me is that when this bill, which is universally supported, winds up in the House of Commons, the minister involved may decide that the bill should have been sponsored by him, rather than a senator, that it should be even bigger and better, and so on.

What would be helpful would be for you, through your association from all of the provinces, specifically Ontario, where the minister comes from, is to put in place a strong letter-writing campaign telling him to support and pass this bill.

That is the kind of help that I think that we need and this bill needs, if I may be so bold as to suggest.

Senator Kenny: I will give him my bill, senator.

The Chairman: As a supplemental to Senator Lawson, and as a lifelong politician and a hack, I just want to say that there are many of us in the Senate who will tell you that indeed letters are important. Although we may not have time to read them all, we are affected by them, so do not hold back in that sense.

Senator Adams: Mr. McDonald, your organization is very effective. Are you funded more from private sources or mostly from the health department?

Mr. McDonald: Our funding comes entirely from individuals - well, I should not say that. We obviously get some corporate support, but the vast majority of funding for the Lung Association comes from individual donations. Canadians are very charitable. Corporate support is important, but by far our support comes from individual Canadians supporting charitable works.

Senator Adams: Do you send out a brochure to the membership to solicit this funding? How does the system work?

Mr. McDonald: Well, we have an elaborate system, actually. There are some 75, 000 registered charities in Canada, each of them trying to support themselves through public donations, and it is very competitive.

Unfortunately, donations are done somewhat because interest rates are down. The people who support charities generally across Canada are older people, and older people's lives are affected by interest rates. If rates are down, their income is down. Things being as they are in the economy - the stock market, gas rates, et cetera - donations are down. As I said, the heart of the support for charitable organizations is older people, retired people especially, and some of these people are having a difficult time paying their bills of late. Hence, charities are suffering, and this includes the Lung Association as well as most other charities across the country.

Senator Adams: I just heard, before I left Ottawa, that some of New Brunswick doctors are going to refuse to look after some lung cancer patients. Do you think that is a good idea? Should there be some kind of policy? There is nothing in Bill S-15 about that.

Mr. McDonald: My personal view is that is it not a good idea, but I can understand physicians becoming frustrated by a patient's continuing to do that which is causing the illness. It must be very, very frustrating. Refusing to treat the patient might be an action that would compel the patient to stop a certain activity, whether it is eating nine cheeseburgers a day or drinking a quart of vodka or smoking two packs of cigarettes.

I have heard of that before, but I was not aware of the New Brunswick issue.

Senator Adams: If 40,000 people die a year from lung cancer, I understand how doctors must be frustrated. If a doctor tells a patient his liver is getting bad, that he has to quit drinking, say, there is no difference between that and the patient who is suffering the effects of cigarette smoking. It is very difficult to say.

The Chairman: Does your organization have a special program for northern or aboriginal communities in the prevention of lung diseases?

Mr. McDonald: We do not have a special program, but we certainly visit northern and West Coast communities, which have the predominant aboriginal populations. We have a number of health educators who travel all corners of the province presenting health education information with a focus, I think I can safely say, on tobacco, because that is where the interest is in the school systems. We do other things with the community, asthma education, chronic obstructive lung disease, air pollution and so on, but the bulk of our activities with respect to our provincial program relates to tobacco use among people.

The Chairman: Are you aware that with respect to the present program that Canada is proposing, which obviously, as you can tell from the Senate, we think is inadequate, the funding will all go to a government department? Under Bill S-15, not only are we collecting three times as much per capita but a great deal of it will be sent back into the community to organizations such as yours. Are you aware of that? I am sure you probably are.

Second, does it bother you a bit that you will become the tail on the anti-tobacco dog committee? Would it hurt your independence?

Mr. McDonald: It is obviously a concern, but I think in this case if this commitment is made you will find the support of the Lung Association and other health agencies that are interested in tobacco use.

Again, I will use my tuberculosis analogy. There are a number of drugs, a number of treatments, and a number of preventative measures. It is not a case of one magic thing doing it all.

Some kids are affected by an ad that shows a woman who has a pretty obvious and compelling issue that resulted from her smoking.

Some kids are induced into smoking by seeing people they admire smoke, say, an uncle who smokes and who has a motorcycle and big sideburns.

There are so many reasons why some young people choose to smoke and while others choose not to smoke. Also, each smoker who quits has a different reason for doing so.

Therefore, there will be hundreds of programs across the country, some that will work in one community and not in another.

I think that through the proposed foundation, with its board and the advisory council that will feature a youth, many good ideas will come forward with respect to tobacco use among youth.

The Chairman: The last question - and it might have been better directed at Dr. Bonham. You mentioned spittoons. Is there any research in your organization on taking in nicotine through other means, say, chewing tobacco, as far as what it may do?

Mr. McDonald: There is a lot of research on what is called smokeless tobacco, and none of it good, I must say, that I am aware.

The Chairman: One chew a day helps keep your blood pressure down or anything like that?

Mr. McDonald: I am not aware of that.

The Chairman: It does keep the girlfriends away, though!

Mr. McDonald: We have some very frightening pictures at the Lung Association, and I know the Cancer Society has some also, that demonstrate the effects of chewing tobacco. They are pretty frightening.

Senator Spivak: Tongue cancer.

The Chairman: Yes.

I would like to thank you, Mr. McDonald, for coming forward. You have been most informative.

This is the end of the Vancouver portion of our hearings on Bill S-15, but this same committee will meet again this afternoon, at 1:30, to consider energy-related issues.

The committee adjourned.

---