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

Issue 5 - Evidence, April 26, 2001 (morning)

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TORONTO, Thursday, April 26, 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 9:30 a.m. to give consideration to the bill.

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

[English]

The Chairman: I call the meeting to order. We are meeting today in Toronto to consider two topics, Bill S-15, the Tobacco Youth Protection Act, and then energy-related issues this afternoon.

This morning our focus is going to be on Bill S-15. I want to take a few moments to explain the process we will follow. Each witness will be asked to make a short presentation and then there will be a short question and answer period.

During the earlier part of the week, the committee heard from witnesses in Vancouver, Edmonton and Calgary, and following our hearings today, we will have another day in Toronto and then we will visit Montreal.

The goals of these hearings are to obtain a sense of how Canadians view issues raised by the bill and build on previous work by Senate committees on this subject.

Once the committee decides it has received all the necessary information, it will go through the bill clause-by-clause and make a report to the Senate.

After that, the Senate may choose to send the bill to the House of Commons by passing a third reading. If both Houses agree to the bill, it becomes law.

Before we begin, I would like to note that earphones and translation are available. The microphones go on when you speak, but if there is a delay, push the button yourself. We are going to break at noon. I would invite our witnesses, and also the senators and members of the public, to visit an exhibition put on by local youth in the King Meeting Room, located upstairs on the second level.

Our first witnesses this morning are John Garcia from Cancer Care Ontario, and Rob Cunningham of the Canadian Cancer Society. Thanks very much for joining us today. Maybe you can begin by telling us a little about yourselves. Are you each presenting a brief or is it a joint one?

Mr. John Garcia, Director, Prevention Unit, Division of Oncology, Cancer Care Ontario: We were planning to present separately.

The Chairman: Leave us enough time to ask some questions. I think we have an hour, all told, before the next witnesses come in.

Mr. Garcia: Thank you, Senator Taylor. Perhaps I could begin. Good morning, and welcome to Toronto. We are really very glad that you came here and that you are travelling across the country to hear our views.

Perhaps I could start by spending a few minutes on myself and my background, because that might assist with the questions later.

I am currently the president of the Canadian Council for Tobacco Control. You may recognize that organization as the former Canadian Council on Smoking and Health. The organization has been in existence since 1974, and for the last 25 years, it has been committed to organizing action on tobacco control.

I am currently the director of the Prevention Unit in the Division of Oncology at Cancer Care Ontario. Cancer Care Ontario is a provincial organization with a statutory mandate to advise the Ontario government on priorities for cancer prevention. As you are well aware, more than 80 per cent of lung cancers are due to tobacco, and at least a quarter, perhaps 30 per cent, of all cancers are due to tobacco industry products. It is a major priority for the organization.

Until January last year, I was senior adviser to Health Minister Witmer in the Province of Ontario. I am working in the office of the Chief Medical Officer of Health.

Between 1994 and 1999, I was actually a vice-president in a private company in Washington, D.C., responsible for a demonstration project that is essentially the culmination of the smoking tobacco control program of the U.S. National Cancer Institute. It is known as the American smoking prevention study, and involved 17 states and affected the lives of 3 million Americans.

In fact, the study is the basis for a lot of work in tobacco control, and I can answer questions about that.

I was formerly director of health promotion in Ontario and understand the conundrums in implementing comprehensive programs province-wide, and while I wear both national and provincial hats, I will try to talk mainly about Ontario today.

Also noteworthy is that one of my first jobs involving tobacco was in the 1980s. I was employed by the City of Toronto as the coordinator for a smoking prevention program under an initiative of Health Canada's "generation of non-smokers" programs.

As an aside, I have two children in university.

I think that we failed that generation miserably and failed to implement the vision that was articulated. I see Bill S-15 as an opportunity to move this along. That is one of the major themes of my presentation today.

First, just a little background about Ontario. You are travelling across the country, and I am assuming you mainly want to hear an Ontario perspective here. We have about 11 million people in the province. That is 38 per cent of the entire population. As you know, it is a very large province, with more than a million square kilometres. Eighty per cent of the population lives in cities and fairly close to the U.S. border, but a substantial number, one in five, live in rural communities.

About seven and a half million of those Ontarians claim to be English speaking, and about half a million claim French as their mother tongue. That leaves a lot of others who speak neither English nor French. Ontario is home to more than 60 cultures where, we are proud to say, all the major language groups are represented, including Chinese, Italian, German, Portuguese, Hindus, Iranian, Greek, Polish, Dutch, Spanish and Ukrainian. Of course, we have a very large population of First Nations and aboriginal peoples, perhaps the largest in the country.

Such a large province obviously has a substantial variation in occupational income status, which, of course, is correlated with smoking rates. I say all this by way of background because it contributes to the cultural richness of Ontarians in Canadian society, but at the same time, it represents a major challenge to the implementation of a comprehensive and effective tobacco program across Canada and across Ontario.

The second point I wish to make is that current levels of spending on tobacco control are clearly inadequate. Until it recently actually added $10 million to its provincial tobacco control program, Ontario claimed to be the highest spending government across the country, at about $19 million a year for the eleven and a half million people.

This is clearly inadequate according to recognized international scientific standards for effective tobacco control. As you are probably aware, considerable controversy was generated over the last week as the Ontario government invested more in assisting tobacco growers to reduce the levels of nitrosamine, so they can better market their products internationally, than they have in tobacco control.

The current investment in Ontario is much less than the government's own expert panel has recommended, and you will be hearing about that later.

We would also say, of course, that the federal government does deserve credit - credit where credit is due - for legislative policy and leadership. Minister Rock's precedent-setting warnings are clearly a demonstration of his leadership, and of course we are pleased they are starting to increase the tobacco taxes, as the minister announced last month.

Unfortunately, that still leaves Ontario with the dubious distinction of having the most retail tobacco products of any Canadian, European or American jurisdiction. The funding for tobacco control is also laudable, of course.

The Chairman: Sorry for interrupting, but we are taking down all your evidence, so it will last for generations, by hand, so if you could just speak a little more slowly.

Mr. Garcia: The federal government deserves considerable credit, and we applaud Minister Rock's leadership on the world-precedent-setting health warnings and the tax increases. We are very excited about the announcements on investments in tobacco control that will grow to $110 million by 2004.

I would note that this has been announced but not yet delivered. We do not question the government's intention, but we have seen such announcements in the past, and certainly these levels of investment fall short of what is required in the opinion of national organizations.

We are all very much committed to working with Minister Rock, and Health Canada, on the first truly well-coordinated and effective tobacco control program. As I say, we are still concerned.

We have been in this business for some time, so forgive us for being cynical; we want to believe this program will be successfully implemented. However, since the mid-1980s, national and provincial governments have made many statements, and there has been a national consensus on the need for an effective, national strategy for tobacco control.

A directional paper was published in June 1987 for the then national tobacco control program; it was subsequently revised to "the national strategy." I think they partly realized they simply did not have any commitment to a program. There was no investment of resources to actually implement the directions set out in the paper.

Of course, this was just recently revised to the "National Tobacco Control Strategy," and as you are aware, it is calling for a comprehensive, multi-faceted, national, provincial and territorial, as well as local strategy to address tobacco control. It has multiple goals, including trying to prevent smoking among kids, motivate and support smokers to quit, control environmental tobacco smoke - a known human carcinogen - and normalize tobacco industry products.

Frankly, these ideas are not new. They are not much different from those articulated by scientific bodies. The National Cancer Institute's position in the early 1990s defined the public health agenda in the United States, the approach taken by Massachusetts and California, and the approach that was adopted but not yet implemented in Ontario. Essentially, it is the approach taken and advocated to the U.S. Congress by the U.S. National Academy of Sciences. The Institute of Medicine suggests in its report, "Growing Up Tobacco Free," that the comprehensive approach should be used to prevent smoking among youth. This includes tax increases, restrictions on advertising and promotion, controls on environmental tobacco smoke, support for adults to stop smoking, and school programs. The Canadian edition is no different.

The point I want to make is that we simply failed to implement it. We have developed this vision but we have not implemented it. This is not to say we have not had success. I mentioned the Tobacco Control Act, and Ontario tobacco control legislation is perhaps the most comprehensive in the world. By-laws are being introduced across the country, and smoking rates are very slowly starting to come down. However, we could have a much greater impact, and much greater progress could be made, with larger investments and greater intensity in tobacco control.

The evidence is clear - I see Rob is going to speak to this later - that comprehensive, integrated, multi-goal, multi-faceted and high-intensity tobacco control programs are effective. Greater levels of investment are associated with greater benefits to public health. This fact has been acknowledged by the National Academy of Sciences in the United States, and is the basis of the recommendations from the U.S. Centers for Disease Control and, of course, Senator Kenny's bill.

Now, do these numbers apply to Canada? I would like to talk a little about that. The Canadian Council for Tobacco Control is a member of this loose group of organizations called the "National Campaign for Action on Tobacco," and while we are all aware of the Centers for Disease Control numbers, we wanted to ensure, before we came before this committee, that we could stand behind the numbers in the Kenny bill.

Therefore we spent some time thinking about what a comprehensive tobacco control program should look like, and we decided that we should adopt the current policy of the provincial government and the federal government as articulated in the directional paper of the National Strategy for Tobacco Control.

We went through the process and costed the strategy. The numbers are probably not all that important, but we believe that Bill S-15 is in the ballpark, although perhaps a little on the low side. We came up with a low figure of $368 million and a high of about $725 million. This is for a program that the government has already adopted in principle; it is a policy direction.

Interestingly, that works out to about $12 per capita or $24 per capita at the low and high ends. The specific numbers by program line are not all that important, because the independent agency will decide how to allocate those resources.

I raise this here because these figures are strikingly similar to those of the CDC. We went through a micro-costing, added up the numbers, and they are fairly similar to the Centers for Disease Control figures. The U.S. CDC is figuring on US $15 to US $16 per capita; depending on the conversion rate, that is about CAN $25. We are in the same ballpark.

Given the challenges I mentioned before, we do need adequate resources to actually address this massive health problem. It is broadly based, it is ubiquitous, but probably most importantly, this mass epidemic has had a very powerful promoter; the tobacco industry itself has promulgated mass addiction and is responsible for the consequences of its production.

We need a powerful antidote to this problem. There are no magic bullets, and in fact it is foolhardy to expect, with such a massive problem, that any single intervention would have an effect. We need a broad-based program to address health behaviour and social behaviour. Greater levels of investment will lead to greater success.

I would like to put the figures into some perspective for the committee. I have been thinking about this. When I talk to colleagues, they say this seems to be a large amount, but it really is not when put it into the perspective of what we spend on health care in this country. The suggested approach of using an independent foundation seems eminently reasonable.

I would like to speak to this briefly. Hospital costs in Ontario that are directly attributable to tobacco industry products are about $1.1 billion to $1.5 billion. No matter the jurisdiction, the cost is usually in the range of 6 per cent to 8 per cent of total health care expenditures.

Last year alone, the Ontario health care system spent almost $23 billion. That is about $1 out of every $10 that is spent on the entire provincial economy. Frankly, we are blessed with a world-class health care system in this country, and all Canadians are proud of this.

To give you some examples of comparable numbers, the Hospital for Sick Children has an annual operating budget of about $345 million; the St. Michael's Hospital, $323 million; the University Health Network, which includes three hospitals, Toronto General, Princess Margaret and Toronto Western, more than half a billion, more than $600 million per year. So taking all that together, expenditures on those five hospitals are roughly equivalent to the costs of tobacco use in Ontario. Yet the expenditures proposed by Bill S-15 are less than 30 per cent of the expenditures of those five hospitals alone.

The funding generated by the S-15 proposal is actually approximately equivalent to that needed to fund one hospital in this country - one single hospital. It is interesting to note that hospitals are governed by independent boards. Bill S-15 suggests a similar approach, and we think that can and should work for prevention.

I would also suggest that there is a need for us to all support the federal government initiative. This was an important initiative, but it does not preclude our supporting Bill S-15, nor will it preclude our supporting provincial government investments to the level required for effective tobacco control.

We think it is a false distinction to talk about making a choice between the federal government initiative announced by Mr. Rock, and the Kenny bill. We need both. We need both provincial and federal investment.

Just to digress, in the United States, it is often seen as foolhardy to put all your eggs in one basket. Various states, including Minnesota, have put resources into a multitude of places, including the state health departments, the private sector and private foundations.

I wanted to state that we are very pleased we are able to be here to support this important bill. We certainly encourage all politicians, if they are concerned about youth addictions and ending this epidemic, to do the same. We are talking about members of the committee, members of the Senate, and all members of the House, including Mr. Rock. Certainly we would like to thank Senator Kenny for his leadership on this, and thank you very much for the opportunity to discuss this with you.

The Chairman: Maybe we'll ask you both questions after we are done.

Mr. Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society: My name is Rob Cunningham. I work as a senior policy analyst at the national level for the Canadian Cancer Society. I first became involved in tobacco control in 1988, and among my recent activities was the authorship of the book Smoke and Mirrors: The Canadian Tobacco War that looks at the history of efforts, both by the tobacco industry and by the health sector, with respect to the tobacco epidemic.

April is Cancer Month, and it is fitting that this committee is considering the leading preventable cause of cancer, tobacco, at this time. I just want to acknowledge the committee's efforts in travelling across Canada to hear the views of Canadians on this bill, and to thank you on behalf of the Canadian Cancer Society for the opportunity to again express our support for Bill S-15, the Tobacco Youth Protection Act.

In the context in which this bill is being considered, we have the only legally available product in Canada that is lethal when used exactly as intended. We have a product that is highly addictive. The overwhelming majority of smokers begin before the age of 18, before the age of responsibility, and ultimately go on to a treadmill of disease and death; 45,000 Canadians per year die from tobacco-related diseases.

I would like to table with the committee a written submission for your consideration. It is entitled, "Compilation of Selected Evidence Regarding the Need for Comprehensive Tobacco Control Programs: A Submission to the Standing Senate Committee on Energy, the Environment and Natural Resources for Use During Consideration of Bill S-15, the Tobacco Youth Protection Act."

This submission contains 45 tabs. There is extensive evidence that comprehensive tobacco control programs reduce smoking and protect public health.

There is documentation within this submission from California, Massachusetts, Oregon and Florida about the success of their sustained, large-scale, well-funded tobacco control programs.

There is also documentation supporting implementation of various aspects of a comprehensive provincial program, including the use of mass media, and there are literature reviews on how this aspect, among others, can successfully reduce smoking. There is evidence from outside North America, such as from Australia, that certain interventions have proven to be very successful.

The World Health Organization, as noted in tab 45, recommends that countries, and I quote: "have in place effective health promotion, health education and smoking cessation programs."

We have a series of recommendations from around the world about success. We just need to make it happen.

It is interesting that two of the three major manufacturers in Canada have endorsed this bill, as we see yet again from an advertisement in the press this morning. The third company, while not giving unqualified support, did testify before this committee last year to offer support in principle, but with certain amendments.

There is recognition in the United States that educational programs can successfully reduce smoking; the industry itself is engaged in such initiatives. Now I think the quality of what they are doing can be criticized, but even the tobacco manufacturers recognize the value of interventions.

It is recognized in their internal documents, and just to quote from Robert Parker, who was asked what could be done to eliminate or reduce youth smoking while testifying before a Senate committee in April 1997:

I think much can be done in terms of advertising. Obviously there is information on the health risks. There are peer activity groups.

He was referring to the kind of things that young people who appeared before that committee participated in.

This is a very unusual situation, whereby you have endorsements from the public health community, tobacco manufacturers, and also the Canadian public. You will see a series of opinion polls in this material, one of which was conducted last year and referred to the content of Bill S-20, the predecessor bill to Bill S-15. Canadians were asked if they supported or opposed it - strongly supported, somewhat supported, and so on. Overall support was 74 per cent. Overall opposition was 25 per cent. It is rare that bills proposing government interventions attract that high level of support, and I think that is worth noting and emphasizing.

In examining what level of funding for tobacco control is appropriate, it is worth recalling that the federal government was collecting $2.2 billion per year in tobacco taxes, not including GST, and not including the incremental revenue that will result from the tobacco tax increase announced a few weeks ago.

There is also a surtax on tobacco company profits that collects about $80 million per year. When this surtax was initially introduced on February 8, 1994, at the time of the tobacco tax rollback, the government announced that all of this revenue would be earmarked for or allocated to the largest anti-smoking campaign this country had ever seen. Now, that did not happen, and a year and a half later, and again on a subsequent occasion, the amount was cut back from what was initially announced and intended.

The government increased the surtax proportionally a couple of weeks ago.

Health care expenditures of all kinds total $80 billion per year in this country. That is a lot of money, especially compared with the $260 million that would be raised through the levy in this bill, and recognizing that tobacco is the leading preventable cause of disease, disability and death.

We applauded the federal government's announcement on April 5 and we still support it. Finance Minister Paul Martin certainly deserves praise for increasing tobacco taxes. It is going to have an impact and we hope that this is foreshadowing future increases, since Ontario and Quebec have the lowest cigarette prices in North America.

Health Minister Allan Rock also deserves praise. The announcement of more money for tobacco control, ramping up to $110 million per year, is important. It is going to have an impact, and we support that.

At the same time, we very much reiterate our support for Bill S-15, proposed legislation that the Canadian Cancer Society has actively supported since a predecessor version was initially introduced in the Senate in 1998, and we noted several advantages to Bill S-15 when the government made its announcement on April 5. The first is sustainability. The levy and the structure are very important. The prevention of smoking is very much a long-term issue. We know that the resources announced by the government in 1994 were cut back just a year and a half later, despite the very important need, and ultimately dropped to $10 million per year for the entire tobacco control strategy.

We know that tobacco companies engage in long-term planning. That is why, as we have seen from experience and their documents, they have targeted young people, knowing that if they can get them hooked, they could well be customers for 40 years or more.

Also, the importance of the health effects of smoking necessitates planning on a sustained basis; $360 million is certainly far more than previously, and something that we commend.

I will not elaborate on what Mr. Garcia indicated. He made a very good case as to why $360 million, if not higher, is a justifiable and appropriate amount of money for tobacco control.

The third point deals with the benefits of an outside agency. This would be an arm's-length agency that could act independently of government and have the flexibility to more quickly engage in certain interventions that government has not traditionally been willing to implement.

I think that decisions and action could be taken faster by an independent agency, that there would be that flexibility, and that we would realize the benefits that other operating agencies or Crown corporations have enjoyed. It has been traditional in Canada to recognize the benefits of having a separate agency, and that is a further important aspect that highlights why we support the bill.

I also want to commend the Senate and this committee for its past work on this bill and predecessor bills, and to urge that this committee, and ultimately the Senate, endorse it.

The Chairman: Before we move to questions, I would like to introduce, among the fair crowd of people attending, the OAC class of Senator O'Connor High School. I hope you get double credits for this.

We will now turn it over to questions. Most of you came in a little late, so the procedure is that after the panel presents its thoughts, the senators get to ask questions. We have had meetings in Vancouver, Calgary and Edmonton, and we are going to have a meeting in Montreal. Our committee makes a report to the Senate, and then on the third reading, our Senate either passes or rejects the bill.

Since it has been passed in different forms twice before, chances are it is going to pass this time. Then it goes to the House of Commons, and it holds one vote to either pass it or reject it. That is the procedure.

I think Senator Banks had a question.

Senator Banks: Thank you, Chairman. Good morning, gentlemen. Thank you for being with us today. I have two questions, I guess for either of you. However, I will start with Mr. Garcia, because he talked in laudatory terms about the increased taxes on cigarettes and the concurrent announcement of $98 million from general government revenues to fight smoking.

Governing is an extremely difficult thing. It has much to do with money. The government is faced with having a certain amount of money available, while a certain amount is being demanded by people across the country in various different parts of the economy for various different reasons, all of which are deserving. Farmers need it, fishermen need it, miners need it, education needs it, but they cannot have all the money they would like because you cannot raise taxes that high. It is not possible to do that without destroying the country.

Therefore everybody has to be satisfied with a little less than they would like, and sometimes a lot less than they would like. All governments generally give a little over here, a little over there, and a little over there, so everybody gets something, but it is usually a little less than everybody says they absolutely have to have.

To most people on the street, if you say you are going to spend $98 million ramping up, as Rob said, to $110 million a year on essentially a marketing undertaking, that is a lot of money. I know some of it is going to mass advertising and some of it is going to changing people's minds by other means, but generally, using advertisers and marketers, is $98 million enough? How are we going to convince people? How are we going to convince members of the Commons, through their constituents, that that is not enough money? It is $98 million now. Is there any danger in that announcement if this bill were, for example, to fail? What is your comment on that? It seems like a great deal of money.

The Chairman: We will take a five-minute break. Why not rephrase your question to be very short so we can get it on the record.

Senator Banks: Is there any danger, in your view, in Minister Rock's announcement of $98 million to fund anti-smoking programs?

Mr. Garcia: You suggested in your preamble that the dilemma partly lies in the ability to raise taxes. The advantage of tobacco taxes is due in part to the addictive nature of tobacco products. The increase in price will be proportionally less than government revenues. There is plenty of room to fund tobacco control programs. The tobacco companies themselves have supported S-15, which indicates they support the numbers in the bill and the government's investment.

I think that perhaps the only danger would be a failure by the government to explain to Canadians the rationale for the program. I think once Canadians truly understand the magnitude and gravity of the problem, and the need for the investment, there will be support. As Rob has suggested, there is 75 per cent support for Bill S-15.

Senator Banks: Here is what I am getting at. If I am a doctor, and you have a disease, and I know that you need a certain amount of medication in order to solve the problem, but somehow you get the wrong amount and do not recover, is there a danger of creating the perception that this medication does not work? We have tried this, and it does not work.

Mr. Garcia: It is not now at the necessary level to treat the patient. There is some danger there. We hope that there will be a commitment to support S-15 and that problem will be overcome. We also hope there will be support for investment at the provincial level. This is the nature of Canadian enterprise.

Senator Banks: Mr. Cunningham, one more question. You were with us on the day when we were all geared up to go after the presidents of the tobacco companies after they had been served a subpoena. I am sure that your jaw dropped as low as any of ours when they sat down and pledged their undying support for S-15 in their opening submission. There are cynics in the country who look at that and say there is something strange here. Why on earth would these people be trying to contribute to an effort aimed at reducing their market - not their market share - their market, their potential, their future customers. Why do you think they are doing that?

You talked about how they spent a couple of hundred thousand dollars today, as they did on Tuesday and the week before that. They are spending probably a million bucks to shoot themselves in the foot. Why would they do that?

Mr. Cunningham: I think there are a number of aspects to that, and since I have not been inside their boardrooms, I just have to answer that question based on my best estimations. In 1964, the first voluntary code pledged not to advertise to people under the age of 18. They did not want young people to smoke. In subsequent years, manufacturers did advertise to children. They announced over many subsequent years that they did not want young people to smoke, that they had not advertised to underage people, and that they supported enforcement of laws preventing the sale of tobacco to underage people. Yet over that decade, Imperial Tobacco was doing monthly market research on people as young as 15 - research that they continue to conceal to this day.

I think tobacco companies see a public relations benefit to opposing youth smoking, and I think that is part of their analysis and their decision to endorse this bill. Keep in mind that this committee invited them to appear as witnesses several times, but they declined, and that they only appeared after a subpoena was served. That was part of the context. I also think that they were very conscious of the 1994 appearance of U.S. chief executive officers before Congressional committees, at which they testified under oath that nicotine was not addictive, in their opinion.

They did not want a repeat of something like that, so two of them decided to come forward and announce their support for Bill S-15, which is interesting, because they opposed its predecessor bill through the Canadian Manufacturers' Association. Then once they were before the committee and there were some questions, they said they were kind of caught. They were asked whether they were going to actively engage in support for the bill and implement their commitment to its passage. Then we started seeing these paid advertisements and so on.

If I may, just getting back to your earlier question to Mr. Garcia, places like California and Massachusetts have earmarked revenues from tobacco taxes. That revenue has been dedicated and cannot be reduced in subsequent years, so that a certain proportion of the money raised is going to tobacco control. That sustainability is very important, and we know that without that type of dedication, the earmarking through the levy we see in Bill S-15, there is a risk that a future government would not maintain the level of funding announced on April 5.

Senator Banks: Thank you.

Senator Adams: I have a question. The government is going to spend over $90 million a year on a campaign to get people to quit smoking. Bill S-15 is more concerned about young people not starting to smoke. Beginning in 1987, there has been research to help people who smoke. Over the last few years, what percentage of people more concerned about second-hand smoke; are you familiar with it? Is it working right now in some places, especially in Toronto and other cities like Vancouver, that there should be a no-smoking area in restaurants and bars?

People who are working have to go out and smoke, and we have heard a lot about them, especially in Ottawa, where they go outside at minus 20, minus 25. Now I see more standing outside to smoke; they should quit smoking. Do you think that is working?

There should be some more effective way than S-15, the government proposal, and people sitting outside smoking.

Mr. Garcia: A complex comment. It has been more than 15 years since the first studies linked cigarette smoking to lung cancer. More information has come out over time information, and even modest information, like the Surgeon General's announcement, and the advent of non-smokers' rights, have actually demonstrated positive results. Studies by economists have demonstrated that advocacy activity has actually saved lives.

The rate of smoking among men has come down substantially since the 1950s, and certainly since 1964. Unfortunately, that decline stalled during the 1990s. We have not seen the drastic reductions that we would like, and while cancer rates have actually started to decline over time, which is largely attributable to changes in smoking rates among men, there is a very long way to go. That decline could be accelerated substantially, and the California tobacco program has actually demonstrated declining lung cancer rates that greatly exceeded the national decline in the United States.

In Ontario, even though the rates are going down, the actual number of cases is actually going up by 2 per cent to 3 per cent per year, so we still have a long way to go.

Fully a quarter of those cancers are due to cigarette smoking, and we should be eliminating those entirely. You are suggesting, I think, that the approach is complex - and I agree with you - that with public attitudes and changing social norms, when we talk about "normalization," we are really talking about making tobacco a less normal part of Canadian society. Restrictions on smoking in public places, workplaces, bars and restaurants all contribute to that.

Studies have demonstrated that policies that ban smoking in the workplace and support smokers to stop can cut smoking rates by 25 per cent, and smoking is reduced in those who continue to smoke. Those people are parents, they are family members; they go home, they do not smoke at home, and their children are less exposed. So all of this is interdependent. That is why the approach to youth smoking needs to involve cessation efforts, taxes and so forth.

Mr. Cunningham: Senator Adams, I had the delightful opportunity to be in Nunavut when the territory was established, where I met with the deputy minister of health, who told me about the very serious smoking problems there. He estimated that 90 per cent of teenage girls were smoking, and that elders were dying early from emphysema.

Senator Kenny: What per cent was that?

Mr. Cunningham: Nine zero. Elders and parents are dying from emphysema. This is a young territory that is just getting established and it does not have the resources to address this problem. I have no doubt that Bill S-15 would assist very much in that.

Senator Adams: In the meantime, while the government Health department is concerned about second-hand smoke, you have cancer of the teeth and all over the body. I go to places sometimes and people will put a cigarette packet down. I ask them, "What do you think about this, the picture, the warning on the cigarette packet?" People say, "Willie, I have to smoke, you know." How do you reach those people there, still young people - especially the younger people right now?

We heard in Calgary and Edmonton over the last couple of days that kids get cigarettes anywhere. There is no problem getting a cigarette. How can we stop it? You go to the corner store, you see the notice that it is 19 or 18 before you are able to buy cigarettes. That is why we have a problem with that.

Even up north, we see the kids break for class in the afternoon or the morning and they are smoking outside the school. How are we able to stop that? I think that is where we are getting started.

Mr. Garcia: Maybe Rob will want to comment on this as well, but I think that your previous comments about the importance of a wide range of influences on smoking behaviour are important. As I mentioned in my presentation, health behaviour is developed and shaped in a social context. It is very much a cultural issue and we need a combination of interventions. There is no single magic bullet that will have an effect.

The good news is that we know that comprehensive, well-funded, intense public health education programs work. The evidence is clear that normalizing mass media programs delivered in conjunction with community programs have an effect We just simply have to have the political commitment to implementing these programs.

The Chairman: Thank you. I thought for the information of the students from Senator O'Connor High School, I would point out that Senator Kenny is from Ontario, Senator Adams is from Nunavut - the only bilingual member of the committee - Senator Banks is from Alberta, as am I, and Senator Kelleher is from Ontario.

Senator Kenny: Thank you, Chair. I wonder if I could ask Mr. Garcia to elaborate for the committee on what constitutes a comprehensive tobacco control program. When we talk to our colleagues in Ottawa, they are repeatedly looking for a silver bullet. They want a single solution. They say, "Okay, what is it going to take? Do you want an advertising program, do you want a school program? Tell us what you want and we will do that one thing."

I would like you to describe for the committee how you see a comprehensive tobacco control program working and what it should look like in Canada. If it were properly funded and properly organized, how would it work?

Mr. Garcia: Again, that is a very broad question. We are talking about a comprehensive, integrated approach to tobacco control that will actually reduce the epidemic. We need a clear commitment to targeted reductions of smoking rates among children and youth. I understand that Gerry Bonham recently suggested that a 5 per cent smoking rate among kids is completely achievable under Bill S-15. I believe that is true.

However, to achieve that objective, we do need policy interventions and we do need to educate the public about the value of tobacco taxes and the need for restrictions on advertising and promotion. We need a mass media program to actually expose the crimes and the deceit of the tobacco industry. I am talking about mass media campaigns to de-normalize the industry, the product and tobacco use.

We need the resources to implement programs in multiple sectors, including the school system, the workplace, health care settings, community groups and the like. We need educational resource materials and trained professionals to deliver them. We need grants to communities, public health agencies, school boards and so forth. As is suggested in your bill, we obviously need a comprehensive system of monitoring and accountability of the structure to ensure that it is governed and managed based on the strategic objectives, and a mechanism for infusing additional resources into the system if we are failing to achieve them.

That is a very broad-brush approach, but it is the essence of the strategy.

Senator Kenny: Mr. Cunningham, it is good to have you here. I cannot think of a more effective watchdog on government than you have been over the past decade. Cancer societies in North America have that reputation. We heard witnesses from the California division of the American Cancer Society when we were in Vancouver who talked about their battle and their difficulties with the state.

I believe the California rate of smoking is approximately 6.9 per cent, and while we measure it slightly differently here, ours is approximately 28 per cent, which is a significant difference.

Could you outline for the benefit of the committee the performance of the federal government, good and bad, over the last decade. What has the government done that has been productive and helpful, and what commitments has the government made that it has not followed through on, or what actions has it taken that have not been helpful? Then we would have a better perspective from your and the Canadian Cancer Society's point of view.

Mr. Cunningham: Certainly. I think the government has had a strong record on the legislative front in the last 10 years. There are restrictions on advertising, new package warnings - and they are the best in the world - and legislation to prevent the sale of tobacco to minors. There is the Non-smokers' Health Act governing federally regulated workplaces, but it has not been updated since 1989, so it is time for that.

The government released a discussion paper on promotion regulations in 1999 but has not yet acted on it, so we are waiting for that. The 1994 tobacco tax rollback has had an absolutely detrimental, adverse impact on smoking trends.

Senator Kenny: Could you describe for the committee the levels of smoking prior to and after that?

Mr. Cunningham: Yes, I can. There were no annual federal government surveys then, but I believe the rate of smoking nationally among 15- to 19-year-olds was 21 per cent in 1991; after the tobacco tax rollback in 1994, various surveys showed rates of 29 per cent or 30 per cent. That is a massive increase and will have tragic consequences.

There was an increase in per capita consumption among adults, even though there had been a tremendous decline in prior years. Per capita consumption in 1992 was 40 per cent lower than in 1982. That is a tremendous decrease, and there were a number of reasons for that, including especially tobacco taxes, restrictions on advertising and package warnings.

However, trends changed after the tobacco tax rollback. There have been a number of tax increases since then, and that of April 5 is greater than some of the previous tobacco tax announcements, which tended to be $1.20, $1.40 per carton, split between two levels of government, which is $4 per carton.

There have been missed opportunities on the programming side, and that is where I thing low marks can be assigned to the federal government over the last 10 years.

The three-year tobacco demand reduction strategy was announced in 1994. It was going to be about $60 million per year, but that was cut back within a year and a half and then cut back again.

Senator Banks: Was the surtax cut back too?

Mr. Cunningham: The surtax on tobacco companies' profits that was supposed to fund the tobacco demand reduction strategy was not cut back. In fact, the revenue from the surtax increased as tobacco companies' profits increased in subsequent years. It was initially $60 million, but it increased to approximately $80 million, while the amount for tobacco control decreased.

You asked Mr. Garcia what is required in a comprehensive strategy. We do not currently have a national "quit line" in Canada. We should have a toll-free line that people can call to facilitate smoking cessation in adults.

Senator Kenny: Can you please take a moment to explain to the committee what a quit line is?

Mr. Cunningham: Certainly. It is a toll-free line that people anywhere in the country, whether in a remote northern or rural community or in an urban setting, can call to get assistance, advice or materials, or perhaps counselling from a trained nurse, on how to quit smoking. There are different kinds of quit lines that have different levels of effectiveness, depending on the resources and what strategies are used. However, it is a desirable component of a tobacco control strategy.

Senator Kenny: How would a first-class quit line work? Tell us about the possible call-backs, the periodic checks and so on and so forth.

Mr. Garcia: I am not an expert in smoking cessation, but essentially it uses intake assessment methodology to determine the state of preparedness to stop smoking. There is a psychological theory called "stages of change," in which individuals are assessed on their readiness to stop smoking, as well as their dependence on tobacco products. Then cessation services are tailored to the individual's level of readiness to stop smoking. They generally receive self-control behaviour therapy based on -

Senator Kenny: If I may, Mr. Garcia, talk to me as though I am a smoker who is smoking a pack a day and tell me how it would work.

Mr. Garcia: You would see advertisements on cigarette packages and through the media pointing out that your cigarette smoking is likely going to kill you if you continue - half of those who smoke are going to die prematurely as a result. If you are concerned about that and want to stop, you can phone the number. We know the vast majority of smokers have tried to stop; 75 per cent or so have tried, but it often takes multiple attempts.

There will be a friendly voice at the other end of the line, no matter what time of day, 7 days a week, 24 hours a day, to assist you to stop smoking. They would be able to assess your past experience to determine what is an appropriate method for you and give you some practical advice. They would tell you about resources in your own community to help you stop smoking and what support you might be able to receive.

They would determine whether you were interested in receiving a call-back. Would you like them to phone back in a week, in a month, to determine how you are doing?

Mr. Cunningham: It is important to recognize that a very large proportion of smokers, young people and adults, want to stop smoking and about 40 per cent attempt to quit in any given year. They want help, but they want that positive element. The package-warning method could perhaps be characterized as negative. They have an impact.

A large number of smokers want that assistance and it should be there for them.

Senator Kenny: I apologize for interrupting you, but go ahead with the other missing program elements.

Mr. Cunningham: I think we need a monitoring function to provide detailed annual information on what is happening in the marketplace and smoking rates among different subsets of the population. We have not done that consistently in Canada.

In addition to some things that Mr. Garcia mentioned - the mass media activities, effective school education programs, community programs, different kinds of cessation programs apart from a quit line - there should be subsidies to reduce the cost of smoking-cessation products. We have heard about some of the prescription and non-prescription products that are available.

We need more research; there is a lot that we can learn. We know a lot now about what can be done, but there is still a lot more to be gained, and extensive research in various parts of the world continues to yield new knowledge that can be put to good use.

Evaluation is very important and goes hand-in-hand with research. We need to learn from our experience so we do not repeat the mistakes of the past and can move ahead effectively.

We need community action. A lot of good things happen at the community level, but organizations do not have the necessary resources to do what should and can be done.

Public health units in every province should have mandatory core programs - that is not currently the case in Canada - with follow-up steps that should be implemented every year. Of course, you need resources for that to happen.

Senator Kenny: How much?

Mr. Cunningham: It depends. Whether we are talking about the total strategy or just public health units, it depends on whether we want the class A program, the best of the best. If we do not, we can go to class B, and although it would be effective, it would not be as good. I will have to get back to you with a specific number for the public health units.

Senator Kenny: Globally?

Mr. Garcia: The California Health department's general rule of thumb is to put a third of the money into mass media programs - I see Minister Rock has allocated 40 per cent, a slightly larger portion - about a third into public-health-led interventions and about a third into community-based programs.

Senator Kenny: My question was about dollars per capita.

Mr. Garcia: We suggested that the cost of a well-funded, national, provincial and local program would be approximately $368 million to $725 million.

The Chairman: Mr. Cunningham mentioned a restriction on advertising. Has either of your organizations done anything recently to petition the government or to try to stir up the public on denying tobacco companies the write-off on their advertising costs against their income tax that they currently enjoy? It seems peculiar to give a tax bonus to companies that are spending money on trying to subvert our youth and other people. That does not seem to be a very wise thing to do. Some people say that is free enterprise. Getting a deduction to advertise something that is harmful to people is not free enterprise. Have you done anything about that?

Mr. Cunningham: Yes, we have. When the government was considering new national tobacco legislation in 1996, we urged the elimination of the tax deduction for tobacco marketing expenses. A number of bills that were not subsequently adopted have been introduced in the U.S. Congress in past years, but the rationale would be similar in Canada. It is one thing for tobacco companies to market their product; it is another thing for Canadians, through their government, to subsidize that.

We support a total ban on advertising and promotion, but until we get there, we should certainly eliminate the tax deduction for marketing expenses. If we can eliminate the tax deduction for Canadian companies that advertise in U.S. periodicals or on U.S. TV stations, we can certainly do it for tobacco companies.

Senator Banks: I am relatively new to this and I just want to make sure that I understood. You said earlier that the government introduced a surtax on tobacco sales - I think it was 1994 - with the stated purpose of funding an anti-smoking campaign, but subsequently, while the tax continued to be collected, the money was not spent on tobacco reduction programs. In other words, they earmarked the money that was collected, but then put it into something else, either education or the army or any number of other things.

Is that correct?

Mr. Cunningham: That is correct. The federal government announced and implemented a surtax on tobacco company profits in 1994, and while there was a simultaneous announcement of this allocation, no legislation requiring that this revenue be dedicated to tobacco control was introduced. That is where Bill S-15 is different.

Senator Banks: Quite aside from the general mistrust of politicians, is that one of the reasons that you see the advantage of a levy, not a tax, in Senator Kenny's bill, is that the money does not fall into the government's hands, and is therefore not subject to the vagaries of electoral politics?

Mr. Cunningham: Yes, Senator, that is correct. It is a formal legislative enactment such as we have seen in places like California and Massachusetts and elsewhere. This would be a levy, not a tax, and the revenue would go to an independent foundation. It ensures sustainability, and the confidence and ability to plan, implement and develop.

Mr. Garcia: I do not think any of us questions Minister Rock's commitment to this. Ministers change.

The Chairman: Thank you very much, panel. I would like to mention to the audience that nothing stops a citizen in a democracy from writing to the Prime Minister and saying that S-15 should be passed. As a matter of fact, speaking as an former elected politician who was later appointed, I can tell you that we do not read every letter, but a whole pile of them scares us into wondering what is going on.

If any of you want to write a note to the Prime Minister, you do not have to tell him you love him first before you tell him that S-15 should be passed. You do not need a stamp when you write to the Prime Minister. You just throw the letter in the mailbox.

Thank you very much for appearing.

Just before we go to our next witness, some people might like to hear that last night, Ottawa City Council adopted a by-law to ban smoking in public places, restaurants, bars, and even bingo halls. Slowly but surely, we are winning the war.

Now we welcome Mr. Chuck Wolfe.

Mr. Chuck Wolfe, Executive Vice-President and Chief Operating Officer, American Legacy Foundation: Thank you. Senators, it is a pleasure to be back with you. This is my third visit to your country to discuss tobacco control and some successes that have occurred throughout the United States, with most attention being paid to the Florida youth tobacco prevention program.

If I may, I would like to begin with a brief outline and review of my previous testimony about the Florida tobacco pilot program and its efforts.

In the past, I have waited to the end to remind you of successes, but I will start today by letting you know that after a two-year program in Florida, tobacco use among middle school students aged 12 to 14 was reduced by 54 per cent. Tobacco use was cut in half in two years.

Anybody who questions whether these programs can work should simply look at those numbers, as published by the Centers for Disease Control.

Tobacco use by the older teenage group aged 14 to 18 was reduced by 20 per cent in those same two years.

These programs can have a dramatic effect. The Florida program was led by young people. We had a 70-member board of directors with a 10-member executive committee, and they spent the money. They determined how the money should be spent, in what program areas, what tone advertising should take, and what messages should be delivered. Then we, the staff, implemented their recommendations.

Now, many elected or appointed officials find it a little odd to give the responsibility of deciding how the money should be spent to young people, especially since they do not have a vote. However, it turned out to be the crowning glory of this situation. It was the capstone of what we were trying to do.

There is no doubt that the young people were serious about it when they took on this challenge, and they came up with what I think still remains the edgiest anti-tobacco program ever produced. The results came from young people believing that it was their program, and understanding that they had the responsibility for it and control of it.

They built five program areas - marketing is the one most talked about, and I will discuss that briefly - and built a branded anti-tobacco campaign known as "Truth." The Truth campaign created a rather edgy beginning when the young people introduced themselves to the tobacco companies and explained that they were smarter, faster and better looking, and that they would be visiting the tobacco companies in the future with a message. The message was that they were tired of the companies' lies and manipulation; they wanted to stand up and tell the truth about tobacco. They were tired of people making tobacco products look sexy, cool and rebellious. They wanted to talk about the true nature of the product, which has nothing to do with the wonderful marketing aspects that the industry has been able to present for a long time.

In addition to the marketing campaign, an education effort appropriate for both sexes was launched in all grades. We did a baseline study at that point and found that 16 per cent of our youth were already tobacco users before the age of 12; we had to develop new educational tools to reach them in the early grades and not just in Florida's middle schools and high schools.

To accomplish this, we created new supplemental materials to be used in the classroom; some are reader books, such as "The Berenstain Bears Sinister Smoke Rings" for grades one, two and three; we developed new math, social studies and science programs, mainly because teachers in the States are teaching towards tests these days as opposed to creating new curricula, and we wanted to give them materials that could be used towards those tests.

For example, in teaching for math proficiency, they are able to use problems that calculate a tobacco company executive's profit, how much profit each cigarette represents for an executive or shareholder, or how much of the shareholder's return is based on how many cartons of cigarettes sold.

They are doing math problems now that are infused with information about tobacco; this is not a traditional health curriculum.

We found that the traditional health curriculum teaches people that tobacco is bad for you, and it turns out 100 per cent of the people know that, and so simply reiterating that fact does not have much effect.

Social studies includes civics lessons on how bills are passed in the legislature and how to deal with well-paid lobbyists trying to prevent their passage. They are able to talk in science classes about the addictive effects of tobacco, of nicotine.

That is a quick recap of education programs.

It is at the community level that sustained behavioural change actually occurs. These community-level programs created something called "SWAT" - Students Working Against Tobacco. There is a chapter in every county in Florida and they started putting on great concerts.

I do not know whether you have heard of the band NSYNC, but I am guessing that many people have. They put on one of the best concerts in Miami, Florida, and it was a big anti-tobacco event. They put on a big concert to promote Truth; that was a great kick-off for the campaign, which helped.

There were other community efforts such as a train that travelled throughout the State of Florida delivering the Truth message. There was another concert at each stop of the "Truth train," which was a big draw in bringing young people into the organization.

We also had programs in enforcement. It is illegal in Florida for people under the age of 18 to possess tobacco. More importantly, it is illegal to sell tobacco to them, and so there was a significant investment in training retailers. There was also community pressure to remind retailers. For instance, if a retailer was found selling drugs to a minor - and we have to remember that the sale of cigarettes to a minor is the same as the sale of any other illegal narcotic - it should be treated the same way. Communities would say, "Please no longer shop at retailer X, because they are selling drugs to our kids."

This obviously raised some eyebrows, but it had an effect in some communities, although not state-wide.

Finally, there was an evaluation and research component that allowed us to gather the numbers with which I started. An outside organization studied what the program did to reduce tobacco use, both in terms of the process and programmatically.

In addition, the Centers for Disease Control youth tobacco survey measured these results in Florida and published them.

That is a quick recap of the five program areas in Florida.

I want to talk to you briefly about the American Legacy Foundation and the national effort in the States. Last year, the foundation extended the Truth brand across the country.

There is now a national advertising campaign for the Truth brand, and it is catching on in many states, with community-level programming being developed to support it.

The foundation made grants to many of those states to allow them to build local chapters, whether they want to call it SWAT - Students Working Against Tobacco - or something similar.

I am currently working with about a dozen states on building their programs, including Montana and Washington, Ohio, Indiana, Georgia, Tennessee - and Georgia and Tennessee are tobacco-producing states. Each state is coming up with its own creative ways to build community-level programming.

They are also finding interesting ways to administer such programs. Sometimes it is being done by private foundations like the American Legacy Foundation. The State of Ohio created a not-for-profit foundation and funded it. Indiana set up a completely independent, separate agency to run an anti-tobacco program, and then there are the traditionally less-well-funded programs inside state health departments.

Therefore, there is now a variety of models in the States for us to study, and what we are finding, of course, is that programs with the creative freedom to include the audience in their development are succeeding at a faster pace than more bureaucratic programs.

I am referring to programs like the one I described in Florida, where young people are developing the message and designing the delivery vehicles. If you are talking about an adult cessation program, adult smokers should be developing that message. They should be talking about how they wanted to quit, how they have tried many times, and what it would take to help them along, as opposed to what is often considered best practice, which is to have an academic develop an anti-tobacco program.

Everybody in the anti-tobacco world is well-meaning and serious about it, but until you start using a business model in which your customers help design your product, you will not achieve the levels of success of places like California and Florida. It is very important, when you are doing a prevention campaign, for young people to be involved and responsible for the program. If you are conducting an adult cessation campaign, or a second-hand smoke campaign, such as you were describing earlier, Mr. Chairman, in Ottawa, then smokers should be involved in talking about how, where and how often they smoke, and the issues should be presented in a way that is courteous to the smoker.

There is the issue of what you can accomplish with limited resources as opposed to trying to build the best. We will use the auto industry as an example. You want to build the best SUV in the world, and you realize that if you are successful, you will capture the entire market. However, the shareholders say you can only have 10 per cent of the resources it would take to build that best SUV. Then you go out and build a vehicle that is worth 10 per cent of the best one, and you get 10 per cent of the results.

Montana is an example of a state with limited resources. Their first appropriation was adequate but their next was not, and the year-to-year gamble on whether you are going to have sufficient funds or not puts you in a difficult situation when developing a cessation program for adults, for example. People who want to quit have the support one day and not the next. It is a very difficult way to conduct a medical intervention. One day you are willing to treat the patient, and the next day you are telling him or her, "Sorry, we are not interested in seeing you any more." Those uncertainties in funding levels are frustrating many states in the development of their programs.

Then they have to pick their priorities and decide which one of these best practices is best for them and in which areas they really want to see results. Do they want youth tobacco use reduced, do they want to see adult cessation, or do they want to reduce exposure to second-hand smoke? Pick one or do them all. If you pick them all, you have to be honest about what it will take and not try to deliver a program with minimal resources.

Those are some examples of what is happening of which I am aware. Many states are currently delivering excellent programming, and I would say that Florida, Massachusetts and California are at the top of the list. Arizona, Washington, Minnesota and a couple of other states make up perhaps the next level of good examples, and more states will provide examples as their programming comes online.

That concludes my remarks, Mr. Chairman.

Senator Kenny: Thank you, Chair, and welcome to Canada, Mr. Wolfe. It is good to see you back. You made a comment a moment ago, when you were talking about SUVs, that if you invest 10 per cent of the required cost of developing the best possible SUV, you will get 10 per cent of the possible results. I would like you to examine that a little further for us. If you invest 10 per cent of the cost of an SUV, that might get you the axle and the two rear wheels.

Mr. Wolfe: It wouldn't deliver the four-wheel drive that you think you are going to get with an SUV.

Senator Kenny: It might not even get you the two front wheels.

Mr. Wolfe: It might not.

Senator Kenny: The question I am trying to put to you is this: Is there a critical mass that you have to hit before you have an effective program? If so, tell us a little about it. If we spend, say, $2 or $3 per capita, will that give us $2 or $3 worth of value when we know that the Atlanta Centers for Disease Control is recommending somewhere between CAN. $9 and CAN. $22?

Is it fair to say, if you are getting some money, maybe a third or quarter of what you need, that you are getting some results from that?

This is a serious question. Is it a viable approach to begin with limited resources and try to ramp them up, or do we have to hit a certain level before we are going to have anything effective?

Mr. Wolfe: It is an excellent question, and I will try to answer it in stages. First, I would like to attack the idea of ramping-up. There have been examples in the States where the legislature says we will give you 10 per cent of the money for year one, as you will need that to get started, and maybe 20 per cent in year two. What happens is, they never fulfill the commitment. They never get to the 100 per cent that was originally asked for because by then, they are trying to convince a new group of legislators of the value of the program.

Remember that my background is in business and politics, and frankly, the ramping-up idea is a way for elected officials to tell the voters back home they have done something about the problem, and then not do anything else.

There is a critical mass. Please do not ask me to look into a crystal ball and tell you what it is. I would have to spend a lot more time in your country to understand the costs associated with delivering a program.

What I can say is that we have found that you will not achieve results without providing full and complete resources for an anti-tobacco program.

I like to use an example which I think is appropriate when speaking to legislative and elected bodies. When a campaign manager tells an elected official what it will cost to run that campaign, it is very unusual for the candidate to say no, let's run it on 10 per cent of that. Usually, the candidate figures out how to raise that money and run the campaign to win. I have never seen it the other way around.

If anything is more important than an opportunity to freely elect your officials, it is to have good health and protect young people in any country.

Therefore, the idea that you would say no, let's only spend 10 per cent of it is on shaky ground in my mind.

Using this example, I think nobody would want to launch a campaign without adequate resources. You can make decisions on what it is you are really funding, but it is important to say up front, "No, we do not want a cessation campaign, we are not going to get involved with helping adult smokers to quit; or all we are going to do is help adult smokers quit. We are not going to pay attention to young people who are continuing to use tobacco products at increasing rates."

If you have to start making those choices, you are not delivering a fully comprehensive and integrated campaign. Unfortunately, those are choices that sometimes come to the table, but given the opportunity, everybody involved in tobacco control would like to deliver an across-the-board, comprehensive program, because that is what works.

Senator Kenny: Let me give you an example. Say in Canada it was concluded that it would take $90 million to launch an effective tobacco control advertising campaign. Could that campaign possibly be effective if it was not coordinated with local, state-wide or regional programs, the other elements of a comprehensive program?

Really my question is, if you do not have the other elements in the program, will any one of the components function effectively?

Mr. Wolfe: Can you do one without the other? The answer is simply no. Doing one element of the campaign and letting it stand on its own will not achieve behaviour change. Behaviour change happens at a community level. As it becomes a sustained effort, everybody talks about it, everybody is aware of the issue, and everybody learns that the reason tobacco products look sexy, cool or rebellious is because the companies are great marketers, not because the product has any inherent value.

That change at the community level has to happen. It does not happen just through running a great advertising campaign. It happens through being present on the ground. Similarly, elected officials cannot run a campaign just on good advertising. They have to be willing to get out there and meet the electorate. These things happen because people start talking about them on a local level.

Senator Kenny: Are we being overly worried or overly cautious if we are fear that by running a good advertising campaign alone, we might discredit a comprehensive tobacco campaign down the road?

Mr. Wolfe: There is some history to this. Some places have launched anti-tobacco efforts with either minimal funding or funding for one program category only. There has been suspicion that there was a secret desire for them to fail. Whether that is true or not, it leads to speculation that that could be the result.

Launching one component without the support of the others is like sending your army off to battle and cutting off the supply line; you just do not do it unless you are not interested in them coming home.

In a war against tobacco, you would not just provide air cover without ground support, and so you need to be providing community-level education and cessation-level work at the same time. There are costs to that.

If you do not do that, at some point down the road, somebody will say, "Well look, we spent all this money doing this, but tobacco usage rates have not changed." And rightly so, because you have not done a complete program.

Senator Kenny: Thank you, Mr. Wolfe.

The Chairman: I want to welcome grade seven and eight students from Holy Angel School to the hearing. This is a Senate hearing. As you probably know, Parliament is composed of two Houses, the Senate and the House of Commons. We are from the Senate. We are holding hearings this morning on Bill S-15, an anti-smoking bill.

Bills can be introduced in either the Senate or the House of Commons, and this one started in the Senate. We are out here listening to the public's opinion of Bill S-15 as well as any improvements they might suggest. Then it goes back to Parliament. We report to the Senate, we have what is called a "third reading," and if the bill is passed, it then goes to the House of Commons.

That is some civics for you today. Tell your teachers that I hope you get a couple of credits for that.

I should also introduce committee members to the class. Senator Kenny and Senator Kelleher, who are tying down each end like bookends, are from Ontario. I am Senator Taylor, and I and Senator Banks are from Alberta. Senator Adams is our only bilingual member. He speaks Inuktitut as well as English. He is from Nunavut in the far north.

Senator Adams: It is nice to see you again, Mr. Wolfe. I last saw you in Ottawa last fall. It is very obvious to me, living in the Arctic rather than Florida, that we have a different culture. Our native community has the highest smoking rates, and over 70 per cent of young people in the territory smoke.

My concern is that we do have a commercial now. I think everybody knows cigarette packets tell you that cigarette smoking can give you cancer and you can die. However, people are not really concerned about it. In the meantime, we have some cancer posters in the malls and on the walls in some public places. Maybe it is more sexy in Florida and California because you have warmer weather and long daylight hours.

Especially in the High Arctic, the days are getting longer now, and we will have 24-hour daylight beginning in September. Then we never see daylight for three or four months. I think that is why people smoke so much, but I am not sure. Maybe that is the reason some of the young people are addicted to nicotine.

Is it mostly the municipalities in the States that are starting to make more regulations about people not smoking? Is it mainly the government, or how does it work?

Mr. Wolfe: Sorry, are you asking if government at the community level is involved in getting kids not to smoke?

Senator Adams: In the States.

Mr. Wolfe: One interesting thing related to some of your comments is that Florida has a variety of populations, for example from Puerto Rico or Cuba, or visitors from Germany or Canada. There are many different cultures to relate to, which goes back to our earlier conversation about advertising. You can launch a big campaign to cover a mass population, but it does not work when you get right down into the community where they might not speak the same language or have the same cultural norms that broadcast television delivers. That is why it is called "broadcasting."

You need to be in the community and working within its cultural norms when you are trying to change behaviour, and "community" can be defined in terms of age and not just geography.

Community-level programming needs to take account of geography, age, sex, and other appropriate program descriptors. For instance, Oklahoma, which has Native American populations in the south-west, is trying very hard to develop a specific program for them. They are finding that the only way to do that is to allow them to design the program, and not to preach what it should be from an academic viewpoint.

There are good examples of that throughout the States, and in fact the American Legacy Foundation this week announced $21 million in additional funding for people to work directly with special populations on coming up with anti-tobacco messages.

Senator Adams: Right now, just some of the organizations have funding, and it will do more good in the classrooms and some of the public places. Is more being done now than before on the concern that cigarette smoking is bad for your health? Did you say that smoking among adults has been reduced by about 54 per cent?

Mr. Wolfe: The education question is a two-edged sword. You will never see the Truth message delivered in a classroom because that has a stifling effect on young people. Anti-tobacco messages delivered in a traditional classroom setting prove to be less effective than when delivered through cool, hip media, whether it is the Internet or television.

As I described earlier, the additional materials that teachers can use in math or social sciences are a way to deliver tobacco information outside the traditional health curriculum, and it appears to be having much more success in some states.

The State of Washington recently released a study on two curricula recommended by the Centers for Disease Control that demonstrated zero effect on behavioural change.

The State of Florida had a similar experience. If you use the traditional classroom as a delivery vehicle for these messages, you have to be very careful not to tell people something that they already know and will tune out.

Senator Adams: Yes. However, I think you have to have people at least visiting more classrooms. I do not know how the education system works. Some teachers may say, "Do not bother me. It is my turn to teach here today, and you are campaigning for kids not to smoke." In the meantime, as soon as it is recess, or they go home for the day, the kids say, "I have no use for somebody telling me not to smoke."

I want to know how things work in the classrooms. Especially where I live, as soon as they are finished school, they will go home and watch TV. I would like to find out how things work.

Mr. Wolfe: I am hesitant, of course, to compare youth norms in the States with cultural norms in Canada. However, I can tell you that one of the classic findings was, the minute you tell a teenager not to do something, you have invited that behaviour.

We do not tell anybody not to smoke. That is pretty much the "kiss of death" for any of our efforts. Therefore, if you are asking about effective ways to deliver the message, give them the responsibility and control to develop their own messages and programming, and they will do it themselves. Give them an opportunity, if they care about the issue of tobacco and want to learn more about it, to self-select and become involved. They will become involved when they learn that they have real responsibility, real authority over either dollars or programming, and those types of decisions.

Senator Adams: It should be no different for the Girl Guides and Boy Scouts. We have lots of Cadets, Boy Scouts, Girl Guides and other organizations like that in the territories, and it should be no different, if it is something of interest in the future.

The Chairman: You intrigued me when you talked about the youth committee in Florida being in charge of a how many millions-of-dollars campaign?

Mr. Wolfe: It was US$70 million.

The Chairman: $70 million. The youth decided how the money should be spent. Can you tell me about the make-up of that committee? How large was it, how many boys and girls were there, and what were their ages?

Mr. Wolfe: Yes, I would be happy to. The state legislature passed a bill that provided for the five program areas that I have described and a lump sum for each. We met with 600 youth at a youth summit, and they helped clarify what should happen in those program areas. Then they gave us the parameters for developing those programs, which we took back to their board of directors. Their board was composed of 70 young people from around Florida; there was one from each of Florida's 67 counties.

The Chairman: They were appointed?

Mr. Wolfe: They were selected by the kids.

The Chairman: By the kids themselves?

Mr. Wolfe: Yes, they decided who would represent them on the board of directors, just like any group of shareholders will elect a Chair. There were also three members at large.

In the beginning, the large group of 70 met on a quarterly basis. Then they narrowed that down by choosing a 10-member executive committee that we, the staff, met with on a regular basis. We described that relationship as one of staff and shareholders. They were the bosses and we were the staff who implemented what they wanted.

A great example is when they decided they wanted a train tour to spread the Truth message all around Florida. As dutiful staff, we tried to find them a train, but failed. We came up with the alternative of buses. We went back to the board of directors and said, "Well, we could not get you the train, so we want to use buses." They asked to discuss it among themselves. They came back to us and said no, they wanted a train.

We had done all this work to find the buses, we had the contracts in place ready to go, and they wanted a train. They got it. We found a train and reserved tracks for 11 days. We had 10 cars on the Truth train and we had them specially painted for the trip. When NSYNC is showing up for part of the event, you want it to look good, so we agreed to paint the cars. It is an example of how they were responsible.

The Chairman: What were their ages; were they from high school?

Mr. Wolfe: From 12 to 18. The leaders were primarily in the 15 to 18 age range.

Senator Kenny: Tell us the results again.

Mr. Wolfe: Of the overall program? After two years, there was a 54 per cent decline in smoking in middle school and a 20 per cent decline in high school, high school being 14 to 18 and middle school 12 to 14.

The Chairman: A train would go over well in this country because everything was built along the railroad tracks.

Senator Banks: I want to follow up on Senator Taylor's previous question. I really like your analogy of air cover and the effort on the ground. I also liked your shareholder analogy. Senator Taylor asked about the program direction. I have been involved many times in advertising and marketing efforts, and in broadcasting in one way or another, and I therefore have a keen perception of the sensibilities of creative people. I am just imagining moments which I know must have happened between the board of directors as you described - and I think that is exactly the way to do it - on the one hand, and the creative advertising/marketing people on the other, who would no doubt try, as ad agencies do, to convince the board of directors or management that they did not understand. "Let us explain to you how this should be done."

That kind of creative tension must surely have occurred in the situation which you described. Did the board of directors always prevail? As they should, I suppose. I have to tell you that I am coming at the question from a different angle, because I used to be the creative director of an advertising agency, and I know the disdain in which we used to hold our clients' management personnel, whom we regarded as idiots who had to be trained and disabused of their stupid ideas. They signed the cheques, so we had to do that very carefully.

What happened when that creative tension occurred?

Mr. Wolfe: You have hit on a very fun point, to be frank. The concept of youth empowerment to tackle youth tobacco use receives a lot of lip service and sounds very good. Then when you try to put it into practice, the adults who used to have the power try to say, that it is not a good idea. You really do not want a train, you really want buses; if you have a group of determined young people like you hope you have, they will remind you of your place as the staff person.

I do not want you to think that it was all glory all the time. There were definitely times when developing the board of directors and staff concept was very difficult for the adults involved. It was also very difficult for the young people involved because they had never been in this situation. Frankly, nobody had ever said before, "Here is $70 million; go do it." We had to recognize they didn't understand when we talked about shareholders and a board of directors and budgets. Conceiving of $70 million was just beyond them.

Therefore, we found ourselves in the position of training our shareholders.

Senator Banks: And there is a danger in that.

Mr. Wolfe: There is a danger. You might try to train them to do what you want, and it took a lot of reminding the adults involved that this was not their program, this was the young people's effort. All the adults, whether they were long-time health practitioners or members of NGOs concerned about smoking, had to rethink that.

The advertising agency was actually the easiest group to help rethink because they were edgy. We were very blessed in that we found the right agency for the job. We were not saddled with an existing contract. We conducted an open search, free of any political influence, and retained an extremely edgy agency that developed what is now an award-winning ad campaign. Their original attitude was, "We have never done this with a client before. Usually, we bring the creative ideas, we hear a little feedback and tweak it a little, but we do not really move away from our concept." Their first concepts were much too edgy for the young people. The kids said, "No, no, no. We do not want to be mean about this. We want some humour; we want it to be a little lighter."

That was a pretty strong direction for a client to give, and the agency was wonderful about revamping it completely and coming back with a much more fun, light-hearted way to deliver the message.

This education continues as your partners change. We were blessed in working with some wonderful agencies in Florida. The Nixon Group and Crispin, Porter & Bogusky were very good firms that continue to be dedicated to this and to preaching the message of youth empowerment.

It was very interesting in that when the kids would say we want to do this and the advertising agency's initial reaction was negative, the kids would say, "Well, tell us how it works. Tell us what it is that you do. How do you make an ad?" Then we realized we had to spend a lot of time bringing folks up to speed on what these programs do and how they are developed. It is just like, how do you write a book for a classroom? How do you get your own chapter in a book to talk about the Truth campaign? We took all of those steps as time went on.

We learned lessons from which other states are now able to benefit, but they are still having to teach adults how to let go and let young people make decisions.

Senator Banks: That sounds exciting, and I hope that if this bill succeeds, it will follow that process.

I have a technical question, and I am sure that you are the best person to answer it because you have been involved in this from the start, I believe.

I do not know if this has a mirror in Florida, but if so, I would like to hear about it because it would certainly affect the design and delivery of programs. We have heard that there has been a significant decline in smoking among adult men in this country which has not been matched in women. In fact it seems to be going the other way. We also hear that there are differences between the genders in young people that vary according to the demographics and geography of our widely diverse country.

Were you able to design a generic program that was sort of one-size-fits-all or "unisex," if you like, or did you sometimes have to tailor your message on a gender basis in some parts of the state because of the different cultural practices of the population?

Mr. Wolfe: That is an excellent question that demonstrates your knowledge of advertising. The truth is that even within one state - and many are finding this out - there are varied demographics and cultural norms that have to be addressed.

In Florida, for instance, we discovered after year one that we had made no inroads among African American youth using tobacco products. While they use the product at a substantially lower rate than Caucasian youth, we were still concerned that we were missing the mark.

We also learned that certain slang words played better in Orlando than in Miami. Therefore we actually produced two ads in which one word was different because it was noticeably more acceptable in one part of the state than in the other.

Senator Banks: That is right. For example, if I said to you, "Pass a serviette; I just spilled poutine on the chesterfield," you would not know what I was talking about.

Mr. Wolfe: I would have no clue, and I hope I have not spilled that, whatever it is.

Senator Kenny: We will translate that. "Pass a napkin because we spilled cheese and fries on the sofa."

Mr. Wolfe: Your point is well taken. This goes back to two points that I would love to reiterate. If you are going to enter the battle against tobacco, you are going to enter a long war. This is not something that can be accomplished in a year or two. It is a long-term process that needs to be sustained for a long time without interruption.

California is a dramatic example of how, when the program was interrupted in the middle of the last 10 years, rates rose dramatically again. That makes total sense. You do not start a war and not try to finish it. If you are going to fight this, you need to do so over the long term, and that means addressing every part of your country, every community, every subset of that community, and every demographic group. Whether communities have a 70 per cent prevalence rate or a 15 per cent rate, they should all be addressing the issue.

Air cover that is just a broadcasted message does not lead to sustained change. You have to allow the local community to build and deliver a well-nuanced program.

Senator Banks: One last question. You have just made another war analogy, and I will now tell you it is my personal impression that the war on drugs has failed, will continue to fail, and cannot succeed in the way that it is now being waged.

Are you saying that the war on tobacco, which is a drug, can be won when the other cannot?

Mr. Wolfe: I am saying it is being won, and that we now have dramatic examples of that.

Let's be fair. This is a legal product for people over 18 and the States is not trying to eliminate the product. While there are some who would like to see the product completely eliminated, that is not what I am speaking of. I am speaking about how to prevent people from starting to use a product that great marketers tell them is sexy, cool and rebellious, but in reality is not.

Prevention is one thing. I am not talking about eliminating or eradicating or prohibiting the product. That is what the war on drugs is about.

I think there is a distinct difference between a prevention campaign or nicotine replacement therapy or cessation efforts, and the complete prohibition or eradication of other drugs.

Senator Banks: Therefore if we continue the analogy - and this is a little off our direct topic - the war that you are talking about is having success.

Mr. Wolfe: Yes.

Senator Banks: I suggest the other one is demonstrably not.

Mr. Wolfe: Right. I am not going to comment on whether it is or is not a war on drugs. I have done my best to separate the two in the States. However, to continue the analogy, tobacco has taken more lives than any other battle, so it is appropriate to talk about loss of life.

Thinking about this effort as a battle for market share can even be more appropriate. That is exactly how your competitors, the tobacco industry, think of it. They think about which company has the largest market share and how to get more of the market.

For a long time, the companies in the States thought about how to get young people to enter the market and choose their brand, their products. If you think of it as a battle for market share - and this is a little different from traditional public health thinking - your market share is the number of tobacco non-users or the number of youth who do not become customers of your competitor. There is a very clear distinction between who is winning or losing in the battle for market share.

I am telling you that there are great examples in places like Florida and California and Massachusetts of how you can take market share back when you have not been in the fight for a long time. You can enter it and begin to reduce your competitor's market share.

The Chairman: If students from Holy Angel and Senator O'Connor have a question, this is an informal meeting.

Mr. Wolfe, you mentioned cultural differences. We heard in Western Canada, particularly in Alberta yesterday and the day before, that there is a problem there with chewing tobacco. "The Marlboro man" there is bypassing cigarettes and using non-smoke nicotine. Have you run into that at all in your campaign across the U.S.?

Mr. Wolfe: The United States tobacco company that produces smokeless or spit tobacco has done a great job of marketing its products, primarily through rodeos. That needs to be considered in the context of overall use of tobacco products.

There is an alarmingly high rate of spit tobacco use by boys as young as nine and ten years old in some regions of the States. Many of them have begun carrying a tin in their back pocket because it is culturally acceptable in their community; they want to start wearing a circle in the back pocket of their blue jeans.

Again, this drives home the point that simply running advertising will not change social norms. It is not sound business to develop an ad to be broadcast nationally to deal with a local cultural phenomenon. Instead, you need to use what we call "grassroots marketing," or "street marketing," or "the plains marketing" in the case of rodeos, where you delivering a message in an appropriate way, which could mean having a presence at the rodeo or striking an arrangement with the biggest pick-up truck dealership in the area. It depends.

Culturally appropriate message delivery is what really leads to sustained change.

The Chairman: I guess you realize that we might cut out a certain number of baseball pictures too. There was one question at the back

Ms Agnes Sader, Student, Senator O'Connor High School: I just have a comment. I think this bill is a good idea. Youth should be protected and that is a good time to start, and but it is also important to raise the issue with younger children, because I know that I was aware of cigarettes when I was about five or six.

I believe that our society thinks we shouldn't tell these poor little babies anything, and yet they are learning about this stuff and gaining these ideas at a young age.

We should basically set an example and tell them exactly what is expected and what happens.

I have seen some of the government commercials on the effects. For example, there is one commercial showing something being taken out of a vessel from the heart. I personally think that is ineffective, because teenagers do not really care about the costs and other things. There are a lot of health care problems and a lot of people getting sick from smoking, especially baby boomers, who are coming into their prime now.

When you think about it, there are a lot of young people right now who outnumber other groups, like little children and the older people, so when the number of people who smoke rises, so will disease and health costs. We will still be paying for this either way. Either we are going to help now while there is still hope, or when somebody is being wheeled into the hospital suffering from the effects of smoking.

The Chairman: Did you want to comment on the comment, Mr. Wolfe?

Mr. Wolfe: I did not need to comment. What you have just seen is the greatest example of youth empowerment you could have. Any ad agency that sat down and chatted with her one-on-one - what used to be known as the focus group method - would have learned that those ads were probably going to miss the mark.

I have not seen the entire campaign, but I think this is an example of what needs to be done to deliver culturally appropriate messages.

Senator Banks: Mr. Wolfe, we are talking about advertising and marketing, as was the young lady. Have you had a chance to see the newspaper ads that the tobacco industry is running in Canada?

Mr. Wolfe: I am not sure if this is what you are referring to, but I saw today's ads where two tobacco companies were saying they were supportive of S-15.

Senator Banks: What do you make of that?

Mr. Wolfe: I do not know what to make of it. We have never seen such a thing in the United States.

The Chairman: It is like your first hockey game, is it? Those are the two biggest tobacco companies.

Mr. Wolfe: Well, I would say, congratulations. If that is a sincere change in attitude, it seems to demonstrate a progress that perhaps litigiousness in the United States has not encouraged. The progress we have seen does not appear to be that public.

The Chairman: We have a question from the audience.

Ms Roslyn Levy, Youth Tobacco Coalition: I just want to respond because you are not from Canada. I am with the Youth Tobacco Coalition, an organization driven by young people in Ontario, and I would say from consulting with our youth, their perception is that the companies are telling them not to smoke. As was already mentioned this morning, that is the biggest come-on for youth to start smoking.

Mr. Wolfe: Yes, I think part of the answer lies in how this is followed up. Do they launch their own "Think, do not smoke" campaign, as Philip Morris did in the States, and which many people believe was designed to encourage tobacco use? Or was this an ad directed at you, coming to town for a hearing?

Senator Banks: Those are national ads.

Mr. Wolfe: Are they celebrating the fact that you are having these hearings and trying to publicize this at the same time? I do not know. I am not sure what strategic thinking in a corporate boardroom led to the production of this ad. If it is a way for them to tell young people not to smoke, then you are right, it will have the opposite effect from what we all would like.

The Chairman: I believe one presenter a couple of days ago said that the ad tried to get a message across that smoking is an adult pleasure, which is guaranteed to make youth want to try it. It is adult pleasure, and you youth shouldn't smoke.

Mr. Wolfe: Interestingly, after the master settlement agreement in the States, one tobacco company launched a massive advertising effort to improve their public image by talking about feeding the homeless, delivering food to seniors who are shut in, and that type of thing. They actually spent more money promoting what they had done than on doing the good deed, which tells you that sometimes the priorities are not what we think they are when we read advertisements.

The Chairman: Thank you very much, Mr. Wolfe, for providing us with your views, and thank you to the audience too. This wraps up the morning session. This afternoon we will begin at 1:30 to hear one additional witness on S-15, as well as witnesses relating to the study of energy. We are combining the two.

The committee adjourned.

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