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

Issue 8 - Evidence

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OTTAWA, Thursday, May 10, 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 9:10 a.m. to give consideration to the bill.

Senator Mira Spivak (Deputy Chairman) in the Chair.

[English]

The Deputy Chairman: Good morning, and welcome to our witnesses, Dr. Robert Cushman and Dr. Andrew Lynk. We are here to examine 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.

I know you have some presentations. Please proceed. The senators will have questions.

Dr. Andrew Lynk, Canadian Pediatric Society: Honourable senators, thank you for inviting me to make my presentation here today. My name is Dr. Andrew Lynk. I am a community pediatrician from Sydney, Nova Scotia. I am speaking today on behalf of the Canadian Pediatric Society. We are a national organization. We represent 2,000 Canadian pediatricians from across the country. One of our primary mandates is to advocate for the health and well-being of our nation's 7 million children and youth.

Let me be clear, honourable senators, that the Canadian Pediatric Society strongly supports Bill S-15. While the federal tobacco control initiatives that were announced back in April 5, 2001, are welcome, we feel they are insufficient to do the job.

I am sure all the honourable senators are aware of the health consequences of tobacco products but, just for the record, I would like to highlight some of the relevant facts.

We know that smoking is the number one cause of preventable death, premature death and disease in the country. The use of tobacco products causes many forms of cancer, heart disease, stroke, chronic lung disease and, in terms of children, it is associated with still births, infants of low birth weight, sudden infant death syndrome and long-term negative neuro-behavioural consequences. It kills 45,000 Canadians every year prematurely. That is more than the combined rates from AIDS, car accidents, alcohol abuse, illegal drugs, homicides and suicides. That is more than the total number of Canadians who died fighting during the six years of World War II.

Over 200,000 Canadian children annually become addicted to nicotine, and approximately 25 per cent of those children are destined to die of their addiction by middle age. We know that about 25 per cent of Canadian adults smoke. The percentages range from about 20 per cent in British Columbia to 29 per cent in Nova Scotia. The percentages are higher still among the First Nations, Inuit and Métis populations.

Approximately 29 per cent of Canadian adolescents smoke. The low of 24 per cent is found in British Columbia and the high of 36 per cent is found in Nova Scotia. Where I come from in Cape Breton, 40 per cent of the adolescents smoke and this figure includes about 50 per cent of our young pregnant mothers.

For 80 per cent of the people that become addicted to nicotine, the addiction will occur before they reach the age of 16. Therefore, when the tobacco company tells us that smoking is an adult choice, I submit that their statement is false. Smoking is an addiction of young people.

Almost 50 per cent of Canadian children are exposed daily to environmental tobacco smoke, or second-hand smoke, which contains over 40 cancer-causing agents. It can be associated with increased rates of asthma, pneumonia, cancer and sudden infant death syndrome. In summary, this is how you spell "carnage."

Physicians are rightly encouraged by the health ministries, hospital administrators and health economists to justify their health care resources with state of the art evidence. This is known as evidence-based medicine. We submit that governments also have a duty to develop and implement evidence-based policies that will benefit the health of all citizens.

There is ample evidence in the health care literature to design and implement an effective, comprehensive, tobacco control strategy in Canada. I would like to refer you to three documents with which I am sure you are familiar. One document is from the United States Centers for Disease Control and Prevention paper entitled, "Best Practices for Comprehensive Tobacco Control Programs," published in August 1999. There is also the U.S. Surgeon General's Report from December 2000. Just to be patriotic, there is also the Steering Committee of the National Strategy to Reduce Tobacco Use in Canada, which was produced by the provincial and territorial deputy ministers of health in 1999.

Together, these three documents provide a blueprint and a plan on how to implement an effective national strategy. I would submit to you that Bill S-15 gives us the means to do this.

When you review the highly successful tobacco control programs implemented in such places as California and Massachusetts, you will see that there are several key elements used for effectiveness. We have to have programs that combine prevention, protection and cessation. There has to be built-in evaluation and accountability. Most important, there must be stable long-term funding in the order of anywhere from $9 to $24 per capita per year. There also must be elements of community and regional coordination.

Both the Centers for Disease Control and the Canadian study recognize that a comprehensive approach combining these key elements is likely to have a positive effect in reducing tobacco initiation and consumption. While the Canadian Paediatric Society welcomes the recent federal tobacco control initiatives, we feel that they are insufficient to do the job. In fact, they may even undermine the credibility of future tobacco control initiatives. For the following reasons, we would urge that the Senate pass this bill.

One reason for the passage of this bill is that Bill S-15 addresses the funding gap. The federal government proposes to increase its tobacco control funding from the current 66 cents per capita to just over $3 per capita. Bill S-15 would provide $12 per capita, in accordance with the Centers For Disease Control guidelines which are between $9 to $24 per capita.

Second, Bill S-15 provides $360 million per year in long-term funding. The federal government would offer only $96 million for five years. And there would be to guarantee that it would not be cut. This happened to their tobacco control budget back in the 1990s. At that time the government cut back many programs due to its austerity program. I say to you that it will take far more than five years to significantly lessen the current carnage from tobacco addiction.

Third, Bill S-15 creates an arm's-length foundation to administer resources from this levy. This foundation is modelled after the highly respected Canadian Institute of Health Research. It has several advantages. One, it depoliticizes tobacco control. We know from both the United States and Canada that the politicians can interfere with a successful program. Two, it provides 10 per cent of its funding for evaluation, which we believe is key. We will be able to know both the successes and failures. This will allow the tobacco control community of both policy people and scientists to develop better programs based on the published evidence.

While we welcome the federal government's initiatives to increase the tobacco taxes, we maintain that those taxes are not high enough. Although long overdue, we applause the increase in tobacco export taxes in order to decrease smuggling. The attempts to set measurable ten-year smoking targets are appreciated, even though they are rather weak and pale at best.

We doubt that these measures will significantly address issues of tobacco and health in Canada. The resources and the time frames are too limited. I will remind you that last year, when this bill was before the Senate as Bill S-20, two out of the three CEOs of Canada's major tobacco manufacturers supported this bill. I am not sure why they did, but they did. I have to go with that.

The Canadian Cancer Society did a poll, about one year ago, and found that 74 per cent of Canadians supported the bill.

In summary, we believe that the war against tobacco is being lost. In 1990, 21 per cent of our youth smoked and in 1998, 29 per cent smoked. Forty-five thousand Canadians die every year and over 200,000 new child soldiers are being recruited each year. Believe me, they are being actively recruited by the tobacco industry. Make no mistake, this is a war.

Given what we know now, we have a chance to take a quantum leap forward. The social climate for significant change is much more favourable than it was even five or ten years ago. As I mentioned to some of the senators around the table last week in Halifax, when I first came as a paediatrician to Cape Breton about 10 years ago, I was green. I went into the hospital to the labour and delivery rooms. I remember delivering a premature baby that was so small that he could fit in the palm of my hands. He was two months premature and gasping for breath. I had to take this baby out of that room, down the hall to the neo-natal intensive care unit. On my way, I had to pass by the waiting room where all the family members were waiting. They were smoking their brains out. A blue haze wafted out to the hall, and I had to take the poor, gasping baby through that smoke.

I thought to myself that it was a crazy situation. We then worked very hard to remove smoking from the third floor, where obstetrics was located. Later we worked on having smoking in the hospital completely banned. I was called a fascist. People wrote me nasty letters.

Now, 10 years later, along with Ottawa and the help of Dr. Cushman, the Medical Officer for Ottawa-Carleton, Sydney, Nova Scotia, has passed a smoking bylaw that will ban smoking in all restaurants, bars and casinos. This will come into effect within the next two years. Ottawa has done the same thing. We beat Ottawa by one week, I would like to say, but we worked together. That is how far this has come.

The Chairman: Everything is slower here.

Dr. Lynk: I have a 17-year-old patient who has cystic fibrosis. Cystic fibrosis is a disease that progressively plugs up your lungs with mucous. It destroys your lungs. Young people die from it in their teens or 20s. I discharged this young fellow last week and he said, "Dr. Lynk, I really think I am going to die this time. I feel like I am dying because things are getting worse." I said, "Yes, they are getting worse." He smokes. He has smoked since the age of 12. We tried to get him off cigarettes with the help of nicotine patches and pills. We just cannot succeed. That is how addictive nicotine is. If you combine the addictive nature of nicotine with that of the marketing practices of the tobacco industry, you have a lethal combination.

Senators, you have an historic opportunity today to legislate sustained, substantial and significant funding for an evidence-based, comprehensive, tobacco control program. You have the opportunity to turn the tide against this terrible carnage. If the 45,000 young people who are about to die were dying immediately, as opposed to these young people who will have to wait 20 or 30 years before they do die, I think things would happen far more quickly.

The health impact of Bill S-15 will be on par or exceed those programs and laws governing clean water, seat belts and vaccinations. If the federal government passes Bill S-15, or one similar in principle or funding, it will probably do more for the health of this nation than all of the thousands of Canadian heart, lung and cancer specialists can do in their combined lifetimes. There is no doubt about it. Dr. Cushman and I and others cannot win this war. We are losing this war by ourselves. We need your help.

Tobacco addiction is the major childhood pediatric disease of our time. If the federal and provincial governments ever wanted an inaugural program for their national children's agenda, Bill S-15 is it. We urge that the Senate pass it.

Robert Cushman, Medical Health Officer, Region of Ottawa-Carleton, Health Department: Thank you very much, Mr. Chairman. Good morning, senators. It is a pleasure to be here and to speak on this very important issue. I must say, a lot of our presentations overlap and touch on the same themes as those of Dr. Lynk. His is a hard presentation to follow. However, I will try to highlight a few points that Dr. Link has made. He has made a very compelling argument for the importance of this bill. He has pointed out that this bill has the potential to rank as one of the major public health innovation bills in the history of this country. We would like to see this bill alongside the bills dealing with immunization programs and seat belt legislation.

While we do recognize that some recent federal progress has been made on the tobacco front we still have some concerns. One is the independence of Health Canada. Health Canada, because of the political pressures that Dr. Lynk alluded to, has historically not been able to effectively fight the tobacco war.

The second issue is the $3 per capita that is being spent on this war. You have heard that this amount is inadequate and falls well short of Best Practice guidelines.

To put it into perspective, this government wants to spend $3 per capita on tobacco control. That is roughly $100 million a year. Ladies and gentlemen, that is the combined deficit of the local hospitals. That is their margin of error. Consider how much more important this issue is. In terms of health care costs and health care benefits, that figure is nothing. It is inadequate. As I said, that amount is the combined deficit of local hospitals. It represents a managerial margin of error or perhaps a touch of hospital underfunding. It is peanuts in comparison to what we could do with more money.

The third issue is political whim, the in-and-out factor, the fact that money comes and goes or might be removed. This bill is designed so that the funding is essentially tagged to the problem. The more cigarettes that are sold, the greater the problem, and the more money there is available to combat it. Theoretically, over the years, when this war is won, we can get into a sort of a demilitarization of the situation.

The fourth issue is the Best Practices for Tobacco Control Programs paper and it's evaluations. No one in this country has a better understanding of that than Senator Kenny. He deserves to be applauded.

My last appearance before this group was on D-Day. You have heard that more Canadians die every year from tobacco than died during the entire course of World War II. I would like to make some analogies to D-Day, as I did on that particular day.

We need a comprehensive approach. You cannot have a single-faceted approach. D-Day had naval, air and land support. There was a fantastic multiplier effect. That is what this bill looks at. You need prevention, protection and cessation. All these things go together. Individually, they do not really make much of a contribution, but together there is a significant multiplier effect.

Second, we need the money. We need the resources. Think about what went into D-Day. It has been said we cannot spend all this money right away. In fact, let it earn some interest in the bank while the plan is organized. In fact, a lot of the plans are here and available. We have not yet heard from the powers to be as to what their plans are and what their purpose is.

The third point is, let the generals do the work. I will tell you some stories about how tied down I am by "administrivia" and funding issues. Let the people on the front line do their work. Let my public health nurses in the schools do their work. They should not have to worry about funding. Our program should not be reduced by one third because someone is on long-term disability. That is how precious and fragile these resources are.

That is the analogy to D-Day. We need a comprehensive approach and adequate resources.

As for a comprehensive approach, you have heard the importance of all these factors, price included, but I would like to come straight to the purpose of the bill. The purpose of the bill is to protect our youth.

This statistic has been given to you this morning. Some 29 per cent of Canada's youth smoke. I submit to you that figure is the most important public health figure and statistic in the land. It tells you two things. It tells you where they youth come from. It tells you that they are hooked by the age of 19, or that they are experimenting and are close to being hooked. Fifty per cent of them will be unable to quit. Some 45,000 people a year will die. That is the most important statistic. That statistic is more important than the percentage of low birth weights or the average lifetime expectancy. That is the cardinal figure and that is what this bill deals with.

I would like to give you some personal anecdotes from my experience here in Ottawa. I have three nurses in the schools. One of them is on long-term disability. We now have two nurses for 300 schools. That is for 150,000 kids. What are we doing?

You have heard of the problems in the teaching profession. Do you think that, with the new curriculum and all the pressures of extracurricular activities, teachers can deal with tobacco problems? No, you do not think that. Three nurses; one is home sick, so I have two.

What would it cost to have a good school program, a program planned centrally but delivered locally? I suspect that we could do it for $2 or $3 per child. Perhaps we have 800,000 people in Ottawa. I suspect we could deliver the program and really make a difference for $800,000.

What about enforcement of sales to minors? Ontario has the Ontario Tobacco Control Act. I have two enforcement officers running around Ottawa. There were two federal officers helping them. They are not helping them any more. In their wisdom, Health Canada decided that because Ontario is doing such a good job the two federal officers were no longer needed. They did not want to duplicate services. As a result the number of enforcement officers has been cut from four to two. Did they look at the evidence? Did they look at the goals? The goal is for 90 per cent compliance, that nine out of ten corner stores do not sell tobacco to kids. Guess what? We are at stuck at 70 per cent compliance. That means that three out of ten of the vendors in these stores will sell tobacco to kids.

We are not doing our job. We are not meeting our goals. Yet, the federal government, in its wisdom, decided that Ontario is doing a great job and reduced the officers in Ottawa from four to two.

What would it cost to do this? Again, I think it would cost one dollar per capita to have a really good program in this city. This all falls within the levy. Actually, I think levy is the wrong word, but the amount that you are looking for is I think is $1.50 per carton. We could do it here. We have seen the evidence from Illinois and other jurisdictions, that if you have people visible and out on the street, it is like having no policemen for speeding tickets. In fact when the vendors see these people, they do not sell tobacco to kids. It makes it much more difficult for kids to get the product.

What about smoking cessation? Twenty-nine per cent of our youth smoke. Therefore, we not only have to look at prevention, we have to look at cessation. I had a pediatrician in my office the other day and we were talking about how we could have one physician associated with each high school in this community to run smoking cessation clinics.

We want public health nurses and other staff to support them. This comes at a price. We cannot afford this.

We were trying to think of ingenious and devious ways. Could the physician bring their OHIP number to the school? Could we inflate the billings with the OHIP number to pay for the nurses and the nurse practitioners to be there?

People in the front line should be dealing with health issues. We should be dealing with prevention and cessation. We should not be becoming deceitful accountants.

What do we do about a bylaw? Bylaws are important for kids. They protect our children. As you heard, a large number of our children are exposed to second-hand smoke. Once you go public on this, it protects them in the public domain. It also protects them in the private domain because there is "modelling".

It also is very good for youth, for kids. They cannot leave the school premises and go across to the greasy spoon to have a cigarette. There is nowhere to go except for the great Canadian outdoors. It denormalizes smoking and makes it more difficult to do. Guess what? I hate to say this with my colleague next to me, but we did spend quite a bit of money to mobilize the community for the bylaw, and now we will need to spend more to implement the bylaw. For $2 per capita, you could have a bylaw anywhere in Canada. You could have one bylaw to ban smoking and one bylaw to enforce it in the first year, when there are some difficulties. There would then be a steady maintenance phase.

Where did we get our one dollar per capita to bring this issue to town? We had to apply for grants. We were writing grants. We did not know if we would get lucky or not. Turns out, we did get lucky. We received some money from the Ontario tobacco control program. For something as simple as a bylaw, we needed to go to granting agents.

Health Canada bellied up late in the game. I received that usual call late this March. We received some money and must spend it before year-end. We did not get money until then.

Let me tell you another story. This was for the Ottawa bylaw. It was Health Canada tobacco money but somehow it had to be used exclusively for children. That money actually came from a nutrition program. Tobacco and a nutrition program! The money went to a private agency before it came back to a coalition. It then found its way into the pocket of the medical officer of health so that he could work on the bylaw locally.

Ladies and gentlemen, life should not be like this. We need stable funding. We know what can be done and what has to be done. We know that California has gone from roughly 30 per cent of youth smoking to 10 per cent of youth smoking. We have seen the great public service announcements. I am sure Health Canada can go out and buy those, but we need much more broad, comprehensive and deep programming.

I spend half my time fighting bureaucracies and being somewhat devious in terms of looking for which tree to shake for funds so that I can run my tobacco program. I should be able to get on with my job. Even more so, I think that my staff should be able to get on with their jobs.

Remember, we have gone from four officers to two officers for compliance sales in this city. We have one of our three nurses sitting at home on long-term disability. As was said by Dr. Lynk, this is a wonderful opportunity that we have in front of us. This is an opportunity to make a major difference and to protect our children and our youth.

As I said to you earlier, 29 per cent of youth smoke at the age of 19 years. They do not start at a later age. Many of them will not be able to quit, and many of them will die. That is the key statistic. That is the cardinal public health statistic that you people are addressing here today.

The Chairman: That is powerful testimony from both doctors.

Senator Spivak: Dr. Link, they find more and more diseases that are affected by smoking, including sudden infant death syndrome. Is that a recent discovery? Could you tell us more about it? Is it the cause of sudden infant death syndrome or part of the cause?

Dr. Lynk: It probably came out within the last five years to eight years. For senators who may not know, sudden infant death syndrome is the number one cause of death for children ages one month to one year, or it had been until recently. It was once called "cot death." In other words, a healthy child is put to bed and the next morning the child is found dead.

Senator Taylor: I did not realize that it was that high.

Dr. Lynk: Yes. The epidemiologists, the people who studied this issue, found that there was a number of contributing factors involved in sudden infant death syndrome. These factors included children who lived in homes where there was cigarette smoking. It also included children who were put to bed on mattresses that were too soft. The third contributing factor was children who had been put to bed in a room where the temperature was too high. These were all contributing factors to the death of the victims. Exposure to cigarette smoking was the number one cause.

Smoking is not the only cause of sudden infant death syndrome. There are other rare things. Some children are killed and it is called sudden infant death syndrome. There are all sorts of different issues there.

The other important contributing factor was the position of the child. Children had been sleeping on their bellies. We now say that it is best for children to sleep on their back in a smoke-free environment. It has been shown in New Zealand and our country now that those measures decrease the incidence of sudden infant death syndrome by almost half. However, cigarette smoke is a big risk factor.

Senator Spivak: What is the link? Is it the lungs? What is it about tobacco?

Dr. Lynk: We do not fully understand it yet. There is an association. I do not know the extent of it being an actual causal factor. It may be that smokers are in lower socio-economic groups and that their housing is poor and that their beds are poorly constructed. We do not know. Some people feel it may be a direct effect in terms of the breathing apparatus in babies. We are not sure.

Senator Spivak: What kind of research is being done in terms of smoking and tobacco to link them to other chronic diseases? I am referring to chronic diseases such as immune fatigue syndrome and migraine headaches. Some people suspect pollution in the environment, but I am wondering whether there is any research being done to look at whether tobacco has any link to these and other diseases. It seems to me that we find more and more things that tobacco affects every year. There are things that you would never suspect.

Dr. Lynk: That is an ongoing area of research for people who study broad-base population health. Epidemiologists are population health specialists. I am not sure how to answer that in terms of new things that may be linked to smoking. It is almost easier to tell you to what it is not linked to because the list is so long. Perhaps Dr. Cushman might want to try to answer that question in terms of new adult illnesses to which it has been linked.

Dr. Cushman: The point was well made, that the list gets longer all the time. We should concentrate on the big killers. Clearly in terms of the burden of illness, smoking is almost entirely the cause of lung disease. As to heart disease, smoking causes approximately 30 per cent of the problems. Osteoporosis, breast cancer, you name it. These are the physical problems associated with tobacco use.

Senator Spivak: Osteoporosis?

Dr. Cushman: Yes, it is very much an issue in terms of bone strength. Women who fall and break their hips in their 60s and who do not recover well, are usually smokers.

Senator Spivak: You are not linking that to tobacco?

Dr. Cushman: Yes.

Senator Spivak: I did not know this.

Dr. Cushman: The list is legion. The major health problems, such as osteoporosis, heart disease, stroke, sudden infant death syndrome, cancer, and asthma, are all linked to smoking.

I would like to add one more and that is addictions. If you look at the problems in our society, you will see that addictions are becoming more prevalent. Addictions other than the addiction to nicotine, can be to gambling or to other issues. We know two things.

Early use of tobacco is the gateway to further addictions. The other thing we know is that, contrary to what the tobacco companies tell us about the quality of life of smokers, tobacco use is just legion in psychiatric hospitals, in prisons and amongst teenagers with attention deficit disorder. It makes you wonder whether this should be a regulated drug sold by prescription or whether we should have stronger antidotes for it.

Senator Spivak: Perhaps these drugs should be in the Hazardous Products Act. We know about the big killers. Therefore, with the passage of this bill there might be money to study other things. If the other diseases were, for example, linked to tobacco the problem would be easier to approach, because you know the cause. I did not know about sudden infant death syndrome and now you are telling me about osteoporosis. I did not know about that either. The public needs to look at this as the major issue and yet the public does not do so. They know that smoking is a hazard, but when they consider cancer and heart disease they see a different picture. I comment on that aspect, because Bill S-15 might help to free up money for the kinds of things that we normally do not have money for.

Senator Banks: Good morning, doctors, and thank you for attending. I have read carefully, as I am certain that you have also read carefully, Minister Rock's announcement of April 5, 2001. This announcement, to which you have referred, outlines the government's new undertaking. Dr. Lynk said it was welcomed, but insufficient.

It seems to me that $100 million per year is a great deal of money. I think that most Canadians would agree with me. It is approximately six times the amount that we currently spend on tobacco reduction. I see things on television, and I see programs in the schools. It seems to me that if we multiply that by six, it will be a very substantial program that might actually work. Both of you have said, and we have heard others say, that, notwithstanding that increase and notwithstanding the fact that you welcome this new initiative, it is still not enough.

We continue to hear the word comprehensive. The Atlanta Centers for Disease Control recommends a comprehensive approach to the program. Minister Rock's background announcement states that this is a comprehensive program. He wants to spend $100 million over five years on a comprehensive program. How can you convince a Canadian voter, or a member of Parliament, that what is already in place by the government is simply not enough? It sounds like a great deal of money to me.

Dr. Lynk: That is a good question, Senator Banks. I say, that regarding the announcement of April 5, if you look at the details, almost one half of that money is to be spent on a national media campaign. We have been down this road before with national media campaigns. They do not work by themselves. Spending one-half of your scarce resources on a national media campaign, while at the same trying to create smoking bylaws and education programs in the schools has not proven to be effective. It does not work.

Things need to be coordinated locally, regionally and nationally. When I look at that announcement, I realize that some of the monies will be for the RCMP, revenue people and border officers. I do not know if that is new money or old money. That has not made clear, and I am a little suspicious of that.

I have two things to say. We have to go with Best Practices and where the evidence is to guide us. When you look at the Centers for Disease Control in the U.S., and when you look at the 1999 document from the deputy ministers of health, it becomes apparent that we need to form a a major assault on this problem. Three dollars per capita, which the federal government is proposing, will not do it. Besides, there is the fact that the funds could be cut at any time. If the opposition parties ever get their act together and come into power, that funding could be cut in an instant. I know that some of the major parties have tobacco sponsors. I believe this with all my heart and soul, senators.

I want to refer to Dr. Cushman's analogy of D-Day, because it is a very good one. I am an amateur, humble student of 20th century history, but I do remember that the Canadians tried a raid on Dieppe during World War II. The raid suffered from a lack of resources, was poorly coordinated and ended in disaster. They waited for awhile, got their act together and then did the multi-phase, comprehensive, well-resourced effort that resulted on D-Day. When you have been to the beaches of Normandy, as I have, it is quite something to realize the sacrifice and energy that went into the operation.

You have your choice. We can do Dieppe, which is what the federal government is offering us, or we can do D-Day, which is what Bill S-15 is offering us. This is too big a problem to mess around with small amounts of money that will not be coordinated and will go God-knows-where.

Bill S-15 is the only way that the medical and health care community feels that we can go. It is too big a problem. We have tried the other way before, senators. That is my response to that question.

Dr. Cushman: I gather from the price increase, that it is 41 cents of the four dollar increase. You probably know more about this than I do. Is that right?

Senator Kenny: It ramps up over time, but our understanding is that 41 cents is close.

Dr. Cushman: I have two points. First, it falls short of the Best Practice figures that have been given by the experts. Hence, you have the potential for a Dieppe. Second, during the Ottawa bylaw hearings the debate became very heated. There was a line in the sand, and some people were on one side and most people were on the other. However, there was universal agreement on two issues. One is that the federal government has to do something. There was a common public enemy number-one and that enemy is seen as the tobacco companies. The experts alluded to the stakeholders not being present. The chain smokers that did not want these bylaws shook their fists at the tobacco companies. There was universal agreement on that issue. My next point is that you can tax and take those monies for the tobacco control program out of the price of cigarettes. Everyone agrees with that. You should not put it into other issues or other spending streams.

Second, $12 per capita has been proposed in Bill S-15. We have 800,000 people in the City of Ottawa. If $3 of those $12 went to the mass media campaign, which obviously we would not want to touch, I could easily spend the other $9. I have already told you how I could do that. I have mentioned spending the money on bylaws, on school programs, on high school cessation programs and on surveillance checks for vendors. We can do this. We could spend $9 here and give the $3 to mass marketing. We could do a good job. The $3 will not get down to this level.

Let me give you another example. We have licencing fees for tobacco from the former 11 municipalities in Ottawa-Carlton. They vary from zero to $200. We must now harmonize those fees in the new order. With a 70 per cent compliance rate, I am looking at revenue generation. I have thought, arbitrarily, that people should pay $1 a day to sell tobacco at the corner store. We would put that into the monitoring of sales to youth. If 30 per cent of the folks are non-compliant, why not pay to do this? If compliance goes up to 90 per cent, we could drop the rate.

Let me put a point to you. Why should I be doing that? Why should the medical officer of health in Ottawa be into some small-scale taxation scheme that would put local corner store vendors noses out of joint? It would not endear me to that community. It would be difficult to pass at council. That kind of tax should be collected by the federal government. Then the money could come down to the local level to run the program.

Senator Banks: One of the problems that some members of Parliament see with respect to Bill S-15 is that it is in fact not a tax. The federal government never collects the money. The federal government never holds the money and has no control of the money. The federal government has no discretion with respect to that money, precisely because it is a levy and not a tax.

I have one more area to address. You have said that all the people at your meetings were unanimous that the federal government should do something. We are accustomed to that because it if does not rain enough, people think that the federal government should do something.

You both made references to the Center for Diseases Control in Atlanta. That is an American program. Most of the research there is based on American efforts, facts, demographics, population studies, health statistics, and jurisdictions. Why are we so certain that those numbers are applicable in Canada?

Dr. Cushman: One thing that the federal government should do is simplify the tax revenue collection. We should not have to pay this tax and that tax. Let us tax what the problem is or increase the price. A tax on cigarettes is important in order to recycle the funds to deal with the problem. That is my point.

As to the American studies, you are right. There is a range. However, how different are our kids from American kids? How different are their lungs from our lungs? How different are their addictive centres from ours? Are there any differences in terms of peer pressures and models? I would say that the North American society slash economy is fairly homogeneous.

Senator Kenny has gone within that range and has come out with a figure that is in the bottom quartile. Dr. Lynk will tell you that we need that critical mass to progress so that we can be effective.

Dr. Lynk: I will come to the American-Canadian model in a second. First, I will speak to that specific levy that the government does not touch or have control over.

There is an oil spill levy that is placed on shipping. There is also a blank cassette levy because people have been copying records and CDs. The recording artists get a percentage of that tape levy. Tobacco is a singular, huge, public health issue. I think that it deserves special status. I do not have problems as a taxpayer or citizen with that particular concept.

If I read the bill correctly, and Senator Kenny can correct me if I am wrong, I believe that the federal government still would have a hand in things. The minister of health appoints the people who will administer the foundation. There is some accountability that way.

Whether it is public policy or health care policy, we must look at Best Practices. I agree with Dr. Cushman that American kids and the society in which they live are not much different than Canadian kids when it comes to tobacco use. I believe it is valid to accept the American models. Remember there are 50 separate states in America. Essentially you have 50 different ways of doing things. Each of these states was studied. I cannot imagine that the Canadian model is much different from the American.

I refer again to the 1999 document that the deputy ministers of health from the provinces and territories compiled on a national strategy to reduce tobacco use in Canada. This document, made in Canada, by the health care community and the policy makers, echoes what CDC and the U.S. Surgeon General have said. The game attack is the same. There is no reason to think that the funding for this, be it national, regional, or local, would be any different than the recommended $12 per capita. There is no way that this will fly on $3 per capita. You may as well throw it in the garbage can. It is not going to work.

Senator Finnerty: Thank you very much for attending. It has been scary listening to you. Hopefully, we will be able to have the bill passed.

Do we have copies of the documents that you have so that when we are lobbying our colleagues on the other side we can impress upon them how important it is to pass this bill?

Dr. Lynk: I will ensure that Senator Kenny or the chair has them.

Senator Finnerty: One question occurred to me when you were talking about the shortage of nurses available in the schools. When my kids were in school in the early 1970s, we had policemen coming to the schools with samples of a lung. That scared the daylights out of my two sons, and they never smoked.

Would we be able to encourage people to come back into nursing. We are short of people everywhere. Would we have the manpower to do the job we have to do once this bill passes.

Dr. Cushman: It is an interesting question, senator. You have addressed the nursing shortage. I would like to make a comment about that. We have a medical care system that is in trouble. A large percentage of the business that they have is tobacco-related. We have an opportunity to reduce that in the next generation. That is important.

More to the point, we have a labour crisis. People in the field of nursing are unhappy. They are leaving. There is a nursing shortage in the United States, so they may take some of ours, but also nurses are leaving and going into other fields. We not only have an under funded system but we, regrettably, have a system where the backbone of it, the professionals, are becoming disinterested and dissatisfied with what they are doing. It is a twofold crisis, and obviously, they are related.

We find that after working in the hospital sector, many nurses decide that they are tired of treating asthma, chronic lung disease and lung cancer. They want to enter the prevention world. I think that the physicians you will hear from today represent that constituency.

There is a natural evolution. We do find that public health jobs are popular. People do want to move into the community and do want to do this work. They want to invest their careers in the children to prevent a generation of smokers rather than deal with the generation of smokers. I think that the answer to your question is yes.

Dr. Lynk: Senator, in my community about 20 to 25 per cent of our nurses are addicted to nicotine. We will loose those nurses and compound the problem. That will affect everything. That is another reason to have this bill passed.

The Chairman: Thank you very much. You have given us some very powerful evidence.

The next panel is from the Toronto District School Board and Toronto Public Health.

Mr. Ryan Hicks, Student Trustee, Toronto District School Board: Thank you for inviting me today. I am pleased to be here to present before the Senate committee and offer my support for Bill S-15.

I will focus my presentation from the perspective of a youth consumer of tobacco prevention programs and to particularly emphasize the valuable role that I believe young Canadian students can play in anti-smoking efforts.

My experiences as a student trustee have provided me with the opportunity to meet many of my peers at school and at workshops. I have had the opportunity to speak to many of my peers about the issues that are important to young people growing up through their teen years. When it comes to health issues, cigarette smoking is inevitably identified as an important social and health issue. These issues need to be addressed by government and society at large.

I am pleased to tell you that the Toronto District School Board has endorsed and supports Bill S-15 through a motion that I moved a few weeks ago. They will be sending out a letter to 300,000 students, parents and guardians telling them that they should throw their support behind Bill S-15.

I am still amazed at the reasons my peers usually give for why they smoke cigarettes. More than half of my peers say that they started to smoke because their friends smoke. We all know that teens tend to start smoking because they think it will help them to be cool and to relate with their peers. Someone at school said that smoking is a way to settle your nerves. One girl said that starting high school was explanation enough for why she started smoking.

Most young smokers I have spoken to do not think that the long-term consequences of smoking will affect them because they do not think they will become life-long smokers. You do not need to read the literature to understand these relationships. Just spend a day with teenagers in their school settings and speak to them. They will tell you that despite knowing about the health effects of smoking, many of them began to smoke and will continue to smoke because the short-term gains far outweigh the long-term losses. Anyway, they would say to you: What long-term losses? I will be able to quit easily when the time comes. This is a sad truth that exists today, even though we have had knowledge about smoking and health for more than half a century.

The truth is that the anti-smoking messages that young people hear once in a while just are not having any impact on preventing these children from picking up the habit. A smoking prevention program may have a short-term impact, but this advantage is quickly lost because more than likely the messages will not be reinforced when these students graduate into high school. I remember receiving anti-smoking lessons during primary school. They were excellent lessons at the time, and I went home thinking about the significant people in my life that smoked cigarettes and feared for their health. I wanted to tell them all the bad things about smoking that my teacher had taught me. I wanted them to quit smoking immediately. However, time is a healer, and you forget all of this after a while. Society imparts such positive attitudes towards smoking, with people smoking freely in public places and kids smoking everywhere, that you soon begin to get the impression that perhaps smoking is not so bad for you. After all, all these people who smoke cannot be wrong.

I believe that if there had been more ongoing, intensive efforts with these lessons in school, they would have been more effective. There are so many creative ways for these lessons to be taught. Young teens could write an essay on the practices of the tobacco industry. In science class they could learn about the carcinogens in tobacco. They could learn about the laws that govern tobacco and ways in which they can influence these laws. The list is endless. The point I am making is that one-shot lessons do very little to deter young children from starting to smoke.

Since becoming actively involved in supporting Bill S-15, I have learned a great deal about what can work and what has worked with successful programs in California, Massachusetts and Florida. The success record in these states provides us with the hope that we can also follow in their footsteps and achieve similar successes. Adequate and sustained funding through Bill S-15 provides us with that hope.

The laws governing the sale of cigarettes to minors are simply not working to keep cigarettes out of the hands of young people. As a youth consumer I can tell you first-hand that it is still very easy to access cigarettes. With almost 30 per cent of youth smoking cigarettes, it becomes obvious that getting access to tobacco is not a problem. Ask any young smoker, and you will hear that cigarettes can easily be purchased either locally or through a friend who is of legal age. One of my friends said, "There is always some greedy person who will sell them." Stores don't care since they're making more than any fines they are getting. If you need cigarettes, there are always places you can go to get them.

The provincial regulations, which prohibit the sale of tobacco to minors, are a great start to tackling this problem. For example, a City of Toronto Department of Health campaign called "Not to Kids" is a great start. This campaign is aimed at educating tobacco vendors and the public regarding the sale of tobacco products to minors. I am aware that this campaign has shown significant reductions in the percentage of vendors willing to sell cigarettes to minors. With additional funding through Bill S-15, Toronto's Not to Kids campaign can be strengthened.

Another area that needs to be strengthened relates to the lack of smoking behaviour programs within the high schools. There are the few scattered lessons in health or parenting classes that address smoking behaviour but for the most part the lessons are totally ineffective. Many kids start to smoke in Grade 9 or 10, yet I cannot remember receiving a full lesson on smoking prevention during those grades. Grade nine is a particularly sensitive grade, when a lot of my peers begin to smoke. You just have to walk past the high school in the morning and see all the kids congregated outside having their morning smoke to know that this is a huge concern. These young people could have really benefited from having a strong smoking prevention program offered to them during the earlier grades in high school.

Smoking cessation support is another area that I know is completely lacking in high schools. Many of my peers, that I have spoken to in Grades 12 and 13, have expressed a desire to quit smoking. If support was available, within the school for them, I know they would take advantage of the program. Some recent research conducted by Toronto Public Health confirms this need. Focus groups have been conducted, with male and female high school students, in order to better understand youth experiences with quitting smoking. Girls showed a high interest in quitting smoking and indicated they would be willing to attend a school-based cessation program if it were available. The boys were more ambivalent about quitting smoking. Again, Bill S-15 will provide the funding needed to support services for youth in this area.

Smoking among the youth population is still very much a socially accepted part of popular culture. Somewhere along the line, the health messages have been completely lost. The various levels of government should be very concerned that not enough is being done in the way of anti-smoking advertising campaigns and school programs. The government should be concerned and learn how to mould the attitudes, opinions and behaviour of young people when it comes to smoking cigarettes. Sustained mass media campaigns will help to create a social environment in Toronto that would "de-normalize" smoking behaviour among youth.

I remember hearing radio ads from the "Breathing Space" campaign. They caught my attention and the attention of many other young people. Breathing Space is a media-based and community-based campaign aimed at reducing exposure to environmental tobacco smoke within home environments in which children reside. We need more of these types of ongoing campaigns rather than month-long blitzes.

Public health staff have told me that evaluation of this campaign has been positive in terms of raising awareness about environmental tobacco smoke. We know that advertising campaigns work. We need to become serious about ensuring that we have national anti-smoking ads on a regular basis and that we de-normalize the use of tobacco products among young people. Give the young kids a chance to help with developing these ads, and they will do a great job. Bill S-15 will provide them with the means to impact on their own lives and the lives of their peers.

Recently a group of students across the greater Toronto area have formed coalition called "Youth Taking Action Against Tobacco" or YTAAT. This group has come together to provide a unified voice in support of Bill S-15. We have met several times, and we will continue to strategize on ways to advocate with all levels of government to support appropriate anti-smoking policies.

During the meetings and discussions that have been held with YTAAT, I have become aware that these young people have great ideas. There is tremendous energy and creativity among these young people. They know, better than many adults, about programs and campaigns that will work. They also know what will not work. Young Canadians such as these need to be involved and provided with an opportunity for input into these anti-smoking efforts.

Groups such as this one will be empowered through funding made available through Bill S-15. They will be able to make a difference and have say in the development of anti-smoking messages and larger campaigns. They speak the language of youth and are able relate to them at a much closer level than adults. They know what youth will listen to. They know what types of images and various campaigns will gain the attention of the young people who smoke or are contemplating beginning to smoke.

I would like to conclude by saying that Bill S-15 will provide a major breakthrough in efforts to curb the smoking epidemic among young Canadians. I have read that nicotine is as addictive as crack cocaine. Given this fact, it is astonishing that the various levels of government have not acted more promptly.

It makes you wonder where the governments' priorities are when they announce that $20 million is to be given to tobacco farmers for kiln conversion. This same $20 million could have had a significant impact on the lives of young children in Ontario if it had been used on anti-smoking ads instead of on promoting tobacco products. The federal government owes it to Canada's young children to pass Bill S-15.

Dr. Sheela Basrur, Medical Officer of Health, Toronto Public Health: Mr. Chair, members of the committee, you have heard the perspectives of the physicians, both well regarded paediatricians and also well regarded local medical health officers for Ottawa. You have now heard the perspective of youth in the form of our student trustee at the Toronto District School Board. To try to follow that is a bit tough, so I will say that I will bring you the perspective of a public official who is as they say, "mad as hell a not going to take it any more."

People look to the government, to the people that they have elected, for leadership. I am pleased to see that the Senate is taking consistent and progressive leadership on this important initiative.

You all know the statistics better than most people. There is no point in my repeating the toll that tobacco takes on health. Neither is it necessary to point out the cost to the health care system. I do not need to inform you on the mechanics of how the bill will operate. It troubles me that we have a bill that is well regarded by the public and certainly well regarded by the health community but apparently not well regarded enough to be passed by the very people you would think would have the most to gain by its passage. I am referring to the government and more specifically to the government and the areas of health and finance. I do not understand it.

There was a public opinion poll done in Toronto. It was done for the purpose of assessing public support on this bill. This was in the previous campaign. We found that 67 per cent of people, when given very basic rudimentary information about the bill, were in support of it. You can subtitle it "the no brainier bill." It makes eminent sense.

Those who were opposed to it were opposed because they thought that there was no point to spending money because nothing would work. When these people were told that there are effective programs in California that have lowered the youth smoking rate from 30 per cent to less than 10 per cent, they switched their positions. We wound up with well over 90 per cent public support for a bill that has been consistently blocked by the government.

The government is here to represent the interests and the desires and the needs of the public. Frankly, they are failing at that task.

I look at the toll that tobacco takes on the kids in our schools and on their parents and grandparents. You will not find a person in this room who does not know a child who has asthma or a child who has had a preventable infection. Not one of you can say that a parent, grandparent or family member has not had heart disease, emphysema, bronchitis, complications from diabetes, or osteoporosis. These conditions are caused or exacerbated by tobacco.

Images on the TV and pictures in the newspaper show hospitals that are clogged with line-ups of people trying to get into emergency rooms. There are also line-ups of people trying to get out of the hospital because there are not enough long-term care beds. The health system is broken.

This bill is an antidote for that. What do we do? We are messing around on the margins. Perhaps I am missing something. I would appreciate it if the cause of the resistance could be explained to me. Then I can return and explain it to the people that I represent. These people, like myself need to know what the problem is. Then, perhaps we can figure out if something can be done about it.

The federal government's recent announcement annoyed me the most. I would be the first to say that a rise in tobacco prices is an excellent public health policy. Putting a $4 excise tax on a carton of cigarettes makes a ton of sense. I have no trouble with that at all. I do have trouble with how that money might be spent. The excise tax of $4 would be split between the two jurisdictions. Two dollars would go to the province and the federal government would keep $2. The $2 that would go to the province would be spent according to provincial priorities. In my opinion, the money will probably go to anything other than tobacco control. It will be spent to either subsidize kiln conversion for tobacco farmers or to subsidize income tax cuts.

Of the $2 that is kept at the federal level, about 50 cents will go into tobacco control and $1.50, or three times that amount becomes a tax grab in the guise of tobacco control. When I marry that with the failure to pass this kind of bill because their initiative is better, I think it is wrong.

I will say that as the medical officer of health for Toronto, I have a duty to identify local public health needs and to identify measures to address those needs. I have the duty to do my utmost to advocate for measures that will reduce preventable health problems. Tobacco is the sine qua non of preventable health problems in Canada, bar none.

We have been doing our best. It is certainly a public health priority for Toronto public health. However, we are swimming against the current in every respect. We have school based prevention programs. The school system and health professions are in a state of turmoil. It is not easy to go into a school and tell the kids to just say no.

We offer cessation clinics in all parts of the city. How did we do that? It is reminiscent of Dr. Cushman. We had to beg, borrow and steal to get resources. We begged for unused space and furniture. It was catch-as-catch can to support cessation.

If a person who smokes gets sick, heavens, the system is there to pay all of their expenses. That is until they are home and need oxygen and then we are not there for them any more. The system's priorities are totally topsy-turvy. We do not pay for cessation, but we will pay the cost of treatment even if it does not mean a cure.

If the bill is passed at $360 million or $12 per capita, on average about $27 million would flow into the catchment area in Toronto. That is not to say it would all be at the municipal level. It would be in the catchment area and thereby available at least to local public health and to local non-governmental organizations such as the Canadian Cancer Society, the Lung Association, and the Heart and Stroke Foundation. Those funds would be available to the provincial government and the federal government, et cetera.

Funding of $27 million each and every year is no small amount of money. That is particularly notable because it is entirely off the tax base. Would it not be wonderful for the federal government to do something that, for once, made Torontonians really happy with the federal government? People would cheer here as much as they would in Toronto, if something could be done to give a cash infusion to our area. That infusion would alleviate the tax problems faced because there are so many areas where investments are needed.

In summary, as they say in the field, "actions speak louder than words," and inaction continues to come at the expense of our kids and our youth. They deserve better than that.

Senator Banks: I believe that you were in the room to hear the question that I asked of Dr. Lynk and Dr. Cushman. I will not restate it. However, I should like to hear your comments that would convince me, or a member of the Commons, that $100 million per year is not enough to do the job. Why is that not enough money?

Dr. Basrur: I would sum it up by saying that if you continue to do things that do not work, then doing them faster will not make it right. If you are digging a hole in the wrong spot, do not dig it faster. Rethink the location. Frankly, we are digging ourselves into a deeper hole, and we can do better if we rethink the strategy.

The Chairman: Doctor, if you ever go into politics, you will be dangerous.

Senator Kenny: Mr. Hicks, could you please tell the committee what it is like to be a Student Trustee for the Toronto District School Board?

Mr. Hicks: As Student Trustee for the Toronto District School Board, I represent 300,000 elementary and secondary students. There are two student trustees for the City of Toronto. We represent students from Etobicoke, Scarborough, North York and all the way downtown. There are 500 different schools, so we are on the front lines. We do not just see what is happening in one area, but rather all across the city. I speak to kids all the time in my own school, and then I go to other schools. In that respect, I am right there. I am right inside the minds of our youth.

Senator Kenny: Were you elected?

Mr. Hicks: Yes.

Senator Kenny: Does your vote count like anyone else's vote does at the school board meetings?

Mr. Hicks: At the school board meetings, student trustees only have a recorded vote. It is not a vote that could make or break anything, because of legal implications. They would have to rewrite many laws if that were ever to happen. We have more influence than any of the other trustees on the board.

Senator Kenny: Can you tell us about your experience, or the experience in your school? What efforts were made as you went through the system to prevent you from smoking or to help you and your classmates to stop smoking?

Mr. Hicks: There is a school rule that you cannot smoke on school property. You have to go off school property. Off school property means, that if you want to smoke you must do so on the sidewalk or beside the school or in front of the school. You cannot smoke on school property. It is more of an annoyance than anything else. No one sees the point because the students smoke on the sidewalk or across the street. If people think that is the kind of thing that will stop smoking among youth, they are wrong.

We have the "Not to Kids" campaign happening right now. I saw one of their signs in my school yesterday. Those are the kinds of things that can work. They are needed from primary school, through middle school and especially for grades 9 and 10.

I can't emphasize enough the fact that students in grades 9 and 10 are the most vulnerable. When they hit high school, it is all new. They have no idea what it's about and there are millions of different things coming at them. That is the time when we need these kinds of programs.

In Ontario, there is space for it in the physical education and health curriculum. Teachers can cover it for about 10 minutes only, and that is not enough. We know that we need more time than that, especially for grades 9 and 10. That is where it is really needed and that is where it has failed.

We have not had enough education regarding tobacco and its effects. I always remember having a lesson or two on that in primary school, but honestly, I barely remember primary school at all. When you are in grade nine, you are only thinking about what is ahead, you are not looking backwards at what happened before.

Senator Kenny: Dr. Basrur, you mentioned Toronto, which is your area. Are there many groups in Toronto that are interested in this legislation?

Dr. Basrur: Yes. I have not found anyone who is opposed to this legislation. We have had the précis of the bill go through the Toronto Board of Health, which received total, unanimous, resounding endorsement.

Why was that? First, it addresses a major public health priority for our division. Second, it provides some relief for the property tax base, which funds 50 per cent of our costs. As a property taxpayer, why should you be required to foot one half of the bill for tobacco control? That is the public health regime in Ontario. Anything that gives a proper investment on a major public health priority, without bleeding dry the property taxpayers, is a welcome benefit. Both Bill S-20 and Bill S-15 went resoundingly through the Toronto Board of Health, and Toronto City Council twice.

We have support from the Toronto Star, the Toronto Sun and from all of the NGOs. We have public support, as I mentioned in the public opinion survey that was done. Honestly, I cannot mention anyone who is not in favour, although I have to confess that I have not spoken to Minister Rock recently, and he is a member of our area.

Senator Kenny: It is fair to say that there are some members of this committee who are a little preoccupied with the kind of reaction we will find in the other place. What sort of reaction have you received from the groups that you have been in touch with, or from members of Parliament in the Toronto area.

Dr. Basrur: The reaction has been mixed. Surprisingly mixed from the outside, but not from the inside. There were a few members of the 22 members of Parliament that we have in Toronto, who sent letters requesting an expression of their position on the bill. We had hope that they would express support for the bill. Although I do not have the final tally with me, I would say that about three or four of the 22 members expressed unequivocal support. In other words, it was not couched in: "We like Health Canada's strategy and I am in favour of tobacco control. Yours truly, ... ." It was more along the lines of, "Yes, Bill S-15 deserves to be passed. Yours truly, ... ." A small minority took that strong position.

An equal number were not in favour because they said it is a tax and not a levy. Tax people on the street like the fact that it is a levy and could not careless what the difference is between a tax and levy. They just like the idea that the user pays and the user in this case is not just the smoker, but the tobacco companies that make the profits from it.

There was a 50 per cent non-response. I do not know how to classify that.

Senator Kenny: We heard Dr. Cushman describe his resources here in the City of Ottawa. I believe you were in the room to hear his testimony. Are your resources comparable to his? Are you in better shape than he is on a per capita basis, or is his description typical of a community in Ontario?

Dr. Basrur: I am not sure we are typical for a community in Ontario, but perhaps Dr. Cusham is more so. Toronto is the biggest city in Canada. If you look even at per capita funding, I am not sure it is a fair comparison because of the unique geography and socio-economic profile of the population. I will say that having heard the picture he painted of the public health resources available for tobacco control in schools across the province, he is probably doing better than a number of other health units are because they have to deal with everything. If they are dealing with problems with water supply or water quality, there is no way they can be ramping up tobacco control. You have what seems to be a clear and present danger on one hand and something that (a) is longer term in its outcome and (b) ought to be someone else's responsibility, on the other hand. You have to deal with the things that you cannot defer or delay. That means that sometimes the things that are the most important to do in the long run do not get done properly because they can always be put off, or a finger can be pointed in another direction.

The Chairman: That was probably the argument used by the government in 1994, when they decided to take the $80 million they were going to use for tobacco education and use it somewhere else. No doubt if it is in the government treasury it is easy to divert. That is one of the advantages of a side fund.

Dr. Basrur: Certainly the concern in terms of the track record is in how the money will be allocated. Will that allocation remain in place, or not? How will it be used? Will we wind up every year with an under-the-table telephone call that asks if we need some cash. I hope not. At the same time, if it is spent on a national TV and radio campaign, it will go quickly. All it will do is bring you ads brought to you by the Government of Canada. I do not think it will be effective in stopping kids from smoking; they saw the Queen's logo at the bottom of the ad.

Mr. Hicks: I think we are worth a lot more than that. Through Bill S-15, we can get more than the $100 million, and it will not go on a media blitz that lasts for only a few weeks or a month. This bill will show Canada's youth that you value their health because they are worth it. We have to spend more than what is being spent on them right now.

Senator Eyton: Thank you for appearing. I do not know of any issue that has had such enthusiastic and unanimous support. In fact, we have spent quite a lot of time talking to a variety of witnesses and talking among ourselves. We all agree that it is quite a wonderful idea. I do not think we need to convince anyone here. However, we have referred to the need to convince the government and, I suppose, the members of the House of Commons.

I wonder why anyone might oppose a bill such as this. The only thing that I can think of is that it is new and this particular approach has never been tried before. It is another program and in essence another tax. There is no guarantee of success, at least the kind of success we contemplate. Are you aware of any precedent for the kind of legislation or the kind of approach that is embodied in Bill S-15?

Dr. Basrur: Senator, I am not aware of any. That is not to say it does not exist, but I personally am not aware of a precedent either in Ontario or from Ottawa in which a government has established a foundation that would have a comparable public purpose to the one contemplated in this bill. I am familiar with philanthropic foundations that do good work in certain domains of public policy. For example, the Canadian Living Foundation assists in the start-up of school nutrition programs. Any one can apply for that kind of money and get a start. Without that money, they would not have anything and would be dependent on the government. The model is there in principle. As to the mechanics of it as articulated here, I am not aware of it having been done previously.

As you say, I have not seen what the problem is, aside from the responses I have been getting. Those responses have been that this kind of thing has not been done before; or that we should be the ones doing it; or we should be the ones enacting the legislation. Please, I wish they would just do that.

Senator Eyton: What would be your attitude if, three years from now, this was enacted and happily working but some other better alternative came along? What would we do then? Would we look at this bill and consider its repeal or its amendment?

Dr. Basrur: Something better than the concept of a foundation?

Senator Eyton: As reflected in here.

Dr. Basrur: My understanding is that it is to be reviewed and possibly terminated at the end of five years. That is not to say we expect it to fail. It seems to me we have spent five years just trying to get the bill in place, in the first place!

Senator Eyton: Once there, given inertia, presumably it will last forever. Would you be in favour of enacting the bill, getting it in place, and looking at it five years from now and having a sunset review?

Dr. Basrur: Having the possibility of a sunset provision is important insofar as it ensures clear and hard accountabilities on the part of the foundation and the organizations that are drawing on the funds. Unless there is a consequence for non-performance, you are guaranteed to get non-performance and not necessarily realize it.

Senator Eyton: Changing the subject just a bit, we are coming to the end of these hearings. I understand that later on we will be looking at clause-by-clause consideration of the bill. Anticipating that, I read the bill last night, and I do not have any problem with the bill other than the recitals.

The recitals legally have no significance. I suppose they set a broad context, but they have no legal significance. A number of the recitals are unnecessarily provocative. Can you make any comment? I do not want to take the time of the committee to go through all of them, but I could eliminate four or five of the recitals and I think make the bill more agreeable to more people. Have you looked at the recitals from a critical point of view?

Dr. Basrur: I am not familiar with the technical term "recitals".

Senator Eyton: The preamble.

Dr. Basrur: Honestly, I have no comment on that. I am neither a parliamentarian nor a procedural expert. I understand that the recitals were drafted to ensure that the bill is procedurally sound. In this way the bill would be ready, should it require a ruling by the Speaker in the House. I presume they are correct, but I have no observation otherwise.

Senator Eyton: Mr. Hicks, have you looked at the preamble?

The Chairman: Are you finished on the recitals?

Senator Eyton: Are you cutting me off?

The Chairman: I did not mean to cut you off.

Senator Eyton: I will comment later on the recitals.

Senator Kenny: Inasmuch as you have not met with Mr. Rock, Dr. Basrur, if he were here today, what would you have to say to him?

Dr. Basrur: One way of putting it is: Get going. To be honest with you, there is an expression: Lead, follow, or get out of the way. One of the three would be ideal.

The Chairman: We now have a panel of witnesses from the Ontario Medical Association. Welcome, gentlemen. You may proceed with your presentation.

Dr. Albert Schumacher, Past President, Ontario Medical Association: Honourable senators, I am the immediate past president of the Ontario Medical Association and a family physician from Windsor.

Tobacco policy has been a major focus at the OMA for many years. There are many reasons why physicians are interested in tobacco policy. However, let me state, that from our point of view tobacco policy is a personal issue. Physicians see people one person at a time. We see our patients suffer person by person and it is this suffering, not the impressive illness statistics that has the greatest impact on each of us as individuals.

You have seen pictures of cancer in lungs or a tongue, and those pictures may be disturbing or even upsetting, but for me these cases are reality. I neither want nor need the pictures because these people are in my practice. Yet my colleagues and I feel powerless to stop this tragedy, and this leads to anger and despair. Our patients tell us to work on this serious issue on their behalf.

Thus, we have worked at the public and political level on policy and issues related to tobacco and we have produced many publications. Some of these publications have become world leaders in their scope. However, we are here to discuss the bill before you, and I will describe our approach.

We believe that there are general principles that are now well understood whereby one can judge whether or not a proposal for tobacco control is adequate or not. We would therefore first describe to you the standard by which one could judge this adequacy. Then we would like to analyze and compare that standard both with the recently announced federal initiative and with Bill S-15. Last, I would like to describe some of the attitudes of the medical profession to this present situation.

Dr. Boadway was part of an expert panel comprised of distinguished academic and medical specialists who reviewed the necessary attributes of a comprehensive tobacco strategy. I will ask him to outline some of the relevant findings of this panel.

Dr. Ted Boadway, Executive Director, Health Policy Department, Ontario Medical Association: Our challenge as an expert panel was to make recommendations that were evidence-based and that could be responsive to the changing conditions of the future. We researched the world's literature on the subject and brought in experts from the national and international tobacco control scene. We reviewed the present status of tobacco control efforts in Canada and closely analyzed models here and abroad. Out of this we made a series of recommendations under nine headings. These are described in detail and are in a document entitled, "Actions Speak Louder Than Words."

The first thing that became apparent was that anything less than a comprehensive approach to tobacco control was likely to be met with failure. We made recommendations of nine areas that needed to be addressed in a comprehensive approach. I will leave with you today copies of a description of these nine areas for your consideration.

There is now abundant evidence that a comprehensive program can have a dramatic cumulative effect on consumption. I believe you are familiar with those statistics so I will not repeat them. However, there are four areas that are germane to your consideration of this bill and relevant for your analysis. I will briefly describe those four areas.

First, price increase is the only factor that can alone be demonstrated to be responsible for changing consumption. It is a crucial part of the program.

Second, we now understand clearly how much money is required in order to pass the threshold for an effective fund. We know how much money is needed to go from ineffectiveness to effectiveness. A minimum of $8 per capita, with the mid-range of $10 to $12 per capita, is required. This should be a business decision. The return on investment is immediate. It starts immediately with cardiovascular disease when acute events are prevented, and accumulates over seven years to when lung cancer is being prevented. That is a huge benefit, and the cost savings escalate over 10 years and then health care system experiences the cost saving in perpetuity.

Next, the location of the infrastructure of the strategy is critical to its success. Specific elements of the strategy must be located outside the government in an arm's-length agency. No comprehensive successful program has ever survived anywhere in the world when it has been held within government.

Research, monitoring and evaluation are necessary to measure the implementation and outcomes of strategy components. In order to do that, strategies must be rigorously evaluated, periodic failures tolerated and change expected. Only through such rigorous examination will the strategy be improved and renewed. It is clear from the research that a piecemeal approach to tobacco control will not work and action must be taken in all these areas.

Dr. Schumacher: In light of Dr. Boadway's presentation, I would like to analyze two initiatives. The first initiative is the initiative announced by the federal government on April 5, 2001. The second initiative is Bill S-15, the tobacco youth protection bill before you. First, I will deal with the new federal initiative. The announcement appears to be going in the right direction, but on analysis I find it does not meet the objectives.

In the first instance, the amount of money recommended by the government amounts to approximately three dollars per capita. This is not an amount that has ever been demonstrated to be able to support a comprehensive strategy, and there is no medical or academic base to support this figure. Furthermore, there is no method of guaranteeing that this money will continue as promised for the duration of the strategy.

What if the government begins to pick the money away in bits and pieces? This is not a dedicated fund and it is not a multi-year guarantee. Furthermore, we cannot find evidence that the government intends to move important components of the tobacco strategy outside of the government to an independent agency. On the contrary, the announcement spoke of partnerships. This means, of course, that the government keeps control.

The evidence that has been provided is clear. Here in Canada and elsewhere, it has been shown that programs under government control do not achieve the hard-hitting public relations and community action required. Independent agencies can operate in a more risk-accepting environment and have a single focus, undiluted by the complicated agenda of the government. These two profound deficiencies of the strategy are enough to cause its doom.

I have read the rest of the scanned information provided on harm reduction, cessation and mass media campaigns. I am unable to assess them on the basis of the information provided. Quite frankly, however, if you do not finance it and set it up appropriately, the rest becomes irrelevant.

This closes my comment on a poor proposal and I will now turn my attention to a good one: Bill S-15, the Tobacco Youth Protection Act. The single most outstanding feature of this bill is that it will establish a foundation called the Canadian Tobacco Youth Protection Foundation. The objects of this foundation are clearly set out. The foundation will operate in a transparent manner and will be responsible to a board of directors responsible for carrying out the objects of the foundation and no others.

One of the laudable objects of the foundation is that it will examine existing models of best practices for tobacco control and develop a model to be applied to Canada. This direction is one of the most insightful given to the foundation. We are confident this is exactly the way to go about forming a successful strategy.

Quite frankly, I look at the objects focusing on statistics, research, communication strategies and prevention, and I support each of these statements as they appear. Nothing, however, compares with the mandate that the foundation examine existing models of best practices and review itself from time to time. In this way it will compare itself with other models. This is a strategy for renewal. This is a strategy for the future. This allows learning, adaptation and improvement.

Bill S-15 provides an amount of money at approximately $12 per capita. This is an amount of money that has the potential to fund an effective program. The drafters did their homework. However, this bill has even other more interesting features. It is proposed that the money be raised by a levy and that all of the levy be received and held for the foundation. This means, of course, that there will be a continued and guaranteed revenue stream to fund this initiative into the future.

In short, Bill S-15 is the only legislation that I am aware of at any stage of development in Canada that meets the critical test of independent arm's-length and sufficient funding. It establishes the objects of the foundation such that the initial direction is appropriate and the future course of renewal is insured. It sets the objects up in such a way that success is fostered and points the foundation in a direction that provides maximum possibility for productive endeavours. Bill S-15 asks for research and evaluation. It mandates public education. The bill has features for success that make it totally acceptable. We have looked at the two proposals to see which can measure up to the test of evidence and to the idea that a strategy should be structured in a way that is possible for it to succeed.

I would now like to turn to the question of whether or not the parties proposed to lead this campaign are credible. I have already stated that the establishment of a foundation is the master stroke for allowing success. Bill S-15, in setting up the independent foundation, will allow the establishment of a credible, focused and accountable entity. We will know what the foundation is supposed to do and it will be required to tell us if they do it. They will then be measured against their effort. They will stand or fall on their results. Furthermore, there is an international experience that demonstrates that this is the way to achieve success. This makes this proposal extremely credible.

On the other hand, in order to assess its credibility, I believe we must look at the history of the federal government's action in this regard. In February of 1994 the federal government rolled back tobacco taxes and, in the face of predicted impending increase in tobacco consumption, made many commitments.

First, the government stated that manufacturers clearly mark exported cigarettes. This appeared in Hansard in February of 1984. They did not do this. They committed to increasing fines for the sale of cigarettes to minors. However, instead of holding the tobacco industry responsible, they downloaded that onto the unfortunate salesclerk at the local variety store. This action shifted the responsibility of selling tobacco to minors to the private entrepreneur. This effort has had little effect on the availability of cigarettes for kids. There are 70 million packets of cigarettes sold to minors each year in Canada. The federal government collects $80 million a year from children! Even this ill-gotten tax money is not put back into preventing children from smoking.

The government committed to examining the feasibility of requiring plain packaging. The government-controlled standing committee on health recommended plain packaging on economic and health grounds if a study by Health Canada showed plain packaging would reduce consumption. The study did show that generic packaging is a reasonable component to reduce tobacco consumption. This was reported in "Toward Zero Consumption" in June of 1994. However, the federal government did absolutely nothing on plain packaging.

Another example, was the promise to replace the Tobacco Products Control Act in order to make health warnings on tobacco packages more effective. We were part of the campaign to get the federal government to live up to that commitment. It took years, and exhausted health community resources, to finally convince the government to move forward on this matter. Finally, effective health warnings have come to be but only within the last year. It took almost seven years for this to be accomplished.

As for the comprehensive public education campaign promised to us in Hansard we have to ask: Where is the extensive media campaign today? We know what an effective campaign is because we have seen it in other countries, and we do not have one. This amounts to another unfulfilled promise.

The promise to reach young women, who were noted as starting to smoke at an alarming rate, is seen by most health experts as totally unsuccessful. There is no fulfilment of the promise to use new approaches to reach groups who have not responded to earlier campaigns.

Finally, let us look at the statement by the Prime Minister in a speech to the House of Commons in February, 1994. That is the day that the tobacco industry routed the federal government in an action we refer to as "Craven Cave-in." The Prime Minister said that the money generated by the surtax will fund the largest anti-smoking campaign that this country has ever seen. Well, let us look at that.

The money generated by the surtax was siphoned off into the general revenues. The first year revenues were $65 million. Over five years to the amount rose to almost $100 million per year. Minister Marleau reported first-year expenditures of only $30 million. Over the next two years this figure declined to $10 million. The largest anti-smoking campaign this country has ever seen simply became a figment of the imagination. It went up in smoke.

We have to discuss the previous Senate attempts to initiate an effective tobacco program. You know the history better than I do. It has been clear to an outsider that the government did not accept these bills and it also failed to develop an effective program. Instead of finding a way to see these bills through the House, they buried the bills by using a Speaker's ruling. The explanation was given with a straight face, but I personally am sceptical about this procedural explanation.

Let me state that the tobacco tax rollback in 1994 has been a public health debacle of a type that this profession has never seen. The rollback was predicted by the OMA. It did materialized as predicted, and was a result of deliberate action in the face of this knowledge.

I use the word "debacle" intentionally because, in the confused rush to solve one problem, another was created. It was predicted at the time that there would be an increase in the incidence of adolescent smoking and that is exactly what happened. The percentages went up from 21 per cent to 28 per cent.

Tobacco is the number one preventable cause of disease in Canada. The acid test of any government's commitment to public health comes with the management of this number-one threat. Where is the commitment to this problem? Where is the comprehensive integrated program? I question the credibility of the Government of the Canada in this arena.

Honourable senators, you have before you a bill that represents a major step forward. The doctors of Ontario support you. We are grateful that you have not given up the fight in the face of intense opposition from your own federal colleagues. This bill offers the best opportunity for an effective approach. We will work with you to see this brought to fruition.

Senator Kenny: If I was summarizing what I heard you say, you believe the current program is not sufficient, supported scientifically or secure?

Dr. Schumacher: That is correct, senator.

Senator Kenny: Has your association heard from members across the province? Have they stories like the ones we have heard from the Ministries of Health from Toronto and Ottawa and Nova Scotia?

Dr. Schumacher: Indeed we have. Our members are continually frustrated by what they see in the schoolyards and in the neighbourhoods. They are especially concerned with the rising percentage rates, especially among young women. Physicians look enviously at jurisdictions south of the border. There, the problem has received sufficient attention that the staggering incidences of increased youth smoking have been reversed. These numbers have been contained and lowered to levels that we thought unachievable.

Dr. Boadway: All of the medical officers of health in the province belong to our association. They have their own section within the association. We pay particular attention to the officers of health. We have heard exactly what you have heard from the two previous medical officers of health. There is no exceptions in the Province of Ontario.

Senator Kenny: Dr. Boadway, you made reference to savings coming from a bill of this nature. Could you reiterate that for us? Could you, at the same time, comment on the report called the "California Tobacco Control Update?" On page four they make reference to $3.62 of savings in tobacco-related disease costs for every dollar spent on tobacco control programs. Could you comment on that and tell us whether that is consistent with projections that the OMA has?

Dr. Boadway: Every time I deal with economists I am amazed that medical science, which is imprecise, is as precise as it is. With that caveat, comes quite a range of estimates that exist in the literature to which you can refer.

I believe the most significant aspect is that no matter what the range is it always shows a bigger return on investment. If I am a business person or a taxpayer who wants his money invested wisely, I would say invest my money one place where I get more money back than I spend. This is one place where you can do that.

The reason the California study is so interesting is because they are the first jurisdiction to have spent the adequate amount of money. Secondly, they proactively went out and did the research. That data, in my opinion, is some of the best data because it is not speculative data. Many of the studies you can find are speculative data. The California study is not a speculative study. I would say that of the studies produced, that is one of the best.

Senator Kenny: Is it an oversimplification to say that your position is that we are spending too much money at the back end of the health care system, and not enough at the front end? Are you saying that it would save much of the pain and suffering in the middle and reduce the costs at the back end more if we spent more at the front end?

Dr. Schumacher: Absolutely. There are many things that confront our health care system that will come up now and in the future. We can use some of our savings on those things. There will be only cost savings in dollars but more importantly people will not suffer needlessly. The tremendous cost to our economy and our productivity will also be reduced.

The Chairman: California's health care system is not like ours. In the reference you make to a three-to-one savings, or return on investment, do you mean that that return is for the taxpayers or is it a three-to-one return to the Government of California?

Dr. Boadway: Mr. Chairman, you have the study, but my recall is that that was total expenditures, both public and private. I cannot remember off the top of my head.

The Chairman: It is public and private together?

Dr. Boadway: I believe so, yes.

Senator Spivak: I have one question. I think this is a devilishly clever scheme, but I have one nagging fear. It does not prevent me from supporting the bill wholeheartedly, but I would like your thoughts on this: I know that the tobacco companies are targeting Third World countries in the anticipation they may lose some market share here. Are you at all worried, or has it crossed your mind, that in supporting this bill they are cutting off their customer base? If young kids do not begin to smoke, who will maintain their customer base? Is there any thought in your mind that they may have something up their sleeve that we do not know about in terms of supporting this bill?

Dr. Schumacher: I cannot imagine what is up the tobacco companies' sleeves. However, I think they are going with the odds. They have seen the success or the lack of success of the last two Senate bills. Therefore, I believe that they see no reason not to support the bill in the belief that it will fail.

Dr. Boadway: Mr. Chairman, I would like to answer a question posed by Senator Banks. Even though he is not here now, I will answer his question.

I thought his question was a good one and I have spent a few moments thinking about it. First, I thought Dr. Basrur's question about how much money they give and why it was the right amount was a 10 out of 10 answer so I could not improve on that. I would like to talk about why we think it might work in Canada when we are dealing with some American data.

If you want to postulate that something will not work with one group of people that works with another group of people, you must give evidence of significant enough differences that you can show that it will not work. On the other hand, if you want to postulate that it is possible for it to work, you have to look at the evidence of the similarities and similar fact-based evidence.

The first is that a comprehensive program has nine components. I will not go through all of them but I wish to point out that the evidence for price having an independent effect on consumption is both American and Canadian, and there is convincing and identical evidence in both populations. They behave exactly the same. It is true elsewhere in the world. It is a human condition, not an American or Canadian condition.

Concerning public education, if you are looking at the whole issue of mass marketing and education, mass marketing works on both sides of the border. International companies that sell on both sides of the border use the same strategies because the people are the same. That is the kind of knowledge base we want to tap into. We want to know the way those people do business. We do not need to know the way doctors do business. That is why this foundation can do something. It has been well demonstrated internationally, by other companies, that this kind of thing works on both sides.

Are the points on plain packaging and deceptive tobacco advertising, important? Yes. These points are important because the tobacco industry hates it. If the tobacco industry hates it, you know it works. That is all the evidence you need.

Retail controls are the same on both sides of the border; the problems are the same, the issues are the same and the effect on kids is the same. That has been demonstrated. Smoke-free spaces are an important in that they "de-normalize" behaviour. We already know that works in Ontario. There is evidence of that south of the border and it is true everywhere.

We now must look at the aspects of finance and infrastructure. What is the evidence that it might work in Canada? The first thing is the evidence that it works is in the United States. The place where it does not work is in Canada. We have convincing evidence that what we are doing is not working. The American programs that did not work were like ours. They tried the same things with the same dismal results. They then made a transformation to a new paradigm and it worked. I think there are enough similarities between us as people that we can have some degree of confidence that it will work, but this bill allows changes and adaptations to the Canadian scene.

The Chairman: I will make sure a transcript of that gets to Senator Banks.

Thank you for appearing. I know you are both busy and I hope you will pass on my thanks to your patients who did without you today.

Honourable senators, I believe Senator Eyton had some questions on the "whereas" clauses. Which ones were of concern to you, Senator Eyton?

Senator Eyton: First, you should know that I am strongly in favour of the bill. I have the wonderful advantage that I have never learned how to smoke and never have smoked.

I am, however, concerned with the recitals. Someone referred to them as a preamble. I used to be a lawyer, but I stopped my law practice in 1979. In general terms, the recitals add colour and context, but in legal terms I do not think that they add anything significant.

I can suggest individual recitals that can be eliminated without changing the context or the atmosphere for the bill itself. It would make it less provocative and perhaps easier for every one to live with if they were removed.

Looking at page one of the bill, I see six recitals and I think that the fifth one, that is the second one from the bottom, could easily be eliminated. It says:

And whereas individuals who work in the industry do not wish to be responsible or to be perceived as responsible for the addiction of young persons to tobacco products;

I think we may be speculating a little, and I do not think it hurts the bill to eliminate that particular recital.

On the next page, you need the recital at the top of the page to give sense to the bill. However, we can easily eliminate the next three and end up with:

And whereas it is expedient to enact as hereinafter set forth:

You could leave the top recital:

And whereas the industry is aware that the methods to combat youth smoking used to date have not been effective to eliminate youth smoking;

You would then eliminate the next three. The first talks about lack of credibility, and that is speculation on the part of the bill. The next one talks about legitimacy of these initiatives and motives of those responsible, and I do not know how the bill can say that. The third recital talks about the increasing hostility from the public and the government. I can tell you it is not universal. There are farmers and many people who work in the industry and farmers. It does not add anything.

The bill would then read:

And whereas the industry is aware that the methods to combat youth smoking used to date have not been effective to eliminate youth smoking;

And whereas it is expedient to enact as hereinafter set forth.

It seems to me you have all that you need, and it does set the context for the bill. My suggestion would be that you eliminate the four recitals that I have identified. You will have the same bill and it will be less combative and less provocative.

Senator Kenny: In respons to Senator Eyton's comments, I believe I understand where he is coming from. Previous bills did not have a preamble. He is correct that the preamble has no weight in law.

The Chairman: We just had a big debate on that. We have been talking about preambles quite a bit in the last few weeks.

Senator Kenny: I share Senator Eyton's view that it does not have weight in law. The preambles that you see here, however, are here for a purpose, Senator Eyton. When we sent the last bill to the House of Commons, it was clear that the Speaker was not aware that the tobacco industry had come before Parliament and made all of these statements. What you read here in the preambles, particularly the ones you have pointed out, all come from public statements or testimony made by the tobacco industry. We are simply quoting them.

When you say that you are concerned about the bill being provocative, I must tell you that two of the three CEOs of the companies who came here endorsed the bill in its entirety. The third CEO endorsed the bill with the exception of two points. The first point was that he asked for a seat on the board. That point had not been covered in the preamble. The second point had to do with the lost funding that came from the surtax on profits in 1994. He was of the view that the government should contribute that funding to the start-up of the foundation. Then the tobacco company's funding would commence. All of these are quotations taken from either Hansard or from testimony made before Senate or House committees, or from tobacco company documents.

The procedural experts who worked on this bill advised us that this was the most efficacious way of drawing these facts to the attention of the Speaker. Otherwise, the Speaker would not know that the tobacco companies had come to Parliament and said these things. The experts suggested to us that we might have received a different ruling from Speaker Parent last time if we had drawn these very facts to his attention. That is why the experts suggested that we put them into the document.

As to the question of it being provocative, I must ask, provocative to whom? Obviously you would not raise it if you did not feel they were provocative, but the tobacco industry CEOs who appeared before us did not object to them. Nor did they suggest that they were provocative. They did not deny that they or their representatives had made these statements. It was not addressed as a concern to them.

Senator Eyton: In my suggestion, I was not allowing the industry to escape scot-free. The recital starts off by saying:

Whereas the Canadian tobacco industry ... recognizes that tobacco is a controversial product because of the health risks associated with its use;

And whereas the industry has expressed to Parliament that it believes that smoking is an adult activity and shares the policy objective of government and people of goodwill everywhere to prevent youth smoking;

And whereas young persons continue to use tobacco products sold by the industry despite the fact that the sale of tobacco products to them is illegal in Canada;

And whereas the industry acknowledges that public concern about youth smoking is widespread and justified and that many Canadians blame the industry when young persons smoke;

It goes on to say:

And whereas the industry agrees to actively support the vigorous enforcement of federal and provincial laws forbid ding the sale of tobacco products to minors;

And whereas the industry is aware that the methods to combat youth smoking used to date have not been effective to eliminate youth smoking;

And whereas it is expedient to enact as hereinafter set forth:

I would have thought that there was enough there that the Speaker, or any one else looking at it, would say that the industry is concerned and supportive in one way or another, and wants this bill to pass.

Senator Kenny: For example, the second clause on page two says:

And whereas the industry has on many occasions expressed to governments its willingness to cooperate with them in their efforts to prevent youth smoking because it lacks the credibility to take such measures on its own;

This is the very essence of why you would have a levy for industry purposes. It describes quite clearly to a Speaker why one is taking this approach. This is why one has levies for industry purposes. Clearly, that was one of the reasons why the tobacco companies did not object to it.

Furthermore, at a previous hearing, some members of this committee heard Mr. Parker say precisely this, "Look, we would like to do something about youth smoking, but we don't have the credibility to do it, and we know we don't have the credibility to do it." He was speaking on behalf of all the tobacco manufacturers at the time.

I understand what you are saying, but I do not see the merits in removing it. If it is untrue, Senator Eyton, I would say, yes, let us remove it. If it was not something the tobacco companies had said, I would say, remove it. If it was not something that the procedural drafters said was useful in terms of putting the Speaker in the right context before he makes a ruling, I would say, remove it. However, it does not meet any of those tests.

Senator Eyton: My last comment is that you are relying on testimony before this committee, and that may be fair enough. However, I remind you that are tens of thousands of people involved in the industry across the country, including the farmers who have made a livelihood from growing and selling tobacco leaf for many years. I thought it was unnecessarily provocative. The bill and all of its effects can be achieved without the recitals I have identified.

Senator Kenny: In Bill S-13, there were provisions for funds for tobacco farmers to move toward raising other crops. Tobacco farmers were also invited to come and testify before the committee that was hearing evidence at that time, and they replied in writing that they had no interest in doing so. To the best of my knowledge, they have not requested of the clerk to come and appear before us on this particular piece of legislation. I would ask the clerk whether he has received anything from tobacco farmers or associations representing them.

Mr. Michel Patrice, Committee Clerk: We had no such request.

Senator Kenny: They are aware of the legislation. Ads are running in their papers on a regular basis. We have seen the ads that both JTI McDonald and Imperial Tobacco have been sponsoring. They have been running in I believe, The National Post, The Globe, La presse, The Ottawa Citizen and I think The Hill Times. They may not subscribe to The Hill Times, but I suspect they probably see one or the other of those papers.

The Chairman: Senators, I believe I have made an error. There is a time to debate the preamble near the end. I guess I jumped to that because it was at the beginning. However, according to parliamentary procedure, we must stand these things and then debate them at the end.

Senator Kenny: My understanding is that we can do it that way or we can dispense with clause-by-clause consideration.

The Chairman: Let us follow the pattern.

Senator Spivak: I would move that we dispense with clause-by-clause consideration.

The Chairman: Well, we still have the preamble to examine.

Senator Adams: I have a question too, Mr. Chairman. Senator Eyton was questioning the preamble. I understood that he did so in order to increase the likelihood of this bill passing through the House of Commons because he felt some of the clauses were too strong. Did I understand correctly?

Senator Eyton: I am saying, we can get a bill that is effective and apt to generate more support. That is really all I was looking for. We could put a recital in here that says, "Whereas Senator Trevor Eyton has some reservation with some of the foregoing recitals." We could do that too.

Senator Spivak: That is a very good point.

The Chairman: I believe we have plumbed the depths of the preamble. We will now vote on the preamble and whether we amend it or not clause-by-clause.

Senator Spivak: Do we have an amendment on the floor?

Senator Kenny: No, we do not have a motion before us.

The Chairman: Senator Eyton, do you have a motion that we amend the preamble by removing those four clauses?

Senator Eyton: I so move.

The Chairman: We have a motion on the floor that those four paragraphs be deleted.

Senator Spivak: I might be inclined to support this. I know what Senator Eyton is after. He is after a more elegant bill, and I think he is after the support of some people that I do not care about. I think it is a smart political move. On the other hand, you have the fact that the companies themselves did not object to the clauses. If the tobacco companies did not object to them, I cannot support amending the preamble. I understand where he is coming from and I think it is a wise move, but that is my point.

The Chairman: Let us move the question to the floor, then. All those who support the amendment to delete those four "whereas" clauses? One. Those against? Motion defeated.

Now we have the bill back in its original form. If that is the case, we are ready for a motion from Senator Spivak. Shall we dispense with clause-by-clause consideration of Bill S-15 and report this bill without amendment?

Senator Spivak: Yes, I move that we dispense.

The Chairman: All those in favour? That is unanimous.

Senator Kenny: Before we adjourn, chair, I should like to express some words of thanks to members of the committee and the staff who have worked extraordinarily hard on helping to make this become a reality. I continually have been amazed at the dedication and support that members of this committee have had, and I personally thank you so much. I want you to know that I really appreciate all the interest and support.

The Chairman: Congratulations are in order for you as well. The Senate is often accused of doing little or nothing. This is certainly a bill that attracts attention, and we are on the side of the angels on this one.

Senator Finnerty: It certainly has raised the profile of the Senate. The comments I have heard have always been positive.

The committee adjourned.

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