Yes, Minister, Canadians need strong tobacco-control legislation now!

David J. Walters, MA, MD, CCFP; David MacKenzie, MD, CCFP

Canadian Medical Association Journal 1996; 154: 191-192

Dr. Walters is director of the Department of Health Care and Promotion, CMA, Ottawa, Ont. Dr. MacKenzie is the Prince Edward Island representative to the CMA Council on Health Care and Promotion and the CMA representative to the National Strategy to Reduce Tobacco Use; he practises in Charlottetown, PEI.

Paper reprints of the full text may be obtained from: Dr. David J. Walters, Department of Health Care and Promotion, Canadian Medical Association, PO Box 8650, Ottawa ON K1G 0G8

Abstract
Introduction
Physicians' action plan on tobacco for 1996
References

Abstract

At a meeting with federal health minister Diane Marleau on Nov. 16, 1995, the CMA and other health organizations were told that the minister plans to propose comprehensive measures to limit the manufacture, sale and marketing of tobacco products. On Dec. 11, 1995, the minister announced a "Blueprint on Tobacco Control," which outlined the scope of her plan to introduce tobacco legislation in the spring. On the basis of adamant support for tobacco control from all levels of the organization, the CMA urges the minister to move quickly. It also advocates regulating tobacco as a hazardous product in the meantime. Physicians can take a wide variety of actions to intervene with patients and add their voice to antitobacco lobbying efforts in 1996.

Introduction

For what seemed like the twentieth time during the past few years, the coalition of health groups fighting tobacco use met with the federal Minister of Health, Diane Marleau, on Nov. 16, 1995, to raise urgent concerns. The most pressing was the legislative vacuum resulting from the September 1995 decision of the Supreme Court of Canada to strike down much of the Tobacco Products Control Act(1) administered by the Health Protection Branch of Health Canada. With this legislation gone, the tobacco-manufacturing industry will undoubtedly challenge limitations on advertising and promotion and could even remove the long-fought-for health warnings from cigarette packages. The Supreme Court decision and the monumental tobacco tax roll-back earlier this year have set back progress on tobacco control in Canada 10 years.

Marleau announced at the meeting that she planned to move "as quickly and as far as possible" to fill the legislative gap and that she would submit to Cabinet proposals to limit the manufacture, sale and marketing of tobacco products. These proposals would include measures dealing with advertising, promotion, sponsorship, access, point of sale, packaging and labelling, reporting and product ingredients. She indicated that she would invite consultation not only with health groups and the tobacco industry but also with the public. She said she feared that the tobacco industry would go to any lengths to counter such proposals, but she hoped that, since the stakes for the health of Canadians are so high, her plan would gain broad support.

The CMA representatives stated that tobacco control has been ranked the number-one health issue at all levels of the organization this year. From General Council and the Board of Directors to the Council on Health Care and Promotion, the provincial and territorial divisions and the rank-and-file members, the CMA is an adamant supporter of comprehensive legislative controls, policies and programs to restrict the promotion and use of tobacco products. Its support is based on widespread recognition that tobacco causes an immediate and long-term addiction and is a terrible hazard to health.

The response of the health groups to Marleau's initiative was unanimous: they demanded and promised to support strong, comprehensive measures. However, the money and power wielded by the tobacco-manufacturing lobby are powerful influences on current members of the federal Cabinet and of the federal Liberal government. The health groups also proposed that interim measures, such as regulation of tobacco under the Hazardous Products Act,(2) may be needed to prevent the industry from quick adoption of new marketing gimmicks and removal of warning labels before legislation is passed.

Perhaps earlier than anyone had hoped, the Minister unveiled, on Dec.11, 1995, the "Blueprint for Tobacco Control," which outlined the intended broad scope of new legislation on tobacco, to be introduced in the spring. This proposal included banning tobacco advertising, restricting event sponsorship, sales and access, and beefing up capabilities for controlling the toxic and addictive ingredients of tobacco products. That the plan was immediately hailed by health organizations and attacked vociferously by the tobacco industry spoke to the importance and potential effect of the plan, if it succeeds in producing regulatory measures with any teeth.

Our agenda for the next year becomes clearer. As physicians, we will need to mobilize efforts at many levels to fight tobacco use, starting with clinical intervention with patients and building to effective political intervention to restore tobacco taxes and tobacco-control legislation. The CMA and its divisions, side by side with Physicians for a Smoke-Free Canada and other influential medical and health organizations, must take concerted action on tobacco in the coming year. The following action plan on tobacco is an example of what physicians can do. By acting on any of the ideas here, or by formulating their own alternative action plans, physicians can contribute to the overall effort needed to gain back the ground lost in 1995.

Physicians' action plan on tobacco for 1996

Commitment: Declare helping patients to quit or to avoid starting smoking the number-one preventive medicine policy in your practice.
Mobilization: Update Your training by taking the workshop "Guide Your Patients to a Smoke-Free Future" and participating in the efforts of your medical association to facilitate clinical intervention on tobacco use (see "Mobilizing physicians to conduct clinical intervention in tobacco use through a medical-association program: 5 years' experience in British Columbia," on pages 159 to 164 of this issue [full text]).
Resources: Obtain "Smoke-Free Future" materials and workshop information from the Canadian Council on Smoking and Health (tel 613 567-3050, fax 613 567-2730).
Networking: Familiarize yourself with the National Clearinghouse on Tobacco and Health, which carries excellent fact sheets (tel 800 267-5234).
Teamwork: Encourage training of your office staff (receptionists, nurses and other staff) to facilitate intervention with patients who smoke or are at risk of smoking.
Communication: Intervene consistently with as many patients as possible to ask, advise and assist them with problems related to smoking.
Reinforcement: Follow up patients and suggest that they have a periodic health examination; reinforce with your patients the need to assess all risks and take preventive action.
Nonsmoking environment: Display patient-education material, including posters, videotapes and multimedia presentations about smoking, prominently in offices and community settings, and ensure a smoke-free clinical setting.
Dissemination: Support continuing medical education on addiction medicine and tobacco intervention by becoming a trainer or teacher, and help recruit medical colleagues to conduct active intervention on smoking.
Lobbying: Actively support your medical association's lobbying efforts on tobacco-control policies and legislation, and speak out against the tobacco industry. Please write or call me at the CMA to learn more. Write to the federal Minister of Health (Hon. Diane Marleau, Minister of Health, Brooke Claxton Building, Tunney's Pasture, Ottawa ON K1A 0K9; tel 613 957-0200, fax 613 952-1154), and ask your patients to write.

1995 was a dismal year for progress against tobacco use in Canada. Smoking rates among youth are on the rebound as a result of lower taxes and prices. The results are well known to us: the disastrous short-term effects of addiction and the long-term personal and health care costs of associated illness and death. Physicians must mobilize, individually and collectively, to mount a forceful challenge to the tobacco industry in 1996.

References

Tobacco Products Control Act, RSC 1985 (4th Supp), c 14
Hazardous Products Act, RSC 1985 (3d Supp), c 24

| CMAJ January 15, 1996 (vol 154, no 2) |