Dr. Stuart Kreisman: Time for Canada's first smoke-free generation
January 14, 2022, Vancouver Sun - Lost amid last month’s frenzied news regarding the latest COVID variant was a landmark announcement by the government of New Zealand of a bold new countermeasure aimed at the eventual eradication of an even greater killer: tobacco. In what is known as the “Smoke-Free Generation,” starting in 2027 the legal age for the purchase of cigarettes will increase by a year annually in that country, so that anyone under 18 will never be able to legally buy them, amounting to a lifetime ban.
The week of Jan. 16 is Canada’s National Non-Smoking Week — disappointingly necessary for a 46th year. More than two generations after the immense dangers of smoking were made crystal clear to society, smoking remains the leading preventable cause of death in Canada and worldwide, killing seven million annually, including 45,000 Canadians. This is more deaths than those caused by alcohol, drugs, car accidents, murder, suicide and AIDS combined.
The Smoke-Free Generation (SFG) is a concept that has been in discussion among health advocates since proposed by a professor in Singapore in 2010. Tasmania almost enacted SFG legislation, however it lapsed when Parliament was prorogued in 2018. Last September, a law came into effect in the town of Brookline, Massachusetts, making it the first jurisdiction in the world to initiate an SFG law. At first thought, one may respond, “So what? The kids can just go to the next town.” However, it is worth noting that in 2003, a nearby town, Needham, Massachusetts, became the world’s first jurisdiction to increase the age of purchase of cigarettes to 21, and after studies proved that made a significant difference (primarily by cutting supply lines), it became a widespread movement. As of 2019 it is now law in the entire U.S., as well as many other places. Age restrictions work.
Although Canada’s smoking rates continue to decline, progress has been slow. Additionally, the meteoric rise in vaping is a staggering concern, with last-month rates among older teens now 14 to 29 per cent (depending on the survey and the grades included), more than doubling between 2017 and 2020. As a result, young adults now have Canada’s highest overall rate of nicotine use. Beyond mounting evidence of its own dangers, it is now clear that vaping acts as a gateway to smoking, and many individuals end up as dual users, which may be even riskier. Clearly, there will be no end in sight with our traditional public health approaches.
A past leader, Canada’s anti-tobacco policy has been weak and reactive for many years now, with no coherent strategy to achieve its stated goal of under five per cent prevalence by 2035. To reach that target, we would have to reduce the proportion of Canadians who currently smoke by nearly two-thirds, requiring bold initiatives. Of particular note, Canada has been a laggard with respect to raising age of purchase. While national polls have consistently shown 70 to 80 per cent support for raising it, only PEI has enacted Age 21 tobacco legislation, wisely doing so for both smoking and vaping.
Big Tobacco themselves are now consistently talking about transitioning their businesses away from cigarettes, with slogans like PMI’s “Delivering a Smoke-Free Future” and Altria’s “Moving Beyond Smoking.” Although most health advocates believe that this is just about creating the image of good corporate citizenship rather than a true aspiration or reflection of health concern, maybe this time we should make them eat their words. And do so now, not some time in the undefined future.
Opportunity is knocking, with all provinces currently in closed-door negotiations with the industry after class-action lawsuits forced them into insolvency protection. Ending tobacco use is achievable via a combination of supply-side policies including performance-based regulation (financially rewarding or punishing the companies based on prevalence reduction targets — pinch your nose), retail reform, and tobacco licences (whereby issuance requirements could be designed to place various controls and disincentives on both vendors and purchasers). Otherwise, a monetary settlement against the industry will end up being financed through the sole available approach of recruiting new nicotine addicts. Obviously, any steps to eliminate smoking must be combined with very strong anti-vaping regulations.
Canada must raise the minimum age for both smoking and vaping to 21 now. We should then plan on implementing a Smoke-Free Generation in step with New Zealand starting in 2027. The now century-old smoking pandemic kills no less than half its victims. It is time to get serious about ending it.
Source: Vancouver Sun
Dr. Stuart Kreisman is an endocrinologist at St. Paul’s Hospital, and a director of Physicians for a Smoke-Free Canada.