Thursday, 10 May 2018

Ontario's "Next Chapter" for tobacco control

Last week a copy of the Ontario government's new 5-year plan for tobacco control was provided to us. (You can read it here!)

In many ways, this is an up-to-date strategy that modernizes the province's efforts to help smokers quit. In its acknowledgement of e-cigarettes and cannabis, the province clearly understands that circumstances in 2018 are very different than when the previous strategies were designed (The province first adopted a legislative approach in the mid 1990s when it became the first province to ban cigarette sales in pharmacies).

But in all significant other ways, the province has adopted a "forward to the past" approach. The objectives of the three strategic priorities - cessation, prevention and protection - are very little different than they were decades ago, although they are expressed in a modern management-speak.

There is little in the document to require tobacco companies to meet public health objectives, despite compelling reasons for doing so. Those who hoped that Ontario's slow-moving lawsuit against the companies would be a mechanism to assert industry change can only be disappointed by the complete silence on that file in this strategic document.

Smoke-Free Ontario - the Next Chapter for a Healthier Ontario

This government's "next chapter" for tobacco control is in most ways a shrunk-down and expurgated version of previous chapters. Future policy measures - like reducing availability of retail - are punted to never-never land of "exploring options". There are no new restrictions on tobacco industry practices. The much-discussed but not officially announced decision to de-fund major tobacco control activities (including research, training and youth mobilization) is kept in wraps. Previous commitments to mass media campaigns have been replaced with more modest suggestions of "public education" to "inspire people to quit."

It didn't have to be this way. Not so long ago, the Ontario government sought advice of experts and encouraged the compilation of evidence that was to inform its renewed strategy. In 2016, the Smoke-Free Ontario Scientific Advisory Committee, which included government and non-government scientists, identified the evidence to support a fourth strategic direction - - the "industry", and the importance of "innovative" approaches like restructuring retailing or imposing requirements on tobacco manufacturers to meet certain public health objectives (i.e. with respect to the quantity of cigarettes they sold).

Evidence to Guide Action:Comprehensive tobacco control in
Ontario (2016) Smoke-Free Ontario Scientific Advisory Committee

This report was followed up the following year with recommendations of the Executive Steering Committee of the Smoke-Free Ontario modernization process.  At the head of their list of priority actions were ways to "Challenge and Contain the Tobacco Industry", suggestions for which included reducing the availability of tobacco in retail settings, reducing the supply of tobacco products in Ontario and making industry practices more transparent. Other suggestions were focused on beefing up the cessation system, providing protection from smoke in multi-unit dwellings, raising the minimum age from 19 to 21, and making university campuses smoke-free.

One might have thought that because these advisory processes were established by the ministry that some of the results would have been reflected in the final strategy. Few of the policy advances -- and none of the innovative measures -- appear to have survived the cut.

Not surprisingly, the government has done little to draw attention to its new plan. It is not, for example, listed on the Smoke-Free Ontario site and has been released without fanfare.

Where Ontario fails to lead, will Ottawa follow?

Health Canada's renewal of its tobacco control strategy was due to be renewed in April 2017, but was delayed to give the department an extra year to develop what we were told would be "bold" and "innovative" measures.

The extra year has come and gone without any signal from the department about what it has decided upon. In the meantime, the words "bold" and "innovative" have been dropped during discussions with outsiders.

Given what we know about tobacco industry behaviour, governments should be bringing the tobacco industry to heel, not giving them a free pass.  The tobacco industry is the source of the tobacco epidemic that is killing over 45,000 Canadian a year.

If neither the Ontario government nor the federal government is willing to make bold moves to address the problem at its source, who will protect Ontarians?