Genuine Progress Index for Atlantic Canada Indice de progrs vritable Atlantique The Cost of Tobacco

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Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueThe Cost of
Tobacco in Newfoundland and Labrador andThe
Economics of Tobacco Control and Smoke-Free
PlacesSt. Johns, 1-2 April, 2003
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GDP vs. GPI view of Smoking

• The GDP view - all spending, including tobacco,
  makes economy grow, contributes to prosperity
• Cigarette sales 141 million, 1 of GDP, 2001
• millions for medical costs, hospitals, doctors,
  drugs for smoking related illness
• Nicotine quitting and replacement costs
• In GPI, smoking cost, not gain, to economy

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Newfoundland Smoking Rates, 2001

• 26 of Newfoundlanders smoke (CTUMS)
• Labrador 36 men, 30 women
• 22 of 15-19 year olds smoke
• At todays smoking rates Of the children and
  teenagers alive in NL today, 9,000 will die from
  smoking in middle age and 9,000 more will die
  prematurely later in life

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Percent of Population Who Smoke (1985 and
2001)- Current smokers as of population age 15
and over
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Change in Smoking Rates 1985-2001
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Daily Smokers -as of PopulationAged 12 and
over, by Health Districts, 2000/01
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Who Never Smoked 2000/01 age 12 and up
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Teen Smoking (15-19) 22 in 2001 (down from 28
2000)
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Teen Smoking rates by Gender age 15-19,
1996 vs. 2001
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Smoking Rates by Stress LevelCanada, 18 age
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Smoking Rates Related to Education
Unemployment. E.g. Economic Zone, 2001
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The Cost of Smoking in Newfoundland Labrador

• Illness and early death to smokers
• Medical care costs
• Losses in productivity
• Costs to employers

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Costs of Smoking in NL

• 1,000 premature deaths / year
• 79 million direct health care costs
• 139 million productivity losses
• 113,080 smokers smoke 687 million cigs /year at
  cost of 141 million

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Annual Extra Cost of Employing Smokers
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Exposure to 2nd-hand smoke in NL

• 35 of Newfoundland men and 30 of women are
  exposed to second-hand smoke on most days.
• Labrador 39 and 34
• NS 1995 24 exposed to 2nd-hand smoke at work
  1/3 of children exposed to 2nd-hand smoke at home

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Exposure to second-hand smoke, Nfld health regions
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Smoking Rates, Exposure to Second-hand Smoke, and
Sensitivity to Cigarette Smoke
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Proven Health Effects of Second-Hand Smoke

• Second-hand smoke causes heart disease, lung
  cancer, nasal sinus cancer and respiratory
  ailments in adults.
• ETS causes sudden infant death syndrome, fetal
  growth impairment, bronchitis, pneumonia, middle
  ear disease and asthma exacerbation in infants
  and children.

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Health Hazards of Second-Hand Smoke Recognized by

• World Health Organization (1986 and 1999),
• U.S. National Academy of Sciences/National
  Research Council (1986),
• Australian National Health and Medical Research
  Council (1987),
• U.K. Department of Health and Social Security
  (1988),
• U.S. Environmental Protection Agency (EPA)
  (1992),
• U.S. Public Health Service (1986),
• U.S. National Institute for Occupational Safety
  and Health (1991),
• American College of Occupational Environmental
  Medicine (2000),
• California Environmental Protection Agency
  (1997),
• The Australian National Health and Medical
  Research Council (1997),
• United Kingdom Scientific Committee on Tobacco
  and Health (1998)
• U.S. National Toxicology Program (9th Annual
  Report on Carcinogens, 2000)

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Recent Research Also Shows

• ETS has been linked to cervical and breast
  cancer, stroke, and miscarriages in adults and
  to asthma induction, decreased lung function,
  cystic fibrosis, and cognition and behaviour
  problems in children

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Restaurant, Bar, Casino Workers Most at Risk

• In restaurants, second-hand smoke levels are 2x
  as high as in other workplaces without smoke
  bans. In bars and casinos 3-6 times as high.
• Excess mortality for workers in smoking lounges,
  bars, restaurants, casinos, bowling alleys is
  15-26 times higher than OSHAs significant risk
  level.
• Establishment of smoke-free bars and taverns was
  associated with a rapid improvement of
  respiratory health. Eisner, 1998

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Food workers exposed to toxins and carcinogens

• Food service workers have a 50 higher rate of
  lung cancer than the general population.
• Second-hand smoke is the leading cause of
  workplace death in Canada
• Occupational hazards not accepted in other
  industries

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Costs of Second-hand smoke in Newfoundland
Labrador

• Second-hand smoke kills an estimated 112
  Newfoundlanders /yr, (78 from heart disease, 34
  from cancers).
• Second-hand smoke costs province 12 million a
  year in health costs 34 million in
  productivity losses

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Costs of Second-Hand Smoke, Newfoundland
Labrador

• Deaths 112
• Potential years of life lost 1,624
• Hospitalizations 784
• Hospital Days 8,400

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Direct Health Care Costs - ETS( millions,
Newfoundland and Labrador)

• Hospitals 8.8
• Ambulance Services 0.2
• Physician fees 0.9
• Prescription Drugs 1.8
• Other health care costs 0.2
• Total Direct Health Care Costs 11.9

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Indirect Costs ETS, Newfoundland and Labrador

• Productivity loss (sickness) 0.4
  million
• Productivity loss (mortality) (6 discount
  rate) 33.7 million
• Total Cost to Economy 46 million
• Sources Costs based on Canadian Centre for
  Substance Abuse, The Costs of Substance Abuse in
  Canada, Colman, The Cost of Tobacco in Nova
  Scotia, pages 15-20, and mortality rates in
  Glantz and Parmley, (1995), and Steenland,
  (1992).

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Do Non-Smoking Areas Provide Protection from
ETS?

• Simple separation of smokers and non-smokers
  within the same air space ... does not eliminate
  exposure of non-smokers to environmental tobacco
  smoke. U.S. Surgeon-General, National Research
  Council
• The non-smoking (casino) tables... did not
  measurably decrease employee exposure to ETS.
  U.S. National Institute for Occupational Safety
  and Health
• Simple separation of smoking and non-smoking
  indoor workers fails to prevent involuntary
  exposure to ETS. American College of
  Occupational and Environmental Medicine (2000)

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Courtesy of Choice Hotel Association of Canada

• Courtesy of Choice makes it possible for smokers
  and non-smokers to live in harmony. It is a
  program of self-regulation that uses scientific
  air-flow analysis to guarantee that non-smoking
  areas are truly smoke-free....(It) involves
  effective ventilation and filtration systems to
  ensure that smoke and other contaminants in the
  air are removed.
• The Canadian Tobacco Manufacturers Council gave
  the Hotel Association of Canada 3.2 million to
  implement its Courtesy of Choice program.

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Does Ventilation Protect from Second-hand Smoke?

• Accommodation of tobacco smoke in the workplace,
  the solution proposed by the tobacco industry,
  was found to have no basis in science or public
  health protection.... The ventilation system
  capable of removing tobacco smoke from the air
  does not exist. ASHRAE no longer provides
  ventilation standards for air with tobacco smoke
  in it, only for air in smoke-free buildings....
  Ventilation provides no solution to the problem
  of exposure to second-hand tobacco smoke.
  Ontario Tobacco Research Unit,
  University of Toronto (2001)

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Would restaurants build ventilated smoking areas?

• A random survey of 401 Quebec restaurants found
  that most would not construct ventilated smoking
  areas, even if they were effective, for financial
  and technical reasons. Cremieux and
  Oulette, 2001

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Therefore

• A limited policy offers no advantage over no
  policy at all. (T)he only way to protect
  nonsmokers health is with a smoke-free work
  site. Borland, JAMA
• U.S. Surgeon-General recommends 100 percent
  smoke-free environments in all public areas and
  workplaces, including all restaurants and bars.

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Expert Conclusions

• All involuntary exposure to tobacco smoke is
  harmful and should be eliminated. Ontario
  Tobacco Research Unit, University of Toronto
  (2001)
• Smoking bans remain the only viable control
  measure to ensure that workers and patrons of the
  hospitality industry are protected from exposure
  to the toxic wastes from tobacco combustion.
  Repace (2000)

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Smoke-Free Workplaces Save Lives and Money

• Smoke-free workplaces cut cigarette consumption
  among smokers by 20.
• Smoke-free workplaces can save 220 lives a
  year in Nfld, 25 million in avoided health
  costs, and 65 million in avoided productivity
  loss ( 28 mill - cig costs) - Savings begun!

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And savings to employers

• It costs Canadian employers 2,446 (2001) more
  to employ a smoker vs. a non-smoker.
  Conference Board of Canada
• Smoke-free workplaces can save Nfld employers 22
  mill/yr in avoided absenteeism smoking areas
  costs, and lower insurance premiums.
• Strong economic incentives exist for rapid
  adoption of smoke-free workplaces. American
  College of Occupational and Environmental Medicine

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Occupational Health Safety Lawsrequire
employers to provide a safe working environment
- Heather Crowe

• Employees...should have the right to refuse to
  work in environments with high levels of ETS.
  Canadian OHS legislation that could apply
  indirectly to ETS include the regulation of
  substances found in tobacco smoke (possibly
  through the national Workplace Hazardous
  Materials Information System. Health Canada
• Smoke-free workplaces avoid potential litigation
  based on unhealthy workplaces (e.g. Ontario)

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Nova Scotias 1996 Occupational Health and Safety
Act (ch. 7), sect 13 (1)

• requires every employer to ensure the health and
  safety of persons at or near the workplace and
  to ensure that employees are not exposed to
  health or safety hazards.
• Employers shall render harmless all gases,
  vapours, dust or other impurities that are likely
  to endanger the health or safety of any person
  therein.

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Are Smoke Bans Bad for Business?

• Without exception, every objective study using
  actual sales data finds that smoke-free
  legislation has no adverse impact on restaurant,
  bar, hotel and tourism receipts. (California,
  Colorado, Massachusetts, New York, Arizona,
  Texas, Utah, Vermont, North Carolina, and BC)
• Two of the 16 studies found an initial decline in
  receipts in the first 1-2 months following
  enactment, but no overall or aggregate decline in
  the longer term.
• Several studies find smoke-free legislation is
  good for business as non-smokers eat and drink
  out more often.

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The Researchers Conclude

• Legislators and government officials can enact
  health and safety regulations to protect patrons
  and employees in restaurants and bars from the
  toxins in secondhand tobacco smoke without fear
  of adverse economic consequences.... these data
  further discredit tobacco industry claims that
  smoke-free bar laws are bad for the bar business.
  Quite the contrary, these laws appear to be good
  for business. Glantz 1997 and 2000
  (California)

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Conclusions from the 16 Studies

• All models indicate that smoke-free restaurant
  restrictions increased restaurant receipts in
  towns adopting smoke-free policies, by 5 to 9
  percent. Pope Bartosch, 1997
  (Mass.)
• Other cities can enact similar laws, which
  protect restaurant patrons and food service
  workers from tobacco smoke, without concerns that
  restaurants will lose business. Sciacca
  Ratcliffe (Az)

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More Conclusions

• Smoke-free restaurant ordinances did not hurt,
  and may have helped, international tourism
  From tourism/hotel sales in 6 U.S. States
• The statistical results strongly confirm that
  there are no long-term impacts from restrictive
  smoking regulations. CRD, BC, 2000

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• Nine months after tough anti-smoking legislation
  was imposed in B.C.s capital, business remains
  steady and liquor sales are up.
  Victoria, B.C. 1999
• In one study after another, covering multiple
  states within the US, analysts have found no
  adverse effect of smoking restrictions, including
  complete bans, on local restaurants business.
  Indeed, several of the studies have found a
  tendency for smoking restrictions to increase
  business. Similar findings derive from analysis
  of the effects of smoking restrictions on bars
  ...(and) tourism. Warner, 2000

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Smoke Bans May Increase Sales

• Our results indicate that these nonsmokers are
  more than making up the revenues lost from
  inconvenienced diners who smoke.... At the very
  least restaurateurs should make business
  decisions based on data, not opinion. Ultimately,
  smoke-free legislation is likely to have a
  positive impact on restaurant-industry revenues.
  Our advice to other cities and municipalities is
  to consider similar legislation. The restaurant
  industry collectively may experience higher
  revenues through smoke-free legislation.
  Cornell Hotel and Restaurant Administration
  Quarterly, 1996

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Restaurateur Fears Unfounded

• A survey of Arizona restaurateurs before
  smoke-free legislation found 44 concerned that
  customers would be upset. Afterwards, the same
  restaurateurs reported that most customer
  reactions were positive. Only 15 found negative
  reactions. 88 said the law was positive or
  neutral for staff, and 94 said it was easy to
  enforce. Sciacca 1996

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The tobacco industry resists smoke-free
legislation by

• Denying the overwhelming scientific evidence on
  the health hazards of ETS
• Working through third parties, esp. restaurant,
  bar and hotel associations by spreading fears
  (never empirically substantiated) that
  legislation will harm their business.
• Watering down and delaying legislation shifting
  the focus of debate from public health to market
  choice and arguing that ventilation can remove
  ETS despite scientific evidence to the contrary.

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In Tobacco Industrys Own Words

• The immediate implication (of smoking bans) for
  our business is clear If our consumers have
  fewer opportunities to enjoy our products, they
  will use them less frequently and the result will
  be an adverse impact on our bottom line (Philip
  Morris)
• Our objective is to contain and refine the
  environmental smoke issue in order to decrease
  the pressure for safety measures.
  (Tobacco Institute)

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Using third party sources to gain credibility

• We try to keep Philip Morris out of the media
  on issues like taxation, smoking bans, and
  marketing restrictions. Instead we try to provide
  the media with statements in support of our
  positions from third party sources, which carry
  more credibility than our company and have no
  apparent vested interest. (Philip Morris)

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..keep focus off public health

• We try to change the focus on the issues.
  Cigarette tax become(s) an issue of fairness and
  effective tax policy. Cigarette marketing is an
  issue of freedom of commercial speech.
  Environmental tobacco smoke becomes an issue of
  accommodation. Cigarette-related fires become an
  issue of prudent fire safety programs. And so
  on. (Philip Morris)
• Portray the debate as one between the
  anti-tobacco lobby and the smoker, instead of
  pro-health public citizens versus the tobacco
  industry. (Philip Morris)

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What Enables Smoke-Free Legislation to Succeed?

• Legislators must be well aware of the facts and
  evidence and also of tobacco industry strategies
  to prevent smoke bans.
• An in-depth analysis of the politics of tobacco
  control in California also concluded The
  outcome of proposed local tobacco control
  legislation appears to depend on how seriously
  the health advocates mobilize in support of the
  local legislation. When the health community
  makes a serious commitment of time and resources,
  it wins. When it fails to make such a commitment,
  the tobacco industry prevails. Samuels
  Glantz, 1991

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Tourism and Hospitality Industries Can Protect
their Employees and their Business

• Smoke bans are popular (about 75), and protect
  hospitality industry employees who are most at
  risk from ETS.
• More than 90 of visitors to Atlantic Can. are
  from other parts of Canada and the US, where
  smoke-free legislation is common.

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Taking the High Road

• The California Restaurant Association fully
  supported the smoke-free workplace law that
  applies to all restaurants, bars and gaming
  places.
• Why not take the high road and promote NS as a
  healthy, trend-setting, visionary, smoke-free
  environment a marketing opportunity for the new
  century and new generation of visitors?
  Response to a TIANS survey on smoke-free
  legislation

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The Evidence Clearly Shows

• Second-hand smoke causes heart disease, cancer
  and respiratory illness. Smoke-free workplace
  legislation will save the lives of 220
  Newfoundlanders each year, prevent serious
  illnesses, and save 90 million in avoided health
  costs and productivity losses.
• Restaurant, bar and casino workers are exposed to
  the highest levels of ETS and have the greatest
  health risks.

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The Evidence Shows

• Designated non-smoking areas and ventilation do
  not work. Only 100 smoke-free environments
  protect employees/patrons.
• Smoke-free legislation will not harm restaurant,
  bar, hotel and tourism sales, and may be good for
  business.