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A Framework for Action
2002
Cat. H46-2/02-289
ISBN 0-662-66914-2
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(PDF Version - 772 K)Table of Contents
- Message from the Assistant Deputy Minister
- Part 1
- Part 2
- Part 3
- Part 4
Message from the Assistant Deputy Minister
The beginning years of a new century are showing progress in our continuing efforts to control tobacco products and to minimize their negative effects on Canadian society. Coordinated actions of federal, provincial, territorial, and municipal governments working together and in collaboration with non-governmental organizations have already yielded results:
- Smoking has been reduced from 25% to 22% over the past few years.
- Graphic health warnings on cigarette packaging are drawing Canadians' attention to the consequences of using tobacco products and are being emulated by other countries.
- Many communities have adopted smokefree by-laws.
These are significant achievements; but more must be done if we are to succeed in our longer-term goal of helping Canada to reduce disease and death due to tobacco use.
The Federal Tobacco
Control Strategy establishes a framework for a comprehensive, fully integrated,
and multi-faceted approach to tobacco control. The FTCS is the federal contribution
to the national tobacco control plan endorsed in 1999 by all Ministers of Health.
It focuses on four mutually reinforcing components: protection, prevention,
cessation and harm reduction, supplemented by effective use of public education
campaigns to reach all Canadians.
Announced in April 2001, the Strategy is a concrete plan of action that renews the Government of Canada's commitment to achieve its 10-year objectives. Sustained federal government funding to the Strategy will support its implementation.
The federal government is convinced that the most effective way to prevent and reduce tobacco use in Canada is to address the problem at all levels of society. Support for other federal departments, and coordination with provincial and territorial governments and non-governmental organizations, with respect to policy development and joint programs, makes for a solid foundation. With increased emphasis on young people, Aboriginal and First Nations communities, and other groups, the Strategy remains flexible to respond to widely varying needs.
Tobacco use transcends national boundaries. Therefore, the success of the Strategy will be strengthened by supporting worldwide initiatives and working cooperatively with other countries engaged in similar tobacco control endeavours. Canada's initial leadership role and active participation in initiatives such as the Framework Convention on Tobacco Control will help to galvanize efforts internationally.
The Government of Canada is determined to succeed and ensure that, collectively, tobacco control efforts yield tangible results. Provisions of the FTCS outlined in this document show how long-term benefits can be achieved, and illustrate how the federal government is organized to take action.
Introduction
Smoking Kills
Smoking is the single most serious public health problem in Canada, killing more Canadians than car accidents, murders, suicides and alcohol combined.
- Tobacco use costs the health care system in excess of $3 billion every year.
- Lost productivity of a smoking employee is more than $2,500 a year, with the total economic burden to Canadian society rising to $15 billion a year.
- Over 5 million Canadians use tobacco products, 82% of whom are daily smokers.
Yet in spite of the decreases in the past few years, far too many Canadians continue to smoke or are exposed to second-hand smoke. With new investments to sustain progress, support provided by the FTCS and efforts of like-minded individuals, organizations and all levels of government, the future can be changed and Canada can move towards a smokefree society for future generations.
Every year more than 45,000 Canadians die as a result of disease and illness caused by tobacco use.
Background
The Tobacco Act
Health Canada's legislative,
regulatory and policy efforts on tobacco control are rooted in the Tobacco
Act of 1997 and a range of new regulations, which came into effect in June
2000. The focus of the Act is to regulate manufacture, sale, labelling, and
promotion of tobacco products in Canada. It aims to protect all Canadians
with particular emphasis on youth from the health consequences of tobacco
use.
Canada has made great strides in recent years, with progress including:
- reduced tobacco sponsorship promotion (prohibited after September 2003);
- inclusion of graphic and pictorial health warnings on packages of tobacco products;
- mandatory reporting by tobacco manufacturers of information on sales, research and promotion activities, product ingredients, and toxic constituents and emissions of tobacco products; and
- development of Internet sites that provide information about tobacco use and its health effects as well as online resources to assist parents, educators, youth, health professionals, community organizations and the general public in the design and implementation of effective tobacco control programs and resources.
However, much remains to be done.
Creating a Successful Strategy
- Successful approaches to tobacco control must be comprehensive, with ongoing mass media campaigns as an essential element.
- Controlling tobacco use requires research and vigilance to understand and take action on the diversity of complex issues involved.
- Actions must be integrated to have maximum impact. Integration is crucial at the national and provincial level with input and support from Health Canada's partners.
- Sustained action, combined with long-term funding, are critical factors to changing behaviours.
Developing the Federal Tobacco Control Strategy
A Time to Act
As a major step in enhancing the Government's tobacco control measures, the Federal Tobacco Control Strategy (FTCS) was launched on April 5, 2001. This made-in-Canada approach is intended to fit Canadian realities.
FTCS is built on successful interventions drawn from Canada and elsewhere in the world, where comprehensive, integrated and sustained government actions have been the keys to success. The Strategy builds on the work of other federal initiatives to reduce tobacco demand launched in 1994 and 1997, respectively.
A strong emphasis is placed on the importance of collaboration between the federal government and other levels of government in recognition of the fact that effectiveness in implementation of the Strategy will depend on actions of those stakeholders. Most provinces and territories now have tobacco control strategies. Therefore, the need to coordinate in order to increase leverage and synergies is more important than ever.
The FTCS will target all Canadians, especially high risk groups:
- youth (smoking rate is 22.5%)
- young adults (32%)
- Inuit (72%), First Nations (62%) and other Aboriginal groups.
Smoking Prevalence -- Canada
Current* smokers, by age group, age 15+, 2001
Long-Term Vision
To significantly reduce disease and death due to tobacco use.
Five Objectives of FTCS (2001-2011)
- Reduce smoking prevalence to 20% from 25% (level in 1999).
- Reduce the number of cigarettes sold by 30%.
- Increase retailer compliance regarding youth access to tobacco from 69% to 80%.
- Reduce the number of people exposed to environmental tobacco smoke in enclosed public places.
- Explore how to mandate changes to tobacco products to reduce health hazards.
Strategy Objectives: Opportunities to Create Healthy Communities
The goal to significantly reduce disease and death due to tobacco use will be supported by the development of new policies based on evidence provided by research, surveillance and monitoring of knowledge, attitudes and behaviours of smokers. Mass media and public education will continue to be critical to advancement and promotion of the objectives.
In addition to these objectives, a major focus of the FTCS is to target Inuit and First Nations communities on reserves and in northern Canada where smoking prevalence is high. The mid-term objective of the First Nations and Inuit Initiative is to reduce smoking rates, with the long-term goal being to lessen tobacco-induced illness and death. Part of the FTCS devoted to this segment of the population is designed to:
- alter behaviours and attitudes related to smoking;
- help build the capacity of communities to address health issues concerning tobacco use; and,
- improve retailer compliance through increased education and enforcement.
Key Strategy Areas
The FTCS has four mutually reinforcing components: protection, prevention, cessation, and harm reduction. In addition, an extensive use of mass media campaigns and public education will serve to strengthen and support each component.
Priorities and actions
for each FTCS component are designed to enhance each other while remaining as
flexible as possible to meet changing conditions in society.
Protection
Protection creates an environment (physical, legal and regulatory) that supports non-smoking as the norm in Canada.
- Health Canada will work in collaboration with the voluntary sector, municipal and provincial/territorial governments to reduce the number of people involuntarily exposed to smoke in enclosed public spaces.
- Health Canada will provide tools and resources to assist municipalities in planning, implementing and evaluating non-smoking by-laws.
- Ensuring compliance with federal legislation is a priority, particularly to ensure that the more than 60,000 points of sale for tobacco products in Canada do not sell to youth.
- Research will continue to be conducted to provide evidence and support for all initiatives and any new regulations, as it did for such achievements as the new tobacco health warnings.
- The Government of Canada will continue to defend the Tobacco Act and the Government's position in tobacco-related litigation.
Prevention
Prevention discourages people, especially youth, from taking up smoking.
- Programs specifically aimed at youth continue to be developed -- from educating and informing youth about the dangers of tobacco use and second-hand smoke to engaging youth in the delivery of programs to their peers.
- Research will be undertaken to identify best practices, with information disseminated to health care professionals, teachers and parents on Health Canada's web site.
- Since taxation has been proven to be effective in reducing consumption, Health Canada will continue to work with the Department of Finance to ensure that Canada's tobacco product taxation policy is consistent with the government's health objectives.
- Because collaboration is critical to implementation of integrated programs, Health Canada will continue to work with the provinces, territories and NGOs to build on current networks and enhance the ability of communities to take action.
Cessation
Cessation helps people quit smoking.
- Health Canada continues to work in collaboration with other stakeholders to address the need for a national "systems approach" to cessation, including coordinated planning, development and implementation of tobacco policies and effective cessation programs.
- With the help of NGOs and other levels of government, Health Canada will undertake "best practices" reviews to provide best approaches in the area of cessation (such as cessation for pregnant and post-partum women). Public access to information, programs and resources on "best practices" will be enhanced.
- Working with other stakeholders, Health Canada will provide Canadians with telephone quitline counseling services through a National Network of Quitlines. Health Canada will also provide funding for training and resources, as well as establishment of a national standardized approach to monitoring and evaluation.
Harm Reduction
Harm Reduction recognizes that some smokers will continue to smoke despite our best efforts to encourage quitting and aims at reducing the health hazards of tobacco products to the greatest extent possible.
- Health Canada will explore ways to mandate changes to tobacco products to reduce hazards to health.
- Health Canada works in collaboration with other countries to ensure that any changes made to tobacco products reduce the negative health impacts on the smoker and those exposed to the smoke.
- The FTCS aims to reduce the health hazards of tobacco products by ensuring that misleading information is not provided to consumers.
Mass Media
Mass Media campaign messages will target Canadians of all ages, with special emphasis on youth and other high-risk populations. These campaigns will use the full range of media, including the Internet, and capitalize on those communications elements that have been shown to be the most successful. National campaigns will be supported and reinforced by initiatives funded through contribution agreements at the community and regional levels.
Since mass media communications serve as a key resource for all program areas, the messages will be mutually reinforcing, factual and compelling, and could include messages about industry practices where appropriate and where it tests effectively with Canadians.
Communications activities will seek:
- to build public support for government action on a comprehensive range of tobacco control measures; and
- set the context for our mass media campaigns.
Monitoring Progress
Experience has shown that successful approaches to tobacco control need to be comprehensive, integrated and sustained, and that high-profile, ongoing mass media campaigns are a critical tool. The FTCS encompasses all of these elements as well as clear, achievable targets and evaluation methods.
To gauge the impact of federal health control activities, comprehensive performance measurement tools are being implemented for data collection, analysis and reporting. Monitoring is ongoing and includes a wide range of activities. The following examples represent a sampling of tools being used.
- Data from the Canadian Tobacco Use Monitoring Survey (CTUMS) will be used annually to survey prevalence of tobacco use.
- In order to judge the effectiveness of government marketing campaigns, research will be undertaken to measure changes in awareness, attitudes, knowledge and behaviours of Canadian smokers and non-smokers.
- A variety of studies and research will provide significant insight into the marketing efforts of tobacco companies.
- Examining tobacco control by-laws and control measures at municipal and provincial levels will monitor community involvement and support for FTCS objectives.
- Regular monitoring of behaviour patterns of Canadian smokers will provide information about smoking initiation, prevalence, quitting smoking, locations where young people purchase tobacco products, as well as other factors related to tobacco consumption.
- Recognizing cultural differences, and to promote a more comprehensive, non-duplicative approach, specialized strategies and programs will be used for Inuit and First Nations implemented through community-based programs in targeted areas.
- Contributions made to NGOs and international organizations will be assessed regularly to ensure that they support federal and domestic priorities in the area of tobacco control.
Sample issues for monitoring and surveillance
- General consumer knowledge, attitudes and response to health warning messages.
- Smokers' perceptions on the ability of messages to inform, to discourage smoking, to encourage quitting and to alter self-image (as well as brand image).
- The relative impact of size, pictures and absence of trademarks on cigarette packages.
- Accuracy of health warning messages from medical and scientific perspectives.
Assessment of the New Health Warning Messages -- Youth Smokers
3 Months, 6 Months and 12 Months Post-Implementation
Key Achievements (since April 2001)
The Federal Tobacco Control Strategy (FTCS) establishes a framework for a comprehensive, fully integrated and multi-faceted approach to tobacco control. It focuses on four mutually reinforcing components: cessation, prevention, protection and harm reduction, supplemented by effective use of public education campaigns to reach all Canadians.
Tobacco control is everyone's business. From individual to global action, it must be a cooperative, collaborative and truly collective effort. Health Canada knows that working together with the provinces, territories and NGOs is vital. Many of the achievements listed below have been accomplished in partnership with the provinces, territories and/or NGOs.
"I believe that all provinces and territories are benefiting from the renewed leadership that Health Canada has brought to the table."
(A. Hazlewood, Provincial Co-Chair, F/P/T Liaison Group on Tobacco Control)
During the Strategy's first year Canada took a leadership role in the development of the "Framework Convention on Tobacco Control" (the first international public health treaty), and continues to be actively involved as this enterprise moves to its conclusion. What is more, from within this venue and outside of it, Canada has shared learnings and provided assistance in tobacco control to several countries.
From the outset of the first year, Health Canada moved quickly to initiate and consolidate relationships and to implement innovative programmes, in order to ensure that the strategy will move forward from a strong footing. These approaches have borne fruit across the full range of key FTCS areas.
Cessation
- Partnering with provinces and territories to develop a national network of quit lines
- Web-based interactive self-help cessation tools for youth and adults
Prevention
- School-based learning resources and toolkits for youth engagement
- "Science, Tobacco and You", an interactive CD for grade 4-6 students
Protection
- Toolkits for implementation of smokefree by-laws and workplaces
- Close to a 70% conviction rate for tickets issued in the field, for contraventions of the youth access provisions of the Tobacco Act
Harm Reduction
- Consultation document: "Reducing Fire Risks from Cigarettes"
Public Education
- Two comprehensive tobacco control websites -- www.GoSmokefree.ca and www.Infotobacco.com -- garnering more than 35,000 hits / month
- 1-800-Information Line -- response mechanism for public enquiries
- Première conférence internationale francophone sur le contrôle du tabac
- Third National Conference on Tobacco or Health (jointly with national NGOs)
Mass Media Campaigns
Eight mass media campaigns launched, including:
- "Numbers" -- federal government's intentions around tobacco control
- "Target" -- second-hand smoke within home and family
- "Labels" -- second-hand smoke in Aboriginal communities
- "Heather" -- second-hand smoke in the workplace
- "Couch" -- second-hand smoke and youth
Monitoring Progress
- New surveys, such as the Youth Smoking Survey, North of 60 Survey (NUTAID)
Capacity Building
- Grants and contribution programmes to build capacity and support regional initiatives, as well as to support provincial, territorial and NGO coalitions
- Advice re: litigation to other governments
Capacity Building
Partnership Development
Capacity building is intended to increase the ability of individuals, health intermediaries, youth and communities at the national, provincial, territorial and local community levels to take action on tobacco control. Health Canada's national and regional offices play a key role in building and supporting capacity for action -- an important contribution to comprehensive and fully integrated tobacco control activities. Capacity can take many forms and is characterized by collaboration, sharing of knowledge and the ability of stakeholders to utilize existing and new resources to greater advantage. Important components of capacity building for FTCS are:
- facilitating collaboration;
- transfer of knowledge;
- enriched community problem-solving ability;
- full coordination of efforts; and
- infrastructure support.
Conclusion
Future Directions
Health Canada, its collaborators, and key organizations nationally and provincially will continue to broaden support for comprehensive tobacco control measures by expanding their information bases and by increasing the effectiveness of their strategic investments. Through the FTCS, innovative programs will be implemented under components of Protection, Prevention, Cessation, and Harm Reduction, and complemented by Mass Media and Public Education campaigns. Already, Canada has enacted world precedent-setting policies and regulations. Internationally, Canada will continue to play a leading role in the development of the Framework Convention on Tobacco Control.
At home, efforts will continue to inform all Canadians about the serious threats to public health caused by tobacco use and the soaring costs associated with tobacco-induced illnesses. Young people will be actively encouraged to avoid tobacco products and improve their chances to prosper in a non-smoking society. Those already addicted to smoking will be provided even more assistance and encouragement to quit. A network of legal, financial and social measures will be introduced through a fully integrated regime of disincentives to tobacco use coordinated by Health Canada and its collaborators.
To achieve success over five to ten years and to sustain progress, the Government of Canada is making substantial investments, with continuing funding in subsequent years. In this way, the FTCS will achieve its goal of reducing disease and death among Canadians due to tobacco use, and set the stage for ultimate success in effectively controlling the negative effects of tobacco on Canadians, on future generations, and their environment.
Reference Notes
Introduction
- Tobacco use costs the health care system in excess of
$3 billion every year.
Report on Tobacco Control, January 2000 - Lost productivity of a smoking employee is more than $2,500 a year, with the total economic burden to Canadian society rising to $15 billion a year.
Workplace Smoking: Trends, Issues and Strategies - Over 5 million Canadians use tobacco products, 82% of whom are daily smokers.
2001 Canadian Tobacco Use Monitoring Survey (CTUMS) - Every year more than 45,000 Canadians die as a result of disease and illness caused by tobacco use.
Eva M. Makomaski Illing and Murray J. Kaiserman,
Mortality Attributable to Tobacco Use in Canada and its Regions, 1994 and 1996, Volume 20, No.3 -1999, Chronic Diseases in Canada.
Developing the Federal Tobacco Strategy: A Time to Act
The FTCS will target all Canadians, especially high risk groups:
- Youth (smoking rate is 22.5%)
2001 Canadian Tobacco Use Monitoring Survey (CTUMS) - Young adults (32%)
2001 Canadian Tobacco Use Monitoring Survey(CTUMS) - Inuit (72%)
1999-2000 Annual Review, August 2000 - First Nations (62%)
First Nations and Inuit Regional Health Survey,National Report, 1999, published by the First Nations and Inuit Regional Health Survey National Steering Committee.
Key Strategy Areas
- Table -- Current Smokers. Data from the Canadian Tobacco Use Monitoring Survey (CTUMS) indicate the priority needed to prevent youth from taking up smoking and encourage middle age smokers to quit.
2001 Canadian Tobacco Use Monitoring Survey (CTUMS). - Compliance with Health Canada legislation is a priority, particularly to ensure that the more than 60,000 points of sale for tobacco products in Canada do not sell to youth.
Health Canada's own estimates. 
"Heather" Second-hand Smoke Transit Ad. The harmful effects of second-hand smoke cannot be overstated. Employees routinely exposed to second-hand smoke are 20% more likely to contract lung cancer with increased risk of coronary heart disease.
United States National Cancer Institute of Health, Smoking and Tobacco Control Volumes, Monograph No. 10, Table 7.10.- Table -- Assessment of New Health Warning Messages. Data gathered from the Canadian Tobacco Use Monitoring Survey (CTUMS) reveal that youth smokers continue to strongly support and approve of the new health warning messages.
Wave 2 Survey (August 2001), Wave 3 Survey (February 2002) and Wave 4 Survey (March 2002), Health Effects of Tobacco and Health Warning Messages on Cigarette Packages -- Survey of Youth, Final Report, prepared for Health Canada by Environics Research Group Limited.
