A National Strategy

1.0 Preface

The overall role of the Advisory Committee on Population Health is to advise the Conference of Deputy Ministers on national and interprovincial strategies that should be pursued to improve the health status of the Canadian population and to provide a more integrated approach to health.

The overall role of the Steering Committee of the National Strategy to Reduce Tobacco Use in Canada is to establish goals and strategic objectives for government and non-government organizations to collaborate on the national effort to reduce tobacco use.

The Steering Committee provided broad-based expertise in the area of tobacco control to support the development of the strategy.

2.0 The Health and Socioeconomic Issues

Tobacco use is the most important cause of preventable illness, disability and premature death in Canada.⁽¹⁾ The number of deaths attributable to smoking exceeds the combined total of those due to suicide, AIDS, vehicle collisions, and murder.

The deaths of 45,000 Canadians each year are attributable to the use of tobacco products. Between one third and one half of those Canadians, --over three million people, will die prematurely as a result of their long term tobacco use.⁽²⁾ Others will suffer from years of reduced quality of life.

Unlike other legally available consumer products, tobacco is inherently hazardous and addictive.^{(3), (4)} Because the nicotine in tobacco products is addictive, smokers find it difficult to quit even if they are aware of the hazards associated with smoking.⁽⁵⁾ Increases in smoking since 1993, particularly among teens and young adults, are alarming given the fact that young people can develop an addiction with lifelong consequences.

The length of time between initial experimentation and the ultimate adverse health consequences is typically 20 to 30 years, resulting in a loss of the kind of immediacy generated by less threatening public health issues.⁽⁶⁾ While the death toll will keep rising for some years because it is linked to past smoking prevalence, only by reducing demand for tobacco products in the present can the number who will die from addiction to smoking be reduced in future decades.

The consequences of tobacco use have become an issue of global concern far beyond the confines of national boundaries. The World Health Organization estimates that three million people die every year from tobacco-related diseases.⁽⁷⁾

2.1 Smoking Prevalence in Canada

The latest survey information, from the National Population Health Survey (1996/97) reports that 30% of Canadian men and 25% of women aged 12 and over were daily or occasional smokers. However, there are specific populations for which smoking rates remain significantly higher.

Of particular concern is the rate of smoking among young women. While the rate of smoking among men exceeds the rate for women in every age group 18 years and over, the rate of smoking among girls age 12 to 14 (10%) and 15 to 17 (29%) is substantially higher than among young men of the same age (6% and 22% respectively).⁽⁸⁾

Smoking rates increase as income level decreases. Smoking rates among women and men in the highest income quintile were 13% and 16% respectively, in contrast to rates of 36% and 40% for the lowest income quintile.⁽⁹⁾

Smoking rates are also higher among Francophone populations.⁽¹⁰⁾

The highest rates of smoking in Canada are reported by Aboriginal peoples. The 1997 First Nations and Inuit Regional Health Surveys reported the smoking rates at 62% for the First Nations and 72% for the Inuit. This is more than twice the rate of the Canadian population as a whole. The average age for smoking uptake is also younger (at 10 years) for these populations.⁽¹¹⁾

2.2 The Costs of Smoking

Health Canada estimates that, in Canada, the societal costs attributable to smoking for 1993 were approximately $11 billion, of which $3 billion was spent on direct health care costs such as hospitalization and physician time.⁽¹²⁾ The remaining $8 billion was due to lost productivity, including foregone household income.⁽¹³⁾ Labour Canada has estimated that a smoking employee costs $2,308 to $2,613 more a year to employ than a non-smoker as a result of absenteeism, increased health and life insurance premiums and lost productivity.⁽¹⁴⁾ In comparison, it is estimated that in fiscal year 1993/94 federal excise taxes and duties totalled $2.6 billion.⁽¹⁵⁾

2.3 Health Effects of Tobacco Use

The health risks of smoking and smokeless tobacco use (chewing tobacco and snuff) are well established and numerous. Smoking is a major cause of heart disease, stroke and diseases of the blood vessels, and is responsible for many cancers, including those of the lung, oral cavity, urinary tract and cervix.

It causes respiratory diseases, and increases risks associated with pregnancy outcomes. Smokeless tobacco can lead to cancer of the oral cavity and other serious problems affecting the mouth, teeth and gums.⁽¹⁶⁾

The health consequences of smoking are not limited to smokers. The link between regular exposure to second-hand smoke from other people's cigarettes and fatal disease is well established.⁽¹⁷⁾ Children regularly exposed to second-hand smoke at home or in child care are particularly vulnerable because of their small size and their physiological development.⁽¹⁸⁾

Quitting smoking is the single most effective thing that smokers can do to enhance the quality and length of their lives. For some conditions, such as ischemic heart disease, the benefits of quitting smoking are substantial, both immediately and in the long term. The risks of dying from tobacco-related diseases are reduced over time, in comparison with continuing smokers.