CANCER PREVENTION INSTITUTE OF CANADA

Last updated: 15-Jan-2007

Tobacco Control: A Partial Success Story

In many ways, Canada has led the world in reducing the consumption of tobacco and the adverse health impacts related to smoking.

A case study of Canada’s success in tobacco control was prepared in 2003 for the World Bank.[1] The report describes the coordinated efforts over more than 25 years, led by health advocates from inside the government and from a number of important organizations, such as the Canadian Cancer Society and the Heart and Stroke Foundation. Political / legislative actions, as well as key initiatives in prevention, protection, and cessation, have led to dramatic results. One compelling measure of the concerted efforts: the adult smoking rate dropped from 50% to 22% between 1965 and 2001.[2] Some of the most impressive interventions noted by the report are:

• increased taxation on tobacco products; according to the World Bank, the affordability of tobacco products has always proven to be the single biggest factor in predicting per capita consumption.

• extensive protection in the workplace from passive or second-hand smoke, also known as environmental tobacco smoke (ETS),[3] with a gradual expansion of such policies into other public areas (e.g., Canada was the first to ban smoking on international passenger flights).

• restrictions on advertising and on sales to minors, as well as ground-breaking changes in package labelling, which now includes the famous large pictorial warnings.

Perhaps the most significant advances in Canada, and those hardest to measure, are in the arena of public opinion and social norms, i.e., growing negative attitudes towards tobacco companies, smoking in public, and exposing children to tobacco smoke. This process—usually called denormalization (especially in reference to the tobacco industry)[4]—is an explicit part of the national tobacco control strategy established in 1999.[5] Major work remains to be done on this and other fronts, illustrated by the fact that tobacco-related death rates are still high (estimated by Health Canada to be 47,000 per annum), smoking is prevalent among at-risk populations such as First Nations, and too little attention is being given to help smokers quit. In a letter released November 1, 2004, fifty of Canada’s most influential health leaders urged the federal government to take more aggressive action in fulfilling the national plan to denormalize “Big Tobacco”.[6]

Extensive work has been done recently which expertly reviews all of the current evidence on tobacco control strategies, sometimes incorporating dozens or even hundreds of studies. The Cochrane Tobacco Addiction Group alone currently has 41 online reviews dealing with individual interventions. Three substantial evidence reviews in the US, all from 2000, will also be consulted, as well as a British review dating from the same year. One of these, the US Task Force on Community Preventive Services, has been influential, providing key data to the Australian cancer prevention policy mentioned above.

After introducing a logic model around which the data will be organized, the rest of this section in the report will review the current evidence for best (or better) practices to reduce smoking and decrease the health risks associated with tobacco, in order to promote a state-of-the-art approach to smoking cessation and other pillars of B.C.’s tobacco policy.

[2] This is comparable to the results in the “flagship” tobacco control state, California.

[3] By 1983 in the US, 82% of indoor workers faced some restrictions on workplace smoking, and 47% worked in smoke-free environments. Farrelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: results from a national survey Tobacco Control 1999; 8(3): 272-7.

[4] The B.C. Government Tobacco Control Strategy published in May 2004 notes that First Nations prefer the term “tobacco demarketing” in order to avoid the sense that their traditional / sacred uses of tobacco are not normal.

[5] See the discussion on denormalization at http://www.ncth.ca/ncth_new.nsf/MAINframeset?OpenFrameSet&Frame=BodyFrame&Src=http://www.ncth.ca/NCTH_new.nsf/0/BB9C061688D983AA85256E160077E4C8?OpenDocument (accessed October 2004).

[6] Letter to Ujjal Dosanjh, Federal Minister Of Health, signed by over 50 Canadian public health officials and advocates. November 1, 2004. Available at http://www.nsra-adnf.ca/news_info.php?news_id=238&language=en (accessed November 2004).