Professor Luke Clancy:

I thank the Chairman and committee members for the invitation to address them on this important public health issue. I represent the Tobacco-Free Research Institute, whose aim is to investigate and support the development of a tobacco-free society by engaging in research on all aspects of tobacco from a public health perspective. The institute was set up by the Department of Health and Children in 2002. At present, I am the director general of the institute and am also a respiratory physician. Like my colleagues, I have spent most of my clinical life treating patients with smoking-induced lung diseases. I am almost exclusively involved in research at present so most of my presentation will be about the research aspects of tobacco control.

The institute has been seminally involved in the evaluation of the smoke-free laws that were passed earlier and is also involved in a number of EU-funded projects examining price and taxation. I have prepared some data on the ill-effects of smoking but the committee has already heard much of it from previous speakers so I will not rehearse it in great detail. However, I feel it is justified to restate that tobacco causes heart disease, cancers, stroke and numerous respiratory diseases, including asthma, COPD, lung cancer and respiratory infections, including tuberculosis. Smoking has an effect on children in the womb and in childhood. It is responsible for many of the complications of pregnancy and remarkably, sudden infant death syndrome. In young children, it causes ear and other infections and neuro-biological retardation. We all know the damaging health effects of tobacco and it is difficult to understand how we tolerate them.

In terms of our research, I particularly want to mention the issue of illicit trade. The committee may hear from the tobacco industry that this legislation will increase illicit trade in tobacco. If the industry is really against illicit trade, it should sign up to the WHO protocol on illicit trade. That would show the industry's real intent. We have examined in great detail the illicit trade in tobacco in Ireland and all over Europe and our results are very different to the data put forward by the industry. In our study, for example, we found that 4% of packs were identified as illicit and roughly 10% as non-domestic duty-paid, giving a total of 14.9%, but the figure in the KPMG report for the industry is 20%. I would caution the committee that when it is presented with figures on illicit trade, it is important to check that the methodology used to estimate those figures is given. For obvious reasons, it is very difficult to measure illicit trade accurately but there are validated methods and we have used these. We have also declared our methods but the methodology is redacted from the aforementioned KPMG report. I would urge the committee not to accept figures on illicit trade which do not include full details on the methodology used and which are not peer-reviewed. It is no good just bandying about figures on something which is so hard to accurately measure.

In the context of this law, we must ask what else works in terms of tobacco control. We have heard from many of the previous speakers regarding price, banning advertising of tobacco and restricting its sale to children all work. Smoke-free registration also works, as does regulating the packaging and labelling of tobacco products. The use of mass media to promote a life free from tobacco and smoking cessation services are also effective. All of these are both effective and cost-effective and they need the support of this committee. It has also been found that what works for adults also works for children. This is probably because children want to be adults. Schemes focused directly on children are not always very effective.

However, in international studies, price is the most important measure in tobacco control. We have studied the role of different strategies in Ireland, using what is called the SimSmoke model, and have shown that in Ireland too, price has been the most successful tool in reducing the prevalence of smoking from 34% in 1998 to 26% in 2010, representing a 22% relative reduction. However, the committee should note that the same rate of progress, which was very good, will not get us to 5% in 2025. Better and more interventions are necessary in that regard.

Regarding the evidence for plain packaging, it has been rehearsed already and I will not go into the detail again. However, I will reiterate the point that plainly packaged tobacco products are perceived as less attractive, of poorer quality and taste and, more importantly from the perspective of children, less cool and sophisticated. Plain packages increase one's ability to recall health warnings, the type, size and positioning of which are important. We have been mocking up the type of packs that may result from this legislation, as derived from the heads of the Bill and the EC directive and they are very different from what is currently available.

The committee has heard that a public opinion poll conducted here showed that the introduction of plain packaging would be popular. A huge majority is in favour of this approach. We also found this to be the case with smoke-free legislation. We also found that after the legislation was introduced, it became even more popular. The committee need not be worried that the people will not support this legislation.

The committee may have noticed that many people are not sure how this is going to work in practice. This highlights the need for planned implementation of the legislation and focused, independent monitoring of the resulting effects of the law. Therefore we strongly recommend that the committee ensures that this legislation is not only introduced, but also that resources are provided to ensure that appropriate research is conducted to measure its effectiveness and to meet the predictable challenges of a malevolent industry which will claim to have negative data.

In conclusion, I commend the Oireachtas for its commitment to the introduction of standardised packaging and for securing all-party support for this policy. In particular, I would like to congratulate the Minister for Health, Deputy Reilly, who has restored momentum to the legislative approach to tobacco control in Ireland and made a major contribution to EC tobacco control, where his work on the tobacco product directives has greatly enhanced Ireland's EC standing. As the committee will know, during Deputy Martin's time as Minister for Health and Children, Ireland's standing was at its highest, with the introduction of smoke-free legislation and the setting up of the Office of Tobacco Control and our own research institute. During the tenure of Ms Mary Harney, that momentum was lost, to the amazement of our international colleagues, who are now once again looking to the Oireachtas for leadership in the battle to protect our citizens from chronic disease and premature death. I have every confidence that the Oireachtas will give this leadership and that our children and future generations of Irish men and women will live longer and healthier lives, free from the profit-driven scourge of tobacco-related diseases. This can be done be ensuring speedy implementation of the legislation, by making sure that Ireland persists in using all other tobacco control interventions that scientific research has shown clearly to be effective and by supporting the continued monitoring of the health and social effects of these interventions through independent, scientific research.