Professor Luke Clancy:

Deputy Kelleher asked what specific actions could be taken. I agree with my colleagues in regard to the size of our ambition. The European Commission directive sets a target of 65% but 75% is not unreasonable and would further deprive the industry of advertising space. The models I described earlier indicate that the two main responses required in Ireland are consistent and persistent mass media campaigns and improvements in smoking cessation services. Dr. McAvoy spoke about inequalities of health due to smoking. The people most in need of our services are those who are still smoking but they are not receiving them. The people who stop smoking are well-off by and large. Poor people are not stopping and they are not getting the services they require. This Bill represents a small intervention and if we are to get the most out of it we will have to increase the other elements to which I referred. It will do no good to clap ourselves on the back once the Bill is passed. We must reinforce everything around it that can make a huge difference.

Deputy Ó Caoláin is correct in regard to the evidence for the Bill. We will be the first country in the northern hemisphere to require plain packaging. The best estimates suggest it will reduce the prevalence of smoking by 1% among adults and 3% among children after two years. Even though the percentage figures are small, they represent substantial reductions in the context of the huge numbers affected. However, more will have to be achieved through reinforcing the other interventions that we know can work if we are to reach the targets set by the Government. The Deputy is also correct that there is less advertising of tobacco products in general but why should there be any advertising of cigarette packs?

Deputy Fitzpatrick raised the big question of illicit trade and its impact on prices. We have studied this issue extensively all over the world and the scientific evidence indicates that while price is an initiating factor in making people think about smuggling, it is fallacious to assert that a price increase from €8 to €9 will change the dynamic. The level of fines imposed and other consequences of being caught are more important than price as factors in illicit trade. The penalty for tobacco transgressions is chicken feed. It is much lighter than is the case for other drugs. The strength of the legislation is also important. However, the primary factor is the existence or otherwise of distribution networks. I do not refer to somebody who buys a few packs of cigarettes in Europe. Illicit tobacco is now being transported in containers. It is not possible to profit from illicit trade unless a distribution network exists. Essentially, it is a law and order issue rather than a health issue. Even with the existence of illicit trade, price is the one factor that is bound to work. When we examine inequalities in health as part of the study to which Dr. McAvoy mentioned, the main factors that reduced inequalities were price and, to a lesser extent, smoking cessation services. If we care about the poor, these are the measures that really matter.

Deputy O'Connor asked what we can do to prevent children from smoking. The measures that work for adults also work for children. Price is a strong deterrent for children because they have less disposable income in general.

Another major issue for them is mass media and the messages they receive. Moreover, there are no smoking cessation services for young adults or children in Ireland. While a person might say he or she has only just started and could stop if he or she so wished, he or she cannot. However, it is not the case that the level of smoking is rising among children; it is declining. Our surveys have shown consistently in the past 15 years that the level of smoking among children is declining, among both sexes. Relatively far fewer girls took up smoking than boys in the past ten years. I think it is because they are probably more clever and watching what is going on. Furthermore, the awareness of smoking has increased so much that sensible children who, by and large, are girls have taken up smoking a lot less and I believe this will not be the ongoing problem.

As for the Chairman's question on whether there should be opening hours for the sale of tobacco, I do not know, but he is quite right to raise it because if we simply do what we are already doing, the practice of smoking will still be strong in 2025 and I can guarantee the joint committee that the rate will be nothing like 5%.

On questioning the need for new measures because the rate is declining, new measures are needed because of the diseases about which members have just heard and the reality that at least 6,000 people per year die from this disease. That is an important word I have not used in this context before the joint committee previously, that smoking and tobacco and nicotine addiction is a disease. I wish members would regard it as a disease and get the smoking cessation treatments. As the joint committee may be aware, I am the only respiratory physician in the country who runs a smoking cessation clinic. I must ask, if this is a disease, why is that so? Why is smoking cessation treatment not supported? Perhaps that might help us also.