Dr. Anthony O'Regan:

I thank the committee for inviting us here today to share our views on the public health (standardised packaging of tobacco) Bill. Over 5,200 people die in Ireland each year from tobacco-related disease. The Irish Thoracic Society represents respiratory health care professionals throughout Ireland and our members include physicians, thoracic surgeons, clinical nurse specialists, scientists and physiotherapists. Every day of our working lives our members meet patients who are seriously ill and dying because of tobacco, and this includes smokers and ex-smokers, as well as non-smokers who have been exposed to high levels of tobacco smoke in their home or work environment. Lung conditions such as chronic obstructive pulmonary disease, COPD, and lung cancer are painful, debilitating and often fatal. They are also preventable, and the most powerful form of prevention is ensuring that young people never light up their first cigarette. That is why this legislation is so important, as it represents a major step towards the Government’s vision of a tobacco-free Ireland by 2025, builds on previous initiatives and will put Ireland to the forefront of global health protection

One area of focus is tobacco's relationship to lung disease in Ireland. This legislation is vital for respiratory health in Ireland, as we have high rates of lung disease compared to the European average.

In Ireland lung disease accounts for 20% of all deaths, it is the third most common reason for acute hospital admission, and is the most common reason to visit a GP.

Smoking is the major preventable cause of respiratory illness. Lung disease accounts for over 60% of the 5,200 deaths from smoking annually in this country. Specifically each year in Ireland 1,500 people die from chronic obstructive pulmonary disease, COPD, giving us one of the highest death rates for the disease in Europe, and 1,700 people die from lung cancer. Smoking causes over 85% of these diseases. Smoking has also been shown to exacerbate many other lung diseases including asthma, pulmonary fibrosis, cystic fibrosis and even tuberculosis. Taken with its role in non-respiratory diseases, such as cardiovascular disease, other cancers, and osteoporosis, tobacco kills one out of every two smokers.

Tobacco use is among the biggest causes of health inequalities. Smoking rates are higher in disadvantaged groups and communities and this is where the burden of tobacco related disease is highest. Tobacco accounts for up to half the difference in life expectancy between the richest and the poorest groups in our society. Not surprisingly these differences are strikingly reflected in the prevalence and outcomes of respiratory disease. For instance, the mortality rates for lung cancer and COPD are over two-fold higher in the lower socio-economic classes.

Another significant trend is the increasing prevalence of smoking related lung disease in women. It is apparent from the 1970s onwards that the tobacco industry targeted advertising at women. The fallout from increased smoking in women is now apparent. In COPD there is a convergence of deaths and hospital inpatient discharges for men and women that mirrors the trends in female smoking rates. In lung cancer there is a 0.5% increase in female mortality each year and lung cancer is now the main cause of cancer death in women outnumbering breast cancer deaths by 6%. Lung cancer incidence and mortality in Irish women is amongst the highest in Europe.

Smoking causes damage to the lungs long before it results in clinically symptomatic disease. Although the majority of people diagnosed with smoking-related lung conditions are of middle or older age, most will have started smoking in adolescence or early adulthood. In fact, 80% of smokers start and become addicted before the age of 18. This illustrates the importance of early interventions to reduce smoking rates among our teenagers and young adults to ensure healthier life expectancy for our population into the future.

We know that legislation works. Over the past decade Ireland has made great strides in the denormalisation of smoking thanks to the workplace ban, the ban on advertising and on point of sale display. The success of these initiatives is best illustrated by the reduction in smoking in both children - from 21% in 1998 down to 12% in 2010 - and in adults - from 31% in 1998 down to 24% in 2010. We must continue on this path and indeed accelerate our efforts to ensure that today's generation of children and teenagers do not become tomorrow's COPD and lung cancer patients. The introduction of standardised packaging together with graphic images represents a significant step in achieving this goal.

It is clear that marketing works. It has worked on behalf of the tobacco industry to the detriment of the lives of hundreds of thousands of Irish men and women throughout the 20th century and into the 21st century. We now have an opportunity to remove the last vestige of marketing power that the tobacco industry holds and we must grab it with both hands.

Australia introduced standardised packaging one year ago. While it will take time to fully measure the effects of the policy, preliminary evidence shows that compared with smokers who are still using branded packs, the plain pack smokers are over 66% more likely to think their cigarettes are of poorer quality and less satisfying, and 81% more likely to think about quitting on a daily basis. Plain packaging has also been shown to reduce pack and product appeal; increase the impact of health warnings; and to reduce confusion about product harm that can result from branded packs. Most importantly, research indicates that standardised packaging will reduce the appeal of tobacco products to young people who are the primary target for tobacco industry marketing. The campaign in Australia waged by the tobacco industry challenging this policy is clear evidence of the perceived impact of branding on target populations by these companies.

The Irish Thoracic Society would like to commend the Government on its commitment to the introduction of standardised packaging and to all parties for their support of the policy. This again places Ireland as a leader in the global battle to protect public health from the effects of tobacco. In particular, it puts Ireland to the forefront in the implementation of our legal obligations under the UN treaty – the World Health Organization’s Framework Convention on Tobacco Control. By setting an example to other European countries the benefits of the legislation will not be confined to our shores alone. In order to ensure that this and future generations of Irish children, particularly those from underprivileged areas, can look forward to long healthy lives free of tobacco-related illness, we urge the speedy adoption of this legislation by the Houses of the Oireachtas.