Fidelma Healy Eames (Fine Gael)

I am delighted to speak about health promotion. During the middle to late 1990s and over the turn of the millennium I was on secondments of up to five years working in health promotion and public health in two different health boards and in the education sector in the formulation of the new school subject known as social, personal and health education. I re-examined the statistics for that time in preparation for this debate. The two main causes of early death in Ireland at the time were smoking and fat in one's diet. Interestingly, that is still the case. The problem of fat in the diet or obesity has worsened but smoking still remains a major cause of death. I will focus on that today. Mental health and bullying, which were well discussed by Senator Mary White, are also huge factors in early death.

Health promotion is about the health of the population. I vividly recall that, especially when working with young people, it was about making the healthy choice the easier choice. That was my benchmark. As we get older the issue is adding years to life and life to years. In that regard, one can understand why free entitlement to the medical card for everyone over 70 was a very significant factor in adding years to life and life to years. It has begun to mean so much to them because it is a health-promoting factor in their lives.

I read the speech of the Minister of State although I was not present to hear her delivering it. It is wonderful to note the research she is drawing on, which confirms much of what I am about to say.

Smoking is the main cause of preventable ill health and premature death in Ireland. Some 6,000 people die here every year from smoking-related diseases. As the Minister of State said, 30% of all cancers are caused by smoking and 90% of lung cancers are caused by it. The evidence very strongly supports the view that these are preventible given the correct intervention. The effects of smoking on health include cancer of the lungs, mouth, larynx, throat, oesophagus, cervix, bladder and pancreas, in addition to coronary heart disease and pregnancy and birth complications.

This is a difficult area to work in because one never knows how effective one is. Success cannot be pinned down and, as Senator Ormonde stated, it is no good working solely in schools. A multi-pronged approach is required that reaches the home, school, community and even sports clubs, or anywhere that serves as a key influence in young people's lives.

Tobacco is the leading cause of cancer deaths in Ireland. In 2005, according to the National Cancer Registry, 1,092 males and 750 females died as a result of tobacco and lung cancer. The Slán survey, a survey of lifestyle attitudes and nutrition, indicates smoking is an issue across all age groups. Some 35% of smokers are between 18 and 29 and 34% are between 30 and 44. Therefore, over 70% of smokers are under 45. Smoking is more prevalent among the poorer social classes. Some 37% of smokers are in social class 5-6. The majority of smokers between 18 and 29, 30 and 34, and over 65 are men. Interestingly, more women are smokers in the 45-64 age category.

I would like to draw the attention of the Government to the importance of addressing smoking early in children's lives. The gateway age for the drug is between nine and 13 years. The Health Behaviour in Schoolchildren study summarised the main points. It states smoking is most prevalent among youths between 15 and 17, particularly girls. These girls are more likely to be middle-class girls, which is not so much the case among adult female smokers. While it was encouraging to note in the Slán survey that smoking on the part of boys and girls had decreased slightly in 2006, the rate among girls was still higher than that among boys.

Why do young people start smoking? They talk to me about the weight issue, as referred to this morning, and to peer pressure, the desire to conform when hanging out, self-esteem issues and the lack of physical involvement.

We need to determine the effective interventions. The approach is to start young and start now because of the cost of smoking in terms of ill health and the burden on the health system. This is a major issue that needs to be addressed in future budgets. We spend €15 billion on health annually. Some 10% of the current budget, €1.5 billion, is spent on treatment for tobacco-related diseases. It is well worth addressing this. One of the main steps that can be taken is increasing the price of cigarettes. It was interesting that Senator Fitzgerald stated there is cross-party support for increasing the price of a packet of cigarettes by €2. It would have been an easy method to acquire the extra revenue needed in the budget by comparison with the method the Government chose.

The United Kingdom has been more successful than Ireland in tackling death due to smoking. It has stronger media campaigns, which have been shown to be quite effective. If we follow the advice of the World Health Organisation to monitor tobacco and prevention policies, protect people from tobacco smoke, which we have done very well in our legislation, offer help to those who want to quit tobacco use, warn about the dangers, enforce the laws on tobacco advertising, promotion and sponsorship and raise the taxes on tobacco, we will go a long way towards preventing ill health and death by smoking.