Róisín Shortall (Dublin North West, Labour)

Tobacco packaging serves as a critical link to consumers. The brand imagery of the tobacco package is the foundation upon which all other marketing is built, and it plays an even greater role in jurisdictions such as Ireland where traditional forms of advertising, promotion and sponsorship are restricted. It is therefore critical that health warnings on tobacco packages counteract the promotion of these products.

Due to their reach and frequency of exposure, tobacco packages are an excellent medium for communicating health information. Tobacco health warnings are also unique among tobacco control initiatives in that they are delivered at the time of smoking and at the point of purchase. As a result, the vast majority of smokers report a general awareness of package health warnings and pack-a-day smokers are potentially exposed to the warnings over 7,000 times per year. Health warnings on tobacco packages are among the most prominent sources of health information. Findings from Canada, Thailand and elsewhere indicate that considerable proportions of non-smokers also report awareness and knowledge of package health warnings. As a result, health warnings are a very cost-effective public health intervention and have a tremendous reach.

Health warnings on the packaging of all tobacco products are guaranteed to reach all users, and can increase smokers' awareness of their risk. The use of pictures with graphic depictions of disease and other health-related and cessation images has a greater impact than words alone and is critical in reinforcing the warnings. The first guiding principle of the World Health Organisation's Framework Convention on Tobacco Control is that every person should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke.

Combined text and photograph warnings, also known as pictorial or graphic warnings, were developed by the European Commission for member states that wished to adopt them. The Commission proposed a library of these warnings but, as their introduction is not mandatory, further legislation is required prior to their introduction on the Irish market. While an enabling provision allowing the Minister to make regulations was included in the Public Health (Tobacco) (Amendment) Act 2009, which was enacted in July 2009, the Department was advised by the Office of the Attorney General that this provision in the 2009 Act did not adequately empower the Minister to make the necessary regulations. The AGO advises that an amendment of the 2009 provision is therefore required to give the Minister the necessary authority to make the required regulations.

The 2010 global progress report on the implementation of the WHO Framework Convention on Tobacco Control reported that 44 parties require health warnings to take the form of or include pictures. A total of six EU member states have introduced combined text and photo warnings and a further four EU member states are in the process of doing so. Full-colour picture-based health warnings on tobacco products are far more effective than text-only warnings. Pictorial health warnings on tobacco products make the product less attractive and target smokers by providing them with information on tobacco-related health risks. They are an essential component of a comprehensive tobacco control programme.

In discussing this Bill in the Seanad today, it is appropriate to reflect on the comprehensive range of tobacco control legislation that has been introduced in Ireland since 2002, particularly the successful implementation of the smoke-free initiative in 2004, the ban on the sale of packs of fewer than 20 cigarettes in 2007, and the ban on in-store display and advertising and the introduction of the retail register in 2009. This comprehensive range of tobacco control legislation places Ireland in the top rank of countries internationally.

Despite the significant tobacco control measures that have been established to date and the widespread knowledge of the harm caused by tobacco consumption, smoking prevalence in Ireland remains high, which is a matter of concern. The most recent SLÁN survey estimates that 29% of our population smoke. Clearly, we cannot become complacent, and we must continue to build on the work that has already been done.

We must not lose sight either of the health consequences of smoking. Smoking is the greatest single cause of preventable illness and premature death in Ireland, killing over 5,700 people a year. Half of those who continue to smoke for most of their lives will die of their habit, half of them before the age of 69. Every year, premature deaths caused by tobacco use in Ireland are far greater than the combined death toll from car accidents, fires, heroin, cocaine, murder and suicide, a startling fact not often appreciated.

Tobacco use is also a major cause of increased morbidity. Smoking is the main cause of chronic obstructive pulmonary disease, COPD, and causes nearly 90% of all cases of emphysema. There is also a causal relationship between smoking and acute respiratory infection including pneumonia and tuberculosis. Smoking increases the risk of cardiovascular disease with the risk of mortality from cardiovascular disease in cigarette smokers 1.6 times that of never-smokers.

The impact of smoking on health care costs in terms of treatment services for cancer, cardiovascular disease and respiratory diseases is significant. In the next ten years, if progress is not made on reducing the impact of tobacco, it is estimated it will cost the health service in excess of €23 billion. This would pay the entire cost of running our health services for two years. Smoking costs the economy at least €1 million per day in lost productivity.

A concern could be that the use of shocking images is not the best way to inform smokers. However, qualitative research in the UK has shown images tend to be most effective when they convey shock, immediacy and empathy. Smokers tend to respond to shock images that are disturbing or unpleasant to look at. Research in Belgium has demonstrated similar results. Warnings shown to have the most impact were those that were felt to be the most graphic and most disturbing.

In Ireland, pre-testing of the 42 images in the EU library was carried out by TNS-MRBI on behalf of the then Office of Tobacco Control. Subsequently, 14 warnings to be used on the Irish market were identified. The research found images impacted differently depending on age group and sex. For example, the apple image particularly impacted on the important target group of younger female smokers in the 18 to 35 age group. They could readily see that smoking causes damage to the skin, predominantly around the eyes and the lips. Impotency was found to particularly impact on younger male smokers.

International research into the use of combined text and photo warnings indicates that pictures improve memory from the text that accompanies it. Smokers are more likely to remember a health consequence of smoking, when smoking, if they have seen a picture. More than 50% of Canadian smokers say the warnings compel them to smoke less around other people. Smokers who read, thought about and discussed the combined text and photo warnings were significantly more likely to quit, attempt to quit or reduce their smoking. Up to 31% of Canadian ex-smokers participating in a study reported that combined text and photo warnings had motivated them to quit in the first place and 27% reported that warning labels help them to remain abstinent.

This Bill will allow for the introduction of regulations which will provide that all tobacco products sold in Ireland will carry a combined text and photo warning. This will, in turn, help to reduce the numbers of people smoking and more particularly encourage children and young adults not to start smoking.

The Government is committed to health promotion and tobacco-control measures that will support the aim of de-normalising tobacco. We will work constructively with all stakeholders in the broad health family to achieve this goal.

I recommend the Bill to the House.