Wednesday, 18 September 2013
Report of Seanad Public Consultation Committee: Statements
I am very pleased to have the opportunity to respond to the report of the Seanad Public Consultation Committee in respect of lifestyle and its relationship to cancers.
As the report points out, Ireland lies second in the world in terms of cancer incidence. Within Ireland, it is estimated that one in three people will develop cancer during their lifetime. Bearing this in mind, it is worth remembering that finding and diagnosing cancer at an early stage can result in better outcomes for patients. Screening programmes, early detection and more effective treatment options have led to improved outcomes and survival rates for cancer patients.
Ireland now has three quality assured cancer screening programmes run by the National Cancer Screening Service, NCSS. They are as follows: BreastCheck with its national breast screening programme; CervicalCheck with its national cervical screening programme; and BowelScreen with its newly launched national bowel screening programme.
The HSE's national cancer control programme, HSE-NCCP, continues to reorganise cancer services to achieve better results for patients. The programme is working to ensure that designated cancer centres for individual tumour types have adequate case volumes, expertise and concentration of multi-disciplinary specialist skills.
As a Minister in the Department of Health, I would like to see more emphasis on disease prevention rather than intervention. Healthy lifestyle choices are a key element of creating good health, particularly where cancer is concerned. The European code against cancer has highlighted the fact that the risk of cancer can be minimised by adopting a healthy lifestyle.
Lifestyle trends that threaten health were one of the main motivations which prompted the development of Healthy Ireland - A Framework for Improved Health and Wellbeing 2013-2025. The Healthy Ireland framework was launched in March and provides a framework for action to improve the health and well-being of the citizens of this country. In line with the recommendations made in the report under discussion here today, it takes a whole of government approach to the issue of health and well-being. It also encourages all sectors of society to get involved in making Ireland a healthier place to live, work and play.
One of the most significant lifestyle choices threatening health is smoking. As Members will be aware, 5,200 people die in Ireland every year due to smoking and 44% of these are deaths from cancer. Tobacco use is the leading cause of preventable death in Ireland.
Many successful tobacco control initiatives have been introduced in Ireland. Examples include the workplace smoking ban, the ban on the display of tobacco products at point of sale, and the introduction of graphic warnings. In the coming weeks, the Minister for Health will be launching a new tobacco policy for Ireland. The recommendations outlined in the Seanad's report being discussed here today will help inform that policy.
It is internationally recognised that the countries which have developed and enhanced their tobacco control legislation, policies and services are those which are successful in reducing smoking rates. The new tobacco policy will set out what we need to do in order to move to a tobacco-free Ireland. The Minister has indicated many times that his priority, while not forgetting current smokers, is to prevent children from starting to smoke. The bans on tobacco advertising, packs of ten cigarettes and point-of-sale display have assisted in reducing the number of ten to 17 year olds who smoke from nearly 19% in 2002 to 12% in 2010. The trends are clear. The rates are reducing. The initiatives introduced since that last tobacco policy in 2000 have assisted in this reduction. This new policy, over a decade later, sets out the framework for achieving further reductions over the coming years.
Alcohol is also key when considering lifestyle choices which impact on health. Alcohol plays a complex role in Irish society. While it is associated with many aspects of Irish social and cultural life, it is also responsible for a wide range of health and social harms in society and places a significant burden on the resources of the State in dealing with the consequences of its use and misuse. A recent report from the Royal College of Physicians of Ireland, entitled Reducing Alcohol Health Harm, highlighted the links between alcohol and cancer. Alcohol is classified as a group 1 carcinogen and it is one of the most significant causes of cancer in Ireland, being a risk factor in seven types of cancer. Alcohol increases the risk of more than 60 medical conditions; even at low-risk levels of consumption it increases the risk of developing many major diseases, including numerous cancers and gastrointestinal conditions.
The college reported that between 2000 and 2004, alcohol was estimated to cause 4.4% of deaths in Ireland. The rate of hospital discharges for alcoholic liver diseases increased by 247% for 15 to 34 year olds and by 224% for 35 to 49 year olds between 1995 and 2007.
Research from the National Cancer Control Programme found that approximately 5% of newly-diagnosed cancers and cancer deaths are attributable to alcohol, with around 900 cases and 500 deaths each year. The greatest impact was on organs of the upper aerodigestive tract. Cancer risk due to alcohol is deemed to be the same, regardless of the type of alcohol consumed, and even drinking within the recommended limits carries an increased risk. So what are we going to do about the misuse of alcohol?
My Department has submitted proposals to the Government based on the recommendations of the national substance misuse strategy report launched last year. These proposals cover all of the areas mentioned in the report, including: legislation on minimum unit pricing; the advertising of alcohol; sponsorship; labelling of alcohol products; and prevention and intervention activities on alcohol.
Minimum unit pricing is a mechanism whereby a statutory floor in price levels is imposed for alcohol products that must be legally observed by retailers. The primary function of this measure is to reduce at-risk levels of alcohol consumption, especially by those who drink in a harmful and hazardous way, and it would also have a greater impact on discouraging children from drinking. The primary aim of minimum unit pricing is to target harmful and hazardous drinkers and reduce their consumption. Another aim is an overall reduction in consumption across the entire community. The means of attaining both aims is increasing the price of alcohol that is cheap relative to its strength. This is because research has shown that harmful and hazardous drinkers tend to purchase disproportionate amounts of cheap alcohol, no matter what the income level of the drinker. Therefore, there is evidence that increasing the price of such cheap alcohol using minimum unit pricing should lead to a reduction in the consumption of alcohol by such harmful drinkers.
We have consulted and negotiated extensively with other colleagues in the Government. Of course we have to weigh up all of the different arguments before deciding how to proceed. Governments across Europe and elsewhere have already taken measures, while others are actively considering measures along the lines that we are addressing.
The Cabinet committee on social policy has considered these proposals and it is my intention to submit a finalised package of proposals to the Government shortly for consideration and approval.
Obesity, discussion on which must necessarily encompass lifestyle factors such as diet and levels of physical activity, is also a significant risk factor for cancer. The prevalence of overweight and obesity has increased at an alarming speed in recent decades, so much so that the World Health Organization, WHO, refers to it as a global epidemic. The high levels of obesity in all age groups of the Irish population are of increasing concern, but of particular concern are the rising levels of obesity in young children. The situation in Ireland mirrors the global obesity epidemic, with 61% of Irish adults now overweight or obese and an alarming figure of one in four children overweight or obese at three years of age.
Unfortunately, Irish children are consuming large amounts of energy-dense foods, often outside the home, while many are not engaging in sufficient physical activity to prevent excess weight gain. Most worrying is the fact that childhood obesity has reached epidemic proportions in Europe, with body weight now the most prevalent childhood disease. Some 26% of nine year old Irish children are overweight or obese. The WHO Europe Childhood Obesity Surveillance Initiative, COSI, in which Ireland participated in 2009, found that 23% of seven year olds were overweight or obese.
Obesity in adulthood drives the development and worsens the outcome of chronic diseases including cancer, type 2 diabetes and dementia. Between 70% and 80% of health care costs in Europe are spent on chronic diseases. Most of these health budgets are spent on treatment. Chronic disease management is a key challenge for future health care provision in Ireland. This challenge is not merely a financial one, but also an organisational one that requires a health system with a greater focus on prevention, co-ordination, continuity, integration and information flows that follow the patient. Approximately 80% of the overall disease burden in Europe is due to chronic diseases and the pattern in Ireland is similar.
Chronic conditions will generally increase by approximately 40% during the next ten years due to our aging population and the impact of lifestyle factors. This trend is not sustainable from a cost or hospital capacity perspective. A new model of structured integrated care involving primary care with an emphasis on prevention will be required. We need to shift our health systems away from a medical curative model of health care and encourage patients to participate actively in the management of their own conditions. There is evidence that patient empowerment improves health outcomes. Knowledge of the disease and its treatment not only improves quality of life but reduces dependency on health services.
In working to prevent chronic disease, it is of fundamental importance that we promote measures to increase physical activity generally, but especially among children, and that we continue to warn of the dangers of excessive consumption of foods high in fat, sugar and salt. Eating healthy food and being physically active are two of the most important steps that we can take to improve our health.
It is widely acknowledged that no single initiative will reverse the growing obesity trend, but a combination of measures should make a difference. For this reason, the special action group on obesity is concentrating on a specific range of measures, including actions such as calorie posting in restaurants, healthy eating guidelines, measures to restrict the availability of top shelf food and drinks, nutritional labelling, marketing of food and drink to children, the supply of healthy food products in vending machines, the detection and treatment of obesity and the promotion of physical activity. Many of these initiatives are at an advanced stage and the group will continue to liaise with Departments and organisations in a cross-sectoral approach to progress this area further and to help halt the rise in overweight and obesity. The healthy eating guide and food pyramid for the general public alongside the Food Safety Authority of Ireland, FSAI, guide for professionals are positive steps in the achieving this aim.
There is significant evidence that physical activity promotes well being and physical and mental health, prevents disease, improves quality of life and has economic, social and cultural benefits. However, the majority of Irish people do not meet the levels of physical activity indicated in the national physical activity guidelines. One of the commitments in the healthy Ireland framework is to develop a plan to promote increased physical activity levels across the population. The ambitious initial key performance indicator is to increase the proportion of the population across each life stage undertaking regular physical activity by 20%. A working group, which will be co-chaired by the Departments of Health and Transport, Tourism and Sport, has been established to develop this plan. It will provide a strong focus for modifying unhealthy life habits and promoting awareness of the benefits of physical activity, not just for health, but also in a wider socioeconomic context. It is hoped to have a draft plan completed by the end of 2013.
I commend the work the Seanad Public Consultation Committee has done in the area, and thank the committee for this opportunity to respond to the issues outlined in its report.
Improving our own health is a responsibility we all share. I firmly believe that we must harness all the resources available to us to work together to ensure that people can lead balanced and healthy lives. Although cancer is a serious threat to the lives and health of the population in Ireland I believe that our health policies are already addressing some of the key risk factors and I hope that future trends will reflect the progress that has been made.
I welcome the Minister of State and am glad of the opportunity to make a few points. The Seanad Public Consultation Committee is one of the good news stories of the Oireachtas during this Administration. It did not exist hitherto and I wish to pay tribute to Senator Cummins, the Leader of the House, who has done his best to introduce a variety of different initiatives to this House. As he said on the Order of Business today, it is good to see that the other House is beginning to follow suit. I do not mean to be facetious about this but while we were lucky to have a journalist present for the today's Order of Business - Mr. Fiach Kelly, and fair play to him for being here - the reality is that there is nobody in the Press Gallery now. Yet this issue is important as is the public consultation that informed this succinct and factual report. It is also based on good research and has informed the Minister's consideration of the issue. He has highlighted some things that he will do on foot of the report. That is democracy in action. Is it any wonder there are difficulties in trying to put forward a case for this House when the Government on the one hand, and a willing accomplice in the media on the other, continually choose to ignore the good work, such as this, that is going on?
The members of the committee, including Senators O'Donovan, Bacik, Bradford, Cummins, Paul Coghlan, Daly, Mullen, Higgins, O'Donnell, O'Keeffe and Wilson, deserve our credit and thanks for the consultation that took place in 2012. The report is a very good one. It brought a few things home to me on obesity, the role of alcohol in breast cancer - which is not something people would ordinarily associate with it - and the sheer impact that lifestyle has on the incidence of cancer. Much can be achieved if we adjust our lifestyles.
As regards diet, people far too often reach for convenience foods which are not the best for us. Politicians who live outside Dublin may be more prone to eating meals in the car while driving. I do it several times a week from a plastic coffee cup that is probably very bad for me, and some kind of meat sandwich with additives. How many of us reach for the little tubs of fresh fruit? Probably very few.
Despite the best efforts of the Department of Health, the HSE and various Government agencies, including NGOs, that try to influence dietary and exercise regimes, there is also a whole lifestyle that is promoted by fiction on television. We all enjoy taking refuge in that from time to time. It is not always the healthiest lifestyle. For example, children's television programmes might glorify smokers, drinkers and layabouts. In Hollywood movies, such people are slim, trim and look fantastic whereas real life is very different. Should we take an interest in that, rather than the obvious things like advertising? I am not talking about censorship but we should examine standards in our entertainment that seem to trivialise a certain lifestyle as being acceptable.
It lends the false impression that that person can look as good as Hollywood actor A, B or C while having that lifestyle. That is perhaps something we might look at.
From a health perspective, the National Cancer Control Programme, NCCP, is successful statistically in terms of outcomes. I use the word "statistically" because for 80% of the country that is the case. However, it is not representative of the roll-out of services countrywide. The mission statement of the National Cancer Control Programme is "centrally developed, locally delivered". As Senator O'Keeffe will testify and, up to recently Senator Cummins could testify in regard to the south east, there are gaping holes on the map of Ireland in terms of radiotherapy, for example. That is not to suggest that we need to have a Mayo clinic or St. James's Hospital on every corner. However, we do need specialist centres that are, as per the mission statement of the NCCP, centrally developed and locally delivered. We need to at least begin to plan for the delivery of radiotherapy within a three hour, one and a half hours each way, commutable distance so that mothers who have to undergo eight minutes of radiotherapy per day and have children to care for can get home to care for them rather than have to travel to Galway or Dublin for treatment.
I do not like when the Government - the previous Government was just as guilty of this as is the current Government - takes refuge in the Queen for certain things when it comes to health. It is constantly stated by Government that it is working well with its Northern counterparts. It brings somebody in Glencolmcille who needs radiotherapy no closer to getting treatment because there is a promise of a centre for radiotherapy in Altnagelvin. Even if there were such a centre there would still be gaping wounds in parts of Ireland. Professor Tom Keane changed the landscape of northern Canada in facilitating centres for radiotherapy. While we should still go to hospitals such as St. James's and Beaumont and others in Cork and Galway for specialist treatments, diagnoses and surgery, all follow-up treatments, including radiotherapy, should be delivered in more central locations. I accept that there are costs associated with doing so in terms of the provision of accelerators and radiographers and so on. Nevertheless, it is a plan we need to put in place and aspire to, notwithstanding budgetary constraints at this time. It is something for which we must aim. Perhaps there is a private sector aspect to this in terms of funding, as has been done in other areas.
My mother who died of cancer, which from the outset was terminal, received her treatment in the Beacon Clinic. I recall that at that time brain scans were assessed for radiotherapy in Pittsburgh but delivered in Sandyford. What is proposed can be done. We have all been involved in emotive campaigns in regard to cancer services for the north west, south east and other areas. This is something that can be done. Some Government will at some time put this plan in place. Why not this one?
This is a very good report. In terms of alcohol, minimum pricing is an absolute must. It is critical that when we do this the price is set high enough. We all know that as Christmas approaches, cases of beer will be on sale in local supermarkets for €14. While if I purchased a case of beer I would still have most or a large portion of it next June, sadly younger people would consume it within two hours, which is the type of practise we need to move away from. While other Senators have a different view in regard to price fixing and so on there is a need for minimum pricing on alcohol. At a minimum, we must try it for a period. Ireland is now ranked second in the world in terms of binge drinking. We are all guilty of it.
In terms of diet, all I see in shops are multicoloured fizzy drinks. One has to search for old fashioned orange or lemonade now as virtually all the products are pink or blue and could not be good for us. The most unhealthy sweets are placed at the front of shops, near checkouts. I am sure codes of conduct could help in this regard.
In terms of exercise, physical education very much takes a back seat in the education system. While we have some schools where sport is particularly strong, for example, in the many Dublin schools which focus on rugby, not every child is involved in the local GAA, athletics or soccer club. Senator Eamonn Coghlan will be more familiar with this issue than I am. However, some level of physical activity should be made compulsory and scheduled every day, rather than once or twice or week. Adults need at least 30 minutes of aerobic activity each day, whereas children need 60 minutes of aerobic activity daily. Exercise is habit forming and becomes easy to continue if one takes part in it every day, rather than sporadically.
I thank the Minister of State, Deputy Alex White, for coming before the House. While I have always praised Leaders of the House, I regard Senator Cummins as the best Leader the Seanad has had on the basis that he has shown great flexibility in trying to introduce new initiatives. This does not mean he and I have not been dug out of each other in the odd debate. It is vital that this is the case as we would not be of any benefit to the political system if it were otherwise. It is sad that initiatives of this nature go unnoticed as they demonstrate that democracy works. I do not say this because there will be a referendum on the abolition of the Seanad in a few weeks. These types of initiatives show that the Oireachtas, not only the Seanad, can be used as a successful vehicle for laundering, if one likes, a message from people who have knowledge of certain issues, for example, those who provided the House with information in the consultation phase, and passing it on to the relevant Minister and officials to ensure the correct steps are taken.
I congratulate all the members of the Seanad Public Consultation Committee and the Leader and thank the Minister of State.
I welcome the Minister of State. While the future of the House may be a little uncertain, one thing that is certain is that lifestyle affects one's health. One of the key statistics in the report is that we know, without fear of contradiction, that 30% of common cancers are influenced by the way in which we live our lives. As Senator MacSharry noted, one of the initiatives launched in this Seanad was the establishment of the Seanad Public Consultation Committee. As a member of the committee, I embraced the initiative wholeheartedly and proposed this issue for discussion. We did a good job and I am pleased the Minister of State has come before the House to discuss this extremely important topic.
This process came about as a result of a briefing Dr. Kate Allen, who works for the World Cancer Research Fund, gave to the Irish Cancer Society. Dr. Allen spoke in such stark terms that I decided it was necessary to promote the message that we have some control over our lives. This is not a matter for the Health Service Executive, Department of Health or someone else but for each and every one of us. We must try to understand how to lead a healthier lifestyle. As public representatives, we have a duty and responsibility to try to get this message across in a clear fashion. The issue came before the Seanad Public Consultation Committee for this reason. It will not be a surprise to those present that this report is probably one of the shortest reports ever presented to the Oireachtas. My co-author, Senator Marie-Louise O'Donnell, and I both have experience in journalism and we deliberately decided to produce a short report. We did so because we did not want to wrap up the report in another report or produce a document that no one could get at. It needs to be clear that the report makes simple recommendations, all of which are achievable. We had a good debate on which of the recommendations made by witnesses we would choose and we chose those we believed could be achieved by this Government.
One or two of them are obviously more controversial than others, not least the restriction on the price of alcohol that Senator MacSharry mentioned. However, in the main many of them are very practical. What is the point in getting bogged down in another report by another group? We have more statistics than we know what to do with. I suggest part of the dilemma in the current debate on cancer is that the public is getting confused. There are many scare stories about cancer on the one hand and how many people will get cancer and so forth. There is confusion about the effect of drinking a glass of wine, or eating a bar of chocolate, nuts or porridge. People are getting consumed and confused by that. One of our key responsibilities was to lay out our recommendations for Government in a very clear way and I hope we have done that. I hope anybody picking up the report can read it very quickly and get a grasp of the scale of the challenge facing us.
I welcome the health strategy launched in March. I attended the launch and found it very impressive. It is a very wide-ranging long-term strategy. We can launch as many strategies as we like, but the implementation of the strategy is what should concern us. I am delighted to see an interdepartmental group involving the Departments of Health, and Transport, Tourism and Sport to encourage people to be more physically active, which is what we need. As Senator MacSharry said, not everybody in school likes hurling, soccer, football or whatever, but children spend a considerable amount of time in school every day. Even if they could run around during the day, it would be a help.
I had the pleasure of welcoming the Minister for Education and Skills, Deputy Quinn, to Sligo last week. We visited a girls' school in Collooney where the area for running around is small. The main road to Ballina passes in front of the school and is very dangerous. Those 50 or 55 students are very constrained in the amount of running around they can do. They are not alone. Some time ago we threw out the value of physical education of literally running around even if it is in an unstructured way. One practical thing we could resume doing is having children being able to run around during the school day and not relying on parents having to take them to something else after school to ensure they get the exercise they need.
We often criticise the HSE, which is very easy to do given that it has many problems. However, we are certainly blessed with the people who work there and in the many organisations associated with health and health-care provision in Ireland. They have been screaming that we have a problem in the country and voicing concern, particularly over obesity. One of the recent briefings was entitled "Childhood Obesity Catastrophe in Ireland: Time to Face the Inaction". Many people who attended that briefing made the points the Minister of State will have heard previously about childhood obesity. If the health-care professionals are calling it a catastrophe and referring to inaction, we should be doing more to bring home the message to parents, children, single people and older people that lifestyle is a major contributory factor. During that briefing we were surprised to learn the relationship between the consumption of alcohol and the incidence of breast cancer in women. Many people did not know or realise that and yet it appears to have drifted into the ether along with all the other things.
It is about informing the public and having a campaign and strategy that is rooted in education and information and not frightening people. I was impressed by the Irish Cancer Society's new strategy statement, Towards a Future without Cancer. It concentrates on the idea that we could have a future without cancer and a mission to eliminate cancer. One of the speakers, Dr. John Seffrin from the US, mentioned a 68% survival rate for white men with cancer in the United States heading for 80%.
The message he was trying to get across was that we need not be afraid of this in the way we were 20 years ago. In Ireland, we still are in the stage of being afraid, and all the statistics refer to the fear and terror and its rise, as well as the numbers who are dying every day, hour and week. This is the kind of thing that almost paralyses people and prevents them from taking control of their lives. Consequently, one returns repeatedly to the need for this to be about people taking charge of their lives and how the Government can link into that. If health care professionals are terrifically concerned and wish to become involved, Members have a duty to listen and deliver on that.
Although they were present at the time, it probably is worth reading into the record the groups who appeared to give evidence to the Seanad Public Consultation Committee. Moreover, such was their concern that they also attended the launch of the report. I refer to the Nutrition and Health Foundation, the Irish Nutrition and Dietetic Institute, the Alcohol Forum, the Irish Cancer Society, the national cancer control programme, the Institute of Public Health in Ireland, the Alcohol Action Ireland group, the health promotion research centre in NUI Galway, ASH Ireland, the World Cancer Research Fund, which of course sparked the discussion in the first instance, and safefood. These are all the key people involved. All these groups attended and I note they sent their senior people to both the meeting and the launch.
My request is that the obesity group really should be the cancer group and should not concentrate solely on obesity. While I do not wish to reduce its importance, it should be extended to include alcohol and tobacco and should be turned into a task force on cancer, which would then have all the additional benefits of people being healthier in respect of many other conditions such as diabetes, to give one example.
I am delighted the Minister of State is present and that Members are having this debate. I thank the Leader of the House for encouraging and supporting the Seanad Public Consultation Committee in respect of this initiative. This is the kind of work the Seanad can do well because its Members have that space and some expertise on which they can call, as well as being able to take the time to frame it properly. As a public representative, I take this matter very seriously and I would like to believe the current Administration, led by the Department of Health in tandem perhaps with the Departments of the Environment, Community and Local Government, Education and Skills, Transport, Tourism and Sport, Jobs, Enterprise and Innovation, and Agriculture, Fisheries and Food, can have a role in stating that a foundation is being laid down for a strong approach to giving responsibility to people to feel there is a future without cancer and that they will be supported to make this first step towards living a healthier lifestyle. While it is not easy, it certainly can be done. One hopes some of these recommendations will not be put on the shelf but will be used and considered over time and that everyone can benefit from them.
I must admit I knew very little about the fact that this process was taking place or the consultations it involved. Consequently, I am approaching it as something of an ingenue. That said, I will make one or two points. On the occasion of his famous "Lickgate" speech in this Chamber, the Minister of State, Deputy Brian Hayes, stated the Seanad had the habit of sometimes falling into the trap of simply sitting here talking to itself with no one particularly listening. I greatly hope this is not the case today and Members are being heard. Is the House quorate?
The accusation is made that sometimes we sit here talking among ourselves and nobody is listening and no one is reporting. I may be feeling a little cynical today but I want this process to be something other than people sitting around and basking in the glow of a feel-good factor of making platitudinous statements about the way the world should be. We are not like a boy scout club but Members of what is still one half of the national Parliament. We have here with us a Minister of State who sits at one of the highest tables in government. We can do stuff rather than just talk about it. Let us do a quick report card on some of things that can be done that have come up in my two and a half years in the House.
As the Minister of State may know, I am a cancer expert in my day job, but first things first. We proposed legislation a year and three quarters ago to ban smoking in cars in which there were children, and there was great support for it inside and outside the House. It had one of its primary effects which was to lead to debate on the issue of smoking in cars where children were present. It had an educational effect in that people who did not realise the exact level of danger to which they were subjecting small children when they smoked cigarettes in a car with them present, would modify their behaviour. For the first time this became something people talked about. I am very sad, however, that this legislation is jammed somewhere in the bureaucracy of the Department of Health. We originally thought it would be in place before summer 2012. We did not get it in place before summer 2013 and I am not sure when it will be in place at this stage, but I know that the Minister of State, his senior colleague and a few others, by twisting the right arms and greasing the right elbows, can make this happen very quickly, and we can get it out of the way.
I have to be careful about this because the Minister, Deputy Reilly, is the best qualified and the best Minister for Health we have had for some time. I also believe he has been dealt awful cards and is trying to forge a reform programme at a time when reform programmes are difficult to forge. I know he has the real will to tackle the problem. However, we must be blunt about this, the only smoking legislation the Government has passed in the current Oireachtas is legislation to make it easier to sell cigarettes. That is it. The only legislation that has come through was the legislation the Government was forced to introduce to comply with the European Court of Justice and the European directives ending the fixing of lower prices for tobacco, which effectively meant that the Government was making it easier for the companies to sell tobacco products. I am not saying this happened for any reason other than for the fact that the Government's hands were forced into doing it. To try to redress that balance, one would think that the Government would give a very high priority to passing some legislation that would curtail the smoking habit.
We cannot have this discussion today and not acknowledge the appalling situation that arose when the Prime Minister of this country and several of his senior Ministers met, in flagrant violation of international conventions about the way that Government should deal with the tobacco industry, for a private session with the tobacco industry, which ostensibly was to discuss some issues which might have had some fiscal and economic concern but were in fact used, as we now know, by the tobacco industry, through the agency of a PR company that was well connected to the senior party of the Government, to enable it to get a message across to the Government, articulating its opposition to the Minister's laudable proposal to introduce plain packaging and other measures. This was wrong.
For us to sit here and say we are all getting together to talk about how we can modify lifestyle to reduce cancer while we are not passing legislation which would make it harder to smoke in cars with children and are facilitating the input of the tobacco industry in meeting the senior in the Government, is pure and simple hypocrisy. That is the only way to describe it. We need to have a clear, unequivocal mea culpa rub of the soap on the soul from the Taoiseach and the senior Ministers apologising to the people of this country for having had that meeting and acknowledging that it was, at worst, a major error.
Malignant melanoma, the least common but most fatal form of skin cancer, is a particular horror disease. The incidence of malignant melanoma in Ireland between 1998 and 2008 went up from 400 to 800 cases and between 2008 and last year it went up from 800 to approximately 1,100 cases. This is entirely due to the fact that we were designed by God to live under grey, misty, cloudy skies. Our skin colour and skin defences against the sun are not adequate to give us good protection when we get higher levels of sunlight and we now get the higher levels of sunlight for reasons relating to travel, etc. It is a real problem in Ireland. The cancer, which according to the international legislature is considered an uncommon cancer, is a relatively common cancer in Ireland. We are probably looking at 300 to 400 deaths per year in Ireland if current trends continue over the next few years, which would put it in the same league, although somewhat fewer, in terms of the number of deaths as breast cancer. It is a disease which disproportionately affects younger people, so what can we do?
The first thing we need to do is to introduce legislation to deal with the use of sunbeds. Rather than talking, waffling and sprouting rameis about telling people to cut down on their calories, which is important, we have it in our power in this House to bring in legislation to severely curtail and possibly to ban sunbed use, certainly to ban sunbed use by people who are under the age of 18, and to have the strictest of controls over the way sunbed services are delivered in this country. Parenthetically, I also mentioned that it was not about setting up a bureaucracy called the NCCP, or about centralising or saying we will make the tractors here and deliver them locally the way that was done in the Urals. I was probably too late for that comment to have any impact on the Minister, Deputy Noonan, who is the individual who deserves the most credit in the history of this country for improving cancer services. This is about appointing a few extra doctors whereby people could see a doctor who was a cancer specialist. It was the Minister, Deputy Noonan, who - I say this in the best spirit, imitation is the most sincere form of flattery - lifted a line from a speech of mine in 1994 in which I said there were hospitals in this country to which I would not let a relative of mine go if they had cancer. The Minister acted on that and he set about trying to appoint people. I probably approached the Minister too late in the budgetary cycle last year to remove VAT from sunblock products. Sunblock is currently taxed as if it is a discretionary cosmetic item, but it is a medicinal item. If we are serious about reducing the incidence of skin cancer and cancers in general in this country, there is no way around it. We have to tackle the problems of melanoma and sunbeds. We cannot block people from going on sun holidays although we can educate them . We can tackle the use of sunbeds with the speedy introduction of legislation and we can drop VAT from sunblock.
What of alcohol? It is a strange phenomena that this Chamber, probably uniquely in the world, allows three different groups of alcohol vendors to be nominating bodies for one half of our national Parliament. I understand there are complex historical reasons for that, but it is not appropriate. In the event that the Seanad is preserved, I would hope that there would be a commitment from the Government to introduce reform, along the lines of my Bill, which would take these rather obscure nominating bodies out of the way and completely democratise not only the electoral process but the nomination process. We need to have a really serious think about alcohol. We have to understand that everybody who makes their living selling alcohol is our adversary in public health.
They are not our partners. They are our adversaries. Like many people, I enjoy a drink. I am not being personal or moral about it. I am saying that as a point of public policy, our goal as a society is to reduce alcohol consumption. Their goal is to sell more alcohol. Regardless of how these companies try to couch their activities, for example, in terms of quasi-governed responsibility partnership campaigns, they are there for one reason. If my pension fund was tied up in businesses involved in flogging booze, I would not want them to do anything else. We should not see them as partners. We should see them as our adversaries and we should curtail their activities. Our business is to put them out of business - pure and simple - and that is what we should be aiming to do. We need to examine, independently of the alcohol industry, the way we govern the alcohol problem in this country. We should encourage no drinking, or else responsible drinking. We cannot believe that these people are our partners in this initiative.
I would like to list some of the things that would happen if we all stopped drinking. Liver disease would become uncommon. Five or six of the most common cancers would become substantially less common. Waiting lists in our health service would probably disappear. Our accident and emergency units would be much more manageable. Far more discretionary money would be available to families to spend on their children's food, clothing, education and cultural activities, etc. Parents would have far more time for parenting their children, rather than spending their time drinking. All of the arguments in favour of taking action in this area are overwhelming. One of the big arguments relates to cancer.
It is important to transmit the right message with regard to diet and obesity. It is easy for us to pick targets from some obscure part of the foreign chemical industry that makes food additives or trans fats. We sometimes tend to forget that this country's biggest obesity problems do not necessarily come from eating bad foods; they come from eating too much food. I probably take 20 dietary histories a week in the course of my day job. They provide overwhelming evidence that many people are struggling with their weight not because they eat nachos with cheese, etc. - although many of them do - but because they eat too much bread, too many potatoes, too much sugar and too many scones, etc. We need to have a serious think about the implications it will have for certain parts of our own food industry when we start having a serious think about tackling food.
I compliment my colleagues for introducing this initiative. If it is a case of aphoristic waffle delivered in a fairly empty Chamber, getting no coverage and with no actual action coming from it, I suggest it will provide yet another soundbite for the "abolish the Seanad" campaign. When the Minister of State leaves this House today, I ask him to focus on getting the Protection of Children’s Health from Tobacco Smoke Bill 2012 passed, on bringing further legislation through to tighten up on tobacco in general, on regulating sunbeds and banning their use by young children and on ensuring next month's budget provides for sunblock products to be subject to no VAT or the medicinal rate of VAT.
I welcome the Minister of State to the House. I thank him for his observations I am glad he has agreed to get his officials to look at the recommendations made in the Seanad Public Consultation Committee report, which focuses on how lifestyle changes can prevent approximately one third of all cancers. As Members have said, the committee was established by the 24th Seanad at the suggestion of the Independent Members who were nominated by the Taoiseach. The committee has published a number of excellent reports, some of which have already been acted on by the Government. Action is certainly needed in other cases.
This is a short report, as Senator O'Keeffe mentioned. It recommends that certain actions be taken. We believe the recommendations in the report should be acted on and we hope they will be. I always listen to what Senator Crown has to say about health matters, particularly with regard to cancer. The Protection of Children’s Health from Tobacco Smoke Bill 2012, which he introduced along with Senator Daly, has been the subject of a long delay. I understand the Department contacted the Senators not long ago to ask them for final comments on the Bill that the Government intends to introduce. I hope the legislation in question will be brought before the Seanad, given that the idea was initiated by Members of this House.
I do not mean to be facetious when I say I am glad the reform proposals for the other House that have been announced, and which were mentioned by Senator MacSharry, provide for a system that will mirror this House's public consultation system, which allows us to study and advise on public policy matters. That is to be welcomed. The report before the House was compiled following some extremely informative and deliberate sessions in this House. As Senator O'Keeffe said, the committee engaged with people who work at the coalface. It was harrowing to listen to some of the statistics regarding various cancers and the effect they have on people. We all learned a great deal from these extremely informative sessions. I join other Senators in thanking all of the individuals and organisations that made an excellent input into this report.
Cancer is a disease that affects almost every family in the country in one way or another. The Seanad Public Consultation Committee strongly felt that it was worthwhile to identify simple everyday actions that individuals could take to prevent the onset of cancer. Smoking, obesity and alcohol consumption have been revealed as the three key areas in which lifestyle changes can prevent the incidence of cancer. The committee believes the Government must take a lead in highlighting the research revealed in this report and in driving change through appropriate policy-making and legislation. For example, some 85% of all cases of lung cancer in the Irish population relate to tobacco. The Seanad Public Consultation Committee report recommends the banning of cigarette vending machines and the introduction of a ban on smoking on all educational campuses. We believe such measures would go some way towards preventing the onset of lung disease because they would stop people from starting to smoke at an early age.
The child obesity figures were also telling. There are over 30,000 obese children in Ireland, which is a staggering figure. I was shocked to learn that the number of obese children is increasing by an average of 10,000 per annum and that the cost to the State of dealing with people with health complications arising from the obesity epidemic is over €4 billion. Those figures certainly put this problem into perspective. Immediate action needs to be taken to educate children and their parents on the importance of nutrition and physical activities. A focus on self-esteem is also required.
The alcohol problem that exists in Ireland is a regular issue of concern in this House. We have discussed it with the Minister of State previously. One of the most startling facts to be revealed through the public consultation process was that drinking between three and six standard drinks each day significantly increases the risk of cancer of the breast, liver, mouth, throat, oesophagus and bowel. We might have thought there was a link between alcohol consumption and liver, mouth and throat cancer, but we were shocked to learn that the other cancers might be linked to the over-use of alcohol.
There is an opportunity now for the Government to increase awareness of the link between alcohol and these awful illnesses, via the regulation of alcohol marketing and the introduction of alcohol labelling legislation, which would require products containing alcohol to include warnings about cancer. I would also welcome any other appropriate measures from the Department of Health, the HSE and other publicly-funded organisations, such as the publication of leaflets by the HSE, television or radio campaigns or an Internet campaign which would outline simple lifestyle changes such as those advocated in this public consultation report. These would help our people become aware of the necessary changes that can be made to prevent cancer.
I thank the Minister of State for coming to the House and hope we see action on this report and on legislation like that put forward by Senator Crown. I hope too that we have a speedy introduction of the legislation necessary to combat this dreadful disease.
I welcome the Minister of State to the House. It is good to be here to debate and discuss this report which though short, is heavy in content in terms of the actions and proposals it puts forward. This is what such documents should be like. I commend the authors, the committee on its hearings and all of the experts and individuals who took part in the consultation process and thank them for their input.
The starting point in solving any problem is the acceptance of the fact we have a problem. We are at that position in regard to cancer and the causes of it because of the significant research that has been carried out in recent years. The facts are indisputable that obesity, alcohol and what we eat all play a part in terms of the levels and incidence of cancer in our State. The figures are startling - one in four people in this State will get cancer. The report states that by 2030, twice as many people in the State as now will have cancer. This is because of our ageing population and population growth. However, it is appalling to think we will have twice as many people suffering from cancer. This is a human tragedy that will be traumatic for these individuals and their families, but it will also place a huge financial burden on the State and our health services.
It is obvious that the best place to start dealing with this is by trying to prevent cancer developing initially. Significant research has been done on treatment for cancer patients, which is fantastic and we need investment in that area to ensure people get the best treatment. However, we should invest as much again in preventive measures. The report acknowledges that we have not invested as much as we should in prevention, in raising awareness, in education and other areas.
I would like to mention some sections of the report which merit comment, beginning with the section on smoking. When we look back at what the previous Government did, we can look with horror on much of what was done. However, one good initiative was the introduction of the smoking ban. There was significant political pressure on the Government at the time and a huge lobby against the introduction of that ban. It was a big challenge for the then Government electorally, particularly smokers, to follow through on the commitment and to put the ban in place. The question we must ask ourselves now is whether anybody would want to see that decision reversed. I am sure the majority of people would say "No". I believe that even those who were completely against the ban would now see the benefits and would not want the decision reversed. The same applies to many of the recommendations in this report. It will take political courage to follow through on them and it will be necessary for the Government, all parties and the political system to face down strong lobbies from the cigarette industry and the alcohol industry.
I am sure the Minister faces such opposition in regard to the proposals on alcohol prevention and reduction in the report commissioned by his Department. I was a member of the health committee for two years and was involved in drafting the all-party report published by the committee some years ago. Many recommendations were made by that committee, including one on pricing. I dissented on the issue of minimum pricing, not because I do not believe pricing plays a part in reducing consumption - I think it does and evidence says it does - but because of my concern that the introduction of minimum pricing would not solve the problem but would bolster the profits of the people who provide alcohol. I wanted reassurance from the Government and those who propose minimum pricing that this would not be the case, but that has not happened so far. I still do not know exactly how minimum pricing would work. Many people argued at the committee that if we were minded to use pricing as an instrument to reduce consumption, we should look at increasing excise duty on alcohol. In that case the money would come straight to the State and Government coffers and should then be ringfenced for the type of work recommended in this report regarding raising awareness, education and prevention measures in each area. If the Government is going to use pricing as an instrument, there must be a dividend and that money must be ringfenced so as to ensure that recommendations in this report will be implemented.
The all-party proposals on alcohol consumption contained many other proposals, such as on the issue of sponsorship for sporting organisations, but a different Oireachtas committee came up with a different analysis and set of proposals. Again, there was strong lobbying done in this regard. There is significant lobbying done by the alcohol industry and I saw this for myself when a member of the committee. Hard lobbying is conducted to prevent the Government from doing what is right in these areas and from coming up with measures and proposals that should be implemented. However, if our proposals were implemented, we would be in the same situation as we are now with regard to the smoking ban and could look back and ask why this was not done earlier or why there was not debate on the issues earlier. This is something we should consider.
With regard to the proposals relating to children, I have a child of six and a child of two and was very interested in the question of what should be or should not be in a child's lunch box. The challenge in this regard is to educate ourselves and parents about how we should eat, how we feed our children and how what they eat will impact on their health. Even simple proposals such as banning junk food and vending machines in schools and workplaces are difficult to implement. One would be amazed by the amount of opposition there is to even the simplest of proposals such as this.
There is a responsibility on the political system - all parties - to face up to our responsibilities in these areas. If we are genuine about wanting to reduce the levels and incidence of cancer, we must take tough decisions. We must face down the vested interests and show courage and support each other. We in the Opposition must support the Government when it takes the right decisions on these issues rather than support it for selfish, political reasons. I hope that is how this will play out.
I call on the Minister of State to respond on some of the questions I have raised and to outline what actions he intends to take on board from this document and will implement.
I welcome the Minister of State to the House. The majority of cancers are caused by smoking, alcohol consumption, unhealthy food consumption or obesity.
As legislators, we should be attempting to influence people to make better choices while not restricting choices. Ireland unquestionably has the highest incidence of cancer per head in the world. We must examine this issue with some urgency. I agree with Senator Crown on sun beds. It seems like a no-brainer and I would be interested in the Minister of State's reply.
There are some indisputable facts as regards smoking. For example, it causes 85% of all lung cancers and one third of all other cancers. Tackling this matter must be our main focus. I am something of a hard-liner and would go as far as banning cigarettes from the country, although this could cause other problems. Plain packaging has been introduced effectively in Australia. It is argued that plain packaging would not work in Ireland or would help counterfeiting. If it was implemented correctly, it could actually reduce counterfeiting through the use of proper taxation marks, thereby showing whether cigarettes are legitimate. This should be possible without any difficulty. According to the majority of independent studies, plain packaging has been successful in Australia, has not led to a demonstrable increase in counterfeiting and has made smoking less appealing to young people. Similarly, banning smoking on educational campuses would be a good idea.
The second matter on which we should focus is that of alcohol consumption. I have done a great deal of work on this issue and people are blue in the face listening to me discussing it. It is serious for a variety of reasons, not least the issue under discussion today. The implementation of minimum floor pricing for alcohol seems relatively straightforward, although we will be presented with all sorts of difficulties by lobbyists. We should fight the issue.
A third focus should be that of diet, although this issue can be belittled. Senator Crown mentioned something along the lines of calories being listed on menus, etc. Other issues are seen as being more important in this context. However, the incidence of cancer is much increased among people with unhealthy diets. Education is key, as Senator Cullinane mentioned. Recently, a mother told me that she put Actimel in her child's lunch box, but Actimel contains five or seven spoons of sugar, which is ridiculous.
I would like to say loads more, but the fourth matter on which we should focus is obesity. It differs slightly from the healthy diet argument, as one does not need to be obese to be unhealthy in terms of the likelihood of cancer.
Improvements in lifestyle can prevent approximately one third of cancers. This is an incredible number. As legislators, we should be fighting to make these seemingly simple and small changes. Taken together in a macro view, they can cause significant improvements in the health and well being of our citizens in the short and long terms. While we can put these matters on the long finger and cave under lobbying from each industry, now is the time to take cognisance of the larger picture and take brave decisions. We will reap the rewards in a decade or two.
I will try not to be repetitive. I welcome the Minister of State. The Leader welcomed the call for action, which reminded me of how I presented a Private Member's motion in November two years ago regarding the points for life initiative and physical activity in schools. The night before the debate was to take place, the Government asked me to change one word. There were nine amendments to my motion. The word was "action". The Government wanted to replace it with "explore". I remember thinking that "explore" could mean anything and that, even if we looked into the issue, would we deliver on it? I hope that there will be action on this matter.
Almost two years later, my points for life initiative only got up and running in a couple of schools this month. If I had my way as a legislator and as someone with a background in sports and ongoing experience of coaching young people, I would have points for life initiated in 70% or 80% of schools. I understand that certain factions are opposed to my ideas for imposing initiatives on schools.
Lifestyle changes can reduce cancer rates, obesity and tobacco use. Unfortunately, the public are not taking any action despite the information and statistics that have been passed on to them.
Cancers stemming from lifestyle are self-inflicted as far as adults are concerned. Cancer in young children is not caused by lifestyle. I spent last weekend with Fionnbar and Elma Walsh, parents of a young boy who died of cancer only a few months ago. His choice was to live. He passed on a message about suicide to young people. It has made a significant difference. The Walshs' main concern when it comes to cancer is not about lifestyle, but about the amount of money invested in research into preventing cancer among young children.
I did not realise that I had as many as ten minutes. If anyone else who has not contributed wishes to do so, I would not like to be the cause of their being deprived of time. I was advised that I would only have two or three minutes.
I thank those colleagues who have contributed to our discussion on this important issue. The report identifies all of the key areas involved. Senator Noone was curious as to our response to the various recommendations. I will not go through each response, but I reflected on most in the course of my speech. Regarding the report's general recommendations, for example, the calls on the Minister for Health to develop a national physical activity plan for all age groups that includes cycling and walking schemes, to ensure the activity plan is central to urban and rural planning and to concentrate on the local level when encouraging significant lifestyle change, the Healthy Ireland initiative is where all of this should happen. We need to pull together all of the agencies. I understand Senator Eamonn Coghlan's frustration at being told to replace "action" with "explore". Such requests can be disappointing. It may surprise the House, but this is a frustration that I have encountered as a Minister of State. One wants actions to be taken quickly, but there often seems to be a good reason for doing something and ten for not doing it.
Progress can be made. Issues such as alcohol can grow so large each time we discuss them that we lose the opportunity to get a grip on them. If we take initiatives such as the one achieved by Senator Eamonn Coghlan, even if they are just pilot projects in schools, at least we have made a start. The Senator can point to what has been achieved in two, six or eight schools. He and people who agree with him are in a much better position to point to what they have already done and ask for it to be done in all schools. I have probably become something of an incrementalist in my middle age. Many of us would like to see initiatives being taken quickly, but if a trail can be laid and people can show that a certain amount has been achieved, they can achieve much more.
There is a manifest link between smoking and cancer. The Minister for Health will comment further on a smoking policy in the coming weeks. I hope he will also be able to say more to Senator Crown and others regarding the legislation sponsored by the Senator regarding smoking in cars.
In terms of obesity, I must revert to the Healthy Ireland framework, although not just to point Senators to that document.
The Healthy Ireland development is a real policy initiative and there are really good people involved. I thank Senator O'Keeffe for pointing out the number of committed people behind this initiative who want to see it work. They do not just see it as a document that they have managed to complete, they are now taking this matter up and running with it. Dr. O'Keeffe in particular is leading on it in the HSE and is very committed to it. All the agencies are being pulled together, not just the Department of Health.
While it is a terrible cliché, health is too important to be left to the Department of Health. It ranges across all the areas that Members here have already mentioned, including the Department of Education and Skills, the Department of the Environment, Community and Local Government, local authorities, statutory agencies, public parks and bike trails. All these areas must be brought together to ensure that we have a real set of policies to achieve our aim.
As colleagues know, I am dealing with the alcohol issue. I wish to thank Senators for their various contributions and support in this regard. I do not wish to single out any Members in particular but I do wish to thank Senator Cullinane for the support he has offered. I would like to have an opportunity to discuss minimum unit pricing. I am persuaded of the value of minimum unit pricing for alcohol. Everybody agrees that pricing is the key factor, it is just that there is a disagreement between the use of minimum unit pricing or excise. Minimum unit pricing targets alcohol that is cheap relative to its strength. Excise, however, puts up the price of all alcohol. It is difficult, although not impossible, to distinguish different types of alcohol for excise which is a fairly blunt instrument. Excise will increase the price all around, but is that what Senators want to do, or do they wish to target the alcohol that is cheap relative to its strength?
We are garnering evidence from Canada, including British Columbia and Saskatchewan. They are comparable areas that have introduced minimum unit pricing, so we can demonstrate to colleagues the value and evidence-base of minimum unit pricing. We should consider taking that route. Such proposals, along with those on marketing and sponsorship, are before the Government. I would hope the decisions will be forthcoming within weeks rather than months, but it is a matter for the Government.
There is genuine disagreement among colleagues on sponsorship and marketing but I wish to draw the attention of the House to a report on sponsorship that was published within the last two weeks. It is relevant and appeared in the learned journal Alcohol and Alcoholism. We need to understand that increasing proportions of marketing budgets now go on sponsorship rather than advertising. Many people seem to think that sponsorship is benign. They may think that advertising is the hardcore activity and that sponsorship just involves a company putting up its logo. However, the evidence increasingly shows that it is vastly more sophisticated and that the impact is much more significant.
Last week's remarkable study concerned a frequency analysis of alcohol marketing in televised English professional football. The study identified an average of 111 visual references and two verbal references to alcohol per hour of broadcasting. Nearly all visual references were to beer products and were primarily simple logos or branding. The majority of verbal alcohol references were related to title sponsorship of competitions. A total of 17 formal alcohol commercials were identified accounting for less than 1% of the total broadcast time. Therefore the balance is shifting quickly between the spend on what we would regard as traditional advertising and on sponsorship. The conclusion is that visual alcohol references in televised top-class English football matches are common, with an average of nearly two per minute. Verbal references are rare and formal alcohol commercials account for less than 1% of broadcast time. Restriction of all alcohol sports sponsorship, as seen for tobacco, may be justified according to the authors of that study.
We cannot put together a package of measures on alcohol without seriously addressing the issues of marketing and sponsorship.
The link between alcohol and cancer is undeniable. The Leader has made the point, that is also in this good report, that alcohol marketing must be regulated. We must address that issue and I hope that there will be a level of consensus in the Oireachtas on this matter in the weeks ahead.