Transcript The Cost of Tobacco in Newfoundland and Labrador

Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
The Cost of Tobacco in
Newfoundland and Labrador
and
The Economics of Tobacco Control
and Smoke-Free Places
St. John’s, 1-2 April, 2003
GDP vs. GPI view of Smoking
The GDP “view” - all spending, including tobacco,
makes economy grow, contributes to “prosperity”
• Cigarette sales = $141 million, 1% of GDP, 2001
• $millions for medical costs, hospitals, doctors,
drugs for smoking related illness
• Nicotine quitting and replacement costs
• In GPI, smoking =cost, not gain, to economy
Newfoundland Smoking
Rates, 2001
• 26% of Newfoundlanders smoke (CTUMS)
• Labrador = 36% men, 30% women
• 22% of 15-19 year olds smoke
• At today’s smoking rates: Of the children
and teenagers alive in NL today, 9,000 will
die from smoking in middle age and 9,000
more will die prematurely later in life
Percent of Population Who Smoke
(1985 and 2001)- Current smokers as % of population age 15 and over
1985
2001
50%
43%
45%
40%
38%
40%
35%
33%
20%
38%
36%
36%
32%
30%
24%
25%
39%
26%
31%
25%
26%
26%
25%
25%
25%
20%
17%
15%
10%
5%
0%
BC
PQ
PE
ON
NS
NL
MB
AB
NB
SK
Change in Smoking Rates 1985-2001
60%
Percent of Decline
50%
48%
40%
40%
37%
40%
37%
34%
33%
32%
31%
31%
30%
19%
20%
10%
0%
BC
PQ
PE
ON
NS
NL
MB
AB
NB
SK
Canada
Daily Smokers -as % of Population
Aged 12 and over, by Health Districts, 2000/01
Men
Women
40
35.6
35
30
29.7
30
25
27.1
26.6
23.5
24.2
23.3
23
25.5
22.4
22.1
26.3
25.1
23
19.4
20
15
10
5
NF
6)
La
br
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or
(
NF
5)
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(N
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W
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rn
NF
3)
Ce
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(N
F2
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Ea
st
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n
(N
F1
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% Who Never Smoked
2000/01
age 12 and up
Male
45
Female
42.2
39.3
38.2
40
38.6
36.3
35
32
28.8
30
26.8
27.9
29.2
25
20
15
10
5
0
Canada
Newfoundland
Prince Edward
Island
Nova Scotia
New Brunswick
Teen Smoking (15-19) 22% in
2001 (down from 28% 2000)
35.0%
30.0% 28.6% 28.2%
26.8% 27.1%
24.6% 24.1%
25.0%
22.5%
Percentage
22.0%
20.4%
18.8%
20.0%
16.8%
15.0%
10.0%
5.0%
0.0%
PQ
MB
NS
SK
NB
AB
NL
PE
ON
BC
Can.
Avg.
Teen Smoking rates by Gender
age 15-19,
1996 vs. 2001
45%
40%
40%
35%
30%
24%
25%
24%
21%
20%
15%
10%
5%
0%
1996
2001
Male
Female
Smoking Rates by Stress Level
Canada, 18+ age
Men
Women
50%
46% 45%
45%
Percentage
40%
35%
35%
35%
30%
25%
31%
27%
25%
21%
20%
15%
10%
5%
0%
Very low
Low
Medium
High
Smoking Rates Related to Education &
Unemployment. E.g. Economic Zone, 2001
Smoking Rates 2001
No High School Diploma 2001
Some Post-secondary Training 2001
University Degree 2001
60
50
40
% 30
20
10
0
20
8
9
13 17
7
10
15
16
Economic Zones
19
11 14
12
18
The Cost of Smoking in
Newfoundland & Labrador
• Illness and early death to smokers
• Medical care costs
• Losses in productivity
• Costs to employers
Costs of Smoking in NL
• 1,000 premature deaths / year
• $79 million direct health care costs
• $139 million productivity losses
• 113,080 smokers smoke 687 million
cigs /year at cost of $141 million
Annual Extra Cost of Employing Smokers
F a c to r
Increased life
insurance prem ium s
S m oking area costs
Increased absenteeism
O n-the-job
productivity losses
T otal
C ost P er
C o s t to N L
e m p lo y e e e m p lo y e r s
$84 $4.5 m illion
$94
$5.1 m illion
$214 $11.9 m illion
$2,054 $94.8 m illion
$2,446
$116.3
m illion
Exposure to 2nd-hand
smoke in NL
• 35% of Newfoundland men and 30%
of women are exposed to secondhand smoke on most days.
• Labrador = 39% and 34%
• NS 1995 = 24% exposed to 2nd-hand
smoke at work; 1/3 of children
exposed to 2nd-hand smoke at home
Exposure to second-hand
smoke, Nfld health regions
Men
Women
45
39.7
40
34.6
35
38.7
38.1
36.2
34.2
32
30.2
32
29.5
30
28.8
28
28.3
28.4
26.3
25.3
25
20
15
10
5
C
en
tra
l(
N
F3
)
W
es
te
rn
(N
F4
)
G
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el
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N
F5
)
La
br
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or
(N
F6
)
E
as
t
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(N
F2
)
(N
F1
)
S
t.
Jo
hn
's
an
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0
Smoking Rates, Exposure to Second-hand
Smoke, and Sensitivity to Cigarette Smoke
Smoking Rates 2001
Exposure to ETS
Bothered by Cigarette Smoke
%
60
50
40
30
20
10
0
20 8
9 13 17 7 10 16 19 15 14 11 12 18
Economic Zones
Proven Health Effects of
Second-Hand Smoke
• Second-hand smoke causes heart
disease, lung cancer, nasal sinus cancer
and respiratory ailments in adults.
• ETS causes sudden infant death
syndrome, fetal growth impairment,
bronchitis, pneumonia, middle ear
disease and asthma exacerbation in
infants and children.
Health Hazards of Second-Hand
Smoke Recognized by:
 World Health Organization (1986 and 1999),
 U.S. National Academy of Sciences/National Research Council (1986),
 Australian National Health and Medical Research Council (1987),
 U.K. Department of Health and Social Security (1988),
 U.S. Environmental Protection Agency (EPA) (1992),
 U.S. Public Health Service (1986),
 U.S. National Institute for Occupational Safety and Health (1991),
 American College of Occupational & Environmental Medicine (2000),
 California Environmental Protection Agency (1997),
 The Australian National Health and Medical Research Council (1997),
 United Kingdom Scientific Committee on Tobacco and Health (1998)
 U.S. National Toxicology Program (9th Annual Report on Carcinogens,
2000)
Recent Research Also
Shows:
• ETS has been linked to cervical and
breast cancer, stroke, and
miscarriages in adults; and to asthma
induction, decreased lung function,
cystic fibrosis, and cognition and
behaviour problems in children
Restaurant, Bar, Casino
Workers Most at Risk
• In restaurants, second-hand smoke levels are 2x
as high as in other workplaces without smoke
bans. In bars and casinos = 3-6 times as high.
• Excess mortality for workers in smoking lounges,
bars, restaurants, casinos, bowling alleys is 15-26
times higher than OSHA’s “significant risk” level.
• “Establishment of smoke-free bars and
taverns was associated with a rapid
improvement of respiratory health….”
Eisner, 1998
Food workers exposed to
toxins and carcinogens
• Food service workers have a 50%
higher rate of lung cancer than the
general population.
• Second-hand smoke is the leading
cause of workplace death in Canada
• Occupational hazards not accepted in
other industries
Costs of Second-hand smoke
in Newfoundland & Labrador
• Second-hand smoke kills an
estimated 112 Newfoundlanders /yr,
(78 from heart disease, 34 from
cancers).
• Second-hand smoke costs province
$12 million a year in health costs +
$34 million in productivity losses
Costs of Second-Hand Smoke,
Newfoundland & Labrador
• Deaths
112
• Potential years of life lost 1,624
• Hospitalizations
• Hospital Days
784
8,400
Direct Health Care Costs - ETS
($ millions, Newfoundland and Labrador)
• Hospitals
$8.8
• Ambulance Services
$0.2
• Physician fees
$0.9
• Prescription Drugs
$1.8
• Other health care costs
$0.2
• Total Direct Health Care Costs: $11.9
Indirect Costs ETS,
Newfoundland and Labrador
• Productivity loss (sickness)
$0.4 million
• Productivity loss (mortality)
(6% discount rate)
$33.7 million
• Total Cost to Economy:
$46 million
Sources: Costs based on Canadian Centre for Substance Abuse, The Costs
of Substance Abuse in Canada, Colman, The Cost of Tobacco in Nova
Scotia, pages 15-20, and mortality rates in Glantz and Parmley,
(1995), and Steenland, (1992).
Do “Non-Smoking” Areas
Provide Protection from ETS?
• “Simple separation of smokers and non-smokers
within the same air space ... does not eliminate
exposure of non-smokers to environmental tobacco
smoke.” U.S. Surgeon-General, National Research Council
• “The ‘non-smoking’ (casino) tables... did not
measurably decrease employee exposure to ETS.”
U.S. National Institute for Occupational Safety and Health
• “Simple separation of smoking and non-smoking
indoor workers fails to prevent involuntary
exposure to ETS.” American College of Occupational and
Environmental Medicine (2000)
“Courtesy of Choice”
Hotel Association of Canada
• “Courtesy of Choice makes it possible for
smokers and non-smokers to live in
harmony. It is a program of selfregulation that uses scientific air-flow
analysis to guarantee that non-smoking
areas are truly smoke-free....(It) involves
effective ventilation and filtration systems
to ensure that smoke and other
contaminants in the air are removed.”
• The Canadian Tobacco Manufacturer’s Council
gave the Hotel Association of Canada $3.2 million
to implement its “Courtesy of Choice” program.
Does Ventilation Protect
from Second-hand Smoke?
“Accommodation of tobacco smoke in the
workplace, the solution proposed by the
tobacco industry, was found to have no basis
in science or public health protection.... The
ventilation system capable of removing
tobacco smoke from the air does not exist….
ASHRAE no longer provides ventilation
standards for air with tobacco smoke in it,
only for air in smoke-free buildings....
Ventilation provides no solution to the problem
of exposure to second-hand tobacco smoke.”
Ontario Tobacco Research Unit, University of Toronto (2001)
Would restaurants build
ventilated smoking areas?
A random survey of 401 Quebec
restaurants found that most would
not construct ventilated smoking
areas, even if they were effective,
for financial and technical reasons.
Cremieux and Oulette, 2001
Therefore:
• “A limited policy offers no advantage
over no policy at all…. (T)he only way
to protect nonsmokers’ health is with
a smoke-free work site.”
Borland, JAMA
• U.S. Surgeon-General recommends: “100
percent smoke-free environments in
all public areas and workplaces,
including all restaurants and bars.”
Expert Conclusions
• “All involuntary exposure to
tobacco smoke is harmful and
should be eliminated.” Ontario Tobacco
Research Unit, University of Toronto (2001)
• “Smoking bans remain the only
viable control measure to ensure
that workers and patrons of the
hospitality industry are protected
from exposure to the toxic wastes
from tobacco combustion.” Repace (2000)
Smoke-Free Workplaces Save
Lives and Money
• Smoke-free workplaces cut cigarette
consumption among smokers by 20%+.
• Smoke-free workplaces can save:
220 lives a year in Nfld,
$25 million in avoided health costs,
and $65 million in avoided productivity
loss (+ $28 mill - cig costs) - Savings
begun!
And savings to employers:
• It costs Canadian employers $2,446 (2001$)
more to employ a smoker vs. a non-smoker.
Conference Board of Canada
• Smoke-free workplaces can save Nfld employers
$22 mill/yr in avoided absenteeism & smoking
areas costs, and lower insurance premiums.
• “Strong economic incentives exist for rapid
adoption of smoke-free workplaces.”
American College of Occupational and Environmental
Medicine
Occupational Health & Safety Laws
“require employers to provide a safe working
environment” - Heather Crowe
• “Employees...should have the right to refuse
to work in environments with high levels of
ETS…. Canadian OHS legislation that could
apply indirectly to ETS include the
regulation of substances found in tobacco
smoke (possibly through the national
Workplace Hazardous Materials
Information System.”
Health Canada
• Smoke-free workplaces avoid potential litigation
based on unhealthy workplaces (e.g. Ontario)
Nova Scotia’s 1996 Occupational
Health and Safety Act (ch. 7), sect 13 (1)
• requires every employer to “ensure the
health and safety of persons at or near
the workplace” and to ensure “that
employees are not exposed to health
or safety hazards.”
• Employers shall “render harmless all
gases, vapours, dust or other
impurities that are likely to endanger
the health or safety of any person
therein.”
Are Smoke Bans Bad for
Business?
• Without exception, every objective study using
actual sales data finds that smoke-free legislation has
no adverse impact on restaurant, bar, hotel and
tourism receipts. (California, Colorado, Massachusetts, New
York, Arizona, Texas, Utah, Vermont, North Carolina, and BC)
• Two of the 16 studies found an initial decline in
receipts in the first 1-2 months following enactment,
but no overall or aggregate decline in the longer term.
• Several studies find smoke-free legislation is good for
business as non-smokers eat and drink out more
often.
The Researchers Conclude:
– “Legislators and government officials
can enact health and safety regulations
to protect patrons and employees in
restaurants and bars from the toxins in
secondhand tobacco smoke without fear
of adverse economic consequences....
these data further discredit tobacco
industry claims that smoke-free bar laws
are bad for the bar business. Quite the
contrary, these laws appear to be good
for business.”
Glantz 1997 and 2000 (California)
Conclusions from the 16
Studies
• “All models indicate that smoke-free
restaurant restrictions increased
restaurant receipts in towns adopting
smoke-free policies, by 5 to 9 percent.”
Pope & Bartosch, 1997 (Mass.)
• “Other cities can enact similar laws,
which protect restaurant patrons and
food service workers from tobacco smoke,
without concerns that restaurants will
lose business.”
Sciacca & Ratcliffe (Az)
More Conclusions:
• “Smoke-free restaurant ordinances
did not hurt, and may have helped,
international tourism”
From tourism/hotel sales in 6 U.S. States
• “The statistical results strongly
confirm that there are no long-term
impacts from restrictive smoking
regulations.”
CRD, BC, 2000
• “Nine months after tough anti-smoking
legislation was imposed in B.C.’s capital,
business remains steady and liquor sales are
up….”
Victoria, B.C. 1999
• “In one study after another, covering multiple
states within the US, analysts have found no
adverse effect of smoking restrictions, including
complete bans, on local restaurants’ business.
Indeed, several of the studies have found a
tendency for smoking restrictions to increase
business. Similar findings derive from analysis of
the effects of smoking restrictions on bars ...(and)
tourism.”
Warner, 2000
Smoke Bans May Increase
Sales
“Our results indicate that these nonsmokers are
more than making up the revenues lost from
inconvenienced diners who smoke.... At the very
least restaurateurs should make business
decisions based on data, not opinion.
Ultimately, smoke-free legislation is likely to
have a positive impact on restaurant-industry
revenues. Our advice to other cities and
municipalities is to consider similar legislation.
The restaurant industry collectively may
experience higher revenues through smoke-free
legislation.”
Cornell Hotel and Restaurant Administration
Quarterly, 1996
Restaurateur Fears
Unfounded
A survey of Arizona restaurateurs before
smoke-free legislation found 44%
concerned that customers would be upset.
Afterwards, the same restaurateurs
reported that most customer reactions
were positive. Only 15% found negative
reactions. 88% said the law was positive or
neutral for staff, and 94% said it was easy
to enforce.
Sciacca 1996
The tobacco industry resists
smoke-free legislation by:
• Denying the overwhelming scientific evidence on the
health hazards of ETS
• Working through third parties, esp. restaurant, bar and
hotel associations by spreading fears (never empirically
substantiated) that legislation will harm their business.
• Watering down and delaying legislation; shifting the
focus of debate from public health to market choice;
and arguing that ventilation can remove ETS despite
scientific evidence to the contrary.
In Tobacco Industry’s Own Words:
• “The immediate implication (of smoking
bans) for our business is clear: If our
consumers have fewer opportunities to
enjoy our products, they will use them less
frequently and the result will be an
adverse impact on our bottom line” (Philip
Morris)
• “Our objective is to contain and refine the
environmental smoke issue in order to
decrease the pressure for safety
measures….”
(Tobacco Institute)
Using “third party sources”
to gain credibility:
“…We try to keep Philip Morris out of
the media on issues like taxation,
smoking bans, and marketing
restrictions. Instead we try to provide
the media with statements in support
of our positions from third party
sources, which carry more credibility
than our company and have no
apparent vested interest….” (Philip Morris)
..keep focus off public health
“We try to change the focus on the issues. Cigarette
tax become(s) an issue of fairness and effective tax
policy. Cigarette marketing is an issue of freedom
of commercial speech. Environmental tobacco
smoke becomes an issue of accommodation.
Cigarette-related fires become an issue of prudent
fire safety programs. And so on.”
(Philip Morris)
“Portray the debate as one between the anti-tobacco
lobby and the smoker, instead of ‘pro-health
public citizens versus the tobacco industry.”
(Philip Morris)
What Enables Smoke-Free Legislation
to Succeed?
• Legislators must be well aware of the facts and evidence
and also of tobacco industry strategies to prevent smoke
bans.
• An in-depth analysis of the politics of tobacco control in
California also concluded: “The outcome of proposed
local tobacco control legislation appears to depend on
how seriously the health advocates mobilize in
support of the local legislation. When the health
community makes a serious commitment of time and
resources, it wins. When it fails to make such a
commitment, the tobacco industry prevails.”
Samuels & Glantz, 1991
Tourism and Hospitality
Industries Can Protect their
Employees and their Business
• Smoke bans are popular (about 75%), and
protect hospitality industry employees who
are most at risk from ETS.
• More than 90% of visitors to Atlantic Can.
are from other parts of Canada and the US,
where smoke-free legislation is common.
Taking the High Road
• The California Restaurant Association fully
supported the smoke-free workplace law that
applies to all restaurants, bars and gaming
places.
• “Why not take the high road and
promote NS as a healthy, trend-setting,
visionary, smoke-free environment – a
marketing opportunity for the new
century and new generation of visitors?”
Response to a TIANS survey on smoke-free legislation
The Evidence Clearly Shows:
• Second-hand smoke causes heart disease, cancer
and respiratory illness. Smoke-free workplace
legislation will save the lives of 220
Newfoundlanders each year, prevent serious
illnesses, and save $90 million in avoided health
costs and productivity losses.
• Restaurant, bar and casino workers are exposed to
the highest levels of ETS and have the greatest
health risks.
The Evidence Shows:
• Designated non-smoking areas and
ventilation do not work. Only 100%
smoke-free environments protect
employees/patrons.
• Smoke-free legislation will not harm
restaurant, bar, hotel and tourism sales,
and may be good for business.