On 3 October 2013 the Minister for Health, James Reilly TD, launched Tobacco free Ireland, the government’s revised policy on tobacco control.1 It sets a target of a tobacco-free Ireland in 12 years’ time, which it defines as ‘the achievement of a smoking prevalence rate of less than 5% of the Irish population by 2025. Tobacco will still be available but at a higher price and in restricted outlets.’

 

While the overall aim of Ireland’s tobacco control policy is harm reduction, i.e. ‘unnecessary and preventable deaths and disability’, the government has upped the ante by calling for a tobacco free society ‘where people can live longer and healthier lives, free from the detrimental effects of tobacco’.  To achieve this outcome the new policy document identifies two things that must happen – a decrease in smoking prevalence, and a ‘denormalisation’ of tobacco within society. The former will be realised through employing both population-based approaches (focusing on the whole population) and risk-based approaches (targeting high-risk groups such as children and adolescents, smokers in low-income groups and young women). The latter will require generating public support for policies leading to a tobacco-free society

 

The first five chapters of the policy document review the evidence on the basis of which the Tobacco Policy Review Group has developed the new aspiration. The Review Group reports that the most recent data gathered by the National Tobacco Control Office, which monitors cigarette-smoking prevalence and behaviour on a monthly basis, show that the overall prevalence of cigarette smoking in Ireland has declined from just under 24% in June 2010 to 22% in June 2012. The Group also comments that policy interventions have been instrumental in reducing tobacco consumption, and have also impacted positively on health; for example, a recent study estimates that the 2004 workplace smoking ban in Ireland  has led to the avoidance of more than 3,500 deaths that would have occurred owing to tobacco consumption.2

 

The ambitious new tobacco-free aspiration is set within the policy framework put in place 13 years ago, in the previous tobacco control policy document – Towards a tobacco free Ireland.4 Four additional themes are emphasised in the new policy framework:

 

-    This is to be prioritised in all initiatives.

 

-    Legislation to prohibit smoking within the campuses of primary schools, secondary schools and child care facilities is to be introduced.

-    Tobacco free campuses for all third-level institutions, and for all health care, governmental and sporting facilities, are to be promoted.

-    Tobacco free playgrounds, and also parks and beaches, to be promoted in conjunction with local authorities.

-    Tobacco free environment initiatives will be evaluated with a view to the introduction of legislation needed.

 

-    Promote compliance with and enforce all provisions of the Public Health (Tobacco) Act 2002 as amended.

-    Introduce on-the-spot fines for offences.

-    Develop capacity within the HSE’s Environmental Health Service to enforce all aspects of the tobacco control legislation.

-    Develop special investigation capacity within the HSE’s Environmental Health Service to assess compliance by tobacco manufacturers.

-    Introduce legislation for the publication of information in respect of any person on whom a fine, other penalty or conviction was imposed by a Court, i.e. name and shame.

-    Collaborate with other EU countries in relation to compliance measures for tobacco ingredient reporting.

 

-    Develop a licensing system for retailers who sell tobacco products.

-    Prohibit sales of tobacco in mobile units/containers.

-    Prohibit the sale of tobacco at events/locations primarily intended for persons aged under 18years.

-    Prohibit the sale of tobacco products by those aged under 18 years.

-    Prohibit the operation of all self-service vending machines.

-    Introduce a minimum suspension period for retailers convicted of an offence.

 

The policy framework is further informed by the MPOWER model,which was developed by the World Health Organization to enable countries to implement the Framework Convention on Tobacco Control (FCTC) measures. The model identifies the six most important, effective and evidence-based tobacco control policies:

-    Monitor tobacco use and prevention policies

-    Protect people from tobacco smoke

-    Offer help to quit tobacco use

-    Warn about the dangers of tobacco

-    Enforce bans on tobacco advertising, promotion and sponsorship

-    Raise taxes on tobacco products

The Review Group recommends 35 specific actions that need to be undertaken in the Irish context, including research and data collection, legislative measures, social marketing campaigns, development of guidelines and training health professionals.

 

The Review Group calls for a detailed action plan to be developed outlining the timeframes and responsibilities for the implementation of its recommendations. It repeats the call already made in Healthy Ireland,4 the policy framework for improved health and wellbeing launched earlier this year, which states that positive changes in health and wellbeing require the whole community, the whole of government and all of society to work in unison.5 

 

1. Tobacco Policy Review Group (2013) Tobacco free Ireland. Dublin: Department of Health. www.drugsandalcohol.ie/20655/

2. Stallings-Smith S, Zeka A, Goodman P, Kabir Z and Clancy L (2013) Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national Irish smoking ban: interrupted time-series analysis, PLoS ONE 8(4): e62063. doi:10.1371/journal.pone.0062063. www.drugsandalcohol.ie/19756/

3. Tobacco Free Policy Review Group (2000) Towards a tobacco free society. Dublin: Stationery Office. www.drugsandalcohol.ie/5337/

4. Department of Health (2013) Healthy Ireland – a framework for improved health and wellbeing 2013–2025. Dublin: Department of Health. www.drugsandalcohol.ie/19628/

5. Pike B (2013) Healthy Ireland– implementation matters. Drugnet Ireland (46): 15–16. www.drugsandalcohol.ie/20136/