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Home > Seanad Debate: Protection of Children’s Health from Tobacco Smoke Bill 2012: Second Stage.

[Oireachtas] Seanad Debate: Protection of Children’s Health from Tobacco Smoke Bill 2012: Second Stage. (09 May 2012)

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Protection of Children’s Health from Tobacco Smoke Bill 2012: Second Stage
Seanad Éireann Debate Vol. 215 No. 5
Wednesday, 9 May 2012

Senator John Crown:  I move: “That the Bill be now read a Second Time.”
I welcome the Minister to the House. I extend my gratitude to my colleagues across the House for their support in allowing this Bill get to this Stage today. I thank also my fellow Senators Jillian van Turnhout and Mark Daly who joined me in advancing this Bill and were extremely important in getting it to this Stage.
 
The Protection of Children’s Health from Tobacco Smoke Bill 2012 is a simple amendment to the existing smoking legislation which would extend the current prohibition on smoking in the workplace to smoking in any mechanically-propelled vehicle in which children under the age of 18 are travelling. With the benefit of ten years of analysis we believe the original legislation was visionary and world changing because it established Ireland as a leading country in the international fight against the scourge of tobacco-related diseases.
 
The background is well known to us all, and especially to the Minister who spoke eloquently in the broadcast media in recent weeks about issues related to tobacco smoke. As we are all aware, smoking is the principal cause of lung cancer. Lung cancer is a rare disease in those who have not smoked. It is the major cause of cancers of the head and neck. It is a significant contributor to a number of other cancers, prominently, cancer of the pancreas, the bladder and other parts of the urinary tract. It is perhaps the principal cause of premature cardiovascular disease including sudden death, heart attacks, heart failure and strokes, which might be fatal or life-threatening in terms of the disability they cause.
 
It is beyond controversy at this stage and generally accepted in the medical, scientific and epidemiological communities that there are substantial health risks associated with passive smoke, second-hand smoke, side-stream smoke or, more generally, environmental tobacco smoke which is endured by non-smokers.
 
We are certain that smoking contributes to an increased incidence of asthma and bronchitis, and the International Agency for Research on Cancer has firmly stated that the data conclusively show that systematic exposure to second-hand smoke among lifelong non-smokers is a substantial contributory cause to the occurrence of lung cancer. As a result, many international bodies have now come out and made statements firmly against second-hand smoke in favour of measures to restrict the exposure of non-smokers to second-hand smoke. These bodies include the World Health Organization, the Center for Disease Control and Prevention in Atlanta, the US Surgeon General and the National Institutes of Health and National Cancer Institute in the United States.
 
Children face particular additional risks associated with passive smoke as they breathe more rapidly than adults and, therefore, take more breaths per minute. As a result, they have a greater level of internal exposure to any environmental toxin in the air they breathe. Furthermore, owing to their small size and the efficiency with which gas exchange occurs in their lungs, they have a higher level of tissue exposure per molecule of poisonous chemical in the atmosphere than adults. It is beyond doubt that children who are exposed to second-hand smoke run additional risks, especially in the areas of infection, bronchitis, asthma and, very worryingly, meningitis, which is often a sequel of other respiratory infections. Sadly, there is conclusive evidence that sudden infant death syndrome is more common in infants who are exposed to second-hand smoke. In addition, the British Medical Association has stated its belief, following an analysis of the data, that the incidence of childhood cancers, by which I mean not only respiratory cancers but those cancers which, sadly, occur in children, including brain tumours and lymphoma, are more common in children who are exposed environmentally to second-hand smoke. There is also some data to show that children who have early childhood exposure may have a higher risk of developing lung cancer in later life.
 
The car is a particularly hazardous environment and it is obvious its small confines increase risk to the exposure to smoke. Some of the numbers are startling. Within one minute of a cigarette being lit in an enclosed car, the occupational concentration of dangerous particulates in smoke is 30 times higher than the level at which the Environmental Protection Agency in the United States advocates that people flee the streets and close the windows in their homes to escape environmental smoke. The exposure after one hour in a car with smokers is the same as that which a firefighter experiences in four to eight hours of fighting a brush fire. Tellingly, the emissions are five times higher from a cigarette smoked in the car than from the tail pipe of the car during the period in which the driving is taking place. One hour spent in a smoky car produces the same occupational exposure as eight hours in a smoky pub, which is, thankfully, something of which few people in this country have proximate memories.
 
The next question is whether the problem of smoking in cars exists. Smokers and their advocacy groups argue that responsible parents who smoke will not smoke in cars with children present and the legislation is, therefore, unnecessary. I acknowledge that many smoking parents show a degree of responsibility in not smoking in cars with their children. I wish they would show a higher level of responsibility and give up smoking because they are exposing their children to smoke in other environments and running the real risk of leaving them orphaned. The responsible decision for a parent who smokes is to stop smoking.
 
The problem of smoking in cars with children exists. We have all seen people stuck in lines of traffic or car parks reaching for and lighting up a cigarette in a car in which children are present. Members have had considerable contact and received many messages in their offices from concerned citizens. The overwhelming majority of them are supportive of this proposed legislation. The small minority who oppose the Bill are overwhelmingly smokers who, when asked, admit they smoke in the car with children present. It is essential we pass this Bill, which is not a civil liberties issue but an issue concerning the rights of the child. No one has a right to expose a child to cigarette smoke.
 
In terms of liability the Bill specifies where the liability lies for the act of smoking in a car with children. As a result of the minor amendment, it will extend the list of specified places in the Public Health (Tobacco) Act 2002 to include “a mechanically propelled vehicle in which a person under the age of 18 is present”. Section 47(1) of the Act lists a number of locations where it is an offence to smoke. Any person who smokes in such prescribed places is breaking the law. Under subsection (3), the liability extends to the person who is in charge of the enclosed space in question, in this case, the driver of the car. In addition, the Garda is given the power to enforce the law.
 
This brings me to the issue of enforcement because it has been argued that the law, while laudable in its goals, is fundamentally unenforceable. That is an error. In the first instance, the primary benefit of the legislation is not that we will create a crime against which enforcement will ensue, although the legislation will be enforced, but an educational one because a message will be sent out that, having considered all the evidence, a group of experts as well as the Minister, Department and legislators, is supportive of a ban on this activity because it is so dangerous and exposes children to risk. The next time someone thinks about lighting a cigarette or cigar in a car with children present, he or she will be aware this argument has been made. There will also be moral pressure from those who witness the lighting up taking place and the real moral pressure, of which all parents are aware, that is exerted by children who, in many cases, will not be slow to let their parents know they are doing something which is risky to children and against the law. Even if these moral strictures and educational incentives do not work, there is in the legislation provision for specific enforcement by the Garda, with a ministerial right to set a fine.
 
This Bill is not wholly unprecedented. Cyprus, for example, has already banned smoking in cars with children present and various jurisdictions across North America have enacted such bans. Many more jurisdictions are in the process of enacting similar prohibitions. It is interesting in this election year in the US that two of the four states to ban smoking in cars with children, namely, Arkansas and Louisiana, are red states that are likely to support Governor Romney for President, while the other two are blue states, namely, California and Maine, which are likely to support President Obama. This is not a civil liberties or left versus right issue but a health issue that extends across the spectrum of public opinion. Whatever one’s attitude to the role of government or the necessity for good public health legislation, it is apparent to smart legislators who examine the issue that we should take this measure. Several Canadian provinces, a number of Australian states and some other individual jurisdictions have come down on the side of introducing such legislation.
 
This brings me to the issue of timelines. I have been heartened to receive many messages of support for the legislation from across the political spectrum. The Minister, for instance, expressed his support and noted the necessity for such a ban in the broadcast media. I salute him and offer him my gratitude. It is important we move on this issue, set a date and engage properly with the departmental officials who will have an input into the subsequent Stages of the Bill. We need to implement the legislation quickly. We should set a goal of ensuring children who travel by car with parents or guardians on their summer holidays this year do so in a smoke-free environment.
 
I will mention a young boy of seven years from County Wexford, Fionn O’Callaghan, who is known to the Minister and me. When Fionn witnessed someone lighting a cigarette in a car with children present, he took it on himself to write to the Taoiseach asking him to use his good offices to introduce legislation to enforce a smoking ban where children are present in a car. My understanding is this rather forward and highly talented young man also doorstepped the Minister for Health during a visit he made to Wexford. I also understand several organisations which have the word “Ógra” in their title may well be approaching Fionn with a view to his future career development. When he spoke to parliamentarians at an information evening held in the audio-visual room last week, Fionn made the case more eloquently than any of us older adults could do and stated it was wrong that somebody like him should, in an involuntary fashion, be forced to be exposed to the smoke of an adult who is not responsible enough to protect him or her from it. It is incumbent on all Members and part of our responsibility as parliamentarians to ensure the civil liberties and rights of our children to live, as far as possible, in an atmosphere that is protected from wholly preventable cancer and disease causing chemicals are vindicated. I thank Members for their attention.
 
Senator Jillian van Turnhout: I support the Bill and welcome the Minister to the House. I thank my colleagues, Senators Crown and Daly, for their collaboration on and commitment to this important public health and children’s rights initiative. I echo Senator Crown’s words on young Fionn O’Callaghan who, if he were present, would certainly convince everyone in this Chamber of the reason this Bill needs to be enacted without delay.
 
Article 24 on the UN Convention of the Rights of the Child states that state parties recognise the right of the child to the enjoyment of the highest attainable standard of health. By banning smoking in cars with children present, we aim to protect the health of children who cannot otherwise protect themselves. I am not immune to some of the concerns raised by others in the lead up to this debate. It reminded me of the months preceding the ban on smoking in the workplace in March 2004. I was not convinced that it would work or whether it was right, because I was accustomed to going into a pub or cafe and leaving with the smell of smoke on my hair and on my clothes. Smoking had become so normalised for me that I did not know anything different. I was like the prisoners of Plato’s cave; I had accepted the dancing shadows as my reality. However, at the very least, this mistake was one which I had the autonomy to make. Children do not enjoy this luxury. They cannot extract themselves from smoke filled environments as I could. They are often less aware of the dangers of second-hand smoke, while those who know the risks may not be in a position to challenge their parents or the adults who are driving them. Indeed, they should not have to do so. All children believe that their parents can shield them from danger, and that is a fiction they have a right to believe. Children should always feel safe when with their parents. They need to know that if nothing else, their mothers and fathers will always have their best interests at heart. By regulating this behaviour, we are taking the onus off the child and placing it back onto the parents, challenging them to live up to the expectations of their children.
 
I am sure everyone agrees that the medical evidence presented by Senator Crown is utterly compelling, yet in reviewing the arguments, I am reminded of an anecdote a bar tender once told me. Before the smoking ban was introduced, he would wipe down the bar every night and without fail the cloth was covered in thick grime. Once the ban came into force, he said he only had to wipe the bar down twice a week and the same level of grime was not there. That put a picture in my head of how much we do not see. While it is only an anecdote, I can but imagine the effect a prolonged exposure to such levels of smoke would do to the lungs of a child. According to the British Medical Association, the level of toxins in a car can be up to 11 times higher than in a smoky bar.
 
The national longitudinal study of children noted in 2009 that approximately 60% of nine year olds in Ireland travel to school by car, with an average journey time of ten minutes each way. In addition, we know that children are driven to sporting and youth activities, to other events and homes of friends, and to medical and other appointments. All that time in the car adds up. However, exposure of children to smoke during these journeys represents a substantial risk to their health and well being, so efforts must be made to ensure that these children enjoy the same protection that we have already afforded to adults. We all believe that we have a right not to be harmed or subjected to a significant risk of harm. When it became widely accepted that inhaling second-hand smoke posed such a risk, we legislated for this behaviour. If we believe that a child has the same right to protection from harm that adults enjoy, then there is a corresponding obligation to protect that child from the danger of second-hand smoke. Indeed the risk of harm from exposure to smoke is greater in the case of children. They are far more sensitive to tobacco smoke because their lungs and bodily defence mechanisms are still developing, because they inhale far more pollutants per pound of body weight than adults, and because they are more likely to have allergies or other conditions which make them more sensitive to airborne pollutants.
 
I have heard arguments that this legislation should be part of a wider prohibition of smoking in public places such as parks and beaches. Perhaps there is a need for greater public debate, and I welcome what the Minister has done to raise awareness among the public and to begin that debate. The Bill put forward today deals with a very discrete issue of smoking in cars with children. I appeal to county councillors around the country to use the by-laws and regulations of their councils to look at areas such as playgrounds and other places frequented by children. For example, I believe Fingal County Council is hoping to put it in place in the near future. Sometimes councillors say that they do not have powers to do certain things, but they have the powers to do this, so I appeal to councillors to use the powers they have where children are directly put in harm’s way.
 
I echo the calls of Senator Crown in asking the Minister to accept the Bill today. He should also give a commitment on what will happen over the coming days and weeks. I ask the Minister to outline a clear timetable for the next Stages of this Bill. My hope is that this Bill will be in place for the summer holidays, so that children can go on holidays in a smoke free environment. This gives us enough time to consider any amendments, while also creating an urgency to protect children’s health. The aim of such measures is to denormalise smoking. This Bill is about the protection of one of the most fundamental rights; the right of the child to the enjoyment of the highest attainable standard of health. I am very aware of the Minister’s commitment to this issue. I hope that today will be a first step of many quick steps that will soon see this Bill in place, so that we can show the power we have to improve and protect children’s health......
 
 

Minister for Health (Deputy James Reilly): Tááthas orm an Bille seo a ghlacadh ó na Seanadóirí, ach tá deacracht éigin leis agus caithfimid caint mar gheall ar sin.

 

I am delighted that Senators Crown, van Turnhout and Daly have put forward this Bill. As others have said, the topic of smoking in cars where children are present has received much public attention in the past year or so, although it was mooted a number of years before that by Dr. Fenton Howell and ASH. The Bill is now contributing to that welcome focus. This topic and the issue of smoking in public places is being discussed around the nation in kitchens, pubs, workplaces and on the airwaves. Getting people’s attention on the issue and generating a debate can only be a very good thing, regardless of what view one takes on the matter. Mobilising public awareness on any issue is an important step if we wish to successfully change our lifestyle behaviours.

 

Senators are aware of my position on the issue. I have expressed it many times. I previously indicated my stance and I am committed to taking the steps necessary to significantly reduce smoking in this country. I am particularly committed to working towards a time when children and young people will come to regard smoking as a foolish and unattractive thing to do. I am fully in favour of legislating for a ban on smoking in cars where children are present. As others have mentioned, I wish to make the debate a bit wider. Like all things in life, when one brings about a change, there is a little bit of shock and an uncomfortable sense about it but as people have time to think the matter through, debate and discuss it and realise the pros and cons, one gets a greater understanding and willingness to embrace the change. As people take time to consider, debate and discuss the matter and realise the pros and cons involved, there will be a greater understanding of it and also, perhaps, more of a willingness to embrace the change, particularly when it is aimed at safeguarding those who do not have a voice and look to us to protect them.

 

I could have taken legal advice which would have suggested the Bill ought to be withdrawn. However, while there are numerous difficulties with the legislation, I am not going to seek its withdrawal because I want to accept it. We will have a great deal of work to do in ensuring it passes Committee Stage. There are a number of reasons for this which I will discuss in detail. As stated, the Government supports the Bill. I hope Senators will allow my officials and I to progress it through the legislative process.

 

A number of legal considerations arise in respect of the Bill in its current form. The first relates to seeking legal clarification on whether the Bill must be notified to the European Commission under the technical standards directive prior to its proceeding through the legislative process. If it does prove necessary to refer it to the Commission and other member states, the legal advice indicates that this could involve a standstill period of between three and six months. I hope such an eventuality will not come to pass.

 

There are several other issues with the Bill, one of which is the fact that the Senators are seeking to addend it to the public health (tobacco) (amendment) Bill which, in part, relates to the workplace. Clearly, a car is not always a workplace. As a result, a number of matters arise. We want to ensure the legislation is robust and effective in its operation. I am confident that by working together we can achieve this. If there are deficiencies in the Bill, they will be exploited and challenged by the tobacco industry.

 

I want to be clear about one matter and hope my previous utterances on it have been sufficiently transparent. The Bill is not concerned with restricting the rights of adults, rather it is about protecting the rights of children. Neither is it about attacking smokers. It seeks to ensure children will not be exposed to environmental tobacco smoke in cars. Children may not be aware of the dangers of exposure to environmental tobacco smoke and cannot remove themselves from risk if people smoke around them. As others have stated, the Bill will empower children, particularly those who are older, to speak up in defence of their own rights. We recognise that most people are sensible and would not expose their children to the risk to which I refer if they had full knowledge of the harm being caused. The Bill and the debate on it will make that knowledge available to them. However, there will still be irresponsible individuals who will put their own addiction and habit ahead of their children’s health. We need to legislate for such individuals.

 

Like previous speakers, I emphasise that environmental tobacco smoke is a carcinogen and contains the same cancer causing substances and toxic agents inhaled by the smoker. There is no safe level of exposure to environmental tobacco smoke. It is obvious that exposure to cigarette smoke is particularly dangerous in enclosed spaces such as the interior of a car. Parents and others with responsibility for the welfare of children have a particular obligation to ensure such exposure does not take place.

 

We sometimes miss out on the relevant statistics. In that context, 5,200 people die every year as a result of conditions caused by tobacco smoking. This means that 5,200 families and communities are affected by the results of smoking. Those who die are are our brothers, sisters, fathers, mothers and friends. We do not want the next generation to suffer the same hardship and loss as that experienced by this generation and the one which preceded it.

 

Senator David Norris alluded to his own situation. I recall my father who was also a doctor informing me that if he had known at the age of seven years, when he began to smoke, what he had subsequently learned in his forties, he would never have taken up the habit. We all imitate what we see and denormalising smoking is about eliminating the images of smoking with which children are presented. Reference was made to the allure of smoking as portrayed on television and in films. I have clear and even fond memories from childhood of watching western films and then going to the shop to buy a bottle of red lemonade — very important that it was red — and a packet of sweet cigarettes. This was so that I could sit around drinking a glass of pretend whiskey, smoking a pretend cigarette and acting like I was a cowboy. Children learn by imitating their parents and other adults. We are all aware that in the early teenage years, peer pressure is a far greater influence than parental pressure.

 

As Senator John Crown observed, smoking in cars has been banned in a number of countries. We are undertaking a comprehensive review of such bans in the context of their effectiveness and how they have been implemented. We also require information on the level of compliance and methods of enforcement in the countries to which I refer. I have asked the Health Research Board to review all of the international evidence in this regard. I have also allocated money for the board to examine the reasons the prevalence of smoking in this country has not decreased, despite the smoking ban. Even though our children are not, as we were, exposed to tobacco advertising and do not see the brightly coloured cigarette packets on the shelf behind the sweet counter in their local shops, the prevalence of smoking remains stubbornly high at 29%. We need to discover what the tobacco industry is doing to ensnare the next generation.

 

If one were to consider this matter logically, one would ask children and young adults why they were prepared to pay the guts of €10 for a product that was going to cause them ill health, lead to their contracting cancer and cause them to die earlier than should be the case. Cancer is not the only condition to which tobacco smoking gives rise. People who smoke can also suffer heart attacks and strokes and contract peripheral vascular disease. In my medical practice I used to give patients who had diabetes and smoked a little piece of paper that was to be inserted into every box of cigarettes they bought and on which was written the following, “Diabetes plus smoking equals amputation”. That is how bad smoking is for diabetics. The chances of diabetics who smoke losing, first, a toe and, later on, a limb are huge. In some cases, amputation is almost inevitable.

 

The Research Institute for a Tobacco Free Society has conducted research to estimate the prevalence of environmental tobacco smoke exposure in cars in Ireland. The initial research which covered almost 3,000 children aged 13 to 14 years indicated that 14.9% of children were exposed to smoking in cars.

 

The Health Research Board’s review, to which I referred, has highlighted a US survey which contains worrying statistics. It indicates that 23% of the 11 to 15 year olds surveyed stated they had been an occupant in a car with someone who was smoking in the week prior to their completing the questionnaire. Research carried out by the MRBI in 2007 on behalf of ASH Ireland showed 79% public support for the initiative in respect of smoking in cars. ASH Ireland also refers to an ongoing poll on irishhealth.com which shows that over 80% support a ban on smoking in cars. The levels of compliance and public support for smoke-free public places legislation demonstrate that people are keen to reduce their exposure to second-hand smoke. A study which considered smoking in the home after the smoke-free public places legislation had come into force in Scotland found that respondents had more robust restrictions on smoking in their cars than in their homes. While I am in no doubt that all parents, relatives and carers want to protect the health of the children in their care, sometimes the onus is on us, the policy and law makers, to remind people of their obligations in this regard. Again, I cannot help but re-emphasise the fact that this matter relates to children who have neither a voice nor a vote and who look to us to protect them. We have a duty of care to these children and must fulfil that duty.

 

The development of the legislation before the House is a way of reminding those who care about the welfare of their children not to light up in a car in which children are present. It will also serve as a punitive measure for those who knowingly continue to disregard the welfare of children. Peer pressure does count. When the legislation is eventually enacted, if one sees someone smoking in a car in which children are present, one will feel empowered and have every right to beep one’s horn, roll down one’s window and remonstrate with him or her. Taking action in respect of those who smoke in cars in which children are present is just one of the many matters being considered by my Department. As stated, smoking is the greatest single cause of preventable illness and premature death in Ireland. The number of premature deaths caused by tobacco use in Ireland is far greater than the combined death toll relating to car accidents, fires, heroin and cocaine abuse, murders and suicides. It is a shocking fact that we allow such a product to be used by minors. In 2000 the document, Towards a Tobacco Free Society, was adopted as Government policy. Our aim continues to be a move towards atobacco-free society.

 

I am particularly concerned about the number of young people who continue to take up the habit each year. While it is heartening that the numbers of school-aged children who smoke has been decreasing steadily in recent years, more needs to be done to understand why young people start to smoke. My Department is smoking — I mean working. It certainly is not smoking.

 

(Interruptions).

Senator Mark Daly: Hopefully not.

 

Deputy James Reilly: My Department is working on commissioning research which will give us the answers to this question in the Irish context. We must remember our young people are not now exposed to tobacco industry advertising in the media or in shops as they used to be. The pull factors are coming from other areas and sources which we must identify to effectively tackle them.

 

Tomorrow, the Secretary General of the Department of Health will issue the instruction that it will be a smoke-free campus. I agree with Senators that it is weird that when one walks to the front door of a hospital, one has to wade through cigarette smoke and butts. The tobacco policy review group is working on finalising its report which I will be submitting to my Cabinet colleagues for approval. This report will be of assistance in reducing the level of smoking in our society. A major part of achieving this is to denormalise smoking in our society. There are initiatives already under way that play an important role in denormalising smoking. One example is the tobacco-free hospital campus initiatives operated by the Health Service Executive, HSE.

 

When I attended the United Nations last year in New York, I noted the city authorities amended the Smoke-Free Air Act to ban smoking in some outdoor public spaces, specifically all New York city public parks, beaches, boardwalks, marinas, public golf courses, sports stadia and pedestrian plazas such as Times Square. Fingal County Council has taken the initiative in this area and completed a pilot study on this over the past year. It will be voting at its next meeting on making 50 parks with playground areas smoke-free zones. In its research the council found that 95% of people are in favour of reducing second-hand smoke in playgrounds while 95% are in favour of a complete ban on smoking in playgrounds. In 2008, cigarette waste formed 47.3% of the overall litter composition in Fingal. One journalist made the point she does not want her children rooting around in the sand on the beach finding cigarette butts.

 

I believe the debate about smoking in cars in which there are children is at the point that most people understand its significance, the harm it causes and the need to ban it. I hope with a bit more time, people will understand the problems presented by people smoking where children are present such as in parks and on beaches. If we can enforce the law around mobile telephone use while driving, we can certainly enforce a law around smoking in cars with children present. This is not about a nanny state. We are not telling adults what to do in their own time and place. We are advising them it will be against the law to endanger children through their personal habit.

 

I congratulate Senators Crown, Daly and van Turnhout for the introduction of this Bill. I want it to progress as quickly as possible but there are legal considerations. The Government has a heavy legislative schedule but it is great that the Seanad can contribute by bringing forward its own legislation.....

 
 

Protection of Children’s Health from Tobacco Smoke Bill 2012: Second Stage
Seanad Éireann Debate Vol. 215 No. 5
Wednesday, 9 May 2012

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