Stephen Donnelly, Minister for Health: I move: "That the Bill be now read a Second Time".

I am delighted to introduce the Public Health (Tobacco) (Amendment) Bill, or the smoking 21 Bill as it has been referred to. This is a short Bill with a single substantive measure. It will save thousands of lives in the coming years. We have a long and proud tradition, across all parties, of introducing strong tobacco control measures. We started this with our now globally-renowned workplace smoking ban introduced by the Tánaiste, Deputy Micheál Martin, when he was the Minister for Health in 2004. In 2007, we prohibited the sale of cigarette packets containing fewer than 20 cigarettes and we did this to ensure they would not be available, particularly to our children, at lower prices. In 2009, we banned the display and advertising of cigarettes at the point of sale in our retail outlets. In 2011, we introduced graphic health warnings on tobacco packaging. In 2016, we banned smoking in cars where children are present. In 2017, we introduced plain packaging to make packs look less attractive, to make the health warnings more prominent and to prevent packaging from misleading consumers about the harmful effects of tobacco. Last year, we introduced the Public Health (Tobacco Products and Nicotine Inhaling Products) Act, or the vaping Act. That Act regulated vaping products, which is where most of the attention was focused. As colleagues in the House will know, however, the legislation also contained tobacco control measures as well. It introduces an annual licence requirement per outlet for the retail sale of tobacco products; prohibits temporary or pop-up shops from applying for a licence; ends the sale of tobacco products by self-service such as through vending machines; and prohibits the sale of tobacco products at events for children.

These measures were necessary and they have worked. In 2002, our adult smoking rate was 27% and today it is 18%. Smoking prevalence in children was a frightening 19% in 2002 and today it is 5%. This is very good progress but our latest figures show that these measures, although necessary, are not sufficient. According to last year's Healthy Ireland survey, smoking prevalence for those aged 15 and over is 18%. The prevalence was 17% pre-Covid in 2019. There is no survey data for 2020 but the rate had increased to 18% by 2021 and it has stayed there. In addition, although children’s smoking prevalence is reducing generally, the results from the 2019 European Schools Project on Alcohol and Other Drugs survey showed smoking prevalence among young people aged 15 and 16 at over 14%. Worryingly, this was an increase on the rate of 13% in 2015.

On other issues, we might decide that we have done all that we can do and that sufficient progress has been made over the past 20 years. We cannot and will not do this when it comes to tobacco. Tobacco smoking is addictive and lethal, and, according to international analysis, it remains the biggest single risk factor driving disability and death combined in our country. The life expectancy of a smoker is on average ten years shorter than that of a person who has never smoked. Two out of three smokers will die as a result of their smoking. In addition to the death toll, smoking and exposure to secondhand smoke cause an enormous range of preventable illnesses and disabilities. These include: at least 16 types of cancers and 13% of all cancers here; respiratory diseases such as asthma and chronic obstructive pulmonary disease, COPD; cardiovascular diseases including aneurysms, stroke, coronary heart disease and peripheral arterial disease; eye diseases such as macular degeneration, cataracts and diabetic retinopathy, which can eventually lead to blindness; reproductive effects including an increased risk of ectopic pregnancy, premature delivery, low birth weight and perinatal mortality; diabetes; rheumatoid arthritis; and dementia. In the shorter term, smoking during childhood and adolescence causes both reduced lung function and impaired lung growth. In the longer term, there is evidence that smoking during adolescence increases the risk of developing psychiatric disorders and cognitive impairment in later life. In addition, adolescent smokers suffer from attention deficits, which can become worse with the years of smoking. In our hospitals, smoking and exposure to secondhand smoke account for one day case admission in every 50, one in 20 of all inpatient admissions and nearly one in ten of all bed days.

I am proposing to increase the minimum legal age for the sale of tobacco products to 21. That is what this legislation does: it moves the age from 18 to 21. The purpose of this measure is not to further regulate tobacco products but to begin to eliminate them from our lives and the lives of our children. It is, to use the public health term, an "endgame measure", signalling the beginning of the end of tobacco in our country. We know it will work because we have evidence from other countries and modelling evidence as well. In 2020, a study of US state-level laws showed that raising the age of sale to 21 had strong evidence associated with a reduction of nearly 4 percentage points in smoking for those aged 18, 19 and 20 and a reduction of nearly 3 percentage points in smoking among those aged 16 and 17. Analysis from the context of our own 2007 increase in the legal age of sale from 16 to 18 found reduced smoking prevalence and a reduction among those aged 14 to 15 in the likelihood of ever having tried a cigarette. In 2015, the US Institute of Medicine modelled the implications of raising the national minimum age for the sale of tobacco products to 21. It concluded that the largest proportionate reduction in tobacco initiation will likely occur among adolescents aged 15, 16 and 17. This will be due to this age group being unlikely or less likely to have members of their peer network over the minimum legal age who would be a source of cigarettes. The modelling also found that the expected reduction in the initiation of smoking will, over several years, lead to a 12% absolute reduction in smoking prevalence. Similarly, modelling carried out at University College London, and updated just last year, estimated that increasing the UK legal age for the sale of cigarettes from 18 to 21 would reduce smoking prevalence among the population of 18- to 20-year-olds to just 2% by 2035. Without the age increase, the modelling suggests the rate would be more than 12.4%.

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