Time for Canada’s first smoke-free generation

Opinion: Canada is lagging behind in raising the age of purchase. While national polls have consistently shown 70 to 80 percent support for raising it, only PEI has enacted tobacco legislation for age 21, making it wise to do so for both smoking and vaping.

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Lost amid last month’s insane news of the latest COVID variant was a landmark announcement by the New Zealand government of a bold new countermeasure aimed at the eventual eradication of an even greater killer: tobacco. In what’s known as the “smoke-free generation,” from 2027, the legal age for purchasing cigarettes in that country will increase by a year each year, meaning anyone under the age of 18 can never legally buy, equating to a lifetime ban.

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The week of January 16 is Canada’s National Non-Smoking Week – disappointingly necessary for a 46th year. More than two generations after the immense dangers of smoking to society were made crystal clear, smoking remains the leading preventable cause of death in Canada and worldwide, killing seven million annually, including 45,000 Canadians. This is more deaths than from alcohol, drugs, car accidents, murder, suicide and AIDS combined.

The Smoke-Free Generation (SFG) has been a concept that has been under discussion among health advocates since it was proposed in 2010 by a professor in Singapore. Tasmania almost passed SFG legislation, but it fell through when parliament was postponed in 2018. Last September, a law went into effect in the town of Brookline, Massachusetts, making it the first jurisdiction in the world to initiate an SFG bill. At first glance, one might reply: “And? The kids can just go to the next town.” It is worth noting, however, that in 2003 a nearby town, Needham, Massachusetts, became the world’s first jurisdiction to raise the purchase age of cigarettes to 21, and after studies showed that this made a significant difference (mainly by cutting off the supply lines), it became a widespread movement. As of 2019, it is now law across the US, as well as many other places. Age restrictions work.

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While the number of smokers in Canada continues to fall, progress is slow. In addition, the rapid rise in vaping is a staggering concern: Last month’s numbers among older teens are now 14 to 29 percent (depending on the survey and the numbers included), more than doubling between 2017 and 2020. As a result. its young adults now have Canada’s highest rate of nicotine use. In addition to mounting evidence of its own dangers, it is now clear that vaping acts as a gateway to smoking, and many people end up as double users, which is perhaps even more risky. Clearly, there will be no end in sight to our traditional approaches to public health.

As a former leader, Canada’s anti-tobacco policies have been weak and reactive for many years, with no coherent strategy to meet the stated goal of a prevalence of less than five percent by 2035. To achieve that goal, we would require bold initiatives to reduce the proportion of Canadians currently smoking by nearly two-thirds. Of particular note, Canada has been lagging behind in raising the purchase age. While national polls have consistently shown 70 to 80 percent support for increasing it, only PEI has enacted tobacco legislation for age 21, doing so wisely for both smoking and vaping.

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Big Tobacco himself now consistently talks about switching cigarettes, with slogans like PMI’s “Delivering a Smoke-Free Future” and Altria’s “Moving Beyond Smoking”. While most health advocates think it’s just about creating the image of good corporate social responsibility rather than a real ambition or reflection of health problems, perhaps we should force them to speak up this time. And do it now, not sometime in the undefined future.

Chances are right, with all provinces currently negotiating with the industry behind closed doors after class-action lawsuits forced them into insolvency protection. Ending tobacco use is possible through a combination of supply-side policies, including performance-based regulation (financially rewarding or punishing companies based on prevalence reduction targets – pinch your nose), retail reform and tobacco licensing (where issuance requirements can be designed to impose different controls and barriers on both sellers and buyers). Otherwise, a monetary settlement against the industry will ultimately be funded by the only available approach to recruiting new nicotine addicts. Obviously, all steps to eliminate smoking must be combined with very strict anti-vaping rules.

Canada must now raise the minimum age for both smoking and vaping to 21. We should then plan to implement a smoke-free generation from 2027 in line with New Zealand. The now century-old smoke pandemic kills no less than half of its victims. It’s time to get serious about ending it.

dr. Stuart Kreisman is an endocrinologist at St. Paul’s Hospital and director of Physicians for a Smoke-Free Canada.

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