Minister for Public Health Shona Robison
May 21, 2008
Launch of the Smoking Prevention Action Plan
Scottish Parliament
I am pleased to announce the publication today of our new action plan setting out a longer-term strategic approach to smoking prevention activity in Scotland. We will continue to all we can to help and support smokers to quit but this plan contains an ambitious programme of measures designed specifically to discourage children and young people from starting to smoke and becoming regular smokers.
A generation after the health risks associated with smoking were demonstrated beyond dispute, smoking remains one of the principal causes of illness and premature death in Scotland. It is still linked to some 13,000 deaths each year and many more hospital admissions. Apart from the human tragedy these statistics represent, there is a considerable resultant economic burden.
The annual cost of hospital care alone is estimated to be in excess of £200m per annum and lost productivity some £450m. Smoking also disproportionately affects those already disadvantaged by poverty and is a major contributor in health and premature mortality inequalities. Tackling smoking related harm thus lies at the heart of our health improvement and health inequalities drive.
Significant progress has, of course, been made in recent years to reduce the cultural acceptability of smoking, including through bold and decisive legislative action taken by this Parliament, such as the smoking ban and the increase in the age of sale for tobacco from 16 to 18.
While the decline in population smoking in recent years is welcome, we need to continue firm action to reduce prevalence even further. We have already committed to continued investment in smoking cessation services but also want to see a particular focus on preventing smoking uptake by children and young people.
And let me just, if I may, remind Members why this focus on children and young people is so vital. Smoking is dangerous at any age but the statistics are stark. 80% of smokers start in their teens. The younger people start, the more likely they are to smoke for longer and to die early as a result. And, worst of all, someone who starts smoking at 15 is 3 times more likely to die of cancer than someone who starts in their mid-twenties.
I am sure you will agree that these are very compelling reasons for the focus to shift more clearly towards smoking prevention. In a nutshell, we want to do everything we can to denormalise smoking within society in Scotland to help our young people, in particular, to choose not to smoke.
The measures we propose are in line, with the Scottish Government's desire, set out in the Economic Strategy, to create a more successful country with opportunities for all to flourish.
The Action Plan: overview
The proposals set out in "Scotland's future is smokefree: a smoking prevention action plan" which is published today, were developed in consultation with the Ministerial Working on Tobacco Control, which I chair. I am grateful for their advice and support.
I am grateful also to Dr Laurence Gruer and other members of the Expert Group whose recommendations form the basis of the measures contained in the action plan. The Group conducted a thorough investigation of the issues and, importantly, have provided a strong evidence base for the action we propose to take.
The Group's recommendations were, of course, subject to widespread consultation and I am grateful to all of those who took part in the consultation, including young people who fed in views through focus groups and a Young Scot on-line survey.
Crucially, while individuals and organisations might take issue with particular recommendations, the consultation results were overwhelmingly positive about the need for a longer-term strategic approach to smoking prevention. They also give the Scottish Government a strong mandate to act decisively to stop a new generation of young Scots from becoming addicted to tobacco.
The challenge presented is to make cigarettes and other tobacco products less affordable; less accessible; and less attractive to children and young people. This cannot, of course, be achieved by the Scottish Government alone, but requires ownership and action from a wide range of individuals and organisations including NHS Boards, local authorities, third sector bodies, and the business sector.
So what are we proposing?
The Action Plan: specific areas of action
We propose to deliver a co-ordinated programme of measures responding to all the factors which influence behaviour. Action within the Plan is set out in 5 broad areas:-
Firstly, we propose measures to educate and promote healthy lifestyles to make clear to children and young people the risks associated with smoking and to do everything possible to counter the idea that there is any link between smoking and glamour, celebrity, maturity and independence.
Actions in this respect include:
- Promoting an all-encompassing approach to health and well-being in Scottish schools, fostered through the Health Promoting School and Curriculum for Excellence and via improvements in substance misuse education in schools
- Engaging more effectively with young people in non-school settings, such as universities and further education colleges
- Engaging with harder to reach groups such as those who are not in employment, education, or training or who are in occupations or settings with higher than average smoking levels
- Ensuring tobacco issues are addressed fully within the new Health Improvement Social Marketing Strategy to discourage smoking uptake and promote healthy, smoke-free lifestyles
Secondly, we propose measures to reduce the attractiveness of cigarettes, countering positive images of cigarettes in the media and at points of sale and reducing the opportunities for children and young people to be exposed to smoking.
All such measures are important but the one I would expect to have the greatest impact is our proposal to introduce legislative controls to further restrict the displays of tobacco products at point of sale.
Despite tobacco advertising having been banned in 2002, there are growing concerns that prominent and public displays of cigarettes and other tobacco products in shops and other points of sale, are undermining our wider tobacco control efforts to "denormalise" smoking by shifting cultural perceptions of smoking and discouraging young people from starting to smoke in the first place.
Children and young people have been found to be far more receptive to tobacco advertising than adults. The evidence is clear, young people exposed to tobacco advertising and promotion are more likely to take up smoking.
There is also evidence that displays stimulate impulse purchases among those not intending to buy cigarettes and, importantly, among smokers who are trying to give up.
So giving cigarettes pride of place in shops (a much sought after position in product placement terms) sits uncomfortably with our ambition to create a climate in which everything possible is done to dissuade people, particularly children and young people, from smoking.
I know sections of the retail sector will be concerned about restrictions on displays because of fears they will impact adversely on businesses. However, point of sale display is clearly being used as a promotional tool. The protection of children and young people from the impact of tobacco must be paramount and there are instances -and this is one- when the benefits to public health of the nation must take precedence.
As we move forward with the legislative process, I will engage fully with retailers on this. International experience has shown that where tobacco display bans have been implemented it has not had a dramatic impact on local business. Following a ban on displays one of the Canadian Provinces, for example, no shops were forced to close. Moreover, experience would suggest, the cost of refit is largely borne by the tobacco wholesalers that supply tobacco products to the retail chain. The important thing is that the removal of displays does change public perceptions of smoking.
Thirdly, we propose measures to reduce the availability of cigarettes by stepping up enforcement of tobacco sales law to ensure cigarettes are not sold to minors and to prevent access to smuggled/counterfeit cigarettes.
It is clear despite the law that underage young people have little difficulty in accessing cigarettes if they want them.
We will, therefore, pursue a 2-prong approach involving more effective enforcement of the law by local authorities on one hand- secured through the introduction of an enhanced tobacco sales enforcement programme coupled with increased emphasis on proof of age- and a review and update of tobacco sales law to introduce tobacco licensing and new sanctions such as cautions and fixed penalty notices for breaches of the law.
We will also examine the issue of minimum pack sizes and sales from vending machines as part of this legislative review.
This update of tobacco sales law is long overdue. Currently the provisions governing tobacco sales are contained in the Children and Young Persons (Scotland) Act 1937, which were last subject to a major review in 1991.
There are, of course, a number of possible licensing options and, in developing detailed legislative proposals, we will be looking closely at these in consultation with key stakeholders, including COSLA, Scottish local authorities, and retailers.
My own preference is for an approach which falls someway between the positive scheme favoured by Christine Grahame in her Member's Bill proposals and a negative licensing system which would only "bite" if retailers are found to be selling to underage young people.
We are attracted to an approach which allows tobacco retailers to be clearly identified, enabling trading standards officers and others to offer advice and support to them to avoid illegal sales. Also one which offers a proportionate response to the problem; is administratively simple; and which places minimum burden on business.
The fourth area involves measures to reduce the affordability of cigarettes. This means ensuring cigarette prices are sufficiently high to discourage children and young people from smoking.
The price of tobacco products is one of the most important factors in determining consumption and thus, taxation policy is one of the main tools for preventing tobacco consumption.
And, of course, the availability of cheaper smuggled tobacco products- both cigarettes and loose tobacco- sold from vans, at open air markets and by other means in communities across Scotland undermines fiscal policies aimed at reducing tobacco
In addition to keeping pressure on the UK Government to ensure tobacco duty remain sufficiently high, a protocol is being developed between Scottish trading standards services and HM Revenue and Customs for a collaborative approach to reducing the impact of these illicit products on Scottish communities.
This partnership working is important. As smuggled tobacco is more likely to be sold in deprived areas and increasingly to target children, smuggling would appear to have a disproportionate impact on young people in these areas and be a factor in perpetuating health inequalities.
It is also vital that the action we propose to tighten up illegal sales from legitimate business is matched by firm action on illicit tobacco sales. We will also be examining, as part of the review and update of tobacco sales law I mentioned earlier, the question of minimum pack sizes.
We know for example that young people are 3 to 4 times more price sensitive than older adults. So, as part of the legislative review, we will look at the relationship between packs of 10 cigarettes and tobacco consumption which I mentioned earlier.
The final area of the Action Plan describes how we will deliver, resource and measure progress.
Much of the action within the Plan will be delivered through use of resources already within the system although, in some cases, there may require to be a refocusing or prioritisation of efforts, for example, in social marketing and communications activity.
We will be continuing to make substantial specific funding available for tobacco control. An additional £9m will be made available over the next three years to boost delivery of action within the plan and bring the total specific funding available for tobacco control to £42m from 2008/09 to 2010/11. And this is in addition to the £2m of funding allocated annually to tobacco control which is contained within NHS Boards' unified budgets.
The new £9m is intended to support local delivery of the action plan. £4.5m will be allocated to NHS Boards to enable then to co-ordinate action locally to underpin the measures proposed and to ensure these are embedded in their local tobacco control programmes.
A similar amount will be allocated to local authorities to enable them to step up enforcement activity. We have also pledged to continue to support the activities of the voluntary sector- ASH Scotland, Partnership Action on Tobacco and Health and the Scottish Tobacco Control Alliance -to allow them to contribute fully to the Plan's delivery.
In recognition of the actions proposed in the Plan and to drive delivery we have set new targets for 13 and 15 year olds and introduced a new target for 16 to 24 year olds. We will also establish a research and evaluation framework to assess impact.
This statement has provided is a brief overview of our proposals. The programme we propose is an ambitious one. While I am sure it will be welcomed as a whole, I am conscious also that there will be those who take issue with some elements. And, in particular, may question the need for further legislative action on tobacco.
Nevertheless, given the devastation -and I use that word advisedly- that tobacco has reaped on the Scottish people -causing nearly 700,000 premature deaths over the last 50 years alone- I firmly believe we owe it to Scotland and to the Scottish people to take firm and decisive action to stop damage to future generations.
Moreover, there are times when the public health benefits of a policy must be the overriding concern of Government. This is just such a case where the perceived benefits to society in preventing young people from taking up smoking supersede any minimal costs that may be imposed on Scottish tobacco retailers.
I am sure no-one in this Parliament would take issue with our desire to denormalise smoking in Scotland and save our young people from the misery and distress of cancer and heart disease which is wholly preventable.
By passing historic laws to ban smoking in public places in places in 2005, this Parliament has already shown that is prepared to act collectively and courageously in the interests of public health. I would now call upon it do so again by supporting the Scottish Government in our further endeavours to secure a healthier smoke-free future for Scotland.