Public Health White Paper: Chapter 2. Tobacco and electronic cigarettes Sue Bowker Public Health Division Welsh Government [email protected] Tobacco Public Healthkills White Paper Mortality from lung cancer, 1991 - 2008 The history Source: World Health Organization • Our Healthy Future (2009): “consider whether or not public health legislation would provide significant benefits to health and wellbeing in Wales”. www.cymru.gov.uk • Programme for Government (2011): commitment to “consult on the need for a public health bill to place statutory duties on bodies to consider public health issues”. • Green Paper consultation held between Nov 2012 – Feb 2013. • Asked whether new legislation could help create a healthier population and reduce health inequalities. Tobacco Public Healthkills White Paper Mortality from lung cancer, 1991 - 2008 The history Source: World Health Organization • 371 responses to Green Paper received from different sectors, www.cymru.gov.uk stakeholders, and members of the public. Two main messages: • Clear support for legislation which directs organisations to consider health across their functions. • Calls for legislation to address specific public health priorities. One of the public health priorities that we have addressed is tobacco and electronic cigarettes. Tobacco Public Healthkills White Paper Mortality from lung cancer, 1991 - 2008 One part the overall solution… Source: Worldof Health Organization www.cymru.gov.uk Tobacco kills Directive (TPD) – Tobacco Products Mortality from lung cancer, 1991 - 2008 tobacco products Source: World Health Organization • Prohibits cigarettes and roll-your-own tobacco with characterising flavours; • Requires the tobacco industry to submit detailed reports to www.cymru.gov.uk the Member States on the ingredients used in tobacco products, in particular cigarettes and roll-your-own tobacco; • Requires that health warnings appear on packages of tobacco and related products. Combined (picture and text) health warnings must cover 65% of the front and back of cigarette and roll-your-own tobacco packages; • Sets minimum dimensions for warnings and eliminates small packages for certain tobacco products; • Bans all promotional and misleading elements on tobacco products; • Introduces EU-wide tracking and tracing to combat illicit trade of tobacco products; • Allows Member States to prohibit internet sales of tobacco and related products; Tobacco kills Directive (TPD) Tobacco Products Mortality from lung cancer, 1991 - 2008 NCPs Source: World Health Organization • Obliges manufacturers to notify electronic cigarettes and novel tobacco products before placing them on the EU market. www.cymru.gov.uk • Sets out safety and quality requirements for consumer electronic cigarettes, including: • maximum volume of refill containers; • maximum nicotine concentration; • consistent delivery of nicotine dose; • containers must be child and tamperproof; • must carry a health warning re. addictiveness of nicotine; • must contain instructions for use. Tobacco kills Directive (TPD) Tobacco Products Mortality from lung cancer, 1991 - 2008 NCPs Source: World Health Organization • A number of decisions regarding electronic cigarettes are left to Member States, e.g.: • regulation of flavours www.cymru.gov.uk • advertising without cross border effects • age limits • The rules will not apply to e-cigarettes which are regulated as medicines The TPD is to be transposed by Member States by May 2016 http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:L:2014:127:FULL&from=EN Tobacco kills Existing Welsh secondary legislation Mortality from lung cancer, 1991 - 2008 Source: World Health Organization • The Smoke-free Premises etc. (Wales) Regulations 2007 www.cymru.gov.uk • The Protection from Tobacco (Sales from Vending Machines) (Wales) Regulations 2011 • The Tobacco Advertising and Promotion (Display of Prices) (Wales) Regulations 2012; and The Tobacco Advertising and Promotion (Display) (Wales) Regulations 2012 UK legislation The Children and Families Act 2014 Regulations relating to: • • • • The retail packaging of tobacco products The proxy purchase of tobacco products The age of sale of nicotine containing products (NCPs) The proxy purchase of NCPs Possible Welsh secondary legislation Regulations relating to: • Smoking in vehicles carrying children (Children and Families Act 2014) • Removal of exemption form Smoke-free premises regulations for mental health units providing residential accommodation Tobacco Public Healthkills White Paper Mortality from lung cancer, 1991 - 2008 The proposals Source: World Health Organization Tobacco Retailers’ Register Introduction of a tobacco retailers’ register to further restrict access to tobacco products by young people, and assist trading standards officers to support retailers and enforce the law on tobacco products. www.cymru.gov.uk Electronic cigarettes To ban their use in enclosed public places to support the enforcement of existing smoke-free legislation and to address concerns of e-cigarettes undermining efforts to de-normalise smoking. Smoke-free open spaces Seeks views regarding public places where voluntary smoking bans are currently in operation, and asks whether legislation should be considered e.g. playgrounds and hospital grounds. Internet sales of tobacco Seeks views about whether under 18s are sufficiently protected by current arrangements, or whether an offence of delivering tobacco products to a person who is under the legal age of sale for tobacco products should be created. Tobacco kills – where are we now? Electronic cigarettes Mortality from lung cancer, 1991 - 2008 Source: World Health Organization • Use has increased substantially over the last few years • More newspaper stories have appeared, covering a rangewww.cymru.gov.uk of themes (Rooke and Amos, 2013) • Getting around smoke-free legislation • Risk and uncertainty • Healthier choice • Celebrity use • Price • Use of advertisements and sponsorship Table 1: Prevalence of themes – as a proportion of the total number of stories each year (2007-12) Theme Get around smokefree Risk and uncertainty Healthier choice Celebrity use Price Count (percentage of total no of stories) Year Total no of stories Year 1 (07/08) 8 (100%) 0 6 (75%) 0 8 (100%) 8 Year 2 (08/09) 10 (48%) 9 (43%) 12 (57%) 2 (10%) 9 (43%) 21 Year 3 (09/10) 10 (67%) 3 (20%) 7 (47%) 4 (27%) 5 (33%) 15 Year 4 (10/11) 9 (33%) 7 (26%) 18 (67%) 21 (78%) 7 (26%) 27 Year 5 (11/12) 7 (15%) 12 (25%) 28 (58%) 14 (29%) 12 (25%) 48 Total (07-12) 44 (37%) 31 (26%) 71 (59%) 41 (34%) 41 (34%) 119 Tobaccocigarettes kills – what do we Electronic Mortality from lung cancer, 1991 - 2008 know? Source: World Health Organization • Lots of smokers report using them to quit smoking • Little published evidence to support their effectiveness in quitting www.cymru.gov.uk • Increasing evidence of dual use • Few non-smokers using to date • Numbers of young people using e-cigs is increasing, from a low baseline • Health consequences not yet clear • Several councils, schools and businesses have banned them • A number of countries have banned their use InTobacco summary kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization ‘The genie is probably now out of the bottle in parts of Europe and the USA. Many other nations are opting to wait and see what this natural www.cymru.gov.uk experiment shows.’ (Simon Chapman, 2014, University of Sydney) ‘Their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policymakers need to act quickly.’ (Frank Chaloupka, 2014, University of Illinois at Chicago) ‘On the one hand, excessive regulation could marginalise e-cigarettes in favour of conventional cigarettes. On the other hand, deficient regulation might contribute to the expansion of the e-cigarette market - in which tobacco companies have a substantial stake - potentially renormalising smoking habits and negating years of intense anti-tobacco campaigning.’(The Lancet, 2014) Tobacco kills Public Health White Paper Mortality from lung cancer, 1991 - 2008 Next steps Source: World Health Organization • White Paper consultation launched on 2 April 2014 • Consultation closes on 24 June 2014 • Consultation document available at: http://www.wales.gov.uk/consultations/healthsocialcare/ • Responses to [email protected] www.cymru.gov.uk Diolch yn fawr Thank you very much [email protected]