Ontario was an early leader in tobacco control, introducing the Tobacco Control Act in 1994. This Act introduced restrictions on smoking in the close vicinity of health related facilities and other locations, further restricted sales to underage persons, and a range of other measures. With the introduction of the Smoke Free Ontario strategy in 2004, the government went further, banning smoking in most public places, restricting the visibility and public display of tobacco products, raising taxes on cigarettes, and creating a system of fines to reduce smoking in cars with children aboard.

All of these efforts should pay off with better overall health. Every 11 minutes, a Canadian dies from tobacco use, adding up to more than 37,000 deaths per year across Canada, 13,000 of which are in Ontario. Tobacco also has a staggering economic cost, responsible for an estimated $6 billion in direct health care and social costs in Ontario.

Still a high burden of tobacco related disease and death

It is likely that Ontario can still push smoking rates lower, as evident in countries like Iceland, where only 15% of adults smoke. In the state of Utah, which has the lowest smoking rate in the USA, 9% of adults smoke . In California the rate has recently fallen below 12 %. The recent report by the Ontario Tobacco Strategy Advisory Group suggested setting a target of reducing smoking rates by a further 5% in the next five years, to 13% of all adults.

What are some of the next steps needed to further reduce smoking rates in Ontario?

Promoting and enforcing a culture change

Michael Perley, director of the Ontario Campaign for Action on Tobacco says Ontario’s strategies and campaigns have “changed the climate of public opinion” and that most members of the public “have an aversion to tobacco and tobacco products.” Perley says that the next strategies should focus on influencing consumers’ opinions about whether “tobacco products are within the norms of usual consumer products,” noting that cigarettes “are the most toxic and dangerous consumer product on the market.” Some countries, such as Iceland, have put forward motions to restrict the sales of cigarettes to pharmacies only, banning the general sale of tobacco.

An Ipsos Reid poll conducted on behalf of Johnson & Johnson found that 66% of Ontarians said that the Ontario government should sue the tobacco industry to recoup health care costs associated with smoking. In fact, provincial governments across Canada have introduced cost recovery legislation, as has happened in the United States. British Columbia was the first province to do so in 2000, and in 2009, Ontario introduced the Tobacco Damages and Health Care Costs Recovery Act, asking for $50 billion from the tobacco industry to cover health care costs related to tobacco. So far, the tobacco industry has been unable to block these proceedings. However, it remains to be seen what the outcome of this cost recovery legislation will be.

Another approach to reducing smoking and cigarette consumption is through the taxation of cigarettes and tobacco products, which has been shown to be an effective way to curb use, especially among the young. Ontario has the second lowest tax rate on a carton of cigarettes among all provinces and territories, $14.17 below the average of $43.97 per carton. The Tobacco Strategy Advisory Group recommended a substantial increase in tobacco taxes in Ontario, to align with other provinces and territories. They also suggested that a proportion of Ontario’s revenue from tobacco taxes, over $1 billion in 2009/2010, be invested in comprehensive tobacco control efforts throughout the province.

There are concerns that a rise in tobacco taxation will result in a rise in contraband products, a concern strongly advanced by the tobacco industry. This concern can only be met by enforcing the rule of law.  The Ontario government has recently announced initiatives to restrict the importation and distribution of contraband tobacco.

Perley notes that “there is no comprehensive smoking cessation system in place in Ontario” to help smokers quit. He notes that “we have a lot of separate pieces, such as the Canadian Society Smoker’s Helpline” as well as the recent addition of smoking cessation drugs varenicline (Champix) and buproprion (Zyban) to the Ontario Drug Benefit Plan formulary. However, Perley says there is a long way to go to achieve the situation where “every smoker in Ontario cannot avoid coming into contact with a smoking cessation program or system.” Vivek Goel, the President and CEO of Public Health Ontario, says  “there is sound evidence from other jurisdictions that a comprehensive and sustained approach is required for tobacco control.”

One Step Further in the Fight

While targets, taxes and smoking cessation programs are on the policy horizon for Ontario, some jurisdictions are taking their tobacco control efforts a step further by setting goals to be tobacco free. There is a movement in New Zealand to be tobacco free by 2020, and Finland recently passed legislation aimed at phasing out smoking entirely.

What could Ontario do to further reduce smoking rates?