RNAO response to proposed regulation under Smoke-Free Ontario Act, 2017

Transcription

1 RNAO response to proposed regulation under Smoke-Free Ontario Act, 2017 Submission to the Ministry of Health and Long-Term Care March 2, Pearl Street, Toronto, ON M5H1L3. Ph Toll-free Fax RNAO.ca

2 Summary of recommendations RNAO urges the government of Ontario to: Recommendation 1. Implement the comprehensive strategy outlined in Smoke-Free Ontario Modernization: Report of the Executive Steering Committee. Recommendation 2. Enact the prohibition of the smoking of tobacco, the use of e-cigarettes (including those containing medical cannabis and heat-not-burn products), and the smoking of the cannabis in prescribed indoor and outdoor locations as outlined in the proposed regulation. Recommendation 3. Remove the proposed smoking/vaping exemption from the regulation for guest rooms in hotels, motels and inns. Recommendation 4. Change the wording for specified facilities from "may construct and operate a controlled room" to "may continue to operate a controlled room." Recommendation 5. Enact the proposed prohibition of tobacco and vaping product sales in prescribed places. Recommendation 6. Enact provincial and municipal legislation, licensing fees, and zoning restrictions to reduce the number and density of retail tobacco vendors. Recommendation 7. Add "places that sell or serve alcohol" to the list of locations where the sale of tobacco and vapour products is prohibited. Recommendation 8. Prohibit all flavoured tobacco products, without exemption. Recommendation 9. Prohibit the sale and supply of tobacco products to anyone less than 21 years old. Recommendation 10. Enact the proposed exemption to allow persons under 19 years of age to obtain a vapour product for medical cannabis purposes from a parent, guardian, caregiver, or a person authorized to produce and distribute medical cannabis under applicable federal law. Recommendation 11. Add "heat-not-burn" to the list of products prohibited from display and promotion. Recommendation 12. Legislate and enforce strict regulation to ban all promotion and marketing, including banning price signs in retail settings, prohibiting volume discounts, and banning industry incentives to retailers. Recommendation 13.Implement plain and standardized packaging with more prominent health warnings. 2

3 Introduction The Registered Nurses Association of Ontario (RNAO) is the professional association representing registered nurses (RN), nurse practitioners (NP), and nursing students in all settings and roles across Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses contributions to shaping the health system, and influenced decisions that affect nurses and the public they serve. RNAO welcomes the opportunity to provide feedback to the Ministry of Health and Long-Term Care (MOHLTC) on proposed regulation under the Smoke-Free Ontario Act, RNAO support for comprehensive end-game strategy Smoking continues to kill about 13,000 Ontarians per year and costs the province $8.95 billion in direct health costs and indirect costs such as lost income and productivity. 2 Following the 2017 report of the Executive Steering Committee on Smoke-Free Ontario Modernization, of which RNAO was a member, Ontario has the opportunity to continue its national and international leadership in tobacco control by being the "first to adopt and implement an ambitious, comprehensive, integrated, multi-level 'end-game' strategy consistent with international best practices for tobacco control." 3 This strategy seeks to reduce regular (daily and occasional) smoking prevalence in Ontario from 17.4 per in 2017, to 11 per cent by 2023, to eight per cent by 2028, and less than five per cent by With these targets, the number of smoking-related deaths would be reduced by 4,900 per year (98,000 by 2035). 5 This comprehensive strategy includes goals to substantially reduce tobacco use in Ontario, regulate and limit access to the supply of tobacco and other harmful inhaled substances, and reduce exposure to the harmful effects of tobacco and other inhaled products. 6 It is completely unacceptable that over the last 10 years, the size of Ontario's tobacco crops has nearly tripled. 7 Ontario cannot attempt to protect its own citizens and at the same time export disability and death to people living in other jurisdictions. Thus RNAO would like to highlight the recommendation by the Executive Steering Committee for a mandatory timeline (5 to 10 years) to phase out tobacco production on non-indigenous land along with the development of crop replacements. 8 Recommendation 1. Implement the comprehensive strategy outlined in Smoke-Free Ontario Modernization: Report of the Executive Steering Committee. 9 Places of use Since the inception of the Smoke-Free Ontario Act, 1994(SFOA), RNAO has supported the government's efforts to strengthen smoking laws Given the advances that have been made over that time, care must be taken to proceed toward the end-game strategy and not go backward. That is why an exemption "to construct and operate a controlled room for tobacco smoking, cannabis smoking or vaping is regressive, when many controlled rooms for smoking in psychiatric facilities have already been phased out. 3

4 Recommendation 2. Enact prohibition of the smoking of tobacco, the use of e-cigarettes (including those containing medical cannabis and heat-not-burn products), and the smoking of the cannabis in prescribed indoor and outdoor locations as outlined in the proposed regulation. 12 Recommendation 3. Remove the proposed smoking/vaping exemption from the regulation for guest rooms in hotels, motels and inns. Recommendation 4. Change the wording for specified facilities from "may construct and operate a controlled room" to "may continue to operate a controlled room." Places of sale Smoking is the single greatest cause of premature death and avoidable disease in Ontario, and yet tobacco products are available 24/7 in more than 10,000 retail settings across the province. 13 RNAO urges the government to implement measures to restrict the overall number of retail settings selling tobacco consistent with the end-game strategy and lessons learned from public health approaches to alcohol policy. 16 Highest priority must be placed on decreasing retail sales near secondary and post-secondary institutions, venues that appeal to youth, and marginalized communities targeted by the tobacco industry. 17 Due to the strong association between tobacco and alcohol use, sales of tobacco in places that sell or serve alcohol, including bars and clubs, should be prohibited. Recommendation 5. Enact the proposed prohibition of tobacco and vaping product sales in prescribed places. 21 Recommendation 6. Enact provincial and municipal legislation, licensing fees, and zoning restrictions to reduce the number and density of retail tobacco vendors. 22 Recommendation 7. Add "places that sell or serve alcohol" to the list of locations where the sale of tobacco and vapour products are prohibited. Flavoured tobacco RNAO supports product regulation standards aimed at reducing tobacco use, including banning all flavours. 23 Recommendation 8. Prohibit all flavoured tobacco products, without exemption. Sale and supply to minors As tobacco is a lethal product with no safe level of use, RNAO supports regulation and enforcement to safeguard against sales and supply of tobacco to anyone who is less than 21 years old. 24 4

5 The therapeutic use of medical cannabis as an option for children may be warranted if the benefits outweigh the risks. 25 While non-smoking methods of cannabis administration are preferred, especially when treating children, 26 there may sometimes be a role for medical cannabis used through vaporizers. Recommendation 9. Prohibit the sale and supply of tobacco products to anyone less than 21 years old. Recommendation 10. Enact the proposed exemption to allow persons under 19 years of age to obtain a vapour product for medical cannabis purposes from a parent, guardian, caregiver, or a person authorized to produce and distribute medical cannabis under applicable federal law. Signs, display, promotion, packaging, and health warnings Public policies that improve population health and decrease health inequities must be driven by public health evidence and objectives rather than market forces The World Health Organization Framework Convention on Tobacco Control acknowledges that public health policies to control tobacco must be protected from "commercial and other vested interests of the tobacco industry." 30 It is critical to prevent the predatory practices of the tobacco industry to circumvent tax-related price increases by eliminating price differentials, prohibiting volume discounts, banning industry incentives to retailers, and banning price signs in retail settings. 31 Recommendation 11. Add "heat-not-burn" to the list of products prohibited from display and promotion Recommendation 12. Legislate and enforce strict regulation to ban all promotion and marketing, including banning price signs in retail settings, prohibiting volume discounts, and banning industry incentives to retailers. 32 Recommendation 13.Implement plain and standardized packaging with more prominent health warnings. 33 Thank you for this opportunity to provide feedback to strengthen Ontario's smoking and vaping laws. 5

6 References: 1 Ontario's Regulatory Registry (2018). Smoke-Free Ontario Act, 2017 Regulation. 2 Ministry of Health and Long-Term Care (2017). Smoke-Free Ontario Modernization: Report of the Executive Steering Committee. Toronto: Author, Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 15. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 16. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 16. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 16. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 35. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 35. Executive Steering Committee (2017). Smoke-Free Ontario Modernization. 10 Registered Nurses' Association of Ontario (2011). Bill 186: Supporting Smoke-Free Ontario by Reducing Contraband Tobacco Act, Toronto: Author Registered Nurses' Association of Ontario (2016). Proposed changes to smoking and vaping laws in Ontario: the Smoke-Free Ontario Act, 1994 and the Electronic Cigarettes Act, Toronto: Author Ministry of Health and Long-Term Care (2018). Strengthening Ontario's Smoking and Vaping Laws: Summary of Proposed Regulation under Smoke-Free Ontario Act, 2017, Executive Steering Committee (2017). Smoke-Free Ontario Modernization, Queen's University (2016). A Tobacco Endgame for Canada: Backgrounder paper. Kingston: Author. Summit, September 30-October 1, 2016, Palmer, K., Pendharkar, S. & Buchanan, F. (2017). Can endgame tobacco radically reduce cigarette smoking? May 11, Registered Nurses' Association of Ontario (2016). Letter to Premier Wynne: RNAO urges province to use public health evidence to inform a comprehensive provincial alcohol strategy. Toronto: Author. 6

7 17 Cohen, B. et al. (2011). Exploring issues of equity within Canadian tobacco control initiatives: An environmental scan. Winnipeg: University of Manitoba, Jiang, N, Lee, Y., & Ling, P. (2014). Association between tobacco and alcohol use among young adult bar patrons: A cross-sectional study in three cities. BMC Public Health. 14: Rossheim, M. et al (2013). Associations between bar patron alcohol intoxication and tobacco smoking. American Journal of Public Health. 37 (6): Jiang, N, Lee, Y., & Ling, P. (2014). Young adult social smokers: their co-use of tobacco and alcohol, tobaccorelated attitudes, and quitting efforts. Preventive Medicine. 69: Ministry of Health and Long-Term Care, 4. Executive Steering Committee (2017). Smoke-Free Ontario Modernization, 28. Queen's University (2016). A Tobacco Endgame for Canada: Backgrounder paper, Executive Steering Committee (2017). Smoke-Free Ontario Modernization, Rieder, M. & Canadian Paediatric Society (2016). Is the medical use of cannabis a therapeutic option for children? Canadian Paediatric Society Position Statement. Paediatric Child Health, 21(1): Rieder & Canadian Paediatric Society, World Health Organization (2011). Rio Political Declaration on Social Determinants of Health. World Conference on Social Determinants of Health. Rio de Janeiro, Brazil, October United Nations General Assembly (2011). Political Declaration of the High-Level meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. September Cancer Care Ontario and Public Health Ontario (2012). Taking Action to Prevent Chronic Disease: Recommendations for a healthier Ontario. Toronto: Authors World Health Organization (2013). WHO Framework Convention on Tobacco Control. Geneva: Author, 7, Article Executive Steering Committee (2017). Smoke-Free Ontario Modernization,

8 32 33 Executive Steering Committee (2017). Smoke-Free Ontario Modernization, Queen's University (2016). A Tobacco Endgame for Canada: Backgrounder paper,