[IRELAND 2040 TOBACCO FREE IRELAND (HSE) FEEDBACK] March 16, 2017

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Organisation: Address: Contact: Tobacco Free Ireland Programme, Health and Wellbeing Division, HSE Edward Murphy (Project Manager, Tobacco Free Ireland) Background Tobacco use is the leading cause of preventable death in Ireland today. Half of all long term smokers will die from a tobacco related illness. Each year in Ireland 6000 people die as a result of smoking related diseases. While 23% of the population smoke (19% reporting that they smoke daily and 4% reporting occasional smoking), 18% of the population in Ireland are exposed to second hand smoke (a class A carcinogen) on a daily basis. There is no safe level of exposure to second hand tobacco smoke. In 2016 the Department of Health commissioned ICF International to conduct a review of the economic costs of smoking. This report entitled An Assessment of the Economic Cost of Smoking in Ireland highlighted that the cost of litter pollution due to tobacco use (cigarette butts account for 55% of the main constituent elements of litter pollution) is estimated to have a cost to society of around 69million a year. Tobacco Free Ireland Tobacco Free Ireland was published by the Department of Health in 2013 to provide a framework to reduce the prevalence of tobacco use and tobacco related harm in Ireland, ultimately working towards the achievement of a tobacco free society in 2025. The document is largely concerned with the protection of children and the denormalisation of tobacco use in Ireland. There are a number of recommendations in Tobacco Free Ireland which support these principles and which are relevant to the National Planning Framework and they are to: Promote tobacco free campuses for all third-level institutions. Promote tobacco free campuses for all health care, governmental and sporting facilities. Further develop the tobacco free playgrounds initiative in conjunction with local authorities by way of voluntary measures or by the introduction of bye-laws. Promote tobacco free environments and in particular parks and beaches in conjunction with the local authorities by voluntary measures or by the introduction of bye-laws. Evaluate the tobacco free environment initiatives with a view to the introduction of legislation if required. The Tobacco Free Ireland Programme was established within the HSE Health and Wellbeing Division in 2015. The main aim of the programme is to take responsibility of and systematically drive policy priorities in the area of tobacco control. Burden of Disease and Tobacco On page 17 of the Issues and Choices document there is reference to the disease burden associated with modern lifestyles and the impact of the built environment on health. An overwhelming body of evidence has established that almost 35% of cancer deaths and cases of cancer, and almost 65% of cardiovascular disease deaths and cases are attributable to a number of known and preventable risk factors (Preventing Chronic Disease: Defining the Problem, 2014). Tobacco should feature strongly in this discussion. Smoking is the leading cause of preventable death in Ireland and is the greatest contributor to health inequalities between the richest and poorest sections of society. Tobacco

exposure is calculated to cause 23% of the burden of coronary heart disease, 21% of stroke and 73% of chronic obstructive pulmonary disease (COPD). Ireland 2040 Plan and Tobacco The Ireland 2040 Issues and Choices position paper, within the People s Health and Wellbeing section, states that creating and maintaining environments that encourage people to make healthier, more active choices is central to making the healthy choice the easy choice. The paper asks are we prepared to make changes now so that a healthier places legacy can be handed over to the next generation of Ireland s citizens? What policies can the NPF include to effect improvements to our general health, including physical and mental wellbeing, in Ireland over the next twenty years? The policy of creating tobacco free environments is a significant step forward in creating healthier places that can improve population health. Tobacco free spaces create a healthier, cleaner environment for everyone. Protecting the health of the public, particularly children, and reducing the visibility of smoking as normalised adult behaviour has been a significant factor in reducing the initiation of smoking among children and young adults. Driving the introduction of tobacco free environments in a variety of public places is a significant policy priority both in Ireland and internationally. The World Health Organisation report that smokefree environments not only protect non-smokers, they reduce tobacco use in continuing smokers by 2 4 cigarettes a day and help smokers who want to quit, as well as former smokers who have already stopped, to quit successfully over the long term (WHO Report On The Global Tobacco Epidemic, 2009 Implementing smoke-free environments). It also helps to remind the public that second hand smoke is a class A carcinogen and requires careful controls. It is important to note that most of these policies are self-policing and that over time a cultural change will ensue creating an expectation among the public that smoking is not an acceptable norm in family amenity type /greenway spaces. The HSE would be encouraged to see the National Planning Framework taking the principles and recommendations set out in Tobacco Free Ireland on board as it seeks to expand and develop open shared spaces for Ireland. Smoke free environments should be the new norm in Ireland, rather than the exception with a strong emphasis on the protection of children. Some specific items to consider could include: Any new public spaces /amenities which have the potential to be used by children and families should be developed as tobacco free spaces. This means that clear signage indicating the space is tobacco free should be included in the design. Cigarette bins should be placed outside the space and not on the grounds. These considerations should be factored in to the design, planning and tendering stages of any new projects. See example of signage in appendix. Outdoor areas that have the potential to host public/family oriented events (e.g. food festivals) should be promoted as tobacco free spaces through any websites or hard copy communication promoting the event. Clear information should be provided to the public about the tobacco free public space policy and the reasons for same i.e. (allowing for the next generation of Irish Children to be protected from exposure to tobacco use, thus preventing future tobacco initiation). Tobacco free policies should be introduced for greenways and other areas that facilitate physical/leisure/family oriented activities.

In addition to protecting children and denormalising tobacco use, the initiatives recommended in Tobacco Free Ireland would greatly contribute to significantly reducing the environmental nuisance impact (i.e. cigarette butt littering), cost of cleaning and damage that discarded tobacco products create thus creating a healthier and more aesthetically pleasing environment for all concerned. The costs for implementation would be minimal and the expected outcomes would be significant both in terms of reduced smoking prevalence and reduced cost of environmental damage. ENDS

Appendix Examples of Signage for Tobacco Free Environments