Madam Speaker, in 1919 at Barnes Hospital in St. Louis, Missouri, a doctor summoned some medical students to an autopsy saying that the patient's disease was so rare that most of the students would never see it again. It was lung cancer.
This story is from a December 1992 article by Dr. John Meyers entitled “Cigarette Century” from Time magazine. It illuminates like a lightning flash this fact: much, probably most, of our hideously costly health care crisis is caused by unwise behaviour associated with drugs, eating, driving recklessly, sex, alcohol, violence, insufficient exercise and especially smoking.
Focusing on wellness, on preventing rather than causing illness, will reduce the waste inherent in disease oriented hospital centred high tech medicine. The history of the connection between cigarettes and lung cancer illustrates the fallacy of associating health with the delivery of medicine.
One of those 1919 medical students later wrote that he did not see another case of lung cancer until 1936. Then, in six months, he saw nine cases. By the 1930s advances in immunology and public health measures such as sanitation, the handling of food and so on, were reducing the incidence of infectious diseases. However we were about to experience an epidemic in behaviourally driven disease.
The lung cancer epidemic can be said to have sprung from the 1881 invention of a cigarette making machine. Prior to that commercial manufacturing of cigarettes was largely a cottage industry. However by 1888 North Carolina's James Buchanan Duke, whose wealth brought Duke University to life, was selling nearly a billion cigarettes annually throughout North America. Between 1910 and 1919, cigarette production increased by 633%. The U.S. national cigarette service committee distributed cigarettes free to soldiers in France during World War I.
In 1930 the lung cancer death rate among men was less than five per 100,000 per year. By the 1950s, after another war in which cigarettes were sold for a nickel a pack, were distributed free in forward areas and were included with K-rations to soldiers, the lung cancer death rate among men had quadrupled to more than 20 per 100,000. Today it is more than 70 per 100,000. Women's lung cancer rates are soaring and lung cancer is far and away the leading cause of cancer deaths.
According to the World Health Organization, about half of all long term smokers die from tobacco related illnesses and half of those die in middle age, losing 20 to 25 years of productive life.
We have come a long way from the early days of television when sponsor-anchorman John Cameron Swayze's The Camel News Caravan required him to have a lit cigarette constantly visible to the audience.
The social disaster of smoking addiction illustrates why behaviour modification, especially education, is the key to containing health costs.
To that end, legislation such as the bill we are debating today, the tobacco excise tax act, can serve the public good. However the government must address concerns about the increased smuggling that may result from a spike in tobacco costs and the difficulty of policing our vast borders.
We must not forget that when combating smoking, drugs, foul language and other mischievous activities, especially among the young, social stigma has its place, as the member for Elk Island put it. Information campaigns about the public health dangers of smoking have a role to play as well.
The addictive qualities of tobacco and the craving for the product at the lowest possible price could spur a dramatic increase in cigarette smuggling. On January 27, 1994, the member for Glengarry—Prescott—Russell, the current government House leader, recognized these concerns when he told the House:
Our country is faced with a serious smuggling problem. As a non-smoker, I am generally in favour of high taxes on tobacco to help discourage young people from smoking. However, the reality in Canada today is completely different. Because of the smuggling problem in our country, almost any young Canadian can buy cigarettes cheaply, even illegally...We have no choice, Mr. Speaker. We must put an end to this illegal activity by reducing, however temporarily, taxes on tobacco. We have to work together to enforce the laws of our country.
This was followed by an ambitious crackdown on cigarette smugglers. The government told MPs it would dedicate 700 RCMP officers to anti-smuggling operations and that anyone participating in the tobacco smuggling trade in any capacity would be subject to the full range of sanctions and penalties under the law.
Presumably enthused by the new found enforcement of our laws, on October 20, 1994, the hon. member for Esquimalt—Juan de Fuca called on the government to restore the tax on tobacco to the level that existed on January 1 of that year and to put the increased revenue into health care financing. His call was opposed by the current government House leader who told members the smuggling situation persisted and that the Minister of Health had tabled a report two months earlier which had showed the reduction in taxes had not resulted in an increase in smoking.
The government House leader was wrong. From 1979 to 1991 the real price of cigarettes in Canada increased by 159% and teenage smoking fell from 42% to 16%. In 1994 Canada's reduced tobacco taxes, which were in response to concerns about smuggling, caused the real price of cigarettes to fall by one-third. As a result, teenage smoking increased from 16% to 20% and total tobacco consumption began increasing, especially among young Canadians.
From a health point of view this was a clear and significant failure. Revenue losses were equally acute. The February 1994 tax cuts resulted in a combined federal and provincial revenue loss of over $1.2 billion for the fiscal year 1994-95. The federal loss was $656 million, more than twice what the government had predicted.
In 1998 the government increased cigarette prices to try to reduce consumption. On April 20 of that year the member for Charlesbourg—Jacques-Cartier rose in the House to inform his colleagues that the morning's papers showed that the increase had brought back cigarette smuggling with a vengeance to southern Quebec and Ontario.
The government has dropped the ball on this file in the past, both on the taxation side and the smuggling side. The government's batting average has been far from good.
On May 9, 2000, during a debate of Bill C-24, the so-called sales tax and excise tax amendment act, the member for North Vancouver reminded the House that up to that point, despite the government's dedication of over 700 RCMP officers to the cause, not one person had been charged with cigarette smuggling.
During that same day's debate the member for Elk Island told the House:
It was about three, four or five years ago that cigarette smuggling was a huge issue, so the government decided to reduce the taxes on cigarettes to make the price differential between smuggled cigarettes and those purchased at the store less so there would be less demand for the black market, thereby reducing smuggling. The government tells us that this has had some effect.
Bill C-24 will once again increase cigarette taxes...However, I have to ask the question: If high taxes were part of the reason for developing the smuggling industry in the first place, would it not be possible that by increasing these taxes, as Bill C-24 will do, the problem will return?
I was not a member of the House when those comments were made and yet today we are considering the same question with Bill C-26.
Having worked in Ottawa in 1997 and 1998 and travelled to and from British Columbia extensively at the time, I can tell my colleagues that straight prices for cigarettes in Ottawa were roughly the same as duty free prices for cigarettes at Vancouver International Airport.
At that time federal cigarette taxes were high in Vancouver but dramatically reduced in the Ottawa area in an attempt to reduce smuggling in this part of the country. If taxes are to have the universal benefit of reducing smoking they must be applied at the same level in every part of the country. There cannot be a gap in the cost of cigarettes across Canada. This has been a failure in the past.
As a person who is interested in discouraging smoking from coast to coast, I remind the government that unless it deals effectively with smugglers and enforces the laws of our country, the problems that have plagued past efforts to reduce smoking will return to haunt the government.
Upon passage of the bill it is important that the government carefully and aggressively establish a plan to fight an impending surge of smuggling. If it does not, the good intentions behind the bill will fail to produce what most Canadians want: a healthier country inhabited by fewer smokers.
