Consultation on the Future of Tobacco Control in Canada: What We Heard

Contents

• Preamble
• Executive Summary
• Introduction
• What we heard through the online public consultation
  • Less than 5% by 2035 and other targets
  • Protecting youth & others who don't use tobacco
  • Helping Canadians who use tobacco
  • Indigenous peoples
  • Tobacco use and health and social inequities
  • Building capacity & industry accountability
• What we heard during the pre-consultation
• What we heard at the National Forum
• Next Steps
• References

Preamble

This report provides an overview of what we heard through the consultation on the future of tobacco control in Canada. As such, it is intended to reflect the views of respondents as they were expressed, and does not necessarily reflect the views of the Government of Canada.

Executive Summary

With an estimated 45,000 deaths attributable to smoking in Canada in 2012, leading to nearly 600,000 potential years of life lost for premature mortality^{Footnote 1} , tobacco use remains the leading preventable cause of disease and premature death in Canada.^{Footnote 2}

The renewal of the Federal Tobacco Control Strategy (FTCS) provides an opportunity to chart a new course in tobacco control and further protect Canadians from the devastating impacts of tobacco use and nicotine addiction. The modernized approach would set the path to reduce Canada's rate of tobacco use to less than 5% by 2035. 

In 2016 and 2017, a three-step consultation approach took place to hear from Canadians on proposed measures that would help reach Canada's target for tobacco use reduction. The consultation combined targeted pre-consultations, a National Forum with stakeholders, as well as a broad 7-week online public consultation.

The responses received through the consultation process were resoundingly supportive of the Government of Canada's target to reduce tobacco use in Canada to less than 5% by 2035, with a majority of respondents to the public consultation and most participants in the pre-consultations and forum indicating they are ready to support additional action by the Government.

Respondents to the consultation had a lot to say on how to get there. The majority agreed that tobacco use is a pressing public health issue that calls for coordinated action. Many felt that developing a comprehensive long-term strategy with sustained increased resources would be critical to reaching less than 5% tobacco use in Canada by 2035. Respondents proposed that the strategy include strengthening existing measures (e.g., closing what they consider as loopholes in policies and regulations, raising taxes on tobacco products, enhancing health warnings on tobacco packages), the reinstatement of measures that were successful in the past (e.g., mass media campaigns), and the introduction of new innovative measures that consider the evolving tobacco control environment (e.g., implementing a harm reduction approach). Many felt that the Tobacco Act also needed to be updated.

The need for frequent evaluation and reporting on the implementation of the strategy was also identified as a means to provide for the ability to react quickly and adjust the strategy as necessary.

Introduction

Despite decades of efforts, tobacco use remains the leading preventable cause of disease and premature death in Canada. It plays a role in causing over 40 diseases and other serious health outcomes, including cancer, respiratory ailments, and heart disease, leading to immeasurable suffering for thousands of Canadians, their friends and families.^{Footnote 3}  Overall, an estimated 45,000 deaths were attributable to smoking in Canada in 2012, leading to nearly 600,000 potential years of life lost from premature mortality.^{Footnote 4}

Tobacco use also adds a huge burden to the health care system. The health and economic costs associated with tobacco use in Canada were estimated to total $16.2 billion in 2012, with direct health care costs of $6.5 billion.^{Footnote 5}

The Government of Canada addresses the public health problem of tobacco use through the FTCS. Launched in 2001, the FTCS is a comprehensive and integrated strategy with the goal to reduce tobacco-related death and disease among Canadians, with a focus on protecting Canadians, especially young people, from the health consequences of tobacco use. The Government of Canada also regulates the manufacture, sale, labelling and promotion of tobacco products by administering the Tobacco Act, which was passed in 1997.

In the past year, the Government introduced Bill S-5, an Act to amend the Tobacco Act, the Non-Smokers' Health Act and to make consequential amendments to other Acts, a legislation that is currently being considered by Parliament, to address vaping products, support the implementation of plain and standardized packaging requirements for tobacco products and modernize the approach to tobacco control in Canada. In addition, effective October 2, 2017, the Tobacco Act was amended to prohibit the use of menthol additives in the manufacture of cigarettes, blunt wraps and most cigars, and their sale. These latter products represent 95% of the entire tobacco market in Canada.

More needs to be done to protect the health of Canadians and their families. Even though prevention and smoking cessation initiatives have led to reduced tobacco use, in 2015, 15% (4.6 million) of Canadians aged 15 years of age and older used at least one tobacco product in the past 30 days^{Footnote 6} , down from 23% (5.8 million) in 2003.^{Footnote 7}

As the current FTCS expires on March 31, 2018, this is an opportunity for the Government of Canada to chart a new course in tobacco control to protect Canadians from the devastating impacts of tobacco use and nicotine addiction. The proposed strategy would seek to set the path toward less than 5% tobacco use by 2035. This commitment would focus long-term federal action and help to mobilize all Canadians.

To reach this goal, we need to work together with all Canadians toward the development and implementation of tobacco control measures. This is why Health Canada organized a three-step consultation approach on the future of tobacco control in Canada, combining targeted pre-consultations (completed in summer-fall 2016), a National Forum with stakeholders (March 1-2, 2017), as well as a broader 7-week online public consultation that was open for comments from February 22 to April 13, 2017.

To solicit the views of Canadians on a renewed strategy for tobacco control in Canada, the consultation document Seizing the opportunity: the future of tobacco control in Canada was released. Feedback was sought for six key elements, designed to put the health of Canadians first:

1. Less than 5% by 2035 and other targets - in addition to the goal of less than 5% tobacco use by 2035 for the general population, setting other tobacco use and sub-population targets.
2. Protecting youth - preventing young people and others from starting to use tobacco and vaping products, and protecting them from second-hand smoke and vapour.
3. Helping Canadians who use tobacco - enabling access to treatment to help people quit tobacco and reducing harm to those who are not ready to quit.
4. Indigenous peoples - supporting the development of a shared approach to address higher prevalence rates of commercial tobacco use among Indigenous peoples.
5. Tobacco use and health and social inequities - addressing higher rates of tobacco use in groups such as those living with mental illness and those with lower socioeconomic status.
6. Building capacity - ensuring that the Government of Canada has the resources, information and partnerships it needs to achieve its targets and to support partners in their roles.

A total of 1,749 responses were received through the online public consultation, including responses from representatives from public health, non-governmental organizations (NGOs), academics, other levels of government, industry (vaping, pharmaceutical and tobacco), international organizations and members of the public.

The purpose of this report is to provide a summary of the main themes that emerged from comments to the public consultation on the future of tobacco control in Canada, for each of the six key proposed elements. As such, it is intended to reflect the views of respondents as they were expressed, and does not necessarily reflect the views of the Government of Canada.

While it focuses mainly on what was heard from Canadians through the online public consultation, a short summary of what was heard through the other streams of the consultation (pre-consultations and National Forum) is also presented at the end of the document.

What we heard through the online public consultation

This section provides a high level summary of comments received from respondents to the online public consultation, for each key element discussed in the consultation document Seizing the opportunity: the future of tobacco control in Canada.

In total, 1,749 responses were received through the online public consultation. Representatives from public health, NGOs, academics, other levels of government, industry (vaping, pharmaceutical and tobacco), international organizations and members of the public provided comments. Many responses were based on variations of three different form letters; however, unique responses were received from 354 respondents.

Of the 1,749 responses received, 1,627 (93%) were submitted by the general public. Figure 1 below provides a breakdown of responses received from other respondents (7%).

Figure 1: Number of responses received per category of respondent (not including responses from the general public)

Less than 5% by 2035 and other targets

Respondents were asked to express their views with regard to the less than 5% by 2035 target for tobacco use and other targets that could be set for a new strategy on tobacco control in Canada.

Less than 5% by 2035

An overwhelming number of respondents (approximatively 85%) were supportive of a target of less than 5% tobacco use by 2035 in Canada.

Some respondents pointed out that Canada would need to adopt aggressive measures in order to reach this ambitious target, particularly since, in their view; declines in tobacco use have been relatively slow more recently.

Which products should be included in the target?

About 70% of respondents believe that all tobacco products should be included in the target of less than 5% by 2035, with a few respondents suggesting that vaping products also be included in the target. Most respondents who commented on setting a target for use of vaping products suggested that a separate target be set for youth and others who use vaping products but do not use tobacco.

What other sub-targets should the Government adopt?

Examples of additional targets proposed by respondents include the adoption of a target for:

• dual use of tobacco and vaping products;
• quit attempts;
• daily and occasional tobacco use;
• youth initiation; and,
• tobacco use by young adults.

Many respondents also stressed the need to set specific targets for sub-populations with higher rates of tobacco use.

In addition, a large number of respondents suggested that interim prevalence targets (i.e., annual or every few years) be agreed upon in order to periodically verify that Canada is on track to meet its overarching goal.

Protecting youth & others who don't use tobacco

Although smoking rates among the general population are declining in Canada, the rates of decline are slower in some groups. For example, smoking rates for youth and young adults have remained unchanged since 2013.^{Footnote 8}  Moreover, 82% of adult current daily smokers aged 25 years of age and older smoked their first cigarette by the age of 18^{Footnote 9} , and many go on to become lifetime smokers. In that context, respondents were asked to provide their views on preventing initiation of tobacco use by young people.

Raising the minimum age of access

The majority of respondents (about 73%) would support the idea of raising the minimum age to legally access tobacco products in Canada to 21 years old. A small number of respondents expressed concerns with regard to this idea, namely that age-restrictions are under provincial and territorial (PTs) jurisdiction, but most importantly, that such a measure could be at odds with the regulation of the purchase of alcohol or cannabis and that legally adults should have the right to make informed choices regarding their own life.

Still, others suggested that the Government consider the introduction of measures to create a “tobacco-free generation” in Canada, as it is being considered by some other countries, whereby individuals born in or after a certain year cannot legally access any tobacco products.

Tobacco addictiveness reduction

There was no consensus from respondents on whether or not the Government should consider regulatory options to reduce tobacco product addictiveness (e.g., by mandating reduced levels of nicotine in cigarettes).

Some argued that this type of measure could prevent youth experimenting with tobacco from becoming addicted to nicotine and becoming long-term tobacco users, and influence tobacco users to quit.

On the other hand, some felt that more research is needed on the proposal. These respondents fear reducing the level of nicotine in cigarettes could cause current tobacco users to compensate by smoking more cigarettes. Others think that the measure could present compliance and enforcement issues, particularly since tobacco users could turn to illegal sources to acquire cigarettes with higher levels of nicotine.

Some respondents proposed options that could potentially reduce tobacco product appeal. For example, the palatability of cigarettes could be reduced, making them harsher or less inhalable. Some also suggested that the Government consider prohibiting the use of filters on cigarettes in an attempt to reduce the false sense of security imparted by filters and the environmental impact of discarded filters.

Smoke- and vapour-free spaces

Many respondents believe that governments should do more to protect Canadians from the burden of second-hand smoke. Among them, many would like to see tobacco use banned in all multi-unit buildings, while a few think that the Government should not dictate what they do in their own home. Many suggested that in the meantime, a fund be created to help tenants or lessees who need to fight for their right to a smoke-free home.

Respondents suggested that the Government of Canada work with provinces and territories to consistently adopt further smoke-free areas such as parks, beaches, hospitals and campuses. They also proposed that the scope of smoke-free policies and legislation be expanded to comprise all combustible products, including cannabis. Many recommended that other products such as vaping and heated tobacco products also be banned where smoking is banned. However, some respondents suggested that in order to support harm reduction for those who want to switch from tobacco to vaping products, vaping should only be banned indoors.

Other measures to protect youth and others who do not use tobacco

Most respondents (about 80%) indicated that they support speedy introduction of plain and standardized packaging for tobacco products in Canada. Many provided recommendations on requirements for plain and standardized packaging (e.g., control on brand and variant names, allowing only a single format for cigarette packages). Many respondents also indicated that they support expanding flavour bans, including menthol, to all tobacco products.

Some respondents encouraged the Government to increase youth engagement and outreach activities. For example, it was suggested that the Government of Canada work with provinces and territories to include more prevention and cessation programs in schools. These could include education on how to increase protective factors for youth and young adults (e.g., education on how to deal with personal issues and stress, self-confidence, promotion of healthy-living). It was also suggested that a focus be placed on educating parents, including on their impact as role models and on ways they can talk to youth about tobacco use.

Some respondents suggested that more be done to limit underage access to tobacco products, including through licensed retailers and internet sales. Among other things, respondents proposed that restrictions on the number, type and location of outlets that are authorized to sell tobacco be adopted and that enforcement measures be increased.

Doing more research to understand why youth experiment with tobacco use, denormalizing tobacco use and raising awareness about the tobacco industry marketing tactics targeting youth are also seen as promising measures by respondents. In addition, many urged the Government to close what they consider as loopholes in bans on tobacco promotion. Suggestions include banning tobacco branding on non-tobacco products, implementing a stricter movie classification system, mandating anti-tobacco advertisements whenever tobacco use is depicted in media (e.g., in movies, TV shows, video games) and imposing stricter conditions on the provision of funding for artistic productions.

Addressing contraband

Many respondents think that the Government should do more to prevent and address the contraband issue in Canada and internationally and some recommended potential options in that regard. Some suggested that the Government learn more from other jurisdictions about successful anti-contraband measures. Some also suggested that the Government work in collaboration with international partners, PTs, Indigenous communities and other partners to implement a comprehensive contraband strategy that could include measures to better monitor illicit activities, inform the public on the issue, tighten controls on the supply chain, including on material used to manufacture cigarettes (e.g., acetate tow used in filters), and implement higher penalties on offenders.

On the other hand, many highlighted the need for the Government to focus on countering information from the tobacco industry on the link between tobacco regulations and contraband, and in particular that the Government should do more to dismiss the false belief that higher taxes on tobacco products fuel contraband. Respondents supporting this position suggest that the industry is exaggerating the contraband issue in an attempt to distract Canadians from the bigger issue of tobacco use.

Helping Canadians who use tobacco

Addiction is an important driver of tobacco use. Quitting is difficult. In 2015, less than 6% of former smokers had quit within the past year while approximately 50% of daily smokers had made at least one quit attempt.^{Footnote 10}  Quitting smoking is the best thing a person who smokes can do to improve their health.^{Footnote 11}

On November 22, 2016, the Government introduced Bill S-5, An Act to amend the Tobacco Act and the Non-smokers' Health Act and make consequential amendments to other Acts, which establishes a new legislative framework to regulating vaping products in order to address the risks and potential benefits of these products. The Bill amends the Tobacco Act and changes the title to Tobacco and Vaping Products Act (TVPA). The proposed TVPA aims to protect youth and non-users of tobacco products from nicotine addiction and inducement to tobacco use, while allowing adults, particularly adults who smoke, to legally access vaping products as a less harmful alternative to tobacco.

Balancing cessation and harm reduction

Many respondents expressed support for the introduction of a harm reduction approach for tobacco use in Canada. Most of those respondents proposed that a coherent harm reduction regulatory framework be implemented that recognizes the continuum of risk for products and gives less harmful products market advantages (i.e., less harmful products be more available at retail, be less expensive, have lower taxes and reduced labelling regulations). Coupled with public education on the relative risk of less harmful products, this approach is thought to have the potential to encourage adults who smoke to completely switch to less harmful forms of nicotine such as vaping products. Most proposed that a balanced approach be adopted for harm reduction and cessation, i.e., that the Government offer different cessation options to tobacco users, including harm reduction approaches.

Many respondents also shared personal stories of how vaping products have improved their health and even saved their life, when they had been unable to successfully quit smoking through other means made available to them in the past. These respondents largely believe that the benefits of vaping products for public health outweigh their potential risks. They also believe that allowing multiple flavours for vaping products is critical for smokers to switch to vaping products. Some expressed concerns that requirements for vaping products under Bill S-5 would be too onerous for the vaping industry, which could hurt the industry and have a detrimental impact for public health.

On the other hand, a larger number of respondents indicated some degree of reluctance regarding a potential harm reduction approach to tobacco use in Canada. While recognizing the potential of less harmful products such as vaping products in the context of tobacco control, these respondents generally believe that the Government should focus its efforts on cessation, using evidence-based methods as the gold-standard (e.g., behavioural change help, medication, nicotine replacement therapies [NRTs]).  

These respondents expressed concerns about the possibility that less harmful products such as vaping products could introduce new harms, including potentially leading youth who use these products to start smoking. They support strong regulation of less harmful products, including strict promotion regulations to protect youth and non-tobacco users. They also encourage the Government to closely monitor use trends of less harmful products in order to ensure that they ultimately lead to a reduction in the use of tobacco products.

Some respondents expressed more neutral points of view, advising the Government to use a precautious and deliberate approach toward balancing cessation and harm reduction by ensuring more research is conducted and the products are regulated appropriately (e.g., labelling, safety, access). Some proposed that cessation support be developed to ensure people who use less harmful forms of nicotine eventually quit these products.

Cessation

Most respondents stressed the need for the Government of Canada to optimize the cessation component of the strategy by increasing resources to support cessation efforts, programs and services.

To that end, some respondents proposed that a comprehensive national and integrated plan be implemented for cessation. The plan could include more research on cessation, the expansion of existing cessation programs and services as well as the development and pilot testing of new options, treatments and programs. In particular, the majority of respondents (almost 70%) proposed that the Government of Canada works with partners to make Quit lines the main channel for access to cessation support and services in all provinces and territories.

Respondents encouraged the Government of Canada to use sustained, well-funded, mass media campaigns to raise awareness on the health risks of using tobacco, to promote cessation to Canadians and to increase their knowledge about the resources available to them.

Many respondents also thought that every tobacco user in Canada should have free or low cost access to counselling programs, medication and NRTs. Furthermore, respondents advised that there should be “no wrong door” access to cessation services. One proposed way to achieve this would be to embed cessation services in the public health system and systemically offer cessation services to all patients reaching out for health related services (e.g., hospital patients, routine visit with family doctor).

Some highlighted the need to build capacity among communities and health institutions and other services accessed by tobacco users (e.g., workplaces, employment assistance services) to offer cessation services. Respondents also recommended resources be directed to improve the expertise of health professionals, social workers and addiction professionals through training in tobacco cessation and the creation of a cessation network.

Additional measures were proposed to increase cessation and quit attempts, including broadening of smoke-free places, enhancing and regularly refreshing of health warning messages on tobacco packages, and developing a pricing and retail sector strategy for tobacco products. Such reform could include raising taxes on tobacco products, restricting the sales of discounted tobacco products, preventing the segmentation of prices, limiting the number of outlets or replacing them by government controlled outlets, imposing high cost licensing for retailers and banning incentives to retailers.

Of note, about 80% of respondents indicated that they would support an increase in tobacco prices and taxes in Canada to support tobacco use prevention and cessation efforts. Respondents also proposed that funds be directly earmarked from tobacco tax revenues for tobacco control measures.

New tobacco products

The tobacco industry is also promoting new tobacco products as less harmful and has introduced these products to the Canadian market in the past year. However, this claim has not been independently verified and the effects on human health are currently unknown.

Many respondents think that more research is needed on new heated tobacco products in order to independently verify claims by the tobacco industry that these products are less harmful than combustible products, to assess their potential benefits (e.g., in helping tobacco users to quit smoking) and to anticipate potential issues and risks they could pose.

Some respondents, mostly concerned citizens and public health authorities and agencies, suggested that a pre-market approval for new tobacco products be put in place, one that would ensure scientific data on the potential risks and benefits of these products is adequate, and that strong monitoring, policies and regulations are put in place in advance of new products entering the marketplace.

Still others think that a moratorium should be imposed to prevent any new tobacco products from entering the market.

Indigenous peoples

As part of its long-term plan on tobacco, the Government of Canada is considering how to collaborate and partner with Indigenous peoples and others to co-develop and co-deliver an approach to address high rates of tobacco use among Indigenous peoples in a manner that recognizes First Nations rights, and respects the sacred and ceremonial role tobacco plays in certain communities.

Among respondents who provided comments on how the Government of Canada should work with Indigenous peoples in designing a new path to reduce the use of tobacco in Canada, most highlighted the need for the Government to recognize and respect the differences that exist between ceremonial and commercial tobacco and to increase opportunities and resources for Indigenous communities to create and implement their own strategies. Many also stressed the need for a collaborative strategy that would include a community-based participatory action approach and health and social equity lens. Finally, it was proposed that more research be done to identify and evaluate leading culturally appropriate interventions to reduce tobacco‐related morbidity and mortality among Indigenous peoples.

Tobacco use and health and social inequities

Respondents were asked to comment on how to address health and social inequities in sub-populations with higher rates of tobacco use (e.g., Canadians living in rural and remote communities, those with low incomes, people experiencing other addictions or poor mental health, and lesbian, gay, bisexual, transgender and queer or questioning peoples [LGBTQ2+]). Many agreed that the renewed strategy should include a health and social equity lens. It was proposed that sub-populations with higher rates of tobacco use be identified up-front and that strategies specifically aimed at these populations be integrated as part of the larger strategy. As a start, some respondents suggested that more research be done to understand the social and environmental drivers of tobacco use within sub-populations with higher rates of tobacco use and how to reach these populations.

The importance of tailoring cessation services to the special needs and circumstances of sub-populations and of increasing access to these services was also raised by many. Potential avenues to do so would be to collaborate with partners at all levels in order to integrate cessation and harm reduction into various existing services that already reach sub-populations with higher rates of tobacco use. Examples include community services, health care services and addictions treatment centres. It is also felt that cessation should be addressed in tandem and in consideration of other risk factors and issues, such as trauma, stress, mental health issues and co-substance use.

A few respondents discussed the need to consider that some “punitive” policies (e.g., high taxes, smoke-free places) may reinforce social stigma toward tobacco users and exacerbate health and social inequities in some sub-populations. Respondents with this perspective indicated that compassion is needed if new tobacco control measures are to be successful.

Building capacity & industry accountability

Participants responded to questions on how the Government should increase capacity and work with partners to take action that support Canadians to live healthy, tobacco-free lives.

Industry accountability

Many respondents think that the new strategy for tobacco control in Canada should focus on ensuring that the tobacco industry is held to better account for the societal burdens caused by its products. In fact, more than 80% of respondents clearly indicated that the tobacco industry should pay for tobacco control efforts.

Many advised that a fundamental reform of the industry be introduced, including more stringent regulation and the imposition of prevalence reduction targets coupled with dissuasive penalties that would tie the industry's profits to reducing tobacco use. Some also suggested that the Government impose mandatory proactive disclosure by the industry of the information provided under the federal Tobacco Reporting Regulations.

Many stressed the need for the Government to do more to prevent industry interference in the development of health related policies. To that end, it is suggested that guidelines for officials on interacting with the tobacco industry be developed. More than 75% of respondents also believe that part of the solution is to educate the public on industry marketing tactics and counter disinformation from the industry on tobacco control measures.

Research

To best support research to provide the data needed to inform a new agenda in tobacco control, some proposed that the Government create a research “road map” and an arm's-length independent research body to analyse, synthesize and evaluate programs and policies. Some also advised that the Government work with the Canadian Institutes of Health Research (CIHR) and other funding bodies to create dedicated funding for policy research. Finally, it is proposed that the Government dedicate funding to support the development of a new generation of researchers and policy professionals.

Partnerships

Respondents believe that it is critical for the Government of Canada to establish a pan-Canadian approach with federal leadership if the new strategy on tobacco control in Canada is to be successful. Greater synergy between federal, provincial and territorial governments is needed to ensure coherent and coordinated efforts toward reducing tobacco use in Canada.

Inter-sectoral work is also key if the new strategy on tobacco control is to be successful. Respondents encouraged the government to strengthen its collaboration with existing partners at all levels (e.g., NGOs, academics) and to develop new partnerships. Examples of potential new partnerships include educational institutions; public health and other health agencies; social workers; hospitality, service and retail sectors; pharmaceutical companies; insurance providers; and Indigenous organizations.

Respondents also felt that more funding is needed toward increasing knowledge exchange channels. Among other things, it is proposed that the Government develop and fund knowledge hubs, centralized inventories and/or a community of practice for tobacco control stakeholders that would foster collaboration, coordination and sharing of research, resources and best practices in tobacco control.

It was also suggested that knowledge exchange be supported through enabling and funding partners to take part in training sessions, forums and conferences.

Working with international partners

Tobacco use is a global issue. Respondents believe that the Government of Canada should demonstrate leadership by supporting global tobacco control efforts, including supporting stronger implementation of the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) in developing countries.

Respondents also advised the Government to continue to monitor the efforts of international partners to learn about best practices and challenges encountered in implementing tobacco control measures.

Finally, some respondents recommended that the Government of Canada work with international trade agencies to ensure trade agreements do not impede tobacco control in Canada.

What we heard during the pre-consultation

The pre-consultation phase of the consultative approach on the future of tobacco control in Canada was completed in fall 2016. Its objective was to inform the formal consultation process by obtaining feedback from stakeholders on strengths, weaknesses, opportunities and challenges of the current tobacco control framework; exploring and understanding stakeholders' views of roles and responsibilities in an evolving tobacco control context; and building stakeholders' knowledge and engagement in preparation for broader consultations, including the online consultation and the National Forum on the future of tobacco control in Canada.

Twenty-three (23) pre-consultation sessions and several special bilateral meetings were held, with a total of 142 participants representing 88 different organizations, including representatives from federal health portfolio organizations and other federal government departments, NGOs, public health and health professional organizations, tobacco control researchers and experts, youth and youth organizations, provincial and territorial government departments, provincial tobacco control coalitions, national Indigenous organizations, municipalities and regional health authorities, as well as tobacco users and ex-users.

Stakeholder groups discussed the effectiveness of the FTCS since its implementation in 2001, including successes, failures and missed opportunities; changes in the tobacco control environment and the effects of these changes on the roles and responsibilities of the various key tobacco control actors; innovative prevention, cessation and harm reduction measures that could be explored by the federal government; and potential priorities, goals and targets for the future federal tobacco control strategy.

Most stakeholders expressed strong support for the use of an aspirational, ambitious target for the new federal tobacco control strategy, such as a target of less than 5% tobacco use in Canada by 2035.

A number of stakeholder groups indicated that the government should focus its activities on sub-populations with the highest tobacco use rates, while others suggested that these activities should be balanced and supported by continued, general population-level interventions (e.g., taxation).

What we heard at the National Forum

The National Forum on the Future of Tobacco Control in Canada was held in Ottawa on March 1-2, 2017, as part of the Government's consultative approach towards charting a new course to help Canadians lead healthier, tobacco-free lives.

The Forum engaged 150 stakeholders from the tobacco control community including academia; NGOs; public health professionals; provincial and territorial governments; health care providers; health professional associations; youth; representatives from Indigenous organizations and communities; and other tobacco control experts. The intent of the Forum was to provide an opportunity for broad discussion on issues pertinent to the development of a new federal tobacco control strategy.

The then Minister opened the Forum by describing the impact of tobacco use on the lives of Canadians and by challenging stakeholders to come together and discuss ideas on how to set the path to reduce Canada's rate of tobacco use to less than 5% by 2035.

The Forum was organized into a series of presentations and discussion sessions on themes drawn from Health Canada's consultation document Seizing the opportunity: the future of tobacco control in Canada.

The need to find a comprehensive way to address tobacco use in Canada from a variety of perspectives was discussed. Participants noted that the tobacco use issue needs to be reframed as a context-dependent, complex issue with multi-faceted interventions.

Most participants in the Forum were supportive of the goal to reach less than 5% tobacco use in Canada by 2035.

Discussions on what is needed to reach this target without leaving anyone behind took place. Participants agreed that more research is required to understand the problem as it exists now and that innovative measures are needed to reach the target.

Ideas on how to prevent youth and young adults from tobacco use initiation and on how to help current tobacco users, including through cessation support, harm reduction approaches and population-level policy approaches (e.g., price, taxation) generated much discussion. 

The need to find ways to address these issues while taking into account heterogeneous populations in Canada was extensively discussed at the Forum, especially considering how specific communities are disproportionately affected by tobacco. Among identified groups, the importance of working with Indigenous peoples to address commercial tobacco use in their communities was greatly emphasized.

Many recommended that a “whole of government” approach to addressing tobacco use in Canada be taken, with coordinated efforts across the government.

Participants stressed that adequate resources will be crucial, along with better coordinated knowledge exchange, surveillance, monitoring and evaluation systems, for the strategy to be successful going forward. A number of suggestions were made regarding how funding for tobacco control measures should be provided, including through taxes on tobacco products or a levy on the tobacco industry.

A report of what was heard from stakeholders during the National Forum was posted online on May 31st, 2017 - World No Tobacco Day 2017.

Next Steps

The Government of Canada is committed to setting a path toward less than 5% tobacco use by 2035 in Canada. It will collaborate closely with partners and stakeholders to meet this target that contributes to its overall vision for a healthy Canada.

All comments and information submitted as part of the three-step consultation approach will be taken into consideration as we move forward in the development of a new path for tobacco control in Canada.

References