In the 1960s, cigarettes were ubiquitous throughout Canada. Smoking was permitted in restaurants, schools, hospitals and airplanes, and “lighting up” was advertised widely on TV, radio, billboards, and in magazines. Even Micky Mouse famously smoked in his early cartoon show. Cigarettes were cheap and health warnings were non-existent; as such, roughly 50% of Canadian adults, specifically, 61% of men and 38% of women, would light up regularly.


Today, only 17% of Canadian adults consider themselves to be smokers. This drastic and relatively rapid shift in our cultural perception of smoking was largely brought about through a massive public health campaign jump-started by Judy LaMarsh, the Canadian Minister of National Health and Welfare in 1963. At the time, the tobacco industry was profitable and powerful. For years, it had vehemently denied any correlation between smoking and cancer. Contemporaneous research showing negative health effects was denied by companies, who launched their own studies refuting any such data. However, by 1963, enough evidence had been accumulated to support a clear link between smoking and cancer. LaMarsh, a former smoker herself, declared to the House of Commons, “There is scientific evidence that cigarette smoking is a contributory cause of lung cancer and that it may also be associated with chronic bronchitis and coronary heart disease.” LaMarsh’s bold statement led to action almost immediately; the following year, a national conference was held to discuss the effects of smoking, which ultimately resulted in the launch of a rigorous anti-smoking campaign centred around public awareness.

This moment was incredibly significant in the public health history of Canada. Internationally, LaMarsh’s remarks helped to propel Canada into the forefront of smoking awareness. Her stance in the House of Commons prefaced the famous report published by US Surgeon General Luther Terry citing cigarette smoking as a cause of lung cancer in men and likely women. This report, published in 1964, only strengthened the newly launched Canadian campaign against smoking. Soon after, the Canadian Medical Association pleaded with its physicians to stop smoking and by 1972 health warnings were beginning to be placed on the side of cigarette packaging.

Throughout the following years, Canada demonstrated its dedication to the fight against smoking through promotion of public awareness, smoking bylaws and tax increases on cigarettes. The 1988 Calgary Olympics were designated smoke-free and by 1994 smoking was banned on all domestic and international flights. These progressive steps were cemented into law in 1997 when the Tobacco Act was passed by the Canadian government under the direction of Health Minister David Dingwall. Based on conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases, the Act aimed to protect the health of Canadians through restricted access to tobacco products and enhanced public awareness. It included regulations standardizing the manufacturing and packaging of tobacco as well as strict guidelines for the sale of tobacco to youth; for example, retailers were required to post signs clearly stating that sale of tobacco to those under 19 is illegal. This Act, which was considered a game changer in the fight against smoking, was updated in 2009 and eventually led to all provinces and territories banning the open display of cigarettes in stores by 2010.

Despite this progress, one in five Canadians still smokes and smoking remains the biggest source of preventable death in Canada. Lung cancer is the leading cause of cancer deaths in Canada, killing more people than the next 3 most deadly cancers combined. Most shockingly, smoking rates among youth (aged 12-17) and young adults (aged 18-25) haven’t changed since 2013. This statistic is concerning for public health representatives as more than 80% of current smokers began smoking before the age of 18. In addition to rates remaining steady in youth, smoking rates also remain substantially higher in many vulnerable populations: individuals with less education or with mental illness, Indigenous peoples, and those living in the northern territories. It has been reported that 88% of people with schizophrenia and 82.5% of people with bipolar disorder still smoke. Furthermore, smoking rates remain highest in the Canadian Inuit population, as currently 49% of the population are smokers.

These statistics are making Federal Health Minister Jane Philpott’s job a difficult one. In February of this year, Philpott announced the government’s commitment to reducing tobacco use among Canadians to less than 5% of the population by 2035. To achieve this goal, the government is prepared to take an aggressive approach, including updating the tobacco control strategy, introducing stricter regulations on vaping, and banning menthol from cigarettes. Targeted intervention and specialized public health campaigns are also needed to help spread the message about the dangers of smoking within vulnerable communities. This is especially true for the Indigenous population, as tobacco holds a high cultural value for many tribes and communities. Understanding and valuing the rituals that involve tobacco is incredibly important for public health agencies to lower smoking rates in these communities.

Dependence on nicotine, the naturally occurring stimulant found in tobacco, is the most common form of chemical dependence in North America. For many smokers, long term brain changes induced by continued nicotine exposure result in addiction, and it is believed that 80% of people who start smoking in their adolescent years will become lifetime smokers. Spreading the message to teenagers and young adults that “casual” or “social” smoking can lead to a life-long addiction is imperative. To achieve this goal, one of the most important resources is continued funding. With ample support for interventions targeted towards vulnerable communities and continued education of the public, Canada will retain its international leadership role in the fight against smoking.


References:

  1. Canada’s war on smoking turns 50. http://www.cbc.ca/news/health/canada-s-war-on-smoking-turns-50-1.1303483CBC News, (2013).  
  2. Chai, C. 50 years after historic report, Canadian officials reflect on anti-smoking efforts. https://globalnews.ca/news/1074275/50-years-after-history-making-report-canadian-officials-reflect-on-anti-smoking-efforts/Global News, (2014).  
  3. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking- 50 Years of Progress: A Report of the Surgeon General: Centers for Disease Control and Prevention (US); Fifty Years of Change 1964-2014. https://www.ncbi.nlm.nih.gov/books/NBK294310/. (2014).  
  4. Hales, R. Canada’s war on tobacco turns 50. http://www.cancer.ca/en/about-us/for-media/media-releases/national/2013/war-on-tobacco-turns-50/?region=bcCanadian Cancer Society (2013).  
  5. Hartman, C. Can Canada aggressively lower tobacco use by 2035? https://www.theglobeandmail.com/life/health-and-fitness/whats-being-done-to-aggresively-lower-tobacco-use-among-canadians-by-2035/article34178419/.  The Globe and Mail (2017).  
  6. CAN_ADAPPT. Mental Illness & Smoking: Key Messages for Health Care Providers and Policy Makers.  https://www.nicotinedependenceclinic.com/English/teach/SiteAssets/Pages/Smoking-FactSheets2/Mental%20Illness%20and%20Smoking%20Fact%20Sheet%20for%20Healthcare%20Providers.pdf.  CamH 
  7. Jetty, R. Tobacco use and misuse among Indigenous children and youth in Canada. https://www.cps.ca/en/documents/position/tobacco-aboriginal-peoplePaediatric Child Health (2017).  

 

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Alicia Kilfoy

Alicia is a Master's student in the Department of Immunology at the University of Toronto, where she investigates B-cell acute lymphoblastic leukemia. In her spare time, she enjoys playing soccer, cheering on the Toronto Raptors and spending quality time with her family and friends.
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