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On June 17, 1963, then-Health Minister Judy LaMarsh rose in the House of Commons and said:
"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."
As hard as it is to believe now, that was a monumental statement. Ms. LaMarsh (a once 50-cigarette-a-day smoker) was one of the first public officials in the world to state publicly that smoking kills.
At the time, the position of the tobacco industry (and many others) was that the evidence was inconclusive, despite the fact that researchers showed pretty conclusively that smoking causes lung cancer as early as 1950.
Cabinet documents, released decades later, show that Ms. LaMarsh was urged to maintain a neutral tone and use careful language so as to not cause widespread panic. Still, she ruffled a lot of feathers.
After all, 50 years ago, more than half of Canadian adults smoked – 61 per cent of men and 38 per cent of women.
The comments by Ms. LaMarsh were soon eclipsed by U.S. Surgeon-General Luther L. Henry, when he released a landmark report on smoking and health in January 1964.
Unlike the Canadian Health Minister's statement, the U.S. Surgeon-General's report caused a media frenzy.
But Canada, to its credit, had already taken action, launching a public awareness campaign about the dangers of tobacco. It was the beginning of what has been a half-century long public health battle against smoking.
So, how are we doing?
"Over the years, Canada has been a world leader on tobacco control," said Rob Cunningham, senior policy analyst at the Canadian Cancer Society. "But we can always do better."
Legislative approaches have shifted over time: The 1960s were all about public awareness, the 1970s saw a raft of smoking by-laws, while the 1980s was a time of significant tax increases. Since then, tobacco control efforts have become targeted in specific areas. For example:
Canada was the first country to ban smoking on all domestic flights (1987) and international flights (1994); Calgary hosted the first smoke-free Olympics (1988); Canada was the first country to require mandatory warnings on cigarette packages (1994), and to use graphic photos as health warnings (2001); Saskatchewan was one of the first jurisdictions in the world to ban the visible display of tobacco products in retail locations (2002); Canada was the first country to ban flavours (except menthol) in cigarettes (2010).
Despite all these efforts – and more – about 17 per cent of Canadians still smoke. That's five million smokers.
Smoking kills close to 40,000 Canadians a year: more than 20,000 from lung cancer alone, about 11,000 from heart disease and stroke, and another 8,000 from chronic obstructive pulmonary disease (COPD). Second-hand smoke alone kills an estimated 800 people a year.
So how do we do better?
Mr. Cunningham describes policy-making in the tobacco field as a constant game of leapfrog: One jurisdiction makes a move then others follow and try to go a bit further.
Over the years, Canada's leaps have become a little less bold.
Countries like Australia have moved beyond graphic images and implemented plain packaging for cigarettes. A number of jurisdictions have made outdoor areas like patios, parks, playgrounds and beaches smoke-free. Retail sales of tobacco can be limited: For example, sell cigarettes in liquor stores rather than in every corner store.
Banning tobacco altogether is unrealistic: After all, government policies have helped facilitate nicotine addiction for millions.
But some countries are now talking openly about becoming smoke-free. New Zealand, for example, announced last year that it intends to snuff out smoking entirely by 2025. It's first move was to hike tobacco prices by 40 per cent.
One innovative idea is to set a cutoff date to say, for example, that no one born after the year 2000 could buy tobacco. Ever. Essentially phase out the scourge.
There is no simple, one-size-fits-all solution. What we need today is what we have needed from day one: For societal leaders – elected officials and otherwise – to make tobacco control a priority, to show some leadership.
Fifty years after Ms. LaMarsh's historic statement, we've only just begun to make progress in the war on tobacco.
50 years of war on tobacco
1963 Federal Health Minister Judy LaMarsh declares that smoking is a contributory cause of lung cancer and may also be associated with chronic bronchitis and coronary heart disease.
1963 Canadian Medical Association President urges doctors to stop cigarette smoking, at least during professional duties.
1964 US Surgeon General's Report concludes that cigarette smoking is a cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.
1969 CBC television stops accepting tobacco advertising.
1969 House of Commons Standing Committee on Health, Welfare and Social Affairs recommends that tobacco advertising be banned and that many other tobacco-control measures be adopted.
1972 Tobacco industry voluntary code amendments remove advertising from television and radio, though industry would later use sponsored events to get around this measure. Also, a weak, voluntary warning begins to appear in small print on the side of the package.
1973 Canadian National Railway sets aside nonsmoking sections on some trains between Montreal and Toronto.
1976 City of Ottawa passes first municipal smoking bylaw in Canada restricting smoking in indoor public places, effective 1977.
1977 National Non-Smoking Week begins as an annual event in Canada, held in January.
1982 Smoking is banned on domestic airline flights of 2 hours or less.
1982 Tobacco taxes begin to rise above rate of inflation.
1986 US Surgeon General concludes that secondhand smoke causes disease, including lung cancer, in otherwise healthy nonsmokers.
1987 Federal and provincial governments announce Tobacco Diversification Plan to help farmers exit from tobacco growing.
1987 Federal regulation bans smoking on domestic flights of 2 hours or less.
1988 US Surgeon General concludes that the pharmacologic and behavioural processes that determine tobacco addiction are similar to those that determine heroin and cocaine addiction.
1988 WHO organizes first World No Tobacco Day. This day has continued on May 31 every year.
1988 Federal Tobacco Products Control Act adopted to ban tobacco advertising.
1988 Calgary Winter Olympics become first smoke-free Olympics.
1988 Federal Non-smokers' Health Act adopted to implement strong smoking restrictions in all federally-regulated workplaces.
1989 Pursuant to Non-smokers' Health Regulations , smoking banned on all domestic airline flights in Canada.
1993 Federal Tobacco Sales to Young Persons Act adopted to increase the minimum federal age of sales of tobacco to minors from age 16 to age 18. Today, 6 provinces and one territory have a minimum age of 19.
1993 Lung cancer surpasses breast cancer as the leading cause of cancer death among Canadian women.
1994 Federal government and Ontario, Quebec, New Brunswick, Nova Scotia and PEI reduce tobacco taxes.
1994 McDonald's announces that all of its company-owned restaurants in North America will be smoke free.
1994 Federal Tobacco Products Control Regulations amended to require world precedent setting black and white health warnings covering 35 per cent of the package front and back.
1994 House of Commons Standing Committee on Health recommends plain packaging.
1994 Ontario becomes first province to ban tobacco sales in pharmacies. All provinces except BC have now done so.
1994 Ontario and Nova Scotia become first provinces to ban vending machine cigarette sales. Today, federal legislation prohibits vending machines except in bars, and six provinces/territories have full bans on vending machines.
1995 Supreme Court of Canada by narrow 5:4 majority strikes down advertising ban in Tobacco Products Control Act.
1996 Vancouver becomes first municipality to adopt a bylaw requiring restaurants to be 100 per cent smoke-free.
1997 Federal Tobacco Act adopted, implementing strong restrictions on tobacco advertising and promotion, to replace the Tobacco Products Control Act.
1998 British Columbia becomes first province to file medicare cost recovery lawsuit against the tobacco industry. Nine provinces have now filed lawsuits, and the 10th province, Nova Scotia, has announced its intention to do the same.
2000 Federal Tobacco Products Information Regulations adopted to require world precedent setting package health warnings that include graphic pictures, and that cover 50 per cent of the package front and back.
2000 Canadian Cancer Society establishes Smokers' Helpline in Ontario, providing smokers a toll-free service for assistance on how to quit. The Society would later also provide a similar service in SK, MB, ON, QC, NB, NS, PEI. Quitlines are now accessible from all provinces and territories.
2001 Saskatchewan becomes first province to adopt legislation to prohibit visible display of tobacco products in retail stores, effective in 2002. All provinces and territories would later do the same.
2001 Federal government announces record level of funding for tobacco control (subsequent to passage by Senate of Bill S-20, Tobacco Youth Protection Act , and similar bills).
2003 WHO Framework Convention on Tobacco Control , the international tobacco treaty, approved.
2003 Federal Tobacco Act ban on sponsorship of sport and arts events comes into effect.
2004 Manitoba, New Brunswick, Northwest Territories and Nunavut become first provinces/territories to adopt legislation making all restaurants and bars 100 per cent smoke-free. All provinces and territories have now done so.
2005 Supreme Court of Canada unanimously upholds Saskatchewan ban on retail displays.
2007 Supreme Court of Canada unanimously upholds federal advertising restrictions and sponsorship ban in Tobacco Act. , and federal regulations for 50 per cent picture warnings.
2008 Wolfville, NS becomes the first municipality to ban smoking in vehicles with kids. Today, 8 provinces have implemented such a measure with provincial legislation.
2008 Imperial Tobacco Canada Ltd. and Rothmans, Benson & Hedges Inc. plead guilty to illegal tobacco contraband for actions in the early 1990s. JTI-Macdonald would do the same in 2010. Fines and civil payments total $1.7-billion.
2009 Parliament adopts Bill C-32 to ban flavoured cigarettes and little cigars (effective July 5, 2010), and to ban tobacco advertising in magazines, newspapers and other publications.
2012 Class actions seeking $27-billion in damages from tobacco industry begin trial in Quebec Superior Court. Trial is expected to continue into 2014.
2012 New federal regulations come into effect increasing the size of health warnings to 75 per cent of the front and back of cigarette packages and including a toll-free quitline number and web address in the warnings.
Source: Canadian Cancer Society
André Picard is the health columnist at The Globe and Mail.