1. Dr. Michael Boland, Irish College of General Practitioners Global Alliance Against Respiratory Disease Primary Prevention & Health Promotion

2. Dr. Michael Boland, Irish College of General Practitioners WG1. Defining the Burden, Risk Factors, & Surveillance WG2. Awareness, Advocacy, & Priority WG5. Control of CRD & Allergies, Drug Availability & Affordability. WG3. Prevention, & Health Promotion WG4. Diagnosis of CRD & Allergies. WG6. Paediatric Asthma

3. Dr. Michael Boland, Irish College of General Practitioners WG 3. Prevention & Health Promotion n Chairmanship n Composition of Group ? n 2005 Annual Report n 2006 Action Plan & Indicators n Quarterly Telephone Conferences n One face-to-face meeting/yr.

4. Dr. Michael Boland, Irish College of General Practitioners Open Fires for Cooking & Heating Which countries ? Then selected national initiatives based on substitution

5. Dr. Michael Boland, Irish College of General Practitioners The Irish Office of Tobacco Control Research InspectRegulate Inform

6. Dr. Michael Boland, Irish College of General Practitioners Seven Tier Plan n Educate people about smoking and its effects n Provide more help for smokers to quit n Further regulate the Tobacco Industry n Protect everyone from Passive Smoking (ETS) n Don’t just pass laws – implement them n Extend ‘ownership’ to all the people n Use International Co-operation & Advice

7. Dr. Michael Boland, Irish College of General Practitioners Prevention but also Cessation n If we focus only on prevention it will be 40 years before the substantial benefits will be fully realised. n Cessation substantially reduces smoking related risks within 1–2 years.

8. Dr. Michael Boland, Irish College of General Practitioners Building a National Partnership n n Members of the Parliamentary Committee n n NGOs - Cancer Society, Heart Foundation etc. n n Public Health leaders focus on ET Smoke n n The Minister of Health n n Statutory Agencies Health & Safety Authority Environmental Health Office n n (The Tobacco Industry - soon excluded)

9. Dr. Michael Boland, Irish College of General Practitioners Power to Prohibit & Restrict Smoking n n Public Transport n n Hospitals and Clinics n n Schools and Colleges n n Public Offices n n Places of work n n Cinemas, Theatres, Concert Halls, etc. n Pubs, Bars, Clubs, and Restaurants n n Other ‘Specified Places’ Offence to smoke or to permit it - ‘Person in Charge’ is Guilty of an Offence The Tobacco Acts

10. Dr. Michael Boland, Irish College of General Practitioners Key Influences & Opportunities An All-Party Committee – disenchanted The WHO, FCTC, & European contacts Dedicated Office of Tobacco Control Workers rights to a smoke-free workplace Trade Union & (later) Employer Support A Courageous & Ambitious Minister A small but highly committed OTC (15 staff)

11. Dr. Michael Boland, Irish College of General Practitioners International Support for ETS Ban n WHO & FCTC n International NGOs, Conferences, Networks. n Experience in New York and elsewhere n Authoritative Evidence & Research n The ‘week-long visit’ = media, public, private n Ministerial & deputies foreign Visits All Better Educated

12. Dr. Michael Boland, Irish College of General Practitioners OTC Preparatory Expert Reports n Expert Report on E.T.S. (Allwright et al.) n What do smokers want? (Loscher, MRBI) n Productivity Costs smokers and society (Welte) n Statement by Medical Colleges and Deans n Irish Women and Tobacco (WHO, Slan, MRBI) n Ventilation (James Repace USA) n Economic Effects on the Hospitality Industry (TNS- MRBI, Durcan/McDowell,UCD)

13. Dr. Michael Boland, Irish College of General Practitioners Ventilation n Bar staff must be protected n No ‘Acceptable’ level of exposure n Effective Ventilation rates are impractical? n Ventilation Costs? - a level playing pitch? n Tobacco industry - hospitality programmes n Outdoor smoking areas – false walls.

14. Dr. Michael Boland, Irish College of General Practitioners Key messages: n Everyone has the right to live in clean air. n Repeated exposure to environmental smoke may cause incurable COPD, asthma, cardiovascular disease and cancer. n Complete elimination of the harmful smoke is the only way to remove the risk. n This applies to tobacco smoke in bars and all other ‘at risk’ environments.

15. Dr. Michael Boland, Irish College of General Practitioners Price Increases can stop teenagers smoking 8-17 S Price increase Very Unlikely To Continue Smoking

16. Dr. Michael Boland, Irish College of General Practitioners n Most people obey the law – smokers and non-smokers n Strong support from key stakeholders - unions, health community, policymakers, hotels federation, restaurants, tourism etc. n Intensive compliance building locally - EHO’s - in partnership with business Building Compliant Environments

17. Dr. Michael Boland, Irish College of General Practitioners After Two Years n Compliance very high n Prosecutions after 2 yrs = only 61 (1) n Throughout the country n 94% of all workplaces included such as.. 93% of hotels; 99% of restaurants; 90% of bars; 97% of other premises

18. Dr. Michael Boland, Irish College of General Practitioners Minister announced new controls on the sale of cigarettes n Total ban on sale of packs < 20 cigarettes n Ban on sale of cigarettes to under 18 yr olds n Ban on in-store advertising n New register of tobacco outlets – those defying the regulations will be fined and may lose their right to sell cigarettes.

19. Dr. Michael Boland, Irish College of General Practitioners Strong Public Support –Still Growing 67% support before the law 89% after introduction, called it a success Support one year on (inc. smokers) 98% believe workplaces are healthier (94% of smokers) 96% think law is a success (89% of smokers) 93% think it is a good idea (80% of smokers)

20. Dr. Michael Boland, Irish College of General Practitioners Concerted Action on Tobacco Since the Irish Office of Tobacco Control was established in 2001 the % of the population smoking has fallen by a quarter (31% to 23.5%). Smoking is banned in all public places including Bars since 2004.

21. Dr. Michael Boland, Irish College of General Practitioners But lets not forget……. n Smoking is the leading cause of premature death killing almost 6,000 people in Ireland each year. n Lifetime smokers have a 50% chance of dying from a tobacco related illness – half will die in middle age losing on average 22 years of life. n Irish women smoke as much as men – by 2020 lung cancer will be mostly a female disease. n One fifth of 15-18 year olds continue to smoke

22. Dr. Michael Boland, Irish College of General Practitioners The Possibility of a Major Breakthrough

23. Dr. Michael Boland, Irish College of General Practitioners That’s all folks !