Open Letter

March 12, 2015
Honourable Terry Lake
Minister of Health
Government of British Columbia
Room 337, Parliament Buildings
Victoria, BC   V8V 1X4

Dear Minister Lake,

We would like to applaud your recent announcement regarding your intention to amend BC's Tobacco Control Act to include restrictions on the sales of e-cigarettes to minors and to prohibit them from being smoked where conventional cigarettes cannot be smoked. This will at least help counter their use as a wedge issue with the potential to "renormalize" smoking and hook a new generation.

We would however like to strongly urge you to take this opportunity to more comprehensively amend BC's Tobacco Control Act. British Columbia's longstanding status as Canada's leading province in both tobacco reduction policy and results has come under jeopardy in recent years. Two other provinces have already introduced legislation banning e-cigarette use in public places. Five other provinces/territories have tobacco bans that exceed BC's, such as by including restaurant patios, playgrounds, and college campuses. Most disturbingly, BC is now the only province that still permits the sale of cigarettes in pharmacies.

Even more concerning is that this loss of policy leadership has been paralleled in changes in smoking prevalence data by province/territory. Over the last 5 years, whereas overall smoking rates in Canada have gone down by 1%, British Columbia is one of only 2 provinces/territories where prevalence rates have actually risen slightly. The rise over the last year alone is much more substantial, however hopefully just represents statistical noise, likely due to an overly optimistic 2012 sampling, and not the start of a much more ominous trend. (A table showing results from Statistics Canada's largest health survey is appended to this letter).  It would appear at the least that British Columbia has made no progress in reducing overall smoking rates in the province in the past 5 years.

Accordingly we suggest that you extend your planned amendments to include measures which are already established in some or all other Canadian provinces. These include:

• The prohibition of all smoking on/in patios, hospital grounds, bus stops, recreation areas, parks, playgrounds, beaches, trails and public events, and college campuses, with an increase to the entrance-way buffer distance to 7.5m. The absence of province-wide measures has led to dozens of your BC municipalities filling the gap, leading to a confusing patchwork of variable restrictions across the province.
•  A ban on tobacco sales in pharmacies. British Columbia is the only province to not have such. We strongly suggest that it is time for BC to achieve nation-wide consistency across Canada by banning tobacco sales in pharmacies
•  The divesture of BCIMC's $596 million of direct tobacco stock holdings, as done by Alberta in 2011.

We recommend that you also consider reclaiming British Columbia's anti-tobacco leadership by designing ground-breaking legislative approaches in newly emerged anti-tobacco battlegrounds:

• Protection from smoke in multiple unit dwellings. Fully half of BC's apartment and condo-dwellers are exposed to unwanted secondhand smoke from their neighbours, and while a strong majority would prefer to live in a 100% smoke-free building, very few exist. Legislation to address this could require that all future-built buildings must be 100% smoke-free.
•  The effective management of cigarette litter. Discarded cigarette butts are the leading form of litter by both number and weight. There are over 4 million butts littered daily in the province, individually entering the environment. Voluntary recycling receptacles have proven ineffective in Vancouver. Please consider designing a province-wide deposit-return system to counter such.
•  Reforms to the retail environment. The logic proposed that pharmacies are an appropriate venue for tobacco sales as they are a health-oriented facility able to provide assistance to smokers in quitting is undermined by the fact that the sales are not managed by trained and intervention-ready pharmacists, but that transactions take place at cash registers or customer service areas staffed by untrained employees who are not health professionals. The province could restrict the sale of cigarettes to pharmacies or government outlets and require that they are dispensed in a health-promoting manner. 

Minister Lake, we truly hope that you will take this opportunity to more fully amend British Columbia's Tobacco Control Act, and reclaim your province's prior, longstanding, and widely-admired status as a national and international leader in fighting the leading cause of preventable death in your province, our country, and our world.

Sincerely,
 
Dr Stuart Kreisman
Vancouver
Physicians for a Smoke-free Canada