SPEECH BY THE HON. LOUIS DEGUARA, MINISTER OF HEALTH ON THE OCCASION OF THE W.H.O. MEETING OF THE TOBACCO COUNTERPARTS FOR "A TOBACCO-FREE EUROPE"

Friday 2 March, 2001 - Vivaldi Hotel, Malta

Good Morning Ladies and Gentlemen,

It is my pleasure this morning to welcome you to Malta and officially open the first tobacco counterpart meeting to be held in my country. Your presence on our island so soon after a very fruitful visit by Dr. Wigand confirms my department's commitment towards actively contributing to address this problem.

I am aware that over the next few days you are meeting to prepare for the upcoming Ministerial Conference next June in Warsaw which in itself is a major regional event towards the framework convention on tobacco control. Furthermore you will have an opportunity to discuss and explore current international tobacco policy activities including this year's World ‘No Tobacco Day'.

I am certain that all of this will keep you busy for the next two days and I am not surprised. The tobacco issue is an area that merits such a committed approach. Though your visit is a short one do make it a point to visit our vast historical heritage. You will remain surprised how such a small island could have so much to offer to the discerning visitor.

The two main causes of premature death and morbidity amongst all age groups are tobacco related disease and HIV/AIDS. Most countries have acted on the latter but not the former. Both are preventable yet unfortunately their incidence is still increasing around the globe.

It is estimated that 4 million people die each year as a result of tobacco use. It is projected that unless tobacco control measures are implemented globally this death toll will escalate to 10 million deaths by 2030. This is more than the combined deaths from malaria, tuberculosis, AIDS and several major maternal and childhood conditions.

Within the European Region of WHO tobacco products are already responsible for 1.2 million deaths each year and unless more effective measures are implemented, they will account for a projected 2 million deaths each year by 2020.

We must not forget that used as intended, tobacco kills. This fact alone places global tobacco control as the public health priority if this epidemic is to be eradicated.

In Malta the number of cigarettes sold per person per year increased from 1038 in 1980 to 3702 in 1990. The figure declined slightly to 3627 in 1999 when the average number sold in the E.U. for that year was 1602.

This rise in the local cigarette consumption has often been attributed to a concomitant rise in tourist arrival figures. It is difficult to gauge the size of the effect as the tourist mix has changed significantly over the years. The number of tourist arrivals in 1999 was 1.2 million, which figure is more than three times the size of the resident population. Therefore the relevant effect certainly cannot be discounted.

In devising strategies to control the tobacco epidemic we must all the time keep in mind that tobacco-related diseases and disabilities are all preventable.

The actions necessary to prevent the global burden caused by tobacco are known and cost effective. In reality they require minimal investments. Most if not all of you here today are probably well aware of the Framework Convention on Tobacco Control that I hear is developing gradually and will be finalized by 2003.

The Framework Convention will be a useful tool for governments who seriously commit their resources to curbing the tobacco epidemic. I encourage you all to reflect on the Framework Convention and draw up a Ministerial Declaration that resonates the same scope so that the death toll and suffering inflicted by tobacco on all of mankind is diminished.

Malta's policy on tobacco control is built on three pillars

control of marketing of tobacco products

protection of non smokers

and health education comprising smoking cessation clinics

Control measures include a ban on direct advertising, health warnings on cigarette packets and age restrictions on the purchase of cigarettes. Protection of non-smokers includes prohibition of smoking in designated public areas such as airplanes, cinemas and schools, hospitals and government departments.

I am sure that as you proceed with your agenda, one of your prime concerns will be to protect the wellbeing of young people who easily fall prey to the intense advertising and marketing campaigns of the tobacco industry. Yet in spite of our efforts it is still the young people more then any other group, who are falling victims to this addiction. We know for a fact that just one cigarette smoked at the age of 11 yrs can leave a child addicted for life. We are also well aware that in spite of our persistent endeavours at highlighting the detrimental effects of smoking, female adolescents are smoking more than ever. Not only but, what is more worrying is the fact that new female smokers are taking up the habit at an earlier age. We project that within the next decade the prevalence of lung cancer in females will surpass that of breast cancer.

In 1992 a primary care study carried out locally found a smoking prevalence among young people aged 15 years and older of 28% (40% male; 18% female) versus 29% in the EU in 1995. This indicates a decrease in smoking prevalence among males and an increase in females since 1985, when the prevalence rates were 49% among males and 10% among women.

Therefore not only do governments need to invest heavily in school education programmes at an early age but they need to protect minors by enforcing strong policies and legislation to limit young people's exposure to tobacco consumption as an attractive, trendy and cool act. These deceptive images hide the truth behind what is in reality engineered within a cigarette.

The recent unveiling of documents from the archives of the tobacco industry reveal that well over 4800 toxic chemicals are present in a cigarette. The combustion process of smoking further augments the carcinogenic potential of these poisons. The 600 or so additives added to a cigarette potentiate further its carcinogenicity. The FDA's classification of smoking as a class A carcinogen is therefore well justified. Apart from this, nicotine is an addictive substance which we now know changes the dopamine, serotonin and noradrenaline balance in the brain, hooking the user by an addiction which is more severe than heroine or cocaine. Tobacco products are intended to hook and kill not only their user but also pose a serious health risk to other non-smokers.

We must therefore concern ourselves about the rights of the non-smoker who in the absence of protection from this health hazard have to suffer the consequences of environmental tobacco smoke. This year World No Tobacco Day will be designated to clearing the air for all. We therefore need to empower the non-smoker to voice his right when exposed to other people's smoking. This right should be upheld at the workplace, in places of leisure and entertainment, places providing services and any setting including the home.

It is also necessary for us to assist smokers who wish to quit and to provide them with all the services that will help them stay away from their addiction. Such smoking cessation programmes need to offer a combination of any of the following:-

Behaviour modification therapy

Nicotine replacement therapy

And the recently launched treatment with buproprione.

Science shows that quitters have much to gain in terms of their health. For the country this will also translate into enhanced productivity during the best years of life thereby boosting its economic foundation.

The World Bank in its recent report Curbing the Tobacco Epidemic encourages governments to adopt a multi-pronged strategy to address this pressing public health issue.

Amongst the other key interventions that can have a measurable and sustained impact on tobacco use, it will be necessary to intervene on the following priority areas:-

Increasing excise taxes on tobacco products

Tough effective counter-advertising

Bans on tobacco advertising and sponsorship

Tight measures on smuggling

A ban on unattended vending machines

Labeling on cigarette packs

Large pictorial health warnings on the packet itself

As Europeans we need to emulate the models of tobacco control that our Canadian and Californian peers have adopted. Both have achieved a significant enhancement in public health through the implementation of effective tobacco control measures. I therefore urge you all to note these achievements so that Europe too can make such health gains as her transatlantic neighbours.

Benjamin Disraeli, the British statesman and prime minister once remarked that:

" The health of the people is really the foundation upon which all their happiness and all their powers as a state depend ".

Disraeli's words serve as a reminder that prosperity for a nation depends heavily on the health status enjoyed by its people. Recognizing this vital link, places further importance to your work here in Malta.

I wish you all a pleasant stay in our island and look forward to meeting you this evening at my Ministry.

Thank you for your attention.