Sunday 25 September 2016

Martina Devlin: Smokers harm more than just themselves

Published 19/07/2012 | 17:00

My mother was a lifelong 20-a-day smoker. Family members used to plead with her to quit or cut down, but she always said if her life was shortened she'd take the consequences.

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She was not a confrontational person. She backed away from arguments. But on the subject of smoking, she insisted it was her business and nobody else's.

Seven years ago she had a massive, smoking-related stroke. Three months were spent in hospital and a rehabilitation unit, before going home in a wheelchair.

She never walked again. Never even managed to stand up. Never used her left hand. Not just her body but her brain suffered enormous, irreparable damage.

Cigarettes caused it.

In time, she learnt to speak again, eat again, recognise her children again, she even laughed again: the brain finds new pathways. But she was never able to live independently again.

It takes a family of seven to share the responsibility of caring for my mother, with back-up from the health services. We are not a small family, but at times we are stretched to the limit.

I don't say this to complain but to explain. We love her, and salute her courage in the face of adversity. It's our choice to keep her at home instead of surrendering her to a nursing home.

But her smoking became other people's business.

Dying from a tobacco-related disease is not as clean-cut as it may sound. Death is only instantaneous in its most merciful form. Most long-term smokers kill themselves lingeringly. This means living with illness and incapacity -- and incapacity doesn't mean a chesty cough.

The price is paid not just by smokers but by their loved ones. And by society, which picks up the medical bills.

Let's put this year's projected €500m health budget overspend into context. The Irish Cancer Society says it costs the State an annual €2bn to deal with tobacco-related illnesses -- four times the budget overshoot.

When my mother started smoking in her teens, the dangers were unknown, and she was hooked by the time they became public knowledge. And no wonder: the US surgeon general went on the record calling nicotine as addictive as heroin and cocaine.

Not a dangerous habit, then, but a potentially lethal addiction.

Yet smoking rates remain high. Last October, Chief Medical Officer Dr Tony Holohan said between 28pc and 30pc of Irish people smoked. Lung cancer has overtaken breast cancer as the leading fatal cancer among Irish women. But lung cancer, largely, is a preventable disease.

Young female smokers are a growth market here, with 40pc of those aged 18 to 30 lighting up. Young women, in particular, are attracted to smoking because it is an appetite suppressant, and because at that age we imagine ourselves to be immortal.

As they age, these women will probably need healthcare for smoking-related diseases. A time bomb is waiting to detonate. It is not simply a lifestyle choice, therefore -- it is a public health issue.

Meanwhile, tobacco companies are busily targeting young women -- and, by the way, they benefit from our 12.5pc corporation tax rates. Might be no harm re-evaluating that.

How can the State persuade smokers to change their behaviour? Health Minister James Reilly favours the "shock" tactic of steep price rises, with 20-packs rocketing up from €9 to €15 within six years if he has his way. Shortly before last December's Budget, he wrote to his opposite number in Finance with the suggestion (the letter was published in last week's 'Sunday Times'), pointing out that smoking kills more than 5,000 people a year.

It is a compelling argument for action. But Michael Noonan wasn't convinced. He said tobacco products were already more expensive in Ireland than elsewhere in the EU, and a price rise would encourage smuggling.

Whatever about the hardship imposed by a 65pc hike, the smuggling reason was downright peculiar, especially in view of the public health implications. Take the Finance Minister's position to its logical conclusion, and no unpopular law which could be circumvented would ever be introduced.

It is true that smuggling is rife: one in five cigarettes smoked in Ireland has not been taxed. Some are bought legally outside the State, but most are peddled by criminal gangs through organised distribution networks, with €250m a year lost in revenue.

However, if price rises are a genuine anti-smoking strategy, as opposed to a handy revenue generator for governments with a budget shortfall, then compliance needs to be addressed.

The Health, Finance and Justice departments must work in tandem on this. Gardai and Customs officers have to be given resources to tackle the black market. Not just because the State is losing out financially, but because long-term tobacco use kills one in two smokers.

Of course, there is an argument that charging €15 per pack would make no difference to a proportion of smokers, with tobacco falling into the category of price inelasticity. This means price doesn't matter, ultimately, because an alternative cannot easily be found elsewhere.

Beef, for example, is elastic -- put up the price, and people can switch to pork. Raise the price of rice and people can buy pasta. But there is no substitute for nicotine, making it an inelastic commodity. Users will economise elsewhere to buy it, or will be tempted to deal with the black market.

Tobacco is extremely lucrative to smugglers. In certain housing estates, vans pull up regularly with supplies of black market smokes. At night, unclaimed suitcases crammed with cigarettes are found occasionally on airport carousels, after smugglers have been tipped off that it is too risky to bring them through customs.

According to the World Health Organisation, every 10pc price increase leads to a 4pc drop in use. But that's provided no ready supply exists of illicit smokes.

Having driven smokers outside, it's not advisable to send them underground. Smoking is legal, after all, and a revenue producer. And smokers often complain, with some justification, about the nanny state seeking to curtail their freedom.

But it might be no harm to let smokers know that their habit doesn't just impact on their own lives. It can affect families left to pick up the pieces.

Your business and nobody else's? I wish it were so.

Irish Independent

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