'Troubling signs': Health Canada to review tobacco strategy as smoking rate spikes

Health Canada is looking for outside experts to review its tobacco control strategy — a federal program that appears to have hit a wall after years of helping to drive down smoking rates.

According to a posting on Merx, a website used by Ottawa to list outstanding government tenders, Health Canada is asking contractors to prepare a report on the "value for money" of the longstanding, multi-million-dollar program that has sought to reduce the number of smokers in this country. The review would look back at how well the Federal Tobacco Control Strategy (FTCS) performed between 2001 and 2017.

The number of Canadian smokers aged 25 and up hit 16 per cent of the population in 2017, up from 13 per cent two years earlier, according to a recent survey by Statistics Canada.

The FTCS has spearheaded several initiatives meant to convince Canadians to quit, including graphic warnings on cigarette packages, a toll-free 'quitline' offering smokers access to advice and resources to help them kick cigarettes, and ad campaigns directed at young people. The Liberal government has earmarked a further $330 million over five years for the FTCS.

"The objective of the requirement is to calculate the return on investment (ROI) of the FTCS ... investigating the fiscal benefits that accrue from reductions in smoking prevalence against the cost of implementing such policies," the tender reads.

"This retrospective analysis will be used to update the fiscal success of new initiatives as they are implemented and support ongoing policy decisions regarding the implementation of the best 'value for money' programs in the future."

David Hammond of the University of Waterloo, one of the nation's foremost experts on tobacco controls, said this proposed historical review should take a backseat to an urgently needed, fundamental "rethink" of the current tobacco control program.

Hammond said there have been some substantial changes in the nicotine market since the FTCS was launched, with the recent legalization of e-cigarettes and the introduction of more sophisticated vaping devices.

"There's definitely a need for renewal. We have a massively changing market in terms of e-cigarettes and despite it all we still have 5 million Canadians who continue to smoke," he said.

"Do we need a new strategy? Yes. We need one quickly. In terms of contracting out — to figure out how the last one did — evaluation, reflection is important but we have some new challenges and I'd rather us look forward than backwards.

"There's not too many areas in tobacco control or public health where we have extra resources laying around ... I don't think we can stand around looking over our shoulder for too long because this market is moving so quickly."

Health Canada defended the proposed external review in a statement to CBC News, saying it's standard for any federal program.

"The government of Canada is committed to evaluating our programs to ensure that we are delivering value to Canadians," a spokesperson said in a statement.

"This ‎contract is intended to bring in experts to help us evaluate the value of the previous tobacco strategy, and the benefits it has delivered to Canadians. This is a standard part of regulatory and policy development. The results of this evaluation will inform future strategies and policies."

The strategy, first launched in 2001, has been credited by some experts with helping to substantially reduce the number of traditional cigarette smokers.

The number of smokers aged 15 and over peaked at nearly 50 per cent of the population in 1966 before dropping to 22 per cent in 2001.

As of 2017, that figure stood at roughly 15 per cent — a number unchanged since the last Canadian Tobacco, Alcohol and Drugs Survey in 2015.

'Have we stalled?'

But last year saw the uptick in the number of Canadians aged 25 and up smoking cigarettes, while the percentage of Canadians aged 25 or older who reported having used cannabis in 2017 hit 13 per cent, up from 10 per cent in 2015.

The government aims to drive down the overall smoking rate in Canada to less than five per cent by 2035.

"Have we stalled? It's possible," said Hammond. "We've seen some troubling signs among youth, and that's a big concern.

"If we see another year or so of data that ... suggest the declines have stalled or youth smoking is picking up, then we really need to understand this new dynamic market much better."

Beyond the plain tobacco packaging regulations the federal government is set to introduce, Hammond said the federal government could pursue more restrictions on where cigarettes can be sold. "You can still buy cigarettes more places than you can buy milk," he said.

Hammond also said Ottawa should pursue new regulatory controls over cigarettes themselves.

"Where we've struggled is on the product side. We're really good at telling people not to smoke. We're pretty good at telling them where not to smoke. We're not great at actually helping them to quit," he said.

"Where we've really dropped the ball is in dealing with the product. We've done nothing to make cigarettes less harmful or addictive."

New data from the U.S., he said, suggest mortality from smoking is actually higher than it was 50 to 60 years ago, when cigarettes were far more popular in the West.

"Cigarettes are no less lethal," he said. "It's really gotten out of hand."

He suggested Ottawa could do more to "incentivize people to get off smoke" by championing e-cigarettes and vaping products as safer alternatives to traditional cigarettes. "We have to get off smoke."

"When I see an adult vaping I think, 'Good for you,'" he said, adding that, unlike younger users, the vast majority of adult e-cigarette smokers are people who have quit smoking cigarettes.

Health Canada only recently acknowledged that vaping is safer than cigarettes and a viable smoking cessation tool.

"Except for nicotine, vaping products typically only contain a fraction of the 7,000 chemicals found in tobacco or tobacco smoke, and at lower levels. Switching completely from tobacco cigarettes to vaping products will reduce a person's exposure to many toxic and cancer-causing chemicals," a spokesperson with Health Canada said.

But despite the promise of these devices for former smokers, a spike in usage rates in the U.S. has health experts concerned that young people are picking up a nicotine addiction from vaping devices before turning to traditional cigarettes to get their fix.

While numbers are scarce in Canada because the products were only recently made legal, the number of U.S. high school students who say they've used e-cigarettes in the last 30 days is 78 per cent higher this year than last year, according to the latest National Youth Tobacco Survey, a joint study by the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention (CDC).