§ Ms Claire Ward (Watford)
I am pleased to be one of the first Members to initiate a debate in this Chamber. I must admit to having some reservations about the idea, but I trust that it will give Back Benchers an ample opportunity to raise issues of concern to them and their constitutents and to get a thorough reply from the Government. I hope that I shall succeed in that today.
I want to set in context the reasons for my concern about the increased use by children of tobacco products, and about their increased availability. We all know about the undeniable link between smoking and cancer, but far fewer people are aware of the link between chewing tobacco products and the incidence of oral cancer. I recently met surgeons who specialise in the maxillo-facial work that is associated with the damage that cancer does to the mouth and face. Frankly, I was appalled and sickened by the devastation that cancer can cause to the mouth and face. The surgeons showed me slides of their many patients who suffer from this debilitating illness. Perhaps the most worrying aspect of that meeting was my introduction to a new product that is being cynically marketed to children, especially within the ethnic minority community.
The Minister will be aware that it is an accepted culture within some sections of the Asian community, mainly among Indians and Bangladeshis, to chew tobacco or paan. Such products often take the form of betel nut leaf parcels, containing tobacco, betel nut, lime and other ingredients, and are considered beneficial to digestion and overall health. Bidis, which are unfiltered cigarettes, are also on the market. In addition to the paan products—the leaf-based parcels—a new generation of tobacco products has begun to enter the market. Gutkha is a sweetened tobacco which is packaged in brightly coloured foil parcels—sometimes with children's faces on them—and is marketed in newsagents throughout ethnically diverse communities for as little as 20p.
Although chewing paan is a traditional habit brought from south Asia, it was hoped that the habit would fade rather than passed on to the next generation. That fear has provoked the Indian tobacco manufacturers to seek new ways of gaining a market. Their cynical marketing tactics are designed to attract a new generation, who may be more likely to chew products flavoured with chocolate or sweeteners, as the leaf parcels are a more acquired taste.
Gutkha is not illegal. Hon. Members may remember the introduction, in 1989, of Skoal Bandits, which were pouches of tobacco that resembled tea bags and were designed to be sucked. They brought concern and action from the Government of the day. The then Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), said in a written answer that he was acting to prevent children and young people from taking up such a dangerous habit. He stated that there was evidence that the habit could result in mouth cancer, which is particularly difficult to treat. As a result, the Tobacco for Oral Use (Safety) Regulations 1992 were introduced. They banned the supply ofany oral product made wholly or partly of tobacco which is intended for oral use unless it is intended to be smoked or chewed".33WH I am pleased that that legislation was passed. Unfortunately, by specifically excluding other products that are chewed or smoked, it left no room to apply the regulations to gutkha or any similar product that is chewed rather than sucked. I hope that the Minister will agree that it is strange to distinguish between products that are put into the mouth on the basis of whether they are chewed or sucked.
Although such products are still legal, it is an offence to supply them to minors under the Children and Young Persons (Protection from Tobacco) Act 1991. Just as it is illegal to sell cigarettes to under-16s, it is illegal to supply gutkha. According to reports and media investigations, however, young children from across the cultures are now buying these products. They are a cheap, easy and tastier alternative to cigarettes, but they are equally harmful, if not more so. Research from India gives an insight into the problems that such products can cause to children's health. Children as young as 12 have already been diagnosed with pre-cancerous mouth lesions due to gutkha use. Every year, thousands of British children visit the Indian sub-continent and pick up the habit, which they can continue when they return home because access to gutkha remains so easy. Many of the packages have no description of their contents, although other harmful substances, such as lead and silver, have been found to be present.
The incidence of oral cancer is especially high in India, and has been linked to the use of chewing tobacco. India is the third largest manufacturer of tobacco, behind China and the USA, and produces almost 8 per cent. of the world's tobacco, 75 per cent. of which is used for internal consumption. Pakistan is the 10th leading producer, and Bangladesh is the 17th. Furthermore, children are involved in the production of such tobacco products in harsh labour conditions in India and other parts of south Asia.
We also know that chewing tobacco products is a popular habit in the United Kingdom. A survey of Bangladeshi women in West Yorkshire found that 95 per cent. chewed paan. A study by the university of Birmingham school of dentistry reported that 92 per cent. of males and 96 per cent. of females interviewed chewed paan on a daily basis, and that 39 per cent. and 82 per cent. respectively included tobacco within their paan.
We need only look at the incidence of oral cancer to realise the health implications of using tobacco products, whether they be chewed, sucked or smoked. Oral cancer in the UK accounts for 1.6 per cent. of cancer cases and 1.2 per cent. of all deaths. More than 2,000 cases are diagnosed in England and Wales each year and more than 60 per cent. of patients die as a result of oral lesions. The figures are higher than those for cancer of the cervix or skin cancer, yet, because both those cancers feature more prominently in the debate on cancer, people are more aware of them than they are of the causes of oral cancer. In addition to the huge personal and social costs of oral cancer, the cost to the national health service is estimated to be £50,000 a case. If we are to avoid a massive national bill and thousands more deaths each year, the Government must get a grip of the issue.
It would be strange to have a debate on the subject of children and tobacco products and not deal with the problems of under-age smoking, which is more common 34WH than tobacco-chewing among the young. The effects of smoking on health are well versed. They account for more than 120,000 deaths each year and cause a range of respiratory and heart problems. However, despite the obvious health risks, a significant number of under-16s smoke, and 450 children are believed to start smoking every day. Surveys in 1997 classed 11 per cent. of 11 to 15-year-olds as regular smokers. They also found that more girls smoked than boys. Various reasons were given for that, including the perception of smoking as a cool activity and the desire to copy celebrities and pop stars. In addition, many young girls believe that smoking will help them to control their weight. But the factor that most influences a child's decision to smoke is whether either, or both, of his or her parents, or an older sibling, smokes. Children with two smoking parents are three times more likely to be regular smokers than children who live in households where neither parent smokes. A child whose older sibling smokes is five times more likely to be a regular smoker than a child who does not have an older sibling who smokes.
There is no doubt that the younger a person starts to smoke, the more difficult it is to quit and the more detrimental smoking is on health. Some 82 per cent. of adult smokers start smoking as teenagers. Smokers who start smoking at the age of 15 are three times more likely to die from lung cancer than those who start in their mid-20s. Despite legislation that bans the under-16s from purchasing cigarettes, surveys show that smoking remains an activity for a significant number of children in this country. But few of us need statistics to confirm what we know from observations. How many times have we seen children walking around our towns smoking? Children who hardly look old enough to be out on their own are indulging in an activity that threatens their health.
I am concerned about how children get hold of cigarettes and chewing tobacco. In 1992, the previous Government set a target to reduce smoking among 11 to 15-year-olds from 8 per cent. in 1988 to less than 6 per cent. in 1994. Last year, the Government set a new target to reduce smoking among children from 13 per cent. in 1996 to 9 per cent. or less in 2010. Those figures are still too high. The Government must take a much tougher line on the supply of tobacco products to children.
Far too many newsagents, garage forecourt shops and other retailers are willing to sell cigarettes to children without checking how old those children are. Of course, children often look much older than they are these days—we all know that, and even I find it difficult to distinguish between a 13-year-old girl and a 16-year-old girl. Make-up, clothes and sheer confidence allow children to masquerade as adults. People might suggest that it is also difficult to know how to spot an MP these days. Whatever they wear and however they look, under-16s should not have access to tobacco products. Retailers should be required to ask for identification for all sales to young people who look as though they might be under 16.
Trading standards officers have an important duty to perform—they must be more proactive in seeking out retailers who continue to flout the law and put our children's health at risk. Not only must there be more spot-checks on retailers, but the penalties on those found supplying to under-16s must be stricter. Trading standards officers should be more involved. I was 35WH concerned to learn from a written answer given by my right hon. Friend the Secretary of State for Trade and Industry a couple of weeks ago that levels of funding given to trading standards officers varied. That must have an impact on the work that they are able to do within their community.
It is not good enough for retailers to claim that they believe a young person to be 16—they must demand identification and refuse to sell cigarettes and other tobacco products on a failure to produce identification. I trust that the Government will review seriously the penalties in place—only the most severe sanctions will bring to the attention of retailers the seriousness of the issue.
We know that not all under-16s who smoke buy their cigarettes personally—many get friends, relatives or even strangers to purchase them. That activity, too, must be a target for the Government. Better education on the health risks and on the law regarding under-age smoking is essential if we are to convince people that they must do everything in their power to prevent children from smoking, and if we are to deny the tobacco manufacturers a new generation of smokers.
When I recently visited a school as part of the UNICEF "Put it to your MP day", I was concerned to hear from one of my constituents that children under 16 believe that it is easy to obtain cigarettes. They have merely to stand outside a newsagent and ask an adult or an older friend who is going in to buy cigarettes for them. It must surely be for us to raise awareness of such issues among the public to ensure that we all take responsibility for not assisting in supplying cigarettes to young people.
§ Sir Peter Emery (East Devon)
Will the hon. Lady also urge the Government, as some of us have for many years, to be more stringent on advertising and to make the warning on the back of cigarette packs similar to that used in Australia, which takes up half of the pack and warns of the dangers of cigarette smoking? Too many of our young people are still being encouraged to smoke. As chairman of the National Asthma Campaign, I am most concerned that you should not allow people to be influenced by advertising. Many youngsters follow motor racing and see tobacco advertising. We should be cutting down on all such advertising, and not excluding anybody.
§ Mr. Deputy Speaker (Mr. Nicholas Winterton)
Order. Before the hon. Lady replies to that intervention, I should point out that it is appropriate for all speakers to address the Chair, even though that might be difficult given the lay-out of sittings in Westminster Hall.
§ Ms Ward
The right hon. Member for East Devon (Sir P. Emery) made important and correct points. I agree that we must look carefully at the issue of advertising and that we should prevent children from seeing advertising as they go into shops. The Government have carefully considered the issues of advertising and tobacco sponsorship and I have no doubt that pressure will remain on them on that issue. The Government must generate a high-profile campaign aimed at educating children and young people about the damage 36WH to their health that is caused by smoking. By engaging the support of non-smoking pop stars, celebrities and sporting heroes, they may be able to generate a new message that it is uncool to smoke and that it is certainly not an activity that deserves any respect in the playground or classroom.
So far, I have talked about the children who actively engage in smoking or chewing tobacco products, whether or not they are aware of the damage to their health. The debate, however, encompasses another section of that generation—those who suffer from tobacco products through second-hand smoke. All too often, we see children, and sometimes even babies, being smoked over by their parents and relatives. In the home and in public, children—through no choice of their own—are forced to endure others' smoke. Not only can that encourage them to take up the habit, but passive smoking can increase the chances of asthma and lung cancer in children.
Children are subjected to passive smoking in restaurants and other public places, yet there are no laws in place to prevent that. Perhaps if the Government introduced a measure banning children from sitting in any designated smoking area, we would, in some small but significant way, be able to protect them. Parents would not be able to take their children into smoking carriages on trains or sit them in smoking areas of restaurants or other public places. Such a measure would mean that the Government had to require all public facilities, including restaurants and bars, to have designated no-smoking areas, but I, for one, would welcome that.
The Government have a responsibility to prevent children from having access to tobacco products. They must do all that they can to educate children and their parents about the dangers of smoking or chewing tobacco. No one expects that to be an easy task and everyone recognises the influence of the tobacco industry worldwide. Nevertheless, the future health of our nation depends on a robust and determined effort by the Government to prevent under-age access and reduce the number of adult smokers and chewers in years to come.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)
I congratulate my hon. Friend the Member for Watford (Ms Ward) on securing the debate and providing me with my first opportunity to speak in this newly formed Chamber. Although I agree with you, Mr. Deputy Speaker, that speaking through the Chair may not come as naturally to hon. Members because of the Room's configuration, it is a great pleasure, when replying to an Adjournment debate initiated by a Labour Member, to be able to look at her, rather than having to address an empty space and trying to look backwards. Both Chamber shapes have their advantages; no doubt in due course we will make up our minds about which we prefer.
Children's access to tobacco is an important subject and I am delighted that my hon. Friend the Member for Watford secured time to discuss it. If we do not address the problem when they are young, we as a nation will count the cost in disease and in lives. We do not know enough about the precise health risk posed by oral tobacco, particularly among some of our ethnic 37WH minority communities, but this much we do know: oral tobacco is a potentially lethal product. I shall focus on the Government's commitment to addressing the particular problems associated with it. I stress that we are concerned about getting the message across to both children and adults that oral tobacco products are dangerous in whatever form they are taken. I shall go on to describe the Government's wider tobacco control campaign.
We need to take a three-pronged approach. First, we must find out the scale of the problem. Secondly, we should consider the law and, as my hon. Friend the Member for Watford said so poignantly, better enforcement of existing law. Thirdly, we must examine education and how we can get our health messages over more effectively to this audience.
On the scale of the problem, although we have some information on tobacco chewing habits, it is by no means comprehensive and we are looking at ways of improving our knowledge. I have asked my officials to consider what more we can do. I want to know how prevalent oral tobacco use is among children and adults. Beyond survey evidence, I am also anxious to hear from experts. My hon. Friend recently wrote to the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), offering her an opportunity to meet surgeons who deal with the effects of oral tobacco every day. We are grateful to her for that and my hon. Friend would like that meeting to take place before Christmas.
We need to enforce the powers that are available. I remind hon. Members that legislation to prevent the sale of tobacco products to children has been on the statute book since 1908. The Children and Young Persons (Protection from Tobacco) Act 1991 strengthened the law and made it an offence to sell any tobacco product to children. The definition of tobacco product included any product containing tobacco intended for oral or nasal use. I was struck by what my hon. Friend the Member for Watford said about whether a product could be chewed or used in another way, and I was reminded of the sophistry that one may smoke but not inhale. We must look at the product rather than make distinctions between uses that would be difficult to regulate.
Local authorities are required to review their enforcement of the law annually. The law also requires tobacco retailers to display a warning notice at the point of sale which states that it is illegal to sell tobacco products to anyone under the age of 16. As a mother of a 13-year-old and a 16-year-old, I appreciate how difficult it is to judge the ages of children just by looking at them.
Under the Tobacco Products Labelling (Safety) Amendment Regulations 1993, all tobacco products are required to carry a health warning. There is, however, little evidence that that requirement is being observed by manufacturers and retailers of gutkha-style products. I assure the right hon. Member for East Devon (Sir P. Emery) that the draft directive on tobacco labelling will require the health warnings on packets of tobacco products to be bigger.
§ Ms Stuart
The precise date has not been determined, but I shall write to the right hon. Gentleman with precise details. I am sure that he is aware that matters European can take longer to implement.
There is little evidence that labelling requirements for gutkha-style products are being observed by manufacturers. The legal position is not clear. No child should be sold a tobacco product, whether it be cigarettes, gutkha or other forms of oral tobacco. Any tobacco product should carry a health warning, but the key to the problem is enforcement of the law, which is not always straightforward—for example, not all gutkha contains tobacco—hence the lack of prosecution. However, I am not here to make excuses; we must do better.
We are tackling the problem in several ways. First, I have asked my officials to consider whether, in principle, more could be done through legislation to remove items from the reach of children. Secondly, my officials have been working with the Local Authorities Co-ordinating Body on Trading Standards—LACOTS—for several months. They are developing an enforcement protocol to assess current compliance with the law; to provide education and help for retailers to aid compliance; to produce details of enforcement action taken so that it can act as a deterrent; to consider test purchases and support for proof-of-age cards; and to monitor the results of enforcement action. We expect the protocol to be published shortly. I accept what my hon. Friend the Member for Watford said about funding, but there is the issue of what priorities local authorities give to different aspects of trading standards enforcement. I hope that the meetings between officials and representatives of local authorities will encourage local authorities to return that to the top of their agenda. We are committed to running several training days next year for local trading standards officers on tobacco-related enforcement issues. Those training days will include the issues surrounding gutkha.
The Government have worked constructively with industry to find a solution to the problem of sales of adult products to children. An industry-led voluntary proof-of-age card is now available to help consumers and retailers to establish young people's age when they try to buy age-restricted products. Citizencard, which was launched nationally last February and covers ages 12 to 18 plus, is run by industry groups and has ministerial endorsement.
My officials have already alerted LACOTS to the situation concerning gutkha. They will discuss with them this week what more can be done and where resources can best be targeted to make an impact. For example, we shall consider how to encourage the prosecution of importers who fail to abide by existing labelling regulations. Those regulations make it clear that no person shall supply, offer to supply or possess for supply any tobacco product that does not confirm with labelling requirements.
§ Ms Stuart
The whole labelling issue and how products are made attractive to children will be considered as a package, but a starting point is to deal with products that do not even carry the necessary warning.
My right hon. Friend the Chancellor of the Exchequer stated in his pre-Budget statement the Government's commitment to take further action to tackle smuggling—for example, investment in new technology such as X-ray scanners and vigorous use of confiscating powers.
The third part of our action plan is education. There is considerable evidence that the people using these products are unaware of the health risks. We must get the message across that all tobacco products are harmful, however they are packaged. A three-year, £50 million tobacco education campaign will be launched on 13 December. The campaign materials will be translated into 11 languages. As time moves on, we shall incorporate a number of more targeted campaigns, including programmes aimed at ethnic minority populations.
There is much to be done. Few people are unaware that cigarette smoking is dangerous, although there is still much ignorance about how great the risks are. Unfortunately, knowledge about the health risks of oral tobacco is not so high. Some excellent services exist—for example, Quit's Asian Quitline—but not enough of them. We must make it clear to both adults and children that taking oral tobacco is a big risk to health. The terrible effects of facial cancers are frightening enough, but we must make it clear that the danger does not end there. Nicotine addiction from chewing tobacco can lead to cigarette smoking with its huge risk of cancer, heart disease and other deadly health problems. We hope that children will take our health messages home and thereby help us to reach their parents and grandparents.
Smoking kills. That is a simple and important message. I do not want the problem and the Government's reaction to it to be seen in isolation. I have referred to the tobacco education campaign, which aims to persuade smokers to quit and non-smokers not to start—especially the young and above all young women. Another matter of great concern is the high number of pregnant women who continue to smoke.
We shall develop programmes aimed at youngsters. We know that such campaigns have an impact on the wider adult population. We are determined, despite recent challenges, to ban tobacco advertising and we know that the cigarettes most often smoked by children are those that are most heavily advertised.
I am grateful for the success of the hon. Member for Watford in securing this Adjournment debate and hope that she is satisfied with some of our responses.