Smoking and heart health
Smoking is the chief preventable cause of death and chronic disability in Ireland. Reducing smoking rates in Ireland and supporting people to stop smoking must be a key focus of health policy.

Smoking is one of the major risk factors for cardiovascular disease:

• People who smoke have a three-fold risk of heart attack compared to non-smokers.
• Smokers are twice as likely to have a stroke as non-smokers.

Stopping smoking can have very positive impacts on a person’s health and wellbeing. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year. Fifteen years after stopping, a person’s risk of heart attack will be similar to someone who has never smoked. 

Tobacco Control
Smoking is having a severe impact on the nation’s health – each year more than 6,000 Irish people die from the effects of tobacco. Smoking rates in Ireland, at 29% among the adult population, rising to 35% among people aged 18 -29 years, continue to be unacceptably high.

The Irish Heart Foundation believes that a three pronged approach is required to tackle smoking prevalence – price increases for tobacco products, stronger smuggling controls and comprehensive smoking cessation programmes. These actions will only have the desired effect if introduced simultaneously.

Tobacco price
The evidence is that price is the biggest deterrent to young people taking up smoking in the first place. Price is also an important trigger in making current smokers contemplate quitting. In higher income countries such as Ireland, a price increase of 10% would be expected to decrease consumption by 4%.

While Ireland, has among the highest cigarette prices in the EU, this has been achieved by a series of small ineffectual price increases. Since 2003, the annual increases in the price of cigarettes have been small – there was no increase at all in two Budgets and the increase was between 25 and 75 cent in other years.

International research shows that optimum results to curb smoking are achieved by a large price rise, followed by continuous similar price increases. Such measures ensure that smokers do not become immune to the initial effect of the price rises and remain motivated to stop smoking.

As a means of reducing smoking prevalence, the Irish Heart Foundation sought an increase of €1 on the price of a packet of cigarettes in Budget 2010. No price increase was introduced by the Minister for Finance and the Irish Heart Foundation continues to lobby for increased taxation on tobacco products.

Tobacco price and the Consumer Price Index
Tobacco products are included in the Consumer Price Index (CPI), the mechanism used to calculate consumer inflation. The list of items that make up the CPI is updated every 5 years. Inclusion in the CPI is dependent on having a "significant purchase" status. Because tobacco products are included in the CPI, any significant increase in tobacco prices would lead to an increase in inflation. This has led to a situation where the inclusion of tobacco products in the CPI has been consistently cited as a reason not to increase tobacco price to a level which would be a serious deterrent to smokers.

The Irish Heart Foundation believes that tobacco products should be removed from the CPI, or that a CPI which excludes tobacco products should be used for wage negotiations (as is the practice in France and Belgium).

Anti-tobacco smuggling measures
Smuggling of tobacco products is widespread in Ireland, with an estimated one in five cigarettes being smuggled into the country, at an estimated €400 million loss to the Exchequer.

The tobacco industry and retailers claim that higher taxation on tobacco products is a direct cause of increased levels of smuggling. However, the experiences of other jurisdictions show that high rates of smuggling are caused by lack of deterrents to such activities, rather than by high prices. Low detection rates and diminutive penalties for those who are caught smuggling and selling illegal cigarettes has made Ireland a target for smugglers.

The Irish Heart Foundation argues that concerns about smuggling should not dictate Irish healthcare policy and should not be used as a reason to halt the increase of tobacco taxes, or to reduce taxes in the future. A national anti-tobacco smuggling strategy, providing additional manpower and equipment, is urgently required to tackle the tobacco smuggling epidemic. 

Smoking cessation programmes
Smoking related illnesses have a devastating impact on individuals and their families, as well as placing a huge burden on health care spending. A conservative estimate would indicate that at least €1 billion annually from the public finances is spent on the health effects of smoking.

Resources are required without delay to support those who are trying to stop smoking. The Irish Heart Foundation considers that Ireland should increase its funding on smoking cessation programmes, to bring it into line with the average EU spend in this area. 

Cessation programmes should include a comprehensive and sustainable anti-smoking education programme targeted at different ages and audiences; a free national cessation service at accessible locations; maintenance of the National Smokers’ Quitline staffed by trained cessation counsellors and access to nicotine replacement therapies.

The Irish Heart Foundation is calling for a co-ordinated strategy to reduce smoking in Ireland through measures which simultaneously address tax, smuggling and cessation