Health Canada must stop prevaricating and ban the sale of cigarettes

On the heels of a Canadian court approving a $32.5 billion settlement against Big Tobacco, it’s high time to ban the sale of cigarettes.

The federal agency responsible for helping Canadians maintain and improve their health, Health Canada, has declared that tobacco smoke contains more than 4,000 chemicals, “of which more than 70 are known to cause, initiate or promote cancer.”

In 2024, lung cancer killed more than 20,000 Canadians and cost our health system more than $3 billion. Eighty to 90 per cent of lung cancers are linked to cigarette smoking.

Since the 1950s, when a shocking 50 per cent of Canadians smoked, there has been a steady decline in smoking rates; now only about 10 per cent of Canadians smoke.

Section 7 of The Canada Consumer Product Safety Act states that “no manufacturer or importer shall manufacture, import, advertise or sell a consumer product that (a) is a danger to human health or safety.”

Given that smoking cigarettes is a proven danger and that smokers now make up a small minority of Canadians, Health Canada needs to move beyond education, plain packaging with shocking pictures, escalating taxes on cigarettes and health warnings.

It is duplicitous for Canada’s federal and provincial governments to generate significant tax revenue from the sale of tobacco products  while at the same time complaining about how much smoking costs the health-care system.

It is also disingenuous for our political leaders to sue tobacco companies for selling a product known to cause lung cancer but allow them to continue to sell the product. Our provincial and federal governments’ actions contravene the spirit, if not the letter, of the Canada Consumer Product Safety Act and constitute an act of regulatory negligence.

For example, the Manitoba Centre for Health Policy estimated that smoking cost the Manitoba health-care system $244 million a year (The Cost of Smoking: a Manitoba Study) in 2020-21. During the same period, Manitoba collected $198 million in taxes on tobacco sales and the federal government collected an additional $3 billion nationally.

It appears that our political masters have become addicted to tobacco tax revenues. As the cost of smoking exceeds tax revenues, both patients and the health-care system would benefit from reduced smoking rates.

In 2022, New Zealand became the first country in the world to legislate a generational ban on the sale of cigarettes for those born after Jan. 1, 2009. The goal of generational bans is to create future smoke-free generations. For those born before Jan. 1, 2009, New Zealand was going to reduce the nicotine content of cigarettes and drastically cut the number of cigarette retailers.

Unfortunately, despite strong public, academic and Indigenous support, the new government elected in 2023 rescinded the legislation in 2024.

The United Kingdom is still on track to permanently ban the future sales of tobacco products to those 15 or younger (Tobacco and Vapes Bill). This would result in lifetime sales bans for future generations and, eventually, totally eliminate the sales of cigarettes. In the meantime, for those older than the age of sales bans, the U.K. policy would also toughen outdoor smoking bans, tobacco advertising, tobacco company sponsorships, and vaping issues.

The results of generational bans will not be seen for 15 to 30 years, which is how long it takes for lung cancer to develop in smokers, challenging politicians who will not see the effects during their elected term.

Though computed tomography (CT) lung-cancer screening programs are being piloted across Canada, the potential benefits of CT screening (secondary prevention) are dwarfed by the benefits of primary prevention – quitting or, better yet, never starting smoking.

Almost 30 years ago, I defended my master’s thesis on the epidemiology and cost of lung cancer in Alberta. At that time, the majority (70 per cent) of patients with lung cancer were diagnosed when the cancer had already spread; only 15 per cent survived for two years. It was disheartening to learn that the average age of diagnosis was just after the usual age of retirement of 65.

It is sobering to note that after three decades, 70 per cent of lung-cancer cases are still diagnosed in advanced stages and survival rates have improved only marginally.

Some would argue that an outright ban would boost the sale of cigarettes in the “black market.”

I say: So what? A shrinking number of smokers with cigarettes bought on the black market is preferable to the status quo. Pragmatism wins.

I have no objections to the use of tobacco products for ceremonial purposes, such as smudging. Tobacco used for such purposes is not as chemically laden as cigarettes, and the exposure times are limited.

Now is the time to take advantage of diminishing smoking rates and accelerate the process with a ban on selling cigarettes. Now is also the time for Health Canada to pause the sale of vaping products until long-term safety is established.

Former British prime minister Winston Churchill was right: “Those who don’t learn from history are doomed to repeat it.”