City of Stratford, Public Meeting, April 23, 2013.

Background: Chronic disease now the leading cause of death globally Leading causes of death, Ontario (2003) Myocardial infarction Cancer Stroke COPD Smoking is a major modifiable risk factor for all four. These largely preventable diseases diminish our quality of life, economy and communities.

Background: The impact of tobacco use in terms of economic costs is also substantial: Tobacco-related diseases cost Ontario’s health care system $1.93B annually in direct health care costs Tobacco-related diseases cost Ontario $5.8B annually in productivity losses due to increased sick and days and early deaths of adult workers Ministry of Health and Long-Term Care. (2013). Tobacco Control System Committee, Smoke-Free Ontario Strategy – Cessation Task Force Initiatives [Power Point Slides]

Background: Current “Health Care System” designed to address acute episodic disease We need to change our approach Ministry of Health and Long-Term Care. (2007). Preventing and Managing Chronic Disease: Ontario’s Framework. Retrieved from:

Background: We need to change our approach Delivery System Design (teams, self care) Healthy Public Policy* (legislation, fiscal policy) Creating Supportive Environments* (physical and social) Community Action* (partnerships, enhanced skills) * shared responsibility

Background: Change is possible Anti-smoking efforts began in earnest in the 1970s 1965: 49% Canadians >15 yrs smoked (61% M, 38% F) 2003: 23% Canadians aged ≥ 12 yrs smoked 2005: 22% ≥ 12 yrs (5.9 million smokers) 2010: 20.8% ≥ 12 yrs (~6 million smokers) Source: Statistics Canada: Canadian Community Health Survey 2005, 2011

Background: Cancer Care Ontario. Cancer Fact: Impact of smoking on cancer mortality trends in Ontario. January Available at

Health Canada Determinants of Health

o Tobacco-related illness is still the leading cause of preventable disease and death in Ontario – more than 13,000 die annually (three times the combined deaths caused by alcohol, drugs, suicide, homicide and car crashes) and babies of mothers who smoke throughout pregnancy are at increased risk, before and after birth, of many conditions including prematurity, SIDS and chronic respiratory conditions o Ontarians in the neighbourhoods with the lowest average incomes have the highest rates of smoking o We will all have to work together to impact this (and other chronic diseases) In short……

Background: Current Smoking Rates in Ontario

Perth County Smoking Rate: The percentage of Perth County daily and occasional smokers by year and sex. Source: Canadian Community Health Survey (2003, 2005, 2007, and 2008)

The Perth District Health Unit’s Tobacco Program aims to: Prevent individuals from starting to use tobacco products Protect residents from second-hand smoke Provide assistance and support for those who want to stop using tobacco products

Education Youth Engagement Cessation Policy Enforcement These goals are accomplished through:

Benefits of smoke-free outdoor spaces

Prevent children and youth from starting to use tobacco products

Protection from second-hand smoke Adverse long-term health effects of second-hand smoke exposure SHS Exposure and AdultsSHS Exposure and ChildrenSHS Exposure and Pregnant Women  Acute respiratory illness  Heart disease  Cancer (including breast)  Premature death  COPD  Stroke  Exacerbations of asthma  Decreased lung function  Lower respiratory illness  Middle ear infections  Sudden Infant Death (SIDS)  Low birth weight  Adverse impact on cognition and behaviour Spontaneous abortion/miscarriage  Premature birth  Congenital anomalies and smaller head circumference of baby

Provide assistance and support for those who want to stop using tobacco products

Protect the environment

Municipalities include: City of London City of Hamilton City of Ottawa Niagara Falls Woodstock Almost 60 Ontario municipalities have by-laws regulating smoking in outdoor public spaces

Support for local by-laws for smoke-free public places (Middlesex-London) Source: RRFSS May – Dec Adults (18+) in Middlesex-London May – Dec * It is important to note that only 5.3% (± 1.6%) of the respondents did not support any suggested by-laws.

Options for Consideration In Municipal Parks Maintain status quo; or Post signs suggesting people do not smoke in parks (no by-law); or Prohibit smoking within 9 meters of playgrounds and outdoor recreation facilities; or Prohibit smoking within 30 meters of playgrounds and outdoor recreation facilities; or Prohibit smoking in all parks except in designated smoking areas; or Prohibit smoking in all parks

Other Options for Consideration: Hospital property Bar and restaurant patios One of four key recommendations regarding tobacco in the report: Cancer Care Ontario, Ontario Agency for Health Protection and Promotion (Public Health Ontario). Taking action to prevent chronic disease: recommendations for a healthier Ontario. Toronto: Queen’s Printer for Ontario; 2012.)

High levels of compliance Minimal issues with enforcement No negative impact noted regarding use of recreational areas Ontario municipalities that have implemented smoke-free outdoor spaces by-laws have reported:

Implementation Strategy Education Focus on educating the public about the by-law to ensure a smooth transition with good compliance Signage Develop visible signage to help maximize education and compliance Enforcement Monitor and respond to complaints

Local Success - St. Marys 9 metre set-back from any playground area (identified by a border which encloses an area of sand, rubber or any similar safety surface) or splash pad Affects seven playgrounds (includes one gazebo) and one splash pad Signage in place

Conclusion Smoking rates continue to be a concern in Perth County Municipalities have an opportunity to take action to protect the health of it’s residents By-laws have been successful in other municipalities and will be successful in Stratford too!