Learning disabilities and the environment: What we know – and how our policies are failing children
Barbara McElgunn RN December 2001, Volume 6, Number 10
Learning disabilities and related attention deficit disorders affect an estimated 10% to 15% of children. The consequences of these and other neurological, developmental and behavioural disorders are life-long, often serious for both the child and his or her family, and costly for society. The role of toxic chemicals in the etiologies of these disorders has been largely ignored, although the evidence from both experimental animal and clinical research from the few neurotoxic chemicals that have been studied to date is compelling (1), and the possibilities for prevention are enormous.
An example of the costs of subtle deficits due to exposure to lead was demonstrated in a groundbreaking economic benefits analysis by Schwartz (1994) (2) based on calculations of the costs of lead-related reductions in intelligence quotient on years of schooling and earnings, and cardiovascular effects. The societal benefits of reducing blood lead concentrations in the population by just 1 mg/dL were estimated at $17.2 billion/year to the American economy. Schwartz (2) noted that these benefit estimates are low, as other known effects of lead – on behaviour, attention, hearing, balance and reduced stature – have not been assigned a monetary value (2). This benefit was revised upward in a subsequent economic analysis (3), based primarily on labour market changes and more recent data on the relationship of intelligence quotient with educational attainment and projected earnings gains.
Worldwide, there is growing attention to the differential vulnerability of children to environmental toxicants. Since the mid 1990s, increasing concern, legislation and policy initiatives in the United States, and a joint declaration (4) have brought children’s health and development into the forefront of the environmental agenda. Canada signed the 1997 Declaration of the Environmental Leaders of the Eight on Children’s Environmental Health that pledged action on the following issues: risk assessment and standard-setting that take into account the specific exposure pathways and dose-response characteristics of children; children’s exposures to lead; clean water and water standards; air quality (including environmental tobacco smoke); and emerging threats to children’s health from endocrine-disrupting chemicals (such as polychlorinated biphenyls and dioxins that have been shown to have neurotoxic effects, and to alter thyroid function). Thyroid hormone is critical to most processes involved in brain development – regulating neurite outgrowth, cellular migration, synaptogenesis, myelogenesis and the development of major neurotransmitter systems (5). Despite the above pledges, the effects of toxic exposures on child health and development are receiving little attention in Canada in research or by other federal programs investigating the determinants of health and development. In addition, there are gaps in regulatory programs and policies that need to be revised to protect children.
By contrast, a 1997 executive order from the White House (6) acknowledged that children may suffer disproportionately from environmental health risks, and directed all American federal regulatory agencies to ensure that their policies, programs and standards address these risks. The executive order also established a high level interagency task force to recommend federal strategies and research. The above actions have generated a number of new initiatives in the United States: eight centres for children’s environmental health and disease prevention research, and announced this year, an additional four more centres on neurodevelopmental effects; a new Office of Children’s Health Protection at the Environmental Protection Agency (EPA); and a major proposed study, A Prospective Longitudinal Study of Environmental Effects on Children’s Development, that will involve thousands of pregnancies from American intake sites.
The need for new approaches to government standard-setting and premarket safety evaluations to protect children was addressed in a five-year United States National Academy of Sciences (NAS) report, Pesticides in the Diets of Infants and Children (1993) (7). Among other findings, the report stated: “The data strongly suggest that exposure to neurotoxic compounds at levels believed to be safe for adults could result in permanent loss of brain function if it occurred during the prenatal and early childhood period of brain development”. Many toxic agents are known to damage the developing, and unprotected, brain by interfering with those processes undergoing development at the time of the exposure (Rodier, 1995) (8). It is clear that even subtle structural or neurochemical defects can nonetheless have devastating functional consequences.
TOXICITY TESTING
The NAS report made several recommendations for changes in risk assessments and standard-setting to protect children. To assess risk, regulators need adequate toxicity data to establish a No Adverse Effect Level (NOAEL) and adequate exposure data that takes into account both aggregate exposures (from all sources of the chemical, eg, water, food, carpets) and cumulative exposures (from several chemicals with a similar mode of action). The NAS Committee stated that the need for developmental neurotoxicity testing, which is not a core data requirement for pesticides, was of particular importance, as is the need to assess the potential for toxicity to the developing immune and reproductive systems. In assessing risks to children, the NAS recommended that an additional uncertainty factor be applied to the animal data to take into account toxicity and/or exposure data gaps. This action was mandated by Congress in the 1996 United States Food Quality Protection Act, requiring reassessments of pesticides. New EPA requirements for neurodevelopmental data have lead to some new regulations and bans on the major uses of two common pesticides.
In 1989, The Learning Disabilities Association of Canada (LDAC) and LDA America adopted resolutions titled, “The Need for Federally Mandated Developmental Neurotoxicity Testing to Protect Human Health: Central Nervous System Development” (www.ldac-taac.ca). Canada’s Minister of Health assured LDAC in 1990 that new guidelines would be issued in that year, which has not happened. However, the Pest Management Regulatory Agency is harmonizing its re-evaluation process with the USEPA and requiring developmental neurotoxicity testing for two classes of pesticides that act on the nervous systems of pests. However, this leaves risk assessments for other pesticides, food additives and colours, drugs, cosmetics, and high volume neurotoxic chemicals without these data. For example, an organic form of a known neurotoxicant, manganese, methylcyclopentadienyl manganese tricarbonyl (MMT), was approved, and reassessed as being safe for use in Canadian gasoline without developmental neurotoxicity data. Manganese exposure produces effects on neurotransmitter systems in developing animals, but not in adult animals (9), and in humans, manganese toxicity produces neuropsychiatric disorders and symptoms similar to Parkinson’s disease (10). In the United States, the USEPA refused Ethyl Corporation’s petition to market MMT, based on unresolved health concerns; however, this was overturned in a narrow court decision that found that EPA could not ban a fuel additive based on health effects alone under the Clean Air Act.
EXPOSURE
Because children are smaller, they receive a more concentrated dose of a toxicant than adults. The fetus and the infant have immature detoxification systems, and the blood-brain barrier is not yet formed. Children also consume more of fewer foods, so a child might receive a higher exposure to a chemical contained on or in a favourite food during many meals every day. They play and breathe closer to the floor where contaminants accumulate in air and dust. Compared with adults, children consume more food and water, breathe more air on a mg/kg body weight basis and tend to absorb more toxicants.
The NAS report found that infants would consume up to seven times the amount of water on a mg/kg body weight basis than that consumed by adults. Water can be a source of exposure to toxicants for children, especially to children living in areas where groundwater is contaminated with pesticide and nitrate runoff. However, in Canada there is no federal legislation that sets enforceable standards for contaminants in drinking water; rather, the federal government, with the provinces, establishes ‘guidelines’ or nonenforceable limits for these chemicals and regulation is left to the provinces. Unfortunately, no systematic chemical analyses with reporting and enforcement of drinking water guidelines are mandated for populations in Canada by any department, or level of government. In a survey of well water (Ontario, 1989 [unpublished data]), atrazine, a triazine herbicide, was found in one sample at 210 parts per billion (ppb), 40 times the Canadian Maximum Acceptable Concentration (MAC) of 5 ppb. A five-year study of the effects of environmental groundwater concentrations of pesticides (aldicarb and atrazine) and nitrates on the immune, hormonal and nervous systems of mice found effects, replicated many times, in altered thyroid levels, immune system suppression, and increased aggressiveness (11).
Do drinking water guidelines, or MACs, protect children? The rationale for the MAC for each chemical in drinking water is published by Health Canada, and calculated on an adult weight and consumption pattern. For example, consider atrazine with a MAC of 0.005 mg/L or 5 ppb, and recalculate the MAC based on a 7 kg child consuming 1 L/day, instead of a 70 kg adult consuming 1.5 L/day, the MAC would need to be close to an order of magnitude lower at 0.0007 mg/L or 0.7 ppb.
RISK MANAGEMENT
Research informs both clinical management and regulatory policy. In the 1960s, a blood lead level of 60 mg/dL was considered to be toxic. Since the 1970s, epidemiological research has altered the perception of lead’s hazards, lead was banned as a gasoline additive, and the concern for lead toxicity is now 10 mg/dL. There may be no threshold for lead’s effects – a recent study by Lanphear et al (12) linked levels as low as 2.5 mg/dL with neuro- developmental effects.
Unlike mandated programs in the United States, there are virtually no lead screening programs for children at risk in Canada. A study by Valiquette and Kosatsky (13) investigated laboratory records to review care received by children in Montreal in the 1980s with elevated blood lead levels, greater than 25 mg/dL, and found inadequate follow-up, little reporting to public health authorities or management of the source of lead, which in most cases was lead-containing paint (13). There is a voluntary agreement in Canada with the paint industry that should limit lead in paint to the United States 1977 regulated limit of 600 ppm, but Canada’s regulation under the Hazardous Products Act still permits more than eight times the 600 ppm limit for indoor paint, with no limit on outdoor paint. LDAC has urged that this regulation be updated for more than 10 years. A strategy to restrict the lead content of consumer products that was supposed to be issued for comment in 1998 is still in limbo. The risk assessment for lead is complete, but the snail’s pace approach to regulation shows that there is a need for enhanced risk management in Canada.
PROTECTING CHILDREN
The list of what needs to be done and is known to prevent some fraction of developmental disabilities is lengthy. There is a need for action on many toxic, persistent and cumulative chemicals. The federal government must develop guidelines to ensure that Health Canada bases acceptable levels of toxicants in air, water, soil and food on adequate developmental data and risk assessment policies to protect children. Testing for developmental neurotoxicity must become a requirement for chemicals of concern in safety evaluations and in standard settings. The precautionary principle – not waiting for years for all the evidence to be in before taking action on known or strongly suspected hazards to prevent harm – should take precedence over the calls from vested interests for ‘sound science’ (ie, ‘proof of harm’) before regulatory action can be taken. While the latter view prevails, there is an equal responsibility for government to appropriate the resources to generate this science in the public interest. Health Canada should join the United States Centers for Disease Control and Prevention biomonitoring program, which has recently published the National Report on Human Exposure to Environmental Chemicals (http://www. cdc.gov/nceh/dls/report/), using biomarkers for 25 toxic substances in blood and urine. There is a need for enhanced environmental health research programs, and an expanded birth defects surveillance program with the ability to detect and study clusters of neurodevelopmental disorders. The Liberal Party 2000 Redbook (14) platform promised $750 million over four years for this type of research, and to ensure safe water, air and soil. Health professionals could become important advocates on these issues, and should also consider the possibility that environmental agents may be playing a part in the etiologies of the diseases and disorders that they are seeing in their practices or research.
http://www.pulsus.com/Paeds/06_10/mcel_ed.htm
Butt-out battle flares-AB
Complete public smoking ban plan will be presented to MLAs by April
By JERRY WARD AND ANDREA SANDS, SUN MEDIA Thu, January 13, 2005
EDMONTON -- Health Minister Iris Evans wants a complete public smoking ban in Alberta and plans to present a proposal by April. "I'm going to see how far we can pursue that," Evans said yesterday. "If we can make sure that in every public place, every workplace, every place possible that is either in the public domain, or in a workplace we can reduce or eliminate the use of tobacco, then I think we'll make a significant stride towards it (a blanket ban).
"We have to take a look at pushing it as far we can. We may not be able to accomplish or reach our targets ... but I think we will make some gains this time."
All previous efforts to enact such a law have failed when voted on by Tory MLAs.
Evans is more hopeful now, thanks to a new set of cabinet ministers following the provincial election. She plans to present an all-encompassing, Alberta-wide no-smoking proposal to a Tory government policy committee in March or April to get the ball rolling.
If adopted at that level, the proposal would then go before the government cabinet and caucus for consideration.
"I don't have a magic bullet for this," Evans said. "What I do have is a ministry with costs rising, particularly for drugs and emerging technologies, services and so on."
Evans said she will consult chambers of commerce, health groups, municipalities and others to form the legislation.
New Democratic party Leader Brian Mason said it would be "great" if Evans could round up support to implement a province-wide smoking ban.
"The problem is that municipalities are doing different things and it creates and uneven playing field for small businesses and we're developing a kind of patchwork approach," Mason said.
Even the heavy-smoking province of Quebec intends to establish new provincial rules to curb smoking in public, said Les Hagen of Action on Smoking and Health.
"We're talking about the backyard of tobacco country," Hagen said. "If they can get away with this in Quebec, surely we can get away with this in Alberta, especially when the Alberta government seems so committed to health reform.
"If you're going to talk seriously about health reform, you have to talk about smoking."
Every year, 3,400 Albertans die from smoke-related illnesses, Hagen said.
http://www.canoe.ca/NewsStand/CalgarySun/News/2005/01/13/897021-sun.html
Tabacco growers bemoan attack on industry -ON
Thursday January 13, 2005
By Times-Journal Staff
Tobacco growers in Ontario want governments to be accountable for their “attack” on producers’ livelihood, says the chairman of the Ontario Flue-Cured Tobacco Growers’ Marketing Board.
“We are not looking for a short-term fix,” said Fred Neukamm, responding to comments made by the chairman of the Ontario Fruit and Vegetable Growers Association.
Murray Porteous, maintained the way the federal and provincial governments are handling relief for tobacco farmers might ruin small-volume markets for fruits and vegetables.
“Government payouts, direct subsidies are the answers to short-term situations, but fail to achieve long-term economic sustainability, particularly for agriculture,” Porteous said.
Neukamm responded tobacco growers are the victims of a war waged on the industry where quantities of imported leaf tobacco have increased and contraband and counterfeit activity have increased.
“We have lost our ability to supply the Canadian consumer,” Neukamm said.
Porteous suggested more government funding should be directed at market research and development, “because growers will likely move into horticultural production, causing an imbalance of supply and demand and shrinking already-dwindling prices to the point of no return.”
“Pouring more money into the fruit and vegetable industry may help those farmers that Mr. Porteous represents, but will do little to help beleaguered tobacco farmers,” Neukamm responded.
Neukamm added he believed it was unlikely additional research would result in enough new crops to support production on the more than 100,000 acres tobacco farmers cultivate.
“It has been said before and it will be said again -- the only alternative crop to tobacco is tobacco,” Neukamm said.
Neukamm said the government has declared war on tobacco, not on strawberries or apples, and he urged Porteous to support tobacco farmers.
http://www.stthomastimesjournal.com/story.php?id=137308
Smoke and morals -ON
Father Raymond J. de Souza National Post Jan. 14/05
Ontario Health Minister George Smitherman introduced his new anti-smoking legislation last month, striking a presumed note of moderation: "And so we're saying to Ontarians, if you want to smoke at home, we're not going to stop you."
That's generous. But just about everywhere else, smoking will be forbidden -- even in private clubs, Legion halls and yes, parking garages, where loiterers presumably might be afflicted by "deadly second-hand smoke". Three months ago, the Ontario Medical Association asked the government to ban smoking in private cars if children were present. So far that is not on the agenda, but otherwise Ontario has embraced the full zealotry of the anti-smoking program.
That's not new. But what is striking is how passionate the Ontario government is about providing moral instruction to its citizens when it comes to matters of health.
The anti-smoking strategy includes a government-funded Web site entitled stupid.ca. It assures us that it is not "meant to be an insult to smokers" because "smokers aren't stupid." Rather it offers "social commentary on the choice to smoke or not to smoke." Oh. Browse the Web site and the only possible conclusion is that if smokers aren't stupid -- meaning that they don't know better -- then they are deliberately making bad choices. That is to say, they are morally inferior.
Governments have been in the "social commentary" business for a long while. Historically, they may have used their coercive powers to build up the moral character of their citizens -- one thinks of prohibition or movie ratings or gambling restrictions. Now, government energy is focused on health. If you wish to let your soul rot in hell, the government will affirm your right to do so -- but don't try it with your body.
So we have the rather ironic situation that the government of Ontario operates casinos, but now won't let you smoke in them. The government of Ontario -- like other provinces -- will entice the public to gamble, but as you are wagering away the grocery money, don't think about lighting a cigarette. Our universities promote condoms to new students with great enthusiasm to avoid disease; nary a word is offered that might question promiscuity as a bad moral choice. Public health authorities will facilitate your drug habit with free needles but are not so keen about telling you that it is simply wrong to shoot yourself up.
On health matters, the government is a veritable church lady. On other matters, it is the permissive mother on the block whose house the other children are forbidden from playing at.
The anti-smoking legislation caps a rather remarkable year on the health front. A private member's bill sailed through Queen's Park making helmets mandatory for adults when cycling, rollerblading or skateboarding. My colleague Andrew Coyne demolished the evidentiary case for mandatory bike helmets in November in these pages, but no matter. The initiative is a moral one: There exists a moral imperative to minimize all health risk, and should you dissent, the law will bind you.
More examples? Last September, the government moved to ban fresh sushi, insisting upon frozen instead because it would be safer. That proved a stretch too far, so the ban did not go through.
What apparently cannot be rescinded is the mentality that free citizens cannot be trusted to manage their own health. When it comes to thorny social issues, those advocating the abandonment of traditional mores insist on the supremacy of individual consciences. But not when it comes to health. Our public policy will not vigorously discourage someone from bearing children out of wedlock, with all its attendant pathologies, but it will do its best to make sure those children's bathwater is the right temperature.
Bathwater? Perhaps you are unfamiliar with a recent public campaign by Toronto Public Health, aimed at getting parents not to burn their children in the bath. A full campaign, complete with posters, brochures and flyers all over Toronto's transit system, funded fully by the Ontario taxpayer, telling parents to check the temperature of their hot water, lest the little ones scald themselves. What kind of mentality spends public health dollars to tell parents what every 14-year-old babysitter knows -- that you check the water temperature before plunging Junior in the tub?
The safety and smoking fanatics operate on the assumption that people are not responsible enough to be trusted with their freedom. So they must be harassed and nagged about bike helmets and bathwater, and if they don't comply, then good habits simply must be legislated. We will be healthy, whether we like it or not.
http://www.canada.com/national/nationalpost/news/comment/story.html?id=1eb3143a-f521-4417-b72c-0d878baa4f33
Indian Affairs minister conflicted over reserve smoking-SK
Tim Cook Canadian Press Friday, January 14, 2005
REGINA (CP) - The federal Indian Affairs minister acknowledged he's in a dilemma when it comes to dealing with smoking bylaws enacted by First Nations that attempt to do an end run around provincial rules.
Speaking in Regina on Thursday, Andy Scott said there are two conflicting issues at play - health and aboriginal self-government. "We would wish that communities have more authority over decisions," Scott said. "At the same time I believe strongly that we should do what we can to mitigate the health risks associated with smoking."
Scott made the comments when he was asked about the problems Saskatchewan is having with its tough new anti-smoking law.
Effective Jan. 1, smokers have had to butt out in all public buildings in the province or face fines. The law was meant to apply across the board, both on reserve and off.
But under the Indian Act, if a band were to pass a bylaw that conflicts with the provincial law, the band bylaw would prevail. For a bylaw to come into force, however, it must be first forwarded to the federal minister, who has 40 days to object.
Earlier this week, the Saskatchewan government came forward asking Scott to quash any bylaws that are weaker than the provincial anti-smoking legislation.
Scott said that he wants to consult with all of the stakeholders as well as his cabinet colleagues before he makes a decision.
But that will have to be done quickly.
The White Bear First Nation in the southeast corner of the province submitted a bylaw for approval on Dec. 9. It would allow smoking in bingo halls and casinos.
That means Scott's decision will have to come within a week.
Federation of Saskatchewan Indian Nations vice-chief Morley Watson said it should be up to native people to decide what is best for their health.
He said there are some bands in the province that came forward with anti-smoking bylaws before the province's rule came into effect.
"We're fully aware of making the best decision in our own lives," Watson said. "We cannot continue to have governements come along with very paternalistic attitudes that they have shown all along."
Saskatchewan Aboriginal Affairs Minister Maynard Sonntag got a chance to press the province's case with Scott on Thursday afternoon.
After the meeting, Sonntag told reporters that the Saskatchewan government respects First Nation self-governance, however, the province feels strongly about the health issues related to smoking.
"I don't think we are forcing anything on the federal minister at all," Sonntag said. "We are stating to him what we think is just a critically important health issue and want him to be aware of that."
Two other provinces, New Brunswick and Manitoba, have public smoking bans similar to the one in Saskatchewan. Quebec, Ontario and Newfoundland all have laws on the way and just this week Alberta's health minister mused publicly about getting on board.
New Brunswick is in the same situation as Saskatchewan in that politicians there have asked First Nations to respect the new rules, but can do little should a bylaw be passed.
Manitoba avoided the issue by making reserves exempt from its smoking ban. The exemption has created controversy, however, with non-reserve business owners claiming it's a two-tier system.
http://www.canada.com/national/story.html?id=2d8246af-c276-422d-a9da-f5a4b562da9b
Minister undecided on extending smoking ban to reserves -SK
Broadcast News Thursday, January 13, 2005
REGINA - The federal Indian Affairs minister says he's in a bind when it comes to approving a First Nations' bylaw that would do an end run around provincial anti-smoking legislation.
Andy Scott says there are health issues with smoking but there's also the belief that First Nations should have the right to run their own communities.
Scott was speaking today in Regina about the situation on the White Bear First Nation in Saskatchewan.
While smoking is now banned inside all public places across the province, the reserve has passed its own bylaw that allows residents to light up in bingo halls and the local casino.
Under the Indian Act, Ottawa must approve the bylaw but the province has asked Scott to reject it.
The minister says he wants to consult all parties involved in the issue, including his cabinet colleagues, before he decides.
A decision must be made within the next week.
http://www.canada.com/saskatoon/starphoenix/news/story.html?id=7f94bfcb-6074-47a4-9264-b8c5e4d41920
Klein says no to smoking ban -AB
Last Updated Jan 14 2005 03:51 PM MST
CBC News CALGARY – Premier Ralph Klein says there will not be a provincewide ban on smoking.
Earlier this week, Health Minister Iris Evans said she was going to revisit the debate that started a few years ago. That initiative was eventually shot down by the government caucus.
Evans said she believed that this time the caucus and premier were more willing to take another look at regulating smoking.
But during a news conference in Montreal Friday, Klein rejected the idea saying that municipalities should be free to set their own rules on smoking.
"I've never called for a smoking ban," he said. "But I think that if you smoke you're stupid. Everyone knows the harms of smoking so we will leave it to the municipalities. Here's the problem: smoking is still legal in this country."
But that has municipalities and union leaders upset. Bob Hawksworth, head of the Alberta Urban Municipalities Association, says it's not fair to leave bans up to individual cities and towns because of the costs involved.
Dan McLennan, president of the Alberta Union of Provincial Employees, says cancer is an equal opportunity killer, no matter where you live.
"You have to do a total ban – there is no other way," he says. "We're setting a horrific example for our kids in lagging behind on this legislation."
Meanwhile, an Alberta member of a Canadian restaurant group says some local businesses would suffer under a smoking ban.
The Canadian Restaurant Association's Al Brown says a provincial smoking policy isn't a bad idea, because it sets up a level playing field for all businesses.
However, he says that other than bars, nightclubs and casinos, there are some businesses that would be at a distinct disadvantage.
He points to Manitoba, which has banned smoking in all public places, as an example. "We know now with the numbers we're getting out of Manitoba [...] that their business decreases anywhere between 15 to 25 per cent."
Browne says his group prefers the B.C. model, which requires strict filtration and separation systems for any public place that allows smoking.
http://calgary.cbc.ca/regionalnews/caches/ca-smoking-ban20050114.html
Alberta Premier Klein calls smokers 'stupid' -AB
Canadian Press
MONTREAL — Alberta Premier Ralph Klein, a longtime smoker who has tried many times to quit, called smokers "stupid'' on Friday but said he doesn't believe it's his job to impose a ban on lighting up in his province.
While other provinces are cracking down on smoking in public places such as malls, bars and restaurants, Klein said he believes municipalities should make their own decisions.
"Smoking is still legal in Canada,'' he told a news conference after giving a speech to the Montreal Board of Trade. "I've never called for a smoking ban and never will. But I think if you smoke, you're stupid.''
That comment came despite the fact that Klein himself, an aide said Friday from Edmonton, is a smoker who has tried frequently and unsuccessfully to kick the habit.
Instead of an Alberta-wide smoking ban, Klein said he'd prefer to see family restaurants where children dine with their parents to be smoke-free.
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1105746444254_2/?hub=Health
Smoking ban a 'workplace safety' issue -AB
Health minister seeks tougher smoking laws while premier says: 'If you're stupid, smoke'
James Baxter; With files from Jason Fekete Thursday, January 13, 2005
EDMONTON - Health Minister Iris Evans will push for a provincewide ban on smoking in the workplace as a cornerstone of the government's latest wellness strategy.
The patchwork of municipal bylaws across the province isn't working, so the government needs to take a leadership role by launching a new tobacco-control campaign, complete with new laws, said Evans, who took over the portfolio from Gary Mar after the November election.
"This is a question of public health and it is a question of workplace safety for employees," said Evans. "A lot of municipalities would like to hear whether or not this caucus, and this government, and this health minister would support a tobacco reduction policy and an elimination in public places. Frankly, I would."
On Tuesday, Premier Ralph Klein said he would like to put up billboards along the province's highways that say: "If you're stupid, smoke."
Evans said Wednesday she plans to ask a government committee to come up with new ways to curb tobacco use in the workplace.
"I would like to see how far we are able to go on this health issue, this workplace issue, of reducing smoking or eliminating smoking in the workplace and in public places."
The news was greeted with cautious optimism by anti-smoking groups, who noted that Mar championed similar legislation and failed to get it by caucus.
"Hopefully this is more than just a trial balloon," said Les Hagen, executive director of Action on Smoking and Health. "For us, any time the premier talks about health reform, that's good news, because you can't seriously talk about reform without addressing the leading avoidable cost of illness and premature death in the province, which is tobacco use."
Evans agreed that curbing smoking is a critical component of any serious effort to reform health care and cut costs to the publicly funded system.
"If we can (cut smoking in the workplace), we'll do a lot, I think, to help young people and people of every age to stay healthier ... ," she said.
Liberal health and wellness critic Laurie Blakeman said she supports efforts to cut smoking from the workplace, adding that she believes a majority of Albertans, even smokers, support tougher restrictions on smoking in public places.
"It's a good idea and I'm right there," said Blakeman.
But she too wonders whether Evans will be any more successful than Mar in garnering caucus support.
"I think what the government needs most is intestinal fortitude," she said.
Hagen believes any legislation will be a good test of the influence Rod Love, Klein's chief of staff, has on government policy. Before returning to government service in November, he said, Love worked as a lobbyist for a major cigarette maker.
"I think the chances (of the legislation passing) are good, but depend largely on the resolve of the health minister and of the premier," Hagen said.
"It all comes back to health care reform. If they're serious about reforming health care, then banning tobacco in the workplace is a no-brainer. If you aren't, then obviously other influences are at play."
Love, who was travelling with Klein in Ontario on Wednesday, could not be reached for comment. He has insisted that in cases of potential conflict between government policy and his former clients he will recuse himself from discussions on those issues.
http://www.canada.com/edmonton/edmontonjournal/soundoff/story.html?id=ec06ea21-2ea6-4631-aded-4d899718e7fa
No butts about it -AB
JERRY WARD and ANDREA SANDS, EDMONTON SUN
Health Minister Iris Evans wants a complete public smoking ban in Alberta and plans to present a proposal by April. "I'm going to see how far we can pursue that," Evans said yesterday. "If we can make sure that in every public place, every workplace, every place possible that is either in the public domain or in a workplace, we can reduce or eliminate the use of tobacco then I think we'll make a significant stride towards it (a blanket ban).
"We have to take a look at pushing it as far we can. We may not be able to accomplish or reach our targets ... but I think we will make some gains this time."
All previous efforts to enact such a law have failed when voted on by Tory MLAs. But a new set of cabinet ministers following November's provincial election has given Evans fresh hope.
She plans to present an all-encompassing, provincewide no-smoking proposal to a government policy committee in March or April. If adopted at that level, the government cabinet and caucus would consider the proposal.
Evans said she will consult chambers of commerce, health groups, municipalities and others to form the legislation.
New Democratic Party Leader Brian Mason hopes Evans can round up support for a provincewide ban.
"The problem is that municipalities are doing different things and it creates an uneven playing field for small businesses. We're developing a kind of patchwork approach."
Even the heavy-smoking province of Quebec intends to establish new rules to curb smoking in public places, noted Les Hagen of Action on Smoking and Health.
"We're talking about the backyard of tobacco country," Hagen said. "If they can get away with this in Quebec, surely we can get away with this in Alberta, especially when the Alberta government seems so committed to health reform.
"If you're going to talk seriously about health reform, you have to talk about smoking."
But Premier Ralph Klein has said repeatedly his government won't force no-smoking laws on businesses that can make their own decisions.
In March 2002, Klein told reporters he wasn't about to order "old timers" in places like Crossfield's Oliver hotel to butt out.
"What are you going to do? Have a whole bunch of smoke cops saying, 'C'mon old-timer, put that cigarette out?' "
The manager of the Oliver in the town 260 km south of Edmonton agreed yesterday that the government shouldn't stick its nose into smoking at the "working man's" bar.
"I think people are getting to the point where they're told quite a bit what they can and can't do, and it's taking away a bit of our freedom," said reformed smoker Delores Wood.
http://www.canoe.ca/NewsStand/EdmontonSun/News/2005/01/13/896938-sun.html
Ottawa treading carefully around smoking ban debate
CBC News Last Updated Jan 13 2005 02:23 PM CST
REGINA – The federal Indian Affairs minister appears to be in no hurry to get involved in Saskatchewan's smoking-ban debate.
Under a provincewide ban that went into effect Jan. 1, smoking is not permitted in bars, restaurants and other enclosed public places.
The provincial government contends the law extends to casinos, including those on Indian property. But the Federation of Saskatchewan Indian Nations (FSIN), says the province doesn't have the jurisdiction to impose smoking rules on band property.
The FSIN has said bands will write their own smoking bylaws, although it won't necessarily mean total smoking bans.
In response, Saskatchewan's Minister of First Nations and Métis Relations Maynard Sonntag noted that band bylaws need approval from the federal minister.
He said earlier this week he was counting on Ottawa to refuse.
Asked what he's going to do, federal Indian Affairs Minister Andy Scott, who was in Regina Thursday, said he still hasn't made up his mind.
"We would wish that communities have more authority over decisions," Scott said. "At the same time I believe strongly that we should do what we can to mitigate the health risks associated with smoking."
Scott said he'd have to discuss things with his colleagues, "the community and others" before deciding what to do. He said he'll make a decision next week.
http://sask.cbc.ca/regionalnews/caches/smoking050113.html
Smoking ban tickets might not be issued on reserves
CBC News Last Updated Jan 14 2005 09:07 AM CST
REGINA – A Saskatchewan cabinet minister says the government won't ticket people who smoke on Indian property if the band allows smoking.
It's the clearest indication yet from the government about how it will apply – or won't apply – its province-wide smoking ban on reserves.
For weeks, the government has said the law applies across the province, but has been vague about whether it would enforce it on Indian land.
The ban that prohibits smoking in bars, restaurants, bingos and other public enclosed places has been in effect since Jan. 1.
Some Indian bands are still letting people light up in certain parts of their casinos – including off-reserve casinos.
On Thursday, First Nations and Metis Relations Minister Maynard Sonntag said the province will "respect" different smoking bylaws on First Nations.
He said if those people are smoking with the band's blessing, inspectors will not issue tickets.
The Federation of Saskatchewan Indian Nations says it's a jurisdictional issue – the province has no right to impose a smoking law on Indian property.
The FSIN says bands will have their own smoking bylaws, but that won't necessarily mean a total ban.
Sonntag said his government should have done more to get bands onside in the first place.
"We received no indication that there would not be compliance," he said.
"Had we known more earlier, certainly we would have been in discussions that were centred around this issue for a longer period of time."
Sonntag hopes further talks with First Nations leaders will convince them to ban smoking altogether.
Earlier this week, Sonntag said Ottawa shouldn't approve bylaws that would allow smoking on reserves. However, federal Indian Affairs Minister Andy Scott said he hasn't made a decision on that yet.
http://sask.cbc.ca/regionalnews/caches/smoking-reserves050114.html
Smoking confounds Ottawa
Minister weighs weaker First Nations' smoking bylaw
Tim Switzer Saskatchewan News Network; with files from Canadian Press January 14, 2005
REGINA -- Canada's Indian and northern affairs minister said he is conflicted about whether to approve a smoking bylaw proposed by a Saskatchewan First Nation that the provincial government considers weaker than its own legislation.
Andy Scott said Thursday he will consult with cabinet colleagues, affected First Nations, Federation of Saskatchewan Indian Nations (FSIN) leadership and the provincial government before making a decision next week.
"I am conflicted by my strong support for doing anything we can to minimize the health risks associated with smoking and, at the same time, my genuine belief in the policy and the fact that (First Nations) communities should be making decisions on their own," he said.
After the FSIN said in December it was unlikely to follow the provincial smoking ban in Native-run casinos, the NDP indicated it must respect First Nations' jurisdiction on the issue. But earlier this week the province urged Scott to reject any bylaw weaker than the provincial law.
The bylaw, proposed by the White Bear First Nation on Dec. 9, would ban smoking in enclosed spaces but would allow bingo halls, accommodation units and the Bear Claw Casino to set aside up to 40 per cent of their business as a smoking area.
Under the Indian Act, band councils can pass their own bylaws but they must be sent to the federal Indian affairs minister, who can disallow them. Provincial law applies unless it is inconsistent with the Indian Act or an order, rule, regulation or bylaw made under the act.
Scott has 40 days to respond to the resolution. If he disallows the bylaw, provincial law prevails. If he approves it or doesn't respond at all, the bylaw goes into effect.
FSIN vice-chief Morley Watson said it should be up to Native people to decide what is best for their health.
He said some bands in the province came forward with anti-smoking bylaws before the province's rule came into effect.
"We're fully aware of making the best decision in our own lives," Watson said. "We cannot continue to have governments come along with very paternalistic attitudes that they have shown all along."
After meeting with Scott late Thursday afternoon, Saskatchewan First Nations and Metis Relations Minister Maynard Sonntag said the province isn't trying to force Scott into a decision but rather make him aware of what they feel is a critical health issue.
"The province has also been clear in saying we respect the inherent rights of First Nations people and we will respect the bylaws if approved," he said. "Again, we have not wanted this to evolve into an issue of authorities because we don't think this is an issue where you should have the discussion about who has the authority."
Sonntag also admitted the province could have done more prior to initiating the ban to avoid such problems.
"We certainly could have had more discussions with the First Nations than we did -- hindsight is 20/20," he said. "Having said that, if you look back a couple of months ago, the casinos like (where a city-wide smoking ban was implemented) were complying. We received no indication that there would not be compliance."
Other provinces are having similar problems with their new smoking bans.
New Brunswick is in the same position as Saskatchewan where the ban was applied to all areas but politicians can do little if First Nations bylaws are passed while Manitoba did not include First Nations in their ban but now face pressure from non-reserve businesses.
http://www.canada.com/fortstjohn/story.html?id=31446629-9da5-4853-b4cc-b7d80b678d1a
Federal Indian Affairs minister conflicted over reserve smoking rules
Tim Cook Canadian Press Friday, January 14, 2005
REGINA (CP) - The federal Indian Affairs minister acknowledged he's in a dilemma when it comes to dealing with smoking bylaws enacted by First Nations that attempt to do an end run around provincial rules.
Speaking in Regina on Thursday, Andy Scott said there are two conflicting issues at play - health and aboriginal self-government. "We would wish that communities have more authority over decisions," Scott said. "At the same time I believe strongly that we should do what we can to mitigate the health risks associated with smoking."
Scott made the comments when he was asked about the problems Saskatchewan is having with its tough new anti-smoking law.
Effective Jan. 1, smokers have had to butt out in all public buildings in the province or face fines. The law was meant to apply across the board, both on reserve and off.
But under the Indian Act, if a band were to pass a bylaw that conflicts with the provincial law, the band bylaw would prevail. For a bylaw to come into force, however, it must be first forwarded to the federal minister, who has 40 days to object.
Earlier this week, the Saskatchewan government came forward asking Scott to quash any bylaws that are weaker than the provincial anti-smoking legislation.
Scott said that he wants to consult with all of the stakeholders as well as his cabinet colleagues before he makes a decision.
But that will have to be done quickly.
The White Bear First Nation in the southeast corner of the province submitted a bylaw for approval on Dec. 9. It would allow smoking in bingo halls and casinos.
That means Scott's decision will have to come within a week.
Federation of Saskatchewan Indian Nations vice-chief Morley Watson said it should be up to native people to decide what is best for their health.
He said there are some bands in the province that came forward with anti-smoking bylaws before the province's rule came into effect.
"We're fully aware of making the best decision in our own lives," Watson said. "We cannot continue to have governements come along with very paternalistic attitudes that they have shown all along."
Saskatchewan Aboriginal Affairs Minister Maynard Sonntag got a chance to press the province's case with Scott on Thursday afternoon.
After the meeting, Sonntag told reporters that the Saskatchewan government respects First Nation self-governance, however, the province feels strongly about the health issues related to smoking.
"I don't think we are forcing anything on the federal minister at all," Sonntag said. "We are stating to him what we think is just a critically important health issue and want him to be aware of that."
Two other provinces, New Brunswick and Manitoba, have public smoking bans similar to the one in Saskatchewan. Quebec, Ontario and Newfoundland all have laws on the way and just this week Alberta's health minister mused publicly about getting on board.
New Brunswick is in the same situation as Saskatchewan in that politicians there have asked First Nations to respect the new rules, but can do little should a bylaw be passed.
Manitoba avoided the issue by making reserves exempt from its smoking ban. The exemption has created controversy, however, with non-reserve business owners claiming it's a two-tier system
http://www.canada.com/health/story.html?id=c7812b45-0082-4e3b-870c-2ea718f737b2
A call to defenders of medicare
BOB HEPBURN Jan. 15, 2005. 01:00 AM
Once again, Canada's medicare is under assault — and unless its backers rally to its defence one more time, the publicly funded, not-for-profit system faces a real risk of collapse.
Leading the charge this time is Alberta Premier Ralph Klein, who this week was promoting a "third way" of delivering health care that is somewhere between the current Canadian system and the private health-care system in the United States.
Klein will hold an international symposium this spring looking at health- care systems around the world, including France, Switzerland, Australia and others, but excluding the U.S. He wants to find what works, and why.
Klein insists he wants to retain our public medicare system, but also favours looking at "innovative" approaches to deliver health care. He talks of "publicly funded health procedures privately delivered."
Clearly, Klein is a stalking horse for those who want a private, for-profit health system in Canada. Such people argue — seductively at times — that if you have enough money, why can't you buy health care?
You can spend your own money on the car of your choice, the clothes of your choice, the dentist of your choice, they say. So why can't you spend it on health care, to buy a private MRI when you need one, to buy a hip replacement or get cancer treatment?
Backers of medicare have heard similar arguments for years — and have argued forcefully against them.
But Canadians, who still overwhelmingly support medicare, are becoming fatigued. And they are finding it harder to defend the system when they saw billions of extra dollars poured into it over the last decade without seeing any discernible improvements.
Also, seemingly every week, there are fresh horror stories about children with cancer forced to wait months for diagnosis or treatment, of elderly patients driving to Buffalo for specialized care, of overcrowded emergency rooms that turn away ambulances.
Despite fatigue, though, medicare defenders must not give up the fight.
They cannot let pro-privatization forces seize control of this debate.
They must speak up for the system, acknowledge it is flawed, and propose ways of fixing it, such as reducing wait times, lowering the cost of prescription drugs and by increasing the number and availability of doctors.
And they must concede that, cut to its core, this debate is not just over a question of more money for medicare versus privatization, but about delivering services differently.
Both sides agree more money is needed. It's just that private sector backers would prefer to pay it directly out of their own pocket as they need it while medicare supporters want to pay for it through taxes so all can benefit.
Klein is right to say there is another option. What it is, though, is not a parallel private system as he wants. In fact, we don't need to go the private route at all to impro
