A Critical Analysis of Canada's Tobacco Strategy: Health Reform

This health reform paper provides a critical analysis of Canada's Tobacco Strategy using the Kingdom (2003) model and the 3-Is model of policy implementation. It examines the strategy's effectiveness in addressing tobacco consumption, particularly in British Columbia, where smoking-related lung cancer rates are high. The analysis includes the policy's history, goals, and factors influencing its development, highlighting the lack of detailed data on smoking-related deaths. The 3-i framework (interests, ideas, institutions) is used to understand policy development, emphasizing the role of the Public Health Agency of Canada. The report also discusses policy instruments, implementation plans, and communication strategies aimed at reducing tobacco use, with a SWOT analysis revealing the absence of a specific evaluation strategy as a weakness and adequate funding as a strength. The paper concludes by underscoring the importance of addressing healthcare needs, particularly within indigenous populations and the LGBT community.

Running head: HEALTH REFORM OBSERVER
Health Reform Observer
Name of the Student
Name of the University
Author Note

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Title
Critical analysis of the Canada’s Tobacco Strategy
Abstract
The following health reform paper conducted a critical analysis of the Canada’s
Tobacco Strategy. Analysis of the strategy was done from the perspective of the Kingdom
2003 model and 3-Is model of the policy implementation by Lavis et al. (2012). The use of
this model helped to understand the path which has been travelled towards designing this
policy. The current state of the tobacco consumption in Canada with a special focus on the
territorial province, British Columbia showed that the level of death toll arising out of
smoking induced lung cancer is high in British Columbia. The level is going to increase in
the upcoming years and the main reason behind this is smoking. This statistics helped in
analysing how this policy will be effective in improving the health structure of the Canadian
territory province. At the end, the paper discussed about the process through which the
reform was achieved and the process of evaluation of the reform. The SWOT analysis of the
policy revealed that the main weakness of this policy reform is it has no specific evaluation
strategy and adequate funding was highlighted as the main strength.
Keywords used
Health reforms, tobacco, smoking
Key messages
 Smoking, both active and passive is detrimental to life
 Active approach from the government through adequate funding and framing of the
reforms will be instrumental in reducing the ill-effects of smoking

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 The government must critically analyse the gaps in the healthcare needs in order to
devise the reforms and special focus must be given for the indigenous population and
LGBT community
Description of the health policy reform
Under the Smoking Prevention policy reform, the government of Canada as proposed
5% reduction in smoking of tobacco by the end of 2035 in order to decrease the rate of
staggering death arising out of increase in the burden of tobacco use. According to the
Government of Canada (2018), reaching this target will help to save millions of live and
billions of dollars. The smoking prevention policy reform also provides legislative along with
regulatory efforts in order to protect non-smokers and youth. In order to give proper coverage
to the youth, Tobacco and Vaping Products Act is taken under enforcement. Thus it can be
said that the Canada’s Tobacco Strategy represents a shift towards more comprehensive and
integrated approach of addressing the use of tobacco. The tobacco prevention strategy mainly
includes cessation support, protection of young tobacco users and non-tobacco users,
encouragement behind the use of vapping products and proper surveillance and research1.
History and context
Tobacco use in Canada continues to be a leading yet preventable problem underlying
the premature death. While the use of tobacco has decreased, a significant percentage of the
Canadian population still use tobacco. Smoking of cigarette results premature death of 45,000
Canadian per year 1. According to the statistics published by the Government of Canada, each
year there are 23, 000 deaths of Canadian adults for smoking. Each day 100 Canadians die
due to smoking related illness. Exposure to second hand smoke causes smoking-related
deaths arising from cancer, cardiovascular diseases and respiratory diseases 1. One of the
Canadian Territory Province which counts for high toll of smoking related deaths is British

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Columbia. In British Columbia (Canadian Territory Province) the rate of incidence of lung
cancer is high and the main reason behind this is smoking2.
Figure: Lung Cancer Statistics in British Columbia2
Projected Mortality Rate of Lung Cancer (2)
Diagnosis Year Male Female
2000 51.7 33.8
2005 49.3 35.3
2010 39.9 33.3
2015 35.5 30.3
Incidence of Lung Cancer in British Columbia (2)
Diagnosis Year Male Female
2000 1273 1101
2005 1398 1275

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2010 1447 1357
2015 1576 1645
2020 (projected) 1645 1896
2025 (projected) 1698 2171
Thus under the context of the increased chances of premature death in Canada with a
special mention to the Canadian Territory Provinces, the Government of Canada has come
forward with a smoking prevention policy reform. Effective prevention of smoking of
tobacco will help in the reduction of the diseases associated with smoking like lung cancer3.
Goals of the reform (stated and implicit)
The main goals of the Tobacco Control Strategy of Canada are to reduce the use of
tobacco by an ambitious target of 5%, by the end of 2035. The goal will be achieved through
broad and population based approaches.
Factors that Influenced how and why
Kingdon model
In order to discuss the factors which have promoted the development of the policy
reform, Kingdon (2003) model will be used. This model mainly describes three different
windows (policy stream that are used for the policy development).

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Figure: Diagram of Kingdon Model (2003) 4
Under the policy stream, the main literature support which can be highlighted behind
designing of the policy include smoking as one of the preventable cause of premature death
arising out of respiratory disease, cardiovascular disease and lung cancer (Islami, Torre &
Jemal, 2015). However, there is absence of screening about the incidence of smoking related
deaths and the projected outcome of these consequences in the future. For example, Symbol
of Statistics Canada. (2018) has a detailed review of the Cannabis intake in the territory
province of Canada, but there are no detailed study of the death occurring due to use of
tobacco or tobacco smoking and its impending risk. This has created a political agenda in
order to ensure the health and the quality of life of the people residing in Canada. There are
numerous other reasons, which have lead to the development of the policy reforms in
smoking prevention in Canada 5. These reasons are described under the policy stream of the
Kingdon model (2003). The local initiatives, which are taken in order to reduce the chances
of smoking include smoking include awareness of smoking and its harmful effects and

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decreasing in the rate of smoking in public in order to reduce the harmful effects associated
with passive smoking. However, implementation of the local initiatives is not helpful in the
long run keeping into consideration of the financial investments. The reports published by the
Government of Canada (2015) highlighted that health risks of the second hand smoke is high
in Canada with a special mention to the Canadian provincial territory. This has caused
increase in premature birth and stillbirth. Moreover, exposure to second hand smoking has
also increased the level of incidence of leukemia, lymphomas and brain tumours. According
to the excerpts of Dr. Brett Thombs, chairman of the four-member tobacco working group
within the smoking prevention task force, “Rates of smoking have decreased over the last
couple of decades, but they seem to have plateaued and they're still much too high”. Dr.
Thombs also highlighted that “Among Canadian youth, by the time children and adolescents
are in 12th grade, 36 per cent have tried smoking………….. And that's simply way too high
given the massive burden of smoking on health [and] on our economy”. Thus increase in the
ill-effects of active and passive smoke have highlighted that the local initiatives are not
optimally effective and is also not feasible. There exists lack of co-ordination among the
stakeholders leading to the development of the government initiatives for the prevention of
smoking and ensuring subsequent funding against it 6,1.
Final decision (3-i framework)
The 3-i framework for understanding of the policy development and choices mainly
deals with interests, ideas and institutions.

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Figure: Model of 3-i framework 7
Interests The main interest behind the policy development is reduction in the rate of smoking or
the use of tobacco will help to improve the health-related quality of life of the people
residing in Canada. This healthy approach will help to decrease the premature deaths
arising from active and passive smoking and reduction in the rate of smoking-related
illness like respiratory disease or lung cancer. Other smoking related diseases which are
taken into consideration include cardio-vascular disease and other form of cancers.
Other external factors that influence the development of the policy is influences coming
from the United states towards reducing the rate of smoking in order to lead a healthy
life ahead. The United States of American has already implemented tobacco prevention
reforms and has achieved success. It not only helped to reduce the premature deaths but
have also increase the overall economic structure of the province 3
Ideas The ideas that influenced the development of the policy is the reduction in the ill-effects

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of tobacco in order to improve the health-related quality of life of the people residing in
Canada. The Canadian territory province was taken under special consideration as there
were no specific data about rates of smoking and its projected outcome. Other
systematic review and research which are conducted in this domain were also used as
ideas for the development of the policy
Institutions The main institution which is involved in framing and then implementation of the policy
is Public Health Agency of Canada under the health department of Canadian
Government. The Public Health Agency of Canada has tie up their hands with Canadian
Paediatric Society (2016) in order to reduce to implement smoking prevention reform
among the young adults and children. The main funding authority of government f
Canada10. The budget announced in 2018 has released $80.5M funding for the strategy
building with existing resources. It also aims to bring the total investment to $330M
during the coming five years. Other institutions which are acting in collaboration
include The Medical Psychiatry Alliance (MPA) and Centre for Addiction and Mental
Health 1.
How the reforms were achieved
Policy Instruments
The main policy instruments towards the cessation of the tobacco use proper
government support in provinces and territories. Government is also taking active initiatives
in protecting the youth from developing the smoking habits and protection of children,
pregnant women from becoming victim of second hand smoking and proper enforcement of
laws. Detailed survey is used as instrument in order to reveal the challenges in addressing
commercial tobacco use among the indigenous population and LGBTQ communities. Other
policy instruments include support programs like “Picking Up the PACE” that help to reduce

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tobacco addiction as highlighted by Robert Oliphant, Member of Parliament and Dr. Theresa
Tam, Canada’s Chief Public Health Officer 1.
Implementation Plans
The proper implementation plans includes use of proper advertisements to increase
the level of awareness against the use of tobacco. The advertisement will mainly be featured
in television, social media, and posters. Other policy instruments include set-up of
community based approaches for the prevention of smoking. In order to give proper
assistance for the prevention of smoking to the young and older adults’ promotion of the
nicotine replacement therapy is undertaken along with the use of the vapping instruments 1.
According to the reports published by the Globe and Mail (2017), the Government of Canada
is coming forward and taking active initiatives (Canadian Task Force on Preventive
Healthcare) for the prevention or reduction in the smoking tendency among the Canadian
youth who are aged between five to eighteen years. The Government of Canada (2018), in
order to implement the tobacco policy reforms is promoting smoke-free lifestyles by joining
hands with Centre for Addiction and Mental Health’s work. According to The Honourable
Ginette Petitpas Taylor, Minister of Health, “Promoting healthy living habits goes hand-in-
hand with decreasing the number of Canadians using tobacco and will help us achieve our
goal of reducing tobacco use in Canada to less than 5% by 2035” 8.
Communication Plans
The main communication plans that are being implemented for the prevention of
smoking includes community based health promotion approach with effective
communication for the development of therapeutic relationships with the service users. The
Centre for Addiction and Mental Health and Public Health Agency of Canada is working in
collaboration to communicate and to increase the awareness of tobacco harm 9.

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Evaluation
Process of evaluation
The process of evaluation will be done by conducting the survey in the healthcare
organisation in order to evaluate the rate of hospital admissions and subsequent deaths arising
out of tobacco. This will help in analysing whether the reform was successful in achieving the
target of 5% reduction 1.
SWOT Analysis
The following is the SWOT analysis of the chosen healthcare reform in Canada done
from the perspective of the Canadian population over whom the policy will be implemented.
Helpful (in achieving the target) Harmful (in achieving the target)
Internal origin Strength (S)
The main strength of the policy is its
funding. Proper funding in smoking
prevention and use of vapping technique
will help in the proper and optimal
implementation of the program along
with achieving the desired objectives.
Another strength of the policy is its
specific target towards the aboriginal
populations towards reducing smoking
Weakness (W)
The main weakness of the policy is it
has no specific evaluation methods in
order to detect the success of the
reform in the long run (2035)
External origin Opportunities (O)
It will help in reducing the ill-effects of
the second-hand smoking and decreasing
the effect of smoking over the youths
and the children. This will help to
Threats (T)
Planning of the proper use of the
effective funding is not highlighted and
this might lead to misuse of funding

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promote a healthy future
Source: Creator by author

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References
1. Government of Canada. (2018). Overview of Canada’s Tobacco Strategy. Access date:
21st November, 2018. Retrieved from:
https://www.canada.ca/en/health-canada/services/publications/healthy-living/canada-
tobacco-strategy/overview-canada-tobacco-strategy.html
2. Provincial Health Services Authority in British Columbia. (2018). Tumour Site/ Type
Demographics. Access date: 21st November, 2018. Retrieved from:
http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-
management-guidelines/lung/lung
3. Islami, F., Torre, L. A., & Jemal, A. (2015). Global trends of lung cancer mortality
and smoking prevalence. Translational lung cancer research, 4(4), 327.
4. Brook, D. R., Felton, N. V., Clem, C. M., Strickland, D. C. H., Griffiths, I. H.,
Kingdon, R. D., ... & Hargrave, J. M. (2003). Validation of the urban dispersion
model (UDM). International journal of environment and pollution, 20(1-6), 11-21.
5. Symbol of Statistics Canada. (2018). Provincial and Territorial Cannabis Economic
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https://www150.statcan.gc.ca/n1/daily-quotidien/180430/dq180430b-eng.htm
6. Government of Canada. (2015). Dangers of second-hand smoke. Access date:
21st November, 2018. Retrieved from:
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hand-smoke/second-hand-smoke/dangers-second-hand-smoke.html
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S, Oliver S, Ongolo-Zogo P, & Haines A. (2012). Guidance for evidence-informed
policies about health systems: 2. Linking guidance development to policy

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development. PLoS Medicine 9
(3):e1001186. https://doi.org/10.1371/journal.pmed.1001186.
8. The Globe and Mail. (2018). Health officials urged to help prevent Canadian youth
from smoking. Access date: 22nd November, 2018. Retrieved from:
https://www.theglobeandmail.com/news/national/health-officials-urged-to-help-
prevent-canadian-youth-from-smoking/article34156250/
9. Government of Canada. (2017). Smoking and Mortality. Access date: 21st November,
2018. Retrieved from: https://www.canada.ca/en/health-canada/services/health-
concerns/tobacco/legislation/tobacco-product-labelling/smoking-mortality.html
10. Canadian Paediatric Society. (2016). Preventing smoking in children and adolescents:
Recommendations for practice and policy. Access date: 21st November, 2018.
Retrieved from: https://www.cps.ca/en/documents/position/preventing-smoking