As medical students at the University of Toronto, we are training to prevent disease, treat illness and improve the health of our communities. That means looking beyond the patients we see today to the health of future generations. Canada’s historic $32.5-billion settlement with tobacco companies gives provinces and territories a rare opportunity to reduce preventable suffering. We must use it wisely.
Tobacco remains the leading cause of preventable death in Canada, resulting in a yearly estimate of 46,000 deaths, including a quarter of all heart disease related deaths according to Health Canada. Tobacco use in Canada also contributes to about one third of all cancers.
Millions more in Canada live with chronic conditions directly related to or worsened by smoking. These are not abstract statistics; medical students and healthcare professionals see the human cost daily during our training and work in hospitals and clinics.
And yet, it has been suggested that tobacco settlement dollars should merely focus on harm reduction, promoting new nicotine products rather than targeting prevention and cessation. This is not long-term vision. It is short-term thinking disguised as progress.
The settlement funds should reduce the number of Canadians who start smoking or remain addicted. We know that prevention works.
Over the past five decades, education, policies and community-based programs have driven down smoking rates. Research shows every dollar invested in tobacco prevention and cessation yields several dollars in avoided health-care costs and overall return on investment.
Treatment of tobacco-related illness, including heart disease, cancer and chronic obstructive pulmonary disease (COPD), costs the taxpayer more than $12.3 billion annually in health and economic costs. Prevention is not just the right thing to do; it is the fiscally responsible choice.
Some argue that nicotine itself is not the problem and that the dangers of smoking are limited to the combustion of tobacco. This view is reductive. While the combusting of tobacco produces the most toxic compounds, nicotine is far from harmless. It is highly addictive, can disrupt brain development in youth, elevate blood pressure and heart rate, and worsen existing cardiovascular conditions.
Normalizing nicotine through products such as vapes or nicotine pouches creates a new generation of dependence. Dependence reintroduced under a different guise is not progress.
We recognize that people who smoke today need effective tools to quit. However, the answer is not to rely on tobacco industry-driven solutions. Vapes, nicotine pouches and other emerging products are often marketed as safer alternatives, yet they remain under-researched in the long term.
Public health must be guided by independent scientific evidence, not marketing.
Settlement funds should ensure every Canadian has free access to science-backed cessation therapy best practices which includes a combination of behavioural and pharmacological treatment, supported by counselling and community programs.
It has also been argued that youth nicotine use is primarily driven by illegal markets, and that enforcement should be the focus. While illegal products are a concern, enforcement alone will never be enough for this multivariate issue. Canadian youth require robust prevention programs in their schools and communities, strong regulation of marketing and sales, and public campaigns that counteract the normalization of vaping and nicotine use in today’s culture.
The 2021-2022 Canadian Student Tobacco, Alcohol and Drugs Survey found that roughly one in three high-school students had attempted vaping. Longitudinal studies in Canada also indicate that youth who vape have nearly twice the odds of progressing to daily cigarette smoking.
Prevention, not just enforcement, is how we protect the next generation.
A long-term vision would mean fewer patients suffering from preventable disease, fewer families grieving avoidable deaths and a healthcare system no longer burdened by tobacco’s costs. That can be best achieved by using settlement funds to scale up prevention and cessation.
The tobacco settlement is historic not only because of its magnitude, but due to what it symbolizes: accountability for decades of harm. Now we face a choice. Do we let these funds be diverted into short-term fixes and industry narratives? Or do we use them to build a healthier, tobacco-free Canada?
We urge provincial and territorial governments to seize this opportunity. Invest in prevention. Guarantee free and universal access to proven cessation tools. Fund education that keeps youth from starting. That is the legacy Canadians deserve.
As medical students, we hope for a future where fewer of our patients suffer from preventable tobacco-related illness. A future within reach if we act now.
Salar Farokhi Boroujeni, Shavez Khan, and Rushil Dave are third year medical students at the University of Toronto
Photo courtesy of DepositPhotos
