The morning mist still clung to the shores of English Bay as I met with Dr. Elena Kwan at a small café near St. Paul’s Hospital in downtown Vancouver. A respirologist who has spent two decades treating patients with smoking-related illnesses, Dr. Kwan had just finished her night shift and ordered a double espresso before we began discussing what many are calling a watershed moment in Canadian public health.
“I’ve watched too many patients struggle to breathe in their final days,” she told me, her voice softening as she stirred her coffee. “This settlement won’t bring them back, but it might prevent others from ending up in those hospital beds.”
The “settlement” Dr. Kwan references is Canada’s newly announced $23.6 billion agreement with major tobacco companies, a legal victory nearly three decades in the making. Earlier this week, federal officials confirmed that Imperial Tobacco Canada, Rothmans, Benson & Hedges and JTI-Macdonald will pay this substantial sum to all provinces and territories to resolve healthcare cost recovery lawsuits dating back to the 1990s.
After years of legal maneuvering, the three companies have agreed to make payments over 22 years, with funds beginning to flow as early as September. It’s a moment many tobacco control advocates had started to believe might never come.
The provinces initiated these lawsuits to recover the enormous healthcare costs associated with treating tobacco-related illnesses. According to Health Canada data, smoking-related diseases cost our healthcare system approximately $6.1 billion annually, while claiming over 48,000 Canadian lives each year.
Rob Cunningham, senior policy analyst with the Canadian Cancer Society, called the agreement “historic” during our phone conversation yesterday. “This settlement holds the tobacco industry accountable for decades of health damage and deceptive marketing practices,” he explained. “The billions recovered will help fund stretched healthcare systems and strengthen tobacco control initiatives.”
Walking through Vancouver’s Downtown Eastside later that afternoon, I spoke with community health worker Mariam Abukar, who has been running smoking cessation programs in the neighborhood for six years. She greeted several clients by name as we talked about what the settlement might mean for communities disproportionately affected by tobacco use.
“The tobacco companies targeted vulnerable communities for generations,” Abukar said, pausing to check in with an elderly man she recognized. “Indigenous communities, low-income neighborhoods, people dealing with mental health challenges—they’ve all borne the brunt of aggressive marketing tactics. Any settlement money that reaches prevention programs in these communities would be justice long overdue.”
The settlement comes after Imperial Tobacco, Rothmans, Benson & Hedges, and JTI-Macdonald filed for creditor protection in 2019, a move that temporarily halted the lawsuits but ultimately led to this negotiated resolution. The companies have admitted no wrongdoing as part of the agreement.
British Columbia was the first province to launch litigation against the tobacco industry in 1998, inspired by similar actions in the United States. Other provinces gradually followed suit, creating a nationwide legal pressure campaign that culminated in this collective settlement.
Justice Minister Arif Virani emphasized the significance of the agreement, noting that the funds would support healthcare systems across the country. However, the settlement does not specify exactly how provinces must allocate these billions, raising questions about accountability and transparency.
When I visited the BC Cancer Centre last month for an unrelated story, I met Elijah Crowfoot, a 67-year-old member of the Siksika Nation who was receiving treatment for lung cancer after smoking for four decades. Reaching him by phone yesterday to discuss the settlement news, Crowfoot expressed mixed emotions.
“The money’s good, I suppose, but it won’t give me back my lungs or the years I’ve lost,” he said. “What matters is what they do with it. Will it reach our communities? Will it help young people avoid what happened to me? That’s the real question.”
Public health experts I spoke with share similar concerns. Dr. Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, emphasized that the settlement’s impact will depend entirely on how the funds are deployed.
“The evidence is clear on what works for tobacco control,” Dr. Caulfield told me. “Comprehensive prevention programs, cessation support, counter-marketing campaigns, and policy measures like plain packaging. The danger is that these billions could disappear into general revenue without dedicated funding for tobacco control.”
According to the Canadian Lung Association, tobacco use remains the leading preventable cause of disease and death in Canada, with approximately 4.2 million Canadians still smoking despite decades of public health campaigns. The organization has called for settlement funds to be earmarked specifically for smoking prevention and cessation programs.
As the sun began setting over English Bay, I reconnected with Dr. Kwan, who was preparing for another night shift. “When I started practicing medicine, nearly one in four Canadian adults smoked. Now it’s closer to one in eight,” she reflected. “That progress didn’t happen by accident—it came through sustained public health efforts. This settlement could accelerate that progress, but only if we’re strategic about it.”
The settlement, while substantial, represents only a fraction of the total healthcare costs incurred over decades of treating tobacco-related illnesses. Yet it marks a significant turning point in Canada’s long struggle to hold the tobacco industry accountable for its impact on public health.
Back in the Downtown Eastside, Abukar showed me a small community garden where some of her program participants gather. “Healing happens in community,” she said, gesturing to the small plots of vegetables and flowers. “Whatever comes from this settlement needs to support community-based approaches, not just clinical interventions.”
As provinces prepare to receive their portions of the $23.6 billion, the question remains: Will this hard-won victory translate into meaningful health improvements for Canadians, or will it become another missed opportunity? The answer may take years to emerge, but for those who have spent decades fighting against tobacco-related harm, the settlement represents both validation and a chance to prevent future suffering.