Can we have courage in our tobacco policy-making?
by Daniel Yap
TWO op-eds on tobacco in the run-up to Budget 2017 caught my eye.
The first is one by the economist Mr Donald Low in the Business Times on Feb 17, calling for a “grand bargain” – an exchange of cigarettes for reduced-risk tobacco products.
The second is by Dr Chia Kee Seng, professor and dean at the Saw Swee Hock School of Public Health, National University of Singapore, and Dr Kenneth Warner, Avedis Donabedian Distinguished University Professor of Public Health at the Michigan School of Public Health, University of Michigan, published in Straits Times (ST) on Feb 18.
The two doctors called for an end to the scourge of smoking, pitching once again the G’s already-proposed measures of age limits, flavour bans and packaging changes as the way forward. These ideas are already being implemented by other nations.
Both pieces agree on this point – courageous action must be taken to mitigate the high cost of tobacco on our society. But do Singapore’s policymakers have the courage to save lives?
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Singapore’s tobacco policy of ever-higher taxation, bans and graphic marketing has not put a significant dent in the smoker population in Singapore over the last decade. Smoking prevalence has hovered between 12 and 16 per cent, with male smoker prevalence around 25 per cent.
One should note first that in Singapore, one-fourth of those below 18, the current legal age, had already tried smoking. It stands to reason that more laws will not stop this segment of curious youth from engaging in risky, illegal behaviour. And with the youth segment being the true “gateway” to smoking (a huge majority of smokers get hooked before the age of 21), it seems that more laws alone are unlikely to put a significant dent in the smoking rate.
The Health Ministry has set an ambitious target of 10 per cent smoking prevalence by 2020. It is admirable, maybe even attainable, but it is a big reach nonetheless. Dr Chia and Dr Warner pointed to New Zealand, Finland, Canada, Sweden and France as countries that have set a goal for a smoke-free society in eight to 23 years.
What is notable is that these countries, and many others at the forefront of the anti-smoking movement, allow reduced-risk tobacco products as a way for smokers to either quit or at least reduce the cost of smoking to society.
Singapore remains stubbornly behind the times in this area, maintaining a ban against reduced-risk products and constantly citing worry about a “gateway effect” where e-cigarettes, snus (chewing tobacco popular in Sweden and Finland), and heat-not-burn products would lead youth and non-smokers to pick up smoking.
Studies in the United Kingdom (UK) over the last few years, however, have shown that the gate swings almost uniformly in one direction: helping smokers quit (and typically become e-cigarette smokers) rather than enticing youth or non-smokers to “upgrade” to smoking. You can find the Department of Health’s findings published here.
Taking on some risks for greater good
That’s where Mr Low’s “grand bargain” comes in.
Based on the UK research, would it not be more prudent to lift the ban on reduced-risk products while at the same time clamping down on smoking tobacco? No doubt e-cigarettes are harmful to health, but this is a risk mitigation situation, much like how the G wants gamblers to put their money with well-regulated casinos or with entities like Singapore Pools and Singapore Turf Club, which will redistribute to social causes.
We must remember why we want to bring the smoking rate down: the health and social costs of smoking are high. If there is a way to reduce the costs by allowing alternative products, why not? Reduced-risk products can continue to be regulated and taxed as cigarettes currently are. And with alternatives in place, we can look to the other side of the “grand bargain” – cutting down on smoking, perhaps even to the point of banning it altogether.
It seems that harsher laws against smoking would be most effective in tandem with the availability of alternative tobacco or nicotine products, with a complete smoking ban as the end game.
Perhaps Singapore can lead the world in this area as well, and become a smoke-free nation by 2030? What will it cost us? Likely nothing more than converting smokers to lower-risk non-smoking tobacco and nicotine products. Courageous policy-making like this, I think, is the best care that this nation can provide for the long-term health of its smokers – and non-smokers too.
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