Singapore Looks To Be Tobacco Free

Mr Speaker, Sir, 11 Members have spoken on this Bill. Dr Lam Pin Min gave us a good account of the harm of tobacco.

Mr Hri Kumar’s passionate speech struck a chord. Your common message is loud and clear: “tobacco is harmful, let’s do our best to protect our people from its harm”.

Thank you for supporting this Bill. We will do what is practical to implement it effectively.

Emerging Products

First, many members support the ban on emerging tobacco products. Mr Seah Kian Peng’s account on snus, a smokeless product, is instructive. Let’s not allow them to land here.

However, Dr Lam Pin Min and A/Prof Fatimah Lateef suggested that we do not ban such products entirely, but to consider some of them as part of a harm reduction strategy to help smokers quit smoking.

It reminded me of our experience with Subutex as a harm reduction strategy to get drug addicts off heroin. The West touted this strategy and we tried it out with disastrous results. It took MHA and I quite some time to reverse the policy.

A less harmful tobacco product is an oxymoron. I share Mr Hri Kumar’s view on this subject and agree with his robust approach. In the 1970s, the tobacco companies introduced cigarettes purported to be “low tar”, “light” or “mild” as safer alternatives.

They promoted such cigarettes to smokers who had heath concerns and were thinking of quitting. These products rapidly gained market share. As a result, there was a net increase in cigarette consumption. Independent research later on showed that smokers compensated by smoking more cigarettes or inhaling more deeply.

Prof Lateef quoted the positive experience of snus in Sweden. The Swedish experience has never been replicated outside of Sweden. I note that snus is a Swedish product.

The evidence is actually the opposite, with the use of snus resulting in smokers becoming addicted to both cigarettes and snus. More smokeless tobacco use does not mean less cigarette smoking.

Smokers use smokeless tobacco products to tide over nicotine craving in places where smoking is prohibited while continuing to smoke in other places where smoking is allowed – this perversely reduces the impetus for them to quit smoking.

Meanwhile, tobacco companies get to entice non-smokers to develop nicotine addiction, adding to their customer base.

Our experience with Subutex as a less harmful heroin substitute is similar. Instead of reducing the number of drug addicts, we ended up with more. I strongly advise against adopting such so-called harm reduction strategy.

But I agree with Dr Lam and Prof Lateef that we should try to help smokers “to gradually quit in a controlled manner”. There are proper ways to do so, one is through controlled Nicotine Replacement Therapy (NRT), by following strict guidelines. We do not prohibit nicotine used in such a manner.

I would like to assure Mr Alvin Yeo that we will, in the assessment process, undertake the necessary studies before imposing any ban under Section 15. We will keep an open mind about this.

Education and Smoking Cessation

Second, all the members expressed concerns over the rising smoking prevalence among certain population groups, including the young, the ladies and the Malays. Mdm Halimah’s speech in Malay made a heart-felt appeal to the Malay smokers to think about the welfare of their children and to get them to stop smoking.

To be credible, they have to walk the talk by quitting smoking themselves. I join her in this appeal. I also thank Mdm Halimah for highlighting the harm pregnant mothers bring to their infants if they smoke.

All the Members called for stronger smoking control measures. I agree entirely.

We have implemented various programmes, and we will continue to try new ones. We work with schools, religious institutions, the employers, the charity sector and the community at large. I note Mdm Halimah’s illustration of the Sheraton Towers as an exemplary employer who went the extra mile to get their employees to quit smoking. I applaud such employers and urge more to join the movement.

I heard Mdm Cynthia Phua’s call for schools to reach out to students who smoke and get them to quit. I appreciate her sharing several research findings done in schools overseas on effective counselling, including telephone counselling. I note her point that with teens, enforcement and penalty do not work as well.

The psychology often works the other way. What is prohibited becomes highly valued. We try to tap on the young to guide us on how to reach out to their peers.

I had focus group discussions with young lady smokers. They knew the harm of tobacco and had tried to quit but when their own family members and close friends are smokers, they found it difficult. This is obviously a complex issue. As Prof Straughan noted, one underlying cause could be the larger problem of some youths needing to embrace “sub-cultures” in order to seek “affirmation from like-minded peers”.

We will definitely try to do more and learn from others. We have discussed the various initiatives in this House before. In the interest of time, I will not repeat them here.

Our efforts have not been futile. Let me quote one indicator. The proportion of Secondary School students who have ever tried cigarette smoking has dropped from 26% in 2000 to 16% in 2009. This is a victory for us. But we need to do better.

Third, Ms Ellen Lee, Mdm Halimah, and Prof Straughan called for stronger enforcement against sales to the under-age. I agree. We will step up policing on tobacco retail outlets. We will consider raising the penalty on repeat offenders. We are also considering disallowing tobacco sales in outlets frequented by young customers.

FCTC Obligations

Fourth, Dr Lam Pin Min asked about Singapore’s compliance with the Framework Convention on Tobacco Control (FCTC) and whether we had been tardy. To date, we will be the third country in the world to fulfil all the obligations on tobacco labelling should this Bill be passed.

Dr Lam wondered if the delay in implementing the FCTC was a cause for the increase in smoking prevalence here. I doubt it. We have been ahead of the curve in tobacco control and in any case were largely FCTC compliant right from the start.

Dr Lam asked if we should give the tobacco companies more than 12 months to implement the changes to tobacco product packaging. We decided on “12 months” based on actual past experience when we introduced mandatory health warning labels. They were able to comply.

I appreciate Mr Sin Boon Ann’s thoughtful piece on “lateral advertising”, “subliminal marketing” and “advertising through the internet”. Mr Calvin Cheng made a similar observation. Indeed, these are the innovations that tobacco companies are mounting to get around the FCTC. It is a hot topic currently being discussed among international regulators including ourselves.

We do not yet have all the answers to these challenges. For example, how do we deal with internet advertising?

How do we censor out scenes of James Bond smoking a particular brand of cigarette? I have not noticed Mr Sin’s observation that Mark Lee seemed to be particularly fond of Marlboro cigarettes. I will have a quiet word with him the next time I see him.

But where we can, we should act. For example, we have removed the exemption for congratulatory messages and sponsorship publicity.

Mr Hri Kumar has described past misleading behaviours by tobacco companies. This is unethical behaviour. I agree with his observations.

From a public health perspective, misleading terms are just as misleading, even if they are part of a trade mark. Mr Alvin Yeo raised several legal queries on this. The new s17A will affect trademarks if they contain misleading descriptors.

We are aware of our TRIPS and other international obligations and have consulted the relevant authorities extensively on this point. The proposed section 17A is aligned closely to the FCTC and will not violate Singapore’s international obligations. We are in good company: the EU prohibits misleading terms and descriptors even if they are part of the trademarks or brand names.

Other Issues

Lastly, there were some comments which do not pertain to the proposed amendments in the current Bill. But let me briefly address them.

Ms Ellen Lee and Mr Hri Kumar made a plea on behalf of the non-smokers and especially innocent children, from the effects of second hand smoke from inconsiderate neighbours, and irresponsible parents. Ms Lee asked the NEA to widen the outdoor smoking ban to include more common places in HDB towns, such as void decks and common corridors.

I will raise her suggestion with the NEA. Mr Hri Kumar asked rhetorically how we could extend the law to the privacy of the home, in order to protect the children from second-hand smoke. He knew it is outside my purview. But I note his point.

Dr Lam suggested that we control retail pricing of tobacco products, to make them expensive, thus curbing consumption. In practice, price fixing seldom works, as we live in a region where cigarettes are cheap. For the same reason, while we have been aggressive in tobacco taxation, there are limits, but we will continue to use this strategy where practical and feasible.

Conclusion

Mr Speaker, Sir, tobacco related deaths and illnesses are preventable. Let’s try to make Singapore as tobacco free as possible. When drafting this Bill, we had extensive consultation with Singaporeans. The amendments received strong support from them.

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