It is 2018 and humankind still finds itself unable to rid itself of the smoking habit it had started many centuries ago. Once the major sponsors of famous sporting events like football, smoking is now relegated to the sidelines as an unhealthy and unglamorous habit. The struggle to eliminate smoking is a universal one and more pronounced in Asia where 50% of the world’s smokers live. Singapore, as with the rest of its Asian counterparts, has not been idling in its efforts to stem the spread of tobacco use.
In fact it could be said that the island republic is enacting rather harsh laws in its efforts to reduce tobacco use and addiction. The government banned the buying, using and possessing alternative tobacco products like e-cigarettes, shisha and chewing tobacco on 1 February 2018 as part of an amendment to the existing Tobacco Act which was passed in parliament in November last year.
The ban on these “alternative” tobacco products has stirred public interests and arguments once again on an issue that has been ongoing for a long time without a clear and certain conclusion. Everyone knows the hazards of smoking and yet the law still allows for it albeit in a restrictive and limiting manner of usage. Cigarette smoking is deemed disgusting by health experts, fitness enthusiast but most countries still profit off the taxes levied on these tobacco products. Much like the case for alcohol.
The World Health Organization through its Framework Convention On Tobacco Control had laid out measures to curb the spread of tobacco use. Among them are the need to monitor tobacco use and the implementation of prevention policies. Protection of the public from the hazards of tobacco smoke, raising taxes on tobacco products and the enforcement of bans on the tobacco advertisement, promotion and sponsorship are among the traditional, conventional steps it recommended.
This begs the question of how serious most countries are in effectively curbing what is universally labelled as an unhealthy habit. The selective ban on certain but not all forms of tobacco does not really solve the problem of tobacco addiction. It may in certain ways perpetuate it.
The controversy in recent years has been whether government policies regarding tobacco use are properly based on scientific, empirical studies rather than socio-economic ones.
In order to solve or at least better manage a health problem such as tobacco addiction, it would be practical and logical to depend on science. The social stigma assigned to smokers has not helped to lower the number of people who turn to tobacco use so perhaps it is time to employ the use of other approaches.
That instead of banning alternatives to burned tobacco such as cigarettes, authorities could allow the usage of alternative tobacco products like e-cigarettes or heat-not-burn tobacco as means for smokers to quit smoking. This should and would be done with valid findings by substantiated studies on its use in the long term process of quitting tobacco use entirely.
Every country strives to implement the ideals of a healthy and clean environment for its citizens which is devoid of tobacco smoke. Hence the use of the law to deal with it. Ideals are necessary in nation-building but also necessary are realistic and scientifically-backed steps and solutions to tackle the problem itself.
The addiction to conventional cigarettes are so powerful that statistics has shown that smokers with chronic diseases such as cancer and heart problems have succumbed to the habit even after quitting. Burning tobacco is considered the 6th most harmful substance and more addictive than heroin.
Factors such as family and social modelling, peer acceptance and pressure along with poverty and gender all work together to present smoking as a safe and even warranted form of vice, especially for men.
The conventional nicotine replacement therapy (NRT) method that helps smokers to quit such as the nicotine patch, pills, lozenges are not very appealing and attractive to most smokers. It is promoted as a type of medicine and thus seeking to buy it at pharmacies suggest that smokers are actually sick. Thus there does not seem to be much incentive in quitting if the methods are so impractical and difficult.
Thus it forces us to rethink if the current measures are sufficient in dealing with this tobacco problem. The possibility of trying new ways in dealing with the tobacco problem which continues to plague the world.
In the UK, for example, the government have been studying the impact of alternative tobacco use such as vaping as a feasible means to help smoker to permanently quit smoking. Indeed no method could claim to be risk free but studies have shown that alternative tobacco products pose only a fraction of the risks that burnt tobacco does. In Public Health England (PHE)’s February report on e-cigarettes this year, it reviewed current evidence and updated on its 2015 report which stated that e-cigarettes are 95% less harmful than conventional cigarette.
In particular, PHE’s report highlight that its evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked). A point which Singapore authorities have used to justify the ban of alternative tobacco products such as e-cigarettes.
Governments should consider harm reduction from smoking and not just conventional methods such as raising taxes or banning smokers from lighting up in more and more public spaces. They could commission an independent study to better equip it before forming policies or laws pertaining to tobacco use. So far, the health ministry in Singapore have relied on studies overseas to support its ban on alternative tobacco products and insist on its stance on absolute abstinence of nicotine without banning conventional cigarettes outright.
The crux of the problem must be dealt with and more creative steps taken. Allowing alternative tobacco products could be the first step in the long process of getting smokers to quit entirely.
Andrew da Roza, a qualified addictions psychotherapist based in Singapore, noted in his speech at a forum on harm reduction this year, on how alternative tobacco products have brought down the consumption of traditional cigarettes in various countries.
He noted that despite following all the recommendations by the World Health Organisation on reducing smoking, Singapore and Australia have not seen change of its smoking prevalence. This is in contrast to Japan which allows e-cigarettes and other reduced harm products, which is reporting a 27 percent drop on its smoking prevalence.
- Japan – CC purchases down 27% between 2016 and 2017
- S. Korea – 12% drop in CCs for the recent 4 quarters in S. Korea
- UK – 22,000 – 57,000 smokers a year quit using e-cigs
- US – cessation rate study – e-cig users 4x more likely to quit than non-users
Alternative tobacco products should be presented to the smoking population in a more appealing way to encourage them to consider stopping cigarettes. Hence they would be switching from a more chemically-addictive tobacco product to one that has much less nicotine content and is less addictive. Smokers should be motivated to quit instead of punished for smoking. That being said, e-cigarettes as well other alternative products could still be regulated as cigarettes and not pose any health hazards to the general public.
After all, anything that is done more willingly would be more likely to yield the positive results we seek.