The conversation about secondhand smoke resurfaced in the public sphere recently when Nee Soon GRC MP Louis Ng spoke on his adjournment motion in Parliament on Monday (5 Oct) where he called on the government to ban residents from smoking near windows and at the balconies of their homes to minimise the effect of secondhand smoke on neighbours.

Mr Ng, who is also the chairman of the Government Parliamentary Committee (GPC) for Sustainability and the Environment, noted that those inhaling secondhand smoke are “actually exposed to more chemicals than the smokers themselves”.

He explained further that sidestream smoke—the main component of secondhand smoke—is “four times more toxic than the smoke that a smoke inhales from cigarette.”

In his speech, Mr Ng proposed that a ban on smoking near windows and on balconies are no more intrusive to Housing Development Board (HDB) flat residents than other laws already imposed such as the ban on cats, nudity and feeding wildlife.

He further suggested that surveillance cameras be used to catch those who smoke at balconies and windows.

He said, “Our proposal is enforceable using existing technologies already used on the ground. NEA has been using cameras to catch high-rise litterbugs. These surveillance cameras are focused only on the external facade of the housing units being investigated to capture the act of littering. It can even capture someone throwing cigarette butts out of their windows.

In response, Senior Minister of State for Sustainability and the Environment Dr Amy Khor said that such a ban “could be highly intrusive” to the people and that it is not always possible to position cameras at “suitable vantage points” to catch those smoking at windows and balconies.

Now, given how dangerous secondhand smoke can be to other people—Mr Ng noted that the Ministry of Health has said that even the slightest exposure to secondhand smoke can harm babies and young children—why are we not simply banning cigarettes altogether?

We know that e-cigarettes and vaping are illegal in Singapore. Buying, selling, possessing or even sharing photos or videos of vaping online is an offence under the Tobacco (Control of Advertisements and Sale) Act (TCASA).

Healthhub Singapore notes that as of 4 February 2020, vaping has been linked to at least 64 deaths and over 2,750 cases of respiratory illness in the United States, highlighting also the World Health Organisation (WHO)’s declaration that e-cigarettes are “undoubtedly harmful” and it is not a safer alternative to standard cigarettes.

As for how harmful cigarettes are, Mr Ng pointed out that 383 people in Singapore died in 2016 due to secondhand smoke.

“That is about one person dying every single day. We must do something,” urged the MP.

MOH says e-cigarettes are a gateway to real cigarettes, despite studies showing otherwise

Back in 2017, amendments were made to the Tobacco (Control of Advertisements and Sale) Act which banned for people from buying, using and owning imitation tobacco products, such as e-cigarettes, e-cigars and e-pipes.

When debating the bill, several MPs raised questions on whether there could be a consideration on the total ban on e-cigs and alternative product, suggesting alternative proposals such as the one by then-Non-consituency Member of Parliament, Leon Perera that only confirmed smokers be given controlled access to e-cigarettes as a means of smoking cessation and harm reduction.

However, Parliamentary Secretary for Health at the time, Mr Amrin Amin, brushed aside those concerns by citing studies which show that e-cigarette users have a higher risk of transitioning to traditional cigarettes.

He said, “There had been studies in the US, UK and Canada, which followed up on more than 40,000 youths over time, and found that e-cigarette users had a greater risk of becoming cigarette users. All these studies have found evidence to support the gateway effect.”

However, Mr Amrin did not specify which studies he was referring to exactly.

Mr Amrin also took time to discount the other studies raised by the other MPs, such as when he said the study MP Louis Ng’s referred to—by Prof Linda Bauld, that many people are using e-cigarettes rather than other available options to stop smoking, and it has been successful for a significant number of smokers—was a cross-sectional study that looked at the situation at one point in time and has a design that is not suitable for studying the gateway effect.

Mr Amrin also said that the 2015 report by Public Health England which Mr Perera referenced showing that e-cigarettes are 95% less of a health hazard to conventional tobacco consumption had a limited number of studies used in the report.

He went on to note that an editorial in the Lancet, a leading medical journal, has criticised the report for using weak evidence but did not mention what name was the editorial and when it was published.

There were several other studies and reports which clearly emphasise the usefulness of e-cigarettes in helping smokers to quit which seemed to have been sidestepped by the MOH and the government in their consideration of banning these products, as TOC noted in a 2017 article.

“Our goal is not just a smoke-free future, but a nicotine-free one. So-called lesser-harm tobacco products still expose the user to toxic and addictive substances that are harmful to health.” said the Parliamentary Secretary.

PHE report in 2018 says e-cigarettes are 95% less harmful

More recently in 2018, Public Health England (PHE) released an new report on e-cigarettes as a review of current evidence and an update on its 2015 report which stated that e-cigarettes are 95% less harmful than conventional cigarettes.

Its evidence review came just a few weeks after a US National Academies of Sciences, Engineering and Medicine report on e-cigarettes, which also found that ‘e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes’ based on the available evidence.

The 2018 report found that vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits, e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more, e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country, among other findings.

Most pertinent, however, is the finding that the 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).

Professor John Newton, Director for Health Improvement at PHE said, “Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.”

“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know,” he stressed.

“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety,” he added.

So, given what we know about how deadly secondhand smoke is to others, how detrimental smoking is to smokers, and the evidence that e-cigarettes can play a major role in helping reduce the number of smokers, why is Singapore not also banning conventional cigarettes and allowing less hazardous alternatives?

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