TOBACCO products kill over eight million people globally per year, most of them living in low- and middle-income countries. But the adverse effects of smoking don’t just impact smokers: 1.2 million non-smokers are killed annually due to exposure to secondhand smoke.
In South-East Asia, more than half a million people die from tobacco-related diseases every year.
The situation in Malaysia is also bleak. According to the 2019 National Health and Morbidity survey, more than 27,200 of Malaysians deaths annually are related to smoking. The report found the smoking prevalence among Malaysians aged 15 and above to be 21.3%, with an estimated 4.8 million currently smoking. The prevalence of smokers in the 15- to 19-year-old age group was 12.3%.
The statistics are worryingly high, and indicate not enough is being done to deter tobacco use in our country. Is it time we took more serious measures, and perhaps look at other strategies that can be emulated?
New Zealand’s new anti-cigarette law, announced last month, is one of the toughest in the world. It is expected to be enacted by the end of this year and will be implemented in stages from 2024. It will start with a reduction of authorised cigarette sellers, reduction of allowed nicotine levels by 2025, and by 2027, those aged 14 and under will never be allowed to purchase cigarettes in their lifetime.
In short, New Zealand is moving towards gradually outlawing all cigarette sales in a generational ban to create a “smoke-free generation.”
Unfortunately, New Zealand’s law does not apply to e-cigarettes or vaping, which is increasing in popularity among youths. The reasoning is that e-cigarettes are less damaging and can be used to help people quit smoking. Nonetheless, e-cigarettes also contain dangerous substances like nicotine, and its use has been linked to chronic diseases. The World Health Organisation (WHO) has also warned that all forms of tobacco, including heated tobacco products used for vaping, are harmful.
To ensure all bases are covered, e-cigarettes must also be strictly regulated, or even banned, alongside conventional cigarettes. This is because adolescents who use e-cigarettes are three to five times more likely to start smoking cigarettes compared with those who have never used them, according to data from the Southeast Asia Tobacco Control Alliance (Seatca). In Malaysia, the prevalence of e-cigarette users is highest among the 20 to 24 age group at 14.7%.
Some argue that to truly win the war against smoking, we need to take stern measures like what is being done in New Zealand, or in Bhutan, which banned the sale of tobacco in 2004. But can Malaysia enact such strict legislations against tobacco, and is there the political will to do so?
Right steps
Respiratory physician Dr Helmy Haja Mydin is supportive of a generational tobacco ban in Malaysia, and believes that with the right steps, such a measure can be implemented successfully.
“We all know that smoking is bad for us – 50% of all smokers die from smoking-related diseases – but we struggle with the feasibility of an outright ban. A generational end game (ie, to ban sales of cigarettes to individuals who are born after a certain year) allows us to prepare for such an eventuality in a more practical fashion,” says Dr Helmy.
The rationale behind the generation ban is that while existing smokers are given assistance to quit smoking, efforts are put in place to prevent uptake among new users, Dr Helmy says.
These kinds of policies are designed to reduce the risk of youth taking up smoking and becoming lifelong users of nicotine, which is one of the most addictive substances known to humankind. It will protect youths from the dangers of a lifelong addiction that can lead to lung disease, heart failure, kidney impairment, cancers and strokes – among other diseases.
New Zealand’s bold new legislation may work in a country where only 13.4% of adults are smokers and anti-smoking policies are strong. But how about Malaysia, where the smoking rates are much higher and tobacco companies have strong sway?
In a 2021 Seatca study on tobacco industry interference in Asian countries, Malaysia scored a troubling 66 out of 100. In the study, lower scores mean better implementation of the WHO’s Framework Convention on Tobacco Control (FCTC) Article 5.3 and its guidelines. Higher scores mean that tobacco industries have more interference in a country’s tobacco-control regulations.
FCTC Article 5.3 emphasises vigilance and a need to protect public health from the tobacco industry’s strategies that challenge new and weaken existing tobacco control measures and life-saving policies.
“In a recent meeting on tobacco control issues, Minister Khairy Jamaluddin stated that the Health Ministry is contemplating introducing a similar tobacco generational end game. Such a policy is feasible if stakeholders are given sufficient time for the change and efforts to improve health literacy are ramped up,” Dr Helmy says.
One of the biggest hurdles is countering the pro-tobacco lobby, which Dr Helmy predicts “will come out in full force to oppose a generational end game, a policy that threatens future profits”.
“Some politicians may be tempted to buy into the pro-Big Tobacco argument, but it would be very difficult for a politician to vote against a measure that prevents the death of more than 20,000 Malaysians each year,” he adds.
Big Tobacco interference
Despite overwhelming evidence against smoking and its harmful iterations, the tobacco lobby is strong and continues to expand. According to Seatca, nearly all of the major tobacco players in the region have also ventured into electronic smoking devices (ESDs) such as e-cigarettes. Seatca’s 2021 Tobacco Industry Interference Index report further explains how the tobacco industry has “influenced governments to relax tobacco control measures, including regulations on ESDs in Indonesia, Malaysia, Philippines, and Vietnam to be aligned with its business”.
While an argument could be made about potential financial losses Malaysia might face from a generational tobacco ban – tobacco tax as a percentage of retail prices in Malaysia is 58.6% – this loss in income is balanced out by the the far larger savings that will be made from not having to treat various smoking-related diseases, Dr Helmy points out.
Especially in times of Covid-19, tobacco use and the diseases linked to it will put further pressure on an already weakened healthcare system that is grappling with the long pandemic.
“The acute and chronic effects of these diseases – such as emphysema, heart failure, kidney impairment, cancers and strokes, among others – place a heavy burden on our nation’s finances,” he says.
To anticipate another eventuality, Dr Helmy says that pro-tobacco lobbyists will argue that any move to restrict tobacco sales will lead to a flourishing illicit cigarette market. However, he argues that this is a matter of execution not policy, and that this can be overcome with better enforcement of the law.
“This would include ensuring that enforcement agencies are sufficiently staffed and trained, and mechanisms are put in place to reduce corruption,” he points out.
There is also a link between tobacco use and its perpetuation of the cycle of poverty.
Seatca explains the average expenditure for manufactured cigarettes among Malaysian smokers in 2011 was RM178.80 a month. This is a large amount, especially for poorer families, to divert from limited funds available for basic necessities. Furthermore, longterm healthcare expenses will also impact a family’s spendable income and deteriorate quality of life.
If you need assistance to stop smoking, call the Health Ministry’s JomQuit hotline at 03-8883 4400. The National Cancer Society of Malaysia also runs a Quit Smoking Clinic and can be contacted at 03- 2630 6670.
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