Debated in Parliament on 14 Mar 2016.
Order for Second Reading read.
Mdm Speaker, I beg to move, "That the Bill be now read a Second time."
The adverse health effects caused by smoking tobacco are well-known. Smoking is the primary cause of lung cancer and is also a risk factor for other types of cancer, such as cancers of the mouth, upper throat, oesophagus, bowel and bladder. Smoking is also a risk factor for many major chronic diseases, such as high blood pressure, chronic lung diseases, heart disease and stroke.
Tobacco itself contains more than 60 chemicals, including nicotine. Nicotine is the substance that causes addiction. Once addiction sets in, many smokers find it difficult to quit even though they might want to.
Worldwide, tobacco is the cause of approximately six million deaths annually. More than five million of those deaths are a result of direct tobacco use, while more than 600,000 are the result of exposure to second-hand smoke. Many deaths due to tobacco use are preventable. Smoking is the second highest risk factor that contributes to the burden of disease in Singapore. About six Singaporeans die prematurely from smoking-related diseases each day.
In Singapore, we have brought down smoking rates over the years, from 18.3% in 1992, to an all-time low of 12.6% in 2004. We did this by being aggressive in our tobacco control measures. We introduced progressively stricter restrictions on smoking advertisements, banned the use and possession of tobacco by minors under 18, introduced mandatory graphic health warnings and banned misleading descriptors, such as "mild" or "light".
Nonetheless, our smoking prevalence has, in recent years, crept up somewhat, to reach 13.3% in 2013. We have tightened up our tobacco control measures in the past two years. In November 2014, we introduced the ban on shisha or water pipe tobacco.
In December last year, we banned emerging tobacco products not currently in the Singapore market, such as smokeless cigarettes. On 1 August this year, the ban will be extended to products available here, such as snuff and gutkha.
The Tobacco (Control of Advertisements and Sale) (Amendment) Bill seeks to amend the current Tobacco (Control of Advertisements and Sale) Act to introduce the point-of-sale display ban.
In addition, MOH will be using the opportunity to further streamline our tobacco control measures and address new regulatory challenges posed by the tobacco industry.
Mdm Speaker, please allow me to highlight the major provisions being introduced in the Bill. First, let me elaborate on the point-of-sale display ban.
The ban on point-of-sale display of tobacco products is a continuation of our tobacco control efforts. Firstly, we want to reduce exposure of non-smokers, especially youths, to the advertising effect of point-of-sale tobacco product displays. The aim is to, ultimately, de-normalise tobacco use.
Secondly, we want to decrease impulse purchases of tobacco products, thereby helping smokers who are trying to quit. Other countries, such as Australia, Canada, Iceland, New Zealand, Thailand and the UK, have successfully introduced a point-of-sale display ban.
The new section 12A in clause 14 of the Bill will introduce the prohibition on the display of tobacco products. This will apply to all tobacco products, including cigars, beedies, "ang hoon" and others, in addition to cigarettes.
General tobacco retailers will be required to use storage devices to keep tobacco products out of the direct line of sight of customers and the public within their premises. They may choose different methods to comply with the ban, so long as the storage unit is self-closing. Options include using gravity flaps, vertical blinds, curtains or automated sliding/closing doors. As per current requirements, the storage unit has to be plain and without design, sound or lighting decorations, as these could draw attention to the storage units and be used as a form of advertising.
Specialist tobacconists serve a niche market, as they sell primarily cigars. Unlike customers of general retailers, who may be shopping for other products, most customers who step into a specialist tobacconist shop have already made up their mind to buy tobacco products. Hence, for such shops, we will focus on limiting the advertising impact from outside the shops. Regulations will be crafted to allow specialist tobacconists to display their products within their premises, so long as the products are not visible from outside the premises.
Following feedback and appeals, general tobacco retailers will be allowed to use a text-only price list to facilitate communications with customers. Display of the price list is allowed only upon customers' request and its appearance will be prescribed by MOH. This is provided for in the new section 3(1A) in clause 4 of the Bill.
We have engaged tobacco retailers extensively since 2014 and briefed them on the requirements. Tobacco retailers will be given a one-year grace period before the point-of-sale display ban takes effect.
Globally, there has been a marked increase in the popularity of electronic nicotine delivery systems (ENDS), also known as e-cigarettes, especially among young people. ENDS vapour contains cancer-causing agents. Studies show that high school students who use ENDS are more likely to move on to smoke cigarettes. To protect public health, Singapore has pre-emptively banned the import, distribution and sale of ENDS.
ENDS are banned under the existing Act as imitation tobacco products that are designed to resemble existing tobacco products. Earlier models of ENDS looked like traditional cigarettes, to appeal to smokers or would-be smokers. However, newer varieties of ENDS do not necessarily look like cigarettes. They are sleek, colourful and deliberately attention-grabbing. They target not just current smokers, but also seek to expand market demand, especially among youth and women. Please let me show you. This is ENDS 1.0, an earlier version. And these are the newer ENDS products.
Clause 18 of the Bill repeals and re-enacts section 16 of the Act to make it clear that the existing ban on the importation, distribution and sale of imitation tobacco products also includes products that may be used in such a way as to mimic the act of smoking, even though they may not necessarily physically resemble cigarettes or other tobacco products. The ban will also extend to the components of such products, to prevent such products from being imported in parts and re-assembled thereafter.
With the increasing popularity of ENDS, there is a need to control the advertising of such products. Clause 4 extends the existing prohibition on advertisements for tobacco products to imitation tobacco products and corresponding amendments will be made to sections 6, 7 and 8 of the Act.
With expansion of online access, there is increasing use of the Internet for tobacco advertising and commerce. As part of the global public health community, Singapore should ensure that our existing prohibitions on tobacco advertising and promotion are comprehensive and cover online advertising and promotion originating from Singapore. This is in compliance with the World Health Organization's Framework Convention on Tobacco Control, to which Singapore is a signatory.
Clause 4 of the Bill amends section 3 of the Act such that our ban on tobacco product advertisements extends to advertisements that are published electronically in Singapore. These include advertisements originating from Singapore, even if targeted at a foreign audience, as well as advertisements originating from outside Singapore that are accessible by persons physically in Singapore and published by a Singapore-connected person. A "Singapore-connected person" is defined in clause 2 of the Bill. The amended section 3 also prohibits Internet advertisements that provide a facility to the person accessing these advertisements to buy tobacco products or imitation tobacco products.
Clause 9 amends section 9 to prohibit tobacco product sales promotions that originate from Singapore, even if targeted at persons outside Singapore.
Sales promotional schemes have evolved over the years. The new section 9A in clause 10 of the Bill makes it explicit that customer loyalty programmes involving tobacco products, such as the redemption of reward points for tobacco products, and other promotional schemes are disallowed.
Besides the changes outlined above, we also took the opportunity to make a number of additional amendments to the Act to be in line with the latest legal policy developments, improve clarity, and enhance its implementation. Some of these are as follows:
Clause 12 amends the wording of section 11 to improve clarity. Authorised officers may seize the tobacco products if an offence is committed under section 11(1).
Clause 15 allows the Health Sciences Authority to specify the visual characteristics of the "No sale to minors" sign used.
Clause 16 repeals the current section 14. The existing ban on sale of tobacco products via vending machines will now be covered under the amended section 18.
Clause 20 repeals and re-enacts section 18 to clarify the licensing requirements for the wholesale or retail of tobacco products in Singapore. It will limit the sale of tobacco products to a single point of sale specified in the tobacco retail licence, to limit access to tobacco products. For example, a supermarket may only have one point of sale for tobacco products, which is already the current practice.
The Minister will be empowered to make regulations to give effect to these licensing requirements, as provided for in clause 31. For example, the Minister will be able to make regulations to specify the fees to be paid by tobacco wholesalers and retailers and the length of time for which the licences are granted.
Clause 24 provides that Police officers and authorised officers are empowered to ask a suspect to produce identification, search his bags and require him to reveal the contents of his pockets. This is necessary to prevent suspects from concealing evidence in their bags or pockets from enforcement officers. As a safeguard, enforcement officers have been trained to follow standard operating procedures strictly and regularly undergo refresher training. No physical search of the body is involved.
Clause 25 enhances the powers of investigations, by allowing the Chief Executive, HSA, and authorised officers to require relevant information to be furnished in writing, for the purposes of investigation.
Clause 26 amends section 26 to empower the Chief Executive and authorised officers to inspect and seize electronic documents and materials, computers or other relevant equipment in which evidence may be stored and to request that access codes or passwords be provided.
The clause also extends existing search powers of premises to include conveyances. It will be an offence to wilfully fail to comply with a requirement made under the amended section 26.
Clauses 28 and 29 extend the scope of powers of forfeiture to include any imitation tobacco product, document, material or article and empower the Chief Executive to give directions on the disposal of forfeited items seized under the Act. I would like to clarify that the powers of forfeiture are not new to the Act. The amendments here take into account the other changes in this Bill, as well as the changing enforcement landscape, and are scoped to allow HSA to continue exercising its functions under the Act effectively. Similar powers of seizure are provided for in the Health Products Act and the Sale of Food Act.
Mdm Speaker, smoking is the primary cause of premature death in Singapore. Though we are fortunate that smoking prevalence in Singapore has remained relatively low compared to many other countries, we must not be complacent. We also know the industry aggressively markets their products to youth, so as to hook them from an early age.
As such, we must continue and, in fact, step up our efforts to protect the public from the advertising effects of tobacco and introduce new measures to enable us to keep pace with the rapid changes in the industry. I seek Members' support for this Bill. Mdm Speaker, I beg to move.
*Question proposed. (proc text)]
Mdm Speaker, the enhancements to the Bill are evident indicators of the Government's unrelenting determination to create a smoke-free living environment in Singapore. In Singapore, tobacco kills about 2,500 smokers and 250 non-smokers each year, said the Health Promotion Board (HPB) statistics in May 2015 and that is seven and a half people killed each day. From a social viewpoint, tobacco use impinges on other peoples' lives. From an economic standpoint, the health problems created impose a financial burden on all taxpayers – you, me and everybody. This does not include the emotional and mental suffering of the victims and families who lose their loved ones due to smoking.
We have, as part of our anti-smoking campaign, required cigarette packs to carry graphic images and warnings since 2004. This was recommended as part of WHO's Tobacco Free Initiative. Such graphic warnings were found to be generally effective in creating awareness and motivating people to quit smoking, according to a study by the Harvard School of Public Health. Yet, a survey done in 2013 showed that many smokers in Singapore were undeterred by the graphic warnings. A similar sentiment was echoed by a British study held in the same year. Differing demographics worldwide can lead to inconsistencies. Therefore, we need to review policies regularly and explore new solutions.
Many tobacco companies and retailers rely on point-of-sale displays to compensate for the inability to advertise tobacco sales in many countries. Tobacco companies are great marketers. In some local convenience stores, cigarette packages dominate the most eye-catching display wall. The display takes a premium spot, for example, next to the cashier's counter. In several countries, the UK, Canada, Thailand, Australia, New Zealand among others, such displays are banned.
The Centre for Tobacco Control Research at the University of Stirling said 46% of UK teenagers were aware of the displays and those who intended to smoke were more likely to recall brands they had seen at the point of sale. Research by the Centre for Behavioural Research in Cancer in Australia and Stanford University in the US confirmed this. A study of 25,000 young people in New Zealand found that children exposed to displays were almost three times more likely to smoke.
Research in Australia and the US shed light on the rationale: point-of-sale-display advertising of cigarettes normalises tobacco use for children and creates a perception that tobacco is easily obtainable.
To further drive home the point, RAND Corporation did a one-of-a-kind laboratory replica of a convenience store to examine whether limiting displays of tobacco products in retail outlets could reduce the intention of young people to begin smoking. The results, published in November last year, showed that there was an 11% reduction in smoking intention when the display of tobacco products was hidden, compared to when it was visible behind the cashier.
Point-of-sale display is a common sales promotion tactic. I believe many of us can recount a time when we bought something on impulse at the cashier, simply because seeing it stimulated a desire for it. There is already a blanket ban on advertising and promotion of tobacco products in Singapore. It only makes sense to extend the ban to point-of-sale displays. In conjunction with the proposed increase in the minimum age to purchase cigarettes in the near future, this measure is expected to reduce temptation and impulsive cigarette buys. I pledge my full support for the ban on tobacco displays.
By the same logic, it seems ideal to prohibit Internet advertising, especially as our youths spend more and more time on the Internet. Online shopping is fast growing and last year, a news report indicated that people were hawking banned e-smoking devices online.
But I have to caution against the possible limitations of this. Firstly, forcefully limiting exposure could be a double-edged sword. When there is too little of something, it becomes a novelty, a taboo, an object of curiosity. Consider drugs and marijuana, they are never openly sold, yet people fall prey to it. Just recently, "Ah Boys to Men" actor Noah Yap was sentenced to nine months detention for taking cannabis.
Second, the World Wide Web is too extensive to police. There are numerous online groups advocating smoking.
Just do a search and you will find a number of smoking and drug-use advocacy pages on Facebook with thousands of followers. There are even web articles dedicated to paparazzi shots of celebrities smoking, glamorising smoking in a perfectly legal way.
Ultimately, there is a limit to the effect of banning point-of-sale displays and Internet advertising. I recall a news report that interviewed a smoker who had been smoking since he was 15. He said, "I do not need to see the pack to crave a cigarette. What matters most is the smell." When adults smoke, children and teens see them. They walk by and they whiff the smoke. They probably even associate smoking with adulthood. Thus, we must invest more resources in continued public awareness and outreach efforts, both for youths and adults.
Smoke-free zones in public spaces can also reduce the visual and nasal temptation of cigarettes. In Nee Soon South, we have piloted designated smoking points at one zone. There are smokers who use them though there are still some smokers who smoke outside them, but I believe that, through social conditioning, we can eventually be like Japan, where most smokers voluntarily smoke at designated spaces. Following residents' requests, we are now expanding them to the whole Nee Soon South. Certainly, I hope to see a wider adoption of Designated Smoking Points to minimise exposure of non-smokers to second-hand smoke that causes cancer, heart disease, lung disease and childhood illnesses, including cot death and asthma.
We must also create an environment that is more supportive and encouraging for potential quitters. When we piloted the Designated Smoking Points in my constituency, we also had Blue Ribbon Ambassadors. These ambassadors would not only encourage smokers to smoke in the designated smoking points, but also advise them on how to quit smoking. I hope that we can eventually pool together more resources to turn it into a nation-wide effort. We are striving to be a more compassionate society and, in our good intentions to combat the harmful effects of smoking, we must not make smokers feel alienated and criminalised.
I posted on my Facebook page about me speaking on this tobacco Bill and one of my residents messaged me, she told me that she started smoking at age 15. And she says that you can increase the price of cigarettes, you can put it in different packaging, you can show all the eerie, ugly pictures of the smokers; it will not deter them from smoking.
Because she says that, "Since my lungs are already so black, it does not matter". And she says that one day she saw a flyer from HPB to show them that if you were to stop smoking for a certain number of days – she told me 17 days but when I go and check the website, it has various pages – she says that if she stops smoking for 17 days, her lungs will be free of most toxins.
That gave her the hope and the desire and the motivation to quit smoking. So, she started to quit smoking but she said she failed many times. Eventually, she managed to quit at the age of 27. And now I ask her how old she is now, she said she is 32, happily married with a daughter.
So, I would like to ask for more such encouragement for those smokers. Of course, we need to have more educational talks in schools to deter people from even starting to smoke and perhaps show them how to do so, how to have stress management because many of them say that they picked up smoking because of the stress in school. Perhaps, introduce to them meditation, introduce them to sports and, for those already smoking, there is another set of education – to give them hope and chance to reverse their lungs.
Having said much on the hazards of tobacco smoking, I would like to briefly wrap up by asking for help to small retailers who sell cigarettes. For them, cigarette sale is good revenue.
It would be impractical to expect these small business owners to change their focus to something else in a short period of time. This is especially so since their other major source of revenue, alcohol sales, has been restricted already. How can we help them adapt? What substitute can they sell in place of cigarettes to generate income? As part of our commitment to help small businesses, I hope the Ministry will be able to look into the situations of these small shops. Mdm Speaker, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech.] Singapore has been actively bringing down the smoking rate. Prohibiting shops from displaying tobacco products and banning online tobacco advertisements will minimise the temptation to the young and, hopefully, can reduce the smoking rate effectively. However, the effect of these measures can still be limited as young people can easily see or smell adult smoking on the street. This may even give them the impression that smoking is a sign of adulthood, enticing them to try smoking. Hence, I suggest that we should build more Designated Smoking Points that are far away from schools and crowded areas so as to reduce the temptation to youngsters. At the same time, we must pay more attention to encouraging and helping smokers to quit smoking.
On the other hand, many small retailers are already affected by the restrictions on selling alcohol; now, with tobacco sales also falling, they may face financial difficulties. I hope the authorities can look into how to help these small shops transform. I support this amendment Bill.
Mdm Speaker, I stand in support of the Bill. May I first declare that I am a doctor and a medical oncologist. I look after patients with cancer, including smoking-related cancer. I have sat by the bedside of patients suffering from advanced lung cancer. I have seen what happens when a life is cut short and dies because of smoking.
Mdm Speaker, tobacco is a public health scourge. And it has been known in the scientific community even before Singapore's Independence. One of the first studies was actually done in the UK by British doctor, Sir Richard Doll, published in 1950. Around the world, there has been plenty of research on this. The Harvard Medical School recently has also found that there is no safe minimum level of tobacco use. Even men who smoke occasionally have an overall death rate 1.6 times higher than non-smokers.
We know that, today, among all cancers in Singapore, lung cancer is the number two killer among male cancer patients and lung cancer is the number three killer among female cancer patients. Between 2010 and 2014, there was an average of nearly 1,400 people in Singapore diagnosed with lung cancer each year. We know that smoking-related diseases are among the top killers in Singapore. Six to seven Singaporeans die prematurely from smoking-related diseases each day.
Mdm Speaker, imagine if somebody tried to import a new lifestyle product that caused lung cancer in Singaporeans; contributed to heart disease, lung disease and stroke in Singaporeans; led to the death of six to seven Singaporeans a day prematurely; had no safe minimum level of use; and, worse still, was addictive. Would you want such a substance on sale in Singapore? Or would you want to keep Singaporeans and our children safe from it?
Second-hand smoking is harmful as well. It hurts those around the smoker: co-workers, family members and, especially, young children – who are put at higher risk of asthma, lung infections and, in some cases, the Sudden Infant Death Syndrome.
Smoking can also make the living environment quite unpleasant for neighbours. A number of my Clementi residents have shared these concerns with me.
So, why is tobacco still around in Singapore, despite these harms? Some of it is due to history. Tobacco has been around for a long time in the world and in Singapore. An addictive chemical, once entrenched, is very hard to roll back – no matter the harmful consequences, the poisonous effects of the substance on the consumer, their family and society. This has deep lessons for our efforts in other Ministries, especially regarding drug control, but, today, I will focus on tobacco.
So, how might one roll back the presence of tobacco in Singapore? Of those who have already started smoking, they find it very, very difficult to quit. And I have sympathy for how difficult it can be for a smoker to quit. I remember a patient who could not stop smoking even though he had been diagnosed with lung cancer, even though he had young children at home breathing his second-hand smoke. He could not bring himself to stop because he was addicted.
So, while it is important to help existing smokers to quit, the greatest battle is upstream: for the hearts and minds and help of our children and youth. We must make sure they never start smoking in the first place.
And this is the key, Mdm Speaker, to long-term control of tobacco in Singapore. This is the idea behind campaigns, such as those for a Tobacco-Free Generation: the idea that anyone born after a certain date should not be allowed to buy cigarettes or tobacco. And I call upon MOH to go even further and consider such a proposal. Because a Tobacco-Free Generation policy does not disadvantage existing smokers. Some of them are still battling their addiction. They would still be able to purchase cigarettes, subject to the prevailing laws and regulations, even as they try to quit. But, over time, there would be fewer smokers and less harm caused by second-hand smoke.
The original Tobacco-Free Generation campaigns focused on the Year 2000. The children of the year 2000 will be 16 years old this year. In two more years, they will be 18 years old. Old enough to start thinking about buying cigarettes. Some may even have started smoking because of peer pressure and illegal cigarettes. It is not too late to raise the minimum legal age further. I understand there are consultations on-going. But even better still, Mdm Speaker, if we implement a Tobacco-Free Generation policy, either way, this will help us build towards a Tobacco-Free, smoke-free, SG100 and a healthier future for our children and grandchildren. I support the Bill.
Madam, cancers of the oropharynx, larynx, esophagus, trachea, bronchus, lungs, stomach, liver, pancreas, kidneys, ureter, cervix, bladder, colon and rectum and the myeloid leukemias; chronic diseases like stroke, hypertension, blindness, aortic aneurysm, pneumonia, peripheral vascular diseases, asthma, chronic obstructive lung diseases, diabetes, hip fractures, erectile dysfunction, immune deficiencies and disturbances during pregnancy and congenital problems. That is not the whole list. All these and more have been linked to smoking and exposure to tobacco smoke. That is, practically, the whole body's organs and systems!
Smoking causes more deaths annually than HIV/AIDs; plus illegal drug use; plus alcohol use; plus motor vehicle accidents; plus firearms-related injuries, all put together. Tobacco is the single greatest cause of preventable death globally. Thus, the reason why this Bill is critical for us and for Singapore.
When we pass this Bill, we will join 16 other overseas jurisdictions in banning point-of-sale display, which include Iceland, Russia, Kosovo, Canada and the like. It will also help us push the envelope further after being the first ASEAN country to ban tobacco advertisements in 1971 – that is, very early on. Also, the first ASEAN country to introduce graphic pictures to warn of the dangers of smoking on cigarette packs in 2003; and also being a party to the WHO Framework Convention in Tobacco Control.
Mdm Speaker, I obviously support the Bill. I also want to share on the proposal and concept of tobacco-free generations. This is a worldwide movement and it is also quite active in Singapore. I have been a part of this movement, as with several other Members and we have many students, youths and members of the public who have come forward as ambassadors to the messaging and movement. This relates to the banning of the provision of tobacco to any citizen born after a specific year and the year 2000 has been chosen and proposed as it is easy to remember. There are some jurisdictions that have taken this up more formally, even for debate at their parliamentary levels and in different legislatures.
Also, I have the following clarifications to make: first, are there any tobacconist or such similar facilities or stores that we have in Singapore? If we do, as they are specific niche theme facilities, how will we be managing and regulating them? Will the same guidelines apply to them? Two, for duty free outlets, how will the change be implemented? It is mentioned that they will be regulated later, thus what kind of timeline are we looking at? Third, retailers have been given a 12-month grace period with the passing of this Bill, for compliance. I feel that this may be a little too long, considering the magnitude and the multiplier effect of smoking and tobacco, even one extra day is a day too long. Are there any chances that we could shorten this grace period? Fourth, on the text-only price listing, can the Minister elaborate what exactly can it contain? Fifth, Mdm Speaker, in Malay.
(In Malay): [Please refer to Vernacular Speech.] I fully support this Tobacco (Control of Advertisements and Sale) (Amendment) Bill. Each year, our Malay community occupies the top position in the national statistics on smoking. From 1992 to 2013, the proportion of smokers in our community went down by only 5%, from 30.8% to 25.3%. We must, as a community, try our very best to reduce this figure further, because this is associated with our health and the lives of our future generations.
Our Malay community also has poor health statistics, and smoking is linked to many chronic diseases that affect us. To our young people, please do not associate smoking with the coming of age or the rites of passage, or as a symbol of adulthood. Hence, we must put together a better and stronger effort to improve and reduce these figures significantly. Everyone, every citizen, every family member plays a very critical role.
I would like to send a message to the smokers out there, that is, we are ready to help. There are also voluntary bodies that conduct many programmes to kick the smoking habit. The upcoming Ramadan month this year can be used as the starting point for you to stop smoking completely. As the saying goes: "Where there is a will, there is a way."
So, let us work together with everyone to ensure better health for all.
(In English): Madam, this Bill is about society's stand against cigarette smoking. We need to protect our future generations. There is a strong trend noted worldwide, for those who start smoking as teenagers, they do go on to become adult and long-term tobacco users. We in this House can take the step to break the vicious cycle and we must do it and do it now.
Mdm Speaker, this Bill intends to introduce more controls and measures to reduce smoking rates in Singapore. As a former smoker, I fully support the controls and measures that will be put in place.
On 12 October 2013, I took my last puff after smoking for 17 years. I have not smoked since and I do not intend to. I tried without success to reduce my smoking for many years but I ultimately decided that "cold turkey" was the best way to quit. I did play cheat a little as I quit smoking when I was at a conference in Disneyland. It was a place I knew did not sell cigarettes. I was there for a week and, as such, it made it harder for me to get a cigarette in case I gave in to my cravings, which were quite severe during the first week of quitting.
It was hard to quit, the nicotine withdrawal symptoms were terrible and I was a grouchy smurf for quite a while. But it was worth it and I feel healthier now, my family members benefit and are healthier as well, and I save loads of money.
If there was one thing I remembered about the quitting process, it was that I did my very best to avoid places selling cigarettes, which was actually very difficult or impossible at times as I had to avoid 7-Elevens, coffee shops and the list goes on. Every time I saw a cigarette packet, it was tempting and my cravings shot up.
As such, I find the new section 12A, which prohibits the display of tobacco products, extremely useful. This will not only help people who are trying to quit but also possibly reduce the number of people who are enticed to start smoking.
The amendments to curb tobacco product advertisements are also crucial in our fight to lower smoking rates in Singapore. After all, the goal of advertisements is to make you buy what you do not want to buy and we need to make sure people are not driven or tempted, either subconsciously or consciously, into smoking.
I started smoking when I was 18 years old – pretty stressed in school. But a research by WHO shows that people who do not pick up smoking before the age of 21 are unlikely to ever start smoking. There was previous discussion about raising the minimum smoking age to 21 years old. Can the Senior Minister of State clarify why this proposal was not included in this Bill?
I support this Bill but I do have one concern with regard to the amended section 26(1)(b) and (c) which allows the Chief Executive or an authorised officer to, at any time and without warrant, enter and search any premise, stop, board and search any conveyance that the Chief Executive or authorised officer reasonably suspects is being used for or in connection with the commission of an offence under this Act.
Can the Senior Minister of State clarify why a warrant is not required and what safeguards will be put in place to ensure that there will be no abuse of this? I am especially concerned that even authorised officers are allowed to do this, to search without a warrant.
But, ultimately, as always, we need to go beyond legislation. Among Singapore residents, as we have heard earlier, the percentage of current smokers dropped from 18.3% in 1992 to 12.6% in 2004, but stabilised thereafter with 13.3% of smokers in 2013.
Controlling the advertisement and sale of tobacco and increased enforcement efforts can help, and probably have helped, to reduce the smoking rates. However, I believe that public education is the long-term solution.
I remember when I was young, there was a campaign with the slogan, "One puff and you are hooked." The distinct image of a smoker with a fishing hook in his mouth is still fresh in my memory.
I think we need to change the narrative. While that had the desired effect of educating the public on the dangers and addictive nature of cigarettes, it also gave a fatalistic view of smoking. As Er Dr Lee Bee Wah has mentioned earlier with her resident's story, I think many felt that since they are already smoking and it is so hard to quit, they might as well just continue.
So, while we focus on efforts to ensure that people do not start smoking, let us also see how we can intensify our efforts to encourage more smokers to quit, to show them that it is possible to do so.
The last big public campaign that was launched was the "I Quit" campaign in 2011. I joined that campaign. Since that "I Quit" campaign's inception to 2014, a total of 5,000 smokers have pledged and 14% of those who pledged have successfully quit smoking.
Will the Ministry expand this campaign this year, which will be held in May? Can we think out of the box to launch more campaigns that will help us to reach our aim of getting smoking rates down to 12% by 2020?
There are many things we can learn from other successful "quit smoking" campaigns around the world. One such example is the "Tips from Former Smokers" Campaign by the Centers for Disease Control and Prevention (CDC) in the USA.
One of the main strategies of the campaign was to focus on real people and stories on how smoking has affected their lives and how they managed to quit smoking. While it is true that everyone knows smoking is bad for health, the personal stories shared in this campaign were compelling and communicated in a very human way that smoking causes immediate damage to your body and that this damage can happen at a young age and can be severe. It sparked a national conversation and encouraged non-smokers to speak to their loved ones who smoke.
Some statistics of the campaign include: (a) an estimated 1.64 million Americans tried to quit smoking because of the 2012 campaign; (b) approximately 100,000 smokers are expected to quit for good; (c) an estimated six million non-smokers talked with friends and family about the dangers of smoking; and (d) an estimated 4.7 million additional non-smokers recommended cessation services to their friends and family.
In conclusion, let us continue to implement controls and measures on the advertisement and sale of tobacco, let us continue to find more innovative ways to encourage smokers to quit, and let us hit our target of getting smoking rates down to 12% by 2020.
Mdm Speaker, my request for the Government to review the above notwithstanding, I support the Bill.
Mdm Speaker, together with other Members of this House, I rise in support of this amendment to the Act. I think we are all aware of the health risks to smokers and those exposed to smoke.
Smoking is a significant contributor to disease burden. Many of us have spoken and expressed concern about the increasing healthcare expenditure by the Government. By the simple act of eliminating smoking, this would have a significant impact on reducing healthcare utilisation and also healthcare expenditure in many countries, including our own.
Singapore has made much progress in controlling smoking rates and now boasts one of the lowest smoking rates in the world. But more can be done and there are areas of concern. The rate of reduction of smoking rates is plateauing and the rate of smoking amongst the young is still stubbornly high. Most smokers also pick up the habit in their youth and smoking cessation remains a challenge to most smokers. So, I feel that this amendment is both timely and forward-looking.
With the strict regulation and restriction of tobacco-related products in many countries, tobacco companies have been focusing their marketing efforts at the points of sale. And many studies have demonstrated the effectiveness of such a strategy in enticing new smokers and also making it harder for smokers to quit. At the same time, instituting a point-of-sale display ban has been shown to be effective in both reducing smoking initiation and also helping smoking cessation.
I think many of us have experienced this. When we go for a meal in a shopping mall, in a supermarket queue waiting to pay for our purchases, or at the petrol kiosk waiting to pay for our petrol, we end up purchasing things that we did not actually think we were going to purchase that were just available and attractively displayed at the counter. This phenomenon is not new. This phenomenon of impulse buying is well recognised by retailers and has been exploited by most retailers, including cigarette companies.
A study conducted a few years ago by researchers at Johns Hopkins found that, in the US, as much as 11.2% of cigarette buyers were impulse buyers and the most likely impulse buyers were the young between 18 and 24 years old and also those who were occasional smokers and, finally, those who were trying to quit. And close to a third of respondents confirmed that point-of-sale displays made quitting harder for them.
Besides Singapore, a few other countries have instituted point-of-sale display bans. Iceland was the first to do so, followed by several other countries – Thailand, Ireland, Norway, Finland, Canada and Australia. And Singapore will be the next on the list.
Studies conducted in some of these countries since the ban have clearly demonstrated a marked reduction in consumer exposure to tobacco products, as well as a significant reduction in impulse buying. A review of 20 scientific studies have also overwhelmingly confirmed the association between point-of-sale displays and smoking promotion and susceptibility.
A recent meta-analysis, which is a study that reviews the evidence provided by other well-regarded studies, was published in January this year and it looked specifically at the relationship between point-of-sale displays and smoking rates and susceptibility in the young and adolescents.
The evidence was clear: children and adolescents who were exposed to point-of-sale tobacco promotion have around 1.6 times higher odds of having tried smoking and around 1.3 times higher odds of being susceptible to future smoking, compared with those who were less frequently exposed. And this study concluded that "legislation banning tobacco point-of-sale promotion will effectively reduce smoking amongst young people."
I think it is reassuring that this amendment to the TCASA will spell the end of the Tobacco Power Wall in Singapore and also tighten regulations pertaining to online advertising and marketing and also close loopholes regarding imitation tobacco products.
I have two further issues to raise, which I hope the Ministry will be able to consider.
First, it is with regard to the minimum age at which persons can use or purchase tobacco products. I think this has also been brought up by some of the hon Members who have spoken before me. I also feel that 18 is still too young and would like to call for it to be raised to at least 21 years of age. There is good evidence that such a move will further reduce smoking initiation rates and there appears to be broad support from the public for such a move, as indicated by the findings of the recent public consultations for this amendment. The World Health Organization has also stated, based on prevailing evidence, that people who do not begin smoking before the age of 21 are unlikely to become chronic smokers.
Second, since we are already banning point-of-sale displays, I feel that it would just be an incremental but still significant move if we were to continue with our plans to introduce plain packaging for tobacco products. I understand that the Ministry is already studying this and I call upon the Ministry to expedite this move. Australia was the first jurisdiction to have done so and the impact thus far has been encouraging and several other countries have also indicated that similar legislation is in progress. There is strong opposition to such legislation from tobacco companies and some of them are even bringing lawsuits against governments, but I think this is just another indication that standard packaging would further reduce smoking initiation and accelerate smoking cessation.
Dr Lisa Henriksen from the Stanford Prevention Research Centre of Stanford University recently wrote of the retail environment as a barometer of progress towards the endgame for tobacco control. And I strongly believe that this amendment to the TCASA is an important step towards safeguarding the health of our society and it is an important step towards a tobacco-free generation and so I warmly support it.
Mdm Speaker: Senior Minister of State Amy Khor.
Mdm Speaker, I thank Members for speaking up in support of the Bill. Clearly, all of us have been touched by the issue of smoking at some point in our lives, either personally or professionally.
Dr Tan Wu Meng has shared how, as a medical oncologist, he had witnessed first-hand the damage wrought on his patients by tobacco. Assoc Prof Fatimah Lateef has pointed out the diseases caused by tobacco – it seems as if almost every organ in the body can be affected by tobacco use! Mr Louis Ng provided personal insights on how difficult it can be to quit smoking and how he tried to avoid point-of-sale displays of cigarettes while quitting. I must commend him for being creative in quitting smoking by going "cold turkey" in Disneyland.
During my engagement session with tobacco retailers in December 2015, one comment made stayed with me for a long time. A retailer told me that even though he sold tobacco, he did not want his own children to smoke! He acknowledged that tobacco could cause addiction among his customers.
This is why we need to continue to strengthen our tobacco control measures and provide a supportive environment for smokers to quit. We need to make sure that our youth do not pick up the habit. We want to bring smoking rates down even more. The point-of-sale display ban plays a part in fulfilling these objectives.
Let me now respond to the queries and suggestions made by Members in respect of this Bill.
With regard to the point-of-sale display ban, I had earlier described the requirements for general tobacco retailers to keep their tobacco products out of sight of customers and the public within their premises. I also said that specialist tobacconists are required to keep tobacco products out of sight from outside their premises because these specialist tobacconists usually sell mainly cigars and, perhaps, alcohol. To do this, they can completely make their store windows opaque, use curtains or any other method that achieves the same effect. Presently, there are about 17 such specialist tobacconists – in fact, five of the outlets are from the same company.
Assoc Prof Fatimah Lateef asked about duty-free retailers. Unlike general tobacco retailers, duty-free retailers at Changi Airport serve mostly tourists and overseas passengers who are departing Singapore. Given this, the point-of-sale display ban will not be implemented at duty-free retailers at Changi Airport for now, although we will continue to review the position.
Duty-free retailers at seaports will be required to comply with the point-of-sale display ban. Like specialist tobacconists, the requirements will be slightly different from those for general tobacco retailers. Duty-free retailers at seaports may place their tobacco products within a specified "tobacco area" of the premises, but the tobacco products should not be visible from outside this area. Alternatively, they may follow the requirements for general tobacco retailers. DFS Galleria at Scotts is classified as a general tobacco retailer and will be required to comply with the requirements for general tobacco retailers.
Assoc Prof Fatimah Lateef asked what the price list will look like. The appearance of the price list will be prescribed by MOH. It should be in text, printed on white A4 paper and contain only the necessary information on the product, such as brand and variant, price barcode and stock number. There should be no pictures or logos. We will also control the font size.
As not all customers are literate in English, we will permit the price list to be published in each of the four official languages. But this is limited to one price list per official language. Mdm Speaker, this is a sample of what the price list is going to look like and there will be four official languages – one in each.
Assoc Prof Fatimah Lateef recommends that we shorten the grace period of one year. I am pleased to see her enthusiastic support for the ban. Much as it would be ideal to implement the ban as soon as possible, the reality is that tobacco retailers, especially the smaller shops, will need time to make the necessary adjustments to their existing store set-up. The grace period also gives them time to diversify their business models away from the sale of tobacco products. As such, we think a grace period of one year is reasonable. However, MOH certainly encourages retailers to comply early with the requirements of the ban.
Er Dr Lee Bee Wah expressed concern that tobacco retailers, especially the smaller businesses, would be affected financially by this ban. We have conducted engagement sessions with small retailers since 2014 to help them prepare for the ban. The ban applies to all general tobacco retailers. As such, no tobacco retailer will lose out to another.
Like all our tobacco control measures, the intended effect is to decrease the overall demand for cigarettes. But as this will likely not be an immediate development, small retailers can use this grace period and beyond to start shifting their business models away from dependence on selling tobacco products. They may also consider changing their business practices to increase their productivity.
Members have suggested additional ways to enhance tobacco control, especially measures to prevent youths from picking up smoking and to help smokers quit. I am heartened by their enthusiasm. Let me assure Members that MOH is open to ideas and best practices from around the world and we closely monitor such developments.
Dr Chia Shi-Lu had suggested that we follow in Australia's footsteps and quickly move to introduce standardised packaging. Emerging data from Australia shows that standardised packaging reduces the attractiveness of the tobacco products and makes the health warnings more prominent and effective. There are early indications that it reduces smoking prevalence.
We have been studying and are closely monitoring international developments on standardised packaging. In May this year, France, the UK and the Republic of Ireland will start to implement standardised packaging as well.
The decision on whether or not to proceed with standardised packaging will be based on public health considerations and we will also ensure that any measure, if introduced, will be designed in a manner consistent with our international obligations, including those relating to intellectual property rights.
I fully agree with Dr Tan Wu Meng, Er Dr Lee Bee Wah and Assoc Prof Fatimah Lateef that tobacco control is best managed upstream – that is, we win the hearts and minds of our children and youths to prevent them from getting addicted in the first place.
That is why Health Promotion Board (HPB) works with MOE and Institutes of Higher Learning to incorporate anti-tobacco messages into the curriculum, so as to raise awareness about the benefits of a tobacco-free lifestyle, dispel the misconceptions about smoking and equip youths with life skills to refuse cigarette offers. I also applaud efforts by passionate volunteers to get our youths to pledge to be a tobacco-free generation.
Going beyond promotional measures, both Dr Tan Wu Meng and Assoc Prof Fatimah Lateef had proposed that we could also introduce a cohort ban on smoking, by banning sales of tobacco to Singaporeans born from the year 2000 or another specified year onwards.
MOH is familiar with this proposal and has given it a lot of thought. Our concerns are the significant practical difficulties and risks in implementing and enforcing such a ban and it may not result in the desired reduction in smoking rates.
Such a cohort ban would be easy to circumvent and enforcement is going to be challenging and likely to be resource-intensive. An effective ban would also require laws to penalise persons not subject to the ban who supply tobacco products to the affected cohort. For example, a person affected by the ban could buy cigarettes overseas, or get an older relative or friend unaffected by the ban to buy cigarettes for them. In such a situation, we would have to penalise the person providing the cigarettes. Furthermore, enforcing such a cohort ban can be very challenging as age differences between close cohorts become less apparent physically as they grow into adults.
Hence, MOH will not pursue such a cohort ban for now. But we are aware that this idea is being pursued in Tasmania, Australia, through a Private Member's Bill and we will monitor its development.
Mr Louis Ng has asked why MOH had not included raising the minimum legal age for buying tobacco and smoking in this current set of amendments. Dr Chia Shi-Lu and Er Dr Lee Bee Wah made a similar call for MOH to raise the minimum legal age. We are still studying raising the minimum legal age as part of the on-going public consultation on further amendments of our tobacco control measures, which include standardised packaging and larger graphic health warnings. This public consultation is due to end on 29 March 2016.
Raising the minimum legal age to 21 years is a relatively new measure in jurisdictions that have implemented it, such as Hawaii and New York City. Hence, we would need to carefully study their experiences and see if this would be appropriate in our local context.
MOH agrees with Assoc Prof Fatimah Lateef, Mr Louis Ng and Er Dr Lee Bee Wah that public education efforts and support for smokers to quit smoking complement legislative measures. They are key elements of our multi-pronged approach towards tobacco control.
Mr Louis Ng made a call to intensify efforts to encourage more smokers to quit. Quitting can be perceived as a rather challenging journey by smokers. Hence, HPB introduced the "I Quit 28 Day Countdown" in 2013, to get smokers to quit by breaking down the quit journey into daily, small actionable steps. So, as Er Dr Lee Bee Wah said, by the end of 28 days, the body will be back to normal as before they started smoking. It is based on findings that smokers who stay smoke-free for 28 days are five times more likely to quit smoking for good.
Like the "Tips from Former Smokers" campaign mentioned by Mr Louis Ng, "I Quit" adopts a community-based, but personalised, approach to build a network of support to help smokers quit. The campaign has seen about 10,000 sign-ups each year since 2014. Its Facebook page has more than 40,000 members, with daily exchanges by ex-smokers sharing their personal stories, smokers seeking advice on quitting and non-smokers penning words of encouragement.
We agree with Er Dr Lee Bee Wah on the need to build a conducive environment that encourages smokers to quit the habit. HPB has been expanding its outreach and support network for smoking cessation. Over the past year, HPB has added over 130 new smoking cessation touch-points, including healthcare institutions and retail pharmacies, bringing the total to over 280. By 2020, the aim is to double the number to 600 nationwide. These "I Quit" touch-points offer free smoking cessation counselling to smokers on the "I Quit 28-Day Countdown" programme. Smokers can also call in to Quitline or access online resources for additional support to quit smoking. In addition, we have been educating the public on the harms of environmental tobacco smoke and its impact on loved ones, to nudge smokers to contemplate quitting.
Assoc Prof Fatimah Lateef had expressed concern that the number of Malay smokers remained high, though there was a slight decrease in prevalence in 2013. Please be assured that we are monitoring these trends closely.
Like Assoc Prof Fatimah Lateef has pointed out, we can use culturally significant moments to nudge our fellow Singaporeans to live a healthier life. HPB has held the "I Quit" Ramadan roadshows since 2012. They will host another edition for the upcoming Ramadan in June 2016 and hope to encourage 2,000 Malay smokers to sign up to quit and I hope that the community will support HPB in their efforts.
Assoc Prof Fatimah Lateef has also asked how the amendment would be applicable to online advertising. And Er Dr Lee Bee Wah commented that there could be limitations to the effectiveness of banning Internet advertising. I recognise that limiting access to online advertisements is not easy. In order to effectively ban cross-border Internet advertising, there should be control at its origin in every country. Regardless of developments elsewhere, we will play our part as a responsible member of the global public health community by making it clear that our prohibition on advertising will cover online advertising and promotion that originate from Singapore or from Singapore-connected persons.
Mr Louis Ng raised concerns regarding HSA's enforcement powers under the amended Act. These powers are essential to enable HSA to effectively conduct enforcement activities and investigations under the Act. The amendments seek to update and, where appropriate, clarify the scope of these powers.
Mr Louis Ng asked about the powers to search premises and vehicles without a warrant. I would like to clarify that the power to enter and search premises is not new. It is in the existing Act.
The amendments simply clarify that no warrant is required to exercise such powers because authorised officers need to be able to act on reasonable suspicion and in a timely manner to search premises and vehicles for evidence in connection with a possible offence, before the suspect can dispose of the evidence. The same approach has been used for the Health Products Act.
The existing search powers are being extended to cover vehicles because there have been several cases of illegal peddling of tobacco through the use of vehicles. Let me assure Members that a vehicle will be searched only if authorised officers have reasonable cause to suspect that the vehicle in question is associated with a potential offence under the Act.
Er Dr Lee Bee Wah also proposed that we expand the number of designated smoking points (DSPs), like the ones in her Nee Soon South constituency. I thank her for her active efforts to promote a smoke-free environment for her constituents. MEWR and NEA are currently studying the progress of Project DSP: Cool to be Considerate, to gauge the public's response to these DSPs. We also need to better understand the impact of having such DSPs in our HDB heartlands, including their effectiveness, prior to committing to any expansion of such a programme.
Mdm Speaker, the Members who are physicians have pointed out how harmful tobacco can be to the human body. With the recent increase in the popularity of Electronic Nicotine Delivery System (ENDS) worldwide and their targeted marketing to youths, we need to strengthen our regulatory measures. It is also imperative that we decrease exposure of non-smokers, especially youths, to the advertising effect of point-of-sale tobacco product displays. The aim is to ultimately de-normalise tobacco use.
We also need to update and streamline our regulatory framework to ensure that our enforcement efforts remain effective and robust, yet fair. These changes are needed as part of a bigger community-wide effort towards creating a tobacco-free Singapore and we are, indeed, heartened by the support of the public received during our consultations as well as the support of Members of this House. Mdm Speaker, I beg to move.
*Question put, and agreed to.*
*Bill accordingly read a Second time and committed to a Committee of the whole House.*
*The House immediately resolved itself into a Committee on the Bill. – [Dr Amy Khor Lean Suan].*
*Bill considered in Committee; reported without amendment; read a Third time and passed.*
Order. I propose to take a break now. I suspend the Sitting and will take the Chair at 4.45 pm.
Sitting accordingly suspended
at 4.30 pm until 4.45 pm.
Sitting resumed at 4.45 pm
[Mdm Speaker in the Chair]
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