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Next chief executive should back annual tobacco tax hike in Hong Kong

Your editorial (“Preventive health care is an investment, not a burden [1]”, January 1) has hit the nail on the head regarding the importance of, and investment in, prevention versus cure in Hong Kong.

We all need the “ambulance and curative services” to rescue us when we are taken ill, but unless the whole of government – particularly the finance, trade and economic branches, as well as the Independent Commission Against Corruption and the Ombudsman – grasps the political nettle of issues such as tobacco control, health will never improve, nor will the many thousands of annual deaths from tobacco be reduced.

Indeed, the entire Hong Kong government is under an international obligation to do so, being a party to the World Health Organisation Framework Convention on Tobacco Control.

One of the most important platforms of any incoming chief executive is their future preventive health plan for Hong Kong citizens.

Let us call upon each of the potential chief executive candidates to outline their health platforms. We should discard all those who see these platforms in terms of more hospital beds, which will never solve the problem of improving Hong Kong’s health. And the current health paradigm is such that improvements will only come about by addressing the vested interests of big business – the tobacco, alcohol, food, and even salt industry –including their often unrecognised front groups.

With tobacco control, we have known for decades what works, and how very cost-effective these measures are. Yet governments around the world hesitate to act.

Increasing tobacco tax heads the list of the best single measure to reduce smoking. It may be surprising to many that a fiscal measure is more important than health education in schools or banning sales to youth, for example, but it is the single best action governments can take to reduce consumption among the young.

Why can Hong Kong not follow Australia and New Zealand and commit to an annual tobacco tax increase of, say, 10 per cent per annum to the year 2025?

Any chief executive candidate who would endorse this would get my (hypothetical) vote.

It would give us an orderly and planned route to follow, and avoid the incredible waste of time and energy lobbying annually for tobacco tax increases. And it would have a massive effect in saving young and middle-aged lives, and in what is termed “frailty avoidance” in the elderly.

Dr Judith Mackay, Clear Water Bay

Hong Kong leads mainland in war to cut smoking

http://www.ejinsight.com/20161209-hong-kong-leads-mainland-in-war-to-cut-smoking/

When a person goes to buy a packet of cigarettes in Hong Kong, he or she faces two obstacles. One is the price — Double Happiness at HK$43 and Marlboro at HK$57 — the result of a tobacco tax up to 68 per cent of the price.

The other is the hideous image on the packet of the worst consequences of smoking.

A survey by the Economic Intelligence Unit earlier this year ranked Hong Kong as the eighth most expensive city in the world for a packet of branded cigarettes, at US$7.48.

Top was London with US$14.30, followed by New York with US$13.67 and Singapore with US$9.15.

These two measures, along with the creation of smoke-free areas in public and work places, have been effective in cutting the number of smokers.

According to government figures, the percentage of daily cigarette smokers aged 15 and above in Hong Kong in 2015 was 10.5 percent, down from 10.7 percent in 2012 and 23.3 per cent in the early 1980s.

The mainland, the world’s largest tobacco market with 316 million smokers in 2015, has only recently started to learn the lessons of Hong Kong.

Since 2010, the number of smokers has increased by 15 million and cigarette production risen by 35 per cent.

The health warnings are written, not visual, and appear modestly at the bottom of the packet. They would not frighten any first-time user.

In 2015, China increased the tobacco tax to 40 per cent. Consumption tax from tobacco in 2015 was 536 billion yuan, an increase of 60 billion from a year earlier. The recommendation of the World Health Organisation (WHO) is that the tax should be 70 per cent of the retail price.

“There is certainly room for future tobacco tax increase,” said Jian Shi, director of the information office of the Taxation Research Institute at the State Administration of Taxation in Beijing.

“In some western countries, the tobacco tax rate has reached 70-80 per cent. The room for the increase needs to be considered based on the development goal of the industry and the condition of national revenue.”

Health professionals argue that increasing the tobacco tax is the quickest and most effective way to cut smoking — by both preventing young people from starting and encouraging smokers to quit.

According to WHO figures, each increase of 10 per cent in the price will cause 3.7 per cent of adults and 9.3 per cent of teenagers to stop smoking.

Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Public Health, said that selective or modest hikes would not make much of an impression on smoker numbers in Hong Kong.

“Only a 100 per cent increase in tobacco tax would induce people to quit smoking,” he said. If the government accepted this proposal, an average pack would cost HK$119.

The Department of Health has proposed an enlargement of the health warning.

It said on Nov. 23 that the area of the graphic health warning shall be of a size that covers at least 85 percent of the two largest surfaces of the packet or the retail container and that the number of forms of health warning should be increased from six to 12.

The situation in the mainland is years behind. The biggest obstacle is that the State Tobacco Monopoly Administration (STMA), the world’s biggest manufacturer of cigarettes, is also the industry regulator.

This is despite years of lobbying by China’s health professionals, the WHO and the norms practised around the world. They argue that the two must be separate institutions.

According to WHO figures, 1.2 million die each year in China from smoking-related diseases; this number will double by 2025.

Jian Shi put it succinctly. “The major difficulty lies in that the related departments have quite different views on this matter, and it is difficult for them to reach agreement on this matter. That will cause obstruction to policy making and implementation.”

The STMA opposes graphic health warnings and higher taxes because they would hurt its sales and profits. Yet, simply due to global population expansion, there will be more smokers in 2040 than there are today, so it is difficult to believe that this concern is genuine.

The health lobby has had some success, in the modest increase in tobacco tax and restrictions on smoking in indoor public areas and workplaces and some outdoor areas introduced in Beijing in June 2015. Other mainland cities have taken similar measures at different times.

On Dec. 6, the Beijing Commission of Health and Family Planning said that more than 2,700 people had been fined for violating these restrictions, with total fines of 142,500 yuan, as of Nov. 30 this year.

Professor Dr Judith Mackay, based in Hong Kong and Asia’s leading anti-tobacco campaigner, said that the price of cigarettes in China is still extremely low.

“The latest small tobacco tax increase, while laudable, will not have a serious, sustained effect on reducing smoking. It is time to review the whole tobacco tax structure in China, significantly increase the price of cigarettes and thus protect the health of the Chinese people.

“In Australia, there is a regular increase of 12.5 per cent tobacco excise tax every year. The cost of a packet could soon rise to A$40 (HK$230). Hong Kong and China should both consider long-term tobacco tax planning in this way, so that tobacco control proceeds in an orderly form, and immense energy and time is not wasted year by year in campaigning for a tax increase. Otherwise, thousands will die.”

How Edinburgh University doctor Judith Mackay took on the tobacco industry in Asia

http://www.heraldscotland.com/news/14945140.Meet_the_Edinburgh_pensioner_who__39_s_the_most_dangerous_woman_in_the_world_in_the_eyes_of_Big_Tobacco/

HER’s is a career involving death threats, secret information passed from shadowy ‘Deep Throat’ figures, being held at gunpoint, and caught up in a trial in which key witnesses were murdered or mysteriously disappeared.

But it might be surprising to learn that these are not the experiences of a spy or globe-trotting investigative journalist, instead they are the experiences of a down-to-earth public health expert from Edinburgh.

Dr Judith Mackay, who studied medicine at Edinburgh University and is a member of the university’s Global Health Academy, has spent years battling the tobacco industry in Asia.

Now, for the first time the Hong Kong-based campaigner has revealed the full extent of the threats she faced in her career, during which she was branded as the most dangerous woman in the world by the international tobacco industry.

She told the Sunday Herald how she was for many years a “lone voice” in working at the forefront of tobacco control, trying raise awareness of the health risks of smoking and advising governments.

“Somebody once asked me do you have to be brave to be a tobacco control advocate today and my answer is no, I don’t think you do,” she said. “But I was the lone voice in the wilderness – I was basically the only person in Asia working on tobacco control regionally.

“The tobacco industry had just assumed it would ride its Marlboro cowboy into Asia and there wouldn’t be any opposition at all.”

Mackay, who was born in Yorkshire, moved to Hong Kong in 1967 at the peak of the Chinese Cultural revolution and spent a number of years working as a hospital doctor.

However she began to feel like the work was a ‘band-aid’ in having to treat so many people who had become ill as a consequence of smoking.

She decided to devote her career to tackling the industry full-time in the mid-1980s after a cigarette company attacked her work.

She said: “It [the company] was making a lot of threatening statements about how I was unaccountable and unrepresentative, claiming the tobacco industry was full of good sensible corporate advice. It was one of the turning points in my life.”

Mackay outlined the experiences she has gone through in a blog written for the ‘Dangerous Woman Project’ , which is being run by Edinburgh University’s Institute of Advanced Studies in the Humanities to collate stories of women who have been labelled as ‘threatening’.

She told how she has suffered verbal abuse over the years and in 1993, a US smokers’ rights group described her as a “psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler.”

The group also threatened to “utterly destroy” her – which was investigated by the FBI and led to her being offered 24-hour police protection by the Hong Kong government.

Mackay, who is a senior policy advisor for the World Health Organisation and director and founder of the Asian Consultancy on Tobacco Control, also had a chilling experience when she was an expert witness in a major trial involving cigarettes being smuggled into China.

The chief witness was murdered and eleven others disappeared – and Mackay discovered that she was being followed.

She helped the Hong Kong government take action against the importation and sale of smokeless tobacco, such as snuff, after she learned a ‘Deep Throat’ figure associated with the US tobacco industry had blown the whistle on a plan to immediately launch these products in the country.

In 1990, while she was working in Mongolia and staying at a government guest house, she found herself being held at gunpoint by suspicious Mongolian palace guards after going for an evening walk. She also found out there had been a cabinet meeting held to discuss whether she was a spy sent from the west.

But Mackay said her experiences had not deterred her from the fight against tobacco.

She said: “I have said – even to my lawyer – that if I were to disappear or to be found under a bus, this is not of my own doing.

“I think if anything I got very empowered by all these things that happened – it made me more determined, rather than less determined.

“But I did take some practical steps – one of which was to send our two boys when they were teenagers back to Scotland to school.

“I just felt they were safer back in the UK to finish their schooling.”

Mackay, whose husband is from Lossiemouth, still spends three months of the summer every year in Edinburgh.

The recognition for her work includes being named as one of the most influential people in the world by Time magazine in 2007. She was also awarded an honorary degree by Edinburgh University in July this year.

At the age of 73, she practises tai-chi and has no intention of giving up her work.

Mackay said while much progress has been made in tobacco control, she believes she will still be tackling the tobacco industry for years to come.

“The tobacco industry is certainly as formidable as it ever was – it has just somewhat changed its tactics in terms of what it does,” she said.

“What they now do is to issue legal challenges and trade threats to governments.”

She added: “I have often said I am going to be working until I am 100 and I think that is probably true.”

Vaping’s Long-Term Effects: Here’s what the experts say

The debate over electronic cigarettes rages on, despite the vaping industry’s best efforts to promote its value in decreasing the use of tobacco cigarettes. Proponents of e-cigs argue that the technology is safer than traditional cigarettes and can be used to quit smoking altogether. The scientific community is beginning to see things differently, however. Its consensus: vaping is a scam.

https://mic.com/articles/161221/vaping-s-long-term-effects-here-s-what-the-experts-say#.oZe252gbh

The myth of e-cigarettes as a safe alternative

“The evidence consistently shows that, while some people successfully quit smoking with e-cigarettes, most people using e-cigarettes have their chances of quitting conventional cigarettes reduced by about 30%,” Dr. Stanton Glantz, Professor of Medicine at the University of California, San Francisco’s Center of Tobacco Control Research and Education, told Mic. “The most dangerous thing about e-cigarettes is that they keep people smoking cigarettes.”

Dr. Glantz conceded the possibility of e-cigs as a way to transition from tobacco cigarettes, but argued that the bulk of e-cig users are what are referred to as “dual users” — consumers who smoke both e-cigs and traditional cigarettes.

That notion is backed by a 2012 study published in the American Journal of Public Health, in which researchers found that e-cig utilization was highest among current tobacco cigarette smokers at a rate of 11.4%, compared to 3.4% of the total population surveyed, 2% of former smokers and 0.8% of those who never smoked a traditional cigarette. Furthermore, a study in scientific journal Tobacco Control found that 75% of dual use smokers do not even believe vaping will help them quit cigarettes and “reported planning to quit within the next 6 months less often than adults who smoke cigarettes exclusively.” A substantial 42.3% said they never plan to quit smoking whatsoever.

That continued use means that e-cigarettes will have long-term health effects on users, but it’s still too early to tell exactly what they will be (the first e-cigarette was invented in 2003). Dr. Glantz suggests another 5-10 years are required to conduct definitive research, but his research has led him to develop an understanding of the short-term epidemiological impact, and how it relates to potential long-term risks.

Vaping’s damaging effect on the cardiovascular system

“My current thinking is that e-cigarettes are going to cause less damage than conventional cigarettes in terms of cancer, but they’re probably just as dangerous – if not more – when it comes to heart disease and non-cancer lung disease and asthma,” Glantz said.

According to the Center for Disease Control and Prevention, approximately 610,000 people die of heart disease in the United States every year — that equates to one in every four deaths. In fact, heart disease is the leading cause of death for both men and women in the United States. The spreading popularity of e-cigarettes are likely to increase those numbers.

“One of the main things about smoking that causes heart disease is the ultrafine particles that are delivered through the smoke, which trigger inflammatory processes and damage the cardiovascular system,” Glantz said. “E-cigarettes deliver as much or more ultrafine particles as the ones found in cigarettes. That’s something you can’t get rid of because of the way cigarettes work — you generate an aerosol of ultrafine particles that carry the nicotine down into your lungs where it’s absorbed. You do that by burning the tobacco.

“The way e-cigarettes work is by heating up a liquid solution — propylene, glycol, glycerol, nicotine and flavorants – and that generates the ultrafine particles that go into your lungs,” Glantz continued. “The e-cigarettes that work the best in terms of delivering nicotine generate more and smaller particles than a conventional cigarette, and the smaller these particles are, the more dangerous they are. They have immediate effects on your blood and blood vessels, which we have already been able to measure and quantify.”

“The similarities between e-cigarettes and conventional cigarettes in terms of vascular effects are extremely troubling,” Glantz said, bluntly, as he concluded his explanation.

Vaping’s influence on teenage smoking

Perhaps most troubling aspect is the e-cigarette industry’s hold on adolescents. A July 2016 study published by the American Academy of Pediatrics examined prevalence rates in Southern California and concluded that “the high prevalence of combined e-cigarette or cigarette use in 2014, compared with historical Southern California smoking prevalence, suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products.”

Dr. Glantz partially attributes this phenomenon to marketing techniques utilized by the vaping industry, as well as a plethora of enticing “flavors” which attract younger users. This is highly irresponsible because, even if these teenagers aren’t converting to tobacco cigarettes, “Nicotine is still really bad for the developing brain,” according to Glantz.

Between early use among adolescents and adults’ insistence on dual use smoking, e-cigarettes are bound to have long-term effects — both physiologically and culturally. What exactly they will be cannot yet be definitively quantified, but one thing’s for sure: they won’t be good.

Anti-smoking campaigner wins top award

http://scottishcancerfoundation.org.uk/news/anti-smoking-campaigner-wins-top-award/

An anti-tobacco campaigner who has played a leading role in reducing the harm caused by cigarettes in Scotland has been honoured by the Scottish Cancer Foundation.

Sheila Duffy, the chief executive of ASH Scotland, is this year’s recipient of Scottish Cancer Foundation prize which recognises individuals who have made an outstanding contribution in the fight against cancer.

Today, smoking rates in Scotland are half what they were in the 1970s and the number of young people taking up the habit is at the lowest level ever recorded. Meanwhile public support has grown for measures to regulate tobacco even further.

Sheila Duffy has been at the heart of these changes for the past 20 years. She played a prominent role in building the case in Scotland for the introduction of a smoking ban in enclosed public places in 2006 – the first part of the UK to introduce such a measure. It has been credited with changing attitudes to smoking and has been described as one of the most important public health changes of the past 100 years.

In addition Ms Duffy has campaigned successfully to move tobacco out of the reach of young people, enhance support for those who want to quit, and remove attractive branding from tobacco packaging which reduces its appeal, particularly to young people.

Professor Bob Steele, Chairman of the Scottish Cancer Foundation said: “Smoking causes or increases the risk of a range of cancers and it has been very pleasing to see the positive reductions that have taken place in tobacco use in Scotland in recent years. Sheila Duffy and the organisation she leads have been instrumental in many of these changes which will free hundreds of thousands of Scots from the fear of contracting tobacco related cancer.

“Her commitment has helped to make Scotland a healthier country and she is a very worthy winner of the Scottish Cancer Foundation prize.”

Ms Duffy said : “I am greatly honoured to receive this award, especially in 2016 as we celebrate ten years of smoke-free indoor spaces. Tobacco is the single biggest preventable cause of cancer, and working to put cigarettes out of sight, out of mind and out of fashion must be a priority going forward.”

“The national ambition is that a child born this year will grow up and reach the age of 18 smoke-free. Achieving this will prevent future cancers, and directly reduce health inequalities.”

The award comes with £10,000 prize money which is to be used to further reduce the burden of cancer in Scotland. Ms Duffy said that ASH Scotland plans to use the money on research to improve the help that can be given to people living in challenging circumstances. The smoking rate for the poorest fifth of the population is still 34%, amongst those with a long-term disability or unemployed it is nearly 50% and among prisoners it is 72%. A third of all tobacco used is by people with mental health issues.

The research will focus on factors that lead people in these groups to smoke and the barriers they face to stopping. It is hoped this will fill gaps in our current knowledge and lead to more effective measures to help them.

The Scottish Cancer Foundation prize is supported by the Grant Simpson Trust which helps organisations involved in the “advancement of health.”

The award to Ms Duffy was presented at the Scotland Against Cancer conference on November 21 at the Royal College of Surgeons of Edinburgh.

**PART 2** | POLITICIZING SCIENCE | SIEGEL ON GLANTZ & E-CIGS

POLITICIZING SCIENCE | SIEGEL ON GLANTZ & E-CIGS | PART 1

China: the tipping point in tobacco control

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PART 2 | GLANTZ ON E-CIGS | PROMOTING THE TOBACCO EPIDEMIC

PROMOTING THE TOBACCO EPIDEMIC | GLANTZ ON E-CIGS | PART 1