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Tobacco Tax

Smokers Undeterred as Bills Keep Rising

Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%) for anti-smoking campaigns

https://financialtribune.com/articles/people/65335/smokers-undeterred-as-bills-keep-rising

Iranians spend $1-1.5 million (40 to 50 billion rials) on tobacco products each day and the cost of treating tobacco-related disease is almost three times more than the amount spent on tobacco consumption.

During the past five years, the rate of tobacco consumption has only slightly decreased, studies conducted by the Health Ministry indicate. The rate is still high among adolescents and young people (the peak age for first trying of smoking has decreased from 13 to 10). The figure has also increased dramatically compared to the past decade, the Persian language weekly ‘Salamat’ reported.

“In 2006, Iranians smoked 50 billion cigarettes (worth $33.3 million). The figure reached 60-70 billion cigarettes in 2016,” said Dr Mohammadreza Madani, head of the Iranian Anti-Tobacco Association (IATA).

Another concern is the high prevalence of hookah (water pipe) for smoking flavored tobacco among young people. One hour of smoking hookah exposes a smoker 100-fold to the amount of smoke inhaled from a single cigarette. Even those people around a hookah smoker inhale smoke equal to 10 cigarettes.

Every year on May 31, the WHO marks World No Tobacco Day (WNTD), highlighting the health and additional risks associated with tobacco use, and advocating effective policies to reduce tobacco consumption.

The theme for World No Tobacco Day 2017 is ‘Tobacco – a threat to development.’

But irrespective of the programs to create awareness on the harmful effects of smoking, statistics show that 14-15% of Iranians from the 80 million population are regular cigarette smokers (more than 3% are women, and 20% men).

“Though most of the cigarette smokers are men, hookah smoking doesn’t vary by gender; 21.3% of women and 21.7% of men are hookah smokers,” Madani said.

Dodging Taxes

Iran is one of the nations that has signed the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), by which a country is committed to reduce the rate of tobacco consumption every year (by implementation of both price and tax measures as well as non-price measures to reduce demand for tobacco).

Pointing to Article 8 of the National Comprehensive Law on Tobacco Control, Madani said, “According to the law passed in 2006, every year taxes on cigarettes should be increased by 10%.”

“However, there have been always obstacles in its implementation. For example, in 2010 the figure decreased to 5% due to ‘manipulative tactics’ by the powerful tobacco lobby. Tobacco producers said that high taxes on cigarettes would lead to an increase in cigarette smuggling, and thus managed to reduce the tax.”

However, in January this year, lawmakers passed cigarette and tobacco tax slabs to be implemented under the sixth five-year economic development plan (2017-22).

Based on the new law, the tax slab on locally-produced tobacco and cigarettes is 10%; for local brands jointly produced by domestic and foreign manufacturers, it is 20%; for domestically produced cigarettes with foreign brand names the slab is 25%; and for imported cigarettes and tobacco, it is 40%.

Lawmakers also mandated the Ministry of Industries, Mining and Trade to announce the retail prices of cigarettes and all tobacco products to the relevant authorities for taxation purposes and for printing the tax rates on cigarette packs.

“Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%). The Education Ministry is required to spend the money on increasing students’ awareness of harms associated with tobacco smoking,” Madani said.

Earlier, the tax money was given to the ministries of health and sports and youth affairs.

Facts About Tobacco

There are more than 7 million deaths from tobacco use every year, a figure that is predicted to cross 8 million by 2030 without effective and intensified action. Tobacco consumption is a threat to any person, regardless of gender, age, race, cultural or educational background. It brings suffering, disease, and death, impoverishing families and national economies.

Tobacco use costs national economies enormously through increased healthcare costs and decreased productivity. Some 80% of premature deaths from tobacco occur in low- or middle-income countries, which face increased challenges to achieving their development goals, the WHO website reports.

Tobacco growing requires large amounts of pesticides and fertilizers, which can be toxic and pollute water supplies. Each year, tobacco growing uses 4.3 million hectares of land, resulting in global deforestation between 2% and 4%. Tobacco manufacturing also produces over 2 million tons of solid waste.

By increasing cigarette taxes worldwide by $1, an extra $190 billion could be raised for development. High tobacco taxes contribute to revenue generation for governments, reduce demand for tobacco, and offer an important revenue stream to finance development activities.

Reduction in tobacco taxes to be a disaster: PIMA

Doctors resent government’s plan to make smoking ‘easier’

https://www.thenews.com.pk/print/206442-Reduction-in-tobacco-taxes-to-be-a-disaster-PIMA

Reacting to a statement made by the Special Assistant to the PM on Revenue, who has expressed that high taxes on cigarettes encourage smuggling which, in turn, costs billions to the exchequer, the president of Pakistan Islamic Medical Association (PIMS) Wednesday suggested that if such a cause and effect relationship is logical, then the government should bring heroin, hashish and other menaces in the open market as a commercial commodity as well, and earn huge income through taxes.

“The government should be ashamed for increasing the prices of basic commodities like bread, fruits, milk, petrol, electricity, etc. and reducing the prices of dangerous items like tobacco,” the PIMA chief stated. He pointed out that Pakistan has one of the largest populations of tobacco users in the world, with over 22 million adults smoking cigarettes, ‘huqqa’ or ‘biri’ and millions more using smokeless tobacco products, including ‘gutka,’ ‘naswar,’ and ‘paan.’ Over 100,000 deaths are attributed to tobacco use each year from lung and oral cancers, strokes, heart and respiratory diseases.

Research has shown that increase in tobacco prices leads to a decrease in the number of smokers in a given community, one of the most effective of many strategies to curb tobacco use. “Here, our government is going to do exactly the opposite: make it easier to buy cigarette. While it may not matter for the richer strata of the society, even a small price increase matters a lot for the poor and lower middle class. It is this group unfortunately that is farthest away from any sort of health education, health care and economic benefits when it comes to illness that inevitably stems from tobacco use,” the PIMA president pointed out.

A research study on tobacco taxation in Pakistan, conducted jointly by FBR, World Bank, University of Toronto, Johns Hopkins University, University of Illinois at Chicago, and Beaconhouse National University, concluded that a uniform specific excise tax of Rs31.2 per pack of 20 cigarettes, could reduce overall cigarette consumption by 7.5 per cent, increase tax revenues by Rs27.2 billion, leading to over half a million users quitting and reducing premature deaths among current adult smokers by over 180,000, while also preventing 725,000 youth from taking up smoking.

Only a week ago, the Minister of State for Health Saira Afzal had recommended an increase in the Federal Excise Duty on lower slab of all brands of cigarettes from the current Rs32.98 to Rs44 per pack of 20 cigarettes.

UAE imposes heavy taxes on tobacco and fizzy drinks

DUBAI: The UAE Ministry of Finance has announced a selective tax of 100 percent on tobacco and energy drinks and 50 percent on carbonated beverages on Tuesday.

https://www.geo.tv/latest/143063-uae-imposes-heavy-taxes-on-tobacco-and-fizzy-drinks

It was announced in a tweet of UAE Ministry of Finance after the meeting of the board directors of Federal Tax Authority (FTA) that was chaired by Shaikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai and Minister of Finance.

It is also stated that new taxes will be applied in the fourth quarter of this year.

International transportation, commodities and exports, health and education services, gold imported for investment purposes are exempted from taxes.

Last year, UAE President Shaikh Khalifa had issued a decree setting up the Federal Tax Authority (FTA) which is responsible for setting up and maintaining records on taxpayers and taxes paid. The authority will also issue guidelines and clarifications to taxpayers on matters related to federal taxes and related fines.

The UAE would also implement tax over the next few years including a Gulf Cooperation Council -wide VAT tax, which will start in 2018.

The list of items that will come under new taxation system would be utility bills (water, electricity, internet), tobacco, soft and energy drinks, watches, electronics, entertainment, smartphones, jewelry and luxury cars.

The UAE expects revenue through only tobacco products alone to be Dh2 billion annually.

Cigarette tax hike takes effect June 20th

The price of cigarettes will increase by NT$20 (US$0.6) per pack starting on June 20th

http://www.taiwannews.com.tw/en/news/3160480

The Ministery of Finance announced Thursday that the price of cigarettes will increase by NT$20 (US$0.6) per pack starting on June 20th, after the Legislature passed the third and final reading of an amendment to the Tobacco and Alcohol Tax.

The amendment raises the cigarette tax from NT$590 per 1,000 cigarettes (per kilogram) to NT$1,590, which translates into a tax per packet of NT$31.8, up from the current NT$11.8.

The increase will generate NT$23.3 billion in additional tax revenue per year, which will be used to fund the long-term care program for seniors, according to the Finance Ministry.

Finance Minister Sheu Yu-jer said earlier this year that he believed the policy would also help curb tobacco consumption and promote public health.

ACT Welcomes Tobacco Tax Hike In Federal Budget

The Alliance for the Control of Tobacco welcomes a hike in the federal tobacco tax announced this week by the Trudeau government.

http://vocm.com/news/act-welcomes-tobacco-tax-hike-in-federal-budget/

Executive Director Kevin Coady says they welcome anything to discourage smoking.

He says the surtax the tobacco manufacturer was paying has been removed, and the consumer tax increased, but it should discourage people from picking up the habit, or force them to cut back.

Statistics Canada earlier this week released numbers showing that this province has the highest rate of tobacco use in the country at 24.4 per cent, and marked increase from the previous survey.

Cigarette tax to rise 100 per cent

The tax on cigarettes is expected to be hiked 100 per cent this year as part of a selective tax agreement agreed last year by the Gulf Cooperation Council (GCC) to raise the price of goods deemed unhealthy, the Times of Oman said.

http://www.tobaccojournal.com/Cigarette_tax_to_rise_100_per_cent.54154.0.html

Cigarettes, alcohol and unspecified other unhealthy products have been targeted by the Finance Ministry for the tax increase this year, the Times said. The rationale for the stiff duties is that use of unhealthy products raises healthcare costs for governments, the newspaper said.

The 2016 selective tax agreement by GCC member states Bahrain, Kuwait, Saudia Arabia, Qatar, Oman and the United Arab Emirates calls for comparable duties on products deemed harmful to human health and the environment. For example a 100 per cent tax was approved for tobacco products and high energy drinks sold in member countries, while soft drinks face a 50 per cent tax.

Tobacco Control Program

Context

Tobacco use, and its negative health, social and economic impacts, is a significant global health challenge.

http://www.worldbank.org/en/topic/health/brief/tobacco

According to the 2015 World Health Organization (WHO) Report on the Global Tobacco Epidemic, in 2013, 21% of adults globally were current smokers – 950 million men and 177 million women. Despite increasing global population between 2007 and 2013, smoking prevalence has actually declined worldwide from 23% in 2007, preventing an increase in the number of smokers in the world. The total remains at 1.1 billion smokers globally in 2013.

Tobacco use is a leading global disease risk factor and underlying cause of ill health, preventable death, and disability. It is estimated to kill more than 5 million people each year across the globe. If current trends persist, tobacco will kill more than 8 million people worldwide each year by 2030, with 80% of these premature deaths taking place in the developing world.

In 2015, the “Addis Ababa Action Agenda” adopted at the Third International Conference on Financing for Development held in Addis Ababa, Ethiopia — and later endorsed by the United Nations as part of the Sustainable Development Goals (SDGs) — recognized that public policies and mobilization, and effective use of domestic resources, underscored by the principle of national ownership, are central to the common pursuit of sustainable development, including achieving the SDGs.

Clause 32 of the Addis Ababa Action Agenda states that price and tax measures on tobacco are viewed as an effective and important means to reduce tobacco consumption and health care costs, and represent a revenue stream for financing for development in many countries.

The Action Agenda also stresses that the tobacco tax agenda is fully consistent with obligations acquired by 180 countries that are parties to the WHO Framework Convention on Tobacco Control (FCTC) (an additional seven countries have signed the FCTC but have not ratified it, and only nine countries are neither signatories or parties to the FCTC).

World Bank Group Tobacco Control Program

The World Bank Group’s Tobacco Control Program assists selected countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and controlling illicit trade on tobacco. Work is currently underway or being initiated in the Philippines, Indonesia, Senegal, Colombia, Botswana, Ethiopia, Armenia, Georgia, Liberia, and Lesotho; work in Ghana concluded. Initial discussions are taking place Ukraine, Nigeria, Moldova, China, India, Peru, and Tajikistan. In addition, the program aims to support knowledge exchange, including peer-to-peer advice and support, among selected countries on the economics of tobacco control (for example, through the Joint Learning Network, which includes more than 30 countries). The preparation of a Tobacco Taxation Module as part of WBG/IMF Tax Policy Assessment Framework (TPAF) is underway as part of a new WBG/IMF initiative launched ahead of the Financing for Development Conference in Addis Ababa, held in July 2015, to help member countries strengthen their tax systems. One of the pillars of the initiative includes the development of “improved diagnostic tools to help member countries evaluate and strengthen their tax policies.” Building on their collective expertise, the Bretton Woods Institutions (BWIs) aim to play a fuller role in enabling all of their member countries to assess tax policy performance in order to identify priority tax policy reforms, and design the requisite support for their implementation. The TPAF is a diagnostic framework to provide systematic and structured assessment of a country’s tax policy system, and to develop options for improving such system given a set of policy objectives.

More specifically, the program assists government agencies in developing capacity to assess the health and social costs of tobacco use, and design, enact, administer and monitor tobacco taxation policies. Enhanced capacity will enable countries to increase prices and reduce tobacco use, taking into account the macro-economic and fiscal situation of each country, tax laws, and existing tax administration structure and processes. This process includes assessments and discussions related to fiscal revenues and allocation; smoking patterns and taxes at country level; and socio-economic and health impacts of increasing tobacco tax rates, under different tax policy scenarios, and including impacts on employment, smuggling and other likely impacts of tobacco tax reforms.

The Bank team engaged in this program is multi-sectoral, and includes experts in health, governance, and macro-economics and financial management. Initial discussions are being held to mobilize knowledge and expertise from the International Monetary Fund’s Fiscal Affairs team. The Bank team is also working closely with other international partners, such as the World Health Organization and the Campaign for Tobacco-Free Kids.

The Bank’s Tobacco Control Program is implemented through a multi-donor trust fund financed by the Bill & Melinda Gates Foundation and the Bloomberg Philanthropies. These donors take part in governance of the trust fund and participate in the selection of priority countries included for support under the program.

Joint Learning Network Module: The Joint Learning Network (JLN), connects practitioners and policymakers across countries, facilitating peer-to-peer learning and sharing of knowledge and experience. As part of the Bank’s program, the network is currently developing a Tobacco Tax and Illicit Trade on Tobacco Module targeting member countries in Asia, Africa, Latin American and the Caribbean, and Europe, as well as a diverse group of international, regional, and local partners. The module is expected to focus on tobacco taxation, tax administration, and illicit trade control measures.

In 1991 the World Bank adopted a mandatory operational policy not to lend, invest in, or guarantee investments or loans for tobacco production, processing, or marketing. The Bank’s activities in the health sector discourage the use of tobacco products.

Why the emphasis on tobacco taxation?

Raising taxes on tobacco products is one of the most cost-effective measures to reduce consumption of products that increase mortality , while also generating substantial domestic revenue for health and other essential programs—investments that benefit the entire population. Given this, the World Bank Group Tobacco Control Program gives priority attention to tobacco taxation.

Findings in the 2015 WHO Report on the Global Tobacco Epidemic show that while only 33 countries impose taxes that constitute more than 75% of the retail price of a pack of cigarettes—the taxation level recommended to have an impact on consumption —most countries that do tax tobacco products have extremely low tax rates. And some countries do not have a special tax on tobacco products at all.

Given this situation, the World Bank Group’s program supports governments to look at accumulated country evidence and use tax measures to increase the retail price of tobacco products as one of the best available public health policy measures.

Some important lessons from international experience about how to effectively implement tobacco taxation policy to achieve public health objectives can be adopted and adapted in policy dialogue and operational support to countries. Such lessons include:

While nearly all countries tax tobacco products, an excise tax is the most important type of tobacco tax, since it applies uniquely to tobacco products and raises prices relative to prices for other goods and services.

Simpler tobacco tax structures are more effective than complex ones, since tiered tax structures are difficult to administer and can undermine the health and revenue impacts of tobacco excise taxes.

Use of specific excise taxes enhances the impact of tobacco taxation on public health by reducing price gaps between premium and lower-priced alternatives, which limits opportunities for users to switch to less-expensive brands in response to tax increases. Taxing all tobacco products comparably reduces incentives for substitution.

Ad valorem taxes are difficult to implement and weaken tax policy impact. Since they are levied as a percentage of price, companies have greater opportunities to avoid higher taxes and preserve or grow the size of their market by manufacturing and selling lower-priced brands. This also makes government tax revenues more dependent on industry pricing strategies and increases the uncertainty of the tobacco tax revenue stream.

Specific excise taxes need to be adjusted for inflation to remain effective.

Tax increases should reduce the affordability of tobacco products. In many countries, where incomes and purchasing power are growing rapidly, large price increases are required to offset growth in real incomes.

Strong tax administration is critical to minimize tax avoidance and tax evasion, to ensure that tobacco tax increases lead to higher tobacco product prices and tax revenues, as well as reductions in tobacco use and its negative health consequences.

Regional agreements on tobacco taxation can be effective in reducing cross-border tax and price differentials and in minimizing opportunities for individual tax avoidance and larger scale illicit trade.

For more information, please contact:

Patricio V. Marquez

Lead Public Health Specialist

World Bank Group Health, Population and Nutrition Global Practice

Email address: pmarquez@worldbank.org

Blanca Moreno-Dodson

Lead Economist

World Bank Group Macro Economics and Fiscal Management Global Practice

bmorenododson@worldbank.org

Recent Gains on Global Tobacco Taxation

http://blogs.worldbank.org/health/recent-gains-global-tobacco-taxation

The landmark Surgeon General’s Report on Smoking and Health, issued by U.S. Surgeon General Dr. Luther Terry in 1964, represented the first time that a government report linked smoking and ill health, including lung cancer and heart disease. The scientific evidence accumulated over the past five decades has helped us understand how tobacco use imposes a heavy health and economic burden across countries.

Action to curb tobacco use makes solid economic sense, given the high costs of tobacco-related illnesses and premature death and disability among adults in their most productive years. Smoking harms health, incomes, earning potential, and labor productivity. Smoking also undermines human capital development —a critical factor for inclusive economic and social development.

Raising tobacco taxation commensurate with affordability levels is proven to be the most effective measure to curve consumption. Tax increases are most effective in countries where the social acceptability of smoking is reduced by curtailing smoking in public places and educating the population about its negative health impact.

Contrary to the assumption that tobacco taxes are regressive, the results of recent studies done in Chile and the United States show that the benefits of this policy measured in terms of lower medical expenses and an increase in working years outweighs any relative increase in tobacco prices, largely benefitting the poor more than the rich.

Over the past decade, the World Bank Group (WBG), in partnership with the Bill & Melinda Gates Foundation and the Bloomberg Foundation, and in coordination other organizations, such as WHO, has expanded its tobacco taxation work globally to assist countries implement their public health and domestic resource mobilization efforts. Simultaneously, technical assistance is being provided to strengthen countries’ legal and regulatory capacity to control illicit tobacco trade. Support is also being provided to facilitate knowledge-sharing, building upon existing platforms such as the Joint Learning Network (JLN).

The experience of Philippines over 2012-2016 is one of the most compelling examples of ambitious national tobacco tax reform. It involved a fundamental restructuring of the country’s tobacco excise tax structure, including reduction in the number of tax tiers; indexation of tax rates to inflation; and substantial tax increases which expanded the fiscal space to fund the increase in the number of families enrolled in the health insurance scheme from 5.2 million primary members in 2012 to 15.3 million in 2015.

More recently, national governments in several countries have adopted significant tobacco tax reforms to improve public health and mobilize domestic resources, covering a total population of 200 million people. In the Ukraine, the 2017 budget includes a 40% excise tax increase on tobacco products, above the 2016 level, while maintaining a 12% ad valorem tax. It is estimated that that this measure will increase on average the excise tax burden as a share of the retail price of a pack of cigarettes from 41% in 2016 to 46% in 2017, while consumption is expected to decrease by 10%. To get a sense of the magnitude of health gains likely to result from the adoption of these tax increases, modeling work estimated that, by 2035, Ukraine’s recent tobacco tax increases will prevent 126,730 new cases of smoking-related disease; 29,172 premature deaths; and 267,098 potential years of life lost, relative to no change in tax. These reductions in disease and death are estimated to result in significant healthcare costs avoided.

As part of broad fiscal reforms approved by Colombia’s Congress, new taxes on tobacco products will nearly triple prices over 2017-2018, with annual adjustments for inflation and a mandated specific increase in subsequent years. Likewise, in Moldova, the average excise tax burden on a pack of cigarettes will increase from 39% in 2016 to 45% in 2017.

Following the introduction of the new tax regime in 2017, Armenia’s tobacco excise tax burden will double, increasing to 62% of the average retail price by 2020. In the case of Armenia and Colombia, tobacco taxation increases are part of larger tax system reforms that were included under fiscal consolidation programs.

In moving forward this agenda, we have to be clear that to be effective and sustainable, the design of tobacco tax reforms has to be grounded on a good understanding of how public policy is created and implemented in a country, including the social forces which could support or hinder the passage of strong anti-tobacco measures. We also have to be mindful that the adoption of tobacco tax reforms could be greatly facilitated if they are included as part of broad fiscal consolidation programs as shown by the recent experience in Armenia and Colombia, or as part of the formulation of annual government budgets as shown by the experience in Moldova and Ukraine.

Curbing teen smoking ‘must go beyond raising minimum age’

http://www.straitstimes.com/singapore/health/curbing-teen-smoking-must-go-beyond-raising-minimum-age

Teens below the age of 18 have been barred from smoking legally since 1993 – but the data two decades later tells a different story.

In 2013, the average age when smokers took their first puff was just 16, according to the National Health Surveillance Survey.

Said Mr Vincent Tng, 21, a non-smoker serving full-time national service: “I have friends who started smoking as young as 14 or 15 – they just got their friends to buy cigarettes for them. There are contraband cigarettes around, so you don’t even have to go to a proper shop.”

Experts said the discrepancy shows that efforts to curb teen smoking must go beyond raising the minimum legal age. Issues such as raising awareness and enforcement cannot be sidelined.

Said Sata CommHealth chief executive and anti-smoking advocate K. Thomas Abraham: “We should have a slew of measures that go concurrently with raising the minimum age. How are these young people able to get cigarettes? How do we plug the existing loopholes?”

Last week, the Ministry of Health (MOH) said it plans to raise the minimum legal smoking age from 18 to 21. In Singapore, these are the years when nearly half of smokers become regular smokers. The idea is to put cigarettes out of the reach of underage smokers, who tend to obtain them through their social circles.

A town in the United States known as Needham is often held up as a success story of how this measure can reduce smoking rates.

In 2005, it increased the legal smoking age from 18 to 21. Smoking rates among under-18s dropped by nearly half within five years – from 13 per cent in 2006 to 7 per cent in 2010. At least 215 other locales in the US have followed suit in recent years, including New York City, Boston and California.

Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee for Health, said: “I don’t think that in itself will be enough… but raising the age would help interdict further access to cigarettes amongst the young.”

To complement the move, experts suggested increasing the size of graphic health warnings on cigarette packets, introducing plain packaging to make cigarettes look as nondescript as possible and even raising the tobacco tax.

According to the World Health Organisation, increasing tobacco prices in high-income countries by 10 per cent is estimated to reduce consumption by 4 per cent, said Professor Chia Kee Seng, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Tobacco taxes were last raised in 2014, from $352 per kg to S$388 per kg of tobacco, or 1,000 cigarettes.(+import tax + GST) It was reported that out of the $12 (HKD66) for an average pack of cigarettes, $8.50 (HKD 47) goes to the Government as tax.

Prof Chia said tobacco taxes should be raised further if smoking remains a serious issue, even after the age limit is raised.

At the same time, said Dr Abraham, even more work needs to be done to drive home the anti-smoking message among young people, as “the long-term effects of smoking are not always immediately apparent to a young smoker”.

Nee Soon MP Louis Ng, who used to smoke, said enforcement needs to be stepped up to ensure cigarettes are not sold to underage teens, and more has to be done to change the image of smoking.

“They think it’s cool to smoke and we need to tackle that mindset with a series of public awareness campaigns,” he said.

Management executive Catherine Ruth Jeyaseelan, 34, suggested involving parents too. “Sometimes parents smoke at home and kids will get curious, they might try it when their parents are out.”

Commentary: Smoking is an archaic habit with no place in modern society

The move to raise the legal age for smoking gives a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.

http://www.channelnewsasia.com/news/singapore/commentary-smoking-is-an-archaic-habit-with-no-place-in-modern/3584938.html

Shocking as it sounds, many doctors used to smoke.

The groundbreaking study which first confirmed the link between smoking and lung cancer was carried out on British doctors in the early 1950s. UK Medical Research Council member Sir Richard Doll, who conducted the study chose doctors as his research participants because many of them smoked, and it would be easier to observe what happened to them as a result of smoking.

Within three years of observation, 37 died from lung cancer. All were smokers. The number of deaths rose to 70 after five years. His work provided strong evidence of the dangers of smoking and laid the groundwork for future public debates about smoking

Since then, governments around the world have put in place policies and programmes to stop people from picking up the habit and help smokers kick theirs. For instance, the United States introduced the tobacco advertising ban and tax in the 1960s.

Singapore became the first Asian country to ban tobacco advertising in 1971, followed by the banning of smoking in various public places. The Singapore Government has also dramatically increased the excise tax on tobacco since 1983.

The impact of such combination of measures was visibly evident. The proportion of smokers among male Singaporeans aged 18 and above declined from 42 per cent in the late 1970s to 24.3 per cent in 2010, and the per capita consumption of tobacco decreased from 2.36 kilograms to 0.77 kilograms in a short span of 30 years. The incidence of lung cancer also halved from around 60 per 100,000 in the 1980s to 30 per 100,000 today.

Nonetheless, the decline in the proportion of smokers has since hit a plateau over the last ten years, hovering around 23 to 24 per cent in males, and 3.5 to 4 per cent in females, and has not budged since. What this effectively means is that the number of new smokers now equal those who have died from or quit the habit. To lower the proportion of smokers, more aggressive efforts will be required to prevent Singaporeans from picking up the habit.

WILL RAISING THE MINIMUM LEGAL AGE REALLY HELP STEM THE HABIT OF SMOKING?

Senior Minister of State for Health, Dr Amy Khor, announced recently on Thursday that the legal age for smoking and buying tobacco products will be raised from 18 to 21.

This will be a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.

Raising the minimum legal age (MLA) makes it harder for them to get tobacco products either directly or through their social networks. More importantly, it contributes toward de-normalising smoking.

95 per cent of smokers in Singapore had their first puff before age 21. Increasing the legal smoking age to 21 reduces youth exposure to tobacco products during their adolescence – a critical stage of life where they are more susceptible to peer pressure, where their psycho-social maturity, including sensation seeking, impulsivity, and future perspective taking, are still not fully developed.

Detractors may question the rationale for raising the MLA.

Some critics argue that raising the legal smoking age is simply delaying initiation into the habit. But the fact is that those who do not pick up smoking by age 21 are unlikely to ever begin. There is evidence that the younger the adolescent is when he starts smoking, the higher the level of nicotine dependence, and the greater the probability of him becoming a long-term, heavy smoker.

Others may make invidious comparisons. After all, if an 18 to 20 year old can legally marry, drive, consume alcohol or serve national service, why is he not allowed to smoke?

Tobacco smoking is clearly very different from and far outweighs the aforementioned activities when it comes to fatalities. It is deliberately designed to be addictive and is known to cause disease and disabilities in both the smokers, as well as those breathing in secondhand smoke. There is no moderate level of consumption at which tobacco smoking is safe – for the smoker and those around him. It is a unique product that kills its user when used as instructed.

Another objection is that raising the MLA may lead to the emergence of a black market peddling tobacco products to underage smokers. To deal with that, law enforcement efforts can be intensified, and harsher penalties imposed on the sellers. For instance, New York City stepped up its enforcement and increased penalties for supply of illegal tobacco products when it raised the MLA.

Of course, even with these efforts, it is impossible to entirely curtail a black market. However, future generations of youths will be discouraged from smoking, disease will be averted and lives saved albeit with this negative “side effect”.

ADOPT AN APPROACH THAT IS SYMPATHETIC, EDUCATIONAL AND SUPPORTIVE

In meting out consequences for underage smokers, we ought to bear in mind that they too are victims of Big Tobacco advertising strategies directed at the aspirations of impressionable youth.

Our best defence would be to adopt an approach that is sympathetic, educational and supportive of their efforts to quit the habit. To successfully curb smoking initiation in our youths, we would do well to ensure adequate enforcement of the MLA on retailers who sell tobacco to minors.

The debate over the Government’s move to raise the minimum legal age is a reminder that no single silver bullet to reduce smoking prevalence exists. The MLA is only but one of the existing and additional future measures for effective tobacco control. Singapore has banned electronic cigarettes which tobacco companies intentionally market as “safer” to youths. They also claim that heated cigarettes are safer but studies have shown that they have the same nicotine content as traditional cigarettes.

There are other measures that we can consider in the fight against smoking. First, there is evidence that increasing the size of graphic health warnings (GHW) on the cigarette packaging prevents youth smoking initiation, boosts motivation to quit, reduces smoking among adults and sustains smoking cessation. Expanding the size of the GHW is a highly cost-effective control measure that we should consider implementing.

Second, several countries like Australia, France and UK have augmented their GHW with standardised packaging. Also known as “plain packaging”, this requirement removes all branding elements such as colour, image, trademarks, logos and text, and only allows the brand name to be printed in a standardised font, size and location on the pack. This reduces the appeal of the pack, weakens any branding power each product might have, and strengthens the impact of the GHW.

Australia was the first nation in the world to adopt plain packaging in 2012. Even though the health impact of the policy will take years to be fully seen, a post–implementation review published in February 2016 reported that the policy has reduced smoking and exposure to tobacco smoke, and is expected to continue doing so.

Third, price and taxes are effective tools for tobacco control. According to the World Health Organisation, a 10 per cent increase in tobacco prices will reduce consumption by about 4 per cent in high-income countries. We should raise tobacco taxes further as part of our suite of enhanced control measures, if we think that smoking remains a serious issue even after the MLA has been raised.

Last, internationally, there is a movement to go beyond conventional tobacco control strategies and adopt fundamentally different strategies that aim to eliminate smoking altogether. These are broadly classified as “Endgame Strategies”. Singapore should begin thinking about eliminating smoking completely. We would not be the first country to endorse and adopt this approach. New Zealand, Finland, Canada, Sweden and France have all endorsed the goal of achieving a smoke-free society in the next eight to 23 years.

Smoking was introduced commercially in the 1880s. It is an ancient and archaic habit, and has no place in our modern and progressive society.

Professor Chia Kee Seng is Dean of the Saw Swee Hock School of Public Health at the National University of Singapore.