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Hong Kong

Raise tax on tobacco and make smokers pay for health costs

I support Gauri Venkitaraman’s plea for bans in public areas where the permeation of cigarette smoke is harmful for passers-by or those trying to enjoy the outdoors (“Smoking in public leaves even non-smokers in Hong Kong facing serious health risks [1]”, July 11).

Non-smokers in proximity risk having their asthma flare up. Curious toddlers could become poisoned by ingesting carelessly discarded butts.

The fire contagion risk posed by still-burning cigarette ends is well known during the height of Australia’s bush-fire-prone sizzling summer and hot summers elsewhere.

Less smoking means fewer discarded butts posing a fire hazard. Another reason to impose smoking bans is to prevent adverse lifestyle role modelling for impressionable children.

From a public health perspective, raising tobacco sales tax is likely to reduce daily cigarette consumption and, more importantly, dissuade adolescents from taking up smoking. The cost disincentive of a higher tax holds the potential to improve the community burden of heart and lung disease that consumes avoidable health-care outlays.

It’s about time smokers who adopt unhealthy life habits subsidised the huge expense incurred in treating the acute exacerbation of chronic lung disease, pulmonary community rehabilitation as well as stents and bypass surgery required to alleviate coronary artery disease. Smokers have an addiction requiring an external agency to help them give up.

Imposing higher taxes on fast food and alcohol offers opportunities to improve public health related to “diabesity” (diabetes plus obesity), alcohol-related trauma and interpersonal violence. If we can extend sales tax disincentives to fast food and alcohol, then claims that a tobacco tax discriminates against smokers cannot be justified.

Joseph Ting, associate professor, School of Public Health and

Social Work, University of Queensland, Brisbane, Australia
________________________________________
Source URL: http://www.scmp.com/comment/letters/article/2103457/raise-tax-tobacco-and-make-smokers-pay-health-costs

Smoking in public leaves even non-smokers in Hong Kong facing serious health risks

Cigarette smoking definitely seems to be on the rise in Hong Kong. I commute to and from work by bus and, of late, the amount of second-hand smoke in the vicinity of bus stops has increased substantially.

http://www.scmp.com/comment/letters/article/2102188/smoking-public-leaves-even-non-smokers-hong-kong-facing-serious

There are huge rubbish bins near every bus stop, and people seem to view this as indicating a smoking spot. There have been many instances when I’ve found people smoking while waiting at the bus stops as well. Many times, people simply throw their half-smoked cigarettes in the little receptacle on top of the bins, without stubbing them out. This results in a continuous cloud of cigarette smoke billowing from the many burning stubs on top of the bins.

The other day, I found two schoolchildren hanging around a rubbish bin and one of them was about to surreptitiously pick up one of the burning stubs that someone had tossed away. Kids are, by nature, curious, and burning stubs lying within reach pose the danger of tempting them to try smoking.

Inhaling second-hand smoke is also very harmful and could lead to serious health issues down the line. Humans can be self-indulgent but usually the ill-effects are restricted to that individual. However, when it comes to smoking in public, the ill-effects are not restricted to the smoker. The negative effects of passive smoking has an impact on other people too, an impact that is scientifically proved to be tangible, measurable and, at times, permanent.

Just imposing high tobacco taxes has not really had an impact, as far as pedestrians being forced to inhale second-hand smoke goes. A legal move to increase the size of warnings on the cigarette packs has met with fierce resistance, accompanied by lobbying by tobacco executives and their lawyers.

Many countries have enforced compulsory, graphic health warning signs covering most of the surface area of cigarette packs, along with plain packaging that reduces the effect of branding for drab-looking packs.

The government has laws in place but there needs to be efficient enforcement. When it comes to use of controlled substances like tobacco, there has to be a healthy modicum of respect on the part of users towards the health of non-users, and this is simply not going to be possible as long as effective measures are not enforced.

Gauri Venkitaraman, Lam Tin

Hong Kong Customs seizes suspected illicit cigarettes

Hong Kong Customs yesterday (June 2) seized about 1.5 million suspected illicit cigarettes with an estimated market value of about $4.1 million and a duty potential of about $2.9 million at Man Kam To Control Point.

http://www.info.gov.hk/gia/general/201706/03/P2017060200961.htm

Customs officers intercepted an incoming truck declared to contain cloth at Man Kam To Control Point yesterday. After inspection, Customs officers found about 1.5 million suspected illicit cigarettes inside 156 carton boxes. A male driver, aged 52, was arrested and the truck has been detained for further investigation. Investigation is ongoing.

Smuggling is a serious offence. Under the Import and Export Ordinance, any person found guilty of importing or exporting unmanifested cargo is liable to a maximum fine of $2 million and imprisonment for seven years.

Members of the public may report any suspected illicit cigarette activities to the Customs 24-hour hotline 2545 6182.

Ends/Saturday, June 3, 2017
Issued at HKT 15:30

Support World No Tobacco Day – say “no” to tobacco

To support the World No Tobacco Day 2017, the Department of Health (DH) today (May 31) held a sharing session to remind the public again of the hazards of smoking and to urge smokers to quit smoking as early as possible.

http://www.info.gov.hk/gia/general/201705/31/P2017053100249.htm

Speaking at the sharing session, the Director of Health, Dr Constance Chan, said that the World Health Organization (WHO) has marked May 31 as World No Tobacco Day annually. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development”, with the aim of demonstrating the threats posed by tobacco to the world’s sustainable development, including public health and the economy. Dr Chan strongly urged members of the public to say “no” to tobacco and to continue supporting the Government’s efforts in tobacco control.

“With the collaborative efforts of the Government and various sectors over the years, the work on tobacco control in Hong Kong has attained pleasing results, with a drop in overall smoking prevalence from 23.3 per cent in the 1980s to 10.5 per cent in 2015. Nonetheless, casualties and economic loss directly and indirectly caused by tobacco remain tremendous. Local studies revealed that tobacco-related fatalities reach nearly 7 000 people annually and the economic loss resulting from tobacco-related health problems is estimated to be about 5.5 billion every year,” Dr Chan said.

“Smoking is a causative agent of many cancers as well as cardiovascular and respiratory diseases. Smoking causes harm not only to the smoker but also to their family members and friends due to the secondhand smoke induced, which increases their risk of cancer and many other chronic diseases as well as the chance of children developing respiratory symptoms,” Dr Chan added.

Sharing the research findings on local smoking-related mortality and morbidity conducted by the University of Hong Kong (HKU), the Chair Professor of the School of Public Health of the HKU, Professor Lam Tai-hing, pointed out that at least one out of every two elderly smokers died of tobacco-related diseases. He said that the Government must continue to adopt various tobacco control measures to encourage smokers to quit the habit.

The Head of the Tobacco Control Office of the DH, Dr Lee Pui-man, introduced in the sharing session 12 new pictorial health warnings on cigarette packets, which better inform the public about the specific hazards of tobacco use to smokers and their families. Experience and evidence from the WHO and around the globe also demonstrate that pictorial health warnings are an effective intervention, and increasing the size of pictorial health warnings on cigarette packets is now an international trend.

“The graphics and designs of health warnings should be updated regularly so as to maintain their salience and enhance the impact. The Government updates pictorial health warnings coupled with multiple tobacco control measures to discourage members of the public from smoking and encourage smokers to quit,” Dr Lee said.

Smokers who intend to quit smoking can call the DH’s Integrated Smoking Cessation Hotline on 1833 183, where registered nurses provide professional counselling services on smoking cessation and will also refer service users to suitable social service agencies for follow-up when necessary. To enhance smoking cessation services to smokers, the DH will launch a pilot public-private partnership programme this year to trial a new mode of smoking cessation service supported by family physicians.

In addition, the DH will collaborate with a renowned medical institution, Mayo Clinic, in the United States to organise an online training programme on tobacco dependence treatment, which will be rolled out within this year. Family physicians joining the programme will acquire skills and knowledge on smoking cessation via e-learning, and their capacity in providing smoking cessation services will be further enhanced through training and assessment. The programme aims to ensure that they can provide quitters with effective evidence-based treatment.

In addition, two patient representatives shared their experience of smoking at the sharing session, ranging from smoking-related diseases to successfully quitting the habit. They urged other smokers to quit smoking as early as possible and to seek help on smoking cessation if necessary.

Support World No Tobacco Day – say “no” to tobacco

To support the World No Tobacco Day 2017, the Department of Health (DH) today (May 31) held a sharing session to remind the public again of the hazards of smoking and to urge smokers to quit smoking as early as possible.

http://www.info.gov.hk/gia/general/201705/31/P2017053100249.htm

Speaking at the sharing session, the Director of Health, Dr Constance Chan, said that the World Health Organization (WHO) has marked May 31 as World No Tobacco Day annually. The theme for World No Tobacco Day 2017 is “Tobacco – a threat to development”, with the aim of demonstrating the threats posed by tobacco to the world’s sustainable development, including public health and the economy. Dr Chan strongly urged members of the public to say “no” to tobacco and to continue supporting the Government’s efforts in tobacco control.

“With the collaborative efforts of the Government and various sectors over the years, the work on tobacco control in Hong Kong has attained pleasing results, with a drop in overall smoking prevalence from 23.3 per cent in the 1980s to 10.5 per cent in 2015. Nonetheless, casualties and economic loss directly and indirectly caused by tobacco remain tremendous. Local studies revealed that tobacco-related fatalities reach nearly 7 000 people annually and the economic loss resulting from tobacco-related health problems is estimated to be about 5.5 billion every year,” Dr Chan said.

“Smoking is a causative agent of many cancers as well as cardiovascular and respiratory diseases. Smoking causes harm not only to the smoker but also to their family members and friends due to the secondhand smoke induced, which increases their risk of cancer and many other chronic diseases as well as the chance of children developing respiratory symptoms,” Dr Chan added.

Sharing the research findings on local smoking-related mortality and morbidity conducted by the University of Hong Kong (HKU), the Chair Professor of the School of Public Health of the HKU, Professor Lam Tai-hing, pointed out that at least one out of every two elderly smokers died of tobacco-related diseases. He said that the Government must continue to adopt various tobacco control measures to encourage smokers to quit the habit.

The Head of the Tobacco Control Office of the DH, Dr Lee Pui-man, introduced in the sharing session 12 new pictorial health warnings on cigarette packets, which better inform the public about the specific hazards of tobacco use to smokers and their families. Experience and evidence from the WHO and around the globe also demonstrate that pictorial health warnings are an effective intervention, and increasing the size of pictorial health warnings on cigarette packets is now an international trend.

“The graphics and designs of health warnings should be updated regularly so as to maintain their salience and enhance the impact. The Government updates pictorial health warnings coupled with multiple tobacco control measures to discourage members of the public from smoking and encourage smokers to quit,” Dr Lee said.

Smokers who intend to quit smoking can call the DH’s Integrated Smoking Cessation Hotline on 1833 183, where registered nurses provide professional counselling services on smoking cessation and will also refer service users to suitable social service agencies for follow-up when necessary. To enhance smoking cessation services to smokers, the DH will launch a pilot public-private partnership programme this year to trial a new mode of smoking cessation service supported by family physicians.

In addition, the DH will collaborate with a renowned medical institution, Mayo Clinic, in the United States to organise an online training programme on tobacco dependence treatment, which will be rolled out within this year. Family physicians joining the programme will acquire skills and knowledge on smoking cessation via e-learning, and their capacity in providing smoking cessation services will be further enhanced through training and assessment. The programme aims to ensure that they can provide quitters with effective evidence-based treatment.

In addition, two patient representatives shared their experience of smoking at the sharing session, ranging from smoking-related diseases to successfully quitting the habit. They urged other smokers to quit smoking as early as possible and to seek help on smoking cessation if necessary.

Ends/Wednesday, May 31, 2017
Issued at HKT 15:18

Hong Kong must adopt plain tobacco packaging, say health advocates

Three-quarters of Hongkongers support restrictions on logos, colours and brand images on cigarette and other tobacco product packs in a bid to further reduce smoking

http://www.scmp.com/lifestyle/health-beauty/article/1959203/hong-kong-must-adopt-plain-tobacco-packaging-say-health

We’ve all chosen products purely based on packaging – a bag of chips at the supermarket, a novel at the bookstore, a photo of a dish on a menu. Even when dealing with people, we tend to let first impressions guide our future interactions with them.

The power of packaging to directly influence one’s perception of something or someone is so strong that it’s no surprise the World Health Organisation advocates plain packaging for tobacco products, which kill almost six million people every year.

Momentum for plain packaging has steadily gained in the past few years, starting with Australia’s implemention in December 2012, and now the measure looks to be gaining traction worldwide.

“We’re beginning to see the globalisation of plain packaging,” says Benn McGrady, a legal adviser to the WHO’s Framework Convention on Tobacco Control.

Plain packaging of tobacco products restricts or prohibits the use of logos, colours, brand images and promotional information on packaging other than brand and product names displayed in a standard colour and font style.

Earlier this month on May 20, France and Britain each began implementation of plain packaging. Ireland is also preparing to introduce the measure this year; Hungary and Norway are in the process of developing laws to implement plain packaging; Singapore is undertaking a public consultation with a view to introducing plain packaging; and several other countries, including New Zealand, South Africa and Turkey, have either expressed an intent to implement the measure or are in the policy development process.

Will Hong Kong be next? Antonio Kwong, chairman of the Council on Smoking and Health (Cosh), says Cosh has been advocating the government implement plain packaging since 2012.

About three-quarters of Hongkongers have expressed support for plain packaging, Kwong says, citing results from the 2015 Tobacco Control Policy-related Survey commissioned by Cosh and conducted by Hong Kong University’s School of Public Health to collect public opinion towards current and future tobacco control policies.

“In view of the global successful examples and WHO’s appeal, Cosh recommends the government to actively consider adopting plain packaging in two to three years,” says Kwong.

The WHO is stepping up its drive for plain packaging by making it the theme of this year’s World No Tobacco Day, held annually on May 31 since 1988. WHO has launched a new 86-page guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure.

“Plain packaging reduces the attractiveness of tobacco products. It kills the glamour, which is appropriate for a product that kills people,” says WHO director-general Dr Margaret Chan, a former Hong Kong director of health. “It restricts tobacco advertising and promotion. It limits misleading packaging and labelling. And it increases the effectiveness of health warnings.”

McGrady says there’s a “strong evidence base” supporting the implementation of plain packaging, including more than 80 peer-reviewed empirical studies, three systematic reviews of the evidence, and an official post-implementation review from Australia.

“As a whole, this body of evidence points in one direction, which says plain packaging is an effective public health intervention,” says McGrady.

Smoking prevalence has been steadily declining in Australia for years and, even if plain packaging hadn’t been introduced the rate, was projected to be 17.77 per cent among those aged 14 and older in 2015. However, research shows that between December 2012 and September 2015, there was an additional 0.55 percentage point fall in smoking prevalence attributable to the packaging changes – meaning a 17.21 per cent prevalence – McGrady says.

This equates to more than 108,000 fewer smokers in Australia as a consequence of plain packaging – a “very big” number, says McGrady. “Plain packaging has decreased tobacco use in Australia beyond trend; it has increased the speed of the downward trajectory.”

Tobacco packs act as a prominent form of tobacco advertising and promotion, not only at the point of sale, but also after, says the WHO report. Tobacco products are “badge products”, meaning they have a high degree of social visibility and that consumers identify with the brand image cultivated on product packaging.

“As internal tobacco industry documents recognise, packaging plays an increasingly important role in promoting tobacco products as other restrictions on tobacco advertising and promotion are tightened,” the report says.

In the evidence gathered in the report, studies show that packaging – in particular colour – affects consumers’ perceptions of risk. Early evidence of this can be found in internal tobacco industry documents released to the public through litigation, the report says.

For example, a 1990 tobacco industry document recognised that so-called “lower delivery products” were featured in lighter packs because they have a clean healthy connotation. Other studies tested consumer reactions to ultra-light products packaged in different colour packs. Consumers ranked the perceived tar level of products in different colour packs and commented on factors such as the harshness and strength of the flavour of different colour packs with otherwise identical products inside them.

There’s also evidence that plain packaging influences the intention and increases the urgency of smokers to quit. It also reduces active smoking and the display of tobacco packs in outdoor settings.

Plain packaging also prevents misleading packaging, the report says, such as labels like “light”and “mild”, which suggest products are less harmful to health than regular brand variants when this is not the case. Rather, consumers compensate for the lower tar and nicotine yields in these products, including by smoking more of a cigarette and taking deeper puffs.

With all this compelling evidence, why aren’t more governments rushing to implement plain packaging?

“I think the resistance to tobacco control and plain packaging are driven by the tobacco industry using its deep pockets to oppose implementation of good public health policies. It’s political; it’s nothing to do with evidence or public policy,” says McGrady. “That’s what’s slowing down tobacco control globally.”

Tobacco industry opposition to plain packaging dates back more than 20 years, McGrady says. Most recently the world’s top four tobacco companies challenged Britain’s new plain packaging law, arguing that it unlawfully took away their intellectual property. The High Court struck down the challenge and the law came into effect on May 20.

“It is wrong to view this issue purely in monetised terms,” the ruling said. “There is a significant moral angle embedded in the regulations, which is about saving children from a lifetime of addiction, and children and adults from premature death and related suffering and disease.”

One person dies from a tobacco-caused disease approximately every six seconds according to the WHO. Annual deaths are forecast to rise from 6 million to more than 8 million by 2030.

In Hong Kong, the prevalence of daily cigarette smokers among persons aged 15 and over has decreased steadily from 23.3 per cent in 1982 to 10.5 per cent in 2015 (except for years from 2000 to 2002). Still, a Chinese University study last year found that smoking costs the city HK$11.3 billion each year, in health care expenses and productivity losses related to tobacco.

The WHO recommends implementing plain packaging as part of a comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.

Says Kwong: “Through the implementation of a comprehensive and multipronged strategy, including a policy of long-term tobacco tax increases to reduce affordability, expansion of statutory no-smoking areas, restriction of tobacco promotion and packaging, the banning of tobacco product displays at points of sale, raising the minimum age to buy cigarettes to 21, increasing resources for smoking cessation services, strengthening smoke-free education and promotion, placing responsibility on venue managers for smoking offences in their premises etc, we hope the smoking prevalence will drop to below 5 per cent in the near future.”

Anti-smoking fight heats up

Bringing Hong Kong’s smoking rate down to single digits from one of the world’s lowest will be a slow and difficult drive, with the government considering a two-pronged strategy.

http://www.thestandard.com.hk/section-news.php?id=181900

Undersecretary for Food and Health Sophia Chan Siu-chee said this in an interview with The Standard, as the government is set to gazette an amended law enlarging the size of scare-tactics health warnings to at least 85 percent of the cigarette packets before the current term ends on June 30.

Chan said the government will study new strategies to encourage about 600,000 hard-core smokers to quit and prevent young people from taking up the habit.

Hong Kong’s smoking rate is 10.5 percent – down from 28 percent in the 1980s – but Chan said the long-term goal is to bring down the prevalence rate to single digits, although no deadline has been set for achieving that for several reasons.

“We know that as smoking prevalence decreases to such a low extent – 10.5 is actually one of the lowest rates in the world – the rate of further lowering would be slower than before because many people who are motivated or are prepared to quit have probably already quit,” she said.

But it would be very difficult to get the hardcore smokers to quit.

“But it doesn’t mean we are not doing anything. We just need a different strategy to deal with this group of more hard-core people,” said Chan.

“We need to study the remaining population of smokers more carefully to ascertain how hardcore they are and what strategy we need to deal with the different stages of readiness to quit.”

Chan also said it was very important to prevent young people from picking up the habit.

“That’s why it is also important for us to regulate for example, e-cigarettes which are like a gateway to smoking.”

The Food and Health Bureau is studying the legislative framework to carry that out, she said, but it would not be ready anytime soon.

The Department of Health will study whether the expanded health warnings would have any effect on bringing down the smoking rate once the enhanced warnings were put in place.

“We have international evidence that it would reduce smoking prevalence,” she said.

It would be the first time for pictorial health warnings to be expanded since the warning covering 50 percent of packets was introduced in 2007.

The government will allow the tobacco industry 12 months from the enactment of the law to sell off existing stock and prepare for the expanded warnings that will also include 12 pictures, up from the current six, to be used on a rotation basis.

But she said this did not mean the government had made any concessions to the trade, saying: “Even the last time, we gave 12 months when we first introduced the pictorial warning in 2007.”

She insisted that the plan was “to gazette as soon as practicable before June 30.”

While Chan said plain packaging would not happen in Hong Kong anytime soon, she defended the government’s move to go for 85 percent instead of 100 percent health warnings.

The World Health Organization recommends 50 percent or above, she noted.

But there are legal considerations as seen in countries that have mandated plain packaging being sued by the tobacco giants.

The enhanced warnings also include the Department of Health quit line and a message from the government to quit smoking.

Calls to stub out tobacco deals

http://www.thestandard.com.hk/section-news.php?id=180992

Several legislators yesterday called on the government not to extend further concessions to the tobacco trade that is trying to further delay implementation of bigger graphic health warnings on cigarettes to the detriment of public health.

The government proposed in May 2015 to enlarge the size of health warnings to cover at least 85 percent of the packet or retail containers of cigarettes, saying the existing six graphic health warnings which cover half of packets or containers have been in use since 2007.

The Food and Health Bureau has made four concessions to meet the industry’s concerns, including using any background color to show nicotine and tar content and for the English version of the health warning to remain at 50 percent of the surface area of the lid of a drum-shaped container.

Undersecretary for Food and Health Sophia Chan Siu-chee told a Legislative Council health services panel yesterday that the government will also extend the adaptation period from six months to 12 months upon gazetting of the amendment order of the smoking ordinance.

Tourism-sector lawmaker Yiu Si- wing said: “The government is conceding, giving in to the tobacco sector’s pressure.”

The Labour Party’s Fernando Cheung Chiu-hung: “Public health should come first. Especially as I have had some personal health problems, I understand the value of health.

“I understand from the grassroots that smoking is a relief for them from stress but the government should not concede anymore. It has already conceded enough.”

Peter Shiu Ka-fai, of the wholesale and retail sector, questioned whether the government would have evidence to show that bigger warnings would mean “people will stop smoking?”

Wong Ting-kwong, of the import and export sector, said he is a smoker and that bigger warnings will still affect second- and third-hand smokers as “the smoke isn’t less.”

The panel also discussed the Hong Kong Code, a voluntary code aimed at protecting breastfeeding and to impose restrictions on formula milk marketing practices that give misconceptions about the nutritional value of products for children up to 36 months old.

Chan told the legislators: “We consulted the Department of Justice and the code is not breaching the competition law as this is voluntary.”

WHO Letter to HK Government on Tobacco Control Efforts

Download (PDF, 81KB)

CUHK MPH Student Support for Graphic Health Warnings

Download (PDF, 677KB)