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March 25th, 2012:

Fight may cost Big Tobacco a packet

"The success in Australia is going to be the success of the world" ... Margaret Chan, the head of the World Health Organisation.

“The success in Australia is going to be the success of the world” … Margaret Chan, the head of the World Health Organisation. Photo: Simin Wang

Australia’s plain-pack laws are pivotal in the global battle to cut smoking, writes Amy Corderoy.

The troops are rallying. And as their tiny general takes the stage, the feeling of victory in the air is palpable.

Margaret Chan, the head of the World Health Organisation, will fight this battle to the death.

She addresses her enemy: ”You run a killing and intimidating industry, but not in a crush-proof box. The number and fortitude of your public health enemies will damage your health – tobacco industry.”

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Her army, equipped with research papers and funding grants, gathered this week for the World Conference on Tobacco or Health.

And all their eyes are on Australia.

”The success in Australia is going to be the success of the world,” Chan tells the audience filling the vast ballroom of Singapore’s Suntec Convention Centre. ”It has to be a success because many countries are looking to Australia for leadership and inspiration.”

”Can we allow this to fail?” she asks.

”No,” the crowd mumbles.

”You are soft today, say it again!”


The stakes are high. Tobacco campaigners used to quote the shocking figure that in the 20th century tobacco killed 100 million people, more than all wars combined. Based on present smoking rates, in the 21st century 1 billion people will die from tobacco-related illnesses.

When federal laws requiring plain packaging for all tobacco products come into force in December, Australia will become the first country in the world to completely ban all tobacco advertising.

Public health advocates believe the legislation could be the beginning of the end for Big Tobacco – and that thought must also have crossed the mind of the industry.

There are now three separate court cases fighting the laws. In February last year, Philip Morris Asia bought Philip Morris Australia, allowing it four months later to launch a suit claiming the legislation violated a trade agreement with Hong Kong.

The company, along with British American Tobacco, Imperial Tobacco and JT International, have launched an action in the High Court claiming the move is unconstitutional.

And Ukraine, a country in which nearly half of 13-year-old boys and one in three 13-year-old girls have tried cigarettes, has begun proceedings against Australia under World Trade Organisation laws.

Anti-tobacco campaigners have long argued that sleek market-researched cigarette packets are the last method tobacco companies can use to promote their brand.

The director of the Public Health Advocacy Institute and a professor of health policy at Curtin University, Mike Daube, says he has no doubt the fight against tobacco is being won in developed countries. ”For the first 20 to 25 years I worked in tobacco, people would be saying: ‘You’ve failed, you’ve failed.’ Now they’re asking: ‘What’s the secret to your success?”’

This week Daube was awarded the equivalent of the Oscar of public health campaigning, the American Cancer Society’s Luther L Terry distinguished career award.

His personal success, and popularity, he can’t walk five metres around the conference centre without a wave hello or a friendly word, reflects Australia’s golden moment on the global stage.

The Department of Health and Ageing and Victorian researcher Melanie Wakefield were also recognised, meaning Australians took a third of the award’s prizes.

Daube believes that by 2025 only 5 per cent of Australians will smoke, down from 15 per cent now and 30 per cent in the late ’80s. ”We are definitely winning,” he says.

Daube argues the court challenges are to delay plain packaging, and they will not be able to stop its implementation. And as soon as there is a major victory a domino effect is likely, with Britain, New Zealand and some Nordic countries likely to follow.

All it takes is for countries to appoint health ministers willing to take on the fight. And it’s for that reason the tobacco industry will use everything it’s got to fight this to the bitter end, Daube says.

Perhaps unluckily for them, Jane Halton is no stranger to a fight. Before moving to health after the 2001 election, the secretary of the Department of Health and Ageing ran the Department of the Prime Minister and Cabinet, and survived brutal political scrutiny of her role in the ”children overboard” affair.

She says that in her 30-year career in the public service she has never seen anything like the tobacco industry’s response to plain packaging. ”It’s unprecedented.”

Since April 2010, her department has received 54 Freedom-Of-Information requests on the policy, 53 of which were from the tobacco industry. Unlike most requests, which are finely crafted to hone in on a particular document, they seem designed to cause the department as much trouble as possible.

”This is not a quest for information, this is a very deliberate action to actually drain my resources, there’s no two ways about it,” Halton says.

After months of negotiations the claim is often withdrawn or modified, which can begin the costly process all over again. Halton says every line of redaction is appealed. The requests often involve calling back hundreds of files from archives and thousands of documents.

”They might ask for all documents pertaining to a particular topic for a 10-year period,” she says.

One FOI request from British American Tobacco alone cost her department $643,000 to process.

Halton, who describes Chan as a personal friend, seems comfortable on the world stage. But the second-generation career public servant (her father, Charles Halton, ran the Department of Transport under Gough Whitlam), is probably not used to the role of bureaucrat-as-hero she has been bestowed in Singapore.

She says the department is aware of the intense international interest focused on plain packaging and just why the tobacco industry is so worried about it.

”It’s not that hard to work out that the techniques that we have been using, which have had a demonstrated effect in our country, can and will be picked up by other countries,” Halton says. ”Ultimately there is a logical end point to that, which is why tobacco companies are fighting so hard.”

Australia is committed to achieving a smoking rate of 10 per cent and is one of several countries that are on the cutting edge in terms of their low smoking rates.

”I would be delighted if the rate of smoking in Australia was zero. I’m not sure ultimately what the final number will be, I don’t have a crystal ball,” Halton says.

She says developing new anti-smoking measures is as important today as it ever was. ”There is a new generation coming forward every year who are the potential customers of Big Tobacco,” she says.

And that is what keeps the battle going. For every adult that quits there is a teenager waiting to take their place. For every developed country that implements anti-tobacco measures there is a developing country with an emerging market ready to be tapped.

In the Solomon Islands, more than 41 per cent of the population smoke. In Nauru, it’s almost 53 per cent. Chinese men alone smoke one-third of the world’s cigarettes.

On a typically sweltering day 10 years ago on Singapore’s Orchard Road, a glamorous young woman paused for a moment, gazing in a shop window. She reached into her designer bag and pulled out a white tipped ”mild seven light” cigarette.

Joanna Koh was 18 when she started smoking, on her breaks at work. ”I liked the sense of relaxation and fun, we were young and we could do whatever we wanted,” she says.

In Singapore, Koh is the perfect example of what anti-tobacco campaigners fear most. Young, educated women who are fashion conscious and now have money to burn on the deadly habit. The difference is Joanna eventually quit and has joined a Singapore government campaign to convince other young people to do the same.

Singapore reached a historic low smoking rate of 12.6 per cent in 2004, before creeping back up to 14.3 per cent in 2010, and in that time the number of female smokers increased more rapidly than male smokers.

While the overall number of women smokers is still low (a little more than 4 per cent compared with almost 25 per cent among men), it will take only a small increase in women picking up the habit to have a massive public health impact.

”We are very concerned about young women smoking primarily because the industry is targeting women,” says Susan Mercado, the team leader of the Tobacco Free Initiative in the WHO’s western Pacific regional office. Her job is to help the 37 countries in the region, including Australia, to implement the Framework Convention on Tobacco Control, the bible of tobacco control. Mercado says increasing prosperity is a double-edged sword for women, as they become a bigger target for the tobacco industry.

”They know that women in this day and age, especially in Asia, they have got jobs, they are independent, and they see women as their new market, they are very aggressive,” she says.

Mercado says tobacco marketing links smoking with freedom and independence, and cigarettes and their packets are often brightly coloured or decorated with popular characters such as Hello Kitty.

”The cigarette packet is becoming a battleground now and the tobacco industry doesn’t want to let go of that,” she says. ”Plain packaging for us is a cutting-edge intervention – I think it’s inspiring a lot of countries to go above and beyond what they are already doing.”

Mercado says as the tobacco industry has lost credibility in its fight with public health advocates, it has shifted its tactics. ”The industry is moving towards trade and litigation and away from our area of comfort, which is public health,” she says.

The WHO is now being forced to take on the role of legal defender, to add lawyers and trade experts to its panels of doctors and health professionals, with the backing of rich philanthropists such as the Bill and Melinda Gates Foundation and Bloomberg Philanthropies. The latter this week announced $US220 million ($211.5 million) to go to anti-tobacco campaigns, bringing its total contribution to more than $US600 million.

Amy Corderoy attended the World Conference on Tobacco or Health courtesy of the Singapore Health Promotion Board.

Read more:

New Tobacco Atlas Estimates U.S. $35 Billion Tobacco Industry Profits and Almost 6 Million Annual Deaths

Download PDF : Launch_Press_Release

Singapore Moves to Turn Off Shisha Smokers

A brochure from Singapore’s Health Promotion Board aims to drive home the point that shisha smoking has the same health risks as cigarette smoking, including cancer. (ST/HPB Photo)

brochure from Singapore’s Health Promotion Board aims to drive home the point that shisha smoking has the same health risks as cigarette smoking, including cancer. (ST/HPB Photo)


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Singapore. Every three months, Singaporean Collette Claire Miles, 20, meets a few friends at a shisha cafe in Kampong Glam’s Haji Lane in Singapore. There they puff on fruit-flavored tobacco from a shared mouthpiece for an hour or so, in between chats.

The polytechnic graduate, who first smoked shisha when she was 15, said: “They are all my friends, so I trust they are not sick.”

But viruses could abound in the mouthpiece, exposing users to infectious diseases such as tuberculosis and influenza, said the Health Promotion Board (HPB). Furthermore, shisha cafes do not regularly wash their equipment, it added.

HPB wants shisha smokers like Miles to know these facts about the Middle Eastern practice of inhaling tobacco smoke that is passed through water, via its new campaign starting tomorrow.

It is banking on the “ick” factor to turn off some shisha smokers who may not bother about the main reason that it is bad: It has the same health risks as cigarette smoking, including cancer, heart disease and respiratory disease.

From Friday till April 6, SingTel mobile phone subscribers who come within 1km of shisha hot spot Kampong Glam will receive a multimedia message in the form of an 18-second video.

In it, a man called Tony urges them to “draw deeply on the hose, that will give them a better chance of catching TB or whatever virus that may be left behind by the person before you’.” The video ends by directing viewers to a nine-minute clip which will bring home the dangers of shisha smoking.

Tomorrow, young people in bright yellow T-shirts will distribute flyers against the practice in Kampong Glam.

The campaign launch coincides with the 15th World Conference on Tobacco or Health at Suntec Singapore, which ends on Saturday.

Though it is not known how many people in Singapore have taken up shisha smoking, there were 44 such cafes in January, up from a single one in 2002. Most are in the Kampong Glam area.

HPB is targeting a shisha hot spot for the first time. Previously, it concentrated its outreach efforts on secondary schools and polytechnics.

It is worried about young people’s mistaken belief, highlighted in focus groups, that shisha smoking is a safe alternative to cigarette smoking due to its fruity smell and lack of tobacco aftertaste, said Dr K. Vijaya, director of HPB’s youth health division.

Another worry is that the number of smokers has grown, from an-all time low of 12.6 per cent of the population in 2004, to 14.3 per cent in 2010. The habit is most prevalent among young adults in the 18 to 39 age group.

This campaign comes after the ban on lighting up was extended to more public areas earlier this month.

Five shisha cafe operators interviewed yesterday think the campaign will not hit their business hard, as less than 10 per cent of their customers smoke shisha.

One of them, Shima Haqeem, 29, said offering shisha is not lucrative, but her cafe does so to retain customers.

“When a big group of 15 to 20 people come and one or two of them ask if we offer shisha, we lose the whole group to other cafes if we reply no.”

When shown the anti-shisha brochure, technician Mohamad Razali, 38, who smokes shisha daily at Kampong Glam after work, was unfazed.

He knows it is bad for health but said: “If I get a disease from shisha smoking, then what can I do?”

He and two shisha cafe operators said that the only way to make people stop shisha smoking is to ban the practice.

But Miles, who had been unaware that shisha smoking had so many adverse health effects, made an immediate decision to quit after reading the brochure.

Four public hospitals with smoking cessation programs have not had patients who seek help to quit shisha smoking.

But smoking tobacco in any form — even shisha smoking which is seen as a social rather than addictive habit — puts one at risk of adverse health consequences, said Associate Professor Loo Chian Min, the head and senior consultant at the department of respiratory and critical care medicine at Singapore General Hospital.

Psychiatrist Munidasa Winslow, who runs a private clinic, warned that former smokers who use shisha, even infrequently, put themselves in danger of relapsing.

Tobacco companies getting creative

BATTLE AGAINST SMOKE. Anti-tobacco advocates aggressively push the line against smoking. AFP Photo.

BATTLE AGAINST SMOKE. Anti-tobacco advocates aggressively push the line against smoking. AFP Photo.

SINGAPORE – The Philippine health department saw through the unbelievably numerous scenes depicting smoking in the movie, “Manila Kingpin: The Untold Story of Asiong Salonga.” It is, an agency official said Thursday, a form of indirect advertising and promotion of cigarettes, which is prohibited by law.

Earlier this week, select journalists from different countries were asking Matthew Myers, president of the US-based Campaign for Tobacco-Free Kids (CTFK), just that: Aren’t movies just depicting reality — that there are people who smoke — when they include such scenes?

Myers’ reply: Characters holding a cigarette or puffing it in a movie scene is “not reality” because majority of people are non-smokers. Including smoking in movie scenes therefore “misleads” the viewing public to think that it represents a habit of more people.

The recently launched Tobacco Atlas shows that only nearly 20% of the world’s adult population smokes cigarettes.

Besides, he said, “You don’t watch movies to see people smoke,” and so those smoking scenes are really unnecessary. There’s no other way to interpret those scenes but as indirect advertisement influenced by the tobacco industry.

The Tobacco Regulation Act of 2003 prohibits tobacco companies from placing advertisements in the paid media — TV, cable channels, radio, newspapers and magazines, cinemas, and billboards. The law doesn’t allow them to sponsor public events or hire celebrity endorsers. They cannot engage in any activities that promotes or displays their brands and logos, except inside the retail establishments where the cigarettes are sold.

The ban has since driven tobacco firms to subtle advertising by influencing the content of so-called free media such as news and movies. Newsbreak reported in 2009 that they have been providing “grants” to filmmakers to include smoking scenes in their movies, regardless of whether brands are shown.

“Manila Kingpin,” which starred Laguna Gov E.R. Ejercito, showed actors smoking in half of the movie — in 44 out of 91 scenes. Anthony Roda, acting chief of the government’s National Center for Health Promotion, noted that the film “is filled with tobacco and smoking scenes from the first 4 minutes of the movie up to the last few minutes towards the end. Smoking is also very obvious in the movie’s trailer, music video, print advertisement and poster.”

Roda said smoking scenes “send the wrong message to our children” and “entice people to crave for cigarettes.”

SUBLIMINAL. Smoking in public places has been banned but government regulators find resistance. AFP photo.

Look glamorous

This was exactly Myers’ point. Movies make smoking look glamorous, especially to young people who are vulnerable to such subliminal messages.

Experts support this. In 2011, Simon Racicot of Concordia University in the US said, “Kids who see others smoking are more likely to take up the habit because they don’t perceive cigarettes as unhealthy.”

John Pierce of the University of California in San Diego found in a study in 2005 that, “If movie stars smoke, especially in romantic films, they are effectively encouraging young girls to smoke.”

Myers recalled that the Marlboro Man, the “worst US export,” was conceptualized after psychologists and advertising experts identified the vulnerability of young people — they were looking for an identity and found it fashionable to model the cowboys which they didn’t have in their countries.

As early as 1975, Philip Morris had said in confidential corporate documents that the best time to entice people to smoke is during their youth when “conformity to peer-group norms is greatest.” RJ Reynolds in 1998 said they should target the young because “younger adult smokers are the only source of replacement smokers.”

That is why, Myers said, the youth have to be protected from the tobacco industry’s marketing schemes. In 2008, Myers and CTFK became instrumental in pressuring Philip Morris to withdraw its sponsorship of 2 concerts in Southeast Asia, as this violated the advertising bans in those countries — the Eraserheads reunion concert in the Philippines, and R&B singer Alicia Keys’ show in Indonesia. –

HPB aims to stub out shisha smoking – Channel NewsAsia


Shisha smoking.

SINGAPORE: 12 local and international youth volunteers prowled the lanes of Kampong Glam on Friday evening to spread the word on the harmful effects of shisha smoking.

This is part of the Health Promotion Board’s (HPB) first shisha awareness programme in Singapore.

Youth volunteers Camelia Tang and Ridzwan Rahmad are members of the ‘Live It Up Without Lighting Up’ Global Movement, an initiative that aims to empower young people to adopt smoke-free lifestyles.

Armed with specially designed brochures and videos, Camelia and Ridzwan hope that speaking to youth about the ills of shisha smoking will dissuade them from picking up the habit.

Camelia said: “I am taking part in this because I feel it’s quite meaningful to dispel myths before about shisha, the harms of shisha, before it becomes facts that everyone believes in. So what I am doing now is to advocate and to tell people that it’s actually harmful.”

Dr K Vijaya, director, Youth Health Division Health Promotion Board, said: “We know that shisha smoking is a very social event for youth and young adults. So during a typical one hour session of shisha smoking, the shisha smoker would have inhaled smoke equivalent to 100 cigarettes or more.”

According to HPB, water pipe smoking delivers the addictive drug nicotine, and is at least as toxic as cigarette smoke.

However, many believe that shisha smoking is safer than cigarettes, largely due to the fruity smell of shisha smoke, as well as the lack of tobacco aftertaste.

A shisha smoker said: “I didn’t know how harmful it was and when I saw the video about how much germs and rust was inside, I was surprised, cos I thought smoking was worse than shisha.”

There are currently 44 shisha outlets in Singapore.

The Health Promotion Board hopes to reach at least 50,000 people through their six-week campaign

Health worries may cloud fun of shisha smoking fad

Popular pastime in Hong Kong bars seems to have got around restrictions on smoking, but it may not the safe habit that some who indulge think it is

Jennifer Ngo 
Mar 25, 2012

The surge in popularity of shisha pipes has exposed loopholes in Hong Kong’s anti-smoking laws, which is fooling people into believing the water pipes are a healthy alternative to cigarettes.

Instead, studies show an hour spent smoking shisha tobacco, which is generally mixed with molasses and fruit-flavoured, could be equal to smoking 100 cigarettes.

“Depending on the type of shisha tobacco, in one session the smoker can inhale the equivalent of 100 to 400 cigarettes,” said James Middleton, director of non-profit organisation Clear the Air, in an e-mail to the South China Morning Post (SEHK: 0583announcementsnews) .

One study carried out by Britain’s Department of Health showed that carbon monoxide produced in an average shisha session, about 40 minutes, was four to five times higher than from one cigarette. High levels of carbon monoxide intake could cause brain damage and unconsciousness, the study stated.

The government seems to be unaware that the latest smoking trend is passing through its gates unregulated. Shisha tobacco is possibly neither taxed nor tested for tar and nicotine levels, with the Government Laboratory and the Customs and Excise Department failing to come up with evidence to the contrary.

Middleton said that meant shisha sold and smoked in Hong Kong was unregulated and illegal.

The government also had no figures on how many shisha bars there were in the city.

The Health Department, however, confirmed that water pipes fell within the smoking public health ordinance, were not allowed indoors and should bear health warnings. But it was unable to say if the rules were enforced in bars and restaurants where shisha was available.

Nav Lalji, who imports herbal shisha made with tea leaves, said there were at least 40 shisha bars in Hong Kong, with most having sprung up in the past two years. Herbal tobacco does not need to be declared at customs, so it could even be hand-carried into Hong Kong, he added.

The manager of one shisha bar in Lan Kwai Fong said most bars stuck to tobacco shisha. “You don’t get that kick without [tobacco], but the amount is very small,” he said.

“We used to be the only shisha bar here, but in two to three years this has grown to more than 10,” said the man, who did not wish to be named. His bar is often filled to the brim, especially on weekends.

The bar imports shisha tobacco from the United States, but the manager said he knew some other bars imported theirs from the mainland. He said the bar received shipments through the mail, which were not taxed as the amounts of tobacco in shisha tobacco mixtures were small.

Dr Roland Leung Chung-chuen, a specialist in respiratory medicine, said shisha smokers took in a larger volume of smoke than cigarette smokers, which meant exposure to toxins was amplified.

“Water is not a good filtering system as most chemicals are probably not water soluble,” he said.

He also questioned whether herbal shisha was healthier. ” Even if there is no tobacco, it can still be dangerous and detrimental for health.”

Nothing new about puffing habit
Jennifer Ngo 
Mar 25, 2012

It may be a new fad in Hong Kong, but the shisha – also called the hookah, hubble-bubble, narghile or just waterpipe – dates back to 16th-century India when pipes were made out of coconut shells.

Within a century, as tobacco smoking was spreading throughout the world, the shisha had become firmly established throughout the Middle East and the waterpipe completed its evolution into the shape we know now, according to a World Health Organisation report.

Smoking waterpipes has also been a tradition among the indigenous people of Africa and part of Asia. It is only in recent decades, that the shisha became popular in Europe and North America.

Originally, cannabis leaves were mixed with other herbs and spices and the resulting sticky paste was smoked; the name shisha may have come from the use of hashish in these pipes.

The shisha comprises a head, body waterbowl and a hose. Tobacco is placed in the head then covered with lit charcoal. When a smoker inhales through the hose, the tobacco and charcoal are drawn down the long body to the water bowl and then onto the smoker. Despite popular belief, the water has no filtering effect.

A worker prepares shisha at shisha bar Felfela in Lan Kwai Fong. The Health Department says pipes are not allowed indoors.