SMOKING (CONTROL OF ADVERTISEMENTS AND SALE OF TOBACCO) (AMENDMENT) BILL

SMOKING (CONTROL OF ADVERTISEMENTS AND SALE OF TOBACCO) (AMENDMENT) BILL: Order for Second Reading read.

3.04 pm

The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The dangers of smoking tobacco are well established. Tobacco contains more than 60 chemicals that are known to cause at least 20 forms of cancer. It also contains nicotine, which makes the user feel high, causes addiction and adversely affects the cardiovascular system potentially leading to higher risk for heart attacks and strokes. Despite these well-known risks, many smokers find it hard to quit and new smokers continue to join the ranks. The data is depressing. Tobacco use is the leading cause of preventable death, killing more than five million people every year worldwide. To different

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degrees of success, countries have tried to stem the tobacco epidemic.

Singapore was a world pioneer in tobacco control. We were the first in Asia to ban advertising in 1971 and we have been aggressive in tobacco taxation. In 2004, we again led Asia by being the first to use graphic warnings on cigarette packs to deter smokers from lighting up. Last year, we were the first in the world to mark all duty-paid cigarettes sold here with the letters "SDPC", for "Singapore duty paid cigarette", as a means to combat cigarette smuggling. On efforts to get smokers to quit, the World Health Organization recognised only nine countries, including Singapore, for their nationwide network of smoking cessation services. As a result of these proactive efforts, our smoking prevalence, at below 14%, is among the lowest in the world.

International alliance in tobacco control is growing. In 2003, the World Health Organization (WTO) developed, what is called FCTC – Framework Convention on Tobacco Control, to get its member states to adopt strategies and best practices aimed at reducing the demand for tobacco and regulating its supply. We signed the FCTC in 2004. Two obligations are now due for compliance: (a) imposing a comprehensive ban on tobacco advertising, promotion and sponsorship; and (b) extending health warning labels to the outer packaging, and prohibiting false and misleading packaging and labelling of tobacco products.

The Smoking (Control of Advertisements and Sale of Tobacco) (CAST) (Amendment) Bill seeks to amend the current Smoking (CAST) Act (Chapter 309 of the 2003 Revised Edition). The Bill will allow us to fulfil these obligations. In addition, I am using the opportunity to further tighten our tobacco control measures. There are two reasons for this.

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First, smoking has increased in recent years, particularly among young adults. Between 2004 and 2007, smoking prevalence increased from 18% to 25% among young men, and 7% to 9% among young ladies. This is a cause for concern. Second, tobacco companies are fighting back, against the global smoking control measures, by introducing new and alternative tobacco products. Many of these products are designed to attract new tobacco users and marketed to especially appeal to the younger customers, including women. A recent article in the Wall Street Journal explained vividly how a major tobacco multinational company was transforming into a company that offers a range of smokeless alternatives, such as strips, lozenges, snus and e-cigarettes. I brought along some samples. This is snus and it contains tobacco sachets and with instructions on how to use it – take one, put it under your tongue and enjoy it. This is a pack of e-cigarettes. "e" stands for electrical – you plug it in because you need the battery to light it up and they look like cigarettes. You have to unscrew it and these are batteries, you put it in and it releases nicotine and even lights up. And there are health warnings, "smoking is harmful for health, e-cigarette is good for health." Many of these products closely resemble confectionary items. Clearly, the intent is for them to act as starter products that get young non-smokers addicted to nicotine.

We should expect tobacco companies to want to maximise profits by seeking to grow their customer base. Governments must however be alert to this trend and do their best to protect the people, especially the young, from the unnecessary harm of tobacco and its substitutes. In Singapore, we have to ensure that our legislation and our control strategies keep pace with development in the tobacco industry. We intend to go as far and as fast as other countries in our

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tobacco control measures, for as long as they are practical and effective.

Mr Speaker, Sir, let me now highlight the new provisions that are being introduced in this Bill. First, let me deal with our two outstanding obligations under the FCTC.

Tobacco sponsorship of the arts

The current Act does prohibit tobacco advertising and promotion but it allows exemption for sponsorship of activities such as arts and cultural events. The Act allows tobacco companies to sponsor such events and activities and their sponsorship be publicly acknowledged. This exemption is in conflict with an obligation under the FCTC which imposes a fully comprehensive ban on all forms of tobacco advertising, promotion and sponsorship. The removal of section 3(2)(a) will allow us to remove this exemption clause. We have consulted the Ministry of Information, Communcations and the Arts (MICA) and they support this move. They have been building up alternative sources of sponsorship. We will give the arts organisations a grace period of up to the end 2010 before we remove the exemption clause.

Tobacco packaging

The current Act requires graphic health warnings to be displayed on individual tobacco product packages sold here. The WHO FCTC, however, imposes an obligation to display graphic health warnings on all kinds of internal and external packaging. To meet this obligation, an amendment to section 17(1) will extend the display of graphic health warnings to outer packaging, such as the box or the carton that holds the individual packages for retail.

Tobacco labelling

Under the current Act, we do not regulate on how tobacco companies label

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or brand their products. Some have used terms in their product packaging or labelling that may give the impression that their product or brand is less harmful to health or less addictive. Such terms include words like "mild" or "light". International and local studies found that consumers are misled by such terms. They believe that these products are less harmful and that switching to these products may help them to quit smoking, when in fact this is not so. There is no such thing as a safer cigarette; all cigarettes kill.

The new section 17A will prohibit the importation, distribution, sale or offer for sale of any tobacco product that has or is accompanied by any false or misleading packaging or labelling. Such a prohibition will allow us to fulfil another obligation to the Convention and align ourselves with many other countries with similar prohibitions. The actual terms to be prohibited such as "mild" or "light" will be prescribed within the subsidiary legislation. We will give tobacco manufacturers a grace period of 12 months from the date of Gazette to effect the necessary changes.

New and emerging products

Next, let me discuss the emergence of new and alternative tobacco products. As far back as 1993, the World Health Organization and several countries, including Singapore, had already expressed concern over new and emerging harmful tobacco products, and had recommended banning products – such as smokeless tobacco – that were becoming available. We amended the Act and, hence, section 15 of the current Act prohibits chewing tobacco and provides prescribing powers to prohibit other smokeless tobacco products for oral use.

Since then tobacco companies have become even more aggressive and

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innovative, especially in recent years. Today, unconventional tobacco products come in various forms – smoked tobacco such as flavoured cigarettes; smokeless tobacco such as tobacco gels; dissolvable tobacco which resembles candy – this is particularly harmful because it can "con" the little kids; and tobacco substitutes such as e-cigarettes and even drinks like nicotine water.

These new and emerging products are being marketed as safer alternatives to cigarettes but they are not. If they contain tobacco, whether they are smoked, chewed, inhaled, sucked or topically applied, then they are potentially harmful as tobacco is carcinogenic and causes cancer. If they contain nicotine, then they are still harmful as nicotine is toxic and highly addictive. There is a misconception that tobacco substitutes can be used as cessation aids when they have not been approved for such use. The nicotine level in some of these new and emerging products is actually higher than that in the cigarettes. With regular use, addiction can occur, leading to smoking and even dual use of both cigarettes and the substitutes. This is particularly observed in the west, as office workers find it very hard to smoke because most offices are now smoke-free. Here comes the smokeless alternative. During working hours, they take the smokeless products and when they go home, they take the real cigarettes. This is what the industry call "dual usage".

My Ministry has studied the evidence available internationally and locally, on the harm of tobacco use and nicotine addiction, and the appeal these new and emerging products may have to vulnerable groups, such as young people and young adults. The evidence is substantial. Almost all these new products have not yet reached our shores. Members will not be able to find them yet in Singapore.

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Hopefully it will never surface here. Let us take a pre-emptive step to ban them and prevent them from coming here and harming our people, especially the young. The amendment of section 15 will allow us to prohibit them. The proposed ban will cover these categories of new products:

(a) nasal and oral snuff, of which snus and smokeless cigarettes are sub categories;

(b) dissolvable tobacco, often referred to as "tobacco pellets" or "tobacco candies" and which may also come in strips and sticks;

(c) e-cigarettes and other nicotine-based cigarettes or similar which deliver nicotine but may not contain tobacco;

(d) tobacco and nicotine gels;

(e) nicotine water, drinks and food products; and

(f) fruit and candy flavoured cigarettes and other tobacco products such as cigarillos, beedies and "anghoon".

The proposed amendment to section 15 will also cover some future variations of emerging products by prescribing powers to the Minister for Health to allow prohibitions of future innovative products if they do not fit within the current categories. In making this amendment, we will not be alone. The proposed prohibitions are in line with bans already imposed in several countries including Australia, Canada and the European Union.

Finally, we are taking the opportunity to make a number of technical amendments to improve the clarity of the Act and to enhance its implementation. They include:

(a) Clause 3 which amends the title of the Act from "Smoking Control", which is

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obviously outdated, to "Tobacco Control", as many new products are now smokeless;

(b) Clause 4 which introduces new definitions for "emission", "packaging", "premises", "tobacco product", "tobacco substitute" and "use";

(c) Clause 6 which introduces the term "services" alongside "goods", to extend the coverage of prohibition to sales promotion of tobacco products;

(d) Clause 8 which extends the prohibition of cigarettes sold in packs less than 20 units to miniature cigars or cigarillos. Importers and local distributors will be given a grace period of 12 months from the date of Gazette to effect the change;

(e) Clauses 9 to 10 which include the term "distribution" alongside "import", "sale" and "offer for sale", to cover the entire supply chain and ensure that distributors are also held accountable for compliance with the Act;

(f) Clause 13 which clarifies officers' roles when they carry out their enforcement duties, so that they are deemed as public servants for the purpose of the Penal Code;

(g) Clause 15 which further defines the scope and hence the penalty of obstruction to these officers during their work, so that the officers can perform their duties more effectively;

(h) Clause 16 which refines the maximum composition sum of any offences under the Act, to align it with the provisions in other Acts; and

(i) We are reducing the maximum allowable tar and nicotine yield levels of cigarettes from 15 mg to 10 mg for tar and from 1.3 mg to 1.0 mg for nicotine. This will align us with international best

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practices. Tobacco manufacturers will be given a grace period of 12 months from the date of Gazette to effect the change.

Mr Speaker, Sir, tobacco is harmful and it kills. We have kept our smoking rate low, relative to other countries. But it is a constant battle with the tobacco companies which are savvy and innovative. Our law and our control strategy must keep pace with the developments in the industry. I seek the Members' support for this Amendment Bill.

Sir, I beg to move.

Question proposed.

Dr Lam Pin Min (Ang Mo Kio): Mr Speaker, Sir, thank you for allowing me to speak on this Bill. We all know that smoking is addictive and bad for our health. It can cause serious diseases and even death. Yet, people all over the world still smoke. As long as tobacco is available for sale in the market, smoking will continue. One may think that the most effective way to eradicate smoking will be a total ban of tobacco products. However, this will not work. A good example will be the abuse of illicit drugs. Many countries have strict laws against the possession, sale and use of banned substances. Yet, we still hear of drug addicts in our community, many of whom have their own creative ways of obtaining these banned substances from the black market. Similarly, a total ban of smoking will not eliminate this problem. It will only push it underground, causing a new black market for tobacco products. A more practical and realistic approach would be to help existing smokers quit and to prevent non-smokers from picking up the bad habit.

Therefore, I support the Ministry's effort of introducing strict regulation in the control of advertisements, sale,

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marketing and use of tobacco products in Singapore. As a result, Singapore's smoking prevalence is among the lowest in the world. Concerted efforts of our National Smoking Control Programme since the 1970s have reduced our smoking prevalence from above 25% to below 14% currently.

According to MOH's National Health Surveillance survey in 2007, about one in seven Singapore residents aged 18-69 smoked cigarettes daily. Daily smoking was most prevalent in young adults aged 18-29 years (17.2%). Men are six times more likely to smoke than women. The age-specific male smoking prevalence exceeds 20% for all age groups from 18 to 69 years of age. There is also a significant racial difference. Malays' smoking prevalence is more than double that of Chinese or Indians. Fortunately, our female smoking prevalence is low, at single digit percentage, except for young Malay ladies which stands at 14%. But more than half of women smokers are below 29 years old and their smoking rate has risen sharply from 5% in 1998 to 9% in 2007.

It is irrefutable that smoking is detrimental to health. According to the World Health Organization, a person dies, on average, every six seconds from a tobacco-related illness. That is over 5 million people each year! They also stated that 50% of current tobacco users will die of a tobacco-related illness. Not only do smokers die early, they also deprive their families of income, raise the cost of health care, and hinder economic development. There are strong scientific evidences to link smoking to many serious ailments, such as heart diseases, chronic obstructive lung disease and cancers of the lungs, oral cavity and esophagus. Not only are the health of smokers affected by the habit, innocent bystanders, especially the family members, are also adversely

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affected by the second-hand smoke. Involuntary or second-hand smoke exposure can cause smoking-related diseases and premature death in children and adults who do not smoke. Children exposed to second-hand smoke are at an increased risk for sudden infant death, frequent respiratory infections and more severe asthma.

The adverse effects of smoking have prompted many governments in the world, including Singapore, to mandate the prominent display of health warnings on cigarette packs. Singapore has led Asia by being the first to use graphic warnings depicting disease conditions such as lung and mouth ulcers to deter smokers from smoking in 2004. On top of that, Singapore has become the first in the world to mark all duty-paid cigarettes sold here to combat cigarette smuggling. Yet with all these measures, the prevalence of smoking in Singapore remains significantly high enough to warrant tougher measures. Are we doing enough to tackle this long-term enemy? Should we learn from Bhutan, a small remote Himalayan nation, to address this long time public health concern? Bhutan went on an offensive war against tobacco with a total ban on smoking in public places and sale of tobacco products in 2005. The ban forbids people from lighting up at government offices, hospitals, schools, parks and shopping centres, among other places. With this new law, Bhutanese are, technically, allowed to smoke in their homes and can even import small quantities of tobacco for "personal use", though they will pay as much as 200% in customs duties and sales taxes for the pleasure. This predominantly Buddhist nation is thought to be the first country in the world to impose such a ban. The moves are part of the government's effort to make Bhutan a smoke-free nation. Do we see learning points from such a draconian initiative?

The Framework Convention on Tobacco Control (FCTC) was adopted by

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the World Health assembly in May 2003 and entered into force in February 2005. The FCTC was developed in response to the globalisation of the tobacco epidemic and aimed at reducing the demand for tobacco and regulating its supply. Singapore signed the FCTC in 2004 and has fulfilled its obligations, except on two where compliance is incomplete. I would like to seek clarification from the Minister the reasons for the failure to achieve full compliance since 2004 and whether this has contributed to the increase in smoking prevalence among the young adults in Singapore in the last five years.

The imposition of comprehensive ban on tobacco advertising, promotions and sponsorship in this Bill serves to fulfil our obligations to FCTC. Whilst the current Act prohibits advertising and promotion, it allows tobacco companies to sponsor arts and cultural events with public acknowledgement on a case-by-case basis, as approved by the Health Sciences Authority (HSA). The amended Act will eventually prohibit such sponsorships altogether. I would like to ask the Minister, why should such sponsorship be disallowed if the publicity on the sponsorship is not acknowledged and will this contravene the WHO FCTC? Will the advertising ban also include tobacco companies putting up congratulatory or condolence messages for staff or business partners?

I agree totally with the Ministry's move to amend section 17(1) which mandates that the display of graphic health warnings be extended to the outer packaging, such as the box or carton that holds the individual packages. The new section 17A also prohibits the importation, distribution, sale of any tobacco product that has or is accompanied by any false or misleading packaging or labelling. Labels such as "mild" or "light" that give the impression to consumers that the product is less harmful will also be banned. A

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grace period of 12 months from date of Gazette will be given to tobacco companies to effect the necessary changes. This period, compared to the 30 months provided by the European Parliament and Council of European Union, seems rather short. How did MOH come up with this period of 12 months and is this time-frame adequate or realistic to ensure the industry compliance?

All smokers must be made to understand that the only safe thing to do is not to smoke at all. Whilst we rationalise that a complete ban may not be realistically possible, the Government's approach to maintain the twin-pronged strategy of preventing initiation and encouraging cessation is an important step in the right direction. The amended section 15 prohibits the importation, distribution and sale of any

alternative tobacco products. I understand the indiscriminate and unregulated use of alternative tobacco product can similarly cause harm. However, many studies in Europe have shown benefits of such products in helping smokers kick the habit. As such, I would like to urge the Ministry to consider allowing alternative tobacco products as part of the strategy to help smokers progressively stop smoking altogether. I believe that if the use of these alternative products are regulated and employed judiciously, it can add to the armamentarium of anti-smoking strategies.

Sir, many smokers start smoking at a very young age. They usually pick it up out of peer pressure or curiosity and find it hard to quit later on in life due to the addictive effect of nicotine. It is indeed worrying to note that the smoking prevalence among young men and women have increased from 18% to 25% and 7% to 9% respectively. I would like to ask the Minister what are the possible reasons and what more can be done to arrest this rising trend. Should the proliferation of low-priced tobacco products be curbed

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and can the price of tobacco be tightly controlled to discourage the youth and even adults from smoking?

In conclusion, I would like to applaud the Ministry’s continuous effort in strengthening tobacco control and also in educating the public on the adverse effects of tobacco smoking. The WHO has estimated that, on a global scale, one person dies from a tobacco-related illness every six seconds. The sad fact is that smoking is also the most avoidable cause of death. Smoking-related diseases and death must be seen as an epidemic and a serious public health concern. The Government must continue its effort in tackling this problem, as long as Singaporeans continue to light up.

On that note, I support the Bill.

Assoc. Prof. Fatimah Lateef (Marine Parade): Mr Speaker, I would like to firstly declare my interest as a practising medical practitioner, in stating suggestions and proposals for this Bill.

Smoking kills six times as many people as those dying from road traffic accidents, suicide, murder, poisoning, manslaughter and HIV-related deaths all put together. Cigarette smoke has over 4,800 chemicals, and of which 70 have been proven to be carcinogenic.

In general, policies that encourage existing smokers to quit and discourage non-smokers from starting are ideal. However, it is not a perfect world.

I am in agreement with the suggested amendments. There are, however, two areas which I would like to elaborate on.

Firstly, on tobacco harm reduction. Harm reduction is a widely accepted strategy in public health that recognises

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that there will always be people who engage in risky behaviours. As abstinence is regarded as an unrealistic goal for some, the objective of harm reduction is to mitigate the health risk associated with the risky behaviour. Tobacco harm reduction acknowledges that a significant portion of tobacco users is unable or unwilling to break their addiction.

In this Bill, Sir, there appears to be a lack of tobacco harm reduction strategies. As such, I would like to propose having an option of a strategy to shift current tobacco users who cannot and are unable to quit to the less harmful nicotine products. Overall, the use of smokeless tobacco products confers only 2% of the health risk of smoking and the public health impact would be incredibly reduced. This offers them a gateway to quitting. It is also possible to restrict this further such that it is only for persons undergoing "quit" programmes by recognised bodies and institutions, and not for underage youth or unsupervised usage. These people can be monitored closely by the implementing institutions. This way, we can offer an option to those who need help to gradually quit in a controlled manner. On the other hand, Sir, if we do put forth the blanket rule ban, without assessing the evidence of these harm reducing products objectively, a large proportion of the remaining smokers will continue to smoke and will have a 50% chance of dying.

We have the statistics from the Minister for Health and indeed it is not something that we want to hear – increasing numbers every year. Therefore, I feel tobacco harm reduction must come in. In the US, for example, the Food and Drug Administration (FDA) legislation requires manufacturers of safer tobacco products to prove that they will have no significant population effects before they are marketed.

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Also, Britain’s Royal College of Physicians, a prestigious body indeed, strongly endorses tobacco harm reduction. Comments from the College include, "smokers smoke predominantly for nicotine. If nicotine can be provided in the form of a cigarette substitute, millions of lives can be saved. Harm reduction is an essential component of many aspects of medicine and day-to-day living".

In 2008, the American Association for Public Health Physicians adopted the policy of "encouraging and enabling smokers to reduce their risk of tobacco related illness and death by switching to less hazardous smokeless tobacco products". Smokeless tobacco has been proven to have much lower nitrosamine content, is less harmful than cigarette smoking, is not associated with respiratory illnesses such as chronic obstructive lung disease, and does not cause problem with passive smoking and third-hand smoke. In fact, tobacco-related mortality in low nitrosamine smokeless tobacco is only 10% of the risk of cigarette smoke. The Swedish experience with snus is like a natural "experiment" that has been going on. Since the usage begun, they have lowered lung cancer mortality and there has been no increase in the incidence of head and neck cancer and also several vascular accidents.

The International Primary Care Respiratory Group (IPCRG) published a consensus statement in 2008 on tackling the smoking epidemic, "therapy to manage nicotine dependence can significantly improve patients’ chances of quitting successfully and is recommended for people who smoke 10 or more cigarettes per day".

Surely, Sir, sound medical principles of tobacco harm reduction, as in the examples above, may be a regulatory move worth considering here in

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Singapore, instead of a blanket ban completely. Sir, Singapore has a R&D laboratory, aimed at developing next generation reduced harm products that are substantiated by scientific evidence. If indeed the R&D is done rigorously, becomes successful and the products can be proven scientifically to possess reduced harm claims, then laws that can permit objective assessment of the evidence presented by these harm reducing products, instead of a blanket rule to ban completely, will be worthy of our consideration.

It is also interesting to note that "nicotine is the primary substance responsible for tobacco dependence, but the majority of harm caused by tobacco use is not from nicotine, but from the by-products of smoked (or from burning) tobacco, such as fine particulates, carcinogens and noxious gases, including carbon monoxide." If levels of toxic chemicals can be drastically reduced by heating tobacco, instead of burning it, or by changing the mode of delivery of nicotine, there is a chance of developing a product that might be less harmful.

Sir, there is a good body of rich literature and active R&D going on globally on this topic. There may be potential spin-off benefits for Singapore. The presence of scientists in systems biology, state-of-the-art computational science, and disease modelling, allows for the osmosis of ideas, bridge gaps in knowledge, and creates a fertile R&D environment. Hopefully, this will facilitate some break-throughs.

After all, we can be selective in deciding which ones to be allowed in for regulation. I do support the ban on the sugarcoated and other nicotine candies which may prove attractive to children and youth.

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My second point relates to sponsorship and advertising. With this Bill, we will be removing the exemption clause which allows companies to sponsor arts and cultural events and be publicly acknowledged. Sir, I would just like to share with the House the following information:

1. Tobacco companies do have corporate social responsibilities going on in our community. One example I would like to quote is the "Food from the Heart" programme, supported by Phillip Morris;

2. These companies do employ Singaporeans earning their living;

3. How many of us know that, if an employee of a tobacco company or his or her family members passes on, the company is not allowed to put the company’s name and logo or insignia of any sort with the obituary; and, finally,

4. Give this a thought. Does the average smoker in the street even know names like: Phillip Morris, Peter Stuyversant, and so on. Perhaps, the only thing these smokers care about would be that they have their cigarettes and they get to smoke it too.

Sir, I support the Amendment Bill. I also hope with the arguments I have put forth, consideration will be given to the controlled regulation and usage of certain products in the specific situations I have discussed.

Mr Speaker: Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.00 pm.

Sitting accordingly suspended

at 3.40 pm until 4.00 pm.

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Sitting resumed at 4.00 pm

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[Mr Speaker in the Chair]:

SMOKING (CONTROL OF ADVERTISEMENTS AND SALE OF TOBACCO) (AMENDMENT) BILL: Debate resumed.

Mdm Cynthia Phua (Aljunied): Mr Speaker, Sir, let me first of all express on behalf of my constituents a warm welcome to the Minister after his successful recovery from his recent operation. Today, I also rise in full support of the Bill before this House.

I concur with the Minister when he underscored the dangers that tobacco poses to our young. Nicotine is highly addictive and we should strenuously reduce its accessibility in all forms before it causes irreparable damage to our people, particularly our young and impressionistic students. In going about my daily tasks, I often chance upon young students, in their teens, taking an illegal puff at multi-storey car parks, taking refuge at the walls of staircase landings, thinking that they are able to hide from public view. They are teens in secondary school. Sometimes they are in uniform and other times, in casual wear. These teens get pass our strict laws against cigarette sale to minors by approaching adults for a cigarette or asking them to purchase on their behalf.

I propose that schools take up the challenge and set up anti-smoking advocates to reach out to them. We should try and win over those who have taken up smoking. At the same time, we should build a so-called firewall and ring-fence the non-smokers from being influenced. Schools can organise activities and get the students to talk about the hazards of smoking. Introducing harsher penalties and more law enforcers are not enduring solutions. These youths may

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simply go "underground". In fact, by putting an age limit, it has an opposite psychological effect on the teens. To be able to buy cigarettes is regarded as a coming of age, "I have come of age to be able to buy cigarette on my own."

I also agree that parents too have a part to play, and I am sure many are strictly enforcing the rules at home.

A trial research designed by the Fred Hutchinson Cancer Research Center in Seattle in 2009 on phone counselling found that it was effective in helping teens to quit smoking. These smokers from various high schools in Washington State received personalised smoking cessation counselling. It combined motivational interviewing with cognitive behavioural skills training. The smokers were taught to recognise the importance of quitting based on their own values, to anticipate and cope with stress and other factors that led them picking up smoking. It offered plans for stopping and eventually saw these plans through.

Consistently, an earlier research published in 2001 by the John Hopkins Medical Institution and the Baltimore City Health Department has highlighted that personalised counselling will help smokers recognise the need to quit on their own accord. Activities included building camaraderie among the smokers, self-identification of personal smoking habits and perceived barriers to quitting. It also focused on developing strategies for quitting, and prevention of relapse and dealing with withdrawal symptoms. According to the research, this programme not only had a measurable impact on the smoking habits of participants but was also more effective in promoting quit attempts and in achieving smoking cessation as compared to exposing them to just simply educational materials.

Consecutively-held personalised counselling sessions provided by trained

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counsellors will help to address and curtail smoking among young adults and students. I understand that the Singapore Cancer Society has a counselling scheme where students caught smoking by the Police can be referred – I repeat the words "can be referred" – to them for counselling. This is not sufficient. I urge the relevant Ministries to work together and consider incorporating smoking cessation and personal anti-smoking counselling programmes in schools or in the polyclinics and make it compulsory for the school students who are caught smoking to undergo such personalised counselling programmes since they are proven to be effective.

Mr Speaker, I support the amendment of the Bill.

4.06 pm

Ms Ellen Lee (Sembawang): Mr Speaker, Sir, I commend the Minister for Health for introducing this Bill in Parliament and augmenting on the previous Smoking Act. It is indeed heartening to note Singapore’s achievements in the past few decades in its fight to stay smoke-free and control tobacco and smoking across the island. It is laudable that we are 14% in terms of smoking prevalence, one of the lowest in the world. I support the drive towards curtailing smoking and introduction of further legislation to control advertisements and sale. In particular, it is imperative for our legislation to stay relevant with the advent of smokeless alternatives and new designer tobacco and nicotine-related products which may at first instance appear harmless but can have long-term ramifications and affect our populace, especially the young.

Nevertheless, I have two major concerns which I hope to echo in my short speech on this topic related to smoking and tobacco use. Firstly, I am particularly concerned with the fact that more young adults are becoming smokers

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and also the issue of underage smoking. Secondly, I am concerned with the fact that although we have only 14% smoking prevalence, the majority who are non-smokers are still having to face the brunt of second-hand smoke which is medically known to be just as harmful.

I am aware we have been embarking on concerted outreach to youths and the young on the ills of smoking as well as tightening up enforcement of sale of cigarettes and tobacco to those underage. But is there more that can be done in terms of enforcement against underage smokers as well as convincing our youngsters to skip and quit the habit? This new Bill augments the efforts to minimise this problem but my personal thoughts are whether the current education programmes or enforcement machinery are sufficient. If yes, why is there a trend towards rising number of younger smokers amidst our population?

On my second point, I recently received an email from a resident of mine whom I shall call "A". He lives in an HDB flat with his wife who was recently pregnant. "A" has a neighbour, whom I shall call "B" who lives next to his unit and both "B" and his wife and their siblings living in that unit are smokers. They do not smoke inside the unit as they have a child inside, but they smoke at the corridor. Despite numerous requests by "A", the occupants in "B"'s unit continued to smoke. "A" approached "B" and his wife but was told off that there is no law to curb smoking in the corridor. "A" tried to call NEA and NEA gave the same reply that there is no ban on smoking in corridors. "A" and his wife were highly distressed by this incident. Sadly, "A"'s wife had a miscarriage recently and lost the baby. "A" attributed it to the smoke, distress and depression caused by their inconsiderate neighbour "B" and asked me to voice it out and help

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him stop this problem. I can empathise with him. It is a sad loss.

Though the cause of the miscarriage may not be easily proven, I opine that we can do more to help the majority of 86% of the populace (who do not smoke) so that they do not have to bear the brunt of having to face the harmful effects of second-hand smoke. We have come a long way after we started to ban smoking in certain public establishments and selected public places. However, I submit that NEA can re-visit and re-examine the areas where smoking can be further curtailed through public consultation and to augment the current enforcement efforts to resolutely curb smoking in areas where smoking is prohibited. Ask any HDB dweller and he or she will tell you that smokers are still seen in lifts and many common spaces in the heartlands where smoking is actually prohibited under the new slew of prohibitory measures. I know a total ban is not possible but can and will legislation be introduced to prohibit smoking in void decks, common corridors, apartment lift lobbies and common spaces in the heartlands? I know many non-smokers often suffer in silence when forced to inhale second-hand smoke, including smoke from neighbours who live in close proximity. I speak for them and hope we can do more.

Sir, with these considerations, I support this Bill.

4.10 pm

Mdm Halimah Yacob: I rise in support of this Bill.

About seven Singaporeans die prematurely from smoking-related diseases each day. Hence, I support more stringent measures to curb smoking in Singapore and to bring our law in line with the WHO Framework Convention on Tobacco Control. I also agree that our law should

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cover other new and alternative tobacco products. Although we still have one of the lowest smoking prevalence among females in the world, the number is increasing, especially among young women in the 18 to 29 age group, which has increased from 6% in 2004 to 9% in 2007. Several countries, such as India and Japan, have already reported popular use of tobacco products, such as flavoured cigarettes and tobacco candy, by young women. So, we should stop these products from being sold here.

Nicotine is so addictive that according to estimates, three quarters of those who quit eventually return to the habit. I have people who asked for financial help smelling very strongly of cigarette smoke. Even when they are faced with severe financial difficulties, they are not able to drop the smoking habit.

Sir, I wish to focus on the problems of smoking at the workplace and in the Malay community, particularly Malay youths.

In 2004, 15% of our working population was smoking but this had risen to 16% in 2007. The highest increase is among the 18 to 29 years old, as 20% of them smoke compared to 17% in the general population.

Besides smoking out of habit, young adults have cited the stress of starting their first job and influence from colleagues at the workplace as reasons for smoking. As a majority of the smokers in Singapore are in the workforce, it is very important that companies put in place strong smoking control initiatives.

A 2002 study done by the National University of Singapore and the Nanyang Technological University showed that a 16% smoking prevalence in the workplace would cost companies $2,200 per smoker each year. Smoking results in lower

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productivity, higher absenteeism and larger healthcare costs for companies.

It is clearly in the companies’ interest to encourage employees to stay smoke-free and healthy. Based on the 2006 National Workplace Health Promotion Prevalence Survey, about 25% of the companies with a workforce size of at least 50 have a smoking control programme, an 18% increase from 7% in 1998.

However, much more can be done, and some companies are already doing so, such as Sheraton Towers which started its smoking control programme in 2005 following a survey which revealed that 20% of its employees were smokers. With strong management support, a "No Smoking Policy" was implemented on the hotel’s premises and the cost of conducting smoking cessation programmes by trained medical personnel was entirely borne by the hotel. As a result of these efforts, the hotel achieved a 6% decrease in the number of smokers between 2005 and 2008.

I urge more companies to follow Sheraton Hotel’s example to achieve win-win outcomes, and I urge the Ministry to place greater focus on workplace efforts.

( In Malay ): [For vernacular speech, please refer to Appendix A.] Sir, the smoking prevalence among the Malay community had increased from 18% in 2004 to 23% in 2007, especially among Malay men. In 2007, more than four in 10 Malay men were smokers compared to two in 10 Chinese and Indian males.

This is especially worrying as many of them are also heavy smokers and regularly smoke more than 10 cigarettes a day. The reasons they cited for smoking include for relaxation and relieving stress. Many of them have also cited addiction to cigarettes as the main barrier to quit this habit.

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The majority of these male smokers are married and smoking becomes a financial burden. Furthermore, smoking does not only affect the smokers, it can also harm the health of their family members. It is important to highlight all these issues in the smoking cessation programmes targeted at the Malay community, so that we can see its effectiveness.

Many male smokers started smoking when they were young and this situation still continues. I am very concerned with the Malay youths. Our statistics are worrying. With the help of some friends, I conducted a study among 43 Malay youths aged between 15 and 26 years who are smokers. The statistics that I obtained are very alarming. Thirty-two of these youths started smoking when they were 15 years old or younger. In fact, one of them even started smoking when he was only eight years old. Twenty-five of these youths were introduced to cigarettes by their friends. There were two of them who were introduced by their own fathers. This is bizarre and strange, but it happened. Almost all the youths smoke every day. Thirty-two of them smoke at least five sticks of cigarettes a day, while four of them smoke 15 to 40 sticks of cigarettes a day. Thirty-four of these youths had fathers who smoke. In fact, for two of them, their mothers also smoke – which is quite worrying.

This clearly indicates that when the fathers smoke, they become negative role models to their children, which is consistent with research findings which support the same point. Hence, awareness programmes should also publicise this fact to encourage them to kick the habit, if they truly care for their children’s welfare.

Another issue of concern is the ease with which young people are able to buy cigarettes. The majority of them secured

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their cigarettes from friends, coffee shops, provision shops or convenience stores and, in some cases, they purchased cigarettes that are sold illegally. Most of them also said that the shop operators where they purchased the cigarettes from either did not ask for their age or, even if they did, did not bother to check their identity cards.

*Cols. 833-834.

( In English ): Mr Speaker, if we want to stop the increase in cigarette smoking among the young, there is a need to ensure stronger enforcement measures against shops that are flouting the law by selling cigarettes to those below 18. I urge the Ministry to step up its enforcement action against such errant shops.

Beyond that, I also urge cigarette companies, if they truly have a strong sense of corporate social responsibility, to audit their suppliers, their agents and their retailers to ensure that they do not sell to those under the age of 18 which is against the law. It would indeed be contradictory if cigarette companies participated in community projects aimed at helping the poor and needy, and yet its products could create the smoking addiction which had contributed to the problems of the poor and needy in the first place.

Sir, I also believe it is important to help those who are already smoking to quit. But the survey results that I have cited show that we must also put a lot more emphasis on prevention as the smoking habit once started is extremely addictive and difficult to stop. I urge the Ministry, with the support of community groups, schools and families, to put more effort into preventing smoking among the young. The Ministry should also continuously evaluate the effectiveness of existing smoking prevention and cessation programmes so that our approach can be more focused and targeted.

With this, Sir, I support the Bill.

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4.19 pm

Mr Calvin Cheng (Nominated Member): Mr Speaker, Sir, thank you for allowing me to speak on this Bill. I have only one point to make, in the form of a suggestion. Can I suggest that we include the terms "marketing and promotion" wherever and whenever the term "advertising" appears in the Bill? I believe that this will cover a loophole that tobacco companies may be able to exploit to promote their products.

Some years ago, at an outdoor event, I saw a tobacco company sponsoring a hospitality tent by subtly using the colours of their well-known cigarette packaging as the theme of their tentage. In the tent was custom-made furniture in the shape and colours of their cigarette packaging. The staff who manned the tent were also all dressed in uniforms in the colours that one would automatically associate with the cigarette packaging. Though subtle, this was obviously a clever way for the tobacco company to circumvent the law regarding advertising, but is nevertheless still an attempt to promote their product.

Sir, it is my belief that by including the terms "marketing and promotion" in the Bill, we may be able to catch any sort of promotional, marketing and advertising activities that tobacco companies might get involved with. This will include below-the-line as well as above-the-line advertising, event association and even the subtle forms of marketing that I illustrated earlier. The use of tobacco is a harmful, nasty habit that should not be encouraged in any form. Tobacco companies should not be able to exploit any loopholes in the law in order to market their poisonous wares to an unsuspecting public.

With this, Sir, I support the Bill.

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4.20 pm

Mr Hri Kumar Nair (Bishan-Toa Payoh): Mr Speaker, Sir, it is strange why there is even a sensible debate about smoking in this day and age.

The harmful effects of smoking are well established. I came ready to this House to cite facts and figures to back this up, but many Members of this House have cited the same figures. So I would not trouble the House to repeat them. However, we all know that non-smokers are also at risk. Involuntary smoking involves exposure to the same numerous carcinogens and toxic substances that are present in mainstream tobacco smoke. There are 69 identified carcinogens in tobacco smoke. Indeed, there is a higher concentration of carcinogens found in sidestream smoke than mainstream smoke because the former is produced at a lower temperature, resulting in incomplete combustion of the tobacco.

Studies have shown that non-smokers increase their risk of developing lung cancer by 20% to 30% and heart disease by 25% to 30% when they are exposed to second-hand smoke.

This has had a direct economic impact. According to the Health Promotion Board, the social cost of smoking in 1997 ranged from $673 to $839 million. This includes the direct costs such as payments for hospitalisation and healthcare, morbidity costs (lost of production due to smoking-related illnesses) and mortality costs (lost production from people who died early due to smoking). This social cost therefore overwhelms the economic benefits of smoking – about S$600 million or so collected in Government taxes every year from tobacco products.

The facts and figures I have cited are not new. Yet, large numbers continue to smoke, increasingly so. Why do they do it? For many years, the tobacco

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companies ran advertisements to promote how "macho" and how "cool" smoking was. The Marlboro Man, expertly herding cattle on the great plains while puffing on his cigarette, became the symbol of manhood. Generations were drawn to cigarettes, and became addicted without even realising it. Allegations of health risks were dismissed or demolished. Adverse reports were suppressed. All in the name of profit.

But we now know the truth. Litigation in the US has exposed what some tobacco companies have been doing to protect and expand their business. These include engaging in schemes to defraud smokers and potential smokers by falsely denying the adverse health effects of smoking; falsely denying that nicotine and smoking are addictive; falsely denying that they manipulated cigarette design and composition so as to assure nicotine delivery levels that create and sustain addiction; representing that light and low tar cigarettes deliver less nicotine and tar and therefore present fewer health risks than full flavour cigarettes; falsely denying that they market to youth; falsely denying that second-hand smoke causes disease; and, finally, suppressing documents, information and research to prevent the public from learning the truth about these subjects and to avoid or limit liability in litigation.

One would have thought that with this knowledge, cigarettes would be banned forever. If tomato ketchup or milk had half the carcinogens and toxins cigarettes have, or carried half the health risks, they would be removed from supermarket shelves in a heartbeat. We banned the sale of chewing gums for much less. With cigarettes, somehow it is different.

The debate over the harmful effects of smoking has long been over. Today, tobacco companies openly acknowledge

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that their products cause cancer and increase health risks. That, however, has not stopped them selling the stuff. The stark reality is that the smoking culture has become entrenched in our society. Smokers now say it is their human right to light up. Addiction has the effect. Governments around the world know that even if they wanted to, they are powerless to get rid of smoking completely. A complete ban is political suicide. In some countries, campaign contributions from tobacco companies will dry up or, worst, move to your political opponent. Significant tax dollars will also be lost.

So we take little steps, like putting warnings on packages, or pictures of diseased organs or, like in Australia, having nothing at all on the packages, as if all this will really stop a smoker from getting his fix.

And then we rationalise. We say that smokers now have been warned about the ill effects. We ban smoking in public buildings and say smoking in private places is a matter of choice, except that that choice has been compromised by the drugs deliberately introduced in cigarettes to make them addictive.

And what about the children? Children are particularly vulnerable to the effects of second-hand smoke because their bodies are still growing and they breathe at a faster rate than adults. In the US, between 150,000 and 300,000 children under the age of 18 months get respiratory infections (such as pneumonia and bronchitis) from second-hand smoke. More than 40% of children who visit the emergency room for severe asthma attacks live with smokers. I have on many occasions seen adults smoking with children nearby. Who is looking after the child’s interests? What choice does a child have?

Nonetheless, the increase in awareness of the health risks and the crackdown on

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smoking in public areas have obviously caused tobacco companies concern about revenue loss. That has prompted them to develop and market an increasing range of alternatives to the conventional cigarette. The Minister has given examples of these and they include: safer cigarettes, smokeless tobacco products and alternative nicotine products.

Examples of "safer cigarettes" marketed elsewhere include a cigarette that heats up but does not burn tobacco and is advertised with claims of "less risk" of certain smoke-related diseases. The problem is that these products have not been proven to be medically safer.

Smokeless tobacco has been marketed as useful alternatives where smoking is prohibited, or when it is inconvenient to smoke. These include flavoured chewing tobacco, with flavours such as peach, cherry, wild berry, mint, green apple and wintergreen. There is even now a tobacco lozenge – a mint-flavoured, smokeless, compressed tobacco lozenge (a "cigalett" – about the size of a Tic-Tac breath mint). So while you may be dying of cancer, your breath will always be minty and fresh.

More worryingly, these flavoured tobacco have candy-like appeal, which make them attractive to children. The flavours also make the product seem more harmless. This is a good way to get children started on tobacco-use. The use of smokeless tobacco is more discreet than smoking, which may mean it is easier for children to use without drawing attention to themselves.

The tobacco companies cannot be expected to regulate themselves. Their track record speaks for itself. So unless we act firmly and decisively, a whole new generation may end up being addicted to tobacco and nicotine.

I therefore support the proposed amendments, in particular, the new

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section 17A, which prohibits the use of any term descriptor or trade mark which creates the false impression that a particular tobacco product is less harmful than other tobacco products. And I hope the Minister will ban any statement which is not supported by independent research. I also support section 15, which prohibits the sale of chewing tobacco and also give the Minister power to prohibit other tobacco products.

I would, nonetheless, like to raise three points. First, the amendments also deal with new products touted to be nicotine alternatives. I understand these to be tobacco-free products with added nicotine, intended to deliver the nicotine-kick without smoking. Examples include: nicotine pellets or candy; nicotine water, as the Minister said, which incidentally contains enough the equivalent nicotine of two cigarettes; and nicotine wafers.

As with chewing tobacco, these products may be attractive to younger people, and create a new generation of nicotine addicts. Further, the marketing of such products is troubling. For example, nicotine water has been marketed as a "dietary supplement". These are relatively new and unfamiliar products which may result in people consuming larger doses of nicotine unsuspectingly. So over and above banning them, will the Government also educate the public about the harmful nature of these products so that they will not unknowingly purchase them when they are abroad or bring them back to Singapore for their friends or families to try?

Second, I urge the Minister to use his powers under section 15 to progressively lower the nicotine and tar limits of tobacco products sold in Singapore. The Minister has mentioned certain limits in his speech and I hope that will not be the final limit he sets. The tobacco companies will no doubt ask for time to adjust to new regulations, but if pushed, they will

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no doubt find a way to comply. Where there is a profit, there is a way. Could the Minister share with this House his plans in relation to the exercise of his powers under section 15(2), both immediate and in the future?

Finally, while I accept that this is not within the Minister’s remit, will the Government consider measures to protect children from the effects of second-hand or side-stream smoke? At the very least, the Government should consider regulations against smoking whether in public or in private within close proximity to children? I know it is difficult to regulate what happens in the privacy of a person's home. But we have done it before for other undesirable conduct. And I think there is great value in such a law as a symbol of what we consider to be appropriate and responsible social behaviour.

4.30 pm

Assoc. Prof. Paulin Tay Straughan (Nominated Member): Thank you, Mr Speaker, Sir, for this opportunity to share my reflections. Smoking kills. Addiction to smoking is the greatest cause of avoidable mortality and morbidity. Smoking causes harm to almost every single organ in the human body and is a risk factor that is associated with numerous diseases. In addition to harming their own health, smokers also put non-smokers at risk. Therefore, I give my strongest support to this important Bill that will reinforce the strong anti-tobacco stance adopted by this Government.

The amendments detailed in this Bill, taken together, further reinforce the commitment our Government has taken to alleviate the prevalence of smoking in Singapore and to protect the health and well-being of Singaporeans, in particular, non-smokers from the ill-effects of

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second-hand smoke. The Smoking (Control of Advertisement and Sale of Tobacco) Act as well as the Prohibition of Smoking in Certain Places Act are the pillars which uphold Singapore's tobacco control efforts and sustain a smoke-free Singapore. The prevalence of smoking among Singaporeans aged 18-64 years has decreased significantly since 1975 (when it was at about 27.5%) to the rate that it has been hovering now, at about 13.6% and this is indeed a remarkable achievement. I would like to congratulate the Ministry of Health for this. However, while the overall prevalence has declined, we also note a disturbing trend; an increase in the prevalence of smoking among younger Singaporeans, which the Minister has already highlighted. The prevalence rate of smoking among those aged 18-29 years has increased from 12.3% in 2004 to 17.2% in 2007. Research on young smokers shows that the experiment with smoking in their adolescence, starting from as young as when they are 12 years old.

In our current climate where strong anti-tobacco norms prevail and the harmful effects of smoking are well documented and publicised, these trends are both surprising and alarming. What additional measures can we take to stop teens from experimenting with cigarettes, to alleviate the risk to nicotine addiction? On this note, I have three suggestions. First, we must step up on enforcement to prevent supply of tobacco products to teens below 18 years old. Section 10 in the Smoking Control Act spells out provisions for enforcement on prohibition of supply of tobacco products to persons below 18 years old. In addition to policing establishments that sell tobacco products, we must also enforce punitive measures on those who supply or acquire tobacco products for underage smokers. Second, to further discourage the violation of section 10, will the Minister consider raising the penalty for repeat offenders? My third suggestion focuses on the root

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cause of deviation from the prescribed norms. An important question that I have been asking is, what puts youths at risk for smoking?

Sociological research shows a very strong link between detachment from schools and family, and underage smoking. In her thesis on young smokers, Karen Cheong, who is an Health Promotion Board (HPB) scholar, completing her PhD in Sociology under my supervision, found that teens who perceive that mainstream goals were not within their reach were more likely to embrace sub-cultures and seek affirmation from like-minded peers. For example, teenagers who do not fair well academically would turn to affirmation from peers in similar circumstances. Sadly, there is also a strong correlation between detachment from schools and detachment from the family. For these marginalised teens, family support was also challenged. As we discussed the ill-effects of tobacco use, I would like to seize this opportunity to focus our attention on this group of young Singaporeans who are at the margins. It is important that we continue to look into the needs of our youth, strive towards a broader platform for recognising achievements so that all young Singaporeans will be able to find resonance with the goals we set for them as a community. Only then, can we render deviant norms, like smoking, irrelevant.

4.35 pm

Mr Alvin Yeo (Hong Kah): Mr Speaker, Sir, I rise in support of this Bill. The dangers of tobacco usage are well-documented and we must do our utmost to reduce the incidence of tobacco usage. There are, however, two areas of concern in this Bill that I would like to highlight. First, I should disclose that I have received in my capacity as Government Parliamentary Committee (GPC) Chair for Home Affairs and Law representations

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from a number of tobacco companies. I am also a partner in the law firm which is acting for one of these companies.

Sir, the first issue relates to the implications of this Bill on Intellectual Property Law obligation. As the Bill stands, there is descriptor regulation that is being proposed in section 17A. The proposed section 17A prohibits the importation of sale of any tobacco product if its packaging and get-up may suggest that it is less harmful or gives a false impression of its health effects, or if the Minister prescribes so. The amendment is aimed at preventing the public from being misled into believing that the particular tobacco product is less harmful than other tobacco products because of the use of descriptive language or packaging. That, in itself, is a worthwhile objective and I do support the Bill giving the Minister such a power.

However, my concern is that this amendment does appear to include "trademarks" within its scope. That may lead us to be in possible non-compliance with Intellectual Property Law obligations. As the Minister mentioned, examples of brand names that might be affected are those carrying the words 'light' or 'mild' or something similar. Some of these maybe registered trademarks in Singapore. This is in contrast with other terms used to describe, for instance, taste characteristics such as "low tar" which are generally added after the brand name, as opposed to actually being part of the brand name. Under our Trade Marks Act, a "registered trademark is the personal property" of the proprietor and the proprietor has exclusive rights to use the trademark. Inherent in our statutory scheme for the registration of trademarks is the determination of whether a trademark is of such nature as to deceive the public. Therefore a fair case can be made when the trademark has been registered and used in the past, that it was not considered to have confused or

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deceived the public. Further, Singapore is a party to the World Trade Organization (WTO) Agreement on Trade Related aspects of Intellectual Property Rights (TRIPS). TRIPS requires a minimum level of protection for IP rights. Article 8 of TRIPS provides that signatories "may in formulating or amending their laws and regulations, adopt measures necessary to protect public health, provided that such measures are consistent with the provisions of this Agreement".

Article 17 of TRIPS requires that when measures are taken, limiting the rights of trademark holders, such exceptions should take account of the legitimate interest the owner of the trademark. If we are to adopt section 17A in its present form, we must take care not to marginalise the legitimate interest of holders of registered trademarks and, more importantly, not breach our TRIPS obligations. There may also be treaties where Singapore has entered into, for example, with the United States and Japan, to name just two, which requires us to uphold intellectual property rights. Based on the above, I ask if the Minister could make it clear that section 17A shall not prohibit use of a term that is used in a brand name, which was registered as a trademark prior to the effective date of the amendment Act. I understand that similar approaches have been taken in other countries such as China, Taiwan, Hong Kong and Thailand.

Sir, the second issue I would like to raise relates to the use of regulatory powers to ban particular tobacco products. Section 15 of the draft Bill provides the Minister with powers to ban any and all harmful tobacco products based on his discretion. This provision appears to be targeted at alternative forms of tobacco products such as chewing tobacco and smokeless tobacco. The Health Promotion Board's consultation document noted that most new

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alternative forms of tobacco products are marketed as safer alternatives to cigarettes, despite the lack of conclusive evidence, and that these products potentially undermine the effectiveness of Singapore's cessation strategies as smokers may switch to using these products. This is a valid observation and I support the Minister having such powers. Having said that, I believe that a judicious use of such powers will also be in the interest of public health especially when these alternative products can actually be proven to be less harmful and might lead to more smokers kicking the habit.

I do echo the sentiments raised by two of my colleagues, Dr Lam Pin Min and Assoc. Prof. Fatimah Lateef that harm reduction is a useful weapon in the strategy of reducing the incidence of tobacco usage. We do not live in an ideal world where smokers quit smoking because it is good for them. Provided it can be scientifically proven that such products may result in lesser harm or lesser tendency to be addicted, we should consider allowing such products because it would allow some smokers to reduce their dependency on tobacco.

Could the Minister, therefore, make it clear that before exercising his powers to ban any particular product, there will be a detailed product assessment procedure where affected parties could seek to justify their products as less harmful or addictive, and with an avenue for appeal? There could be provision for an advisory panel of medical experts to make sure that claims of products being less harmful than conventional tobacco products be scientifically supported. I do consider that the ultimate goal would be to stop all smoking. But it may be pragmatic to adopt an approach to permit less harmful or addictive products, which would help to "wean" smokers off cigarettes. This would complement rather than undermine our prevention and cessation efforts.

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On that note, Mr Speaker, I support the Bill.

4.42 pm

Mr Sin Boon Ann (Tampines): Mr Speaker, Sir, I rise in support of the amendment Bill. Tobacco consumption is a vile, habit-forming practice that is potentially harmful and deadly. It cuts short the lives of a third to half of its users. According to a World Health Organization report, perhaps 100 million people died prematurely in the last century from tobacco consumption. This figure, in the eyes of many, is of tragic proportion as the deaths are preventable. Unless we do something very significant now, studies have indicated that another one billion people may die in this century if the current trend continues. Against the backdrop of such alarming statistics, I welcome the initiatives by the Government to put together a tighter restriction on advertisement and sale of tobacco products; all of which I agree.

Sir, while I wholeheartedly embrace the changes in this Bill, I will say that the changes may not have gone far enough. I say this with three specific references in mind. First, this Bill deals with putting restrictions on any form of direct or indirect tobacco product advertisement as opposed to tobacco brand advertisement. At the moment, neither the Act nor the Bill deals with tobacco brands that find its way into other goods and services. Cigarette companies have sought to promote consumption and sales through association with certain lifestyle, activity or values. Many of us will recall how "Camel" brand of cigarettes has found its way into a line of clothing that at first brush may have nothing to do with cigarettes.

Cigarette brand names have also appeared in travel services such as "Peter Stuyvesant Travel & Tours" or "Kent Holidays". Such insidious forms of

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advertisements are a more dangerous form of marketing as it easily targets the young and vulnerable to ensure early brand endorsement. And on this note, I share the similar concerns of my colleagues. Arguably, it would not be difficult for one who is mentally conditioned to move from the "Camel" brand of cargo pants to the "Camel" brand of cigarettes. Would the authorities not be concerned if the same brand of cigarettes started to appear in children's toys in place of "Fisher Price" brand of products?

Tobacco brands appear innocently on products and services. However, they present a very powerful form of subliminal appeal and can make their presence felt quietly in many areas of our everyday lives. This is latent advertising.

In April this year, it was reported that doctors have urged governments to launch an inquiry into alleged "subliminal" tobacco advertising on Ferrari Formula One cars. It is claimed the red, white and black bar code on Ferrari cars and overalls, is intended to remind viewers of Marlboro cigarettes branding. Similarly, the Observer reported that Philip Morris, the manufacturer of the Marlboro cigarettes, is such a believer in experiential marketing that it funds owners of public establishments to have their interior decorations done up in a manner to convey the strength of the brand. For instance, a patron could be lounging in front of a screen and being bombarded with the Wild West cowboy scenes of Marlboro country, and be entertained by Bernstein’s theme song from the Magnificent Seven playing in the background. Now, one can never fail to feel macho about being associated with the Marlboro brand.

Incidentally, I understand that the three of the Marlboro men who appeared in the advertisements, died subsequently from lung cancer. The question really is, where does one draw the line? Should the Government take active steps to stop or

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regulate such subliminal forms of advertising?

Secondly, the social signaling of smoking in the public media. Advertisements are a very powerful form of communication that appeals to the target audience’s sense of being, aspiration and desire. It is meant to connect with the audience and can strongly influence the development and acceptance of a set of socially acceptable values. Sociologists call this social engineering. So we go to the movie houses and see our heroes and heroines, our favorite characters, going about their business with a cigarette half dangling out of their mouths. Think of the pretty slim and young actress smoking away and looking glamorous on the screen. They are our favorite people; and, to us, it must be all right to smoke since they smoke in the movies. A new and recent groundbreaking study linked to the American Journal of Preventive Medicine shows that young adult smokers who are most likely to light up immediately are those who watch smoking in movies. The study is the first of its kind to directly link smoking scenes in movies to actual and immediate smoking behaviour.

I remember some years ago coming across an actor by the name of James Dean in the movies. Again, those of us who are old enough will remember the iconic actor holding a cigarette in his hand. I cannot imagine what kind of impression that image must have left on many impressionable youngsters of the time.

The same concern also applies to what has been portrayed on television. I have come across, often times, scenes on television screens where the protagonist is often seen holding a cigarette in his hand as part of a scene. It was reported in the Wikipedia that Mark Lee, our favourite local comedian, could be seen smoking

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the red Marlboro cigarettes in most of Jack Neo's movies. Would this scene constitute tobacco advertisement under the Act?

While I am not advocating that we should ban all cigarettes from the movie or TV sets, we should at least have a comprehensive policy on how to deal with such indirect form of advertising. In some jurisdictions, there are warnings after the screenings in the end credits section or the packaging of the CD or DVDs, to warn of the hazards of smoking. In the United States, films with G, PG or PG-13 rating, allow smoking incidents (that means depicting tobacco smoking or related signage or paraphernalia) to appear only when there is a substantial reason for doing so. Sir, I think we can do likewise.

Thirdly, there is the risk of tobacco advertising through the Internet. This generation has seen the pervasive use of the Internet as a means of communication and information sourcing. A whole generation of young people is now glued onto the screen surfing the Internet for a wide variety of reasons. It potentially serves as a huge market for sales. I would not be surprised if tobacco companies are also interested in using this medium to promote their products. Presently, I understand that Internet giants like Google and Microsoft have policies that outlaw the promotion of tobacco products on their advertising networks. However, the same cannot be said about all other major Internet service providers whose revenue depends on advertising. Can we realistically expect these companies to say no to tobacco advertisements when there is so much money to be made from it? We have difficulty stopping pornographic materials filtering through the Internet, how confident can we be about regulating tobacco advertising on the Internet? It will be a sad day indeed if popular gaming sites or social networking sites are populated and rife with advertisements on tobacco products; and

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we are not even talking about subliminal advertising that are being used as part of new technology that in essence, involves microsecond flashing of the advertisements to inform the subconscious mind. Does the Government have any policy in this regard in regulating it; or even, is the Government beginning to think about it?

The issue on hand is whether the Government is prepared to do more to curb the advertisements and consequent sales of tobacco products in this country. I note that in some countries, cigarettes are not allowed to be displayed in showcases, whether or not there are youths patronising the establishment. Presumably, this restriction works on the principle of it being out of sight and, therefore, out of mind. Such legislation is far reaching. I am not sure if the Government is prepared to go to such an extent.

Sir, this Bill is among other things to bring Singapore in line with and to fulfil Singapore’s outstanding obligations under the WHO Framework Convention on Tobacco Control. The question is whether it is just enough for us to be up to date or, given the known and harmful effects that tobacco substance abuse has on our society, we should be doing more to educate and prevent the spread of such addictive habits. Given the choice, I would urge our Government to do much more than what is currently being proposed in this Bill.

With that Sir, I support the proposed amendments.

4.50 pm

Mr Seah Kian Peng (Marine Parade): Mr Speaker, Sir. First, let me declare my interest as a Board member of the Health Promotion Board.

I applaud the Ministry for responding quickly to the emerging tobacco trends

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and proposing a range of evidence-informed amendments to the Smoking (Control of Advertisements and Sale of Tobacco) Act. The proposed measures not only signal the Government’s commitment to the world’s first health treaty, the Framework Convention on Tobacco Control, but it also sends a clear message that, despite having a relatively low smoking prevalence, Singapore continues to ensure that measures are put in place to minimise the impact of tobacco use on our people’s health.

Singapore has seen a steady decline in its smoking prevalence since the 1970s when the first tobacco control legislation was enacted. However, as highlighted by Minister Khaw, there has been an increase in the smoking prevalence in recent years, especially among young adults aged 18 to 29 years. The age of smoking initiation was found to be 16 years young! Peer pressure, curiosity, and the misconception that one will not get easily addicted to nicotine – these are some of the reasons why our youths initiate smoking. Once they start, it can be very difficult to quit, given the highly addictive nature of nicotine. Our tobacco control measures must therefore look into how best to tighten access to tobacco products and their substitutes and to prevent initiation, especially among youths.

[

Mr Seah Kian Peng (Marine Parade): ]

I am particularly concerned about the new and emerging products that Minister Khaw has highlighted and he has shown us a few samples this afternoon. International examples have shown that these products are highly popular among youths. Recently, I saw an episode of the popular American documentary programme, 60 Minutes , on YouTube, which focused on snus. It featured a youth who used snus in the gym, in class, and even when having his dinner, simply to satisfy his insatiable craving for nicotine. It struck

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me that such a scenario could easily become a reality in Singapore. In fact, in a recent focus group discussion conducted by Health Promotion Board, youth smokers aged 15 to 17 expressed that they would be curious to try some of the new and emerging tobacco products that were shown to them. In addition, they felt that some of the products appeared easier to use than cigarettes and that they could pose challenges to the enforcement of underaged smoking laws.

Whilst such products are relatively new and studies on their full extent of harm are still ongoing, it is important to take pre-emptive action now rather than later. So, I am pleased to note that the proposed amendments look into banning new and emerging products. However, while we may ban such products, our youths might still be able to have access to them when they are overseas, or be misled by deceiving information from the manufacturers of such products. We, therefore, need to continue to educate our youth, going beyond cigarette smoking to include tobacco in other forms and stressing the addictive power of nicotine. We also need to teach our young to be discerning about the tactics of the tobacco industry and help them to develop life skills to stay tobacco-free for life.

Mr Speaker, Sir, while we look into addressing new and emerging products, we should continue to tighten controls on existing products. Similar to international studies, a local study in 2009, found that a significant proportion of Singapore residents perceived that cigarette packs labelled with descriptors like "mild" and "light", delivered less nicotine, and that they were less harmful to health, and this would make it easier for a smoker to quit, compared with other descriptors. In the same focus group discussion that I had made reference to earlier, the youth

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smokers also shared that they smoked cigarettes labelled "mild" as they were under the impression that these were safer options. I am therefore heartened to know that we are looking at prohibiting misleading labels such as "mild" and "light", and am sure that MOH and HPB will continue to study and to adapt international best practices in this area.

Mr Speaker, Sir, the introduction of the minimum pack size for cigarettes in 1993 had effectively prevented retailers from selling loose sticks of cigarettes at low prices. Price has been shown to be an effective deterrent for individuals experimenting with cigarettes. Congruent to international observations, in a local survey involving smokers and non-smokers aged 12 to 29 years, one in four (that is 25%) indicated that increasing the cost of cigarettes would deter young people from smoking. Youth smokers at various HPB programmes have also indicated that they are more likely to quit smoking if the price of cigarettes was increased.

The call for cigarillos to be sold in packs of no less than 20 will certainly make them less affordable to youths and bring us a step closer towards reducing prevalence of tobacco use in our youths. I support such a call and I feel it is time for the Ministry to look into such measures as well.

Youth are very vulnerable to addiction, and the harm this brings about, as you know, is life-long. While several of the proposed amendments will help towards curbing tobacco use in our younger population, we need to continue to reach out to them and to the people who may have an influence over them to encourage a tobacco-free lifestyle as the desired norm. If anything, I urge the Ministry to step up its plans to further discourage tobacco use among the young.

Mr Speaker, Sir, I support the Bill.

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Mr Khaw Boon Wan: Mr Deputy Speaker, Sir, I thank Mdm Cynthia Phua for her kind words. Yes, it is good to be back alive. I went through a lot and while in the ward, I had the opportunity to speak to many fellow patients – quite a few of them were smokers. I did ask them what they plan to do now; whether they were going to stop smoking. Not 100% said definitively "yes, I would stop it". So you can see how addictive this product is. Those who have never lit up, please do not start. It is not worthwhile. Why kill yourselves? Going through a bypass is a trauma. At least for me, it is a life-changer. My diet, which has always been pretty disciplined, has now become even more austere. And yet, for some smokers who have gone through that, they still find it difficult to quit. So this poison is hard to ban since it has been around for so long. But let us try to protect our people as much as we can.

Eleven Members have spoken on this Bill. Dr Lam gave us a very good account of the harm tobacco can bring. Mr Hri Kumar's very passionate speech struck a chord. I thank all Members. The common message is loud and clear – tobacco is harmful, so let us do our best to protect our people from its harm. So thank you to all Members for supporting this Bill.

We will do what is practical to implement it effectively. First, many Members supported the ban on emerging tobacco products. Mr Seah Kian Peng's account of snus and other anecdotes is instructive. Let us not allow them to land here. However, Dr Lam and Assoc. Prof. Fatimah Lateef suggested that we do not ban such products entirely but to consider some of them as part of a "harm-reduction strategy" to help smokers quit smoking.

I think their intentions are good but I honestly have my doubts as to whether the suggestion will be effective because I have personal experience of such "harm-

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reduction strategy". The suggestion reminded me of our experience with Subutex. And it was the same argument – it was a theory from the West, maybe sponsored or motivated by companies which have financial interest in this, to say, "Let's go all out to promote it, it's good. It will help the heroin addicts wean from heroin. It is less harmful, as switching from heroin immediately to zero is very hard, but with Subutex, it is more likely”. Some of our regulators were persuaded by the argument and allowed it. This happened just not too long ago. The results were disastrous and several Singaporeans were hurt. It took the Ministry of Home Affairs and myself quite some time to reverse the policy and damages. But for some Singaporeans who were hurt, the damages were not reversible. I confess, I will be skeptical of this so-called harm-reduction strategy.

A less harmful tobacco product is an oxymoron. I share Mr Hri Kumar's view on this subject and agree with his robust approach. In the 1970s, the tobacco companies introduced cigarettes purported to be "low tar", "light" or "mild" as safer alternatives. They promoted such cigarettes to smokers who had health concerns and were then thinking of quitting. These products rapidly gained market share. As a result, there was a net increase in cigarette consumption. Independent research later on showed that smokers compensated by smoking more cigarettes or inhaling more deeply.

Assoc. Prof. Fatimah Lateef quoted a positive experience of snus in Sweden. Yes, we have come across such reports. The Swedish experience has never been replicated outside of Sweden, and I cannot help noting that snus is a Swedish product.

The evidence is actually just the opposite, with the use of snus resulting in smokers becoming addicted to both cigarettes and snus. It is the same with

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Subutex and the addicts end up using both. More smokeless tobacco use does not mean less cigarette-smoking. It is not a zero-sum game. Smokers use smokeless tobacco products to tide over nicotine craving in places where smoking is prohibited while continuing to smoke in other places where smoking is allowed – this perversely reduces the impetus for them to quit smoking. Meanwhile, tobacco companies get to entice non-smokers to develop nicotine addiction, adding to their customer base.

As I have said, our experience with Subutex as a "less harmful heroin" substitute is similar. Instead of reducing the number of drug addicts, we ended up with more. So our approval of Subutex upset our trend. MHA had been doing a wonderful job of bringing down the number of drug addicts. But after Subutex was introduced, it was a V-shaped recovery for the (illegal drug) industry. So I strongly advise against adopting such so-called harm-reduction strategy. I would keep an open mind but they would have to make a lot of effort to convince me otherwise from this position.

But I agree with Dr Lam and Assoc. Prof. Fatimah Lateef that we should try to help smokers "to gradually quit in a controlled manner". There are proper ways to do so, one of which is through controlled Nicotine Replacement Therapy (NRT) by following strict guidelines. We do not prohibit nicotine used in such a manner.

I heard Mr Alvin Yeo mention that before we ban new products, we should do proper assessment process and do objective scientific studies. My approach is this. I will be fair to the companies and, as I have said, keep an open mind. But you know my priority. My priority is the interest, the safety and the health of our

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people, not the financial health of the tobacco companies. On that point, I am clear.

Second, all the Members expressed concerns over the rising smoking prevalence amongst certain population groups, including the young, the ladies and the Malay community. Mdm Halimah's speech in Malay made a heartfelt appeal to the Malay smokers to think about the welfare of their children and to get them to stop smoking. I join her in this appeal – please be responsible parents, and usually the fathers, be responsible fathers. You are bringing up the next generation. If you cannot quit smoking, then, at least, at the barest minimum, do not smoke when at home or do not smoke when in the company of your kids. But the best is to be credible as a role model, you must walk the talk, quit smoking yourself for your own sake. I also thank Mdm Halimah for highlighting the harm pregnant mothers bring to their infants if they smoke.

All the Members called for stronger smoking control measures. I agree entirely. We have implemented various programmes, and we will continue to try new ones. We will work with schools, religious institutions, employers, the charity sector and the community at large. I note Mdm Halimah's illustration of the Sheraton Towers as an exemplary employer who went the extra mile to get the employees to quit smoking. I applaud such employers and I urge more to join the movement.

I heard Mdm Cynthia Phua's call for schools to reach out to students who smoke and get them to quit. I appreciate her sharing several research findings done in schools overseas on effective counselling, including telephone counselling. I note her point that with teens, enforcement and penalty do not work as well. The psychology often works the other way. What is prohibited becomes highly valued.

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We try to tap on the young to guide us on how to reach out to their peers. I myself had conducted focus group discussions with young lady smokers. And I asked them, "Don't you know this thing is harmful, it is poison?" They know that. Knowledge is out there – they are not ignorant. So I asked them, "Have you tried to quit?" They said, "Yes, many times." I said, "Why did you fail?" They said they tried a few weeks and some succeeded for a few months. But when their brother is smoking, their father is smoking, or their boyfriend is smoking, they find it very difficult to quit. So let me reiterate the point that adults should know better and especially parents who have brought a new generation into the world – please think about the welfare of your kids and try to be good role models. But this is obviously a complex issue as Assoc. Prof. Straughan has noted. One underlying cause could be the larger problem of some youths needing to embrace "sub-cultures" in order to seek "affirmation from like-minded peers".

We will definitely try to do more and learn from others. We have discussed the various initiatives in this House before. So, in the interest of time, I do not intend to repeat them here.

Our efforts have not been futile. Let me quote one indicator. The proportion of secondary school students who have ever tried cigarette-smoking has actually dropped from 26% 10 years ago to 16% now – a 10-percentage point drop. It is not a great victory but a victory nevertheless. We certainly need to do better.

Third, Ms Ellen Lee, Mdm Halimah and Assoc. Prof. Straughan called for stronger enforcement against sales to the under-age. I agree and I intend to do so. We will step up policing on tobacco retail outlets. We will consider raising the penalty on repeat offenders. We are also considering disallowing tobacco sales in outlets which

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are clearly meant to serve the young in other products.

Fourth, Dr Lam asked about Singapore's compliance with the Framework Convention on Tobacco Control (FCTC) and whether we have been tardy. To date, we will be the third country in the world to fulfil all the obligations on tobacco labelling should this Bill be passed. Yes, there had been some delay, but I do not think it was a major delay. Dr Lam wondered whether this delay was a cause for the increase in smoking prevalence here. I doubt it. We have actually been ahead of the curve in tobacco control and, in any case, were largely FCTC compliant right from the start.

Dr Lam asked if we should give tobacco companies more than 12 months to implement the changes to tobacco product packaging. We did not choose 12 months arbitrarily but because we have done it before when we introduced the requirement that they must display the health warning graphics. We gave them 12 months and they were able to comply.

I appreciate Mr Sin Boon Ann's very thoughtful piece on lateral advertising, latent marketing and advertising through the Internet. Earlier, Mr Calvin Cheng made a similar observation. Indeed, these are the innovations that tobacco companies are mounting to get round the FCTC and it is also a hot topic currently being discussed and brainstormed among international regulators including ourselves.

We do not yet have all the answers to these challenges. In fact, we may never be able to find full complete solutions to some of these challenges, for example, Internet advertising. How do we censor scenes of modern day James Dean smoking a particular brand of cigarettes? I myself have not noticed Mr Sin's observation that Mark Lee seems to be particularly fond of Marlboro cigarettes but I would have a quiet word with him the next time I meet him.

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Where we can, we should act. For example, we have removed the exemption for congratulatory messages and sponsorship publicity.

Mr Hri Kumar has described past misleading behaviours by tobacco companies; in fact, unethical behaviours by such companies. I agree with his observations. From a public health perspective, misleading terms are just as misleading, even if they are part of a trademark. Mr Alvin Yeo raised a couple of legal queries on this. Let me state clearly that we intend the new section 17A to affect trademarks if they contain misleading descriptors. We are not going to exempt them. We are fully aware of our TRIPS and other international obligations and we have consulted the relevant legal authorities extensively on this point. The proposed section 17A is aligned closely to the FCTC and will not violate Singapore's international obligations. We are in good company: the European Union prohibits misleading terms and descriptors even if they are a part of the trademarks or brand names.

Lastly, there were some comments which do not pertain to the proposed amendments in the current Bill. Let me briefly address them.

Ms Ellen Lee and Mr Hri Kumar made a plea on behalf of non-smokers and especially innocent children, from the effects of second-hand smoke from inconsiderate neighbours and irresponsible parents. Ms Lee asked the NEA to widen the outdoor smoking ban to include more common places in HDB towns, such as void decks and common corridors. I will raise her suggestion with the NEA. It is convenient that Minister Yaacob is my neighbour in Parliament. In fact, I had a word with him just now precisely about this point. Mr Hri Kumar asked rhetorically how we could extend the law to the

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privacy of the home in order to protect the children from second-hand smoke. He knew it was outside my purview but I note his point.

Dr Lam suggested that we control retail pricing of tobacco products, to make them expensive, thus curbing consumption. In practice, price fixing seldom works as we live in a region where cigarettes are cheap. For the same reason, while we have been aggressive in tobacco taxation, there are limits but we will continue to use this strategy where practical and feasible.

Mr Deputy Speaker, Sir, tobacco-related deaths and illnesses are preventable, as noted by several Members. So let us try to make Singapore as tobacco-free as possible. Dr Lam mentioned Bhutan. Currently it is still the only country which has banned tobacco. I was in Bhutan a couple of years ago. I made an effort to see if there were cigarette butts in the city. There were cigarette butts. I asked my counterpart. He said, "Oh, all brought in by foreign talent from India." Yes, as Health Minister, I would like to ban it too, but how effective and how practical that will be, we will see. We should keep it as a stretch target. We should see whether there are opportunities to do so. But for those products which are not yet here, let us be pre-emptive. Do not let them land on our shores. Those which are already here, it cannot be helped. We will have to live with them. We will try to minimise their space to protect the 80%-odd (non-smokers) and especially the innocent children. When drafting this Bill, we had extensive consultation with Singaporeans. The amendments received strong support from them.

Sir, I beg to move.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

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The House immediately resolved itself into a Committee on the Bill. – [Mr Khaw Boon Wan].

Bill considered in Committee; reported without amendment; read a Third time and passed.

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