The growing tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than eight million people a year, including around 1.2 million deaths from exposure to second-hand smoke.
Despite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains and is likely to remain the leading cause of of preventable death throughout this century, unless smoking cessation efforts are ramped up or “game-changer policies” are implemented that can significantly and rapidly reduce the number of smokers, particularly in Asia.
In Malaysia itself, we are not spared and the numbers are worrying. The prevalence of smokers in Malaysia aged 15 and above in 2019 was 21.3 per cent of users or 4.9 million people. The trend of increasing nicotine products shows a sharp increase following the emergence of new millennium cigarettes such as electronic cigarettes or vapes.
This is proven through the recent National Health and Morbidity Survey (NHMS) 2022 which has revealed a significant increase in the prevalence of e-cigarette and vape use among Malaysian teenagers. Based on that data, e-cigarette and vape use among Malaysian teens aged 13 to 17 rose from 9.8 per cent (211,084 people) in 2017 to 14.9 per cent (307,109 people) in 2022, which is alarmingly higher even than the United States, which experts themselves acknowledge that the US was struggling with a youth vaping epidemic.
In the US, among middle and high school students, current use of e-cigarettes and cigarettes were reported at 11.3 per cent last year, according to the 2022 National Youth Tobacco Survey (NYTS) by the US’ Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).
Dr Kelly Henning, who leads the public health programme Bloomberg Philanthropies based in New York, even warns Malaysia to learn from the US cautionary tale of its youth vaping epidemic, citing evidence of adverse effects of nicotine on the developing brain and how even inhaling these substances through vaping devices may have long-term consequences on the developing lungs among young children and youth.
The World Health Organization (WHO) chief himself, Dr Tedros Adhanom Ghebreyesus, urges all countries, including Malaysia, to protect their citizens, especially children.
What’s more, the hazard and detriment of this is not just to the health of our nation, but also the health of our economy. Based on a research, as much as RM8.77 billion needs to be spent in 2030 to treat NCDs (non-communicable diseases) caused by smoking complications, such as chronic lung disease, lung cancer, and heart disease.
It is important to note that this expenditure projection only involves three diseases, compared to the actual amount involving the treatment costs of other smoking complications and diseases, which of course are much higher.
It is estimated that for every RM1 collected from the tax currently imposed on tobacco products, RM4 is spent on treating those suffering from its complications and disease. Unfortunately, an estimated 27,000 people annually will prematurely lose their lives due to these conditions.
In 2030, the government is expected to spend as much as RM369 million to treat complications due to E-Cigarette or Vaping Product Use-Associated Lung Injury (Evali).
On top of that, the non-direct costs are even higher. A study by Tan et al published in 2020 showed that smoking caused RM275 billion in loss of productivity to Malaysia.
And that is among the many reasons why the tabling of the Control of Smoking Products for Public Health Bill, which includes the Generational End Game (GEG), in Parliament is of utmost importance and a sensible policy strategy to protect future generations from lifelong addiction as well as chronic diseases, including cardiovascular disease, and will result in significant public health, social, and economic benefits in the long term.
This spirit and principles of this Bill have been 13 years in the making. We know that in order to properly regulate the changing dynamics of tobacco products in our world today, we need a more robust and comprehensive law which governs the sale, use, and promotion of not just conventional tobacco products such as cigarettes, but also for vape and other future nicotine delivery systems.
The current draft of the Bill has also gone through layers of robust scrutiny and amendments in order to address different concerns raised both in Parliament, whether through the Special Select Committees or the main plenary debates, and also multiple engagements with the different stakeholders.
I acknowledge the validity of many of the concerns raised. And I even personally raised concerns and objected to the initial draft of the Bill that was first tabled in Parliament, due to concerns of over-reaching enforcement powers and the general “punitive” nature of the legislation which may lead to possible unintended consequences.
However, after being involved first hand in “polishing the bill” both through the Health Parliamentary Select Committee and Special Select Committee led by the former Health Minister, I can testify how many amendments were made to address many of the legitimate concerns on top of installing safeguards within the Act itself to ensure constant review of its effectiveness and more importantly, that it achieves its intended target without any unintended consequences.
Issues of excessive enforcement powers including issues of body checks by Health Ministry enforcement officers for that group was addressed by omitting the ban on the possession of smoking products, and also limiting enforcements powers for entering premises to only manufacturing, distribution and sales premises, and not residential homes, on top of strengthening enforcement through education.
Body checks on children are also not allowed and an individual within the GEG generation who is caught smoking is only compounded and not criminalised.
The fact is, community service was introduced within the Act itself for such offences to remove the criminalisation element and as an opportunity for further education and awareness of the dangers of smoking to reflect the educational and not punitive intention of the Bill.
Some concerns were also raised by the Coffee Shops Association and retail on the enforcement implementation and economic impact it may have on their income.
While I cannot deny there may eventually be some impact, but that impact actually has at least a 20 to 30-year soft landing as the current generation pre-2007 would not be affected by this legal block. Thus, the current market is not affected until they decide to stop smoking or until they pass on, which may be years from now.
On top of that, those under the GEG generation or those born after 2007 are not forbidden from working in places that sell smoking products.
There are also calls to recognise vape or non-heated tobacco as “harm-reduction” or a less-harmful alternative to traditional cigarettes and to not be included in the GEG. While I am open to the concept of “harm-reduction”, and that is one of the things that will be evaluated in the mandatory review, but the spirit of GEG is to lock the gate against the possibility of new smokers and vapers, especially among young people.
Thus, we are trying to protect them from starting in the first place. That is why this is not a question of “harm reduction”, which is mainly for existing smokers, not the GEG generation. Even so, there is room where decisions and amendments can be made based on the newest data and science if it clearly points that way.
Some argue that GEG is a form of discrimination and infringement of fundamental rights, especially for the young.
First and foremost, there is case law for this where the Court of Appeal held that the decision to ban smoking at public premises does not contravene Article 5 (right to life or personal liberty) and Article 8 (all persons are equal before the law and entitled to equal protection of the law) of the Federal Constitution, on top of stating that it is a “choice” rather than a “right”.
I would also like to put forth that discrimination is depriving one person of a fundamental “positive need”, ie food, education, treatment etc, but limiting something “negative” that causes so much harm to self and harm to those around, is not discrimination but rather, protection. At the end, rights have limits, especially if it causes harm to others (harm principle).
More importantly, another one of the more significant amendments is the addition of a clause in the Bill that mandates a periodic review on the effectiveness of the Act first by January 2025 (before the law applies to first generation of GEG), and then every five years, which will be tabled in Parliament in full transparency.
This is important to determine the effectiveness of the implementation and allow room to ensure issues or even concerns arising from implementation can be addressed even by making necessary amendments on the Act itself, taking into account newer data and science.
That basically is the “safeguard” that allows us to make needed changes and adaptations to ensure the success of the Act and its implementation on a periodic basis.
With all that said, we as policymakers are at an important juncture. Once in a while, we will be presented with a decision, the consequences of which will be felt for many, many years to come. I believe this is one of them.
While I understand the concerns and complexity surrounding the Bill itself, but I strongly believe this is the right and responsible thing to do, especially to protect our future generations.
This decision can catalyse not just a better nation, but give birth to a healthier and more productive generation of leaders that will continue to lead our nation to greater heights for years to come.
Dr Kelvin Yii is the Member of Parliament for Bandar Kuching and a Special Advisor to Health Minister Dr Zaliha Mustafa.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
