Towards Tobacco-Free Singapore

1. Towards Tobacco-Free Singapore Thursday, 25th August 2011 brought to you by: TTFS-NUS Student Interest Group

2. Tobacco Control Conference

3. THE SPREAD OF TOBACCO

4. First record of tobacco • Tobacco was first used by the peoples of the pre-Columbian Americas • Native Americans apparently cultivated the plant and smoked it in pipes for medicinal and ceremonial purposes

5. Pre-Columbus “In ancient times, when the land was barren and the people were starving, the Great Spirit sent forth a woman to save humanity. As she travelled over the world everywhere her right hand touched the soil, there grew potatoes. And everywhere her left hand touched the soil, there grew corn. And in the place where she had sat, there grew tobacco.” Huron Indian myth

6. Discovery of America (1492) “The Spaniards upon their journey metwith great multitudes of people, men andwomen with firebrands in their hands andherbs to smoke after their custom.” Christopher Columbus’ journal, 6 November 1492

7. Spread of Tobacco (1550~) • Christopher Columbus brought a few tobacco leaves and seeds with him back to Europe • Adventurers and diplomats like France's Jean Nicot -- for whom nicotine is named -- began to popularize its use • France in 1556 • Portugal in 1558 • Spain in 1559 • England in 1565 Jean Nicot French Diplomat & Scholar Ambassador to Portugal

8. Global Spread of Tobacco (Mid 16th century) • Africa: Portuguese and Spaniards ship trade • Middle East: Turks took it to Egypt • Asia: Introduced to China via Japan or the Philippines (Mid 18th century in Oceania) • New Zealand: Captain James Cook arrives smoking a pipe and is promptly doused in case he is a demon • Australia:tobacco arrives with the First Fleet

9. Epidemic Begins • 1881 First cigarette-making machine invented by James Bonsack (200 vs 4 cigarettes/min) • 1890s Tenfold increase in US cigarette sales • 1900 0.5% of US citizens smoke; 140 deaths worldwide from lung cancer • 1902 Philip Morris, British-American Tobacco formed First cigarette-making machine James Bonsack

10. Awakening - Timeline • 1930: Researchers in Germany make a statistical correlation between cancer and smoking • 1938: Dr. Raymond Pearl of Johns Hopkins University reports that smokers do not live as long as non-smokers • 1944: the American Cancer Society begins to warn about possible ill effects of smoking, although it admitted that "no definite evidence exists"linking smoking and lung cancer

11. Awakening - Timeline • 1960s: Surgeon General's Advisory Committee on Smoking and Health released a 387-page report in 1964 entitled "Smoking and Health." • Key Points: • “Cigarette smoking is causally related to lung cancer in men.” • The data for women, "though less extensive, point in the same direction." • Average smoker is 9-10 times more likely to get lung cancer than the average non-smoker and cited specific carcinogens in cigarette smoke, including cadmium, DDT, and arsenic.

12. Battle for the Public’s Health • IN SINGAPORE • 1970: Smoking ban in selected public areas like public toilets and bus interchanges first introduced • 1971: FIRST Asian country to ban tobacco advertising • 2006: Gory warning images are printed on cigarette packs • 2007:Smoking ban extended to entertainment nightspots like clubs and bars IN THE USA • 1965: Law passed to print surgeon general's warnings on all cigarette packages • 1971: All broadcast advertising was banned • 1990: Smoking banned on all interstate buses and all domestic airline flights • 1995: FDA plans to regulate tobacco, especially sales and advertising aimed at minors

13. Toll on Public Health • Predicted that 1.5 to 1.9 billion people (~1/4 of world population) will be smokers in 2025 • WHO in 2004 projected 58.8 million deaths to occur globally, from which 5.4 million are tobacco-attributed • As of 2002, 70% of the deaths are in developing countries • Smoking-related deaths are the most preventable cause of mortality

14. Toll on Public Health “Tobacco kills more people in the U.S. each year than alcohol, cocaine, crack, heroin, AIDS, suicide, automobile accidents and fires combined.” Centers for Disease Control and Prevention (2002)

15. Toll on Public Health "It is our No. 1 preventable cause of death – more people in Australia and New Zealand die from cigarettes than from alcohol, illicit drugs, road accidents, suicides, homicides, drowning, shark attacks, falls and electrocution – combined."   Royal Australasian College of Physicians 5/2005

16. Toll on Public Health Current measures are inadequate

17. Singapore’s Current Tobacco Market • Dominated by transnational Tobacco Companies • No home-grown tobacco farming or production industries

18. Singapore’s Current Market Model (no tobacco farms in Singapore) pay government tariffs for right to import goods into Singapore US-Singapore FTA (2003) pay government taxes for right to sell pay government taxes for right to purchase

19. Setting The Stage • Issues: • tobacco has a definite and significant negative impact on health • tobacco companies fuelled by principles of economy – profit-driven, no consideration for health of consumers

20. Callard Thomson Borland Supply Demand Khoo

21. Borland 2003 & Callard 2005 Tay Sok Boon Michael Lee

22. The Economics of the Current Smoking Epidemic Supply Retail Outlets, Smokers Demand Tobacco Companies

23. Introducing a Regulatory Body Borland ‘03 Callard ‘05 (Scale of Government Involvement) Less Involvement Independent Regulatory Body More Involvement Nationalised Regulatory Body

24. Borland 2003 Tobacco Company C Tobacco Company A Tobacco Company B Monopsony Regulatory Body Monopoly

25. Callard 2005 Regulatory Body Tobacco Company C Tobacco Company B Tobacco Company A

26. Issues for Discussion

27. Possible Barriers Political Corruption Illicit Market

28. Thomson 2010 The “Sinking Lid” Strategy Benjamin Liang Li Kexin

29. Overview • Summary of proposal • Pros • Cons • Complementary components

30. Summary of Proposal } Amount of tobacco available to the public • The “Sinking Lid” implemented • Regular reductions in quota • Cap and quota • Fixed total amount • For tobacco manufacturers and importers to bid A B Retailers Public C D

31. Retailers Public Summary of Proposal } Amount of tobacco now available • The “Sinking Lid” implemented • Regular reductions in quota • Cap and quota • Fixed total amount • For tobacco manufacturers and importers to bid A B C D

32. Retailers Public Summary of Proposal } Amount of tobacco now available • The “Sinking Lid” implemented • Regular reductions in quota • Cap and quota • Fixed total amount • For tobacco manufacturers and importers to bid A B C

33. Summary of Proposal

34. Supply Side Intervention • 1) Cap and trade quota system • Quotas for manufacturers and importers • Periodic bidding for quota • 2) Sinking lid • Quota is reduced regularly • 5% reduction every 6 months • Reduction to desired level within target time frame (10 years) • End result  Decreased supply  Rise in cigarette price  Reduced smoking prevalence

35. Demand Side Intervention • Smoking cessation programs • Regulation of retailing and marketing • Pack and product control • Better information • Aim  Reduce excessive rise in price

36. Other Aspects • Smoking of cigarettes remains legal • Home-grown tobacco • Baseline prevalence (prescription-based) • Has been used elsewhere • SO2 and nitrogen oxide in USA • Greenhouse gases in Europe • Gambling machines in NZ

37. Pros • Two-pronged approach • Over-arching concept for other proposals • Clear government message against tobacco • Clear timeline • Higher price as incentive for quitting • Revenue from bidding

38. Issues for Discussion

39. Cons • High cigarette prices • Social inequality in the short run • Cigarette-related crime (smuggling, theft) • Tobacco companies undermine proposal by increasing demand • Free-trade agreements • Government can take over marketing • Border control • Singapore not as isolated as NZ • Easy to obtain/smuggle cigarettes from neighbours

40. Cons • Timeline • People wait till the end to quit • Possibility of being stretched out longer if government changes mind • Proportion of revenue actually spent on anti-tobacco activities • Comparison to SO2/NO cap and trade systems • Simplified since these gases are not goods with a social demand

41. Conclusion • Proposal restricts sale but still advocates a free market • Consumers are more informed • Certain prerequisites • Political will • Good border control

42. Khoo 2010 Phasing out Tobacco: Proposal to deny access to tobacco for those born from 2000 Gloria Cheng Mark Yeow

43. Overview • Currently: Ban sales to under age of 18 • Proposal: Ban sales to those born after 2000

44. Overview • Implementation • Same as currently, ask for proof of ID • Instead of above a certain age, birthday past a certain year (T-ICs) • Foreigners able to buy: foreign passport, social visit pass/work permit • Rewording existing minimum-age legislation

45. Goals • Prevent uptake amongst youths before they get addicted • Removal of “Rite of Passage” • Compare “adult-only” e.g. alcohol, R21 movies with absolute bans like guns / recreational drugs

46. Goals • Demonstration effect: no smoking generation • If a young person knows that none of his or her peers will ever be permitted to purchase tobacco, then there will be much less peer pressure to smoke • Peer pressure is the most important factor in causing a youth to take up smoking

47. Goals • Gradual phasing out of smoking amongst population • Minimizing the immediate impact on current smokers and economy

48. Pros • Targets group most vulnerable to the addiction and the effects of chronic long term smoking • Strong incentive for current generation to act to protect future generations without feeling the pinch themselves

49. Pros • Long lasting effect with an ultimate long term end-point • Simplicity of implementation, minimal change to current legislation • Minimal disruption to current smokers

50. Issues for Discussion