Closing Speech by Dr Amy Khor, Senior Minister of State for Health on the Tobacco (Control Of Advertisements and Sale) (Amendment) Bill

1. Madam Speaker, I thank Members for speaking up in support of the Bill. Clearly, all of us have been touched by the issue of smoking at some point in our lives, either personally or professionally.

2. Dr Tan Wu Meng has shared how as a medical oncologist, he has witnessed first-hand the damage wrought on his patients by tobacco. Associate Professor Fatimah Lateef has pointed out the diseases caused by tobacco – it seems as if almost every organ in the body can be affected by tobacco use! Mr Louis Ng provided personal insights on how difficult it can be to quit smoking, and how he tried to avoid point-of-sale displays of cigarettes while quitting. I must commend him for being creative in quitting smoking by going cold turkey in Disneyland.

3. During my engagement session with the tobacco retailers in December 2015, one comment made stayed with me for a long time. A retailer told me that even though he sold tobacco, he didn’t want his own children to smoke! He acknowledged that tobacco could cause addiction among his customers.

4. This is why we need to continue to strengthen our tobacco control measures, and provide a supportive environment for smokers to quit. We need to make sure that our youth do not pick up the habit. We want to bring smoking rates down even more. The point-of-sale display ban plays a part in fulfilling these objectives.

5. Let me now respond to the queries and suggestions made by Members in respect of this Bill.

POSD Ban implementation

Specialist tobacconists

6. With regard to the point-of-sale display ban, I earlier described the requirements for general tobacco retailers to keep their tobacco products out of sight of customers and the public within their premises. I also said that specialist tobacconists are required to keep tobacco products out of sight from outside their premises, because these specialist tobacconists only sell cigars and perhaps alcohol. To do this they can completely make their store windows opaque, use curtains, or any other method that achieves the same effect. Presently there are about 17 such specialist tobacconists and in fact five of the outlets are actually from the same company.

Exemption for Changi Airport

7. Associate Professor Fatimah asked about duty free retailers. Unlike general tobacco retailers, duty free retailers at Changi Airport serve mostly tourists and overseas passengers who are departing Singapore. Given this, the point-of-sale display ban will not be implemented at duty free retailers at Changi Airport for now, although we will continue to review the position.

Other duty-free retailers

8. Duty free retailers at sea ports will be required to comply with the point-of-sale display ban. Like specialist tobacconists, the requirements will be slightly different from those for general tobacco retailers. Duty free retailers at sea ports may place their tobacco products within a specified “tobacco area” of the premises, but the tobacco products should not be visible from outside this area. Alternatively, they may follow the requirements for general tobacco retailers. DFS Galleria at Scotts is classified as a general tobacco retailer, and will be required to comply with the requirements for general tobacco retailers.

Price list

9. Associate Professor Fatimah asked what the price list will look like. The appearance of the price list will be prescribed by MOH. It should be in text, printed on white A4 paper, and contain only the necessary information on the product, such as brand and variant, price, and barcode and stock number. There should be no pictures or logos. We will also control the font size.

10. As not all customers are literate in English, we will permit the price list to be published in each of the four official languages. But this is limited to one price list per official language.

Grace period

11. Associate Professor Fatimah recommends that we shorten the grace period of one year. I am pleased to see her enthusiastic support for the ban. Much as it would be ideal to implement the ban as soon as possible, the reality is that tobacco retailers, especially the smaller shops, will need time to make the necessary adjustments to their existing store set-up. The grace period also gives them time to diversify their business models away from the sale of tobacco products. As such, we think a grace period of one year is reasonable. However, MOH certainly encourages retailers to comply early with the requirements of the ban.

Loss of income due to POSD ban

12. Er Dr Lee Bee Wah expressed concern that tobacco retailers, especially the smaller businesses, would be affected financially by this ban. We have conducted engagement sessions with small retailers since 2014 to help them prepare for the ban. The ban applies to all general tobacco retailers. As such, no tobacco retailer will lose out to another. Like all our tobacco control measures, the intended effect is to decrease the overall demand for cigarettes. But as this will likely not be an immediate development, small retailers can use this grace period and beyond to start shifting their business models away from dependence on selling tobacco products. They may also consider changing their business practices to increase their productivity.

Suggestions to enhance tobacco control

13. Members have suggested additional ways to enhance tobacco control, especially measures to prevent youth from picking up smoking and to help smokers quit. I am heartened by their enthusiasm. Let me assure members that MOH is open to ideas and best practices from around the world, and we closely monitor such developments.

Standardised Packaging

Standardised / Plain Packaging

14. Dr Chia Shi-Lu had suggested that we follow in Australia’s footsteps and quickly move to introduce standardised packaging. Emerging data from Australia shows that standardised packaging reduces the attractiveness of the tobacco products, and makes the health warnings more prominent and effective. There are early indications that it reduces smoking prevalence.

15. We have been studying and are closely monitoring international developments on standardised packaging. In May 2016, France, the United Kingdom and the Republic of Ireland will start to implement standardised packaging as well.

16. The decision on whether or not to proceed with standardised packaging will be based on public health considerations, and we will also ensure that any measure, if introduced, will be designed in a manner consistent with our international obligations, including those relating to intellectual property rights.

Tobacco-Free Generation

17. I fully agree with Dr Tan, Er Dr Lee and Associate Professor Fatimah that tobacco control is best managed upstream – that is, we win the hearts and minds of our children and youth, to prevent them from getting addicted in the first place.

18. That is why HPB works with MOE and institutes of higher learning to incorporate anti-tobacco messages into the curriculum, so as to raise awareness about the benefits of a tobacco-free lifestyle, dispel the misconceptions about smoking, and equip youth with life skills to refuse cigarette offers. I also applaud efforts by passionate volunteers to get our youth to pledge to be a tobacco free generation.

19. Going beyond promotional measures, both Dr Tan and Associate Professor Fatimah had proposed that we could also introduce a cohort ban on smoking, by banning sales of tobacco to Singaporeans born from the year 2000 or another specified year onwards.

20. MOH is familiar with this proposal, and has given it a lot of thought. Our concerns are the significant practical difficulties and risks in implementing and enforcing such a ban; and it may not result in the desired reduction in smoking rates.

21. Such a cohort ban would be easy to circumvent, and enforcement is going to be challenging and likely to be resource-intensive. An effective ban would also require laws to penalise persons not subject to the ban who supply tobacco products to the affected cohort. For example, a person affected by the ban could buy cigarettes overseas, or get an older relative or friend unaffected by the ban to buy cigarettes for them. In such a situation, we would have to penalise the person providing the cigarettes. Furthermore, enforcing such a cohort ban can be very challenging as age differences between close cohorts become less apparent physically as they grow into adults.

22. Hence, MOH will not pursue such a cohort ban for now. We are aware that this idea is being pursued in Tasmania, Australia, through a Private Member’s Bill, and we will monitor its development.

Minimum legal age

23. Mr Ng had asked why MOH had not included raising the minimum legal age for buying tobacco and smoking in this current set of amendments. Dr Chia and Er Dr Lee made a similar call for MOH to raise the minimum legal age. We are still studying raising the minimum legal age as part of the ongoing public consultation on further enhancements to our tobacco control measures, which includes standardised packaging and larger graphic health warnings, this public consultation is due to end on 29 March 2016.

24. Raising the minimum legal age to 21 years is a relatively new measure in jurisdictions that have implemented it, such as Hawaii and New York City. Hence, we would need to carefully study their experiences, and see if this would be appropriate in our local context.

Community Efforts

25. MOH agrees with Associate Professor Fatimah, Mr Ng and Er Dr Lee that public education efforts and support for smokers to quit smoking complement legislative measures. They are key elements of our multi-pronged approach towards tobacco control.

I Quit Programme

26. Mr Ng made a call to intensify efforts to encourage more smokers to quit. Quitting can be perceived as a rather challenging journey by smokers. Hence, HPB introduced the “I Quit 28 Day Countdown” in 2013, to get smokers to quit by breaking down the quit journey into daily, small actionable steps. So as Er Dr Lee said, by the end of the 28 days, the body will be back to normal - as before they started smoking. It is based on findings that smokers who stay smoke-free for 28 days are five times more likely to quit smoking for good.

27. Like the “Tips from Former Smokers” campaign mentioned by Mr Ng, I Quit adopts a community-based, but personalised, approach to build a network of support to help smokers quit. The campaign has seen about 10,000 sign-ups each year since 2014. Its Facebook page has more than 40,000 members, with daily exchanges by ex-smokers sharing their personal stories, smokers seeking advice on quitting, and non-smokers penning words of encouragement.

28. We agree with Er Dr Lee on the need to build a conducive environment that encourages smokers to quit the habit. HPB has been expanding its outreach and support network for smoking cessation. Over the past year, HPB has added over 130 new smoking cessation touchpoints, including healthcare institutions and retail pharmacies, bringing the total to over 280. By 2020, the aim is to double the number to 600 nationwide. These I Quit touchpoints offer free smoking cessation counselling to smokers on the ‘I Quit 28-Day Countdown’ programme. Smokers can also call in to Quitline or access online resources for additional support to quit smoking. In addition, we have been educating the public on the harms of environmental tobacco smoke and its impact on loved ones to nudge smokers to contemplate quitting.

Malay-Muslim smokers

29. Associate Professor Fatimah had expressed concern that the number of Malay smokers remained high, though there was a slight decrease in prevalence in 2013. Please be assured that we are monitoring these trends closely.

30. Like Associate Professor Fatimah has pointed out, we can use culturally significant moments to nudge our fellow Singaporeans to live a healthier life. HPB has held the I Quit Ramadan roadshows since 2012. They will host another edition for the upcoming Ramadan in June 2016, and hope to encourage 2,000 Malay smokers to sign up to quit. I hope the community will support HPB in their efforts.

Clarifying enforcement powers

Prohibition on cross-border advertising

31. Associate Professor Fatimah has also asked how the amendment would be applicable to online advertising and Er Dr Lee commented that there could be limitations to the effectiveness of banning internet advertising. I recognise that limiting access to online advertisements is not easy. In order to effectively ban cross-border internet advertising, there should be controls at its origin in every country. Regardless of developments elsewhere, we will play our part as a responsible member of the global public health community by making it clear that our prohibition on advertising will cover online advertising and promotion that originates from Singapore or from Singapore-connected persons.

Search of vehicles

32. Mr Louis Ng raised concerns regarding HSA’s enforcement powers under the amended Act. These powers are essential to enable HSA to effectively conduct enforcement activities and investigations under the Act. The amendments seek to update and where appropriate clarify the scope of these powers.

33. Mr Ng asked about powers to search premises and vehicles without a warrant. I would like to clarify that the power to enter and search premises is not new. It is in the existing Act. The amendments simply clarify that no warrant is required to exercise such powers, because authorised officers need to be able to act on reasonable suspicion and in a timely manner to search premises and vehicles for evidence in connection with a possible offence, before the suspect can dispose of the evidence. The same approach has been used for the Health Products Act.

34. The existing search powers are being extended to cover vehicles, because there have been several cases of illegal peddling of tobacco through the use of vehicles. Let me assure members that a vehicle will be searched only if authorised officers have reasonable cause to suspect that the vehicle in question is associated with a potential offence under the Act.

Smoking in public places, including enforcement issues

Increasing DSPs

35. Er Dr Lee also proposed that we expand the number of designated smoking points (DSPs), like the ones in her Nee Soon South Constituency. I thank her for her active efforts to promote a smoke-free environment for her constituents. MEWR and NEA are currently studying the progress of Project DSP: Cool to be Considerate, to gauge the public’s response to these DSPs. We also need to better understand the impact of having such DSPs in our HDB heartlands, including their effectiveness, prior to committing to any expansion of such a programme.

Conclusion

36. Madam Speaker, the Members who are physicians have pointed out how harmful tobacco can be to the human body. With the recent increase in the popularity of ENDS worldwide, and their targeted marketing to the youth, we need to strengthen our regulatory measures. It is also imperative that we decrease exposure of non-smokers, especially youths, to the advertising effect of point-of-sale tobacco product displays. The aim is to ultimately de-normalise tobacco use.

37. We also need to update and streamline our regulatory framework to ensure that our enforcement efforts remain effective and robust, yet fair. These changes are needed as part of a bigger community-wide effort towards creating a tobacco-free Singapore, and we are indeed heartened by the support of the public received during our consultations as well as support from the Members of this House.

Madam Speaker, I beg to move.