Tobacco laws strengthen public health

  • By Wen Chi-pang and Yen Chi-hua 温啟邦,顏啟華

After the government and opposition camps negotiated amendments to the Tobacco Harm Prevention Law (菸害防制法) over the past decade, the Cabinet on January 13 finalized draft amendments.

Preventing the dangers of tobacco is one of the priorities of the WHO, and Taiwan cannot afford to lag behind on this issue if it wants to join the organization. The WHO has stated that 8 million people around the world die from smoking every year. It is said that smoking is preventable and that quitting smoking is good for your health.

In contrast, less than 4 million people died from COVID-19 in the first two years of the pandemic. Yet fear of the pandemic has led people to go to great lengths to prevent the disease.

Faced with the dangers of tobacco, with a mortality rate twice as high as since the COVID-19 pandemic, how can we turn a blind eye to these dangers and not put in place strict controls?

With regard to the draft amendments, the major proposed changes are to be applauded.

The bill proposes to raise the minimum legal age required to purchase tobacco products from 18 to 20 years. At first glance, this change seems like a trivial matter and it should be easier to make than the others. In what is a rare consensus, raising the age limit is strongly supported by both smokers and non-smokers. At the same time, it is likely to reduce the number of new young smokers once it is enacted.

Most students are 18 when they graduate from high school, at which time smoking is no longer banned. Half of adult smokers started smoking and even became addicted within the first two or three years after graduation. Once people get past that age – and have more self-awareness and a more mature mindset – they may not want to start smoking anymore.

The US Institute of Medicine estimates that raising the smoking age could reduce the number of deaths in the United States by 250,000 per year and the smoking rate by 20%, while the extent of the effect is expected to s extend to adolescents under the age of 18.

Teenagers under the age of 18 can ask their older siblings to buy them cigarettes, but if the legal age limit were raised, youth smoking rates would surely drop.

The government has also proposed a ban on flavored cigarettes, which are preferred by teenagers.

The government has proposed expanding warning labels on cigarette packs, which serve as anti-smoking advertising and cost nothing. A person who smokes a pack (20 cigarettes) a day would see the candid images 20 times a day, or more than 7,300 times a year. Therefore, the bigger and scarier the warning label, the more effective it can be.

The amendments would increase the area of ​​warning labels on cigarette packs by 35-85%. Thus, Taiwan would follow in the footsteps of Thailand, which set an unprecedented example for the world some eight years ago by maximizing the area of ​​the ugliest and most disgusting images on cigarette packs.

A Thai academic has published an analysis of the effectiveness of image maximization. Smokers became petrified when they discovered how bad smoking was for their health, non-smokers were dissuaded from trying to smoke, and unsightly warning labels began to circulate in the marketplace.

The policy has strengthened tobacco risk prevention in Thailand as public support for stricter controls continues to grow.

Tobacco harm prevention in Taiwan has stagnated in recent years and needs a boost.

Taiwanese seem to believe that the national prevention policy is sufficient, unaware that there are still 2 to 3 million smokers in Taiwan. As each household typically has three to four members, the smoking population reaches close to 10 million people.

Additionally, about 20,000 Taiwanese die from smoking each year, showing that Taiwan lags behind many countries in the Asia-Pacific region.

The most significant change – after years of debate between government and opposition camps over new tobacco products – is that the amendments would ban e-cigarettes and restrict heated tobacco products.

However, some criticize the government for banning one while allowing the other, accusing it of being bought up by tobacco companies. As a member of the Taiwan Medical Alliance for Tobacco Control (台灣醫界菸害防制聯盟), I and others disagree with this analysis.

The bill clearly states that heated tobacco products must be strictly regulated, as commercial operators would be required to carry out “health risk assessments”, and they could not import or manufacture such products unless assessments are reviewed and approved by the authorities.

As we know, heated cigarettes are like traditional cigarettes – the former simply replaces the traditional burning process of the latter with a new heating process, and heated cigarettes contain the same substances as traditional cigarettes, including more a dozen group 1 human carcinogens.

With regard to traditional cigarettes, it has long been proven that one in two smokers dies from a smoking-related disease. Although long-term data on heated cigarettes are not available due to their relatively short history, it is indisputable that they also contain a variety of Group 1 human carcinogens.

The alliance has always advocated high standards for food and environmental safety, with environmental risks kept to less than 0.0001, but the health risk associated with traditional and heated cigarettes reaches 0.1.

Just as Taiwan uses high standards based on scientific evidence to assess food imports from regions affected by mad cow disease, countries that allow the animal feed additive ractopamine, and Fukushima in Japan and neighboring prefectures, health risk assessments of heated cigarettes may also be based on international standards. .

In doing so, regardless of what the tobacco companies say, a heated cigarette review is unlikely to be accepted in Taiwan if the public and academics can monitor the review process.

The government has taken the first step. If legislators can perform their duties without being influenced by the tobacco industry, a significant improvement in the country’s public health can be expected from the passage of these amendments.

This goal is achievable, as the ruling Democratic Progressive Party holds a majority in the Legislative Yuan.

Wen Chi-pang is president of the Taiwan Medical Alliance for Tobacco Control; Yen Chi-hua is the founder of the alliance.

Translated by Eddy Chang

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