Speech by Mr Edwin Tong, Senior Minister of State for Health, at the Opening Ceremony of 3rd Asia Pacific Cities Alliance for Tobacco Control and Noncommunicable Diseases Prevention Summit

Mayor Dr Bima Arya Sugiarto, City Government of Bogor, and Co-Chairman, Asia Pacific Cities Alliance for Tobacco Control and Noncommunicable Diseases Prevention (AP-CAT)

Mayor Francis Anthony S. Garcia, City Government of Balanga, and Co-Chairman, AP-CAT

Mr José Luis Castro, Executive Director, International Union Against Tuberculosis and Lung Disease

Dr Cut Putri Arianie, Director of Prevention and Control of Noncommunicable Diseases, Ministry of Health, Republic of Indonesia

Your Excellencies

Distinguished Guests

Ladies and Gentlemen

1.        I am happy to join you this evening to open the Asia Pacific Cities Alliance for Tobacco Control and Prevention of Noncommunicable Diseases Summit. To our overseas guests, a warm welcome to Singapore.

2.        Tobacco use is an international health concern. According to the World Health Organization (WHO),^[1] over 1.1 billion people globally – that is around one in every five adults – are smokers. Tobacco use increases the risk of non-communicable diseases (NCDs) such as cancer, heart disease and diabetes. According to the Global Burden of Disease Study 2017,^[2] smoking is the second leading risk factor for ill-health and premature death. It is responsible for more than 8 million deaths a year.

3.        In ASEAN, it has been estimated that 122 million, or nearly one in five, people smoke, which causes more than half a million deaths a year. Tobacco-related diseases cost healthcare systems in ASEAN around US$10 billion every year.^[3]

4.        Singapore, too, is not spared from the harms of tobacco use. Tobacco use is the second highest contributor to ill-health and premature death in Singapore, with about six Singaporeans dying every day from the effects of tobacco use. It is estimated that smoking costs our society at least S$600 million a year in direct healthcare costs and lost productivity.^[4]

5.        Given these challenges, WHO has identified a set of cost-effective, evidence-based “best buy” interventions. Specific to tobacco use, WHO’s top “best buys”, among others, are:

        a. Increasing tobacco taxes to raise prices and reduce demand;
        b. Implementing standardised packaging and large graphic health warnings;
        c. Comprehensive bans on tobacco advertising, promotion and sponsorship to de-normalise tobacco products; and
        d. Smoke-free indoor workplaces, public places and public transport to reduce exposure to second-hand smoke.

6.        I am heartened by recent reports that many of these “best buys” are being implemented in our part of the world. For example, I understand that many countries have introduced smoke-free campaigns at tourism and heritage sites, such as Angkor in Cambodia, Borobudur in Indonesia; these are important and well-frequented sites. The recently reopened Boracay Island in the Philippines is now smoke-free too.Timor-Leste has also mandated larger graphic health warnings,^[5] while Thailand has moved to adopt standardised packaging for tobacco products.

7.        Like our neighbours, one of Singapore’s public health priorities is to discourage our people, especially the youth, from picking up smoking, as well as to encourage current users to quit and start living tobacco-free. As recommended by WHO, Singapore has adopted a comprehensive, multi-pronged approach to tobacco control. Singapore has increased its tobacco tax earlier this year to reduce affordability of tobacco products. Through our tobacco control laws, we have put in place, among others, a ban on smoking in certain public places – from January 2019 this will include Orchard Road, a popular tourist destination; a point-of-sale display ban for tobacco products; and starting from January 2019, the minimum legal age at which tobacco products can be purchased will be progressively raised over three years from 18 to 21 years of age.

8.        In addition, the Health Promotion Board (HPB) conducts public education initiatives on the harms of tobacco use, for example in school education programmes and mass media advertisements. We support existing smokers who want to stop through HPB’s QuitLine and I Quit smoking cessation programme. We are also looking into how to optimise and better provide more cessation support for current smokers who wish to lead tobacco-free lives. I understand that the Chief Executive of HPB, Mr Zee Yoong Kang, will share more about these at tomorrow’s plenary session.

9.        As a result of our multi-pronged tobacco control efforts over the decades, smoking rates in Singapore fell from 23% in 1977 to 19% in 1984, and further to 12.6% in 2004. Although we are now at 12%, which is the lowest thus far, smoking prevalence can rebound, just as it did after 2004. We want to make a concerted, determined, and sustained push to bring the overall smoking rate to as low as level possible. This includes adopting innovative best practices in tobacco control, as well as pressing on with existing measures.

10.       After extensive review and evaluation of available international and local studies, research and evidence, as well as several rounds of public consultations, the Ministry of Health recently decided to introduce standardised packaging with enlarged graphic health warnings, and to apply these to all tobacco products sold in Singapore.

11.       The standardised packaging and enlarged graphic health warning measures will form part of the comprehensive suite of tobacco-control measures in Singapore I described earlier. We anticipate that our suite of measures will, over time, contribute collectively to reducing smoking prevalence in Singapore, and thereby allow Singapore to take a significant step towards becoming a tobacco-free society.

12.       We will be proposing amendments to our laws in early 2019 to introduce the standardised packaging and enlarged health warning measures. These include amendments to ensure that the registration status of tobacco-related trade marks and tobacco-related designs under the respective intellectual property laws will not be affected.

13.       I am encouraged by the many officials and healthcare experts present this evening, and would like to thank the International Union Against Tuberculosis and Lung Disease for bringing together this wealth of experience in regional tobacco control. This Summit is a good opportunity for everyone to share their insights and perspectives on our common fight against tobacco use, and bring about a reduction in the non-communicable disease burden in our respective countries. I am confident that together, we will stand united to improve the health of our people.

14.       On that note, let me now declare this Summit open and wish you a fruitful discussion over the next two days.

Thank you.

^[1] World Health Organization (2018) WHO global report on trends in prevalence of tobacco smoking 2000-2025, second edition. Available at: http://www.who.int/tobacco/publications/surveillance/trends-tobacco-smoking-second-edition/en/
^[2] GBD 2017 Risk Factor Collaborators (2018) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392:1923–94.
^[3] ASEAN figures from the Southeast Asia Tobacco Control Alliance (SEATCA) Tobacco Control Atlas: ASEAN Region 2018
^[4] Cher, B.P., Chen, C., & Yoong, J. (2017). Prevalence-based, disease-specific estimate of the social cost of smoking in Singapore. BMJ Open, 8, e014377.
^[5] Timor-Leste requires graphic health warnings to cover at least 85% of the front and 100% of the back of cigarette packaging.