Comment: Smoking near windows is considered a nuisance to the neighborhood but has public health costs

SINGAPORE: Singapore was a difficult place to live for a smoker.

Smokers are unable to take a break, particularly with the suggestion to ban smoking near balconies and house windows by Nee Soon GRC, Member of Parliament and Parliament Committee on Sustainability and the Environment Louis Ng a October, re-launching a national debate on how far the country should go completely to fight smoking.

Some suggest that smokers close their windows when they smoke.

Ban smoking altogether, some frustrated netizens said.

LISTEN: Is it time to chase the smokers who light up near the windows of their homes?

RESISTANT MEASURES AGAINST SMOKING IN THE LAST YEARS

Singapore has implemented a series of increasingly aggressive legislative measures to stem the habit, especially in the past couple of years

Stores have not been allowed to openly display cigarettes since 2017.

Tax increases in 2018 increased the cost of cigarettes by 10%.

Ugly health warning labels and standardized packaging have been imposed as a result of amendments to the tobacco law, and have managed to somehow stigmatize the habit.

Laws were also tightened to raise the legal smoking age, as the 2010 National Health Survey study showed that eight out of 10 smokers were addicted before turning 21.

And to stem the demand for alternative tobacco products that serve as easy passages for cigarettes for young people, such as e-cigarettes and hookah, a ban on possession, purchase or use was imposed in 2018.

Indeed, this multi-pronged effort to stem smoking in 2018 was so publicly visible, NUS Saw Swee Hock School of Public Health Dean Dr Teo Yik Ying coined it the year Singapore attempted to quench smoking.

READ: Comment: The year Singapore tries to shut down tobacco

Even smokers today are no longer free to light up wherever they want in smoke-free Orchard Road and have to stay in yellow boxes if they do.

These efforts have paid off. The smoking rate dropped from 14.3% in 2010 to 10.6% in 2019.

This is a significant achievement to be commended, when the Ministry of Health previously revealed in 2018 that the incidence of smoking had fluctuated between 12% and 14% over the past decade without a clear pattern of decline.

Smoking rates should be reduced where public health costs are high. At least S $ 600 million annually in direct healthcare costs and lost productivity for Singapore according to a 2014 estimate in the renowned medical journal BMJ Open.

Some public health experts, such as prof. Chia Kee Seng, they went even further by asking to completely exterminate smoking as it is “an archaic habit with no place in modern society”.

READ: Comment: Smoking is an archaic habit that has no place in modern society

TACKING SMOKE AT WINDOWS A PRIORITY

People should eventually be able to do what they want at home, many say. But when it comes to smoking, all of us, smokers and non-smokers, know it’s a completely different game.

For one, while smokers have problems in terms of health effects, those around them also bear the costs of their habit.

This applied to family members stuck at home with the smoker, but took on broader significance as the pandemic sparked Singapore’s largest shift to work from home (WFH) and home learning.

Smoking-related complaints in HDB areas increased nearly sixfold in the first nine months of 2020 compared to all of 2017, Dr Sim Anne, Senior Minister of State for Health, revealed in Parliament last week.

READ: Comment: When Singaporean homes become workspaces – huge changes in the home and beyond

Even that increase can be an underestimate considering how many of us tend to be polite residents embarrassed to raise an uproar every time our neighbor smokes or creates a little inconvenience.

“Working from home is the new normal. People worked in the office. They go home and for an hour or two the neighbors can smoke once or twice in the evening. But people are now home most of the time and may have to go through a whole day of secondhand smoke, ”Mr. Ng told me on CNA’s Heart of the Matter podcast.

The consequences can be severe. “Many residents have complained to me about secondhand smoke because their children have asthma … yet they have a neighbor who constantly smokes at the windows,” Ng points out.

“Imagine if your neighbor is spraying toxic chemicals outside his house and you are breathing it in … this is exactly what secondhand smoke is.”

READ: Comment: COVID-19 Offers New Impetus to Quit Smoking

“There is no safe minimum level of secondhand smoke,” shared Dr Yvette van der Eijk of the NUS Saw Swee Hock School of Public Health in the same episode.

“Secondhand smoke contains something like 60 carcinogens and hundreds of chemicals known to be toxic … It could be more dangerous to our health than what smokers inhale … because (these) aren’t burned completely,” he said. underlined.

SINGAPORE’S APPROACH TO HEALTH CARE HAS ALWAYS BEEN INTERVENTIONIST

When this latest smoking ban tip resurfaced in October by Mr. Ng, concerns about intrusiveness and enforcement multiplied online, which surprised me.

Singapore has probably adopted an aggressive and interventionist approach to public health for decades.

Countless compulsory immunization programs, such as those against measles and diphtheria, which saw the mass vaccination of infants and school-aged children as part of the National Child Immunization Program, have been accepted without too much trouble.

Even when such programs are opt-in, like the BCG shot that protects against tuberculosis, the utilization rate has been close to 100% for decades. Similarly high rates are expected for the opt-in human papillomavirus vaccination program for girls in Secondary 1, which started last year.

READ: Comment: Making sense of COVID-19’s goal shift in public policy and science

Public acceptance of the application against other endemic diseases, such as the National Environment Agency’s controls against dengue, which carry fines but require residents’ permission for inspections, has also been well received.

I suspect that people understand and accept the rules governing individual behavior that could affect the health of the community.

READ: Comment: Discover the factors fueling record dengue cases in Singapore

The practicalities of imposing a smoking ban near windows need to be taken into account, but the technology exists.

Cameras are already used to detect waste in high-rise buildings and thermal scanners that smoke in common corridors. It may be worth considering extending their use to smoking observation for a stronger public health imperative.

During the podcast, Mr. Ng showed us an image taken by these cameras of a smoker throwing cigarette butts from their window.

“That’s how powerful our cameras are – powerful in the sense that … they’re not intrusive … if you’re sitting on your couch or lying on your bed, they can’t catch you but if you’re on your balcony, leaning out and smoking, then they can catch you. “

But he was also quick to warn that such means should be the last resort and that laws should be left to provide strong deterrence against smoking near the windows and change social norms in the same way that Singapore has. treated waste.

For an MP whose GRC has gone to great lengths to build smoking boxes to accommodate smokers, he understands how necessary a middle ground is.

READ: Comment: Youth smoking is a problem, as is youth vaping

IN STEP WITH DETERRIBLE SMOKE TOGETHER

As Singapore moves towards a national health insurance scheme to combine the risks and costs related to hospitalization (through MediShield Life) and disability (Careshield Life) and strengthen these programs in the spirit of collective responsibility, it may just be a matter of time before a moot An even more intrusive stage of pricing in smoking is taken.

Smokers usually pay a higher premium for life insurance policies than non-smokers, according to AIA Insurance, given the health risks associated with smoking.

In the United States, smokers also pay up to 50% more for health insurance.

We may be far from that, but where Careshield Life already adopts actuarial principles such as charging women higher premiums in line with insurance industry practice, and Medishield Life premium increases have been proposed, that chicken may go home to settle before how much we think.

READ: Comment: When it comes to insurance, less is more for young people starting out

And seen in these terms, the ban on smoking near windows is a small problem in the smoking debate.

Even if you put those trends aside, it’s worth looking into Mr. Ng’s suggestion, which goes to the heart of the concern about smoking spreading in homes where people spend the most time, including the elderly and young children.

As Mrs Ng said in our podcast, the challenge should be viewed through a public health lens rather than through neighborhood disputes or complaints from non-smokers.

Lin Suling is executive editor of CNA Digital News, where she oversees the Comments section and hosts the Heart of the Matter podcast.