Promoting a Smoke Free Singapore
Taipei International Healthy City Conference 29 – 31 October 2005
Outline of Presentation
Introduction Milestones in the smoking control programme
National Smoking Control Programme
► Aim ►
Strategies
Impact Challenges
Singapore
Land Area Total Population Singapore Residents
13.9% Malay 7.9% Indian
699 sq km 4.2 million 3.5 million
76.8% Chinese
1.4% Other ethnicity
Source: http://www.singstat.gov.sg, Updated on 5 Apr 05
Singapore
Infant mortality rate
Life expectancy at birth
2.0 per 1000 live births
79.3 years
Male Female
77.4 years 81.3 years
Source: http://www.singstat.gov.sg, Updated on 5 Apr 05
Leading Causes of Death
30% 25% 20% 15% 10% 5% 0%
Cancer Heart Disease Pneumonia Cerebrovascular Disease
28.3% 24.3%
% of Total Deaths
13.1% 8.1%
Source: Ministry of Health
Top 5 Cancers 1998 - 2002
Men 1. Lung 2. Colorectal 3. Liver
4. Stomach
Women 1. Breast 2. Colorectal 3. Lung
4. Ovary
5. Prostate
Source: Singapore Cancer Registry
5. Cervix
Milestones in Smoking Control Programme
Implementation of first legislation – Smoking Act
► Prohibition in Certain Places
1970
1971
1979
Smoking Act enhanced
► Control of Advertisements & Sales of Tobacco
National Health Campaign on ‘Combat Diseases due to Harmful Lifestyles’
► Focus shifted from infectious to non-communicable diseases: ischemic heart disease, hypertension, diabetes, lung cancer.
1980
Campaign on ‘Smoking & Disease’
►Targeted at secondary schools, armed forces
1983
1986
Campaign ‘Superman’
►Targeted at primary schools
Launch of the National Smoking Control Programme
National Smoking Control Programme
Aim
To reduce smoking rates, by
Preventing smoking initiation among youths
Promoting smoking cessation among smokers Protecting non-smokers by exposure to passive smoking eliminating
National Smoking Control Programme Strategies
Reduce demand
Public Education
Reduce supply
Intersectoral MULTILegislation Taxation PRONGED collaboration
Smoking Cessation Services
National Smoking Control Programme
Public education carried out on a year long basis:
► Harmful health effects of smoking ► Benefits of not smoking or quitting ► Denormalise smoking
Mass media through TV, radio, newspapers, magazines
Face to face programmes targeted at specific Groups:
► Youths ► Employees in workplaces ► Healthcare professionals ► Community groups
National Smoking Control Programme
Mass Media
National Smoking Control Programme
Smoking Control Among Youths
School curriculum Train teachers and facilitators Use of peer educators Use of interactive methods eg. Skits educational
Promotion of sports as healthier alternatives
Targeted programmes for at-risk youths
National Smoking Control Programme
School-based Programmes
National Smoking Control Programme
Workplaces
Singapore Armed Forces & Police Force & Prisons
► Train paramedics & counsellors to provide smoking cessation services
General workplaces
► Train industrial nurses to provide in house smoking cessation services ► Lobby for smoke free policies such as ban sales of cigarettes and smoking at work premises ► Recognition of workplaces with good smoke free programmes in the Singapore HEALTH Award ► Regular communication through email
National Smoking Control Programme Healthcare Professionals
General practitioners provide opportunistic intervention and refer to cessation services Pharmacists (private cessation services & public) provide
In-patient hospital cessation programmes
National Smoking Control Programme
Legislation
Smoking (Prohibition in Certain Places) Act Smoking is prohibited in all places except non air-conditioned eating establishments and entertainment outlets such as pubs and discos
Smoking (Control of Advertisements & Sales of Tobacco) Act
► Prohibits tobacco advertising and promotion ► Prohibits sales of tobacco products to persons < 18 years of age ► Tobacco retailers, tobacco importers and distributors are licensed ► Prohibits sale of less than 20-stick cigarette pack ► Mandatory counseling of underage youth offenders ► Graphic health warning on 50% display surfaces of tobacco products ► Limits tar (15mg) and nicotine (1.3mg) levels in cigarettes
National Smoking Control Programme
Taxation
Per-Stick Cigarette Taxation Average retail price of 20 cigarettes: S$11.00 (US$6.60) ~ 67% due to tax
Weight / stick <= 1 gram Every additional up to 1gram Duty (cents) 35.2 35.2
National Smoking Control Programme
Impact of Taxation on Cigarette Prices
Year Excise Duty of Cigarettes S$ 115 115 Retail Price S$ of 20 cigarettes / pack 5.30 5.50
1995 1996
1997
1998 1999
115
130 130
5.60
5.80 5.80
2000 2001
2002 2003
150 180
210 0.255 per stick of <1g
6.40 6.90
6.50 8.50
2004 2005
0.293 per stick of < 1g 0.352 per stick of <1g
9.50 11.00
National Smoking Control Programme
Impact of Taxation
Retail Price vs Per Capita Cigarette Consumption
10 9
Real Retail Price (S$)
2.00 1.80
Cig Consumption '000
8 7 6 5 4 3 2 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year Real Price Per Capita Cigarette Consumption
1.60 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00
National Smoking Control Programme
Smoking Cessation Services
Accessible and affordable quit smoking services Free resources – self-help quit booklets and cards Train facilitators and health professionals to provide quality interventions (ie certification programme) QuitLine – telephone information & quit consultation service
Smoking cessation clinics
National Smoking Control Programme
Intersectoral Collaboration
Ministry of Education Enforcement agencies Malay organisations Grassroots organisations Tobacco retailers – stop selling tobacco on World No Tobacco Day
Healthcare professionals
Workplaces
National Smoking Control Programme
Impact of Smoking Control Programme
Smoking Prevalence Cross-country Comparison
Prevalence %
35%
30.3 28.9 24.8 22.8 19.0 19.5 20.6 34.5 33.8
30% 25% 20% 15% 10% 5% 0%
12.6
26.0
Singapore Germany England 2004 2000 2003
USA 2001
Sweden Australia 2001 2001
Japan 2003
China 1998
Indonesia Malaysia Thailand 2001 1996 2001
Country & Year
National Smoking Control Programme
Impact of Smoking Control Programme
Smoking Prevalence
%
60 50
1970
1986
Legislation
National Smoking Control Programme
Total
40
Male Female
30
20
18.3
15.2
12.6
10
0
Year
National Smoking Control Programme
Impact of Smoking Control Programme
Lung Cancer Incidence (per 100,000)
70 60 50 40 30 20 10 0
19681972 19731977 19781982 19831987 19881992 19931997 19982002
Females Males
5 – Year Period
National Smoking Control Programme
Challenges
Prevalence (%) of Smoking Among Females 18 - 29 years
(%)
10 6.6 5.2 5 3.1
0 1992 1998 Year 2004
National Smoking Control Programme
Challenges
Smoking Prevalence (%) By Gender & Ethnic Group 2004
Ethnic Group
Chinese
Males
20.5
Females
3.1
Total
11.7
Malay
Indian
29.9
22.4
7.4
1.4
18.6
12.1
Total
21.8
3.5
12.6
National Smoking Control Programme
Challenges
To arrest the rising trend of smoking among young women aged 18 - 24 years To reduce the smoking rate among adult Malay men
National Smoking Control Programme
Fresh Air for Women
Increase awareness of female specific risks of smoking Focus on what matters most to young females
► looks ► reproductive health
Female specific programmes integrated into their lifestyles
National Smoking Control Programme
Mass Media Messages for Women
National Smoking Control Programme
Malay Outreach Strategies
Objective – increase awareness of ill effects of smoking and decrease social acceptance of smoking among the Malay community
Empower Malay self-help organisations to provide cessation advice & counselling
Collaborate with Malay organisations to weave smoking cessation messages in their sermons Collaborate with mosques & family service centres to display and distribute smoking cessation posters and materials Organise support groups & parenting workshops which include smoking cessations topics
Ride-on annual forums organised by mosques/Muslim Bodies
Thank you
Dr Theresa Yoong Health Promotion Board Singapore