Abolishing the 14-Stick Pack: Is That It? Taking the Next Step in Malaysian Tobacco Control Regulation

There is no doubt that after signing the WHO Framework Convention on Tobacco Control, Malaysia has jumped on the tobacco control bandwagon. Since the signing of the FCTC, we have introduced the infamous graphic warnings on cigarette packs and no longer allow advertising of cigarettes outside of our Formula One races. In my previous posts, I stated that my estimate for tobacco prevalence among Malaysian males is 80 percent, based on a facebook survey. A WHO tobacco control document available at http://www.who.int/tobacco/media/en/Malaysia.pdf estimated that in the year 1996, tobacco prevalence among Malaysian males is at 49.2 percent.

A study done by Lekhraj Rampal ten years later showed that prevalence among Malaysian males had increased to 59.3 percent. (http://2006.confex.com/uicc/wctoh/techprogram/P3134.HTM). My figures are certainly a lot higher than these ones, and it would probably be interesting to note that my estimates are based on Malaysian males from the ages of fifteen to forty only. The point is, smoking prevalence rates are rapidly on the rise, despite the signing of the FCTC.

So what is Malaysia doing to circumvent the further rising of tobacco prevalence rates? The Cabinet has approved the enactment of a stand-alone Tobacco Control Act within the next one or two years, and it will be interesting to see what effects this Act has on issues like brand stretching, smoking in bars and clubs, and the display of constituents of cigarettes on cigarette packs. At the moment, I'm fairly certain that a high majority of Malaysian males have never even heard of the word 'nitrosamine'.

More recently, however, is the decision by the Ministry of Health to abolish 14-stick packs in an effort to discourage minors from smoking. (http://snus-news.blogspot.com/2010/04/malaysia-health-ministrys-proposal-to.html accessed 22 April 2010). An article by Rachael Kam at http://thestar.com.my/news/story.asp?file=/2010/4/7/nation/6006995&sec=nation/ stated that the 'plan to remove14-stick cigarette packs ... will definitely help', but just how far is this statement true? I immediately texted a good friend of mine in Malaysia, Umair Mohamed, a 24 year old well-educated Malaysian male about his opinion on the issue. His reply was as follows, and I quote: '... Stop youngsters from smoking. Haha. Won't work tho. The only way you can stop them from smoking is to make cigarettes taste like shit.' He paints a bleak picture, but that, I argue, is an accurate depiction of how our Malaysian males view the situation. He is wrong on one aspect; his statement that the only way to stop them from smoking is to alter the taste of cigarettes. There are many ways to reduce smoking prevalence among minors, the most apparent and effective one, in my view, being age verification of purchasers of cigarettes. I am not entirely sure why this step was not implemented by the Health Ministry as an accompaniment to the 14-stick pack ban, and hopefully will somehow get enough information on this matter to blog about it later. Age verification for purchase of tobacco products remains virtually unregulated.

So I think that this leads to the eventual question of: What's next for tobacco control regulation? According to David Sweanor and Rachel C. Grunberger in their 2008 article 'The Basis of a Comprehensive Regulatory Policy for Reduced Harm Tobacco Products', the trick is to reduce accessibility to tobacco products by, et al, restricting the number of locations where tobacco products are sold, preventing sales to minors and increasing the accessibility of products that can assist smoking cessation. (at 86) All three are areas that should be more heavily regulated in Malaysia, in particular the latter. Nicotine-replacement therapies are available in Malaysia but sadly on the health communication side of the story, the public is just not well informed enough about the alternatives to lighting up. It's not like here in Sydney where there's that television ad on Nicorette inhalers. I think it's about time that we have a good close look at how Australia has dealt with tobacco control. It should be noted that today, Australia is one of the countries with the lowest smoking prevalence rates in the world.

Last but not least, I came across a letter dated 6th April 2006 written by Molly Cheah, the Deputy President for the Malaysian Council for Tobacco Control (MCTC), available at http://www.mctc.org.my/legal. At paragraph three of her letter, she proposes a possible fine for smokers. All due respect to Ms. Cheah, such a proposal is not only unrealistic, but is also undoubtedly contrary to basic autonomy rights. As a health lawyer who is semi-libertarian at the most, my view is that the most effective way to tackle increasing tobacco prevalence rates is not to impose individualistic policies such as fining smokers, but instead focus on community education and other wider-aimed health proposals. We have to remind ourselves that smoking is a public health issue, and not a private health issue.