There has been a lot of furore over this, especially from those who deride the move as yet another flip-flop on the government’s part.
The heart of the issue is this: the government feels (and I have been made to understand that these are the thoughts of the Cabinet and the prime minister) that an extension of the “educational enforcement period” would further improve the public’s acceptance of the ban on smoking at open-air eateries.
On the other hand, many among the public, and even from within the health ministry and among healthcare practitioners, feel that this is a U-turn, and that the government is going back on its word.
Educational enforcement is an interesting concept. Many of us use it every day without knowing that we do. For example, we may have small children whom we tell in no uncertain terms to stay away from power sockets. But children, being children, don’t listen and play with the socket anyway. Some parents would then admonish their children a little more sternly, ideally while pointing out what may happen if they touch the socket and get electrocuted.
The situation is dynamic, and reflects the microcosm of human behaviour. Some children would listen to this advice and stay away from the power socket. Others would not. These would receive a sterner warning, and in Asian householders such as the one I was raised in, a slap on the wrist.
It is rare and extremely abnormal for a parent to start beating up a child at the first instance when they play with a power socket. In most cases, children learn their lesson, the educational objective is met, and most importantly, the loving relationship between parent and child remains intact.
This might be an oversimplification, but the same applies to educational enforcement pertaining to the smoking ban. The government, despite what some might say, is a benevolent institution designed to ensure the welfare of its people. The thought behind educational enforcement was that the public should be educated about not smoking at open-air eateries, which is why enforcement officers went out to locate and give notices to those who did.
Think of the official ban as being similar to the example of the parent warning the child against playing with light sockets and the educational enforcement as education of the child. In most cases, and for most children, this would work.
This happens in Malaysia’s case as well. The National Cancer Society Malaysia (NCSM) is cited with having carried out a study that looked at the level of compliance with the ban on smoking at open-air eateries in Kuala Lumpur and Putrajaya. Here’s how the study was carried out:
Since the smoking ban was introduced on Jan 1, the health ministry has also provided a complaint hotline which members of the public can call to lodge complaints. After a few days, even a WhatsApp complaints channel was put in place. Between Jan 1 and Feb 28, 906 reports were made over eateries in Kuala Lumpur and Putrajaya, making up 22.2% of complaints for the whole of Malaysia.
NCSM used scientific methodology from John Hopkins Bloomberg School of Public Health and the International Union Against Tuberculosis and Lung Disease to randomly assign trained observers to assess compliance with the ban in these areas. Based on the hypothesis that at least 90% of eateries would comply with the ban, 173 eateries were surveyed.
The survey found that:
i) 98.3% of the restaurants removed their ash trays;
ii) 75.7% displayed no-smoking signs; and
iii) 60.1% had no customers smoking at the time of assessment.
It is important to place a caveat on the study, namely that despite randomisation of the eateries and times of visit, this study doesn’t really represent the complete picture across the entire country. But then, it was never meant to do so.
What the study meant to do was to assess compliance among eateries that were already non-compliant with the ban, that is, the recalcitrant children who, despite being educated, were playing with the light socket anyway. In this group, compliance was found to be above the 50% mark.
Though we had no input in the ministry’s decision-making process on the extension of the educational enforcement period, its conceptual framework for the decision can be mapped out.
Like a benevolent parent, the government feels that the behaviour of Malaysians can be improved through an extended period of education instead of beating down offenders with huge fines.
Our recommendation is perhaps to add a “slap on the wrist” rather than beating them down with a fine. How? Currently, offenders are given a warning notice if they are found to flout the law. We advocate adding a requirement for them to register and show up for a smoking cessation programme like the ministry’s MQuit programme within 90 days, failing which they should be made to pay a fine.
This is not something revolutionary and has been done in many countries with road transport departments where drivers need to attend counselling or safe driving classes in lieu of having their licences docked.
Some may argue that this is too difficult for smokers to adhere to, but I beg to differ. Remember, the ban is not against smoking. It only limits people from smoking in certain designated public places, which now include open-air eateries. If you decide to smoke and break the law in these places, you are issued a warning note requiring you to attend a smoking cessation programme.
Again, you can choose not to do this and be liable to the fine instead. This way, the choice at all times lies with the individual. The government meanwhile will truly be carrying out its role of educating society and putting into place safe, healthy conditions for its citizens. This is the next step of educational enforcement.
Dr M Murallitharan is a public health physician and medical director of the National Cancer Society Malaysia.
The views expressed are those of the authors and do not necessarily reflect those of FMT.