From Dr Helmy Haja Mydin and Dr Ginsky Chan
The concept of a Generational End Game – in which the use, possession and sale of cigarettes and vape products will be banned for those born after 2007 – was presented to Parliament by health minister Khairy Jamaluddin earlier this year. On Aug 19, a parliamentary special select committee met for the first time to discuss the Control of Tobacco Product and Smoking Bill in detail.
The purpose of the committee is to propose a more robust framework and to address concerns raised, which include questions regarding individual rights. We hope that the MPs in this committee will consider the points that we raise here.
The encyclopaedia Britannica defines externalities as the unaccounted-for consequences received by a third party. This “spill-over” of consequences may be good or bad. An example of a positive externality is the Covid-19 vaccination.
By getting the jab, you receive the personal benefit of a reduced risk of contracting Covid-19, but the baby at home who is not old enough to be inoculated receives the externality benefit of not contracting the virus from the outside world through you. From a population perspective, when a large proportion of a population is vaccinated and is thus less susceptible to transmit the virus, those who are not eligible to receive the vaccine are protected as well (a phenomenon known as herd immunity). Let us look at cigarette smoking – in particular, its negative externalities.
The first negative externality of smoking is the health of others. Malaysia’s Institute for Medical Research published a research paper in 2020 which estimated that in any one week, one in four children were exposed to second-hand smoke in their parents’ car.
Those who do not want their children to inhale second-hand smoke may choose to smoke when they are alone in the car or when they are alone in the house. Unbeknownst to them, current evidence shows, tobacco smoke pollutants remain in house dust and indoor surfaces for as long as six months and contribute to “third-hand smoking”.
Children who have the habit of putting their hands in their mouths or on their face after touching contaminated surfaces are at risk of ingesting or inhaling hazardous carcinogens. Children can be affected even before they are born – pregnant mothers who smoke or inhale second-hand smoke increase the risk of their babies developing weak lungs, heart defects and low birth weight.
The second negative externality of smoking is the healthcare burden. Practically every part of the body can be affected by smoking. According to Khairy, RM6.2 billion was spent to treat just three diseases in 2020, namely lung cancer, heart disease, and chronic obstructive pulmonary disease (COPD).
On the surface, healthcare in Malaysia is largely financed by the “government”, but a large proportion of that funding is derived from taxation. With a smoking prevalence rate of 21.3%, this means that for every smoker who suffers from the consequences of smoking, four other non-smoking citizens pay for his/her healthcare. Furthermore, for every hospital bed occupied to treat patients with diseases caused by smoking, there is one bed less to treat patients suffering from non-preventable diseases.
The third negative externality of smoking is productivity loss. In many workplaces, smoking breaks are allowed. However, as little as 15 minutes a day amount to six unproductive hours per month. As compensation, Piala Inc, a company in Japan, grants an additional six days off each year to non-smoking employees.
Chronic smokers suffering from prolonged periods of cough and breathlessness also have impaired work performance. A 2021 study by Universiti Sains Malaysia reported 32% productivity loss and 17% limitation of activity due to COPD. In addition, as a result of caring for family members with COPD, caregivers reported 7.2% productivity loss and 21.6% limitation of social activity. Furthermore, those who experience more severe forms of COPD or suffer from heart disease and lung cancer would have to opt for early retirement.
Last but not least, smoking causes negative externality to the environment. From growing and cultivation to manufacturing and distribution, tobacco and its products cause detrimental effects to our planet. According to the May 2022 report “Tobacco: Poisoning Our Planet” by the World Health Organization, 5% of deforestation is contributed by tobacco growing, 22 billion tonnes of water is used in tobacco production, 2 million tonnes of waste is produced from packaging and 4.5 trillion cigarette butts pollute the environment every year around the globe.
Non-cigarette products like smokeless tobacco and e-cigarettes also contribute to the plastic pollution and battery waste worldwide. The cost of cleaning up littered tobacco products, of course, falls on taxpayers, most of whom do not smoke.
We have described four negative externalities of smoking, deliberately sidelining the harmful effects to the smokers themselves since some argue that smoking is an individual’s choice despite the effect of addiction on free will.
We advocate for a properly enforced Generational End Game, whereby those born after 2007 are not allowed to purchase cigarettes in any form.
Such progressive and aggressive legislation will protect not only our future generations, but snuff out the act of smoking as an infringement upon the rights of others to health, access to healthcare, economic productivity, and a healthier planet.
To quote John Stuart Mill on the harm principle: “That the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.”
Dr Helmy Haja Mydin is the technical adviser to the health minister for tobacco control and Dr Ginsky Chan is a MSc public health student at the London School of Hygiene & Tropical Medicine.
The views expressed are those of the writers and do not necessarily reflect those of FMT.