PRESS STATEMENT BY THE MINISTER OF HEALTH, The Hon Dato' CHUA JUI MENG ON TOBACCO CONTROL IN MALAYSIA ON 7 NOVEMBER 1996
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Introduction

Cigarette smoking is a serious problem in Malaysia. In a survey conducted by the Ministry of Health in 1986, it was estimated that there were about 1.7 million smokers in Peninsular Malaysia alone whereby one in five adults aged 15 years and above were smokers. The rate of smoking was much higher in males where 41% were then current smokers. Out of the total number of smokers, 28% smoked 1 to 9 cigarettes per day, 36% smoked 10 to 19 cigarettes per day and 35.7% smoked more than 20 cigarettes per day. It was also shown in the same survey that the rate of smoking was higher in each successive higher age group with 12% in 15 to 24 year age-group and 32% in 55 to 64 year age-group, Malays had the highest smoking rate which was 24%, as compared to other ethnic groups namely the Chinese and Indians with smoking rates of 18% and 15% respectively. We have reason to believe that the rate of smoking among adults in Malaysia is increasing. A recent study done by the Disease Control Division at the Department of Public Health in 1995 indicated that the rate at smoking among males aged 20 years and above had increased to 51%.

Cigarette smoking is believed to account for 25% of the total cause of deaths in Malaysia. Deaths due to cardiovascular diseases, strokes and cancers which are the leading causes of deaths has been shown to be associated with cigarette smoking. The hazards of cigarette smoking had been widely publicized and so much has been written on the subject that the general public cannot be ignorant of the fact that smoking is a major health problem. Statistics have shown that about 90% of all lung cancer cases, 75% of all chronic obstructive pulmonary diseases, and 25% of ischaemic heart disease cases in men under 65 years of age have been attributed to smoking. Concurrent with the increase in smoking prevalence, morbidity and mortality due to smoking have also increased. Available data indicates that deaths due to cardiovascular diseases have risen from 3% in 1965 to 20% in 1994 of the total medically certified deaths. Cardiovascular diseases has been ranked first in the 10 principal causes of deaths since 1980. Cancers was ranked second and accounted for 11% of total deaths in 1994. Data from the Institute of Oncology, Radiotherapy and Nuclear Medicine, Hospital Kuala Lumpur have indicated that the incidence of lung cancers is increasing at the rate of 17% per year.

The Rights of Non-Smokers
Smoking within a confined space results in other people in the vicinity breathing air containing tobacco smoke. The knowledge that tobacco smoke contains some 4000 different chemicals of which at least 43 of these are known to cause cancer, has made passive smoking a major health issue. Many people are exposed to environmental tobacco smoke which is made up of the sidestream smoke, that are released from the burning tip of cigarettes and the mainstream smoke exhale by the smokers.
 

Young Children and Passive Smoke
During the first years of life, and particularly during the first year, children can be affected by exposure to smoke leading to asthma-like symptoms of cough and wheeze. The most seriously affected are infants and young children where exposure to secondhand smoke leads to increased respiratory tract infection, pneumonia and bronchitis.
 

Children are often in close proximity to a smoking parent. Studies have shown that infants of smoking parents have much higher levels of cotinine, the major breakdown product of nicotine. Infants often do not have the option of escape from a smoking mother or other family members and are prone to the ill effects of inhaling passive smoke.

While all smoke is likely to affect children, there is evidence from large studies of children's exposure to smoke that children aged five years and under have significant increases in the likelihood of developing asthma if the mother smokes ten or more cigarettes per day. Asthma is also increased in older children when they are exposed to passive smoke. Children exposed to secondhand smoke will have reduced lung function and increased cough, wheeze and phlegm. Secondhand smoke can directly trigger asthma attacks, lead to changes in lung function, sensitize the asthmatic to other environmental triggers or causes of asthma. Passive smoking during pregnancy occurs in a different way, because the baby receives the effects of the smoking by-products through the mother's bloodstream. If a mother smokes, there is an increased likelihood of miscarriage, stillbirth, death and illness during infancy. In addition, physical growth and mental development will be impaired.

Sidestream smoke is more hazardous than mainstream smoke because it burns at a high temperature and is virtually unfiltered. When compared to the mainstream smoke, the sidestream smoke contains higher concentrations of some of the poisonous chemical compounds and carcinogen such as carbon monoxide, nicotine, formaldehyde, Benzo (a) pyrene, B-napthylamine, 4-amino biphenyl, Dimethylnitrosamine and ammonia which constitutes serious threats to human health.

There is now convincing evidence that passive smoking can contribute to a number of diseases in otherwise healthy people in a similar way to mainstream smoke. In general terms, if has been estimated that the passive smoker increase his risk of lung cancer by at least 25% over the person not exposed. it is for more significant in most countries than other form of air pollution. Research on heart diseases show that spouses living with smokers have a 30% increase risk. The risk increases with the amount that the spouse smokes. All of the diseases that can be caused by smoking also occur among nonsmokers exposed to secondhand smoke. People have become aware of the dangers of passive smoking. Public places, homes, workplace and schools must be made smoke-free. The government is duty bound to protect the rights of the public to breathe smoke-free air. To respond to this need, the Ministry at Healthy has decided to expand the prohibited smoking areas to include more public areas and places in the interest of public health.

The Tobacco Control Regulations
In view of its urgency,it was decided that the tobacco legislation be developed as a regulation under the Food Act 1983 which has a provision under section 34 and 36 that allows the Food Act to be extended to tobacco.

Currently there is a total of 1,447 Enforcement Officers from the Ministry of Health and Local Authorities throughout Malaysia to enforce the regulations. They are Medical Officers of Health, Health Inspectors and other Officers specially appointed by the Ministry of Health to carry out enforcement in public premises. Since May 1994 when the regulation was gazetted, until August 1996, a total of 10,561 compound notices had been issued and a total of RM308,283 of compound had been collected, and a total of 646 cases had been brought to court. Extension Of the Smoking Prohibited Areas Under regulation 10 of The Control of Tobacco Products Regulations 1993, only a few places had been included as smoking prohibited areas. The areas include the following:

1. Any amusement center or theatre when such place is open to the public;
2. Any hospital or clinic;
3. Any public lift;
4. Any air conditioned eating house (up to one half of which can be allowed for smoking provided ventilation fans are installed);
5. Any public vehicle;

During the Cabinet meeting that was held on 30 October 1996, the Cabinet had endorsed] The extension at smoking prohibited areas to include 11 more places which include the following:

1. Banks and financial institutions;
2. Spoil complexes including stadiums (whether closed or open);
3. Shopping complexes;
4. Air-conditioned shops (including restaurants or any eating places);
5. Government offices;
6. Transport terminals (bus, taxi, ferry and train);
7. Airports except some designated areas as approved by the Ministry of Health:
8. Schools (including kindergartens, nursery, etc);
9. Institutions of higher learning (excluding hostels and open spaces);
10. Service counters of Tenaga Nasional Berhad, Telekom and Pos Malaysia:
11. Public halls (while in use by the public)

Apart from the public places mentioned above, the Minster of Health under regulation 12 of the control of tobacco product regulations have recently declared all petrol kiosks to be smoking prohibited areas beginning 19 September 1996. The Minister of Health also welcomes any organization and owner of any buildings to request to the Minister of Health to have their properties declared as smoke-free premises.