Henry Tong, chairman of the Hong Kong Council on Smoking and Health, is on Straight Talk this week.

Tong explains how the council is working with the government to set a long-term target of a low prevalence and how a smoke-free Hong Kong can be achieved in order to provide our next generation a healthy environment.

Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Henry Tong:

Chan: Good evening. I'm Eugene Chan and welcome to Straight Talk. Our guest this evening is Henry Tong, chairman of the Hong Kong Council on Smoking and Health (COSH), a statutory body dedicated to public health by combating tobacco use. Under Tong's leadership since 2020, COSH has pushed for stricter tobacco control measures, including banning alternative smoking products and raising tobacco taxes. Their aim is to reduce smoking prevalence to 5 percent or below and try striving for a tobacco-free future in Hong Kong. Today, we will discuss how close we are to a total ban on tobacco products. Welcome, Henry!

Tong: Good evening, Eugene!

Chan: Chairman, you were on our show like two and a half years ago when I know that you and your committee members have done a lot of work and we've seen some progress. But before we move into that, maybe you can share with us, with the viewers, a brief overview of all the ongoing work of COSH, since its inception.

Tong: Well, the Hong Kong government started that tobacco control policy in 1983. At that time, the smoking prevalence in Hong Kong was 23.3 percent. COSH was established in 1987. And in the past, almost 40 years, we've gone a long way to help reduce the smoking prevalence from 23 percent to 9.1 percent in 2023. And then some milestones that we have achieved is a steady increase of tobacco tax – to use tobacco tax to encourage smoking cessation. In 2007, we advocated for the government to ban all smoking indoors and in public places, in all offices, restaurants, and hotels, and so on, and one of the milestones that we achieved was a total ban on the sale and import of alternative smoking products in the year 2022. Last year, we also helped the government, the Health Bureau, to conduct the Smoking Strategy. Consultation, and the result, which was announced by the Secretary last week was that over 90 percent of the Hong Kong public supports the government to strengthen smoking … tobacco control policies in order to reduce smoking prevalence.

Chan: Right, Chairman. You just said that smokers in Hong Kong made up like 9 percent of the adult population compared to like 23 percent many years ago. So, we must congratulate you. I think Hong Kong has been one of the lowest in the world.

Tong: Thank you.

Chan: So, we must congratulate the Department of Health and the good work by COSH. But not only that, we also have seen that that proportion is continuing to fall. So, would you say that the work on anti-smoking in Hong Kong has been a success or could have done better?

Tong: Well, there has been some success, I wouldn't call success, progress which have been made for tobacco control. But there's always room to improve. For example, we welcome and our council really supports the 10 short-term measures which the secretary has proposed last week to strengthen tobacco control in Hong Kong. But there are still some details we would advocate for the government to refine, to make the 10 short-term measures better.

Chan: Before we move on to the 10 short-term measures. We know that the government has set a target of achieving a smoking prevalence of 7.8 percent by 2025, which is next year, but COSH has proposed a smoke-free generation and a total ban by the year 2030. So, there is some, I mean, how is COSH looking at the government's target? Are you happy with that target? Do you think they're too conservative? Or do you think they're too optimistic?

Tong: With the implementation, I hope by the end of this year or by early next year, of the 10 short-term measures, I'm optimistic that the government can reach its targets, its KPI for 7.8 percent smoking prevalence in Hong Kong. But that's not the end and we are striving for a smoke-free environment for our youth to grow up. And, also, we are striving for a smoke-free environment so that there will not be so much burden to our public health system, because we know that most of the public who have lung cancer, have heart diseases because of smoking. Most of them were treated by our public health system, which is a very big burden to our taxpayers and to our doctors and nurses. So, that's why our committee, we have a more aggressive approach, which we hope will have a target, the government will set a blueprint, a roadmap for reducing the smoking prevalence in Hong Kong to 5 percent.

Chan: Chairman, you just mentioned their 10 short-term measures. Why do we need such short-term measures and what's the background of it?

Tong: Well, because in the past, when the Hong Kong government introduced anti-smoking measures, usually it was one by one and the legislation process was very time consuming, either from two years of increasing the warning signal on tobacco packs. It took two years to go through the Legislative Council to ban ASP (alternative smoking products), sale of ASP, which took seven years and that is too slow. And what we have seen encouraging is that the government has stated, has proposed all the 10 short-term measures would be introduced at one time to the Legislative Council by the end of this year. And why we need the 10 short-term measures is because we know that increasing tobacco tax is a very effective way. And it's proven to be the way to reduce smoking prevalence but that's not enough. There must be a multi-pronged strategy to do that.

Chan: Just now you were saying that with 10 measures, you think the target of 7.8 percent should be able to be achieved by 2025. However, if the Legislative Council approved this amendment, it won't be effective until the end of 2025. So, what other measures do you think is going to be effective in helping the prevalence drop from 9.1 percent down to 7.8 percent, if this hasn't been effective until the end of 2025?

Tong: Well, I think the government must increase and improve its free smoking cessation services to the public. From the report we released last week, about 60 percent of the current smokers have never used any free smoking cessation service, which I think they have room to improve, to outreach to these people. And of course, public education and constantly educating smokers that smoking is not only harmful to themselves, but to their family and to the people around them. And also I think the debate or the discussion about these 10 measures has already increased the awareness of the importance of tobacco control which can also encourage smokers to quit.

Chan: Right. One of the 10 measures that people have been talking about is actually to prohibit smoking while queuing, including queuing for public transport, entering designated public premises such as public health care facilities, public pleasure grounds, theme parks and places of public entertainment. So, many other public, particularly non-smokers, were expecting a ban on smoking while walking as well, but it's not included because the government said there will be difficulties in enforcing it and we will only consider it in the future. So, what is your view on that and is it that difficult to enforce?

Tong: We call smoking while walking “locomotives”. We really would like to ban locomotives immediately, because myself and my council and also many legislative councilors or district councilors constantly receive complaints from the public, from their constituents that they get second-hand smoke from people smoking while walking, and there's nothing that we can do according to the law right now. But on the other hand, we do understand that the enforcement of this law, we need some time to research on the ways to implement it. And that's why we have been advocating the government to maybe use video technology to do that. For example, in addition to police, I've seen Food and Hygiene Department, law enforcement officers, which carry a video camera with them for their law enforcement efforts. And I believe that this could be considered for this locomotive ban.

Chan: Chairman, it's interesting you mentioned that law enforcement officers because having tobacco smoking actually is not a criminal offence. It's something for health issues that we want to improve, especially second-hand smoking. So, why should we involve police to do that? Do you think we have gone a bit beyond what we were expecting?

Tong: Well, as an educator myself too, I'm hoping that this legislation, the main purpose is not to penalize people, but to give the public a very clear message that smoking is harmful, not only to the smoker but also to the people around them and we hope that by this legislation and by our public education efforts, people will know that they should not smoke in any public areas, not only while walking, while queuing up for buses, but also at any public areas. This is a very clear message that we want to carry to the public and to smokers.

Chan: Right, Chairman, before we go to the break, I want to just touch on this, the good work that you have done in 2022, that you were here in 2021. And then we talked about the ASP, the alternative smoking habits. I mean, there was a very successful advocacy that these products were all banned by the government. We will touch on that when we come back from the break, and let's have a break now and viewers stay tuned, we will be right back.

Tong: Thank you for staying with us on Straight Talk. Henry Tong, chairman of the Hong Kong Council on Smoking and Health, is with us, talking about how close we are to a total ban on tobacco products in Hong Kong. So, Chairman, before the break we touched on ASP, alternative smoking products, that during your term, had successes. So, maybe you can just remind the viewers what was the rationale of banning the use of these products?

Chan: Well, the government has already banned the import and sale of e-cigarettes and alternative smoking products in year 2022. And now, it has been 2 years after the ban. And we believe that most people who have bought these products before the ban should have used them or they should have expired their life already. On the other hand, we still see on the streets that some people smoking these e-cigarettes or ASP, which is really unreasonable. I won't guess that how they get it or whether from legal or illegal way, I won’t guess that. But now it is the right time because in year 2021 and 2022, the public and Legislative Council has already reached a consensus that ASP is a bad product, a harmful product, it is a new product, and Hong Kong shouldn’t have this new product exist.

Chan: How would you relate this and the flavored cigarettes, that are very popular with people, especially with the younger generation and with lady smokers?

Tong: For our tobacco control efforts, the most important thing is that we try every way to prevent young people from becoming smokers. For older or adult smokers, we try every way to encourage them to quit smoking. But the tobacco industry, they come up with these flavored cigarettes, menthol, fruits, candies, chocolate flavors, which are attractive to young people. From the statistics announced by the government last week, 70 percent of young smokers who are all under 30 years old, they smoke these flavored cigarettes. And these flavored cigarettes, they are actually what we call sugar-coated poison because the flavors, the menthol or the candy taste, it covers up the bad taste of cigarettes, and also reduce the vigilance of the smokers about the harms of smoking. An also there has been research, which has shown that people who smoke flavored cigarettes are harder to quit, it is more addictive. And also the additives put into the flavored cigarettes, they produce more harm for the smokers. That's why we agree and we support the government’s proposed ban of flavored cigarettes.

Chan: Right. When you talked about that, we also always look at overseas experience as well. Can you share with the viewers what are your observations with the overseas experience in banning ASPs? Do they do that as well? And how successful are they?

Tong: Well, in some of the developed countries, they have already seen the harms of flavored cigarettes, and they have already banned all forms of flavored cigarettes, including menthol. For example, Canada, the UK, and the EU, in recent years they have already banned all flavored cigarettes, including menthol. And also they have also banned these flavors in shisha, in waterpipe smoking behaviors too because these additives are harmful.

Chan: Right. I also have been doing some research, and they said that young smokers and females are saying that such a prohibition of such products isn't going to make them quit. So, are we on the right strategy?

Tong: Well, I think for encouraging smokers to quit, there must be multiple strategies. Banning some of the types of cigarettes, which are attractive to them, overall reduces the attractiveness of the cigarettes is one strategy. And other strategies include public education, including family supports, and including friends supports too, which our council is doing, having … training young and female smoke-free ambassadors to encourage their friends who smoke, to support them in families, and all these things add up to encouraging smokers to quit.

Chan: Right. Just now you mentioned that we are getting a lot of news on these new 10 measures. And one of our lawmakers has raised concern that, especially during such sort of an economic challenging time, that the ban on flavored tobacco products and even prohibiting smoking while waiting in line is going to harm the hospitality and the tourism sectors. Do you agree?

Tong: I don't really agree because banning smoking behavior in queuing has already implemented in some developed countries or some cities, which we are well known of. For example, in Beijing, in Shenzhen, in their queuing for public transportation, smoking behaviors are already banned. And also in Singapore, in Sweden, nationwide smoking is banned in their queuing behavior. And also I would not think Hong Kong’s tourism or hospitality industry has to survive on encouraging some very harmful behavior to both the smokers and the people around them. And also there are countries, which have stricter measures than Hong Kong, like Singapore or the UK or Canada, they have some other bans that Hong Kong doesn’t have. But I've never heard anyone saying that, or any business saying that they won’t go to Singapore or the UK or Canada.

Chan: Yeah, but having said that, I mean, it is always the timing issue, isn’t it? I mean recently we have seen the shelving of our charging scheme for solid waste. Do you think now for Hong Kong it is the right time to do such sort of more banning on such products in a more high-profile way, especially now when we are trying to attract more overseas visitors?

Tong: Well, I am also very concerned about our public health system. During the pandemic, we see how fragile our public health system can be. And the government last week, they cited study in year 2021, saying that smoking behavior cost, there is a socio-economic cost to Hong Kong for HK$8.2 billion a year. And actually our council commissioned a study at the end of last year. And the professor estimated that the social and economic cost to Hong Kong was HK$45 billion per year because of smoking behavior. By reducing the number of smokers in Hong Kong and by improving Hong Kong to be a healthy city, a smoke-free city would not only help the healthcare system of Hong Kong, but also help the economy of Hong Kong.

Chan: Right. Thank you for a different way of looking at the whole issue. And we know that the smoking prevalence in Hong Kong is already one of the lowest in the world. And some people actually argue that further strengthening tobacco control effort will make Hong Kong what we call “a nanny state”, and the boom of the black market, you have all these untaxed cigarettes in the market, as well as repackaging, while the effect on reducing smoking is not that drastic. So, how will you respond to that statement?

Tong: I cannot bear to see young people keep falling into the traps of tobacco industry. Smoking cigarettes doesn't produce anything, smoking cigarettes only produces death, disease, waste of money for the smokers, harm to the people around them, and produce a lot of waste for the environment. The only person who profit, who can benefit from smoking cigarettes are the tobacco industry. Tobacco industry often use some unsound reasons or some reasons which are suspicious to counter our smoking … our tobacco control efforts. And I hope the public would not be deceived by the arguments of the tobacco industry, such as increasing tobacco tax would increase smoking, smuggling, illicit trade. The World Health Organization has recently said that there is no direct relation to the increase of illicit trade and to the increase of tobacco tax.

Chan: Right. So, I think for the whole of this evening, you have mentioned to us your view or the COSH view on why we should move towards sort of a total ban of tobacco products in Hong Kong. But is that realistic though? Because is there any country or city in the world that has a total ban on smoking, especially smoking hasn't been criminalized?

Tong: Right now, there is not a country in the world which has a total ban on cigarette smoking yet. And as I understand, the Hong Kong government’s stance is progressive stance of creating a smoke-free Hong Kong. Right now, we are making progress, and we would like to see this progress to move on.

Chan: Let me ask you a more direct question. Some see a need to strike a balance between the citizens’ free choice of, what we call, legal behavior, and public health concerns. So, what would you say to them?

Tong: I would say public health concern and environment, smoke-free healthy environment for our children to grow up should take precedence.

Chan: So, last question for you: can we afford to have a smoke-free Hong Kong? We have to pay a price, of course. Can we afford it?

Tong: I don't want to put a … I don't think anyone can put a price on life, and I don't want to put a price on life. According to a study by the University of Hong Kong, every year 7,000 Hong Kong people die prematurely because of diseases caused by cigarette smoking. And 10 percent of them, 700 of them, die from second-hand smoke-caused diseases. How can we put a price on life and how can we do nothing to save someone from doom?

Chan: So, Chairman, let's move onto an area that we talked about a lot, which is the Greater Bay Area, where our mainland counterparts have a high prevalence of smokers. So, how do you see that being an interacting factor to our good work that we are moving towards … I mean 9.1 percent to 7.8 percent, but we have a high population of smoking just across the border?

Tong: The state council has published the outline for the program of Health China 2030, and one of the most important objectives in the Health China directive is to reduce, continually reduce the smoking prevalence in the Chinese mainland. And the National Commission for Health has repeatedly announced Hong Kong is a good, excellent example of tobacco control in the whole China. So, Hong Kong has been setting a good example for China. And we hope Hong Kong will continue to set a good example for the mainland.

Chan: All right. Thank you, Henry, for your insights into tobacco control. With the government's new anti-smoking measures, Hong Kong is moving in the right direction towards a healthy environment for ourselves and future generations. As the saying goes, “Your health is your wealth, don't let tobacco steal it!” Have a good evening and see you next week!