Commentary: If people smoke at home, the problem of secondhand smoke will not go away
Another initiative to get people not to smoke in their homes and bother their neighbours has been launched. But the issue of regulating smoking in the home environment is a tricky one to negotiate says the NUS Saw Swee Hock School of Public Health's Yvette Van Der Eijk.
SINGAPORE: The issue of secondhand smoke, drifting into homes from neighbours smoking in nearby units, came into focus yet again when two air-conditioned smoking cabins were launched at public housing estates in Clementi.
Complaints about secondhand smoke have been on the rise as more people work from home. People are rightly concerned about the health effects. Secondhand smoke is a cocktail of over 250 carcinogens and toxic chemicals.
It is linked to cardiovascular disease, respiratory diseases, infant cot death and various cancers such as lung cancer, breast cancer and leukaemia. According to the World Health Organization, globally it kills about 1.2 million non-smokers per year.
When he raised the issue in parliament last year, Member of Parliament (MP) Louis Ng cited figures in Singapore, saying in 2016 alone there were 383 deaths linked to secondhand smoke – that’s one death a day.
Scientific studies have shown that even short-term exposure to secondhand smoke can affect health. Five minutes of exposure triggers inflammatory immune reactions that can persist for a few hours.
Twenty minutes of exposure triggers reactions in the blood vessels that can lead to blood clots, raised blood pressure and other cardiovascular issues. It also triggers reactions in the lungs that can diminish lung function and cause respiratory disease.
Secondhand smoke is especially dangerous for people with pre-existing health conditions, such as heart or lung diseases. It is also more toxic to children as their smaller bodies mean they take in higher toxicant exposures compared to adults.
For these reasons, there is no safe level of secondhand smoke exposure. When thinking about interventions to protect people from secondhand smoke, the level of exposure we should aim for is zero.
HOMES ARE FINAL FRONTIER
Singapore’s smoking incidence is fairly low at just 10 per cent, compared to 25 per cent in the 1970s.
In 1970, Singapore was one of the first countries to ban smoking in public places. Over the past five decades, smoking bans have evolved to include almost all public indoor areas, outdoor areas like Orchard Road, and communal spaces such as HDB void decks and common corridors.
READ: Commentary: Smoking near windows dismissed as neighbourly nuisance but has public health costs
But there is currently no law that protects people from secondhand smoke in their own homes.
Singapore is somewhat unique in the sense almost 95 per cent of the population lives in multi-unit housing (HDB flats and private condominiums). This means that, even though smoking is less common than in other countries, people are still likely to be exposed to secondhand smoke in their home environment.
For those exposed, there are not many effective solutions. Air purifiers don’t adequately filter out the chemicals in secondhand smoke. Keeping windows closed is not a feasible solution for many, due to the hot and humid climate and high cost of air-conditioning.
Reasoning it out with neighbours that smoke is an option, but without regulations, the outcome ultimately depends on the goodwill of the neighbour in question.
The idea of regulating smoking in homes is, however, quite controversial.
What makes this issue contentious is that it is no longer about public spaces but about private home life. On one hand, a law that restricts smoking inside homes intrudes into smokers’ private life.
But on the other hand, when people smoke inside their homes, especially near balconies or windows, they are encroaching into the health and therefore private lives of their neighbours.
It is a bit simplistic to say that smoking in one’s home is an absolute right. As the old saying goes: “your right to smoke ends where my nose begins.”
WHAT CAN WE DO?
One approach is to have campaigns to promote a sense of social responsibility and harmony between smokers and non-smokers.
This idea is not new; tobacco companies popularised this approach in the 1980’s to avoid smoking bans. Essentially, tobacco companies were pushing the message that smokers and non-smokers should try to live in harmony by being more considerate of one another.
It sounded good on paper, but it did not work in practice. It was only after governments started enforcing smoking bans in public places that people were protected from secondhand smoke in these areas.
Another approach is to create designated smoking areas in housing estates, much like the yellow boxes in Orchard Road or the airconditioned smoking cabins in Clementi.
For this to work, the smoking area should be far away enough that it doesn’t affect people who live nearby yet near enough for smokers to actually use them. But going outside to a smoking area is far less convenient than just going to the balcony. For some it might be unfeasible, for example those with mobility issues.
Which leaves us with regulation. This could be done by banning smoking inside homes altogether, or by banning smoking at windows and balconies as MP Louis Ng proposed in parliament in October last year.
Replying, Senior Minister of State for Sustainability and the Environment Amy Khor said that such legislation could infringe on residents' privacy and there are “significant practical challenges” which will limit how effectively it can be enforced.
Another potential issue is that, if people smoke inside their homes instead of on their balcony, they might expose their family members to higher levels of secondhand smoke.
Although no country has banned smoking in homes, some property management companies and localities in the United States and Canada have banned smoking inside multiunit housing.
Studies so far show that this protects residents from secondhand smoke and benefits smokers, with more of them quitting or cutting down after the smoking bans.
(What can be done to curb the problem of second-hand smoke from people who puff away on cigarettes next to an open window at home? We tackle this with MP Louis Ng and Yvette Van Der Eijk on this episode of CNA's Heart of the Matter podcast.)
In Oregon, for example, self-reported quit rates increased from 14 per cent to 22 per cent following a smoking ban covering all multiunit housing, including all communal areas and private spaces, owned by Guardian Management Limited, the largest property management company in metropolitan Portland.
This leads to a final option, which is to simply get rid of smoking altogether.
Of course this is not simple and cannot be done overnight. But it can be done. Finland, Ireland, New Zealand, Canada, and various other countries have set official targets to be tobacco-free, defined as a smoking prevalence below 5 per cent, by a certain year.
They are achieving this with a combination of measures such as tobacco taxes, public education campaigns, and quit support for smokers.
Singapore is in a good position to set a tobacco-free target as smoking prevalence is already low at 10 per cent.
Singapore could do more by banning tobacco flavours, raising taxes, and providing smokers with more quit support. Initiatives that protect people from secondhand smoke will also help in achieving this target.
Yvette Van Der Eijk is Assistant Professor at the Saw Swee Hock School of Public Health, National University of Singapore.