This morning, the Ministry of Health got in touch with me via email, which I have reposted below in its entirety with their permission. I found the response helpful in providing more insight into the deliberations behind the ban, and would encourage you to read it. Separately, I also received a call from A/Prof Faishal on this matter. These were in response to the petition and open letter which I had started on 5 November 2014 (link here - https://www.change.org/p/ministry-of-health-singapore-revie…). One thing that I am glad the Ministry clarified is that shisha tobacco and cigarettes are ‘subject to the same tax regime’ (Para 6), so that clears up what (I think) is the most common public misconception out there. Naturally, Prof Faishal spoke of the need to impose a ban to protect the public, given that shisha smoking was a concern that the authorities had been monitoring since 2009. He also mentioned that there are several doctors within the MOH who have shared their experiences with patients who have suffered from tobacco consumption (though far more likely in my view to be from cigarettes than shisha). He did go on to say that shisha consumption would be something afflicting youth, and talked about removing the issue before it got too entrenched. Perhaps I remain idealistic, especially when compared to many others in Singapore who are happy that youth are now going to be protected from the evils of shisha tobacco. I still fully advocate free will, and do think it a great pity that the public will soon be deprived of yet another choice, in this case to consume shisha if they so please. While I agree with banning certain substances that pose a real danger to public safety, I remain unconvinced that the public always needs protecting from themselves. For isn’t it the liberty of choice that gives us much of the pleasure in living? Yet, I do understand where A/Prof Faishal was coming from. Whether or not I agree with the MOH's approach, it is obvious that they have good intentions - much like a well-meaning parent. Nonetheless, conflict between parents and their children often arise because many parents instinctively feel the need to shield their children from all the ills of this world, whereas children grow frustrated with the constant interference, particularly as they grow older. However, after the trials and errors of parenting experiments coupled with teenage angst, both parties often come to a common understanding later in life. It is my hope that perhaps at some point in future, policymakers and we can also arrive at a healthy reconciliation of views. As for the impact on Arab Street, I am also not sure that, post-ban, the area will be nearly as vibrant as before. I suppose we’ll have to wait this one out – hopefully I’m wrong about this. At the end of the day, all of this simply boils down to a difference in balancing considerations. Though our ideas of what is best for society may differ, I have no doubt that this decision was taken in the spirit of public mindedness. I did however propose that in future, the Ministry might wish to more effectively communicate at the outset detailed considerations behind new policy change, so as to preclude unnecessary speculation or confusion amongst the public. Hopefully, others will continue to constructively engage the authorities on matters relevant to our community, so as to have more say in shaping policymaking in Singapore. Thanks for taking the time to read this Sincerely, Isabelle Encl: Letter from MOH dated 27 November 2014 Dear Ms Yeo, Thank you for the feedback. We have received your petition and we appreciate your interest on the issue of shisha. 2 Shisha smoking is harmful and causes its users and exposed by-standers to be at risk of cancers, heart diseases and respiratory diseases. According to the World Health Organisation (WHO), a typical session of shisha smoking involves the inhalation of smoke that is equivalent to smoking 100 or more cigarettes, which is more than what an average smoker smokes in a week. This exposes the shisha smoker to high levels of harmful smoke toxicants including tar, carbon monoxide and nicotine. The high levels of fine particulate matter, also known as PM2.5, in shisha smoke can also adversely impact bystanders. 3 Shisha use has been increasing among youths and young people. The National Health Survey 2010 showed that 7.8% of young adults aged 18-29 years smoke shisha at least occasionally, compared to 1% among older adults aged 30 years and above. In addition, the Student Health Survey found that the proportion of students who used alternative tobacco products, such as shisha, had increased from 2% in 2009 to 9% in 2012. 4 There are also common misconceptions that shisha smoking is less harmful and addictive due to its sweet smelling smoke, and the passing of smoke through water in the apparatus. According to a Health Promotion Board (HPB) study, 3 in 5 (61.1%) shisha smokers wrongly believed that smoking shisha was less harmful than cigarettes. These misconceptions make it more challenging for shisha users and young people who may be trying shisha for the first time to accurately assess the health risks of shisha smoking. Additionally, research suggests that shisha may become a potential gateway to cigarette smoking for youths, and increases the likelihood of shisha smokers becoming users of both shisha tobacco and cigarettes. 5 The Ministry of Health has been monitoring local smoking trends and international research, such as those by the WHO, which had highlighted the many health risks of shisha smoking. During a public consultation exercise in 2009 where Singaporeans’ views were sought on alternative tobacco products, the majority supported the view that alternative tobacco products were of public health concern and highlighted shisha as the product of greatest concern under the smoked tobacco product category. Some other examples of alternative tobacco products included cigarillos (also known as mini cigars), candy flavoured cigarettes, smokeless tobacco products and tobacco derivatives. 6 We are concerned about the impact of shisha on the lives of Singaporeans, especially our youths. In view of the health risks associated with shisha smoking, and the concerns regarding its proliferation, the Government has decided it is timely and necessary for us to ban the import, distribution and sale of shisha now, so as to prevent it from becoming entrenched in Singapore. 7 Cigarettes and shisha tobacco are subject to the same tax regime. However, unlike shisha smoking, which is a relatively recent development in Singapore, cigarettes are entrenched locally and globally. In view of this, we have adopted a multi-pronged strategy that includes taxation, public education, smoking cessation services, partnerships and legislation, to reduce cigarette smoking in Singapore. The HPB has also set up a website to educate the public on the harms of shisha and we will continue to ramp up our efforts to increase awareness on the issue. 8 We would also like to assure you that inputs from various agencies had been sought in the deliberations on the ban and the agencies supported the decision. While we understand the affected businesses’ concerns, there is a need to prioritise our citizens’ health and the benefit of the larger community. We anticipate the level of impact on these businesses to be minimised as tobacco importers and retailers will be given ample time to run down their stocks of shisha and restructure their business models to refocus on other areas. In fact, most of the businesses affected operate food and beverage outlets and will have time to restructure their businesses. 9 You may wish to note that shisha is not an inherent characteristic of the heritage of the Arab Street/Kampong Glam area, but a relatively recent introduction about a decade ago. Shisha smoking is incongruent with the history, tradition, community aspirations and cultural heritage of Kampong Glam. With the introduction of shisha to the area, there have been shisha retailers who have persistently flouted the law prohibiting smoking in places such as food and beverage outlets, resulting in the revocation of their licenses after multiple offences. It is important for us to preserve the culturally-rich Kampong Glam precinct and protect our young people against the harms of shisha smoking. With an eclectic mix of offerings that showcase its unique Malay/Muslim heritage and growing contemporary retail and dining scene, we are confident that Kampong Glam’s range of offerings will continue to attract visitors, even without the availability of shisha smoking. The Government will continue to work with stakeholders on upkeep of the precinct and to support culturally relevant events and activities which contribute to the heritage of Kampong Glam. 10 In conclusion, we have noted the comments from the petition and we understand that there are different perspectives and considerations from the various stakeholders and the general public. Nevertheless, the health of our citizens remains the top priority and for that reason we need to take action to curb the entrenchment and further proliferation of shisha. 11 Once again, thank you for the feedback. I or my staff would be happy to meet you to further discuss your concerns, if you think this would be useful. Thank you. Yours sincerely, Associate Professor Muhammad Faishal Ibrahim Parliamentary Secretary for Health