I don’t like the word “Endgame”, at least not for Hong Kong. At best it’s PR puff, designed to make smoking policy look more effective than it’s been. At worst, it builds new smoking policy on very weak foundations. So, on the eve of the Council on Smoking and Health (COSH) “Towards a Tobacco Endgame in Hong Kong” Conference in Hong Kong, I’ve put together a back-of-the-envelope list of problems with the word.
The 12 issues fall into three categories:
- issues with the concept of Endgame itself
- issues with applying Endgame to Hong Kong; and
- the elephant in the room… China.
Issues with “Endgame” itself
- The phase is embraced by the tobacco industry (TI) as a valve to relieve regulatory and public outrage, create a planned slowdown in the sale of combustible smoking products, and allow plenty of time for TI to research alternative nicotine profit centres.
- Endgame tends to focus on prevalence rather than consumption, and may give a misleadingly rosy view in areas of fast growth. For example, an estimated 3.1 billion cigarettes were sold in the territory in 2015: hardly a sunset industry by any view, but Endgame’s focus on prevalence misses this consumption giant – in fact, while Hong Kong’s cigarette smoking prevalence has risen 0.1 percentage point since 2003/2004 the associated number of cigarettes sold has risen an estimated 17% over the same time.
- Gender: Endgame’s focus on prevalence ignores the huge gender gap in smoking. For example, as a whole, Hong Kong’s smoking rate is 14.8% but this relatively benign figure hides a huge problem of 25.2% of men smoking. “14.8%” of a population could be considered on the high end of “Endgame”, “25.2%” cannot.
- Many endgame strategies, according to Tobacco Control, are complex and esoteric: complicated smoking policies are unlikely to ever get Hong Kong government approval (especially where even simple laws fail to be passed due to unrelated political filibustering and where the political will to tackle cigarette taxation, for example, does not exist).
Putting the cart before the horse
Hong Kong is a long way from a cigarette Endgame and using the term may be dangerously premature.
- Endgame strategies presume more serious steps eg higher basic cigarette taxes, packaging and Point-of-Sale issues have already been taken care of. Hong Kong has not raised cigarette taxes in three years: if this basic step cannot be executed, we are not ready for Endgame finesses such as polluter pays, cigarette licenses, cigarette waste taxes etc.
- Illicit cigarettes. An estimated one in four cigarettes smoked in Hong Kong are illicit. Endgame strategies are too flimsy to fight illicit cigarettes, this is something which needs to be shored up before discussion the final clear-out.
- Hong Kong has a strong smoking culture. We have public ashtrays lining the streets every 25 metres;
- cigarettes are sold advertised in booths at open street level (yes, fancy-designed “shelves” with graphic design featuring large-sized cigarette packets are actually adverts. Complaints to Tobacco Control Office about this have thus far remained unanswered);
- and, as mentioned, 25.2% of men in Hong Kong smoke. 3.1 billion cigarettes were sold in 2015, with an estimated 0.8 billion illicit cigarettes smoked. With volumes like this in a crowded city, Endgame is simply wishful thinking.
- Weak enforcement of non-smoking areas. People can still be seen lighting up in bars and restaurants on Lamma Island, for example; and indoor smoking remains a problem. A 2-hour Blue Skies China study yielded 73 cases of illegal smoking in known hotspots around Fortune City One mall: Tobacco Control Office missions to enforce are woefully inadequate, and smokers smoke in non-smoking areas with impunity knowing prosecutions are rare. (The 73 cases reported yielded an investigation and one subsequent prosecution: meanwhile mall owner ARA Asset Management/Fortune REIT has received awards annually since 2012 for its supposed excellence in creating a smoke-free environment…)
China has a huge smoking problem and patchy compliance with the WHO Framework Convention on Tobacco Control (FTCT). If Endgame is premature for Hong Kong, it’s out of the question for China: Strategies for Hong Kong must take into account this elephant in the room.
- Around 4 million mainland Chinese enter Hong Kong every month. Using China’s official smoking rate (28.1%) that’s a million smokers coming onto our streets each month (very roughly with a basic and inaccurate assumption that each comes and stays for the month, but you get the idea); and so, even if Hong Kong does achieve a fantastic “Endgame” of 0%, we would have an effective “on the street” prevalence of ~10% – and with many people smoking, the triggers for others to start up make our “0%” highly unlikely to remain at zero. Hong Kong needs to develop a strong anti-smoking culture to combat this and discourage mainland visitors smoking in the city – Endgame strategies are too dainty for such major cultural change.
- In 2047, Hong Kong likely becomes a regular Chinese city. It is unclear what impact on tobacco control or regulations this would have: but given China’s backwards and undeveloped sense of tobacco control; and its patchy compliance and reporting on the WHO FTCT, it’s hard to imagine Hong Kong’s smoking fortunes would improve. “Endgame” for Hong Kong must include realistic and workable “endgame” for China, too, or all the work will simply be undone come 2047. We would suggest working on setting Hong Kong as a model Chinese city, with strong, robust and simple measures which could be replicated across China. “Endgame” with a separate Hong Kong does not achieve that.