Government speaking from both sides of its mouth on smoking

Science and Health

Eleven days ago, representatives of 25 Israeli public health organizations sent a strong letter of protest to Finance Minister Bezalel Smotrich, denouncing his declared intention not to raise the tax on electronic cigarettes (e-cigs). 

“This will lead to an unprecedented smoking epidemic in Israel, especially among teenagers,” they wrote, with copies to the chairman of the Knesset Finance Committee, the acting health minister, the ministry’s director-general, the chairman of the Council of Local Authorities and the health of the council’s health committee.

Mistaken assumptions

The health organizations and their representatives called on the finance minister to withdraw his intention not to raise the tax on e-cigs on the false grounds that “they are less dangerous” than smoking tobacco. 

The organizations, which also include prominent physicians, researchers and scientists, maintained that Smotrich’s decision stood in complete contrast to the professional position of the Health Ministry and the scientific knowledge accumulated in recent years on the harms of e-cigs as well as rolling tobacco and heated tobacco cigarettes (IQOS). 

But the Health Ministry was then completely silent on the decision – the third anti-health decision of the Netanyahu government after it cancelled the soft-drink tax and the tax on plastic disposables after demands by haredi (ultra-Orthodox) parties. 

MK MOSHE Gafni (right) in deep discussion with fellow United Torah Judaism MK Yitzhak Goldknopf in the Knesset plenum last week. (credit: YONATAN SINDEL/FLASH90)

Among those who remained strangely silent was Health Ministry director-general Moshe Bar Siman Tov, who on Wednesday released the 120-page Annual Smoking Report for 2021 that it is bound to send to the Knesset in accordance with the mandatory reporting law regarding the health damages caused by smoking tobacco products, “with the aim of presenting the current picture of the smoking epidemic in Israel. The report aims to raise the issue to the public agenda and emphasize the need to combat the phenomenon of smoking and the severe damage it causes to health.”

Smoking is one of the leading causes of morbidity and mortality and is a risk factor for many diseases, the ministry declared when issuing the report. “The health system has a decisive and continuous role in eradicating the phenomenon of smoking and providing help and assistance to the smoking public who wish to quit smoking. The ministry constantly continues its efforts to eradicate the phenomenon of smoking and try to prevent as much as possible exposure to all smoking products, among the general population and the youth in particular. A fifth of all Israeli adults still use tobacco. This figure has remained steady and even increased in recent years while it has declined in most Western countries.”

But in his message released with the report, Bar Siman Tov declared: “Children and teenagers mainly use disposable electronic cigarettes, which are their gateway to the world of smoking. We see a jump in the use of these products that harm their health: Three percent of children in fifth and sixth grades and 10% of teenagers in tenth grade report smoking e-cigs. In one year, the percentage of children who report starting to smoke at the ages of 12 to14 tripled (from 3.4% in 2021 to 13.7% in 2022). This,” wrote the director-general, “is a real epidemic that harms the health future of children and we must do everything to stop this trend. A decision to reduce the tax will do exactly the opposite.

The low taxation conveys an apparently reduced risk, although this is not the case, and will encourage even more consumption of a product that causes addiction to our children and is harmful to their health. Like any bad habit that is harmful to health – the best way to get rid of it is not to start at all.” 

Another senior Health Ministry official who clammed up when Smotrich announced his decision was the head of the Public Health Division, Dr. Sharon Elroy-Preis who said in the Smoking Report that “reducing the phenomenon of smoking and its harm is one of the most important national tasks in the field of public health, and we are committed to the fight against smoking and its consequences. In recent years, the Ministry of Health has led many national moves, including the imposition of taxation on e-cigs, education and outreach activities among youth and adults to prevent smoking and exposure to it and extensive collaborations with government ministries and civil society organizations in the field of smoking prevention. The fight to eradicate smoking in Israel needs an increase and stability in budget resources and professional personnel, to make sure that as few teenagers as possible enter the circle of smoking and that those who are in it receive an adequate response that allows them to break free from this addictive and dangerous habit.”

The Health Ministry contradicts itself

So what caused the Health Ministry to speak from both sides of its mouth? The Jerusalem Post asked the ministry spokeswoman, Shira Solomon, to comment, but received nothing hours after this reporter sent the request.

Amos Hausner, the chairman of the Israel Council for the Prevention of smoking, said that the ministry is not serious about fighting tobacco. “New Zealand is. It has banned cigarette advertisements and smoking in most public places and enforces it. From 2024, it will reduce the number of shops allowed to sell cigarettes. The following year, it will lower the amount of nicotine permissible in cigarettes to make them less addictive.  And most far-reaching of all, from 2027 it will make it illegal to sell cigarettes to anybody born after 2008; such people will never be allowed to buy tobacco legally.” 

Hausner added that in Singapore today, those under 21 can’t buy tobacco products. “Our Health Ministry has refused to back civilian lawsuits against tobacco companies to pay for medical care for health damage to smokers. In 1998, the US government reached a $245 billion settlement, but our health system, which is always in a deficit and could get NIS 45 billion back, has done nothing. The ministry has opposed efforts of citizens who want to prevent their neighbors’ smoke from reaching their own apartments,” Hausner declared. “A man who had to undergo the insertion of four stents in his hear due to clogged coronary arteries was asked by his cardiologists how long he had smoked. He said he never did. The toxins came from his neighbors!”

In a response to the High Court of Justice on the issue of neighbors’ smoking, ministry chief toxicologist Dr. Tamar Berman last September voiced the ministry’s position that it did not back such prohibitions, because “it is better for parents not to smoke inside the house and endanger their children, rather than stopping people from smoking in stairwells and on balconies that harms the health of their neighbors.”

Hausner reported that a February 2021 survey by the Midgam Institute found that half of all Israeli homes are exposed to their neighbors’ tobacco smoke, and that even half of smokers complain that they suffer from intensive smoking by their neighbors. He added that tobacco smoke causes health damage nine meters from its source, “so 2.8 million Israeli adults, plus children, are needlessly exposed to toxic tobacco smoke.”

For years, the health minister held a press conference in his office to present the Annual Smoking Report. But then-minister Yaakov Litzman – who was accused by journalists of doing little or nothing to fight smoking because of the financial interests from advertisements from a tobacco company in the newspaper Hamodia that his Agudat Yisrael Party publishes – stopped this practice. Since then, the ministry has abandoned the press conference, just issuing the report to reporters by email, preventing health journalists from asking prying questions.

Only 69 local authorities reported on the scope of enforcement in 2021, but although it can be seen that the scope of reporting increased compared to previous years, compliance with reporting is still low, the report admitted.  Most of the local authorities do not report figures, contrary to the provision of the law that requires an annual report to the health minister and despite a direct request to receive the information by the division for enforcement and supervision. Of the local authorities that reported according to law, 36 authorities reported that there is enforcement to prevent smoking, but no fines were issued in 2021.

Among the 69 local authorities that reported issuing fines in 2021, those in Haifa (2,877), Tel Aviv-Yafo (1,699), Beersheba (1,397), Rishon Lezion (657) and Petah Tikva (374), lead in the number of fines handed out. The local authorities handed out a measly 8,189 fines during the year 2021 for violating the law to prevent smoking in public places and exposure to smoking.