Open letter : Gazetting alfresco restaurants as no-smoking zones

The following letter is signed by 30 Malaysian medical organisations. We represent the majority of the medical fraternity in Malaysia.
We are writing to express our support for the Ministry of Health’s recent announcement by the Deputy Health Minister Dr Lee Boon Chye that the Ministry intends to gazette alfresco restaurants as no-smoking zones under the Control of Tobacco Products (Amendment) Regulations 2017.

Dr Lee was quoted as saying “The gazettement of the new smoke-free zones under the Control of
Tobacco Product Act is to protect the public, especially non-smokers, from the dangers of
secondhand smoke”.

We could not agree more with this statement.

One in two smokers will die from the use of tobacco. While that is a tragedy on its own, it is an even
greater travesty that many non-smokers suffer numerous ailments as a result of secondhand smoke.

Secondhand smoke contains more than 7000 chemicals, of which many cause cancer. Studies have
shown that it causes premature heart disease and lung cancer amongst non-smokers and even leads
to strokes.

The effects are particularly felt by women and children, who are often at the mercy of smokers and
are unable to voice out their concerns. For example, secondhand smoke leads to more frequent and
severe asthma attacks, respiratory infections and ear infections. It also increases the risk of
premature birth, low birth weight, birth defects and sudden infant death syndrome.

It is also essential to note that there is no risk-free level of exposure to secondhand smoke.
With these factors in mind, many governments across the world have taken measures to protect their citizens from the harmful effects of secondhand smoke. For example, a policy making it illegal to smoke in work places in England came into force on 1 July 2007 as a consequence of the Health Act 2006.

An analysis of studies found that admissions for heart attacks fell by 42 per cent among men and 43
per cent among women in the five years since the ban was introduced in 2007. Rates of
hospitalisations for asthma were also reduced. In the United States, a review found a 14 per cent
reduction in strokes in counties which introduced a ban, compared with those which did not.

These numbers translate to real lives that are saved from the physical, financial and emotional
burdens of disease. Although some will undoubtedly voice concerns regarding the negative economic impact on local restaurants, it is worth noting that even here the evidence suggest otherwise – in England, many eateries have thrived since the smoking ban as they changed their focus on more high-quality food and trying to attract families – including those with young children – who would previously have avoided smoky atmospheres.

Furthermore, the government will be fulfilling their obligation to protect public health & make public places 100% smoke-free, as detailed in the World Health Organisation’s Framework Convention on Tobacco Control, which Malaysia signed and ratified.

We acknowledge and congratulate the new government’s emphasis on preventive medicine and
addressing the scourge of non-communicable diseases at their infancy. We look forward to both Dr
Lee and our Health Minister, Dr Dzulkefly Ahmad, leading the way in ensuring that the gazettement is made official.

There is no greater modifiable risk factor than tobacco, and by implementing measures to reduce the impact of secondhand smoking, the government will go a long way in reducing the nation’s healthcare costs whilst increasing the well-being of the rakyat.


Academy of Medicine of Malaysia
Academy of Medicine of Malaysia – College of Surgeons
Academy of Medicine of Malaysia – College of Physicians
Addiction Medicine Association of Malaysia
Asthma Malaysia
Family Medicine Specialists Association of Malaysia
Federation of Private Medical Practitioners’ Associations Malaysia
Islamic Medical Association of Malaysia
Lung Foundation of Malaysia
Malaysian Association for Bronchology and Interventional Pulmonology
Malaysian Association of Thoracic and Cardiovascular Surgery
Malaysian Council for Tobacco Control
Malaysian Medical Association
Malaysian Medics International
Malaysian Oncological Society
Malaysian Paediatric Association
Malaysian Psychiatric Association
Malaysian Society of Geriatric Medicine
Malaysian Thoracic Society
Medical Mythbusters Malaysia
Medical Practitioners Coalition Association Of Malaysia
Medical Tweet Malaysia
National Cancer Society of Malaysia
National Heart Association of Malaysia
Obstetrical and Gynaecological Society of Malaysia
Perinatal Society of Malaysia
Persatuan Kesihatan IKRAM Malaysia
Persatuan Pakar Perubatan Kesihatan Awam Malaysia
Pertubuhan Doktor-doktor Islam Malaysia
Vascular Society of Malaysia