Betel nut to be regulated under a dedicated law, Lin Wan-yi vows to end the "unregulated" predicament
Betel nut has been "unregulated" for decades, causing harm to all three sides: the ecology, the chewers, and the farmers. Executive Yuan Minister Without Portfolio Lin Wan-yi declared today that betel nut will be actively brought under regulation, transitioning from the past "three-no policy" (no guidance, no encouragement, no prohibition) to a "three-must policy": must promote awareness, must provide guidance, must prevent and control!
Speaking today (the 2nd) at a press conference on the "10th County and City Oral Cancer Prevention Capacity Survey Results," Lin Wan-yi said the government will move past the cognitive dispute over "whether betel nut is a food" and directly model a "Betel Nut Dedicated Act" on the Tobacco Hazards Prevention Act, drafting implementation details for each ministry and agency covering the field production end, market exposure end, education and prevention end, and health education and awareness end of betel nut, pushing it forward across ministries, and vowing to end the years-long "unregulated" predicament of betel nut.
Bureau of Animal and Plant Health Inspection and Quarantine Director-General Feng Hai-tung said that because betel nut is sprayed with pesticides in a special way, spraying from bottom to top and scattering pesticide broadly into the sky, the pesticide drifts and contaminates neighboring fields severely. He stressed that the Bureau will do its utmost to announce a feasible set of field management techniques for betel nut plantations before the end of the year, including usable pesticides and non-pesticide control methods, in hopes of reducing the harm caused by pesticide use on betel nut.
Executive Yuan: Transforming betel nut policy -- must promote awareness, must provide guidance, must prevent and control
In July, News&Market published the report "Uncovering Taiwan's Biggest Pesticide Loophole -- 30 Years of the Betel Nut Shared Trade," revealing that although betel nut is Taiwan's second-largest crop, with a production area second only to rice, management is full of loopholes, with government agencies passing the buck to one another and long neglecting both the pesticide needs in betel nut fields and the problem of additives on the market end.
Executive Yuan Minister Without Portfolio Lin Wan-yi said at today's press conference that the "Taiwan Betel Nut and Oral Cancer Prevention Alliance" and the Health Promotion Administration of the Ministry of Health and Welfare have both proposed draft versions of a Betel Nut Dedicated Act, and the Legislative Yuan is expected to discuss it in the next session, ending the years-long "unregulated" predicament of betel nut.
On the part about switching betel nut to other crops, Lin stressed that drafting the "dedicated act" does not mean demanding that betel nut plantations disappear immediately, nor is it meant to create antagonism between betel nut farmers and other crop farmers. Rather, since it is now known that betel nut production methods and consumption methods have major impacts on the public and the environment, appropriate management methods must be studied. If in the future, under free mechanisms such as market demand and consumer preference, betel nut gradually phases out, the government must also provide farmers with sufficient resources and guidance for switching crops.
Council of Agriculture: Integrated betel nut control methods to be announced before year-end
Nantou has seen improper betel nut pesticide use cause mass honeybee deaths for three consecutive years, not only severely damaging beekeepers' livelihoods but also subjecting the local ecology to pesticide poisoning. Although the government has declared it will face the betel nut problem squarely, drafting a "dedicated act" takes time. Can it prevent a repeat of next year's honeybee catastrophe?
Lin Wan-yi pointed out that the "dedicated act" involves comprehensive discussion from the prevention side to the treatment side of betel nut, with many details, but the formulation of field pesticide management falls under the authority of the Council of Agriculture. Opening up reasonable and usable field pesticides for betel nut farmers does not need to wait until the dedicated act is drafted; it can be announced at any time.
In response, Council of Agriculture Bureau of Animal and Plant Health Inspection and Quarantine Director-General Feng Hai-tung said that earlier they contacted local improvement stations in betel nut production areas (Taichung Station and Kaohsiung Station) and successively collected pest and disease control needs that may be encountered in betel nut cultivation. At present, they have identified "coconut black-headed caterpillar" as the main pest, which gnaws flower buds and directly affects fruiting, causing very high damage to both flowers and fruit. It is the main pest of palm family plants such as coconut and betel nut.
Changing betel nut spraying methods is "very difficult" and requires research from scratch
However, because betel nut pesticide spraying is "rather special," "spraying from bottom to top and scattering broadly into the sky, the drift problem is especially severe. It is truly rare to find pesticides that betel nut can use and that will not cause neighboring-field contamination. Current pesticides all carry risks, especially if used during the flowering period, when pollinating insects will also be killed."
Given this, should betel nut farmers be guided to change their spraying methods? "This is very difficult. After all, changing farmers' existing techniques and habits takes time, and developing new techniques may take even longer. Since the government did not encourage betel nut cultivation in the past, research in this area is essentially zero and must start from scratch."
Feng Hai-tung pointed out that at present it is still not possible to open up pesticide items usable by betel nut farmers, but he stressed that a feasible set of field management techniques for betel nut plantations will definitely be announced before the end of the year, including usable pesticides and non-pesticide control methods, in hopes of reducing the harm of betel nut pesticide use to the public and the environment.
Han Liang-chun: Betel nut has the "substance of food"; calls on the government to bring it under regulation
Han Liang-chun, chairman of the "Taiwan Betel Nut and Oral Cancer Prevention Alliance" and emeritus professor at the National Taiwan University School of Dentistry, said that betel nut has long not been treated as food, but it is a fact that people put betel nut in their mouths and their bodies absorb betel nut components. "Although betel nut does not have the 'name of food,' it has the 'substance of food.' The risks to those who consume and come into contact with it should not be neglected, and it should be properly managed."
The "Taiwan Betel Nut and Oral Cancer Prevention Alliance" (note) also announced at today's press conference the results of the 10th survey, for year 108 of the Republic of China (2019), of county and city oral cancer prevention capacity. Of the nation's 22 counties and cities, 21 responded, with only Yunlin County not participating. The scoring items were verifiable effectiveness data, self-made distinctive results posters, and the alliance's monitoring of county and city government website information, questionnaire submission status, and so on.
The organizers used an adult betel nut chewing rate of 6.1% as the baseline, dividing counties and cities into a "high betel nut chewing group" (12 counties and cities in total) and a "low betel nut chewing group" (9 counties and cities in total), selecting three outstanding counties and cities from each, and also selecting a "Distinctive Results Award" based on the content of counties' and cities' self-made distinctive results posters. This year's survey also added a "Network Popularity Award." Han Liang-chun said the purpose of holding the competition is to let all citizens participate and, through annual statistical surveys, to let the concept of betel nut prevention take root over the long term.
Counties and cities share experiences in promoting oral cancer prevention
At the press conference, counties and cities shared and exchanged ways to enhance the promotion of oral cancer prevention. Taoyuan City, Changhua County, and Pingtung County won as the three continued-outstanding counties and cities in the "high betel nut chewing group." A section chief surnamed Chen from the Health Promotion Division of the Taoyuan City Department of Public Health said that within its jurisdiction, the Department of Urban Development and the Public Works Department match with construction site owners to conduct oral cancer screening for employees, and also incorporate "betel nut prohibition" into living conventions and manuals, promoting betel nut prevention from the workplace. They further collaborate with the Sports Affairs Bureau to have the well-regarded basketball team film anti-betel nut short films, conducting betel nut awareness campaigns aimed at junior high and senior high school students.
Yao Yu-chin, section chief of the Changhua County Health Bureau, pointed out that within its jurisdiction they hold a "Champagne Program" to warn of the health harms of smoking and betel nut chewing, designing creative competitions for students of different grade levels. For example, elementary school students hold a "Smoking Cessation Elf" activity, while junior high and senior high schools promote "Nationwide Tobacco Screening." The main purpose is to take root from the education end.
Keelung City won as an outstanding county or city in the "low betel nut chewing group." A specialist surnamed Lin from the Health Promotion Division of the Keelung City Health Bureau said Keelung has a large population engaged in fishing, and fishermen are one of the main groups of betel nut chewers, so anti-betel nut education for schoolchildren is even more important. Within its jurisdiction, dentists have formed an association and regularly hold elementary school summer camps, using competitions and obstacle courses to deepen students' understanding and awareness of the consequences and effects of betel nut chewing. They also hope students will in turn urge their elders at home not to eat betel nut, achieving the effect of "children turning into monitors."
Alliance calls for additional medical manpower: early detection is the only way to early treatment
The "Taiwan Betel Nut and Oral Cancer Prevention Alliance" has held the county and city oral cancer prevention capacity survey and competition since year 99 of the Republic of China (2010), and this year marks ten years. Alliance vice chair and Sunshine Social Welfare Foundation chief executive Shu Ching-hsien said that this year's high betel nut chewing group counties and cities performed better in positive follow-up rate (screening positive cases and follow-up effectiveness) and adult betel nut chewing rate, and their awareness rate of betel nut carcinogenicity was also higher than the national average. As for the low betel nut chewing group counties and cities, they performed well in betel nut cessation services, and the male incidence rate declined somewhat.
Looking across these ten years of betel nut prevention promotion, Shu Ching-hsien pointed out that social structure is the hardest link to change. Because laborers work excessively long hours and bear overly heavy workloads, they have a need to chew betel nut to stay alert, especially in transportation and construction. The "betel nut chewing culture" in the workplace actually derives from labor conditions. "We have heard some workers say they have no time to drink water at work, so they just keep eating betel nut, because betel nut has the function of promoting salivation and quenching thirst. To work and earn money, they instead harm their health. This is putting the cart before the horse."
The "Taiwan Betel Nut and Oral Cancer Prevention Alliance" stressed that when it began promoting the county and city oral cancer prevention capacity survey ten years ago, only 14 counties and cities responded, while in the past two years participation has been nearly 100%, showing the public is more aware of oral cancer prevention. In the next ten years, it hopes the country can complete the drafting of a "Betel Nut Dedicated Act" as soon as possible, drawing up a more comprehensive promotion plan from primary prevention (awareness and prevention) to secondary prevention (screening and treatment), and also intervening in betel nut production and sales management, such as converting abandoned betel nut plantations to other crops and production pesticide use.
At the same time, the shortage of medical manpower must be faced squarely, training for screening physicians and betel nut cessation personnel must be restored, and the frequency of oral cancer screening must be increased and its quality improved. "The drafting of a dedicated act can give betel nut prevention a legal basis for promotion. Otherwise, even if the health bureau wants to promote oral cancer screening, enterprises can refuse to cooperate. Next, resources must come in. We cannot let health units fight alone, because that way capacity is limited," Shu Ching-hsien said.
The problem of young children chewing betel nut: proposal to impose fines on guardians who provide betel nut and require them to attend awareness classes
Looking through ten years of statistical data, although the adult betel nut chewing rate shows a downward trend, the adolescent betel nut chewing rate has continued to rise for three consecutive years in half of the counties and cities, and public awareness of betel nut carcinogenicity is still insufficient. The male incidence and mortality rates of oral cancer have also not declined significantly. The national oral cancer incidence rate is 22.43 per 100,000 people (7,805 people), and the male incidence rate is as high as 42.43 (7,144 people). Oral cancer ranks fifth among the top ten cancer causes of death, and each year more than 3,000 citizens die from oral cancer, continuing to threaten public health.
Liu Chih-yang, head of the advocacy group at the "Taiwan Alliance for the Promotion of Youth Rights and Welfare," said that according to a July survey report by the Health Promotion Administration, 70% of domestic junior high and senior high school students' first betel nut chewing experience came from relatives and friends, and nearly 60% of junior high school students who had tried betel nut did so before age 11. He called on the government to face the problem of young children chewing betel nut, and suggested studying whether to bring parents and guardians who provide betel nut to minor children into the legal system, for example by imposing fines or arranging awareness classes, so as to effectively patch the loopholes in the implementation of current laws and provide children and adolescents with a healthier and safer growth environment.
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Note: The "Taiwan Betel Nut and Oral Cancer Prevention Alliance" is composed of 9 social organizations and 4 experts. At present, the alliance's 9 group members are: Sunshine Social Welfare Foundation, Taiwan Cancer Whole-person Care Foundation, Chinese Oral Pathology Society, Chinese Oral and Maxillofacial Surgery Society, National Federation of Dental Associations of the Republic of China, Chinese Family Dentistry Association of the Republic of China, Taiwan Cancer Prevention Association, Taiwan Civilizational Disease Prevention and Promotion Association, and Taipei Medical University Hospital. The 4 expert members are: Professor Han Liang-chun, Professor Li Ming-hsien, Chief Executive Huang Rui-tien, and Secretary-General Huang Chih-li-tzu.