M. A. Jabbar :
WHO and its member countries observed World No Tobacco Day on 31 May like all the previous years to draw attention of all concerned and take action by the policy makers, health personnel, NGOs, civil society and in fact, every individual from their respective places. The day is an opportunity to recall the health hazards and economic losses of tobacco use and take action to address the same in an appropriate manner.
WHO selects a theme every year for the day. The theme of the World No Tobacco Day for 2016 is Get Ready for Plain Packaging that highlights about the health risks associated with tobacco use and advocates for effective policies to reduce tobacco consumption calling the member countries to get ready for plain packaging of tobacco products. As per Article 11 and 13 of WHO Framework Convention on Tobacco Control (WHO FCTC), Plain packaging is a key method to reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of tobacco advertising and promotion, limits misleading packaging and labelling by the tobacco companies and increases the effectiveness of health warnings.
According to Article 11 of the FCTC, the use of Graphic Health Warning (GHW) on tobacco packs is obligatory by the WHO member countries. The use GHW on tobacco packs remind the tobacco users every time about the harmful effects of tobacco when they use it and help them to refrain from this deadly habit. Example shows that the GHW has played significant role in reducing tobacco use in many countries of the globe. This was introduced first in Canada in 2001 and so far, over 77 countries have introduced GHW on tobacco packets. Data reveals that 90% GHW is used in Nepal, being the largest space, India 85%, Thailand has alloted 85%, Sri Lanka uses 80% and in Indonesia 40% of all forms tobacco packs contains graphical health warnings.
We are aware that government of Bangladesh has made the 2005 anti-tobacco law more smarter and effective by an amendment which is a milestone in the history of tobacco control programme in the country. Section 10 of the amended law directed the tobacco companies for printing the graphical health warnings on top of both sides of tobacco packets, cover, and box covering at least 50 percent of the total area of each. It also says that if the section of the law is violated, the punishment contains rigorous imprisonment less than six months or monetary fine less than taka lwo lac. If the violations are occured second time, the punishment will be double gradually. Tobacco companies were given a 12-month deadline to obey the rules since activation of the law in 2015, which ended on 19 March 2016.
Although Bangladesh government is relentlessly working for making the law fruitful and effective, but companies are active to thwart its efforts in many ways and stand on the way against implementation of the same. As per law, the tobacco companies were obligated to follow the government instructions and ensure the use of GHW at least 50 percent of both sides on tobacco packs as mentioned above, but most of them are not yet following the rules rather reluctant and continue to ignore the government instructions. As such, different anti-tobacco organizations and health foundation namely National Heart Foundation, Progga, Work for Better Bangladesh, Pratyasa, ADHUNIK, Manobik, Ubinig, Tabinaj, Anti tobacco media Alliance, Ahsania Mission and United Forum Against Tobacco and many other organizations raised voice against the tobacco companies. The anti-tobacco organizations also arranged human chain in different places of the country calling them to obey law or face tough situation. Simultaneously the anti-tobacco organizations extended helping hands to government and assured allout cooperation in its endeavour for implementation of the GHW by the tobacco companies.
Facts about tobacco epidemic- In a situation where the global tobacco epidemic kills nearly 6 million poeple each year of which more than 600000 are non-smokers dying from breathing second-hand smoke, the epidemic will kill more than 8 million people every year by 2030 and more than 80% of these preventable deaths will be among people living in low and middle-income countries.
Not only the smokers, but also tobacco causes harms to non-smokers: A non-smoker cannot be safe so long, there are smokers around. Non-smokers are vulnerable to the deadly habit of the smokers’ smoking, which is called second-hand smoke without any fault of the non-smokers. They happen to inhale the air polluted by tobacco smokers and they run the same risk as the smokers.
WHO facts reveal that there are more than 4000 chemicals in tobacco smoke of which at least 250 are know to be hrmful and more than 50 are known to cause cancer. In adults, second-hand smoke causes serious cardiovascular and respiratory disease, including coronary heart disease and lung cancer. In infants, it causes sudden death and in pregnant women, it causes low birth weight. Almost half of children regularly breathe air polluted by tobacco smoke in public places. Over 40 percent of children have at least one smoking parent.Tobacco users who die prematurely deprive their families of income, raise the cost of health care, and hinder economic development. As such, this year’s World No Tobacco Day theme -Get Ready for Plain Packaging is very timely and appropriate for tobacco control for the socio-economic and health benefits of the people.
In Bangladesh, 43% of adults use some form of tobacco. Smokeless tobacco is used by 28% of women and 26% of men, whereas 45% of men and 1.5% of women smoke cigarettes. Nearly one lac people die every year from tobacco related diseases and 3,82,000 people were suffering from diseases and disabilities due to use of tobacco. Economic losses of tobacco is also alarming, as data reveals that every year 1 percent of GDP is spent for cigarette and 0.4 percent of the same is spent on purchase of bidi. It is estimated that the country produces 8000 crore-stick cigarette and 5000 crore-stick bidi every year and cultivable land for crop production is diminising due to tobacco production and for longer period of tobacco cultivation, land fertility is at stake. The situation becomes aggravated when tobacco cultivation on the both side of bank of rivers and thereby mixing of tobacco chemicals with water during rainy season causes water pollution and seriously effect the water resources. Tobacco preparing cost is also alarming as for burning one ton of tobacco leaf, it is estimated that 5 ton of energy wood is burnt which is certainly a great loss to the economy.
How to overcome the burden of tobacco hazards- The use of Graphic Health Warngins is a strong weapon for tobacco control for all. Article 11 of the Framework Convention on Tobacco Control (FCTC) urges upon the member states for introducing the Graphic Health Warnings on tobacco packs. It was proved most effective in many parts of the globe. Therefore, GHW should be introduced at the earnest way.
Facts reveal that in December 2012, Australia became the first country to fully implement plain packaging. In 2015 Ireland, the United Kingdom of Great Britan and Northern Ireland and France all passed laws to implement plain packaging from May 2016. Most of the member countries are in advanced stages of considering adoption of plain packaging laws.
As multiple approaches are essential to eradicate tobacco, in addition to GHW, there should be extensive application of taxation on all forms of tobacco alongwith graphic health warnings. Tobacco taxes are the most effective way to reduce its use, especially among young and poor people. WHO facts reveal that a tax increase that increases tobacco prices by 10 percent helps decreases tobacco consumption by about 4 percent in high-income countries and by upto 8 percent in low-and middle-income countries. Therefore, taxation on tobacco should be encouraged and applied extensively on all forms of tobacco and tobacco products. It is worth to mention that tax structure on cigarettes in Bangladesh is based on 4 stages, the lowest being 40% and the highest 60%. The supplementary duty/tax on bidis ranges between 20% and 25% depending on whether it has filter or not. There should be a tax increase upto 200 percent on low-grade cigarettes and bidis, which will help increase government revenue and decrease demand particularly among the poor people. iii. Adequate steps should be taken to stop tobacco cultivation and supply chain be stopped. This should be materialized with priority basis and by providing loan to farmers on easy terms. iv. Smoking be prohibitted at all workplaces, factories, and industries and support center for the non-smokers including smokers who desire to quit smoking may be established in factores and industries.
Study among the tobacco users indicates that most of them are aware of the dangers of tobacco and want to quit the deadly habit. As nicotine exists in tobacco, it becomes difficult on the part of the smokers to quit. In this respect counselling, cooperation from the near and dear ones, medication and various awareness measures can help a smoker to quit the habit.
Bangladesh has played key role in implementing WHO strategies and policies relating to its tobacco control programme and is committed to eradicate tobacco from the society for health and socio-economic benefits of the people. Ministry of Health and Family Welfare along with other Ministries are working with the available resources in this respect. National Tobacco Control Cell (NTCC) under the Ministry of Health is playing important role in this respect. We have the support and strength of the head of the government. This has been reflected when the hon’ble Prime Minister Sheikh Hasina said at the South Asian Speakers’ Summit that tobacco use would be eradicated by 2040, which refers that tobacco use will be brought below 5 percent and ultimately could be eliminated totally from the country. The use of Grapphic Health Warnings is a great weapon and can contribute significantly towards elimination of tobacco from the society. The World No Tobacco Day theme this year has created obligations for the tobacco companies and, on the other, opportunites for the policy-makers, health personnel, civil society and NGOs to work unitedly for a tobacco-free environment. Working together, we can achieve the goal.
(M. A. Jabbar is executive secretary of ADHUNIK, national anti-tobacco organization of Bangladesh.)
