Tobacco use in any form is deadly. Smoking kills more then half of all regular users, and the smokers die on average of 15 years earlier than non-smokers. Tobacco related mortality is increasing rapidly in Pakistan. According to a WHO 2008 report 32% males and 6% females smoke in Pakistan. Youth smoking prevalence is from 10% to 15%.
A significant number of people also use smokeless tobacco in the form of Paan, Gutka, Naswar etc. Pakistan Tobacco Company reported 17% rise in its sales from January to September 2008 compared to 2007. Rise in profit of 9.3% was from the increased sales volume and rest because of increase in the price of cigarettes. In order to curb the growing tobacco epidemic in Pakistan we do not need to re-invent the wheel. Several tobacco control measures have proven track record, which if implemented in Pakistan can slow down the tobacco epidemic. Some of these measures are described below.
A. Smoke Free Public and Work places
Tobacco smoke pollution (TSP) causes number of diseases including Lung cancer, heart attacks, pneumonia and exacerbation of asthma. Comprehensive smoke free policies and its implementation improve health, motivates smokers to quit and help reduce tobacco consumption.
Unfortunately our law which calls for prohibition of smoking at all public places is not being implemented in the country. Research has shown that smoke free policy is only effective if all indoor public places are completely smoke free. Its effectiveness is weakened if designated smoking areas are allowed.
Following measures are suggested to implement the law
B. Effective Health Warnings on Tobacco (Cigarette Packs)
Smokers tend to underestimate the health risk of tobacco use. Effective health warning on cigarette packs encourages smokers to quit and discourage non-smokers particularly the youth from starting. Health warning need to use strong, clear language and must include “pictures” highlighting the health risk associated with tobacco use.
C. Comprehensive Ban on Tobacco Advertising and Promotion
At present the ban on tobacco advertising is only partial in Pakistan. Such partial ban does not work. Comprehensive ban on tobacco advertising has shown to decrease tobacco consumption in many countries. After partial ban on TV, now more smoking scenes are shown on TV drama serial. Point of sale advertising has markedly increased in Pakistan.
Tobacco industry continues to promote tobacco through youth magazines, mobile cinema halls and free distribution of cigarettes at musical concerts. All so called lucky draws and prize scheme which are announced by the tobacco industry from time to time must be stopped.
D. Tobacco Taxation
Recent survey shows that cigarette price in Pakistan are the cheapest in the region. Increasing the price of tobacco via taxation is the single most effective way of reducing tobacco consumption. Cigarette consumption falls when taxes rise. Price increase encourages people to stop smoking, prevent others from starting smoking and discourages ex-smoker from starting smoking again. A price rise of 10% decreases tobacco consumption by about 8%.
E. Smoking Cessation
Majority of smokers realize the need to give up smoking but find it difficult to do so in the absence of any organized efforts to do so. Also there is no formal training of health care providers on smoking cessation. Telephones quit lines are in its infancy in Pakistan. All 3 smoking cessations medications are now approved by the MOH which can help motivated people in giving up this powerful addiction.
F. Public Health, Mass Media Campaign
Despite conclusive evidence of the dangers of tobacco, relatively few tobacco users fully grasp its health risk. Most people generally believe that it is simply a bad habit. The extreme addictions of tobacco and the full range of health dangers have not been adequately explained to the public.
G. Tobacco Cultivation and Crop Substitution
Pakistan is a tobacco growing country. Tobacco farming is very profitable for the multinational companies, small farmer fall into a debt trap perpetuated by tobacco companies. WHO Framework Convention on Tobacco Control (FCTC) calls governments for financial and technical assistance to tobacco growers. Shifting to nutritious, economies viable and environmentally sound alternative crop would promise a bright future for Pakistan. Tobacco is not good for any countries economy; in fact it makes poor country even poorer.
H. Tackling Illicit Trade
There are three verities of illicit trade in tobacco, smuggling, tax evasion and counterfeiting. All three practices contribute to increasing the availability and accessibility of cigarette in the market and more losses to the exchequer.
I. Monitoring Tobacco Use and Prevention Policies
We need data in Pakistan on the current prevalence of tobacco use in adults, youth; females’ etc. We also need to measure the health care cost of managing tobacco related diseases. Policy makers much have access to this data. Smokeless tobacco use is also a growing problem in the country but little epidemiological data exists to plan future strategies. However for doing any research no funding should be accepted from the tobacco industry.
J. Tobacco Litigation
There are several successful example of tobacco litigation in the developed world. Tobacco litigations were started in USA but this is clearly increasing around the world. WHO encourages litigations for purpose of tobacco control.
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Javaid A Khan is FRCP (Edin), Chair National Alliance for Tobacco Control, Professor of Medicine, Section Head of Pulmonary and Critical Care Medicine and Consultant Chest Physician at the Department of Medicine at The Aga Khan University.
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