Controlling the tobacco epidemic in Pakistan

Last week when I entered my clinic I saw a handsome gentleman waiting anxiously for me. His wife sitting beside him looked equally anxious. The couple came to me for a second opinion about the abnormality found on his recently done chest x-ray. Unfortunately, the x-ray appearance was highly suggestive of lung cancer at a very advanced stage. Subsequent biopsy of lung tumour confirmed it to be lung cancer. The patient was an engineer aged 38. I only had shocking news to communicate to this couple that the lung cancer was at a stage that it cannot be cured and in fact the patient had only four to six months to live.

This gentleman started to smoke when he entered engineering university. Initially, he used to smoke three to four cigarettes only but for the past decade or so he has been smoking about twenty cigarettes per day. His wife was in tears when she heard the tragic news about her husband having advanced stage lung cancer. She mentioned that ever since she got married she tried her best to persuade her husband to give up smoking but he never gave a serious thought to making a quit attempt.

This textile engineer was not the only one who has suffered from the deadly consequence of smoking. I see several patients every day in my clinical practice suffering from tobacco related diseases. Over 90 per cent of lung cancers are caused by tobacco use and thus are preventable. Mortality from lung diseases in Pakistan can be reduced by 50 per cent if smoking is avoided. Unfortunately, most smokers think about giving up smoking when they develop a serious disease like lung cancer, heart attack or emphysema. When people are young they think that it is very easy to stop smoking and they will give up smoking at their will whenever they want. But they soon realise that quitting smoking is not as easy as they thought. Most smokers think about smoking as simply a bad habit, they are least aware about the powerful addictive nature of tobacco and about the serious health consequences associated with its use.

Smoking is on the decline in most developed countries of the world but sadly, on the rise in low income countries like Pakistan. The tobacco market is thus shifting from the West to countries like Pakistan. Our public is not aware about the hazards associated with tobacco use and the tobacco industry capitalises on this lack of awareness. The tobacco industry finds Pakistan - a country of over 170 million people - an ideal place to do business and make huge profits…at the cost of human lives. If we want to control the tobacco epidemic in Pakistan and thus reduce the burden of tobacco related diseases we have to take certain measures which include:

- Educating the public on the hazards of tobacco use through electronic and print media.

- Making all public/transport places smoke free zones e.g. hotels, restaurants, shopping centers, banks etc.

- Increase taxation on tobacco products and making cigarettes costly beyond the reach of the common man.

- Complete prohibition of smoking/tobacco use in our movies and TV drama serials.

- Pictorial health warnings on cigarette packs (as announced recently)

- Establishing smoking cessation clinics in the country

- Making all educational places like universities smoke free zones

If we take such measures I am sure it will motivate smokers to give up this powerful addictive substance which kills an estimated 100, 000 people per year in Pakistan.

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. His original research paper on the same topic can be read here.