The case for public smoking bans in Pakistan
Recently, in the International Journal of Tuberculosis and Lung Diseases, we published findings from a study investigating the burden of secondhand smoke (passive smoking). According to the survey, based on standards set by the US Environmental Protection Agency, average secondhand smoke exposure in both shisha smoking and cigarette-only smoking venues was at hazardous levels, at which there is a significant risk of developing disease even amongst healthy adults. Overall, secondhand smoke exposure recorded in this study is three times greater than in similar surveys that have been conducted in the West.
Exposure to secondhand smoke causes arteries to constrict and promotes blood in the heart to clot, making it especially dangerous for those with existing heart disease. Cities in the West that have banned public smoking have seen admissions of acute coronary syndromes (heart attack and related diseases) drop by one-third within three years of implementing complete smoking bans. If such measures are adopted in Pakistan, similar if not greater benefits can be seen and many lives will be saved. Other benefits include reduced asthma exacerbations, decreased respiratory infections in children and the elderly and there is evidence to suggest that lung cancer rates can also decline. Pakistan currently tops the chart for sudden stillbirths of which a common cause is exposure to secondhand smoke amongst pregnant women. Another apprehension is that smoking bans will be harmful to the economy as businesses will lose out. Evidence from around the world indicates that overall, there are no statistically significant losses for venue owners and any short-term loss to the economy will be off-set by substantial gains in the long run through reduced healthcare costs by decreased secondhand smoke exposure and reduced tobacco consumption.
The benefits of smoking bans are not limited to non-smokers only. Evidence indicates that an overwhelming majority of smokers wish to quit at some point in their lives and smoking bans have proven to be one of the most effective ways of helping smokers quit. By decreasing the opportunities to light a cigarette, consumption declines and cessations rates rise. In fact, comprehensive smoking bans help decrease overall tobacco consumption by nearly a quarter, thus providing protection to the health of even the smoker.
Economics, politics and debates on liberalism aside, smoking bans are a moral imperative. Tobacco in all its forms is dangerous, the smoke it produces is lethal. It claims four times as many lives every year in Pakistan than the entire death toll from terrorism of the last 10 years combined, all of which are preventable. And it does so silently. The government may or may not be able to enforce this law and we can choose to ignore it the same way we can choose to break a red traffic light, the onus is upon us to abide by it. By banning public smoking we can send out a simple message — this is a practice that is no longer acceptable in our society.
Published in The Express Tribune, August 10th, 2011.
COMMENTS (13)
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Dear Cautious
You have asked for a ban on AK47 first before we talk about implementing the ban on smoking at public places.May I ask how many people die in the country from AK47? As a physician who see young people die from tobacco related diseases every day I can tell you that death toll from tobacco is far more then total deaths from Target Killings,Road Traffic Accidents,Suicidal Bombings and Alcohol use combined in the country.We are talking about controlling the single largest preventible cause of death in the world today..
The problem is implementation of legislation, not coming up with legislation itself. The Shisha ban is highly ineffective to say the least. There are Shisha places in Blocks-5/9 of Clifton, Karachi, still open and serving shisha publicly.
Ultimately, mass education would be required, with or without legislative action. People need to realize that by exposing others with smoke, they are causing them harm and do corrective action. People who are passive smokers and do not like it need to speak up against it.
What has been a suggested model is an explicit "education-tax" on cigarettes and then using the revenue for advertisements or other means for massive education drives.
Reduce the production of tobacco and number of factories producing cigarettes? But those responsible for the health and welfare of the nation will never agree since they receive their kickbacks from International and local tobacco magnates. Now depending on the ratio of the smokers and non-smokers in the media, the public cpould be educated about the hazzards of smoking and specially second hand smoke, by the soap operas offered through TV. Today in the west mainly in US and Canada retailers cannot exhibit tobacco products, while selling to a minor under age 19years could slam one with heavy fines, imprisonment or both and ban from selling tobacco products. I wonder if any Corp Commander has the moral courage to tell the COAS not to smoke during the meetings? On the other hand as a chain- smoker if he refrains from smoking during the conferences then all other Government Officials and CEO's Directors should follow the example.
How about banning AK47's first?
Bravo! Congratulations to Prof Javaid Khan -- the Principal Investigator and Dr Asad Kazi for this amazing article.
Your premise of using a US EPA study is entirely flawed Pakistan has no semblance of such a public health establishment.
@Shahid: My 'Dear' Shahid, I feel compelled to respond to such a naive comment! This isnt a just an issue of 'other' societies, its our problem too. Do you not see the countless smokers around you and the dozens of kids that pick up the habit everyday? As physicians, we daily see patients needlessly suffering from the preventable use of tobacco. We didnt just come up with these figures,we went out and researched them. I suggest you go and do the same before you retort with such mesmerizing statistics as 'every third person'. Nobody is denying that water-borne illnesses is an important issue but progress is being made and mortality is declining, unlike that of heart disease and cancers which are growing unchecked. We do not want to create the problem-it already exists!
@Asad Zaidi
Get a life dear! There are already too much bans, none working!
Instead ask for ban on adulterated food, fake medicines, massive air pollution, unclean drinking water...there is a long list. The disillusionment middle class copies ideas from other societies and start applying it in drawing room revolutions without sparing a second to think about real issues.
Every third person in Pakistan is suffering from water-borne diseases, fake medicine and food items kill more than all other factors combined. Come out from drawing room and try to learn about some real problems, rather than creating more problem just to get an article published in news paper.
What about alcohol. There is more damage caused to the individual and the society by drunks. You will not hear anyone speaking up against it as the Western population is obsessed with alcohol. What about the pollution in general? What about the industries and the traffic smoke? No one talks about this.
I would like to congratulate Dr Asad Zaidi for his hard work in doing this study. Scientific studies like this would help in persuading not only the decision makers but also the general public that things are very bad as far as seccond hand smoking is concerned in the country.We have a law since May 2009 which completely prohibit all forms of smoking inside a restaurant and other public places.Unfortunately we as citizen are known to violate the laws because hardly ever any one is punished for violating the law.In this day and age no one would dare to light up a cigrattes inside a public transport or at a public place anywhere in the world except in Pakistan.
Other day I was at a Aftar/Dinner at a famous Club at Karsaz Road Karachi.Soon after breaking the fast large number of people started smoking with in the closed airconditioned room close to the main counter of the restaurant.When I lodged a strong protest to the Manager on duty he said"Who follows the laws in Pakistan.
Famous fast food pizza chain is violating the law in Pakistan for past 2 years. I have written atleast a dozen letters to the management here and in USA with a copy to police IG and Minstry of Health.So far no action has been taken against the concerned fast food chain.This food chain is by the way smoke free all over the world but not so in Pakistan.
In order to control tobacco use in the country the two most important measures which can help is implementation of smoking ban at public places and making tobacco products very costly beyond the reach of common man.Our public must protest when they are forced to inhale tobacco toxins by others.Seccond hand smoking in a way is the violation of basic human right to breathe clean air.Smokers have a right to smoke but they have no right to destroy our heath of others by their unhealthy habit.
We are very impressed by your eminent knowledge. (Go for a fellowship in Respiratory Medicine. I hope good universities like AK work more on preventive-medicine.)
However, it misses the whole point - the ban, is it the best way, how to achieve same results with other proven methods.
In recent decades, Western countries have almost succeeded in up to 70% elimination of tobacco consumption.
It was achieved thru multi-throng restrictions. Gradual increase in cigarette duties/taxes. Ban on cigarette advertisements went hand in hand with ban in closed public places - office buildings etc. Later the restaurants and cafes (inside) were added in that ban. And so on. Our local parks are still open for smoking in open areas. But a smokers are rarely seen.
Do not underestimate smoking fervor in Western countries. Only 10-15 years ago you could see cigarette, cigar, pipe smoking men all over. Smoking in bars/cafes - equivalent of our chaikhanas - were considered as last bastions of smoking public.
What you cannot do and should not do is a TOTAL ban of smoking, from day one. And never at private places, residential areas etc.
This gradual campaign succeeded because of the disastrous of similar total ban on alcohol ban on alcohol back in 1930's. Such drastic measures resulted in bootlegging and later to emergence of notorious mafia.
In our context, engaging women - spouses, mothers - I suspect would produce good results. They and their children are victims of second-hand smoking. Health card probably will give them authority to nudge males at home to restrict smoking at home.
Giving medical lectures to smokers is waste of time. Try convincing non-smokers how second hand smoking can be equally disastrous. Keep it simple - lung damage, asthma, breathing problems, and CANCER. Things that an average person can grasp and recount.
Rural area? That may pose different challenge.
Partial ban, ban on cigarette advertisement, TV and community heath campaign with persistence produces amazing results overtime.
I live in a country that is almost hysterical about smoking and second-hand smoke. You cannot smoke in the open air in some places and not even in parks!
Pakistani's by comparison are very casual about smoking. That is consistent with our general perchant to disobey rules.
Someone who will not be mentioned by name had the PIA ban on smoking removed because he liked to smoke on a short trip from Karachi to Islamabad. Thank God he is not around but one still hears of passengers who try to sneak a smoke on flights.
Internationally, if you smoke and get caught, the passenger is fined. In flights to the US, the fine is $3,000.0
Requests for Full-Texts of the research article can be made to the Principal Investigator of the study, Dr Javaid Khan, Professor of Medicine, Aga Khan University.