The case for public smoking bans in Pakistan

Evidence suggests there is no statistical loss for venue owners, short-term loss is off-set by decreased health costs.

The Sindh Assembly recently introduced legislation banning the use of shisha in public places. Most experts would agree, this is a good thing. Unfortunately, in the current political climate, our governments seem to be chided even for making the right decisions. Sceptics see smoking bans as an infringement on personal freedoms. In reality, this is a step towards addressing a major, hidden public health burden.

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 10^th, 2011.