From decades, tobacco use is killing a huge number of people around the world. Globally, tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use while around 890,000 are the result of non-smokers being exposed to second-hand smoke. Around 80% of the world’s smokers live in low and middle-income countries where the burden of tobacco-related illness and death is substantial. According to World Health Organization children accounted for 28% of the deaths attributable to second-hand smoke in 2004. It is estimated that 165,000 children die before the age of 5 due to lower respiratory infections caused by second-hand smoke and 700 million children in the world breathe in polluted environment caused by passive smoking.
Tobacco use is also a leading cause of diseases. Smoking is the primary cause of lung cancer with over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or at the work place also increases risk of lung cancer. Smoking is also a cause of chronic obstructive pulmonary disease (COPD). The risk of developing COPD is mainly higher among individuals who start smoking at a young age. A cigarette is composed of 4000 chemicals from which 40 are cancer causing. American Lung Association states that cigarettes are the most common form of tobacco use, and causes 90% of all lung cancer deaths. In addition, about 80% of people with oral cancer use tobacco. Cigarettes contain more than 60 cancer-causing agents.
The magnitude of the tobacco use is more serious for a country like Pakistan. Per year 160,000 people die due to tobacco use. Nearly 24 million people use tobacco. Tobacco use prevalence among children between 13-15 ages is 10.7%. According to Globe Youth Tobacco Survey 2013, 21% of the students are exposed to smoking at home. Pakistanis spend more than PKR 250 billion on tobacco. Households spend 3% of their income on tobacco. Money spent on tobacco is an amount not spent on food, education and health.
Institute for Health Metrics and Evaluation (IHME) an Independent Global Health Research Centre reveals that in Pakistan, 25,000 persons die due to cancer, 24,500 persons die due to cerebrovascular disorders and 38,828 people die due to heart diseases caused by tobacco use. According to Shaukat Khanum’s official website smoking increases the risk of at least fifteen different kinds of cancers. Nearly 40% of cancers in adult males seen at Shaukat Khanum Memorial Cancer Hospital and Research Centre can be linked to the use of tobacco.
Several cancer patients don’t have enough income for treatment and they are single bread earners of their family. The Network for Consumer Protection, an independent policy advocacy organization has reported a similar case study; “Mushtaq Ahmed, age 40, started smoking when he was in 5th class. For the past few years, he started feeling pain in his breathing pipe. He consulted a doctor who diagnosed it as throat cancer. He underwent throat surgery. He was unable to speak, eat and drink. He is lying on bed with no source of income. His wife is a maid who washes dishes in different houses to earn bread for their 3 children”.
Comprehensive multi-sectorial approach coupled with effective enforcement would help to save peoples’ lives especially children. Adequate budget is also a mandatory requirement in order to save lives, reduce health care expenditures and make Pakistan healthier
From decades, multinational organizations have been targeting children to capture market shares; these companies sell tobacco products to children and are adopting various techniques for marketing. For instance: Cigarettes are being placed with candies and chocolates to trap children and embed the concept of cigarette smoking in their subconscious mind. Attractive branding inside the shop further helps as a starter pack for the school going children between 10-15 ages. As a result nearly 40% school going children (13-15 ages) start smoking before age 10.
From past many decades, Pakistan has been striving to reduce tobacco prevalence. In this connection, Pakistan has ratified WHO-Framework Convention on Tobacco Control (FCTC) in 2005. Pakistan’s efforts to reduce tobacco use prevalence are mainly focused only on demand reduction measures. Pakistan has made progress prior to ratifying FCTC by introducing Vender Act 1958,the cigarettes (Printing of Warning) Ordinance, 1979 and The Prohibition of Smoking and Protection of Non-smokers Health Ordinance, 2002.
In recent times, Pakistan has taken various steps including banning sale of cigarette to under age. Ban on smoking at public places. Ban on sale of loose cigarettes. Ban on sale of cigarettes within 50 mater of the school boundary. In 2015, government announced to increase the Pictorial Health Warning (PHW) on cigarette pack to 85% but decision was not executed due to tobacco industry’s interference. Later in 2018, PHW was enhanced from 40% to 50% and further 10% is going to be enforced from July 2019. A case to implement the decision of 85% PHW is pending in Islamabad High Court.
There is a partial ban on Tobacco Advertising, Promotion and Sponsorship (TAPS). Only outside the shop tobacco advertisement is banned but not the inside of the shop. After ratification of FCTC, a state bounds to implement comprehensive ban on TAPS within the period of 5 years. Similarly, price of cigarettes should enhance by increasing tax on tobacco as recommended by article 6 of FCTC. But it has seen a sharp decline because of introduction of low price 3rd slab in tobacco tax structure. This situation has made cigarettes more affordable for children.
Pakistan is facing innumerable challenges to curb tobacco use. Tobacco industry’s interference at policy level is a huge challenge. As a result no comprehensive tobacco control legislation has been made in Pakistan. Absence of multi-sectorial tobacco control policy or strategy is another dilemma. Furthermore, poor enforcement of existing laws has ruined the purpose of legislation. Comprehensive multi-sectorial approach coupled with effective enforcement would help to save peoples’ lives especially children. Adequate budget is also a mandatory requirement in order to save lives, reduce health care expenditures and make Pakistan healthier.
The writer is a tobacco control expert based in Islamabad