Still a long way to go before stubbing it out

Successes are many. But Bangladesh still struggles in its fight against tobacco with at least 156 people dying and another 1,095 becoming disabled due to smoking in the country every day.

Tax increase and other government interventions to cut tobacco consumption seem fruitless, as production, export, import and consumption of cigarette and smokeless tobacco are on the rise.

Lured by higher earnings from tobacco production, many farmers are switching from crop cultivation to tobacco farming. Rough estimates show farmers can get up to Tk 2 lakh more by cultivating tobacco in one hectare of land instead of crops.

On the other hand, young consumers are being targeted by some local and multinational cigarette companies with clever campaigns through distribution of T-shirts, caps and even free cigarettes among students, WHO experts and anti-tobacco campaigners say.

'ONE DEATH EVERY SIX SECONDS'

Latest data is not available, but according to a 2012 research by Human Development Research Centre (HDRC) and Campaign for

Tobacco-Free Kids, tobacco production in Bangladesh rose to 60,000 tonnes in 2009 from less than 40,000 tonnes in 1980.

Export and import of tobacco also increased significantly during the period. And between 1997 and 2009, national cigarette consumption rose from 50 billion sticks to 70 billion sticks and bidi consumption from 45 billion sticks to over 80 billion sticks, the research found.  

Only last year, tobacco was grown in 108,000 hectares of land, up from 70,000 hectares the previous year, according to the Department of Agricultural Extension.

All this goes against the WHO Framework Convention on Tobacco Control (FCTC) that Bangladesh signed in 2003 and ratified the following year, becoming one of the first countries to do so.

Sections 17 and 18 of the world's first public health treaty call on governments around the world to help farmers grow alternative crops and to take preventive steps to protect the environment and public health from tobacco damages.

But 12 years on, there is little government campaign against tobacco production and consumption.

WHO experts say the fight against tobacco is important because it causes cancer, stroke, heart disease and respiratory problems, among other deadly diseases. It also affects sex life and long-term smoking may cause gangrene that leads to disability.

“Tobacco use is the leading cause of [millions of] preventable deaths,” said Dr Poonam Khetrapal Singh, regional director for the WHO Southeast Asia region.

She was speaking at the opening of the 68th regional committee meeting in Dili, the capital of Timor-Leste, on September 7. Global health experts and health ministers, state ministers, officials and journalists from the 11 member states of the region attended the five-day meeting, which discussed the regional health issues and ways to tackle them.

Tobacco was high on the agenda this year.

According to 2009 data, in Bangladesh nearly six in every 10 men aged 15 years and above and three in every 10 women of the same age group use tobacco, whether smoking or smokeless.

That's the fourth highest consumption rate in Southeast Asia region of the WHO, where about 500 million people use tobacco and about 1.3 million die due to tobacco use every year.

The region is now one of the largest producers of tobacco products because cigarette companies are shifting their factories to this region, as a growing number of people in the developed world quit smoking.     

A 2004 research by WHO Bangladesh found 57,000 people die in tobacco-attributable diseases in the country every year. There hasn't been any similar research since then.  

In 2012, 21 percent of the global population aged 15 and above smoked tobacco. Globally, tobacco kills around 6 million people each year. That's one death every six seconds.

FLAWED TAX SYSTEM

Raising tobacco taxes is the most cost-effective strategy for reducing tobacco use. Higher tobacco prices are especially effective in cutting tobacco use by vulnerable section of the population and the youth.

However, although tobacco tax in Bangladesh is fairly high (about 70 percent), the tax system is complicated and far from best practices, S Mahfuzul Huq, technical officer (tobacco control) of WHO Bangladesh, told The Daily Star.

Unlike most countries around the world, Bangladesh has different tax structures for different tobacco products -- cigarette, bidi, and smokeless tobacco (Gul, Jarda). Then, there is a four-tier tax system (based on prices) for cigarette and a five-tier system for bidi (based on number of sticks).

While this makes it easier for the companies to evade higher taxes just by readjusting the prices and changing packages, many tobacco users simply change brands or shift to lower-quality cigarettes.

“Bangladesh's tobacco tax system is far from ideal as very few countries in the world are currently using multi-tier pure ad-valorem tax system. And the tax increase isn't that effective to reduce consumption because it isn't proportionate with the rise in people's income,” said Huq, also a physician.

THE FRENCH WAY

France is a great example of how price increase can cut prevalence of smoking and reduce deaths from lung cancer.

In 2009, the country's adult smoking prevalence dropped below 40 percent from close to 60 percent in 1974 as tobacco prices almost tripled during the period.

At the same time, deaths in lung cancer came down to below 1.5 from two persons per 1,00,000, according to the WHO Report on the Global Tobacco Epidemic 2015.

SUCCESSES & CHALLENGES

But Bangladesh has its own achievements in the fight against tobacco. Successive governments have effectively curbed smoking prevalence over the years.

An estimate by the WHO shows that in 2000, nearly 62 percent men aged 15 and above used tobacco against about 6 percent women of the same age group. In 2010, it came down to 46 percent and 1.2 percent respectively.

Smoking has been banned in selected public places and public transports. Promotion and advertisement of tobacco products are also prohibited under the Tobacco Control Act-2005. The law was amended two years ago with provisions for stronger control and harsher punishments, though action on the ground is far from visible.

By March next year, cigarette companies are legally bound to use pictorial warnings on the packets, showing the damages tobacco can cause. The National Tobacco Control Cell (NTCC) with technical assistance from the WHO has finalised nine graphical warnings that the companies will have to use in turn.

But challenges remain, as the number of tobacco users is increasing with the rapid population growth. The biggest challenge will come from the most obvious place: tobacco companies.

And Zahid Maleque, state minister for health who led the Bangladesh delegation at the WHO meeting, knows it.

Addressing the delegates on September 7 in Dili, he reiterated the government's commitment to cut tobacco use, but warned: “Industry influence is also a reality in Bangladesh, working as a barrier [in the fight against tobacco].”