Is it possible to reduce tobacco use in Bangladesh?

Reducing tobacco use is highly challenging in a country like Bangladesh, where there is widespread use of different forms of tobacco among men, women and even children, and where devious interference by tobacco industries into government systems and policy measures has gone largely unchecked. Every year, about 161,200 people are killed by tobacco-induced diseases. Over 172,000 children (10 to 14 years) and about 25 million youths and adults (15 years and above) use tobacco every day. Non-communicable diseases account for 67 percent of all deaths, and tobacco causes about one in every five deaths in the country.  

The government has an almost nine percent ownership share of British American Tobacco (BAT) and has appointed several high-level officials on the company's board. Bangladesh has also taken foreign direct investments from Japan Tobacco Industries (JTI). As a result, tobacco is categorised as an economic crop. Cigarettes are on the list of essential commodities as per the Essential Commodities Act, 1956, and even during Covid-induced lockdowns, production, marketing, and sales were fully functional. Tobacco companies in Bangladesh regularly employ ill tactics including tax evasion, child labour, manipulating the government system and policy, misusing fertile lands, and targeting youth. 

Despite the widespread challenges and the tobacco industry's interference, the government of Bangladesh has taken many steps to control tobacco use, and the prime minister has vowed to make the country tobacco-free by 2040. 

There has been a significant reduction in tobacco use among Bangladeshis over the years, from 43 percent of the population to 35 percent of the population using tobacco between 2011 and 2018. Nonetheless, this stat is still high compared to our South Asian neighbours, with tobacco use having a 28.6 percent prevalence in India as per GATS 2016 and 19.1 percent prevalence in Pakistan as per GATS 2014.

We definitely do not want our adolescents and youth to fall prey to the alluring trap of the tobacco industry. To ensure this, we have to further amend the Smoking and Tobacco Products Usages Control Act, 2005 and update it to be time-worthy and comprehensive. Our first and foremost goal should be to prohibit designated smoking areas at all public places and public transport as well as multi-room restaurants to stop adolescents and youth from being tempted by smoking zones and to save others from secondhand smoking. The current smoke-free policy allows smoking and tobacco use in multi-room restaurants. So the owners of restaurants are permitted to designate smoking zones inside the restaurants. The WHO Framework Convention on Tobacco Control (FCTC) Article 8 roundly calls for 100 percent smoke-free environments as tobacco smoke moves easily from designated smoking areas (DSAs) to nearby non-smoking areas, leaving no scope for safety to non-smokers from the harms of secondhand smoking.

Prices of tobacco products in Bangladesh are cheaper than almost all other countries in Southeast Asia. Tobacco taxation, an effective tool for tobacco control, is also based on an age-worn ad valorem system that warrants an immediate revamp into a specific taxation policy. Without the uniform specific two-tier tax system, the proven tool for curbing tobacco consumption for the greater interest of public health, reduction of tobacco use will continue to be out of reach. 

In the garb of social safety, philanthropy and cultural promotions arranged as a part of corporate social responsibility (CSR), tobacco companies engage other organisations like universities to arrange extravagant festivals like debates, cultural shows or concerts for the young generation, which are attended by influencers and celebrities. These can be termed as overt and covert advertisement techniques of tobacco companies.  

In 2016, the Government of Bangladesh introduced Graphic Health Warnings (GHWs) by replacing written text warnings covering 50 percent of product packaging. Increasing the size of graphic health warnings from 50 percent to 90 percent and putting graphic warnings on the front of the industry's most pervasive marketing channel – cigarette packs – is the best way we can guarantee that tobacco users receive regular reminders of the harm they are causing themselves. Evidence from countries where large graphic warnings have been implemented – 78 so far – tells us that this will help reduce tobacco use. If we are serious about saving the lives of our fellow citizens, we cannot shirk away from showing people the ugly outcome, or rather the truth, of tobacco use.

Prohibition of exhibition of tobacco products at points of sale will be effective only when we prohibit the sale of single sticks, unpackaged or loose tobacco, and smaller packs. Looked at from an economic standpoint, a smoker is compelled to think twice or to give up smoking when they have no ability to buy a full pack of cigarettes. The same goes for tobacco users who will find no alternative but to quit smoking when faced with the challenge of finding unpackaged or loose tobacco. And before it becomes an uncontrollable menace, there should be an immediate ban imposed on heated tobacco products and e-cigarettes. 

Achieving the desired reduction in adult tobacco use prevalence and noncommunicable diseases (NCD), saving people's lives and improving the economic and health conditions of the poor, is a long and arduous task for any country. The government has to amend the tobacco usages act, chalk out a roadmap, make a strategic plan and set up sustainable goals in reducing tobacco consumption each year so that it succeeds in fulfilling its commitment of establishing a tobacco-free Bangladesh by 2040. 

Shafiqul Islam is country advisor at Vital Strategies, and a former additional secretary to the government.