Do we need stricter tobacco control?
Bangladesh's fight against tobacco has come a long way since the country signed the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. Between 2009 and 2017, the prevalence of tobacco use fell from 43.3 percent to 35.3 percent. This was a result of years of legislative and fiscal measures and cooperation between relevant government bodies and other anti-tobacco stakeholders. However, comparing the progress made by other South Asian neighbours (i.e., 28.6 percent of tobacco use prevalence in India as per GATS 2016 and 19.1 percent in Pakistan as per GATS 2014), Bangladesh's achievement is discouraging.
A strong legislation consistent with the goal sets the stage for bolder and more effective measures. This is particularly true for tobacco control. The obligation of safeguarding public health is one of the key foundations of Bangladesh's state policies, according to Article 18(1) of Bangladesh's Constitution. "The right to life" is protected under Article 32 of the Constitution. Bangladesh government is also a signatory to the WHO Framework Convention on Tobacco Control (FCTC) and has enacted tobacco control legislation in accordance with the Convention. Target-3A under 2030 Agenda for Sustainable Development calls for implementation of the FCTC. Bangladesh's 8th Five-Year Plan (FYP) also emphasises this requirement.
Bangladesh's current goals of implementing Sustainable Development Goals (SDGs) by 2030, achieving higher middle-income country status by 2031 and moving towards becoming a developed nation by 2041 are also in conflict with the massive toll, in terms of injuries to health and consequent deaths that tobacco inflicts on people. A study shows that in FY 2017-18, the economic burden due to tobacco use in Bangladesh (medical expense and loss of productivity) stood at Tk 30,560 crore, which is much higher than the revenue earned from the tobacco sector which was Tk 22,810 crore. Tobacco claims around 161,000 deaths in Bangladesh a year. It has been ranked as the fourth major contributing factor behind premature deaths in the country.
The findings of the 2009 and 2017 Global Adult Tobacco Survey (GATS) identified areas regarding which legislative attention regarding tobacco control is lacking. While the Smoking and Tobacco Products (Usage) Control Act 2005 and subsequent amendment of 2013 in Bangladesh banned advertisement and promotion of tobacco products, tobacco companies have adopted clever tactics to take advantage of the loopholes and grey areas of the law. According to GATS 2017, almost 54 percent of the population have seen advertisements of cigarettes or bidis, while nearly 21 percent have seen some advertisement of jarda or gul (chewing tobacco). The proportion of people who saw advertisements of bidis rose by 22.5 percent between 2009 and 2017. In case of smokeless tobacco products, the increase was 47.9 percent. It should be kept in mind that these cheap tobacco products are mostly consumed by the low-income people and the women who are most susceptible to influence as a result of advertisements.
Elimination of the existing legal provision for Designated Smoking Areas (DSAs) or "Smoking Zones" in public places and public transportation can go a long way towards ensuring the realisation of much higher benefits accruable from Tobacco Control Laws. A "smoking zone" in the middle of an otherwise smoke-free area does not protect people from second-hand smoke. As a result, such a provision is incompatible with public health perspectives and acts as an obstruction on the way to smoke-free living. According to the 2017 GATS, 42 percent of all people who work in a covered place are regularly exposed to passive smoking. While using public transportation, about 25 million persons globally are exposed to second-hand smoke. A total of 67 countries, including Thailand, Nepal, Turkey, and the United Kingdom have already enacted full smoke-free legislation, which includes the total abolition of designated smoking zones.
Bangladesh's tobacco control efforts are hampered by the unpackaged sale of bidi, cigarettes, and smokeless tobacco products (jarda and gul). Such sales make tobacco products more available and affordable for such groups as adolescents, youth and low-income people. Furthermore, when tobacco products are purchased loose rather than in packs, the Graphic Health Warning (GHW) on the packs is rendered useless. Article 11 of the FCTC also advises nations to prohibit the sale of single sticks or small packs of bidis and cigarettes, which has already been implemented by a total of 118 countries around the world. There is a growing need to address new threats on the horizon as manifested in the growing popularity of emerging tobacco products (ETPs).
The Covid-19 crisis should have called for stronger tobacco control measures. Unfortunately, the opposite has happened in Bangladesh, as suggested by the evidence reflected in the 2021 Bangladesh Tobacco Industry Interference Index.
Experience in recent years shows how the tobacco industry uses its so-called corporate social responsibilities (CSR) as a pretext to create strong liaison with influential government bodies, which, in turn, influence policymaking and implementation. A society where certain policymaking circles are subject to influence by the tobacco industry cannot but be rather weak regarding the adoption of strong tobacco control measures. It is, therefore, essential that tobacco control law is amended to ban the tobacco industry's CSR activities. An amendment of Bangladesh's tobacco control law must reflect the realities of post-pandemic new normal and what we have learnt during the pandemic.
Qazi Kholiquzzaman Ahmad is an economist, and an expert on environment and convener, National Anti-tobacco Platform.