World No Tobacco Day: Where Does Sri Lanka Stand?

World No Tobacco Day (WNTD) was established twenty nine years ago in 1987 by the Member States of the World Health Organization (WHO). The theme for this year’s World No Tobacco Day, “Tobacco – a threat to development”, calls for countries to accelerate tobacco control efforts as a part of the 2030 Agenda for Sustainable Development. Tobacco control has been included in Sustainable Development Agenda and is identified as an effective means to help achieve SDG target 3.4 of reducing one third of the global tobacco use, by 2030. This target covers tobacco control, reduction of premature mortality from non-communicable diseases by one third, and prevention of disaster risks which lead to improvements in the health conditions of the population. Improvements in health subsequently lead to economic development. WHO estimated that the global economy is losing around US$ 1 trillion (£820bn) due to depleting productivity levels, and the additional burden on health services caused by tobacco use. Controlling tobacco use has been a proven approach to improve the health of the workforce which in turn improves the business productivity and profitability of companies, leading to enhanced revenue, according to the Centre for disease Control and Prevention (CDC). Reducing tobacco use also enables families to redistribute the money spent on tobacco products on covering household expenditures and reduces expenditure on health care.

 

In this context, the article examines the effectiveness of various tobacco control measures used by different countries, including Sri Lanka, in reducing the use of tobacco.

 

The WHO Initiative

 

As WHO has pointed out, “the objective of WNTD is to abstain from tobacco use for 24 hours and draw worldwide attention to the prevalence of tobacco use and its negative health effects.” According to WHO, tobacco kills nearly 6 million people a year and if the current trends continue, the number is estimated to rise to 8 million by 2030. It further says, the day also sheds lights on the significant number of deaths, nearly 600,000, resulting from passive smoking and the health hazards posed by secondhand smoke. This dire situation has led to the focus of the initiative being on advertising efforts of the industry sources, especially aimed at youth; as WHO has revealed the tobacco industry is aiming to replace older, quitting, or dying smokers with younger consumers. The campaign to stop these efforts of the tobacco industry has met with growing support from world, and public health organizations, amidst resistance from tobacco users, growers and the industry itself. WHO initiative for WNTD is further strengthened by creating a global public health policy through the Framework Convention on Tobacco Control (FCTC) Treaty, with the agreement of 170 parties, and 80 per cent of the global population, to implement policies toward cessation of tobacco. WHO tobacco control framework, involves warning about the dangers of tobacco use, enforcing bans on tobacco advertising, and raising taxes on tobacco. Sri Lanka ratified FCTC in 2003 and in line with the above initiative, introduced measures such as restrictions on smoking in public places, the pictorial health warnings on cigarette packets to cover 60 per cent area of the pack, in addition to text warnings on all packs, and established the National Authority on Tobacco and Alcohol (NATA) along with penalties for violating these regulations. Further, in October 2015, the government raised prices of cigarettes by 43 per cent and tax on tobacco was increased to 90 per cent.

 

Measures Relating to the Reduction of Demand for Tobacco

 

Among the measures that the world adopted to control smoking, the most effective has been the raising the prices of cigarettes or tobacco products, which leads to a reduction in the demand and  limits the market power of tobacco companies, as per Article 6 of FCTC. It was reported in Australian Budget Review 2010-2011 that, policies to control tobacco use, including introducing tobacco tax and increasing prices, can generate significant government revenues for health and development work. Tobacco prices have steadily increased in European countries, Australia, African countries and some East Asian countries as a measure to curb tobacco smoking. According to World Bank estimates, a 10 per cent increase in taxes will decrease demand by 8 per cent. However, the impact of tax increases on smokers who are poor is often portrayed as a disadvantage of policies that increase taxes on tobacco products.

 

Next to the increase of prices, anti-tobacco campaigns are concentrated on pictorial warnings, accompanied with text warnings. Many European countries opted to display only text warnings such as “SMOKERS DIE YOUNGER” or “SMOKING KILLS” while Australia introduced plain packaging without pictorial and text warnings. In Sri Lanka introducing pictorial warning took place in different stages. In 2012, the government announced through a Gazette notification, the enforcement of pictorial warnings covering 80 per cent the cigarette packet. Subsequently the court reduced the percentage of the pictorial warning to 60 per cent, after an interim order sought by the industry players. In 2016, new legislation was introduced to the effect that 80 per cent of the surface of the cigarette packet should be covered by the pictorial warning. India, on the other hand uses a combination of pictorial and text warnings, with graphic photographs of oral and throat cancers occupying 65% of tobacco packages, while 15 per cent of the surface is used for text warnings.

 

Sri Lanka’s Achievements

 

According to NATA, in Sri Lanka – and around the world – there has been tremendous progress made in both adopting these measures and reducing the devastating toll of tobacco. Annual tobacco related deaths in Sri Lanka have been estimated at 24,000 by the Ministry of Health. With the aim of curtailing tobacco related non–communicable diseases, the government introduced amendments to NATA Act 3 of 2015, to increase the pictorial warnings on tobacco pack to 80 per cent. Further, according to Department of  Excise, the battle against tobacco smoking, mainly cigarettes, gathered momentum in recent time with the increasing of prices, while beedi (raw tobacco)– not smoked or even seen on the streets of Colombo – is growing in popularity in rural Sri Lanka, unchecked. Beedi is a small and medium scale industry. It engages local farmers to cultivate tobacco, imports a specific leaf called ‘tendu’ that is used to roll the beedi, and women in most rural households,  engage in rolling beedi for a pittance using the tendu leaves imported from India.

 

Sri Lanka’s effort in battle against tobacco smoking has yielded positive results but smokers will find alternatives to satisfy their addiction due to availability of low cost raw tobacco products, and the easy access to smuggled cigarettes. The only good sign is, there is a marked drop in smoking by the younger population, as reported by industry sources, which will lead to building a healthy generation in the future, and could help to achieve SDG 3.4.