Speakers: THR Framework key in achieving a smoke-free Bangladesh

Prof Dr Konstantinos Farsalinos

Cardiologist and most-cited tobacco harm reduction researcher 

Dr Konstantinos Farsalinos Courtesy

Medicine has some ways to help smokers quit, but they tend to fail as well. In the majority of cases, even the best medications that we have right now have a success rate of about 20%. You need to remember that in order to apply a medical procedure to quit smoking, the government needs to invest a lot of money, and you need to create smoking cessation clinics and services, either in hospitals or outside hospitals.

Many people consider that nicotine and smoke are the same thing, especially in terms of risk. We've conducted studies and we've even seen expert physicians thinking about the same concept that nicotine is the major contributor in smoking related disease. That's not at all the case. We know for about 45 years, that people smoke for nicotine but die from the tar. They die from the combustion before they die from the chemicals. Combustion being created when the tip of a tobacco cigarette is being burned at 800 degrees Celsius or higher when you take a puff.

Dr Delon Human

Former Secretary General of World Medical Association

Dr Delon Human Dhaka Tribune

From a policy point of view, the one international treaty, which is the first international global legal treaty that was put together by the World Health Organization is called the “Framework Convention on Tobacco Control.” And the idea with the FCTC, was to provide member states with the basic framework of how policies could be put in place. But if you wanted to summarize the big battlefields, and especially consumer goods, it's usually around marketing. It's around the ingredients of the products, whether it's tobacco, or alcohol, or food and beverage, it's the ingredients, then how they are labeled, and then how they are taxed. 

Almost 10% of the total internal revenue of Bangladesh is dependent on tobacco. In order for the government to pursue a goal of smoke free, it's not only a public health and a medical issue, it's also an economic issue which is why the policy cannot be decoupled.

In terms of policy, it is imperative that the tobacco harm reduction policy framework is made part of Bangladesh's macro-economic planning cycles.

Dr Marewa Glover

Director, Centre for Research Excellence: Indigenous Sovereignty & Smoking

Dr Marewa Glover Dhaka Tribune

It's the lower income and the marginalized groups and rural people who are being left behind. And so, in maybe the last 20 years, my research has focused more on those groups that are being left behind. In New Zealand, our indigenous population Maori make up about 15%- fairly powerful politically and demanding. It has been very important to reduce the inequity on smoking rates between the European New Zealanders and the indigenous Maori.

As we all know, smoking tobacco is a form of physical dependency, the behaviour is what people really find hard to break. There are many aspects that make it, as people say, “addictive.” We had to look at providing help. They said, “you can't just tell us to stop. How do I stop? I need to know how to stop.” 

In 2006, we started a program of smoking cessation support, and national free phone, quit service and campaigns training health providers throughout the country on how to help people to stop smoking.

Masud-Uz-Zaman

Convener, Voice of Vapers Bangladesh  

Masud Uz Zaman Courtesy

Sheer willpower -- like it's called, “going cold turkey” -- yes it's possible but I have not seen too many people do that. Quitting an addictive behaviour is not easy without any support: mental counseling and support as well as physical support. 

Within one month of quitting, I started to feel certain changes in my body. My sense of smell came back, my appetite came back, I used to feel palpitations before -- because I used to smoke two or three packs a day. Maybe after two or three flights of stairs I climbed, I would start to feel breathless. Those things went away. Of course vaping is not harmless, but it is less harmful from smoking.

Many people don't understand. Anti-tobacco NGOs are acting as anti-vaping NGOs. If you are anti-tobacco you should be supporting vaping, because it is actually helping your cause. Nicotine is present in vaping and also in cigarettes, which is why they are confusing it and saying it is as bad.

Prof Dr Lutful Hassan

Vice-Chancellor, Bangladesh Agricultural University 

Prof Dr Lutful Hasan Courtesy

Vaping and e-cigarettes are 95% less harmful than traditional cigarettes, which is indeed a very important discovery. More importantly, vape and e-cigarettes can also stop secondhand smoking which will be quite beneficial for us. Therefore, in order to reduce smoking incidence, it is important that that our government implements regulation that allow vaping systems and materials. We should also do further research on vapes and e-cigarettes and get a better understanding of how these devices work.  

Prof Dr Mohammad Mizanul Haque Kazal

Secretary General of Bangladesh Agricultural Economist Association (BAEA)

Prof Dr Mohammad Mizanul Haque Kazal Courtesy

To achieve a smoke free nation alongside implementing appropriate policies and regulation, we should increase social awareness. Tobacco consumption is higher among people from poor socio-economic conditions. We must take initiatives to aware them through education programs especially in the rural areas. Inclusion of such awareness in the primary level can also be beneficial. Alternatives are important to reduce smoking. Even in the agricultural sector we are trying to research for alternative crops that farmers can cultivate instead of tobacco. 

With World No-Tobacco Day approaching, we should focus on tobacco harm reduction if we want to reduce smoking. Alongside the suggestions provided by experts in this discussion, we should work to increase social awareness and religious practices. 

Prof Dr AKM Zakir Hossain

Vice-Chancellor, Kurigram Agricultural University

Prof Dr Akm Zakir Hossain Courtesy

We need to have Tobacco Harm Reduction policies, social and cultural awareness, to encourage people to stop smoking and chewing tobacco, government regulating framework and recommended vapour products. 

BSTI's Food and Agriculture Committee's primary work is evaluating and assessing various ISO standards that are to be locally adopted in Bangladesh since it is a signatory of International Organizations for Standardization. Among other issues, our committee was assigned the task for evaluating and potentially adopting the existing ISO standards for vaping materials as well. 

During our evaluation, we found that vaping devices are widely used in different countries. Substandard products of vaping have already flooded in the market of Bangladesh. There are no regulatory measures. Its mandatory standards is not done yet. This can be adopted to prevent more health risks and hazards. Therefore, policies and regulations are necessary to maintain its standards. 

Tobibur Rahman

Member, Bangladesh Health Reporters Forum (BHRF)

Tobibur Rahman Courtesy

Sweden has already declared itself as a tobacco-free country, where the policy of reducing tobacco harm has played a leading role. There is a proposal to ban e-cigarettes in the law that is being amended in our country. There is a debate as to whether vaping is really a good alternative to smoking cessation. The biggest risk we face while working in that field is that, we don't get any research from our country on this regard. It can be through a government or a private organization. If we get any research findings after 6 months or a year, then we can work better on behalf of the media to ensure the harmful aspects of tobacco and a tobacco free Bangladesh.

There is a need for more research with local context that could be cited to raise awareness within the community, the media and also presented to policymakers. 

Maj Dr AKM Mahbubul Haque (Retd)

Maj Dr Akm Mahbubul Haque Courtesy

Despite every data, every day 441 deaths occurring in this country in relation to smoking. Every year, 1.26 lakh are dying and still 1.5 million are suffering from the diseases directly attributed to smoking. Considering the taxes we got last year, if we put it against the cost of treating the diseases of these people, it is much higher than what we are earning from the taxes.

We must look into regulating less harmful alternatives to balance health as well as revenue agenda.

Syed Zain Al-Mahmood

Executive Director, Center for Communication Action Bangladesh (Moderator)

Syed Zain Al Mahmood Courtesy