As a medical professional deeply entrenched in public health, I cannot overlook the critical issue that tobacco-related non-communicable diseases (NCDs) pose to the people of Bangladesh. The alarming mortality rates, particularly from cancer, underscore the need for a comprehensive and science-based approach to tackle this crisis.
The statistics reveal a grim reality – 126,000 people die annually from tobacco-related diseases in Bangladesh, accounting for 13.5% of total deaths. The economic burden is equally alarming, with smoking-related diseases costing the country Tk30,570 crore annually, representing 1.4% of the total gross domestic product.
The research conducted by the Bangladesh Cancer Society in 2019 should have been a wake-up call. More than 7 million adults suffer from tobacco-related diseases, and 61,000 children are victims of passive smoking. Tobacco consumption significantly increases the incidence of non-communicable diseases, including cardiac diseases, stroke, and cancer.
The complexities of addiction and habits tied to tobacco use necessitate a nuanced strategy, moving beyond the traditional paradigm. The recent advocacy for Tobacco Harm Reduction (THR) by former WHO directors Robert Beaglehole and Ruth Bonita in The Lancet, reflects a pivotal shift in our battle against tobacco-related mortality. It is crucial to offer consumers the choice to choose from alternatives that help them break free from traditional tobacco products.
It is no longer just Sweden that has seen record-breaking declines in smoking thanks to smokers being able to choose an alternative that can replace cigarettes. Norway, UK, New Zealand or Japan have seen unparalleled declines in smoking rates as safer alternatives displaced deadly cigarettes.
However, it is necessary to distinguish new types of cigarettes to have an appropriate control policy. Currently, most people still confuse new tobacco products and this is one of the reasons for the slow introduction of appropriate and effective control mechanisms.
Not all tobacco products are the same. In particular, cigarettes are classified as the most toxic due to combustion. In contrast, heated cigarettes, or electronic cigarettes, belong to the group of smokeless products with lower levels of harmful substances than cigarettes. The biggest difference between these two products is the raw materials. E-cigarettes use nicotine-containing solutions, while heated cigarettes use tobacco materials. The WHO also stated E-cigarette products and heated tobacco products (HTPs) both contain nicotine but differ in composition. Heated tobacco has tobacco materials in special short cigarettes. E-cigarettes are composed of essential oil solutions with about 15,500 flavourings used, many of which are toxic, cause health effects, can cause fire and explosion, and can mix other substances into the solution. While not risk-free, extensive scientific research suggests they are 90% less harmful than traditional tobacco products.
However, regardless of tobacco, it is necessary to prevent young people from accessing it in any form. So, cautious implementation and regulations are crucial. It’s vital to ensure these products aren’t marketed to non-smokers, especially youth, and that robust safety measures are in place. Additionally, comprehensive tobacco control policies remain essential.
By embracing a science-based approach that acknowledges the potential of harm reduction alongside traditional tobacco control measures, Bangladesh can join the global fight against smoking-related NCDs and cancer. This involves carefully evaluating the evidence surrounding safer alternatives like e-cigarettes and HTPs, developing appropriate regulations, and prioritizing public health over dogma. Only then can the country effectively protect its citizens from the devastating consequences of tobacco use.
The urgency for a science-based policy approach cannot be overstated. Policymakers must stay informed, continually updating strategies to bridge existing knowledge gaps. The 2019 statistics, revealing 4.7 million deaths in the Asia Pacific region attributed to tobacco, demand immediate and concerted action.
While some nations have made commendable progress, others, like Thailand and India, face challenges despite adhering to WHO. The crux lies in understanding that the core of the problem is smoking cigarettes, necessitating a targeted focus on behaviour rather than a blanket approach to all forms of tobacco consumption. Policymakers must exercise caution, inadvertently contributing to the escalating scourge of smoking.
As health policy leaders, we must advocate for a science-based approach and resist dogmatic prohibitions. The global alliance to end the use of combustible cigarettes by 2035 is an achievable goal, provided policymakers display the courage to embrace innovative solutions. Remember, quitting smoking altogether remains the best option for anyone’s health.
However, safer alternatives can offer a harm-reduction pathway towards a healthier life for those who struggle to quit in Bangladesh.
Md Fazlee Kibria Chowdhury is a doctor who obtained his MBBS degree from Dhaka Medical College and is a doctor of medicine in chest diseases. Currently, he is a consultant of respiratory medicine at Evercare Hospital, Chittagong
