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Rising tobacco use sparks concerns

  • Published at 05:39 am June 1st, 2013
Rising tobacco use sparks concerns

The tobacco control law of 2005 provides for bans on advertising, promotion and sponsorship, smoking in public places and public transports and requirements for warning on cigarette packets. However, direct tobacco advertising had been banned only for smoking products. Advertisements through points of sale, the Internet, international TV and radio had not been fully covered in that law.

Also, indigenous tobacco products such as bidi (made of raw tobacco), jorda (tobacco leaf), gul (grains of tobacco) are not included in the tobacco control law. Since the costs of these products are very low, they are easily available to a large number of people in lower income groups in the country, including young and female users.

Anti-tobacco activists in the country have long been calling the 2005 law “weak” and unable to effectively control tobacco usage in the country. The activists also said that the law had some legal loopholes, which tobacco companies can use to run their promotional activities. Also, the lacks of implementation and proper monitoring have made some of the provisions of the law a futile.

The good news is, after overcoming more than four years of delays and strong tobacco industry opposition, the Parliament of Bangladesh enacted a new law this April that significantly strengthens the country’s efforts to reduce tobacco use.

The current tobacco control law in Bangladesh has several shortcomings. The smoking ban allows for smoking areas; its advertising ban applies only to direct advertising, but not corporate social responsibility activities that the industry uses to promote itself. The law requires text warnings on cigarette packs, but not the more effective pictorial warnings, and the labelling law does not apply to the smokeless tobacco products which are very popular in South Asia.

The new law closes loopholes in the country’s existing health laws, including strengthening restrictions on tobacco advertising, promotion and sponsorship and expanding requirements for smoke-free public places.

The new law:

Ÿ             * Requires graphic warning labels covering 50% of the front and back of tobacco packaging

Ÿ             * Bans point of sale advertising, promotion of corporate social responsibility projects and signboards

Ÿ             * Expands smoke-free public places to include restaurants and workplaces

Ÿ             * Bans the sale of tobacco to and by minors

Ÿ             * Bans the use of misleading descriptors such as “light,” “low tar,” “mild” and “ultra light”

Tobacco consumption  in Bangladesh

According to data from the Global Adult Tobacco Survey (GATS) done in in 2009 , a total of 41.3 million adults currently smoke tobacco or use it in a smokeless form in Bangladesh.

About 21.2m men, 0.7m women and overall 21.9m adults currently smoke tobacco.

Nearly 12.5m men, 13.4m women and overall 25.9m adults currently use smokeless tobacco.

Among the youth (age 13-15), about 2% currently smoke cigarettes (boys 3%, girls 1%). Nearly 6% currently use tobacco products other than cigarettes (boys 8%, girls 4%).

Bidis, cheaper handmade cigarettes, are popular among the poor in Bangladesh and account for 75% by volume of  cigarettes sold.

Over 57,000 people die in Bangladesh each year from tobacco related diseases. About 16% of all deaths among people age 30 years and above are attributable to tobacco use. There are about 1.2m cases of tobacco-related illnesses in Bangladesh each year.

Nearly 42% of the youth (age 13-15) are exposed to secondhand smoke in public places and 35% are exposed to secondhand smoke at home.

The GATS report said that six in every 10 workers are exposed to tobacco smoke at  indoor workplaces. It also said that lost economic opportunities in highly populated, developing countries are severe because half of all tobacco related deaths occur during the prime productive years (age 30-69).

Tobacco and women in Bangladesh

Women comprise 20% of the world’s more than one billion smokers. In Bangladesh, 29% of adult women uses tobacco in some forms, said the global adult tobacco survey of 2009 (GATS) of Bangladesh.

Especially high are rates of smokeless tobacco use among women and exceed use of the same among men. Nearly 28% of adult women uses smokeless tobacco, about 1.5% smoke cigarette, while 1.1% smokes bidis, the GATS data said.

Women also report high levels of exposure to second-hand smoke from smoking by men. In 2009, 30% of women reported exposure to secondhand smoke at the workplace and 21% reported exposure in public places.

Dr Arup Ratan Chowdhury, a noted anti-tobacco activists said that the use of smokeless tobacco in the form of Jarda or Gul is a serious concern among Bangladeshi women.

“Smokeless tobacco causes oral cancer, esophageal cancer, pancreatic cancer, increased blood pressure and heart rate and negative reproductive outcomes such as an increased risk of having a low birth weight infant”, he said.

He also said that while females smoke less than men, non-smoking women and girls suffer increased risk of lung cancer and other health problems due to secondhand smoke exposures from males.

Tobacco taxation

Strange as it might sound, the truth is  tobacco products purchasing power of  people in Bangladesh has actually increased in the last two decades as the real price of tobacco hasn’t increased the way prices of other essential commodities have.

At the beginning of 1990, an average smoker, who smoked one packet of medium or higher end cigarettes per day, needed to spend about 17% of his/her monthly income on the tobacco product.

But now a smoker, even with the habit of consuming a packet of premium quality cigarettes, doesn’t need to spend more than 6-7% of his/her monthly income on it.

Explaining the matter, tobacco economist and media and advocacy coordinator of the US based Campaign for Tobacco Free Kids (CTFK), Taifur Rahman, said based on the median income of people then and now, it is evident that the purchase power of tobacco has increased.

The tobacco economist said, faulty taxation has dropped tobacco prices in Bangladesh “steadily” since 2001, encouraging new users.

He said the problem with tobacco taxation in Bangladesh is that it doesn’t have a uniform tax model, rather it has four types of taxation slabs based on cigarette pricing. Tax on brands priced at Tk12.10 to Tk12.43 per pack of 10 sticks is 39%. The tax on packs priced at Tk24.75 to Tk25.30 is 56%, for those costing Tk35.20 to Tk39.60 is 59% and for those priced at Tk66.0 a pack and above, it is 61%.

Cigarettes priced at Tk1 constitute over 51% of the total harmful products consumed, which was only at 20% five years ago, he said.

Rahman said, increasing the price of tobacco through higher taxes is the single most effective way to decrease consumption and encourage tobacco users to quit.

He said increasing tobacco taxes by 10% decreases tobacco consumption by 4% in high-income countries and by about 8% in low and middle income countries.

“A 70% increase in the price of tobacco could prevent up to a quarter of all smoking related death worldwide,” he said

Rahman said, young and lower income people are much more sensitive to the price of goods. Tax increases help the poor stop using tobacco and allow them to re-allocate their money to food, shelter, education and health care.

He said tobacco tax increases do not reduce government revenues, in fact, increasing tobacco taxes by 10% generally leads to increases in government tobacco tax revenues of nearly 10%.

He suggested that all products must be taxed at equivalent rates to prevent tobacco users from switching tobacco brands and types based on tax and price differences.

Referring to the International Tobacco Survey in 2009, he said that the survey showed tobacco products became more affordable in 2006 than in 1990 due to its declining real prices.

“Globally it is evident that increasing taxes at a certain level reduces consumption, but immediately pushes government’s revenue,” Rahman said.

“It’s because people don’t quit (tobacco) immediately after the tax is imposed. So revenues don’t fall suddenly.” He said South Africa has been constant in increasing tobacco taxes. “Finally it went up to a level when industries were compelled to raise their products prices to survive in business.”

Interestingly, referring to WHO studies, Rahman said Bangladesh spends double of what it earns from tobacco. The WHO study in 2004 said Bangladesh earned around Tk26bn in revenue from the tobacco sector while nearly spends Tk50bn for tobacco-related illness.

“So if a proper study has been conducted, I think the policymakers will realise the false fact that tobacco sector is one of the highest revenue earning sectors for the government,” he said.

Noted economist Abul Barkat said, before the last budget, the real price of tobacco had, indeed, fallen in Bangladesh as the different taxes were levied on different price slabs and were never based on inflation.

Increasing real incomes have made  tobacco products affordable, he observed and recommended specific cigarette tax of Tk34 per 10 cigarettes, Tk4.95 per pack of 25 bidis and ending existing price slabs.

“Then government will earn Tk22.2 bn more in revenue from those products even though 10.4m people will quit the habit,” he noted in a report. “It will save thousands of lives in Bangladesh where more than 150 people are estimated to be dying every day due to tobacco-related illness.”

He said that the 2012-13 budgets drew intense backlash as the finance minister, without abolishing price slabs on cigarettes, made a 10% price

hike in all four slabs, which, economists argue, only benefited tobacco manufacturers.

The budget imposed only 3% more supplementary duty on the cheapest brand of cigarettes and 1 % on the other three slabs.

That raised the supplementary duties to between 39% and 61% in four tiers from between 36% and 60%. “This type of increase only benefits the tobacco companies, not the cause of helping people to quit smoking,” he said.

Tobacco promotion and marketing

To sell a product that kills up to half of all its users requires extraordinary marketing savvy. Tobacco manufacturers are some of the best marketers in the world and increasingly aggressive at circumventing prohibitions on

advertising, promotion and sponsorship that are designed to curb  tobacco use.

Through advertising of its products, the tobacco industry tries to create an environment in which tobacco use is familiar and socially acceptable and the warnings about its health consequences are undermined.

Anti-tobacco activists across the world have long been fighting for comprehensive bans, which prohibit use of all marketing strategies by the tobacco industry, reduce tobacco use among people of all income and educational levels.

Partial advertising bans are less effective, in part, because the tobacco industry switches its marketing efforts to unrestricted outlets when bans are not comprehensive.

A study of 22 developed countries found that comprehensive bans reduced tobacco consumption by 6.3%. A study of 102 countries showed that in countries with partial bans, consumption only decreased by 1% compared with almost 9% in countries with comprehensive bans.

Anti-tobacco activists in the country have long been asking for a full-fledged study on how the tobacco industry has run its promotional campaign using the loopholes in the tobacco control act to its favour.

But only a single study has been conducted on tobacco promotion activities till now.

The Naogaon civil surgeon is implementing a project called the “model district on tobacco advertisement, promotion and sponsorship (TAPS) ban,” in collaboration with the national tobacco control cell (NTCC) of MOH&FW and WHO.

A baseline survey was done in all district and upazila headquarters to document violation of the TAPS ban. Members of the rover scouts collected relevant data by following a guideline and using a pre-tested questionnaire. An end-line survey will be conducted at the end of the project to find out the impact of the project and a report will be published.

Dr Mahfuzul Haq, technical officer of WHO in Bangladesh said the tobacco industry’s marketing strategy in Bangladesh is a complex issue, with practical and academic dimensions.

“A study on such a marketing strategy would require sound methodology and credible data.

The tobacco industry will not cooperate by disclosing their marketing strategy, so data collection will be a real challenge,” he said

Dr Haq said if the government imposes pictorial warnings on tobacco products packaging, it will work as a boomerang for the industry.

“The shiny tobacco packaging itself is a big marketing tool for tobacco. With pictorial warnings, such marketing techniques will effectively lose their edge,” he noted.