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Tobacco control: ‘MPOWER’ measurements of WHO

Published : Friday, 31 May, 2019 at 12:00 AM  Count : 982

Tobacco control: ‘MPOWER’ measurements of WHO

Tobacco control: ‘MPOWER’ measurements of WHO

More than one-third (35 per cent) of Bangladeshi adults are accustomed to tobacco either in smoke and/or in smokeless form. Another one-third (39 per cent) of adult population is exposed to secondhand smoking at their homes, if you consider the workplace, the percentage is higher (43 per cent) than home. These tobacco affiliations result into a yearly economic cost of 159 billion taka for Bangladesh. The figure includes direct costs related to healthcare expenditures and indirect costs related to lost productivity due to early mortality and morbidity in our country.
In 2003, WHO came up with Framework Convention on Tobacco Control (FCTC) for countries like Bangladesh and others to help them fight against tobacco. Bangladesh being one of the foremost countries to ratify the FCTC (in 2004) enacted the Smoking and Using of Tobacco Products (Control) Act in 2005. In 2008, WHO suggested that countries should respond to the tobacco epidemic through full implementation of the FCTC and by adopting the MPOWER measures at the highest level of achievement, which involves developing, implementing, and enforcing the most effective tobacco control policies aimed at reducing the demand for tobacco.

The MPOWER package containing the following six basic strategies, which are in parallel with the measures and practices in the Tobacco Framework Convention: monitoring tobacco use; protecting people from tobacco smoke; offering help to quit tobacco use; warning about the dangers of tobacco; Enforcing bans on tobacco advertising and promotion; and raising taxes on tobacco products.
National Tobacco Control Cell (NTCC) has been established in 2007 for controlling tobacco activities in Bangladesh as a central hub of national coordination, referral and support centre for all tobacco control stakeholders. Supervision, monitoring & coordination of anti-tobacco activity have also been conducted from this cell. The mission of NTCC is to protect people of Bangladesh from the devastating and harmful effect of tobacco through raising mass awareness and effective enforcement of tobacco control law.

In Bangladesh, there are several policies for tobacco control and prevention such as Tobacco Control Law 2005 with amendment of 2013; Smoking and Tobacco Products Usage (Control) (Amendment) Act 2013; Smoking and Tobacco Product Usage (control) Rules, 2015; Health Development Surcharge Management Policy 2017 etc. Through amending the tobacco control law in 2013, smokeless tobacco is brought under purview of law; penalty for violation of various sections of the law has been increased; ban on advertisement of tobacco products made comprehensive; sale of tobacco to and by minors has been banned and printing of Graphic Health Warning on packs of tobacco products made mandatory since 2016.
Moreover from 2017, government introduces the integration of tobacco cessation into health services through training program for health care physicians. The comparison fact sheet of GATS 2017 report revealed a significant increase of the proportion of current smokers who were advised to quit by health care providers from 52.9 per cent in 2009 to 65.8 per cent in 2017 in Bangladesh. But unfortunately there was no significant change in the percentage of smokers who made quit attempts in the last 12 months.The percentage of current smokers who thought of quitting smoking tobacco use because of health warnings on cigarette packages increased significantly in 2017. The percentage of adults who noticed anti-cigarette smoking information during the last 30 days in any media/location increased significantly from 49.8per cent in 2009 to 55.9per cent in 2017.

Raising taxes on tobacco products would save lives and increase Government Revenue as this is the most effective way to reduce tobacco use. Higher prices discourage youth from initiating tobacco use and encourage current users (nearly 6.4 million among 3.1 million cigarettes smokers and 3.3 million biri smokers) to quit.  Moreover, value added tax; supplementary duty and health development surcharge are imposed on all kinds of domestically produced tobacco products including cigarettes, biri and smokeless tobacco products to curb this tobacco menace.

Recently, a committee on Health Development Surcharge Management has decided to approve around 70 million BDT from government revenue for use in tobacco control. The National Tobacco Control Policy (Draft) is now in final stage. On the other hand, Health Services Division has taken a new initiative to ensure 100per cent smoke free environment in educational institutes and display no-smoking signages as per tobacco control law & removal of point of sales of tobacco products from entry points of educational institutes. But unfortunately, we are yet to see its impact at educational institutes.  

One study finding revealed that smoking in medical profession is notable in Bangladesh. Compare to 55per cent smoking in male adults in general population 33per cent male doctors of a tertiary level hospital smoke. However, doctors and other health-care workers are most effective in assisting patients to quit when they serve as role models by not smoking themselves. Their effectiveness increases further if they are visibly involved in local and national tobacco control activities. Therefore, appropriate measures need to be taken as WHO suggests "health professionals should not smoke".

Survey shows that about 70 per cent of smokers and 50 per cent of smokeless tobacco users are willing to quit tobacco in Bangladesh. However, tobacco cessation service is not adequate in our country context. A recent study showed that tobacco cessation by a simple counselling can be very successful in a village level clinic in Bangladesh, especially for smokeless tobacco use, where its prevalence dropped from 33.2per cent to 0.4per cent from 1st to 5th counselling session. So this type of counselling service can also be taken for cessation strategy.

In order to achieve the Sustainable Development Goal target of a one-third reduction in NCD premature mortality by 2030, tobacco control is a priority for governments and communities worldwide. But still, the country is not on track to meeting this target as 7 per cent of youth aged 13 to 15 years use tobacco which is alarming. Therefore, research based appropriate measures should be taken to make the country tobacco free by 2040.  We all start campaign for no tobacco not only celebrating the World no Tobacco day on 31 May each year but for round the year and ensure sustainable development for our future generation.
The writer is Deputy Director (Research), Bangladesh Institute of Governance and Management

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