The global initiatives for tobacco control are being spearheaded by the World Health Organisation (WHO) that has worked on comprehensive guidelines for countries striving to achieve this objective. These include the package called MPOWER developed to help the signatories implement WHO Framework Convention on Tobacco Control (FCTC) in a better way.
The word MPOWER stands for six actions supposed to Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship and Raise taxes on tobacco and borrows the first alphabets taken from these.
Pakistan is a signatory of FCTC and has been taking certain measures to curtail tobacco use. The country has a series of laws legislated before FCTC was ratified, such as the vend act 1958, cigarette printing of warning ordinance 1979 and prohibition of smoking and protection of non-smokers health ordinance 2002. Anyhow in order to comply with the terms of FCTC, the government has to show regular progress on tobacco control and update its status on MPOWER.
Dr Maria Qureshi, Project Director at The Network for Consumer Protection, says the country does not have any proper tobacco control policies. She says there have been multi-lateral surveys to monitor the extent of this issue and measures to protect people from exposure to second-hand smoke but a lot more needs to be done.
For example, she states, currently there are only two major cessation clinics in Pakistan and the warning about dangers of smoking through graphic health warnings on packs and all advertisements is 40 per cent. Though an increase to 85 per cent was announced by the government last year, the decision was then reversed and currently the civil society has taken the ministry to court so it may reinstate its previous order.
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Similarly, she says, there is a ban on tobacco advertising promotion and sponsorship (TAPS) but stricter controls are needed to check Point of Sale (POS) advertising. She hopes a law that has been presented in the Senate for a comprehensive TAPS ban would bring compliance to the concerned article of FCTC. "On taxation, as per the FCTC the Federal Excise Duty (FED) should be at least 75 per cent of the price of cigarettes though currently this tax is only 59 per cent. There is also a tier system making the more sold brands more affordable that should be done away with," she adds.
A recent debate in this context is about the role of provincial governments in tobacco control, especially after the 18th Amendment to the Constitution of Pakistan. According to a study, "Legal Framework For Comprehensive Ban on Tobacco Advertising, Promotion & Sponsorship (TAPS)" carried out by The Network for Consumer Protection, the implementation and enforcement of tobacco control being a matter of public health falls in the jurisdiction of the four provinces and, thus, is an inter-provincial issue as tobacco is grown in specific areas and traded in all the four provinces.
In addition to tobacco-specific laws, the study adds, certain general legal instruments are available with the provincial governments, which they can employ to take executive measures against the spread of tobacco. For example, the provincial governments can invoke The Public Health (Emergency Provisions) Ordinance, 1944, declare tobacco use an issue of public health emergency and act accordingly.
The study also refers to a Supreme Court (SC) decision on February 3, 2016 that set aside the stay order on an SRO challenged by Philips Morris International (PMI) in the Sindh High Court (SHC) on grounds that the federal government cannot regulate health related affairs. This shows that health regulatory matters still lie in the jurisdiction of the federal government.
The tobacco industry also has its story to tell. According to an industry representative, currently the legitimate market holds 60 per cent of the market share and the remaining 40 per cent is held by the illegal cigarette industry growing unabated. He says it is important to note here that this very segment of the industry has made the government of Pakistan suffer Rs91 billion in revenues through tax evasion in the past five years.
He says the real issue lies in lack of enforcement of the existing laws. "The legitimate industry (60 per cent of the market) complies with all of the TAPS regulations whereas the illegal industry complies with none. In addition, other tobacco products including smokeless tobacco (naswar, gutka, etc.) go unchecked."
The representative says FCTC calls for a 30 per cent on textual warning and states that it ‘may be in the form of or include pictograms or pictures’. "Pakistan with its current graphical health warning constituting 40 per cent of the size of the pack is already 10 per cent in excess of the FCTC’s minimum recommendations," he says, adding: "121 countries in the world still have no graphical health warning and of these 54 have no health warning at all. Pakistan, on the other hand, is ahead of 121 countries in terms of size and type of health warning."
He says it is imperative that the black market of smuggled cigarettes that sell openly without health warnings shall be brought under check before additional size increases as consumers will always have the option to switch to the warning free alternatives.
Banning tobacco crop he says would affect the livelihood of growers and 0.6 million vendors across the country. "These growers were made to switch to tobacco from opium," he adds.
Dr Maria Qureshi, a public health expert, believes the menace of smuggling has to be checked by the Federal Board of Revenue (FBR) and it has nothing to do with the health-related initiatives. She also says there is no evidence that existing tobacco growing areas would produce opium in the past.
On the issue of the proposed anti-tobacco legislation, she says there are groups within PTI. "One group is totally against tobacco and the other comprises tobacco growers and their supporters. The party needs to adopt a clear stance," she adds.
Fact Sheet
TNSreceived a fact sheet prepared by the Tobacco Control Cell (TCC) of the Ministry of NHSR&C. Its selected contents follow:
Under Section-5 of the "Prohibition of Smoking and Protection of Non-Smokers Health Ordinance, 2002", use of tobacco products at any place of public work or use is prohibited. Lahore High Court (LHC) declared adjacent places to hotels/restaurant as public places. Prior to that, smoking was not banned in open to sky places. After this decision, smoking is banned at open to sky places adjacent to hotels and restaurants.
TCC is coordinating with provincial and district governments to make public places smoke-free. Islamabad has been declared first Smoke-free city. Public parks, health and educational institutions are completely smoke-free. Regarding enforcement, more than 800 cases have been registered against the violators of tobacco control laws (violations at public places) across Pakistan.
Pakistan established cessation clinics at national and sub-national level with government funds. Two clinics have been established in Pakistan Institute of Medical Sciences and National Institution for Rehabilitation Medicine (two tertiary level hospitals). One clinic has been established in District Headquarters Hospital (secondary level) in Gujranwala.
Despite strict restrictions on TAPS, some promotional activities at Point of Sale (PoS) are going on. Tobacco industry is also sponsoring some activities under the umbrella of Corporate Social Responsibility (CSR). In 2016, current legislation to ban TAPS will be strengthened by banning POS advertising.
The ministry is planning to consult the stakeholders to devise a strategy on introducing possible alternative crops in tobacco growing areas. Identification of alternative crops is also a consideration.
Last year, 21.6 per cent and 15.12 per cent FED was increased on lower and upper slabs respectively. In November, 2015, 7.58 per cent and 4.13 per cent FED was further increased on lower and upper slabs respectively (total increase in FED was 30.88 per cent on lower and 19.87 per cent on upper slabs). In future, the working group will continue to work and will develop a roadmap for progressive increase in tobacco taxation by Ministry of Finance in upcoming budgets, leading to implementation of WHO recommendations by 2018. i.e. 75 per cent tax of retail price. Current tax rate is 65 per cent of consumer price in Pakistan.