Tobacco control is one of the biggest challenges faced by the global community. It is a strange situation where its business is legal but consumption totally unadvised. The companies producing tobacco products are allowed to sell their products but under strict rules where they cannot target new smokers and under-aged people. There are restrictions on the advertising of their product in the mass media and sponsoring of events where their brands and logos could be displayed.

Amid all these restrictions there are still concerns about the success of initiatives and the tactics adopted by cigarette companies to maintain and boost their sales and expand their clientele.

In this backdrop, the sixth session of the Conference of the parties (COP6) to the WHO Framework Convention on Tobacco Control (FCTC) was held in Moscow earlier this month. Several landmark decisions were adopted in the course of the six-day session, which has been termed one of the most successful in the WHO FCTC’s history.

The concerns of the parties (signatory countries) represented at the event are genuine and well-reflected in the words of WHO Director General Dr Margaret Chan. She said, "as implementation of the Framework Convention reaches new heights, the tobacco industry fights back, harder and through every possible channel, no matter how devious those channels and practices are."

Pakistan was also among countries which presented their case at the event and devised their future course of action. It was observed by the international community that though the country had progressed a lot in this regard there were some areas which have to be addressed on priority basis.

Focusing on Pakistan’s case, Caroline Renzulli, who is associated with the international communications wing at the global Campaign for Tobacco-Free Kids, says "the FCTC obligates parties to implement proven measures to reduce tobacco use -- including 100 per cent smoke-free spaces, graphic pictorial warning labels, increased tobacco taxes, and comprehensive bans on tobacco advertising, promotion, and sponsorship."

Though Pakistan does have a smoke-free law, she says, "stronger enforcement of this law is needed to protect all Pakistanis from the dangers of secondhand smoke." She adds that Pakistan does have graphic warning label but the WHO recommends implementing warning labels that can be rotated (repeated and revised) so that the labels remain impactful over time. This, she says, "has not been done in Pakistan despite the two year mandated rotation by the law."

Caroline tells TNS that "another major concern regarding tobacco control in Pakistan is that smokeless tobacco use is high here and these are not included in many of the country’s tobacco control laws." For example, she says, smokeless tobacco products are not required to have warning labels which are an effective means to warn of the dangers of tobacco use.

The tobacco tax regime in Pakistan is also an area under the scanner. WHO recommends raising tobacco excise taxes so that they account for at least 70 per cent of the retail price of smoking tobacco products. But Pakistan’s taxes fall well below this recommendation. The country has a complex tax structure where there are different rates of taxes on different tobacco products.

The tax rates are high on expensive brands and low on the cheaper ones. It is advised that excise rates should be the same for all the products regardless of the price tag. If this happens, one will not feel compelled to switch to products which are cheaper and the taxes applied on them are lower.

Caroline says that point of sale (POS) advertising remains an issue in Pakistan as it is the major tool for promotion of tobacco products after the ban on advertising in the mass media. Tobacco marketing at POS, she says, "includes advertising, promotion (through price discounts and free product giveaways), and product display at any location where tobacco products are sold."

She makes the point that POS marketing weakens the effectiveness of tobacco control laws, and exposes the population to tobacco industry marketing tactics that are intended to increase the sale and consumption of tobacco products. "Youth are particularly vulnerable to POS marketing and it makes it harder for smokers to quit," she concludes.

Mazhar Nisar Sheikh, Director Implementation at the Ministry of National Health, Services, Regulations, and Coordination agrees there are issues related to tobacco control in Pakistan but adds that "the government had achieved a lot of desired results. Efforts were also underway to further tighten control on tobacco use through additional measures."

He tells TNS the Tobacco Control Cell (TCC) was established in Pakistan July 1, 2007 to fulfill the obligations under FCTC. He says TCC, since its inception, is implementing multifarious strategies to reduce prevalence of tobacco use in Pakistan. Some major achievements of the Cell, he says, are introduction of pictorial health warning on cigarette packs and outers, ban on free samples, cash rebates, discounts and sponsorship of events, restrictions on tobacco advertising, promotion and sponsorship, ban on manufacturing and sale of cigarettes packs having less than 20 cigarette sticks, illegalization of "Designated Smoking Areas" and incorporation of tobacco control messages in curriculum.

Besides, he says, "a working group consisting of technical experts from FBR, WHO, World Bank, etc, has been formed. This group will help the country develop an implementation mechanism to increase taxes on tobacco products and earmark tobacco tax revenues for tobacco control measures including treating diseases caused by tobacco use, in Federal Budget 2015-16."

Mazhar dispels the impression that tobacco control laws are hardly enforced in Pakistan and says that more than 100 cases have been registered against companies for violating tobacco control laws. Out of these, five cases were registered against Phillip Morris International (PMI) Pakistan, three against Pakistan Tobacco Company (PTC) and the remaining against the management of sheesha bars, retailers, smokers, cigarette smugglers and so on.

"All these measures aimed at controlling tobacco use cannot deliver until and unless there is a drastic reduction in the quantity of tobacco grown in the country," says Nadeem Iqbal, CEO at The Network for Consumer Protection, based in Islamabad.

He rejects the justification that tobacco cultivation is acceptable as it gives good returns to farmers in a conflict zone. He says if this logic is to be accepted then one can also justify growing of poppy and opium in the same region. He urges on the government to discourage tobacco cultivation in KP and help tobacco farmers switch to some other crop.

He says a strong resolve is required to achieve this end as tobacco growing lobby is very influential and is always running campaigns in favour of tobacco cultivation.

For example, the message an advertisement conveys is that tobacco can grow on soils with low fertility which are invariably not suitable for successful production of other crops and in areas that are distant from air and shipping ports, which are unsuitable for crops grown in bulk, unless the crop yields high returns that allow for the travel costs to be covered.

Besides, the lobby claims that tobacco is less perishable than most other potential alternative crops and can easily be stored; there is no better cash crop in most environments suited to tobacco, the crop enjoys very high price stability and in many areas of the world, it is the only crop paid for in cash on delivery, or very shortly after.

"All these justifications hold no ground when one finds that, as per WHO claim, tobacco kills nearly 6 million people each year," Nadeem remarks. He says it is a false claim that tobacco growing farmers are well-off. The reality, he says, is that they are the exploited lot bonded by debt and unable to switch to other crops.