Vulnerable to smoking

There is a strong link between price increase and quitting smoking

Even though laws prohibit the sale of cigarettes to children under 18 years of age, it is estimated that the number of children who smoke cigarettes is increasing in Pakistan. Research says that tobacco industry targets younger smokers who can be counted upon to continue smoking for decades.

Pakistan is among the most vulnerable countries when it comes to bearing the brunt of smoking. According to a fact sheet released by the Tobacco Control Cell (TCC) of the Ministry of National Health Services, Regulations and Cooperation, the number of tobacco users in Pakistan is 23.9 million. The number of smokers is 15.6 million. The ministry also found that 1,200 children in Pakistan start smoking every day. The WHO claims that the tobacco industry is a unique case of selling products that will kill almost 50 percent of its users.

A study titled, Global Burden of Disease by the Institute of Health Metrics and Evaluation, USA, indicated that in Pakistan about 163,360 people had died due to tobacco use in 2017. Moreover, over 5,000 Pakistanis were admitted to hospitals every day because of complications arising from the use of tobacco. The total costs attributable to all smoking-related diseases and deaths in Pakistan for 2019 was Rs 615.07 billion.

Meanwhile, promotion of cigarettes has not stopped in Pakistan despite the law passed in 2002. One of the main reasons for the ineffectiveness of government’s anti-tobacco policies is aggressive marketing by tobacco industry, especially on internet through social media influencers. Studies show that tobacco marketing drives the uptake of smoking, especially among young people. While tobacco industry continues to argue that it only markets to persuade adult smokers to switch brands, overwhelming evidence links the industry’s use of marketing to high rates of tobacco use.

These tactics of transnational cigarettes companies are not specific to Pakistan. Time and again, big tobacco companies have dug into their pockets for lobbying and spinning public perception. But in other parts of the world, they are finally being held accountable for past misdeeds. In the US, a federal court in 2017 ordered four tobacco companies, including Philip Morris USA to run ‘corrective statements’ on television, in print and online. The advertisement include admissions like, “Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction.”

Anti-tobacco activists believe that tobacco industry marketing remains a significant global problem, particularly among the vulnerable groups in the poorest countries who are the most exposed to it. A study titled Switch, Reduce, or Quit: How Do Smokers Respond to Tobacco Increase in Pakistan? was released in April 2021 by the Pakistan Institute of Development Economics (PIDE). It found that the initiation age for tobacco use in Pakistan is as early as six years. “Young people in general and adolescents, in particular, are the most vulnerable to initiate tobacco use.

Around 60 percent of smokers start using tobacco during their adolescent years.” The study also stated that among smokers, a majority (65 percent) used cheaper multinational cigarette brands. “Affordability is found to be the main facilitator for smoking, especially at a young age,” concludes the study.

The anti-smoking law, Prohibition of Smoking and Protection of Non-smokers Health Ordinance of 2002, prohibits the sale of cigarettes within 50 metres of any educational institution - school, college or university. This restriction is applicable to all children under the age of 18 years and all educational institutions. But since the enforcement of law is weak the exposure of children to smoking has increased.

According to the Society for the Protection of the Rights of the Child (SPARC), affordability of cheaper cigarettes and smoking habits of parents or friends expose most children to smoking. “Parents and policymakers are sensitised to harmful effects of smoking and such efforts have started giving results,” says Muhammad Kashif Mirza, the advocacy and communications manager at the SPARC. “If a parent is smoking in a family, the children can start smoking at an early age. The same happens in the case of peer smoking habits,” he adds.

Cigarette affordability, according to the WHO, is the main facilitator for smoking, especially among young people. Studies suggest that higher cigarette taxes deter smoking initiation among youth, reduce cigarette consumption, and even lead some smokers to quit. According to the US-based Campaign for Tobacco-Free Kids, “Tobacco tax increases are one of the most effective ways to reduce smoking and other tobacco use, especially among kids”. In the US, according to the Campaign, every 10 percent increase in cigarette prices reduces youth smoking by about 7 percent.

The tobacco taxes in Pakistan as a proportion of prices are much lower than the 70 percent minimum suggested by the WHO. The taxes should be increased at least to this threshold to have an impact on cigarette consumption in Pakistan, especially among the youth. The PIDE study also found a strong link between price increase and quitting smoking, “as prices (of cigarettes) increase, the number of quitters increases. A 50 percent increase in price would result in almost half of smokers quitting smoking, especially young smokers.”

The writer is based in Karachi

Tracking and tracing

The tracking and tracing of tobacco products as proposed by the WHO is an effective technique to tackle illegal tobacco markets

The World Health Organisation (WHO) asserts that smoking alone causes around 8 million casualties annually. This includes 1.2 million non-smokers as well. Pakistan presents unique challenges in terms of curtailment of tobacco consumption.

According to the World Bank report of 2019, Pakistan is included among the countries with highest prevalence of tobacco consumption. Owing to numerous structural issues and governance problems, Pakistan is among the worst victims of tobacco trade.

The alleged influence of tobacco companies is one of the prime factors that undermines the effectiveness of any tobacco control campaign planned for the benefit of the masses. Apparently, the tobacco lobby uses its connections to bend public policies in its favour through statistical exaggerations and false case studies.

A classic example of this influence is over-emphasising illicit trade as one of the factors exacerbating health and economic implications for the state. Oxford Economics and some other institutes of international repute claim that the percentage of illicit tobacco trade is as high as 41.9 percent in Pakistan. Upon close inspection, these claims, often funded or inspired by tobacco companies, are found full of contradictory facts and questionable methodologies. According to the official survey conducted by the Pakistan National Heart Association (PANAH), the volume of illicit trade is no more than 9 percent. This suggests that the figures quoted by the tobacco industry are highly inflated. The World Bank Group also reported in 2019 that the tobacco proponents have created a false impression of massive illegal trade in Pakistan to demand lower taxes.

Major tobacco firms have been accused of involvement in smuggling tobacco products due to the weak local legislative structure. According to rough estimates, the tobacco black market causes a revenue loss of around Rs 70 billion to the national exchequer. In order to put an end to this, the government of Pakistan has decided to introduce the tracking and tracing system.

The tracking and tracing of tobacco products as proposed by the WHO aims to tackle illegal tobacco markets. The Illicit Trade Protocols suggest that each product can be identified through its unique ID, thereby aiding the governance institutions to reach the source of this menace and nip the evil in the bud. The Federal Board of Revenue (FBR) will be getting all the details relevant to the manufacturing and taxation of each cigarette packet, thereby putting an end to illegal trade and tax evasions.

While the track and trace initiative was thought of as a major step to keep the tobacco industry in check, evidence suggests that the tobacco lobby has been successful in defying the local authorities.

It seems that in another attempt to sabotage the protocols initiated for controlling local and international smuggling, the tobacco companies have decided to control the tracking and tracing system through their front men and companies. It has been suggested that the story of tobacco track and trace system implementation in the European Union is being replicated by local actors.

The Illicit Trade Protocol needs to take into account the efforts of tobacco companies to overpower the accountability process. All the stakeholders must come together to ensure that the devious attempts by the tobacco lobby are countered with strict compliance of rules and regulations.

The mechanism must be implemented with complete transparency. Additionally, the companies must be fined heavily for their links with the tobacco industry.

— Aimen Babur

Vulnerable to smoking