As the world observes World No Tobacco Day tomorrow, Pakistan needs to do more to save its people
The tobacco epidemic is one of the most significant public health risks humankind has ever encountered, with deaths of more than 8 million people globally in a year. More than 7 million of those deaths result from direct tobacco use. At the same time, around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
More than 80 percent of the tobacco use remains in low- and middle-income countries, resulting in tobacco-related health diseases and mortality. Tobacco use aggravates poverty by switching domestic spending from essential commodities, such as food and shelter to tobacco.
The WHO Framework Convention on Tobacco Control (FCTC) is a global treaty to address the global tobacco epidemic. It is legally binding for the state parties.
Global Adult Tobacco Survey (GATS) is the global standard for systematically monitoring adult tobacco use (smoking and smokeless). It was conducted by the Tobacco Control Cell of the Ministry of National Health Services, Regulations and Coordination in coordination with the Pakistan Bureau of Statistics and the World Health Organisation. It was the first survey of its kind carried out in Pakistan in 2014. It was a population-based survey of those aged 15 years and older.
Pakistan signed and ratified the WHO FCTC in 2004. Like most countries, Pakistan has made significant progress in tobacco control since the Convention entered into force. Under Article 5.2 of the FCTC, the parties to the treaty are mandated to place proper and effective national coordination mechanisms for multi-sectoral coordination of tobacco control efforts.
To fulfill obligations under Article 5.2 of FCTC, Tobacco Control Cell was created in the Ministry of Health (Defunct) on July 1, 2007, under the director general for implementation as a part of the non-development budget. The objective of the Tobacco Control Cell is to reduce the prevalence of tobacco use in Pakistan by taking administrative, legislative and coordination measures and implementation of FCTC Articles.
Every year, WHO recognises individuals or organisations in each of the six WHO regions for their accomplishments in the area of tobacco control. This year, the Tobacco Control Cell became the recipient of this award for their decade-long efforts and struggle towards FCTC-compliant tobacco control policies and their implementation with support from stakeholders across the country.
To comply with obligations under Article 11 of the FCTC, Pakistan introduced pictorial health warning (PHW) on cigarette packets and outers in 2010. This warning was supposed to be rotated on a yearly basis. In order to rotate the existing PHW, Tobacco Control Cell notified a new pictorial health warning on January 29, 2015. It also enhanced the size from 40 percent to 85 percent of cigarette packs on both sides. This PHW was to be implemented from March 30, 2015. Later, the implementation date was extended and an inter-ministerial committee (IMC) to review the impact of pictorial health warning on revenue and smuggling and to consult with stakeholders regarding implementation issues was constituted.
The committee deliberated on the issue and recommended a phased approach. Meanwhile, two petitions were filed in Islamabad High Court against the constitution and decision of the committee. This ministry is a party to the case. The matter is still before the court.
Health costs associated with tobacco-related disease and higher indirect costs related to premature loss of life and disability due to tobacco-related disease create significant negative externalities of tobacco use.
Health costs associated with tobacco-related disease and higher indirect costs related to premature loss of life and disability due to tobacco-related disease create significant negative externalities of tobacco use. Efficient tobacco taxes reduce these externalities through reduction in governments’ expenditures for healthcare costs. Implementation of Article 6 of the WHO FCTC is an indispensable element of tobacco-control policies and, thereby, efforts to improve public health.
To increase tobacco taxes in federal budgets for 2015-16 and 2016-17, the working group made recommendations to the Ministry of Finance/Federal Board of Revenue (FBR). Resultantly, there was an increase of 40.3 percent in excise duty on cigarette packs (44.77 percent on lower slabs and 35.89 percent on upper slabs, respectively).
In the 2017 finance bill, the duty was increased from Rs 74.10 to Rs 74.80 for the upper slab and Rs 32.98 to Rs 33.40 for the lower slab. A new slab, with a reduction in FED (i.e. Rs 16) was created. This resulted in a decrease in consumer prices for most sold brands from Rs 72 to Rs 48.
The decision was challenged before the Wafaqi Mohtasib. The WM issued directions to implement Article 6 and 15 of the FCTC. The decision was challenged before the president of Pakistan who set aside the decision on technical grounds. The Tobacco Control Cell evaluated the impact of the introduction of the third slab on the revenue growth and growth in the production of cigarettes and requested the FBR/Finance Division to withdraw the third slab.
In the 2018 finance bill, the 3-tier structure was continued but excise duty on all three tiers was increased from Rs 16 to Rs 16.96, Rs 33.40 to Rs 35.40, and Rs 74.80 to Rs 79.28. In addition, a health levy at the rate of Rs 10 per kilogram was proposed to be imposed on raw tobacco. The TCC proposed a levy on cigarettes at the rate of 10 percent of the printed retail price of cigarettes. The parliament has since withdrawn the levy imposed on tobacco. In return, the excise duty on all three tiers was increased from Rs 16.96 to Rs 17.08, from Rs 35.40 to Rs 35.52 and from Rs 79.28 to Rs 79.40.
In September 2018, the new federal minister for National Health Services, Regulations, and Coordination (NHSRC) requested the minister for finance to increase taxes on cigarette packs and remove the third-tier introduced in the Finance Act. Moreover, the ministry was requested to introduce a tracking system. In the Finance Supplementary (Amendment) Bill 2018, excise duty on all slabs was increased - from Rs 17.08 to Rs 25.00, Rs 35.52 to Rs 36.80, and Rs 79.40 to Rs 90.00.
The tobacco industry argues that high taxes on tobacco products make them expensive so that smokers are tempted to buy smuggled, counterfeit, and non-custom paid cigarettes. It says this increases the rate of illicit trade of cigarettes. Tobacco Industry claims that the share of the illegal trade of cigarettes in Pakistan reached 37.6 percent in 2020.
In March 2021, tobacco industry was quoting a figure of Rs 44 billion annual loss due to illicit trade of cigarettes in Pakistan. Three months later, they are claiming that this figure has increased to 75 percent and comes to a Rs 77 billion loss. They are heavily and aggressively promoting this figure through a mass media campaign to discourage the government from increasing taxes on tobacco in the upcoming budget.
Non-communicable diseases (NCD), including heart diseases, stroke, cancer, diabetes, and chronic lung diseases, are collectively responsible for almost 68 percent of all deaths in Pakistan. In Pakistan, the NCDs are causing 51 percent of the total burden of diseases, mostly in the young age group. Pakistan is obligated to achieve the targets set in the Sustainable Development Goals (SDGs). Under target 3.4, Pakistan has to reduce one-third of premature mortality from NCDs by 2020. Simple measures could reduce the burden of NCDs, including tobacco use.
Based on evidence, a Federal Health Levy Bill was drafted by the Tobacco Control Cell for consideration of the cabinet to impose a Federal Health Levy at the rate of Rs 10 per pack of 20 cigarette sticks and Re 1 per bottle of two hundred and fifty milliliters on sugary drinks for the financing of Health Insurance Scheme, Fatal Diseases Programme and other NCDs Control Programmes.
The ministry of NHSR&C amended/updated the bill and included measures to check illegal manufacturing and illicit trade of cigarettes and other tobacco products. After vetting, the draft bill was handed over to the FBR to include its provisions in the Finance Bill, 2019. Unfortunately, the provisions of the Federal Health Levy Bill, 2019, were not made part of the Finance Bill.
On the request of the FBR, the Law Division has vetted this bill again.
sPakistan’s children are also subjected to a wide array of tobacco industry tactics near their schools that encourage lifelong tobacco addiction. To counter this damaging trend, the Ministry of National Health Services, imposed a ban on the display of tobacco products/cigarettes at sale points in 2020.
The writer is a former technical head of the Tobacco Control Cell, Mo NHSRC, and a former focal person of the government of Pakistan to FCTC & ITP. He can be reached at [email protected]