- BY Aung Tun
Tobacco is one of the world’s leading health threats, and a main risk factor for non-communicable diseases (NCDs) including: cancers, diabetes, chronic respiratory disease and cardiovascular disease. According to Myanmar’s “The Control of smoking and consumption of Tobacco law”, Tobacco products means any material prepared for the purpose of smoking or consumption of the whole or part of the tobacco plant, leaf or stalk of the same.
Tobacco is used in many different ways around the world, but the global predominance is the use of manufactured cigarettes, which account for 96% of total worldwide sales. The next largest components are the smoking of bidis in South-East Asia, the chewing tobacco in India and Myanmar and the smoking of kreteks in Indonesia. New forms of tobacco are constantly being invented, while older forms historically localized to specific regions of the world (such as the hookah and bidi) are becoming global.
Nearly 20% of the world’s adult population smokes cigarettes. About 800 million adult men and nearly 200 million adult women worldwide smoke cigarettes. Cigarette consumption historically has been highest in high-income countries. Total consumption of tobacco products is increasing globally. More than 80% of the one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Deadly Chemicals in Tobacco smoke
Tobacco smoke contains more than 7000 chemicals including at least 70 known carcinogens that can damage nearly every organ in the human body. Tobacco smoke includes tar, carbon monoxide, nicotine and thousands of other chemicals, many of which are toxic, addictive, carcinogenic and damaging to the coronary arteries that supply the heart. The use of any tobacco product can cause disease and other adverse health effects. The adverse health effects of tobacco use are also experienced by non-smokers exposed to second-hand smoke. No tobacco product is safe.
Tobacco use is the leading preventable cause of death. This year, more than 7 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease. The annual death toll from the global epidemic of tobacco use could rise to 8 million by 2030.Tobacco caused 100 million deaths during the twentieth century, and if current trends continue, approximately 1 billion people will die during the twenty-first century because of tobacco use.
The Risks to Lung Health posed by Tobacco
Tobacco smoke has major implications for the lung health of smokers and non-smokers globally. Exposure to tobacco is a principle contributor to the development of the following lung diseases. -Lung cancer. Tobacco smoking is the primary cause for lung cancer, responsible for over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or in the work place also increases risk of lung cancer. -Chronic Obstructive Pulmonary disease (COPD). Globally, 45% of all deaths from COPD are attributed -to tobacco use. -Asthma. Exposure to tobacco also aggravate asthma. -Tuberculosis. Tobacco smoking increases the risk of developing TB, and it makes treatment for TB less effective. People who smoke are twice as likely to get ill with TB. Active TB, compounded by the damaging lung health effects of tobacco smoking, substantially magnifies risk of disability and death from respiratory failure. -Across the life-course. Infants exposed in-utero to tobacco smoke toxins, through maternal smoking or maternal exposure to second-hand smoke, frequently encounter reduced lung growth and function. Young children exposed to second-hand smoke are at risk of the onset and exacerbation of asthma, pneumonia and bronchitis, and frequent lower respiratory infections. Globally, an estimated 165 000 children die before the age of 5 of lower respiratory infections caused by second-hand smoke. Those who live on into adulthood continue to suffer the health consequences of second-hand smoke exposure, as frequent lower respiratory infections in early childhood significantly increase risk of developing COPD in adulthood. -Air pollution. Tobacco smoke is a very dangerous form of indoor air pollution: Though smoke may be invisible and odourless, it can linger in the air for up to five hours, putting those exposed at risk of lung cancer, chronic respiratory diseases, and reduced lung function.
World No Tobacco Day 2019
May 31 is World No Tobacco Day, a day designated by the World Health Organization to draw global attention to the and to advocate for strategies to reduce tobacco use. The theme for 2019 is “Tobacco and Lung Health”. World No Tobacco Day 2019 will highlight on the multiple ways that exposure to tobacco affects the health of people’s lungs worldwide. The specific goals of The World No Tobacco Day 2019 campaign are as follows:
/ risks posed by tobacco smoking and second-hand smoke exposure;
/ awareness on the particular dangers of tobacco smoking to lung health;
/ magnitude of death and illness globally from lung diseases caused by tobacco, including chronic respiratory diseases and lung cancer;
/ emerging evidence on the link between tobacco smoking and tuberculosis deaths;
/ implications of second-hand exposure for lung health of people across age groups;
/ importance of lung health to achieving overall health and well-being;
/ feasible actions and measures that key audiences, including the public and governments, can take to reduce the risks to lung health posed by tobacco.
Tobacco Control in Myanmar
Myanmar has one of the highest rates of tobacco use (Smoking and Smokeless) among men and women compared to other countries in the WHO South-East Asia Region. More than two in five men and nearly one in ten women smoke, which puts the health and wellbeing of themselves and their families at risk. Smokeless tobacco use is a problem where more than half of men and a quarter of women use this type of tobacco. Tobacco use in Myanmar claims the lives of approximately 64,000 citizens per year, with 56 percent of deaths occurring among individuals under age 70. The poor are disproportionately impacted by tobacco use in Myanmar, as 28 percent of tobacco-related deaths occur in Myanmar’s poorest income quintile.
Tobacco control is one of the priority programmmes of Ministry of Health and Sports. In July 1998 when WHO reorganized efforts within a new structure, the Tobacco Free Initiative (TFI), this movement greatly enhanced the momentum of the anti-tobacco activities in Myanmar. The National Programme on Tobacco Control was officially launched in January 2000 with the drafting and approval of the National Policy on Tobacco Control and Plan of action. The National Tobacco Control Committee was formed in March 2002. The Control of Smoking and Consumption of Tobacco Product Law was adopted on 4th May, 2006. In accordance with new administrative structure, the National Tobacco Control Committee was reformed in January 2011, headed by the Minister for Health and included heads of related departments and chairpersons of several national NGOs as members. In 2018, Ministry of Health and Sports (MOHS) singed a new MOU with International Union Against Tuberculosis and Lung Disease (The Union) to strengthen tobacco control program in Myanmar. Several achievements were made between 2013 and 2018. These includes adoption of a 100% smokefree notification and adoption of a 75% pictorial health warning. During the period, Myanmar has also signed Illicit Trade Protocol which will be endorsed in near future of 2016. Myanmar hosted a SEARO and Asia Pacific meeting on Illicit trade protocol in 2015.Recently Ministry of Health and Sports established a tobacco Control Unit under the Non-Communication Disease (NCD) Division with dedicated human resource.
Ministry of Health and Sports works with Attorney General and parliament health committee for legislation development. It works with Ministry of Finance for taxation and establishment of health fund for tobacco control. MOHS works closely with Ministry of Manpower, Ministry of Home Affairs, Ministry of Foreign Affairs, Ministry of Education, Ministry of Trade for their support to make effective enforcement of law and legislation. The collaboration will be further strengthened.
Ministry of Health and Sports has identified subnational government’s role is very crucial to implement the tobacco control program as well as countering tobacco industry interferences at the local. Thus, MOHS has already established a subnational government alliance to accelerate their consolidated efforts for making tobacco control possible at each level. Working with subnational leaders would further expand the people’s participation in tobacco control movement. It also works with non-government sector such as World Health Organization, International Union Against Tuberculosis and Lung Disease, Johns Hopkins Bloomberg School of Public Health, People’s Health Foundation, Universities, and media for policy advocacy and technical assistance.
In May 2018, the WHO Convention Secretariat, UNDP, WHO and the FCTC Knowledge Hub on Tobacco Taxation (Cape Town) undertook a joint mission to Myanmar to conduct needs and situational assessments as part of the FCTC 2030 project. The FCTC 2030 Project is a global initiative funded by the UK Government to support countries to strengthen FCTC implementation to achieve the Sustainable Development Goals (SDGs). Myanmar is one of just 15 countries worldwide receiving this dedicated project support.
The Investment case for Tobacco Control in Myanmar: The Way Forward
According to FCTC 2030 project report (2018), tobacco use costs Myanmar MMK trillions in economic losses and causes substantial human development losses annually. Fortunately, the investment case shows that there is an opportunity to reduce the social and economic burden of tobacco in Myanmar. Enacting the recommended multisectoral tobacco control provisions would save tens of thousands of lives each year and reduce the incidence of disease, leading to savings from averted medical costs and averted productivity losses. In economic terms, these benefits are substantial, adding up to ~3.3% of GDP in 2016 and MMK 8 trillion over the next fifteen years. Further, the economic benefits of strengthening tobacco control measures in Myanmar and implementing new ones greatly outweigh the costs of implementing them (MMK 8 trillion in benefits versus just MMK 0.036 trillion in costs).
By investing now in tobacco control provisions, Myanmar would not only improve health and grow the economy, it would also reduce hardships on the poor. The investment case shows that, contrary to common misperception, tobacco control would benefit lower income earners the most. Raised cigarette taxes would not only help the poor (and others) avoid out-of-pocket health expenditures, it would also raise revenue for the Government to advance any of its sustainable development priorities. The investment case has identified the strongest tobacco control investments for Myanmar to take.
With the support of the FCTC 2030 project, the FCTC Secretariat, UNDP and WHO, The Government of Myanmar will pursue the following actions to reduce the enormous burdens that tobacco continues to place on its country.
1. Raise awareness among the public and government of the true costs of tobacco and the enormous development benefits of tobacco control.
2. Strengthen tobacco control coordination and planning
3. Strengthen the current tobacco control law and/or introduce a newer, stronger and more compressive one
4. Ensure adequate funding and resourcing of tobacco control measures
5. Strengthen Enforcement
6. Advocate for additional increases in tobacco taxes
– Word No Tobacco Day Tool Kit, WHO, 2019
– Investment case for tobacco control in Myanmar: The Case for Investing in WHO FCTC Implementation, MOHS/WHO/UNDP/FCTC Secretariat/RTI Int. December 2018
– The Tobacco Atlas, 6th Edition, American Cancer Society, 2018
– The Health Consequences of Smoking-50 years of Progress: A Report of the Surgeon General, US CDC, 2014.