By Umesh Moramudali.
According to statistics, nearly 60 people die daily in Sri Lanka due to smoking. Thus nearly 60% of cancer patients are smokers and as the President; who was the former Health Minister claimed, the government spends about Rs 4,500 million to treat those diagnosed with various diseases related to smoking. The total amount of deaths reported due to smoking in Sri Lanka amount to 21,000.
It was World Tobacco day yesterday (2) and today (3),’Health is Wealth’ has dedicated its page to enhance public awareness about the dangers of smoking. According to WHO estimates, tobacco use both by smoking as well as chewing, is currently responsible for the deaths of around six million people across the world each year with many of these deaths occurring prematurely. This total includes 600,000 people who are estimated to die from the effects of passive smoking.
Adverse impacts on health
Smoking has always been associated with ill health. More often than not, smoking has an impact on disabilities and non-communicable diseases mainly oral and lung cancers. In addition, research findings have revealed that smoking also increases the risk of death from communicable diseases as well.
Under a UN mandate to address four non-communicable diseases (NCDs), the World Health Assembly in 2013 established a global voluntary tobacco target to help reduce and prevent premature and avoidable mortality from NCDs. The agreed global tobacco target is a 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years.
The setting of this target not only provides a context for the development of policies and programmes of action to attain the target but it also provides an opportunity for policy makers to monitor progress towards achievement of the target over time.
The ability to monitor change in any indicator rests on the availability of data to measure the indicator adequately over time. The NCD tobacco target refers to tobacco use which includes both tobacco smoking and smokeless tobacco uses. The quality and quantity of data on tobacco smoking is enough to allow for an attempt to draw trends in tobacco smoking by country. Smokeless tobacco data, although improving rapidly, is still too scant to allow for derivation of meaningful underlying trends for many countries. As a result, the work presented in this report focuses only on tobacco smoking.
After a careful analysis of data quality and completeness of data availability, WHO aims to undertake a similar exercise for smokeless tobacco, most likely to be limited to a number of countries.
According to statistics, nearly 60 people die daily in Sri Lanka due to smoking. Thus nearly 60% of cancer patients are smokers and as the President; who was the former Health Minister claimed, the government spends about Rs 4,500 million to treat those diagnosed with various diseases related to smoking. The total amount of deaths reported due to smoking in Sri Lanka amount to 21,000. Alcohol and Drug Information Centre (ADIC) noted that Sri Lankans spend approximately Rs 250 million on cigarettes per day and the Health Ministry had consistently claimed that the government had to spend a large sum of money to provide treatment to those who got sick due to smoking. Accordingly, the money spend on such treatments was larger than the tax revenue collected from cigarette companies.
An official report, titled ‘Brief Profile on Tobacco Control in Sri Lanka’ (2009), revealed that 39% men and 2.6% women in Sri Lanka smoked tobacco. Besides cigarettes, other products on the local market are cigars, low-cost and less refined bidis, and betel quid with tobacco leaves.
ADIC has been conducting spot surveys on tobacco trends biannually since 1998. The findings in these researches cannot be generalized but they revealed several important facts about tobacco consumption and its adverse impacts. This survey also helps to monitor and identify the prevailing trends and patterns related to tobacco consumption. Most importantly, the research attempted to identify public attitude towards consumption of tobacco. However, the survey was only conducted in Colombo, Gampaha, Galle, Kegalle, Anuradhapura, Jaffna, Batticaloa, Kandy, Kurunegala and Mannar districts.
According to research findings, adult males in the Colombo District are 10.74 times likely to develop the risk of lung cancer compared to those who have never smoked.
It was revealed that if smoking among males was to be stopped, 84% of lung cancer cases could be prevented in Sri Lanka.
“All 62 cases (100%) and 246 out of 248 controls (99.2%) participated in the study. When the effects of confounding variables were controlled, ever smokers were found to have 10.74 times higher risk of lung cancer compared to never smokers. Other significant risk factors for lung cancer among the males were, having a low educational level, having been exposed to X rays and having a family history of cancer. The percentage of smoking for lung cancer was 84.04% based on the overall prevalence of smokers determined by another community prevalence survey. These findings need to be shared among the policy makers and public to implement successful smoking preventive measures,” the research findings recommended.
Another research conducted by L.K. Athauda and A.R. Wickremasinghe stated that the average cigarette consumption per capita in Sri Lanka from 1960-2004 was 289.19 sticks per year, and the average domestic tobacco distribution from 1960-2010 was 8399.79 kg.
“Smoking had been gradually increasing in Sri Lanka, until the year 1978, and thereafter a decline at the rate of 2.33 per capita per year was observed. Considering males as only consumers of tobacco, Sri Lanka showed a trend of 4.16 per capita decline per year since 1978. The average price of the most popular cigarette brand in Sri Lanka was correlated with percentage of current smokers from 2000-2012. Percentage of smokers was negatively correlated with stick prices with 63.9% of the results. Since 1953 tobacco and excise taxation have been in place. Both these taxes, as well as pricing fall short of the WHO recommended levels. A decreasing trend commenced in 1978, where no specific control policy can be associated with except the commencement of the open economic policy.
Conclusions: It appears that the Sri Lankan trend of smoking has been following a global trend since 1978,” stated the research findings.
It was further noted that the taxation levels though regularly increased have not met the WHO standard. Despite the NATA act and other policies being implemented, they do not appear to have impacted smoking patterns.
What has been done so far?
As the high consumption of tobacco has led to many health issues in the country, consecutive governments have taken various steps to reduce tobacco consumption. Sri Lanka signed and ratified the Framework Convention on Tobacco Control (FCTC) in 2003. This was followed by the government taking initiatives to set up the National Authority on Tobacco and Alcohol (NATA) through an Act of Parliament in 2006.
Health warnings have been printed on cigarette packets and advertising of cigarette and tobacco products are highly restricted. Later, laws were imposed prohibiting smoking in public places.
The government then took brave and strict action to impose laws to display pictorial warnings covering 80% of cigarette packets. This decision was challenged by cigarette companies and the pictorial warnings were displayed only covering 60% of tobacco products based on a Court ruling. The regime change thereafter passed a new law making it compulsory to display pictorial warnings covering 80% of the tobacco products.
Lack of awareness about NATA
Despite attempts made by governments to reduce smoking through various ways and means including setting up of the National Authority on Tobacco, it is found that public awareness on the matter was not satisfactory.
Research conducted by P.W. Pallewaththa , H.P.G. Niwarthana and S. Nanayakkara in their findings noted that awareness of the NATA Act and the implementation of the Act was found to be poor among the authorized officers.
“Support of the community and other authorized officers to implement the Act was reported as poor. The study found that there was no Monitoring and Evaluation (M&E) plan on implementation of the Act. Clarification of legal procedures about ‘enclosed public places and public areas’ was reported to be not clear. The authorizing officers complained that there were no allocated, financial aid and other facilities to implement the Act and that the involvement of the National Authority on Tobacco and Alcohol was poor.
The study concluded that authorizing officers had faced many problems in implementing the Act and recommended the following to improve the situation. It suggested conducting well organized sessions on NATA Act amongst authorized officers. The research further suggested placing a mechanism to expand support from the community and other authorized officers.
Impose more tax on cigarettes
ADIC in their suggestions to reduce smoking suggested to increase the tax imposed on cigarettes. ADIC noted that there was no consistency in terms of the tax rates imposed on cigarettes and that it should be further increased and be consistent.
“Every 10% increase in the real price of the cigarettes reduces overall cigarette consumption by approximately three to five per cent. It also reduces the young smokers by 3.5%,”
The research findings from Verite research revealed that the government lost nearly Rs 20 billion annually due to the underpricing and low rates of taxation imposed on cigarettes.
(Courtesy – Ceylon Today)