Smokeless Tobacco Control in South-East Asia...
Transcript of Smokeless Tobacco Control in South-East Asia...
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SmokelessTobaccoControlin
South-EastAsiaRegion
DrJagdishKaurRegionalAdviser,TobaccoFreeIniAaAve
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Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare e x p e n d i t u r e a n d l o s t productivity
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Effective tobacco
control is need of the
hour
SEAR is home to about one-fourth of the
world's population,
one-fourth of world’s
smokers and 90% of
smokeless tobacco users
Diverse population groups with high
socio-cultural acceptance of ST products in many
countries Most countries are LMIs
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0.0
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Bangladesh Bhutan India Indonesia Maldives Myanmar Nepal SriLanka Thailand TimorLeste
Percen
tPercentageofcurrentsmokelesstobaccousersamongyouthin
selectedMemberStatesoftheSouth-EastAsiaRegion
Source:GlobalYouthTobaccoSurvey2003-2016
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1.7 2.6 3.2
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19.7 19.8 21.4
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43.2
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29.626.4
62.2
2.0 1.45.2 5.3 4.8
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27.924.1
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Indonesia Maldives(Malé)*
Thailand SriLanka Nepal Bhutan Timor-Leste India Bangladesh Myanmar
PercentageofcurrentsmokelesstobaccousersamongadultsinselectedMemberStatesoftheSouth-EastAsiaRegion
Total Male Female
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Flavoured ST constitutes 70–98% of all ST products in SEAR
Many ST products are used along with betel nut Betel nut itself has high prevalence of use in many countries
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Aggressive marketing of areca nut products such as supari and pan masala by the industry, especially in countries attempting to enforce some sort of ban on ST products
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Paan(pan)andpaan(pan)masalashouldbeconsideredtobaccoproducts
BetelnutBetelnutgrown
widelyandconsumedalong
withSTorseparatelyinSEARcountries
UniversalstandardclassificaAonoftwoproductsindigenoustotheIndiansubconAnentandpopularamongSouthAsiansgloballyastobaccoproducts
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Bangladesh
STcoveredunderthetobacco
controllaw
TAPSbanBanonsaletominors
TwoGHWs
assignedtoST
products
MediacampaignsCessaAon
TobaccoFree
Hospitals
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Doma zhes is one of the most heard and widespread phrases inBhutan:"Pleasehavebetel leafandarecanut"becomesa leitmoUfeachUmetwo individualsmeet,attheendofameal,and inall theoccasionsofeverydaylife.Customers buy the betel leaf at the weekly markets, their dress'spocketbulgingwithsilverboxes,orjustsimplywithplasUcbagsfilledwith betel leafs; pe]y sellers at bus terminals selling ready madequid, called kamto, in cone shaped papers;monks returning to themonastery with their bags filledwith quanUty enough to last for aweek’s consumpUon;betel leafwitha smallpieceofarecanut thatthe host offers with his two hands to the guests at the Ume of aceremony;betel leafsandnutsput inaplatealongwiththosefilledwith chocolates during archery games or official ceremonies ; betelleafsandnutspassedroundaberdinner;redstainsinthestreet;menandwomenwithredstainedteeth.
Bhutan Onlycountryintheworldtobantobacco
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India
AlltobaccoproductscoveredunderthelawBetelnutproductsneedtodisplaythe
warning
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Banonselected
STproducts
BangladeshMyanmar
Bhutan,Nepal
SriLankaMaldives
CountriesoutsideSEAR
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Banbutnoban–HindustanTimesDespitethebanandsubsequentSupremeCourtorderforcompliancereportbuyingchewingtobaccoisassimpleastoffees
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InnovaAvemarkeAngMostcigareZeshopssellpaanmasalaandchewingtobaccowhichismixedbytheuserstopreparemixtureofgutka
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VicePresidentofIndiaatTimesofIndiaLi]est2017openingceremony25thNovember2017,NewDelhi
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Myanmar
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Myanmar AungSanSuuKyi,Myanmar’sdefactonaAonalleader,askedallchiefministerstotakeacAontomakepeoplecutdownontheirhabitofchewingthenutsandspidngoutthedarkjuiceinpublicplaces.
ImplementedamediacampaigninSept-Oct2017againstST&betel
nut
Banonchewing,spidngorsellingbetel
nutsinorneargovernmentoffices,schoolsandhospitals
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Centraltobaccocontrol
commiZeechairedbytheMinisterofHealth
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IntheprocessofamendingexisAnglawtomakeitmoreinclusive&
effecAve
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Nepal
STcoveredunderthe
law
90%GHWsonalltobaccoproducts
Licenserequiredbyvendorsforsellingtobaccoproducts
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SriLankaProtocol
toeliminateillicittrade
Stoptobacco
culAvaAonby2020
TobaccoFreevillages
NATASub
commiZeeOnST
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ChewingarecanutandbetelbannedJuly2017
InvolvingreligiousleadersinbehaviorchangeofpopulaAon–
betelfreetrays
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Timor-Leste
NewcomprehensivetobaccocontrollawforprevenAonand
control–implementaAon
started
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AcceleraAngFCTCImplementaAonTo accelerate
efforts against
tobacco, SEAR
countries
adopted the Dili
Declaration on
Tobacco Control All countries pledged a full-on war against tobacco by strengthening WHO FCTC implementation
The declaration highlights the urgency for stronger measures to stop the tobacco epidemic
in SEAR
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Article 6 of the
WHO-FCTC is poorly implemented in
SEAR
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Taxes on indigenous smoking products
and ST products are even lower
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WHO provides technical assistance toM.SsonSTpolicies&programs• MPOWERtechnicalpackage(keydemandreducUonmeasuresunderFCTC)
• SupportCOPdecisionsonST• TobaccosurveillanceincludingGTCR• TobaccoproductregulaUon• Tobaccocontroleconomics• InnovaUveintervenUons-mCessaUon• InternaUonalandRegionalCooperaUon&collaboraUon
• SupporttheKH
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2014study-STnototherwisespecified(NOS)becauseoflackofinformaUonontheprecisenatureoftheunburnedtobaccoProductsandofbetelquidwithouttobaccointheeUologyoforalcancerinSouthAsiaandthePacific.
STNOSandBQwithouttobaccoareriskfactorsfororalcancersinAsiaandthePacific
ControlofSTNOSandBQwithouttobaccomustremainanintegralpartoftobaccocontrolinanypublichealthstrategy.GovernmentsaroundtheworldshouldprohibittheimportofallSTproducts
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Roadahead?• MainstreamSTandbetelnutprevenUonandcontrol
• Strengthensurveillanceandresearch• Intensiveandfocusedbehaviorchangecampaigns
• BuildcapacityofhealthsystemsforcessaUonsupport
• MulUsectoralcoordinaUon• InternaUonalandRegionalCooperaUon