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    Volume 9 Issue 22| May 28, 2010|

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Costs of Smoking

Zahidul Naim Zakaria

Dr. Fong

Globally, tobacco represents the largest preventable cause of death. A hundred million people died in the last century of tobacco-related causes and a billion people are projected to die in this one. And the problem is greatest in low- and middle-income countries such as Bangladesh, where over 70% of the tobacco-related deaths will occur.

About seven years ago, Dr. Geoffrey T. Fong created an international research project to address the dearth of research work done not only to monitor tobacco consumption patterns, but also to find out whether the laws that are passed by countries actually work or not. Do graphic warnings really have an impact on smokers? Do smoke-free laws create a disincentive to smoke? Dr. Fong is Professor of Psychology and Health Studies at the University of Waterloo and Senior Investigator at the Ontario Institute for Cancer Research. He was in Dhaka last week to launch the official International Tobacco Control (ITC) report for Bangladesh. The ITC Project is conducting extensive surveys evaluating tobacco control policies and measuring tobacco use in 20 countries, including Bangladesh, India, China, Brazil, Mexico, Uruguay, United Kingdom, Canada, United States, Australia, France, Ireland, Germany, Netherlands, South Korea, Thailand, Malaysia, New Zealand, Mauritius, and Bhutan. In all, the ITC Project covers 50% of the world's population and 70% of the world's tobacco users.

Unlike other threats to global health, tobacco use is the only one that has international public relations firms and lobbyists to promote itself. In comparison, malaria mosquitoes have no lobbyists. Hence the need for rigorous and extensive research to guide policymakers to create strong, evidence-based policies to reduce tobacco use: because the tobacco industry is always trying to protect itself by promoting myths about tobacco control policies. This is a situation where good research can make a difference.

The countries that have been selected for the ITC Project are mostly countries where tobacco use is either currently causing a high level of death and disease or has the potential for it. Countries were also chosen because of the fact that tobacco control policies were about to be introduced in the near future. Bangladesh has the 7th largest population in the world. That alone justifies Bangladesh's inclusion. There are now over 41 million tobacco users in the country, of which 20.9 ??million? smoke cigarettes or bidis or both. Currently, about 57,000 deaths a year in Bangladesh occur due to tobacco. Because Bangladesh's tobacco problem is relatively new, compared to other countries, the incidence of tobacco-related diseases and the number of deaths due to tobacco are not yet very high. But if nothing is done, the tobacco problem will erupt into a dramatically higher level of death and disease. The number of deaths may reach as high as 150,000 to 200,000 deaths a year.

A unique characteristic about Bangladesh is that bidis exist here, but they don't in the West. A second difference is that (according to the research???) in Bangladesh, the average number of cigarettes/bidis smoked per person per day is approximately 10, compared to 16 per person in the West. But this does not necessarily mean that tobacco is causing less harm in Bangladesh because fewer cigarettes are being smoked. A lot depends on how cigarettes are smoked. For example, more harm is caused if a person sucks harder on a cigarette for longer durations. This is the reason why “light” cigarettes are usually not less harmful since people tend to suck harder on light cigarettes.

Taxation is universally recognised as the most effective policy for reducing tobacco use. The current estimate for price elasticity for cigarettes is negative 0.43, meaning that a 10% rise in prices will lower consumption by 4.3%. For bidis, the price elasticity is greater: negative 0.64, which indicates that increasing taxes on bidis would have greater impact than on cigarettes. According to economic analysis, about two-thirds of the impact of price would be on reducing the number of smokers; the remaining one-third of the impact would be on current smokers smoking fewer sticks. Another reason why taxes are so popular is because they generate revenue for the government, which can then be rerouted to beefing up security needed to enforce smoke free laws.

Cigarettes have become more affordable in recent years. In 1990, 100 packs of Star brand cigarettes cost an amount equal to 16.8% of average annual per capita income. But in 2006, the same 100 packs cost only 6.6% of average annual per capita income. In other words, cigarettes have become over 2.5 times more affordable! The considerably lower tax rate on bidis impedes government efforts to reduce smoking rates as cigarette smokers can simply substitute the more expensive forms of smoked tobacco with cheaper forms. In light of this, demand management is imperative.

One important demand reduction policy is warning labels. According to Dr. Fong, “Bangladesh should introduce graphic warning labels, which have been found to be very effective in educating people about the harms of tobacco. In a country where there are many illiterate and semi-literate people, text-only warnings can hardly be effective. Warning labels should include photographs and illustrations that show people about the reality of smoking-related diseases. Think of it this way: Cigarette companies have been associating tobacco with all kinds of positive things for decades. The cigarette companies have been successful in getting people to associate a product that kills up to half of its regular users with fun, freedom, independence, popularity, sports, and good times, precisely the OPPOSITE of the reality for many many smokers.”

The battle against tobacco should involve making smokers really feel how real the problems can be for each individual. Very few other sources of information exist in Bangladesh, so graphic warning labels would be very effective. Another important facet of curbing tobacco consumption is to create laws that can be enforced. Bangladesh has a law stating that smoking in public places in prohibited, a law that is not being enforced. People have to be given rationale behind laws and awareness has to be built behind the need for such laws. The media in Bangladesh, especially the television networks, can play a very important role here in building awareness through airing Public Service Announcements.

According to the ITC report, 95.2% of all Bangladeshi smokers view it as a negative and harmful thing. Dr. Fong believes that the fact that so few Bangladeshi smokers have plans to quit despite so many people viewing smoking as negative points to a large number of people being on the edge of quitting. But in Bangladesh, there is an immense need for informational campaignslike in mass media, or on cigarette and bidi packs, in the form of information about the benefits of quitting. Knowledge of harm and the motivation needed to quit are two different things. There are millions on smokers who are on the border between smoking and attempting to quit. They are consciously or unconsciously looking for signs that will either push them further into the habit of smoking or signs that will motivate them to quit. Media campaigns and warning labels can be effective in motivating these smokers to quit.

Tobacco consumption in Bangladesh can be curbed with stronger laws like higher tobacco taxes, introducing graphic warning labels, and enlightening people about the need for strong, comprehensive smoke-free laws, and then passing and enforcing them.

Learn more about the International Tobacco Control (ITC) Project at www.itcproject.org

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