Dr. Firdosi Rustom Mehta (WHO Country Representative in Sri Lanka) in an email interview, talks about the adverse effects of tobacco and preventive measures that could be adopted.
Q: What are the benefits for a government involved in tobacco control activities?
If current patterns continue, tobacco use will kill more than 8 million people per year by 2030. Up to half of the world’s more than 1 billion smokers will die prematurely of a tobacco-related disease.
The economic costs of tobacco use are equally devastating. In addition to the high public health costs of treating tobacco-related diseases, tobacco users are also less productive due to increased sickness, and those who die prematurely deprive their families of much-needed income.
Tobacco use and poverty are inextricably linked. Many studies have shown that in the poorest households in some low and middle-income countries, more than 10% of total household expenditure is on tobacco. This means that these families have less money to spend on such basic items as food, education and healthcare. In addition to its direct health effects, tobacco use leads to increased healthcare costs.
It contributes to higher malnutrition and illiteracy rates, since money that could have been used for food and education is spent on tobacco. The role of tobacco use in exacerbating poverty and hindering economic development needs to be fully recognised.
There are many cost-effective tobacco control measures that can be used in different settings and have a significant impact on tobacco consumption. The most cost-effective strategies are population-wide public policies like bans on advertising, promotion and sponsorship of tobacco products, tobacco tax and price increases, forbidding smoking in all public areas and workplaces and requiring large, clear and visible graphic health messages on tobacco packaging. All of these measures are outlined in the WHO Framework Convention on Tobacco Control.
Q:What else has to be done by the Sri Lankan government apart from the measures that have been taken to control the tobacco epidemic?
Sri Lanka has done a lot of work in terms of tobacco control activities and at the request of the government of Sri Lanka a needs assessment was also done to assess the status of implementation of the WHO FCTC in Sri Lanka. This needs assessment report presents an article-by-article analysis of the progress the country has made in implementation, the gaps that exist and the subsequent possible action that can be undertaken to fill those gaps.
The key elements that need to be put in place to enable Sri Lanka to fully meet its obligations under the Convention are summarised below:
1.The WHO FCTC is an international treaty and therefore international law. Having ratified this treaty, Sri Lanka is obliged to implement its provisions through national laws, regulations or other measures. It is important to identify all obligations in the substantive articles of the Convention, including achievements and gaps, through a strong multisectoral, collaborative approach.
2.Under Article 5.2(b) of the WHO FCTC, Parties have an obligation to develop and adopt national tobacco control legislation to enable full implementation of the Convention. Sri Lanka has adopted the National Authority on Tobacco and Alcohol Act No. 27 of 2006 (the Act), and consequently, as mandated by Article 34 of this Act, adopted the Tobacco Products (Labelling and Packaging) Regulations No. 01 of 2012 (the Regulations). The legislation addresses Articles 5.2(a), 8, 9/10, 11, 13, 15 and 16 of the Convention. However, to fully implement the requirements of the Convention, amendments need to be made to the law in several areas, specifically with regard to smoke-free environments, point-of-sale and cross-border tobacco advertising, and sales to and by minors. In addition, the Regulations should be implemented without delay and further regulations need to be developed as mandated by the Act (in Articles 30(1) and 33 of the Act).
3. Under Article 5.3 of the WHO FCTC, Parties have an obligation to protect public health policies from commercial and other vested interests of the tobacco industry. Information reported by several stakeholders indicates that the tobacco industry uses various tactics and strategies to interfere with public policies, specifically in the areas of illicit trade in tobacco products and sales to and by minors and through various “corporate social responsibility” initiatives. Tobacco industry interference needs to be prevented by raising awareness of the industry’s activities within all branches of the Government and/or including a clause in the national legislation or any other relevant normative documents.
4. Taxation on tobacco products in Sri Lanka is governed by Tobacco Tax Act No. 8 of 1999 and the Tobacco Tax (Amendment) Act No. 9 of 2004. Excise taxes do not apply to all smoking tobacco products nor to any smokeless tobacco products. In addition, the excise rates vary according to the length of cigarettes, making the structure complex. There have been regular increases in tobacco excise rates in recent years, which has led to a decreased demand for cigarettes. It is therefore recommended that the tobacco taxation structure be simplified and the excise tax applied to all tobacco products, including smokeless forms, at the same or similar rates as cigarettes to prevent shifting between different products. It is also recommended that tax rates continue to be increased on a regular basis to take into account both increases in consumer prices and household incomes, in order to decrease the affordability of tobacco products and ultimately reduce consumption.
5.The current smoking ban imposed by the Act is almost comprehensive in its coverage, but has exemptions for hotels, guest houses or lodges, restaurants, clubs, airports, private workplaces and outdoor public places. It is therefore recommended that the Act be amended to remove these exemptions. The enforcement of smoke-free policies also needs to be strengthened. It is therefore recommended that the Act be amended to confer the necessary powers on all Authorised Officers to enable swift enforcement and to enable them to apply fines without an arrest warrant.
6.The Regulations adopted in 2012 to implement the relevant requirements of the Act call for pictorial health warnings to be printed on the top surface area of both front and back of every cigarette packet, package or carton and to cover an area of not less than 80% of the top surface area of both front and back of every cigarette packet, package or carton. However, progress in implementing the law has been halted due to cases filed by the tobacco industry against provisions of the Regulations on packaging and labelling. Article 11 is a time-bound provision with a three-year deadline from the date of entry into force of the Convention. The Convention entered into force for Sri Lanka on 27 February 2005and the pictorial warnings should have therefore been implemented in 2008.
7.Efforts to educate target groups, including schoolchildren, youth, parliamentarians, the media, religious leaders, etc. on the harms of tobacco use and exposure to tobacco smoke are ongoing, but there is a need to give more emphasis to issues related to all tobacco products, in particular smokeless forms of tobacco.
8.Sri Lanka does not have national guidelines on cessation services and treatment of tobacco dependence. A quit line is available which provides information on the locations of health centres at which the public can receive substance abuse counselling and prescriptions for medicines that aid cessation. Nicotine replacement therapy is not registered under the essential drugs list and is therefore not available in Sri Lanka. It is therefore recommended that Sri Lanka strengthen its implementation of Article 14 of the Convention and the guidelines for its implementation.
9.The Protocol to Eliminate Illicit Trade in Tobacco Products adopted at COP5 provides an additional legal instrument to reduce supply. The Protocol is now open for ratification by the Parties to the WHO FCTC. Consultations have already started within the Government regarding the possibility of ratifying the Protocol. The Government is encouraged to complete this process as soon as possible.
10.Sri Lanka has made progress in implementing Article 16 of the WHO FCTC to ban sales to and by minors, although there are areas that require strengthening. Sri Lanka could strengthen the Act by including a prohibition on sales by minors, by requiring sellers of tobacco products to place a notice at points of sale indicating that tobacco products may not be sold to persons under the age of 21 years, and by prohibiting the sale of cigarettes individually or in small packets, which increase the affordability of such products to minors.
11.The Government does not provide subsidies to the tobacco sector (including tobacco growers) and does not support tobacco cultivation under its National Irrigation Scheme. Tobacco farmers are now voluntarily moving away from tobacco cultivation due to diminishing profits from the sale of tobacco leaf, soil erosion, reduced tobacco yields and better profitability of replacement crops. It is recommended that the Government capitalises on this natural trend and support activities that help tobacco farmers make the transition to other economically viable alternatives.
12.Implementation of the WHO FCTC should be viewed as a poverty alleviation, human rights, gender equality and human development issue and not just a public health matter.
13.The needs identified in this report represent priority areas that require immediate attention. The Convention Secretariat, in cooperation with WHO and relevant international partners, will be available and committed to supporting Sri Lanka in addressing all areas of tobacco control.
Q:hat are the strategies and tactics used to undermine tobacco control activities carried out by governments in the world?
The tobacco industry has operated for years with the express intention of subverting the role of governments and of WHO in implementing public health policies to combat the tobacco epidemic. The tobacco companies are among the world’s most sophisticated and successful marketers. They spend billions of dollars to promote their deadly products, prevent governments from protecting their people and mislead tobacco users and potential tobacco users regardless of the impact on public health. The Government needs to be alert to any efforts by the tobacco industry to undermine or subvert tobacco-control efforts and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts. The main issues to highlight are:
There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests. The tobacco industry produces and promotes a product that has been proven scientifically to be addictive, to cause disease and death and to give rise to a variety of social ills, including increased poverty.
When dealing with the tobacco industry or those working to further its interests, should be accountable and transparent.
Because their products are lethal, the tobacco industry should not be granted incentives to establish or run their businesses. Any preferential treatment of the tobacco industry would be in conflict with tobacco control policy.
How the tobacco industry influences policy and thwarts effective regulations:
Using trade agreements to attack public health measures
Distorting the science of the health effects of tobacco use, and secondhand smoke
Challenging ad bans, restrictions on secondhand smoke and tax increases
Promoting illicit tobacco trade (smuggling)
Suing or threatening to sue governments
Demanding active involvement at policy level at the table in order to prevent consensus
Drafting and then exploiting tobacco friendly loophole ridden legislation
Promoting and funding ineffective “youth smoking prevention” programmes
Interfering with FCTC ratification
Challenging government timelines for implementing laws
Health initiatives on other issues in return for inaction on tobacco
Providing funds directly to government regulatory bodies
Using PR efforts claiming to be responsible corporations to mask their harmful behaviour
Promoting ineffective voluntary regulation as a substitute for enforceable laws
The following important activities are recommended for addressing tobacco industry interference in public health policies:
Raise awareness about the addictive and harmful nature of tobacco products and about tobacco industry interference with Parties’ tobacco control policies.
nEstablish measures to limit interactions with the tobacco industry and ensure the transparency of those interactions that occur.
Reject partnerships and non-binding or non-enforceable agreements with the tobacco industry.
Avoid conflicts of interest for government officials and employees.
Require that information provided by the tobacco industry be transparent and accurate.
De-normalise and, to the extent possible, regulate activities described as “socially responsible” by the tobacco industry, including but not limited to activities described as “corporate social responsibility”.
Do not give preferential treatment to the tobacco industry.
Q: The FCTC is considered one of the best treaties in the world to protect people and generations yet to come. What are the main
reasons behind this recognition for FCTC?
The World Health Organiation Framework Convention on Tobacco Control (WHO FCTC) is the first international health treaty negotiated under the auspices of WHO and was adopted in 2003.
It has since become one of the most widely and rapidly embraced treaties in the history of the United Nations, with 177 Parties to date. Sri Lanka ratified the WHO FCTC on 11 November 2003, being the first country in Asia and the fourth in the world to do so. The Convention entered into force in Sri Lanka on 27 February, 2005.