South Asia comprises a contiguous block of eight countries representing the most populous and perhaps the most culturally diverse region in the world. As a new world plant, tobacco was introduced in the region in the early 16^th century and spread across different agroclimatic zones that created several new varieties. It is widely believed that tobacco is traditional to South Asian societies, a myth perpetuated by the tobacco industry that finds widespread acceptance among pliant policymakers. Consequently, tobacco is consumed in myriad ways in the region costing about one and a half million premature deaths every year from tobacco-related diseases.

There are some distinct features to this region when it comes to the landscape of the tobacco industry and how countries are implementing tobacco control regulations. Public health researchers and advocates gathered at a workshop organised by the  Centre for Combating Tobacco (CCT) hosted by University of Colombo, for the initiation of South Asian Regional Consortium Centre for Combating Tobacco (SARC-CCT), compared notes to find many similarities but also some differences in how tobacco industry undermines tobacco control efforts across countries in South Asia.

So, how can countries protect their public health policies from the vested interests of the tobacco industry? The World Health Organization Framework Convention on Tobacco Control (FCTC), the first United Nations global health treaty, highlights a fundamental and irreconcilable conflict between the interests of the tobacco industry and that of public health policy. The article 5.3 of the treaty mandates the member countries to adopt a national policy to protect public health policy from tobacco industry interference. All the countries in the South Asia region have ratified this treaty. However, there seems to be slower progress in implementing article 5.3 of the treaty in the region.  So far, only Sri Lanka, Nepal and select states in India have adopted such a policy.

The size of a country doesn’t seem to matter when it comes to interference from the tobacco industry. The little Maldives with a population of less than half a million faces obstacles from the tobacco industry as does India with a population of about 1.3 billion.

One of the participants aptly summarised the industry tactics of interfering in tobacco control policies across countries as the four ‘D’s i.e. deny scientific evidence, deceive governments, delay policymaking process and policy implementation, and dilute the effectiveness of policies.  Most tobacco companies seem to be failing in complying with the tobacco control regulations.  This creates a chasm between policy and its implementation.

A popular industry tactic across countries is to use corporate social responsibility (CSR) activities to build a positive image and gain access to policymakers. While the FCTC denounces so-called CSR by tobacco companies, only Nepal in the region has banned CSR by the tobacco industry. Another common tactic is to mobilise front groups that speak from the industry’s playbook. Across the region, pictorial health warning on tobacco packs is a single major regulation targeted by the industry. When countries pass stringent tobacco control measures, such as large-size pack warnings, governments are often dragged to the court by industry. India, Sri Lanka, and Nepal have all faced such intimidation tactics for their prominent pack warnings. Other policy measures where countries have commonly experienced industry interference include taxation on tobacco and measures to regulate newer tobacco products including e-cigarettes. It is also apparent across countries that the tobacco industry approaches non-health departments, such as trade and finance to protect its business.

It is striking that unlike the global tobacco discourse that is pegged around cigarettes, it is the non-cigarette smoked products (like bidisinIndia, Nepal, and Bangladesh) and myriad forms of smokeless tobacco products that dominate tobacco consumption in this region. These markets are also marked by informalities (i.e. segments with poor regulations) and a dearth of reliable information on industries available in the public domain.

The British American Tobacco dominates cigarette markets in the region and is present in all former British colonies. Other global cigarette giants including Imperial Tobacco, Phillip Morris International, and Japan Tobacco International entered these markets much later.

Bhutan, however, is an exception. It does not have a tobacco industry of its own. There is a prohibition on tobacco cultivation, manufacturing and sales of tobacco products in the country. The Maldives also prohibits the cultivation of tobacco on its soil. These instances stand out in the region that is otherwise a big producer and supplier of tobacco leaf in the world. Similarly, India, Sri Lanka, and Pakistan prohibit manufacturing, sale, and consumption of one or more smokeless tobacco products creating scenarios of hope in the region that is distinctly known for smokeless tobacco consumption. With the tools in hand and a resolve to work in collaboration, the SARC-CCT marks a new beginning in preventing industry interference in the region. This shall go a long way in saving lives through ensuring effective tobacco control regulations in the region.

Upendra Bhojani¹, Pranay Lal², Mary Assunta³

¹Director &Wellcome Trust/DBT India Alliance Fellow, Institute of Public Health, Bengaluru, India

²Senior Technical Advisor, International Union Against Tuberculosis and Lung Disease (the Union), New Delhi, India

³Head of Global Research and Advocacy, Global Center for Good Governance in Tobacco Control, Thailand – the WHO FCTC knowledge hub on article 5.3

 

Disclaimer: This post summarises contributions made by public health researchers and advocates from South Asian countries as part of the Initiation Workshop of the South Asian Regional Consortium Centre for Combating Tobacco (SARC-CCT) held at Colombo between 15-18 July 2019.