Mohit Singh Thagunna, Research and Evaluation Officer, Action Nepal, Kathmandu, Nepal.

Email: thagunna.mohit@actionnepal.net ; thagunna.mohit@gmail.com

Tobacco epidemic is one of the burning challenges and biggest public health threats that the world has ever faced. Almost one third of the population (adult: 933 million) smoke daily globally¹, which is one of the major risk factors and causes of Non Communicable Diseases (NCDs) that includes cancer, chronic respiratory disease, cardiovascular disease etc². Tobacco is killing half of its users. Tobacco kills more than 8 million people each year across the world.  Over 80% of the world’s 1.3 billion tobacco users live in low and middle income countries³. Non communicable diseases are the leading cause of deaths globally. In Nepal, 66% of all deaths are caused due to cardiovascular diseases (CVD), chronic non-infectious respiratory diseases (like COPD), cancers, diabetes, and mental health. Behaviour like tobacco smoking is main risk factor for the country and region⁴. The burden of tobacco related diseases on society is enormous. According to the WHO, the economic burden of tobacco is particularly high in the developing world and by 2030 four out of five tobacco-related deaths will occur in less developed countries.

Annually, tobacco kills around 27,137 people (accounted for 14.9 % of all deaths) in Nepal⁵. According to Nepal STEP survey 2019, 28.9% of adults 15-69 years of age (48.3% of men, 11.6% of women) were current users of tobacco, in any form, and this is equal to 3.8 million adults. Out of these tobacco users 17.1% of adults (28.0% of men, 7.5% of women) equivalent to 2.8 million adults were current smokers of tobacco whereas 18.3% of adults (33.3% of men, 4.9% of women) equivalent to 3 million adults were current users of smokeless tobacco. Furthermore, 2.5% of adults (3.7 million) were exposed to second-hand smoke at work place and 33.5% of adults (5.5 million) were exposed to second-hand smoke at home⁶. The globe itself is facing the detrimental health effect due to tobacco consumption. Basically, three causes of death, ischemic heart disease, chronic respiratory disease and cardiovascular diseases (CVD), are associated with tobacco consumption. It is a major risk factor for lung cancer and CVD-related deaths⁷. The economic cost associates with the treatment of tobacco related disease is significantly high, and it not only affects the income status of victim and his/her family but also the overall economy of the nation.

To fight with tobacco epidemic, the government of Nepal became  a party to a WHO Framework Convention on Tobacco Control (FCTC) on February 5, 2007 and being a signatory of the Treaty, Nepal government introduced the anti-tobacco directives “Tobacco Product Control and Regulatory Act 2010” in November, 2011. Now, Nepal has strong tobacco control legislation including 90% PHW, ban on selling loose cigarette and sales ban to minors and pregnant women, ban on selling tobacco products via internet, and prohibition of all tobacco advertising, promotion, and sponsorship, and the law prohibits the sale of tobacco products within 100 meters of school/educational, health facilities, and child care centres. The law also forbids smoking on public transport and in specified list of public places. Furthermore, there is complete media ban on tobacco industries activities which are intended to the promotion of tobacco products and tobacco use. Tobacco Control Law and Regulation has prohibited the government officers from taking any gifts, cash or any other support and cooperation in relation to implementation of tobacco control law. Moreover, from March 13, 2017, it is mandatory for all the retail traders to obtain a license from government authority to sell the tobacco products in the market⁸.

However, tax on tobacco products is approximately 30% from its price which is the lowest among South Asian Countries. The tobacco tax rate differs from product to product in Nepal and government seems to be reluctant to increase tax rate as recommended by the FCTC. Thus, tobacco products are easily and widely available in the market in affordable prices. Global Tobacco Index 2020 has reported that government of Nepal generated NPR 14 billion as tax revenue from tobacco industries whereas it has imposed NPR 23 billion in economic losses ( health and productivity loss)⁹. In addition, lack of effective implementation of legislations and control measures is a key issue in Tobacco control in Nepal. Hence, there is a need for collaboration and cooperation from all the stakeholders to motivate the government to be accountable for optimal implementation of existing laws and regulations related to tobacco control in Nepal.

References

1. Reithsma MB, Fullman N, Ng M, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: Lancat. 2017; 389 (10082): 1885-906

2. Eriksen M, Whitney C, Risk Factors: Tobacco. In: McQueen David V, editor. Global Handbook of Non Communicable Diseases, Health Promotion, New York, Springer New York, 2013. P 115-36.

3. World Health Organisation (2018). Fact sheet on tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco

4. World Health Organization, (2011). Economics of tobacco toolkit: assessment of the economic costs of smoking. Geneva: http://www.who.int/iris/handle/10665/44596

5. World Health Organisation (2018). Fact sheet on tobacco : Nepal

https://apps.who.int/iris/bitstream/handle/10665/272687/wntd_2018_nepal_fs.pdf?sequence=1

6. Nepal STEP Survey 2019: Fact Sheet; Nepal Health Research Council (NHRC)

http://nhrc.gov.np/wp-content/uploads/2019/11/National-Factsheet-English-1.pdf

7. World Health Organization. The fatal link between tobacco and cardiovascular diseases in the WHO South-East Asia Region. Regional Office of South-East Asia, New Delhi, India, 2018.

8. Campaign for Tobacco – Free kids https://www.tobaccocontrollaws.org/legislation/country/nepal/summary

9. Global Tobacco Index 2020 file:///C:/Users/shine/Downloads/GTI2020%20Fact%20Sheet%20-%20NP.pdf