MD. SAZEDUL ISLAM
World No Tobacco Day will be observed across the world, including in Bangladesh, on May 31. Created by World Health Organization (WHO) in 1987, the annual event is aimed at raising awareness on the dangers of using tobacco, and what people around the world can do to claim their right to health and healthy living and to protect future generations.
The event is being observed at a time when the world is facing Covid-19 pandemic. Evidence released this year shows that smokers were likely to develop severe disease with Covid-19 compared to non-smokers. Corona pandemic has led to millions of tobacco users saying that want quit.
Smoking is the leading cause of preventable death across the world. There are 8 million smoking-related deaths annually, killing more people than HIV/AIDS, malaria & tuberculosis combined.
In Bangladesh, about 126,000 people died of tobacco-attributable diseases in 2018, and this constituted 13.5% of all deaths recorded in that year. The overall economic cost of tobacco use was estimated to be 1.4% of GDP in 2018.
According to Bangladesh Country Report (March, 2021) of CSF Global, one of the largest tobacco consuming countries in the world, Bangladesh is home to an estimated 46.3 million adults who use of a variety of combustible and/or smokeless tobacco products. 37.8 million (35.3 percent) adults are consuming a variety of smoked (e.g., cigarettes, bidis) and/or smokeless (e.g., betel quid with tobacco, gul, sadapata, khaini) tobacco products. The prevalence of tobacco usage in Bangladesh differs by gender.
Smoking prevalence is far higher among males (36.2%) than among females (0.8%). The use of smokeless tobacco (SLT) is much higher among females (24.8%) than males (16.2%). There is also variation in the prevalence of tobacco products between rural and urban areas. While the prevalence of bidi use declined substantially from 2009 to 2017, the use of cigarettes and SLT products remained almost static over the same period, said the report.
Men are the main drivers of tobacco use in Bangladesh. The prevalence of tobacco uses significantly decreased among adults, from 43.3% in 2009 to 35.3% in 2017 (from 58.0% to 46.0% among males; from 28.7%to 25.2% among females). This represents an 18.5% relative decline of tobacco use prevalence (20.8% decline for males;12.2% decline for females). Exposure to secondhand smoke in homes and public places has significantly declined. In homes, exposure declined from 54.9% in 2009 to 39% in 2017.
The number of current smokers who were advised to quit by healthcare providers increased significantly, from 52.9% in 2009 to 65.8% in 2017. There was no significant change in the percentage of smokers who made quit attempts in the last 12 months.
Smoking prevalence in Bangladesh has been assessed infrequently since the mid-1990s. Surveys suggest that smoking prevalence has been relatively flat (40-45%) among men for a long time, but declining somewhat among women (4-1.5%).
Three annual urban and rural cross-sectional surveys carried out between 2001 and 2003 found that the overall prevalence of smoking, chewing tobacco, and gul usage constituted 20.5%, 20.6%, and 1.8%, respectively. Current smoking and gul usage were significantly higher in males (42.2% and 2.2%, respectively) than in females (2.3% and 1.5%, respectively), whereas chewing tobacco was slightly more common in females (21.6%) than males (19.4%).
No significant urban-rural difference was observed in smoking rate after adjusting for socio demographic variables, but chewing tobacco was 1.5 times more likely to be used by rural residents, and gul usage was 3.6 times more likely in urban residents. On average, a smoker consumed 9.3 sticks a day, and males and rural residents smoking more.
The 2004 national survey revealed that 41% of men and 1.8% of women (aged 15+) smoked tobacco products, whereas 14.8% of men and 24.4% of women used smokeless tobacco; 36.8% of adults (aged 15+) used some form of tobacco.
The 2006 Urban Health Survey attracted attention to the socioeconomic disparities in tobacco use – the overall smoking prevalence among men was 53.6%, and the study found a significantly higher occurrence of men smoking in slums (59.8%) than outside them (46.4%).
Respondents living in slums were significantly more likely to confirm that they smoked cigarettes (53.3%) as compared to those living outside slums (44.6%). A similar pattern was found for bidis (slums, 11.4%; other areas, 3.2%).
Several waves of the Demographics and Health Survey were conducted in Bangladesh, but data on tobacco use were collected only in 2007. Health survey which held on 2007, the report documents a high prevalence of tobacco use among Bangladeshi men – 60% smoked cigarettes, and 20% consumed other forms of tobacco.
Tobacco use was more common among older men, those living in rural areas, men with no education, and men in the lowest wealth quintile. Regional variations were also notable. Although rural men were more likely 27 to smoke cigarettes than urban men, urban smokers tended to smoke more cigarettes per day than their rural counterparts.
In 2017, the WHO supported the National Institute of Preventive and Social Medicine (NIPSOM) to pilot tobacco cessation service. Through brief interventions in primary health care settings, NIPSOM set up a training network on tobacco cessation in collaboration with NTCC and DGHS and trained 30 master trainers and 120 primary healthcare physicians on brief interventions. With these master trainers, services can be scaled up.
The WHO Framework Convention on Tobacco Control (WHO FCTC) is an evidence-based treaty that asserts the importance of both demand and supply reduction strategies. The WHO FCTC is the first global public health treaty negotiated under the auspices of WHO in response to the globalization of the tobacco pandemic.
Bangladesh ratified the WHO FCTC in 2004, and in 2005, enacted the Smoking and Using of Tobacco Products (Control) Act. The law was amended in 2013 to make it more compliant with the WHO FCTC.
As part of its target to make a “tobacco-free Bangladesh” by 2040, the government has been discouraging tobacco cultivation through the DAE, other agriculture and environment related organizations to save soil fertility and public health as well as environment from pollution. To regulate tobacco cultivation, it has taken various initiatives such as decision to stop loan facilities in tobacco farming by Bangladesh Bank, ban on using subsidized fertilizer in tobacco farming by the Agricultural Ministry but they are almost of no use.
Tobacco use imposes a heavy burden on the societies and families by increasing illness and deaths; worsening economic situation of tobacco users and their dependants; worsening livelihoods of tobacco farmers; harming the environment; and increasing risks of fires.
WHO says, tobacco consumption, in any form, kills more than 161,000 people on average every year, amounting to around 19% of all deaths in Bangladesh.
The government should take steps to control tobacco. These include increase prices to deter people from taking up the habit; increase awareness of tobacco use impact; provide support to farmers by finding ways to become less dependant on tobacco growing. It is important for the government to assess the smokers’ needs and take their opinion on policies which govern their lives and habits. Cessation support, which suits the smokers’ needs, will go a long way in achieving the targets set by Bangladesh government relating to tobacco use and NCDs.
The author is a freelance journalist
