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NON-COMMUNICABLE DISEASES
The World Health Organization has reported that most smokers start smoking before the age 18, and
almost a quarter of these individuals begin using tobacco before the age of 10. Currently there is an
estimated of 1.3 million people smoke worldwide and 84% of these smokers live in developing
countries.
Smoking has been associated with increased mortality from several diseases. It is known to be
responsible for 90% of all lung cancer cases, 75% of chronic bronchitis and emphysema and 25% of
ischemic heart disease globally.
In Brunei Darussalam, non-communicable diseases were estimated to account for 82% of all deaths
in 2011. The top four causes of death in Brunei Darussalam were cancer, cardiovascular diseases,
diabetes mellitus and cerebrovascular diseases.
In 2013, Brunei Darussalam National Multisectoral Action Plan for the Prevention and Control of
Non-communicable diseases (BruMAP-NCD) 2013-208 was developed to prevent and control NCDs
through enabling healthier environments as well as reducing risk factors and better management.
The goal is fully aligned with global target of a 25% relative reduction in premature mortality from
NCDs by 2025 which has been translated to 18% relative reduction by 2018 in Brunei Darussalam.
There are 2 strategic themes: improving health through enabling environment and healthy choices
and improving health through enhancing the continuum of care for NCD, with five objectives.
Objective 1: To reduce tobacco use
Objective 2: To promote balanced and healthy diet
Objective 3: To increase physical activity
Objective 4: To identify people at risk for NCDs and manage effectively
Objective 5: To improve the quality of care and outcome of NCDs management
FIGURE 1: BruMAP-NCD FRAMEWORK 2013-2018
REDUCE TOBACCO USE
National targets for reduce of tobacco use in Brunei Darussalam under the BruMAP-NCD are:
A 30% relative reduction in prevalence of current tobacco use in persons aged 15 above by
2018
All public places to be smoker-free by 2018
TOBACCO CONTROL MEASURES
BRUNEI DARUSSALAM
Brunei Darussalam has been implementing Tobacco Control Initiatives since early 1970s in which
there was a voluntary ban of tobacco advertising on National Television and Radio. Progress of
Tobacco Control Initiatives in Brunei Darussalam is shown in table 1 below.
YEAR TOBACCO CONTROL INITIATIVES
1976 Voluntary ban of advertising on national TV and radio
1991 Written health warnings mandated on cigarette packs
1994 Smoke-free government buildings
Increased tobacco tax by 200%
1998 Non-smoking flights on Royal Brunei Airlines
2002 Smoke-free school buildings
2004 Ratification of WHO FCTC in June 2004
Islamic perspective on smoking made public
2005 Tobacco Act 13 June 2005
First Smoking Cessation Clinic
2007 Tobacco Regulation 18 July 2007
2008 Pictorial Health warnings (50%) on 1 December 2008
2009 National Committee on Tobacco Control established and chaired by Minister of Health
2010 New amendment on Tobacco Regulation
Increased tobacco tax by 300%
2012 Expansion of smoke-free public places
Pictorial Health warnings (75%)
2013 Increased fine from $150 to $300 for first offence
TABLE 1: TOBACCO CONTROL INITIATIVES IN BRUNEI DARUSSALAM
Brunei Darussalam signed and ratified the World Health Organization Framework Convention On
Tobacco Control (WHO FCTC) in June 2004. For effective implementation of the WHO FCTC by the
member States, WHO recommended the six MPOWER policies to reduce demand for tobacco:
M - Monitor tobacco use and prevention policies
P - Protect people from tobacco smoke
O - Offer help to quit
W - Warn people about danger of tobacco smoke
E - Enforce ban on advertising, promotion and sponsorships
R - Raise taxes to reduce demand
TOBACCO ORDER 2005
FIGURE 2: TOBACCO ORDER 2005
TOBACCO ORDER 2005
Control the use of tobacco products
Control the sale, promotion, packaging and trade description of
tobacco products
Prohibit advertisements
relating to smoking
Protect persons below age of 18 years Control of smoking for
those below age of 18 years
Prohibit smoking in specified places and
vehicles
Duties of managers and operators
GLOBAL YOUTH TOBACCO SURVEY (GYTS) 2013
Global Youth Tobacco Survey was conducted in 2013: a total of 1,574 eligible students in grades 7-11
completed the survey, of which 917 were aged 13-15 years. Results are as follows:
FIGURE 3: PREVALENCE OF TOBACCO USE AMONG 13-15 YEARS OLD
FIGURE 4: EXPOSURE TO SECONDHAND SMOKE AMONG 13-15 YEARS OLD
TOBACCO QUESTIONS FOR SURVEY (TQS) 2014
Tobacco Questions for Surveys (TQS), a shortened version of the Global Adults Tobacco Survey
(mini GATS), is a global standard for systematically monitoring adult tobacco prevalence and
tracking key tobacco control indicators. It was part of Knowledge, Attitude and Perceptions on
NCD Survey carried out from December 2014 until January 2015. There were a total of 1294
completed individual interviews. Results are as follows:
FIGURE 5: PREVALENCE OF TOBACCO USE AMONG ADULTS AGED 15 YEARS ABOVE
FIGURE 6: EXPOSURE TO SECONDHAND SMOKE AMONG ADULTS AGED 15 YEARS ABOVE
PROTECT PEOPLE FROM SECONDHAND SMOKE
Prohibition of smoking in specified places and vehicles: any person who smokes in the specified
places and vehicles is guilty of an offence and will be liable to a fixed compound of $300 for the first
offence.
FIGURE 7: SMOKE-FREE PUBLIC PLACES IN BRUNEI DARUSSALAM
Smoke-free public places also covers 6 meter parameter from any commercial building lines which
includes pathways and parking spaces as demonstrated in Figure 10 below:
FIGURE 8: 6 METER BAN FROM ANY COMMERCIAL BUILDINGS
The Health Enforcement Unit under the Ministry of Health Brunei Darussalam performs regular
inspection at the prohibited places and attended to complaints and reports made by public, and are
eligible to issue penalty to smoking offenders.
Section Details of offence Compound
6(2) Sale of tobacco product imitation 1st offence: $300
2nd offence: $500
10(1) Underage smoking 1st offence: counseling at Smoking
Cessation Clinic
2nd offence: $100
12(3) Sale of tobacco product without license $500.00
14(2) Smoking in prohibited places 1st offence: $300
2nd offence: $500
15(3) Managers fail to show notice of prohibition
(No Smoking sign)
1st offence: $300
2nd offence: $500
16(4) Managers fail to do their responsibilities 1st offence: $300
2nd offence: $500
TABLE 2: OFFENCES UNDER TOBACCO ORDER 2005 THAT ARE LIABLE TO COMPOUND
OFFER HELP TO QUIT TOBACCO SMOKING
The community smoking cessation services were first established in 4 different community health
centres in 2005 to provide support services for smokers who wish to quit smoking through group
and individual counseling as well as pharmacotherapy when necessary.
Most of the services are nurse-led by a 'Smoking Cessation Counselor' (nurses who have been
trained to provide cessation services), with prescription for pharmacotherapy by a general
practitioner or a physician, when required. The service provides an intensive smoking cessation
programme which runs for 6 months including free counseling/ consultations and pharmacotherapy
namely Nicotine patch, Nicotine Lozenges and Varenicline. The success rate for smoking cessation
services since 2005 to 2014 is 20 to 30%.
Smoking Cessation Counseling Workshops for health professionals and other relevant stakeholders
are also organized by Health Promotion Centre annually, to:
increase their knowledge on various aspects of smoking
cessation including current effective pharmacotherapies,
improve their skills and competencies to deliver
standardized smoking cessation brief 5 ‘A’s advice,
support and services,
share information on the global tobacco epidemics and
its impact on health,
discuss on the tobacco control measures in Brunei
Darussalam
The 2005 Clinical Practice Guideline on Smoking Cessation for Health
Professionals has also been revised in 2014 and has been distributed
to all health centres. The revised guideline provides updated evidence-
based recommendations on interventions to treat tobacco use and
dependence. The objective of this guideline is to assist all health
professionals to identify and assess the tobacco use status of every
patient and to deliver evidence-based effective tobacco use and
dependence treatments.
TABLE 3: COMMUNITY SMOKING CESSATION SERVICES IN BRUNEI DARUSSALAM
HEALTH CENTRES DAY OF SERVICE CONTACT NO.
Bandar Seri Begawan Monday (pm) 2230038, 2230046, 2230035
Jubli Perak Sengkurong Saturday (pm) 2661067, 2661068, 2661069,
2661415
Pengiran Anak Puteri Hajah
Muta-Wakkilah Hayatul Bolkiah,
Gadong
Saturday (pm) 2428241, 2428248, 2424991,
Berakas ‘A’ Tuesday (pm) &
Saturday (pm)
2340808, 2340809, 2340810,
2340811, 2340812, 2340813
Berakas ‘B’ Tuesday (pm) 2340815, 2340816
Pengiran Anak Puteri Hajah
Rashidah Sa’adatul Bolkiah
Sungai Asam
Tuesday (pm) 2201593, 2201594
Muara Saturday (pm) 2770177, 2770175, 2770176,
2772991
Jubli Emas Bunut Tuesday (am) 2650450, 2655073, 2655074
Pangkalan Batu Saturday (pm) 2683991
Pusat Pergigian Negara Thursday (pm) 2380430/433
Pekan Tutong Saturday (pm) 4260812
Telisai Thursday (pm) 4244456
Lamunin Saturday (pm) 4237397
Sungai Kelugos Saturday (pm) 4240646
Kuala Belait Saturday (pm) 3335331
Seria Wednesday (am) 3222564, 3222651
Sungai Liang Thursday (pm) 3230428, 3230438
Hospital Pengiran Isteri Hajah
Mariam, Temburong
Saturday (am /pm) 5221210
Morning session: 8:30 am until 12:00pm
Afternoon session: 2:00 pm until 4:30pm
FOR FURTHER INFORMATION:
PLEASE CONTACT HEALTHLINE 145 OR SCC HOTLINE 8882005
In June 2015, Health Promotion Centre has launched a mobile application for smoking cessation
named “Sihat Tanpa Rokok” or STaR. STaR is the health ministry’s latest effort to further reduce
smoking and raise awareness on the negative impacts of the habit nationwide.
The app provides real-time information from the HPC about ongoing tobacco usage, trends and its
dangers, as well as recommending ways to stop smoking. Another feature of the app is its function
that allows users who intend to stop smoking to keep track of the number of days that have passed
since they quit the habit. It also shows the estimated amount of money they would have saved
through doing so. STaR provides users with the option to create individual profiles, and includes a
chat function allowing like-minded users to interact with one another online.
WARNING PEOPLE ON DANGER OF SMOKING
Health messages on cigarette packaging deliver important information directly to smokers. The
message is repeated and reinforced every time a smoker reaches for a cigarette. Brunei’s pictorial
health warning has increased from 50% to 75% in 2012.
Sustained use of mass media campaigns contributes to population-level decreases in smoking
prevalence by increasing knowledge about the harm of tobacco use, encouraging quit attempts and
preventing young people from taking up the habit.
Health Promotion Centre, Ministry of Health does anti-tobacco public education via mass media in
conjunction with World No Tobacco Day annually, including incorporating anti-tobacco education via
the Non-communicable Diseases Awareness Campaign, giving health talks to schools and
government and private offices and providing exhibitions in strategic public places in the country.
FIGURE 9: KNOWLEDGE AND PERCEPTIONS ON HARMS OF SECONDHAND SMOKE AMONG YOUTH 13-15 YEARS OLD (GYTS 2013)
FIGURE 10 : KNOWLEDGE AND PERCEPTIONS ON HARMS OF SMOKING AMONG ADULTS AGED 15 AND ABOVE (KAPSNCD 2014)
In July 2004, the State Mufti issued a fatwa (religious edict) declaring that smoking is haram
(prohibited in Islam) and has been gazetted in 2014 and since has become a law under the Religious
Act under the Ministry of Religious Affairs jurisdiction, and is only applicable to Muslims residing in
Brunei Darussalam.
BAN ON ADVERTISING, PROMOTION AND SPONSORSHIP
Bans on advertising, promotion and sponsorship deny the tobacco industry one of its tools to recruit
new tobacco users to replace those who have quit or died, to maintain or increase use among
current users, to reduce tobacco users’ willingness to quit and to encourage former users to start
using tobacco again. Advertising bans also help reduce the social acceptability of smoking and
tobacco use.
Brunei Darussalam has a comprehensive bans on direct tobacco advertising, promotion and
sponsorship including advertising on national television, radio and printed media and also at point-
of-sale. Brunei Darussalam also does not allow corporate-social responsibility activities from tobacco
industry.
FIGURE 11: BANS ON TOBACCO ADVERTISING, PROMOTION AND SPONSPORSHIP IN ASEAN
RAISE TAXES TO REDUCE DEMAND
Increases in tobacco taxes that lead to higher cigarette prices encourage smokers to quit, increase
successful quit attempts, reduce the number of cigarettes smoke per person and pevent initiation
among youth. Youth, minorities, and low-income smokers are more likely than others to quit or
smoke less in response to cigarette price increases. Because cigarette prices influence youth smoking
initiation, increases in price significantly reduce long-term trends in cigarette consumption.
Brunei increased tobacco taxes in November 2010 via the Customs Import Duty Order
(Amendments) 2010 and Excise Duty Order (Amendments) 2010 and duty-free tobacco products are
also prohibited.
TABLE 4 : TOBACCO TAXES IN BRUNEI DARUSSALAM
FIGURE 12 : TOBACCO TAX BURDEN AS PERCENTAGE OF RETAIL PRICE
REGULATIONS OF E-CIGARETTES OR VAPE UNDER THE TOBACCO ORDER 2005