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Smokeless Tobacco Control in South-East Asia Region Dr Jagdish Kaur Regional Adviser, Tobacco Free IniAaAve WHO SEARO [email protected]
SmokelessTobaccoControlin
South-EastAsiaRegion
DrJagdishKaurRegionalAdviser,TobaccoFreeIniAaAve
Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare e x p e n d i t u r e a n d l o s t productivity
Effective tobacco
control is need of the
hour
SEAR is home to about one-fourth of the
world's population,
one-fourth of world’s
smokers and 90% of
smokeless tobacco users
Diverse population groups with high
socio-cultural acceptance of ST products in many
countries Most countries are LMIs
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.02007
2013
2004
2006
2009
2013
2003
2006
2009
2014
2011
2007
2011
2016
2007
2011
2007
2011
2015
2009
2015
2013
Bangladesh Bhutan India Indonesia Maldives Myanmar Nepal SriLanka Thailand TimorLeste
Percen
tPercentageofcurrentsmokelesstobaccousersamongyouthin
selectedMemberStatesoftheSouth-EastAsiaRegion
Source:GlobalYouthTobaccoSurvey2003-2016
1.7 2.6 3.2
15.817.8
19.7 19.8 21.4
27.2
43.2
1.53.9
1.1
26.0
31.3
26.5
16.1
29.626.4
62.2
2.0 1.45.2 5.3 4.8
11.0
26.8
12.8
27.924.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Indonesia Maldives(Malé)*
Thailand SriLanka Nepal Bhutan Timor-Leste India Bangladesh Myanmar
PercentageofcurrentsmokelesstobaccousersamongadultsinselectedMemberStatesoftheSouth-EastAsiaRegion
Total Male Female
Flavoured ST constitutes 70–98% of all ST products in SEAR
Many ST products are used along with betel nut Betel nut itself has high prevalence of use in many countries
Aggressive marketing of areca nut products such as supari and pan masala by the industry, especially in countries attempting to enforce some sort of ban on ST products
Paan(pan)andpaan(pan)masalashouldbeconsideredtobaccoproducts
BetelnutBetelnutgrown
widelyandconsumedalong
withSTorseparatelyinSEARcountries
UniversalstandardclassificaAonoftwoproductsindigenoustotheIndiansubconAnentandpopularamongSouthAsiansgloballyastobaccoproducts
Bangladesh
STcoveredunderthetobacco
controllaw
TAPSbanBanonsaletominors
TwoGHWs
assignedtoST
products
MediacampaignsCessaAon
TobaccoFree
Hospitals
Doma zhes is one of the most heard and widespread phrases inBhutan:"Pleasehavebetel leafandarecanut"becomesa leitmoUfeachUmetwo individualsmeet,attheendofameal,and inall theoccasionsofeverydaylife.Customers buy the betel leaf at the weekly markets, their dress'spocketbulgingwithsilverboxes,orjustsimplywithplasUcbagsfilledwith betel leafs; pe]y sellers at bus terminals selling ready madequid, called kamto, in cone shaped papers;monks returning to themonastery with their bags filledwith quanUty enough to last for aweek’s consumpUon;betel leafwitha smallpieceofarecanut thatthe host offers with his two hands to the guests at the Ume of aceremony;betel leafsandnutsput inaplatealongwiththosefilledwith chocolates during archery games or official ceremonies ; betelleafsandnutspassedroundaberdinner;redstainsinthestreet;menandwomenwithredstainedteeth.
Bhutan Onlycountryintheworldtobantobacco
India
AlltobaccoproductscoveredunderthelawBetelnutproductsneedtodisplaythe
warning
Banonselected
STproducts
BangladeshMyanmar
Bhutan,Nepal
SriLankaMaldives
CountriesoutsideSEAR
Banbutnoban–HindustanTimesDespitethebanandsubsequentSupremeCourtorderforcompliancereportbuyingchewingtobaccoisassimpleastoffees
InnovaAvemarkeAngMostcigareZeshopssellpaanmasalaandchewingtobaccowhichismixedbytheuserstopreparemixtureofgutka
VicePresidentofIndiaatTimesofIndiaLi]est2017openingceremony25thNovember2017,NewDelhi
Myanmar
Myanmar AungSanSuuKyi,Myanmar’sdefactonaAonalleader,askedallchiefministerstotakeacAontomakepeoplecutdownontheirhabitofchewingthenutsandspidngoutthedarkjuiceinpublicplaces.
ImplementedamediacampaigninSept-Oct2017againstST&betel
nut
Banonchewing,spidngorsellingbetel
nutsinorneargovernmentoffices,schoolsandhospitals
Centraltobaccocontrol
commiZeechairedbytheMinisterofHealth
IntheprocessofamendingexisAnglawtomakeitmoreinclusive&
effecAve
Nepal
STcoveredunderthe
law
90%GHWsonalltobaccoproducts
Licenserequiredbyvendorsforsellingtobaccoproducts
SriLankaProtocol
toeliminateillicittrade
Stoptobacco
culAvaAonby2020
TobaccoFreevillages
NATASub
commiZeeOnST
ChewingarecanutandbetelbannedJuly2017
InvolvingreligiousleadersinbehaviorchangeofpopulaAon–
betelfreetrays
Timor-Leste
NewcomprehensivetobaccocontrollawforprevenAonand
control–implementaAon
started
AcceleraAngFCTCImplementaAonTo accelerate
efforts against
tobacco, SEAR
countries
adopted the Dili
Declaration on
Tobacco Control All countries pledged a full-on war against tobacco by strengthening WHO FCTC implementation
The declaration highlights the urgency for stronger measures to stop the tobacco epidemic
in SEAR
Article 6 of the
WHO-FCTC is poorly implemented in
SEAR
Taxes on indigenous smoking products
and ST products are even lower
WHO provides technical assistance toM.SsonSTpolicies&programs• MPOWERtechnicalpackage(keydemandreducUonmeasuresunderFCTC)
• SupportCOPdecisionsonST• TobaccosurveillanceincludingGTCR• TobaccoproductregulaUon• Tobaccocontroleconomics• InnovaUveintervenUons-mCessaUon• InternaUonalandRegionalCooperaUon&collaboraUon
• SupporttheKH
2014study-STnototherwisespecified(NOS)becauseoflackofinformaUonontheprecisenatureoftheunburnedtobaccoProductsandofbetelquidwithouttobaccointheeUologyoforalcancerinSouthAsiaandthePacific.
STNOSandBQwithouttobaccoareriskfactorsfororalcancersinAsiaandthePacific
ControlofSTNOSandBQwithouttobaccomustremainanintegralpartoftobaccocontrolinanypublichealthstrategy.GovernmentsaroundtheworldshouldprohibittheimportofallSTproducts
Roadahead?• MainstreamSTandbetelnutprevenUonandcontrol
• Strengthensurveillanceandresearch• Intensiveandfocusedbehaviorchangecampaigns
• BuildcapacityofhealthsystemsforcessaUonsupport
• MulUsectoralcoordinaUon• InternaUonalandRegionalCooperaUon
