World No Tobacco Day: A Reel Through Nepal’s Struggles, Initiatives and Implementations

Nepal has been addressing many of the issues that threaten the health and life span of its population. It has been constantly working to fight diseases like thalassemia, hemophilia, diabetes and many others.

It’s recent achievement in eliminating trachoma speaks of how dedicated the country is towards its health initiatives!

However, among many health issues that plague Nepal, the chronic condition of the people involved in tobacco consumption has been haunting the country for quiet some time now.

Despite the progress that Nepal has made in controlling tobacco consumption in the recent years, people continue to die and become sick unnecessarily. It has been observed that there is a steady rise in the price that the society has to pay due to tobacco consumption. And that is why, Nepal has a long way to go in terms of curbing this life-threatening practice.

Some Alarming Statistics

Each year, more than 27,100 Nepalis die due to tobacco-caused disease. Despite this, it has been noted that more than 21,000 children between the age group of 10-14 years and 37,45,000 adults above 15 years continue to use tobacco each day! Insufficient steps towards the epidemic has encouraged the Nepali tobacco industry to continue its production and increases the death-toll each year.

• Costs incurred

The economic costs of smoking add up to 22, 942 million Nepalese rupees. This cost includes direct costs on healthcare expenditures and indirect costs on lost productivity due to early mortality and morbidity.

• Consequences of Smoking Tobacco 
  • Impact on Development
    Buying tobacco deprives families of the resources they need to emerge out of poverty. In Nepal, a smoker spends 42.19% of their average income (measured in terms of per capita GDP) to purchase 10 most popular cigarettes each day in a year.
  • Impact on Environment
    Cigarette butts and packets are the most-commonly disposed trash in the world. An estimated number of 4732 tons of butts and packs amount to toxic trash in Nepal, every year.
  • Impact on Equality
    To strengthen its impact on consumers, the tobacco industries, target women and children.
  • Impact on Neurological activity
    People with mental illness smoke two times more than the other people.

• Industry Figures

The combined revenue of the world’s six largest tobacco-producing companies in 2016 was more than USD 346 billion, which is 1513% larger than the Gross National Income of Nepal.

• Agricultural Production

In 2014, Nepal produced 2,329 metric tons of tobacco. However, the country has only 0.04% of its agricultural land dedicated to tobacco plantation.

Initiatives to Curb Tobacco Usage in Nepal since January 2018

• On January 04, the locals of Bharatpur Metropolitan city held a demonstration to persuade the municipal officials to free the city from the practice of chewing tobacco products like Ghutka.The participants not only spoke about the harmful effects of Ghutka, but also argued that sachets of Ghutka and other chewing-tobacco items were thrown carelessly, resulting in causing environmental pollution.

• On January 12, the Nepali Ministry of Health (MOH) launched the ‘Tobacco Products Control Convention Strategy 2030’ with the aim to reduce tobacco consumption in the long run. The strategy provided guidelines to policy makers, service providers, the concerned ministries and bodies, and the national and international Non-Governmental Organizations (NGO) involved in the development and implementation of tobacco control programs.The National Health Education, Information and Communications Centre under MOH drafted the strategy. While addressing the convention, Minister Bohara expressed his belief that the strategy would be a milestone in controlling tobacco products that cause many non-communicable diseases.

• On February 25, the Kathmandu Metropolitan City (KMC) submitted a plan to strictly curb the purchase, sale and consumption of tobacco or smoking in public places with the objective of promoting a healthier lifestyle.The release also talked about KMC’s plans to deploy police personnel to check purchase and sale of tobacco, along with strict regulations (such as fine of Rs. 100-1000) on those indulging in consumption or dealing and shops displaying and selling products to people below 18 years and expecting mothers. KMC Spokesperson, Gyanendra Karki said the office was planning to completely ban the purchase and sale of tobacco products in few years.

• On April 07, Tribhuvan University sent letters to its divisions, departments, offices of deans, sports council, research centers and constituent campuses, asking them to prohibit tobacco consumption on their premises.Chief, TU General Administration Department, Suvash Chandra Kandel said, “We have circulated the letters to all the concerned bodies and have informed all not to smoke, consume tobacco or drink alcohol on the premises of TU or its constituent campuses. As educated people visit these places, I hope we don’t need to use force or establish a check-point to enforce the rule”.

• On April 30, MOH proposed for a 70% hike in excise duty on tobacco products to the Government of Nepal through the budget for Fiscal Year 2018-19.Through this move, MOH aimed to discourage the tobacco consumption in the country while boosting the government’s revenue.

• On May 12, MOH wrote a letter to the Office of the Prime Minister, Council of Ministers and Ministry of Home Affairs requesting them to ban the sale, distribution and use of tobacco and related products in the premises of Singha Durbar. The Minister for Health and Population Padma Kumari Aryal took a decision in this regard on March 23, 2018. The ban has been implemented and no one is allowed to carry tobacco into the premises.

The History of ‘World No Tobacco Day’

May 31^st is celebrated as the ‘World No Tobacco Day’, internationally, every year.

On this day, the general public is educated about the ill-effects of tobacco consumption, the business practices of tobacco companies, the measures of the World Health Organization’s (WHO) in tackling the consequences of tobacco consumption and at a more personal level, people’s awareness about healthy living and safety of future generations.

Although the member states of the WHO started the’ World No Tobacco Day’ in 1987 with the vision of drawing global attention to the tobacco epidemic and the harm it causes, May 31^st in 1988 came to be known as the day dedicated to ‘No Tobacco’ after Resolution WHA42. 19 was passed.

Tobacco Breaks Hearts!

In 2018, the WHO and its partners decided to emphasize on ‘Tobacco and heart disease’ as the theme for the ‘World No Tobacco Day 2018’.

Under the theme, WHO lays it focus on:

• The link between tobacco and heart and & other Cardiovascular Diseases (CVD), including stroke, which when combined are the world’s leading causes of death
• Enable key audiences including governments and the public to take feasible actions and measures to reduce the hearth-related risks posed by tobacco
• Encourage countries to strengthen implementation of the proven MPOWER tobacco control measures contained in WHO Framework Convention on Tobacco Control (WHO FCTC)

As per a document compiled on the basis of the theme, tobacco kills over 7 million people every year, which means more than 19,000 people die from tobacco consumption and secondhand smoke exposure.

Yes, tobacco can be deadly for non-smokers as well. Secondhand smoke contributes to heart disease, cancer and other diseases, resulting in around 890,000 premature deaths each year.

• Tobacco use and second-hand smoke exposure are major reasons for CVD leading to approximately 17% of all cardiovascular deaths globally, about 3 million deaths per year
• The cardiovascular risks due to tobacco smoking increases with the amount of tobacco smoked and the years of having smoked
• The risk is substantially increased by exposure even to low levels of tobacco smoke, as with exposure to second-hand smoke. In fact, smoking only about one cigarette per day incurs half the risk of developing coronary heart disease and stroke incurred by smoking 20 cigarettes per day

How does Tobacco break hearts?

Tobacco smoke contains over 7,000 chemicals and is divided into two phases, a particulate phase and a gas phase. 

• Particulate Phase: This phase of smoke contains nicotine, a highly-addictive Substance, and is associated with rise in heart rate, blood pressure and myocardial contractility and the total aerosol residue (tar), which together contribute to heart disease through the following pathways: Inflammation, impairment of the endothelium (the lining of the blood vessels), enhanced formation of clots and reduced level of high-density lipoprotein (HDL) cholesterol.
• Gas phase: This phase contains the poisonous gas carbon monoxide along with other gases. Carbon monoxide replaces oxygen in the blood, thereby reducing the availability of oxygen for the heart muscle and other body tissues.

These pathophysiological effects of tobacco predispose both active tobacco users and passivesmokers to the formation of atherosclerosis or narrowing of the arteries, leading to various types of CVD such as ischaemic heart disease, cerebrovascular disease, peripheral artery disease and aortic aneurysm.

Benefits of Quitting Tobacco Usage

The WHO has recommended that awareness on tobacco be carried out through means of counselling through toll-free quite lines and mobile text messages. Mentioned below are some interesting health benefits:

Immediate Benefits:

• Within 20 minutes the heart rate and blood pressure drop
• Within 12 hours, the carbon monoxide level in the blood drops to normal
• After 2-12 weeks of quitting tobacco use, the circulation improves and lung function increases
• After 6 weeks, 97% of oral leukoplakic lesions are completely resolved
• After 1-9 weeks, coughing and shortness of breath decrease

Long-term Benefits:

• One year after quitting smoking, the risk of coronary heart disease is about half that of a smoker
• 1-4 years after quitting smokeless tobacco use, the risk of death falls to nearly half that of a person who continues to use it
• 5-15 years after quitting smoking, the risk of a stroke is reduced to that of a non-smoker
• 10 years later, the risk of lung cancer falls to about half that of a smoker and the risk of cancer of the mouth, throat, esophagus, bladder, cervix and pancreas decreases
• 15 years later, the risk of coronary heart disease is that of a person who never smoked.

We hope to see that Nepal’s government and people work collaboratively to create and implement policies and rules that the will rid the nation of this hazardous epidemic.