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Nepal’s tobacco consumption defies awareness initiatives as smokers turn blind eye

person buying cigarettes
Representational image. Photo: Pexels/ Ron Lach

A man in his mid-20s goes to a shop to buy a pack of cigarettes. He sees the gruesome picture printed on the pack. The picture does not matter to him as he turns it over, pays for his cigarettes, and smokes the sticks one by one. 

This is the reality for a lot of people in Nepal as data states 51 per cent of males smoke in the country. Despite the many years of awareness campaigns against tobacco consumption, the smoking population in Nepal has not decreased as estimated or deemed ideal. 

Today (May 31), the world celebrates World No-Tobacco Day, but experts are still wary about the lack of progress Nepal has made in decreasing the smoking population and the nonchalant attitude of smokers about the impact of smoking on themselves and others around them. 

A familiar threat

Starting in 1988, World Health Organization (WHO) started observing this day as the day against tobacco consumption with campaigns that aimed to raise awareness about the impacts of tobacco on health. But smoking is still a growing concern even after 35 years of campaigning

This year’s theme for campaigns is — We Need Food, Not Tobacco.

“Various forms of tobacco consumption, such as smoking cigarettes, vaping, and using smokeless tobacco products like khaini and surti, have a significant impact on health,” Roshan Prajapati, Head of the Oncology Department at Bhaktapur Cancer Hospital says, “These habits involve the intake of more than 70 per cent of chemicals and carcinogens, directly affecting the blood, lungs, heart, mouth, and 12 other organs.”

Head of the Oncology Department at Bhaktapur Cancer Hospital Roshan Prajapati talks about tobacco consumption in nepal
Head of the Oncology Department at Bhaktapur Cancer Hospital Roshan Prajapati. Photo: Nasana Bajracharya

“It is particularly associated with cancer with an estimated 70 to 80 per cent of lung cancers attributed to smoking,” he adds.

According to him, second-hand smoking is responsible for about 40 per cent of tobacco-related cancers, including oral cancer, and research indicates that it can increase the risk of asthma, other respiratory problems, heart disease, and certain types of cancers by 30 to 40 per cent.

Female smokers can face an increased risk of developing uterine and female cancers, as well as experiencing fertility problems with both first and second-hand smoking.

“Ovarian cancer ranked as the 18th most common cancer worldwide and the eighth most common in women. Studies have shown that tobacco consumption, in particular smoking, increases the risk of mucinous ovarian cancer,” Srishti Shrestha Prajapati, Gynaecologist at B&B Hospital says.

“Likewise, cervical cancer is twice as likely to develop in women who smoke compared to non-smokers, as it weakens their immune system and makes them more susceptible to HPV (human papillomavirus) infection, which is responsible for 90 per cent of cervical cancers. Vaginal cancer is also more prevalent among smokers, especially those with HPV infection.”

The rise in popularity of vaping and hookah smoking is a concern, as they pose additional health risks, such as they are directly inhaling harmful chemicals and smoke from (char)coal.

The economic impact of tobacco consumption in Nepal is substantial, with smoking-related costs accounting for approx 1.8 per cent of the country’s GDP. The costs of tobacco-related illness fall on both the government and individuals, including direct and indirect costs such as out-of-pocket expenditures and hospitalisation.

Additionally, approximately 1.5 million hectares of land are being used for tobacco farming in the world and 600,000 hectares of land have been deforested due to this industry. Land used for tobacco farming also makes it unsuitable for agriculture, harming the population more indirectly.

The data highlights the urgent need for increased awareness and effective measures to combat the detrimental impact of tobacco. By prioritising public health over profit, reducing tobacco consumption is achievable, leading to a healthier population and environment in Nepal.

And in these 35 years, many attempts have been made in Nepal. However, despite many efforts to discourage tobacco consumption and smoking, their effectiveness has been limited. 

Laws and outlaws

On paper, laws and policies of Nepal against tobacco, including banning promotion, sponsorship, and visualisation, exist but require enforcement are a hit and miss. Awareness campaigns about the hazards of tobacco and implementing comprehensive measures to combat its harmful effects have been a constant. “The ban on tobacco advertisements in Nepal is a positive step towards reducing tobacco consumption, but challenges remain in other parts of the implementation,” says Roshan.

One of the movements that have not been effective as it should be is printing scary images of mouth cancer on cigarette packets. People got spooked at first but then it has been useless in terms of people buying cigarettes as they have learned to avoid the pictures. 

Meanwhile, time and again the government has imposed a ban on public smoking however it is not been effectively implemented, despite its illegality. As per WHO guidelines and laws of Nepal, disclaimers are necessary to be put in every use of alcohol or tobacco consumption on screen.

But that has also been ineffective, Roshan says, “The letters are so small and an obligation only. People are more busy watching the actors on screen. Many even copy them and start smoking.”

Executive Director of Bhaktapur Cancer Hospital Dr Bishnu Dutta Paudel talks about tobacco consumption.
Executive Director of Bhaktapur Cancer Hospital Dr Bishnu Dutta Paudel. Photo: Nasana Bajracharya

On the failure of the government to implement the rules, the Executive Director of Bhaktapur Cancer Hospital, Dr Bishnu Dutta Paudel comments, “It is the lacking in implementation part. Laws are there but what is the use if not implemented? We have MaPaSe check (drunk driving checking) as the best example of how the laws can be implemented properly to ensure that people follow them for their safety.”

Data from the emergency wards of the hospitals have also shown that cases of DUI and accidents and physical altercations caused by it have decreased significantly. But that is not the case with public smoking or tobacco consumption. He says, “People are scared to drink and drive. But you will not see anyone who fears that they will be penalised for smoking in public or selling tobacco products against the law to children or pregnant women.”

Roshan suggests that implementing a public smoking ban is crucial, to protect people from second-hand and third-hand smoking too. He adds, “Children and non-smoking adults who are exposed to secondhand smoke are at increased risk of developing these diseases.”

Efforts should also be made to ensure that tobacco producers and manufacturers do not influence regulations or hinder effective monitoring, he adds.

One of the most effective ways to control tobacco consumption, they say, is to increase the tax on tobacco products. “There are some studies that suggest increasing taxation can help control consumption. Immediately after the increase, there is always a drop in consumption,” shares Roshan.

But the tax on tobacco for the next fiscal year in the budget announcement has been deemed the lowest raise in the last 10 years raising concerns among stakeholders.

What can be done?

Experts say it is essential to consider measures such as banning tobacco imports and production to address this problem.

“Ideally, it would be great if could ban the import and the production of any form of tobacco in Nepal. Because that is a useless thing and a problem we are paying and inviting ourselves. It can easily be avoided,” says Paudel.

chewing gum for tobacco consumption
Representational image. Photo: Unsplash/ Gabriel Dalton

But there is a certain backlash that might tag along with that step. Even more concerning, Roshan says, “Approx 25 per cent of the smoking population in the low socioeconomic countries are known to shift from smoking cigarettes to bidi. And that will not help decrease tobacco consumption.”

He suggests having a strong campaign for people to quit smoking and building a support system for people who want to quit smoking. Quitting smoking or tobacco consumption can lead to improved respiratory health, and even one year of abstinence can make a significant difference. “As of now, we lack any cessation programme that helps even one of the 51 per cent of males who would want to quit,” reminds Paudel.

“In collaboration with WHO and the Ministry of Health and Population, we are initiating a programme to distribute nicotine chewing gum to heavy and light smokers,” Roshan informs, “The suggested routine is to chew the gums every four hours to help them overcome tobacco addiction.”

Paudel further suggests, “To work on it, we need to have a dedicated body to work on the matter and make a year-round calendar to see the change. And to do that we will also have enough funds.” According to him, just redirecting the revenue and tax collected on tobacco would be enough for that separate entity to function and make a difference in all the provincial and federal level operations.

“Making the penalty system stronger will also help in the process, they say. Research and policies backed by data can be a great addition too,” Paudel says. But research has been scarce in Nepal.

“Yes, there is not enough research but before dwelling deep into tobacco consumption, we first should be able to make use of the data and research that we have,” he adds, “Just knowing that 51 per cent of the males smoke does not help the case, we need to work on it.“

On the sidelines, Prime Minister Pushpa Kamal Dahal expressed commitment to implementing effective tobacco control programmes and tuberculosis control strategies, with the allocation of adequate resources to achieve elimination.

But experts say the awareness programme should be prioritised and implemented effectively in all three-tier of governments with multi-sectoral campaigns rather than considering it a mere formality. 

“It is crucial to include information about the hazards of smoking and tobacco consumption in the school syllabus for adolescents to prevent them from succumbing to peer pressure and starting smoking,” stresses Roshan.

To do so, Roshan says that people need to work on understanding. There is a misconception that smoking for 25 years without experiencing health issues implies good health, while non-smokers develop cancers. However, lung cancer is not the only consequence of smoking, and the detrimental effects can affect various aspects of health. 

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Bajracharya is a sub-editor at Onlinekhabar. She mostly writes on culture and nature.

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