Going up in smoke?

By Dr Arif Azad

In a year-end review of 18-31 December issue, the weekly Guardian, surveying the state of tobacco industry’s profitability, revealed that while profit of big tobacco giants has fallen in Europe and countries where tobacco control law are strict, the tobacco industry has more than made up for these losses by making record profits from countries like Pakistan and Nigeria during the last decade.

This has come as a shocking revelation for public health officials and tobacco control advocates in Pakistan despite the common knowledge that cigarette smoking has been on the rise. The conclusion that Pakistan has become a fertile ground for tobacco industry’s operation is apparent from the report.

What makes this news more disturbing is the fact that this has come against the backdrop of a major international treaty aimed at curbing tobacco use being enforced worldwide. This treaty called Framework Convention on Tobacco Control (FCTC) drafted under the aegis of World Health Organisation (WHO) was adopted by world health assembly in 2003. So far, 168 countries have signed up to this landmark treaty which places mandatory obligation upon all the parties to the treaty to incorporate the FCTC into domestic legislation to give teeth and international law force to domestic legislation on tobacco control. Also to present a unified stand against the powerful tobacco industry — which has sought to undermine all efforts at tobacco control over the years.

Like other countries, Pakistan ratified the FCTC on Novembers 3, 2004, binding herself into legal obligations enshrined in the framework convention. FCTC is a comprehensive convention which embraces full panoply of tobacco control measures which, if fully adhered to, can make a big dent in tobacco consumption worldwide. The act of ratification represented a major advance for tobacco control efforts for which the government of Pakistan deserves applause. Until now some significant advances have been made on advertising of tobacco which has gone some way in curbing the activities of tobacco industry. Yet one of the major provisions of FCTC regarding pictorial warnings on cigarette packs remains unimplemented due to the zig-zag game with deadlines.

Article 11 of FCTC requires the signatories to introduce pictorial health warnings on cigarette pack as a measure to reduce tobacco consumption. This single measure has been known to be highly effective in reducing consumption of tobacco in countries where it was introduced. One international study conducted by International Tobacco control project on the effectiveness of pictorial warnings in 19 countries in 2008 concluded that pictorial warning on cigarette packs were more effective than text-based warning in raising awareness of harmful effects of smoking and motivating smokers to quit.

These findings also lend support to additional guidelines on Article 11 which stipulates that at least 50 percent area of a cigarette pack should contain pictorial warning. In Pakistan, where literacy rate is abysmally low, pictorial warnings are the most effective weapon in the armoury of government’s tobacco control policy.

Pakistan made a significant leap forward on pictorial warning legislation when, on May 31, 2009 on World Health Day, the then Federal Minister for Health, Mir Aijaz Jakharani, announced the introduction of pictorial warnings on cigarette packs by January 1, 2010. This put Pakistan among the 30 countries which have undertaken to implement Article 11 of FCTC.

Some sections of the press headlined pictorial warning announcement as the landmark decision which earned Pakistan international kudos. Like all other announcements made amid much fanfare, this landmark announcement has yet to land six months down the road. Like elsewhere in the world, Pakistan tobacco industry, using its vast financial muscle, swung into action to torpedo the initiative ever since the announcement was made. This has resulted in the implementation of pictorial warning being serially delayed to newer deadlines.

Tobacco industry has also sought to reduce the size of pictorial warnings, a re-run of tactics employed in other countries in an effort to reduce the effect of pictorial warnings.

In October 2009, the ministry of health moved the January 1 deadline to February 2010. Now the press inquiry has established that the deadline has been extended to May 31, 2010. There is no official notification to this effect, nor any clues as to how this decision has been dropped. This has happened despite the issuance of statutory regulation order (SRO) for February 1, 2010. If the press reports are to be believed then tobacco industry has been given a whole year to comply with pictorial warning legislation. Countries like Chile and Venezuela managed to enforce pictorial warnings. The unwarranted delay in the implementation of pictorial warning legislation will further contribute to tobacco deaths, which is mounting by roughly about 300 annual deaths in Pakistan.

Article 5.3 of FCTC also binds signatory state to protect their health policies from commercial interest of tobacco industry. This places an added obligation on the government of Pakistan to stick to its February 1 deadline for the full implementation of pictorial warnings so that mounting pile of tobacco deaths could be reduced. It would be a great service to the people of Pakistan and a massive boost to public health policy goal. Parliamentarians and political parties have a major role to play in giving teeth to tobacco control policy by moving the government to stick to its February 2010 deadline for pictorial warning legislation.

For any tobacco control policy to be effective, FCTC would have to be implemented in letter and spirit. The new Federal Minister for Health, Makhdoom Shahabuddin, would be doing a great service to the nation by announcing the implementation of pictorial warnings and other provisions of FCTC within the timeline announced. This singular act would go a long way in reducing the mortality rate due to tobacco use and give a definite shape and direction to the tobacco control policy.