The tobacco control tug of war
In a generic form, the process of governance entails enactment of laws and establishment of norms to rule an organised society in the given territorial bounds. To ensure normalcy in everyday life, it is essential to ensure the safety, security, health and economic well being of the citizens. To this end, states set up various institutions, departments, boards, cells, offices and authorities. These governance structures must work in the interest of the country and ensure a beneficial, secure and healthy environment for the citizens.
It follows from the theory of governance that a government cannot have two contending institutions – one of them must go. This means that no sensible government can promote an agenda using one of its organs and try defeating its purpose using another. Such a practice is not only contrary to the commonsense but also an unnecessary financial and social burden.
Another aspect of efficient governance is that committees and boards may be formed from time to time and dissolved conveniently once the results desired of them have been achieved. Meeting the needs of the general public remains the centre of gravity for all governance and policymaking.
In Pakistan, public health has remained a neglected domain for too long. The plight of government hospitals is a loud testimony to this. Devolution of certain powers to provinces through the 18th Constitutional Amendment has resulted in worsening the neglect of many vital issues. Showing images of the brain of a malnourished child during one of his early speeches Prime Minister Imran Khan had expressed an interest in public health. He left a lot to be desired.
Relevant to the issue of public health is a classic display of perplexing governance – two government agencies working against each other’s mandate. They are the Pakistan Tobacco Board at the Ministry of Commerce and Tobacco Control Cell at the Ministry of National Health Services Regulation and Coordination.
The Board was established in 1968 for the “promotion of cultivation, manufacture and export of tobacco and tobacco products, marketing, fixation of prices and other information”. The message from the chairman clearly states that “We take measures in the interest of tobacco industry”.
Get it straight: the government of Pakistan is fostering a department working in the interest of tobacco industry. This industry is producing tobacco products resulting in a health burden of billions of rupees annually for the same government.
A plethora of research and empirical evidence is available on the use of tobacco and its impact on health economy. However, the Pakistani policymakers remain in denial
Tobacco Control Cell was established 40 years down the road, in 2007, to resist the unchecked spread of tobacco and its products. Its main aim is to accelerate the “tobacco control activities in Pakistan through multifaceted efforts starting from planning, resource mobilization, institutional strengthening, and public-private partnership and monitoring”. After the devolution of Ministry of Health to the provinces, the Tobacco Control Cell was placed under the ministry.
So there you have it. There is a government body working to promote tobacco, tobacco products and their exports and another making laws that limit smoking spaces, limit tobacco advertisement, ensure adequate graphic health warnings on the packing and promote excessive pricing and taxation to curb tobacco use.
Tobacco Board Rule 24 of SRO 1111(I)/2016 of November 21, 2016, allows promotional signboards to be placed outside tobacco businesses. This is in clear contradiction with the ban on all types of tobacco promotion and sale, notified by the Ministry of Health notification F.13-5/2003HE dated October 25, 2003.
Tobacco has been defined by the Tobacco Board Ordinance of 1968 as a commodity made from the leaves of the plant nicotiana tobaccum or nicotiana rustica that includes adjacent tender stalks or green tobacco but does not include tobacco waste.
Pakistan is a signatory to the Framework Convention on Tobacco Control since 2004. It needs to have a user friendly, rather than a producer friendly, definition of tobacco as desired by the treaty. FCTC Article 1(f) defines tobacco as “any product entirely or partly made of the leaf of tobacco as a raw material which is manufactured to be used for smoking, sucking, chewing or snuffing”. This definition is absent from all Tobacco Control laws.
The Tobacco Control Cell research claims that 160,100 Pakistanis die of tobacco related diseases annually. In simple terms, this means tobacco industry is responsible for affecting the life and health of thousands of families annually. The indirect costs include loss of working hours due to disease, worker replacement cost and the health burden cost on hospitals and organizations.
Tobacco Board, on the other hand, claims a job promotion of 50,000 to 60,000 farmers and another almost 100,000 tobacco traders. Unfortunately the total combined claim is less than those who die every year. The Tobacco Board also claims to have earned Rs 1,233.86 million, which in today’s term mean little more than $8 million in an economy of almost $315 billion (the figures provided on Tobacco Board website are in Pakistani Rupees).
A plethora of research and empirical evidence is available against the use of tobacco and its impact on health economy. However, Pakistani policymakers remain in denial. Public health is one of the major areas needing special attention, and within that the role and burden of tobacco on the public health.
Under Prime Minister Imran Khan the focus of governance has to shift from a top-centric approach to grassroots level. From building affordable housing to distributing health cards and from job creation to general safety and security, the government has been promising to make the commoner the measure of all things. It would make sense therefore to reconsider the presence of contending offices in the government. This could have a far-reaching effect on national health and national health economy.
Thankfully, tobacco is not grown on very vast lands. The 46,000 hectares currently under the crop can be better utilized for other cash crops like cotton or rice. It is a matter of national priorities. The influential tobacco industry does not allow an open discussion on such healthy transitions. Pakistan could learn a lesson or two from Bhutan, a South Asian neighbour that prides itself in being a “tobacco free” nation.
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The opinions expressed in this article are the author's own and do not necessarily reflect the viewpoint or stance of SDPI.