Rethinking Pakistan’s tobacco control approach

View of the cigarettes and tobacco stack. The tobacco plant is part of the genus nicotiana and of the solanaceae (nightshade) family.

In Pakistan, tobacco smoking has remained one of the most pressing issues for public health, with around 163,360 people dying in 2017 due to smoking (Source: Tobacco Control Cell, Government of Pakistan). According to WHO, Pakistan ranks among the top 15 countries worldwide suffering from health issues from tobacco smoking. To combat the country’s worseningpublic health, the Pakistan government, through the Ministry of Health, has been consistently working on developing and implementing tobacco control laws and programs. In 2005, Pakistan became a part of the WHO Framework Convention on Tobacco Control (FCTC) and in 2008, developed the Tobacco Control Cell, which is responsible for tobacco control nationally (Source: The Union).

Despite all the diligent efforts, Pakistan’s tobacco control policies and programs have seen only a slight reduction in the number of smokers in the country. Until now, the government of Pakistan has been focusing on tobacco cessation through increased taxeson tobacco products, improved graphic and text health warnings, and bans on advertising them in the media. However, one of the main setbacks faced by these laws and policies is their anti-smoking mantra without practically extending anyhealth service to the users to quit tobacco consumption. This renders the cessation programs, despite undoubtedly being the ideal action, unable to achieve favorable results.

Understanding the unfortunate complexities involved in outright quitting, Pakistan can take inspiration from the UK government. They have smartly adopted a harm reduction strategy to achieve their goal of saving their population from the dangers of tobacco smoking. Harm reduction refers to a range of public health policies that prioritize reducing the negative consequences of various human behaviors, both legal and illegal when outright abstinence is unachievable. The UK government promotes shifting to vaping, heated tobacco products, and other scientifically substantiated alternatives for users who cannot quit.

Similarly, the New Zealand government reversed its ban on vaping, realizing tobacco users’ obstacles in quitting. The country envisions a smoke-free New Zealand by 2025, encouraging smokers- who would have continued to smoke otherwise- to shift to less harmful alternatives.

Although not risk-free, alternatives such as e-cigarettes, heated tobacco products, nicotine pouches, snuff, etc., do not require the burning of tobacco (which is the primary source of emission of carcinogens and other toxic materials, posing the real threat), hence exponentially reducing the risk involved with tobacco consumption.

The Way Forward: In light of the constraints involved with outright tobacco smoking cessation, which make it far from an ideal situation, Pakistan’s best shot would be torather adopt a harm reduction approach, providing less harmful alternatives to legal-age smokers who are unable to quit smoking.

Only with the right regulatory encouragement and support from civil society can we deliver better alternatives at scale to the hundreds of millions of adult smokers who would otherwise continue to smoke.


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