Smoking In Asia: A Looming Health Epidemic

In the wake of Australia’s landmark ban on cigarette package advertising, Asian Scientist Magazine casts an eye over smoking in Asia.

AsianScientist (Aug. 22, 2012) – All across Asia countries are bucking gloomy global economic trends with positive growth, a phenomenon also observed in its smoking rates. While smokers in the West are stubbing out for good, increasing numbers in Asia are lighting up.

The world’s two most populous nations – India and China – are home to more smokers than the entire population of the European Union. In China, more than 300 million people are tobacco users, while India adds another 275 million to the tally.

A study by the George Institute of Global Health in 2010 revealed that the Asia-Pacific region is home to 30 percent of the world’s smokers, and the World Health Organization (WHO) has found that almost 80 percent of smokers live in low to middle-income countries. The impact of smoking is greatest in these countries because smokers who develop lung cancer are diagnosed at later stages of the disease and receive less effective treatment.

Should developing countries in the region continue to smoke at the current rate, the number of people dying from smoking-related lung cancer would double over the next 20 years, the WHO study found.

Big Tobacco targets women and youth

“In many Asian countries like China and India where men already smoke at an incredibly high rate, women and young people are now being targeted by the tobacco industry,” said Edouard Tursan D’Espaignet of the WHO tobacco control program in an interview with German radio broadcaster, Deutsche Welle.

And why not target women in a region where female smokers are vastly outnumbered by men? In China, only four percent of women smoke compared to 60 percent of men, a situation that is similar in Indonesia and Malaysia. Women and girls form an enticing market with large growth potential and Big Tobacco is now starting to target this demographic with fancy cigarette packages, such as packaging in the form of lipsticks.

The youth also represent a ‘cash-disposable’ crowd, and have been wooed heavily by big tobacco companies.

In Singapore, despite overall falling smoking numbers over the past few decades to the current 14.3 percent, the incidence of smoking in Singaporeans aged 18 to 29 jumped by 33 percent between 2004 and 2010, and more under-18s were caught smoking in 2010 than in previous years.

Indonesia, which has 240 million people of whom 57 million are smokers, has the dubious honor of producing a YouTube sensation in Ardi Rizal, a two-year old, two-pack-a-day chain-smoking toddler.

A year-long investigation by ABC News into the expansion of Big Tobacco into Indonesia has documented the huge success of Philip Morris International (PMI) in enticing youth smokers. The Indonesian government recently reported that since PMI entered the market in 2005, youth smoking rates have doubled.

Not surprisingly, the CEO of PMI, Louis Camilleri, said in an interview with ABC News that “there are marketing freedoms that we don’t have in a number of other places, and we need to compete.”

Women represent an untapped demographic for tobacco companies in Asia (Photo: Thomas Hawk/Flickr).

Big Tobacco versus the state

Governments have certainly not remained idle against the looming health threat. Measures adopted by various governments against smoking include banning smoking in public spaces, advertising bans, and graphic health warnings on cigarette packaging.

The WHO Framework Convention on Tobacco Control (WHO FCTC), which was established in 2003 and adopted by more than 170 countries, has also called on governments to continue combating tobacco industry interference.

Driving home the WHO message on World No Tobacco Day this year, WHO Director-General Dr. Margaret Chan said: “Multinational tobacco companies have been shamelessly fueling legal actions against governments at the forefront of the war against tobacco.”

One country has heeded WHO’s call to action. The recent upholding of Australia’s plain tobacco packaging law by the Australian High Court set an important precedent in the global war against tobacco.

Here, four tobacco giants (British American Tobacco (BAT), Japan Tobacco International, Imperial Tobacco, and Philip Morris) had claimed the law infringed their intellectual property rights and was unconstitutional. In a move that has been lauded by organizations such as the Southeast Asia Tobacco Control Alliance (SEATCA), the Australian High Court dismissed the case on August 15, 2012.

Indeed, there is a clear need for Asian governments to adopt stronger initiatives to reduce tobacco use, the world’s number one cause of preventable death. One such step would be the banning of tobacco advertising.

Asian countries that currently ban tobacco advertising include Hong Kong, Malaysia, Pakistan, and Singapore. Four ASEAN countries (Brunei, Malaysia, Singapore, and Thailand) require graphic warnings on cigarette packaging, while the remaining six (Cambodia, Indonesia, Laos, Myanmar, Philippines, and Vietnam) require only text warnings.

But in Pakistan, where tobacco companies have been exploiting legal loopholes to pursue aggressive marketing strategies, Nadeem Iqbal, an executive coordinator at the consumer protection agency TheNetwork, told The News International that “although Pakistan’s tobacco control laws restrict mass media advertisement, the tobacco industries are showing their marketing aggression at shops that are decorated with promotional material.”

Out of sight, out of mind?

Although several Asian countries such as China, India, Indonesia, and Singapore are considering introducing plain packaging laws, these laws form only a small part of the state’s arsenal against Big Tobacco.

Taxing tobacco is the most effective way to target smoking, says the WHO. Raising tobacco prices by ten percent due to tax increases leads to a reduction in smoking by up to eight percent in low- and middle-income countries, it says.

“Increasing taxes to make tobacco products as unaffordable as possible is the best way to go,” said WHO’s Tursan D’Espaignet.

In addition to pricing cigarettes out of reach of the poor and the young, some countries are aiming to put cigarettes out of sight and hence out of mind of would-be smokers.

Last month in New Zealand, a ban on the display of cigarettes in shops came into force. The ban is aimed at reducing the connection made by youth between sweets and cigarettes.

“Retail displays, innocently positioned alongside everyday confectionery and sweets, are a key component to making cigarettes attractive to recruit young smokers,” said the New Zealand Associate Health Minister Tariana Turia, as reported in the New Zealand Herald.

Innovative proposals are also being put forward where traditional approaches are believed to have reached their limit of efficacy.

For example, a campaign in Singapore promotes the gradual phasing-in of a complete ban on tobacco sales from 2018 by prohibiting sale of tobacco to Singaporeans born from the year 2000 onwards.

In China, a country where leading brands of cigarettes are de rigour at wedding banquets, tobacco-free weddings are being promoted to raise awareness. According to tradition, when the newlyweds toast each guest table, the bride lights a cigarette for each male guest.

In India earlier this year, where public cigarette lighters are common, the Cancer Patients Aid Association launched a campaign by rigging public lighters with an Indian “death chant.” Each time someone tried to light a cigarette, the lighter would play a chant associated with funerals.

But despite the best efforts by governments, a recent study published in The Lancet medical journal found that most developing countries have very low quit rates of less than 20 percent overall in countries such as China and India.

After a spate of tobacco-related policy changes in China and across Asia, governments can only hope that these will be enough to stem the looming health epidemic that threatens to reverse the socioeconomic gains of the past decade.


Copyright: Asian Scientist Magazine; Photo: World Bank Photo Collection/Flickr.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

David Tan is a post-doctoral researcher at the A*STAR Institute of Medical Biology, Singapore. David received a PhD in stem cell biology from the University of Cambridge, UK.

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