By Zubeida Mustafa
HOW much is a human life worth? Why is it held to be invaluable in the developed democracies of the West but dirt cheap in a Third World country like Pakistan? This contradiction emerged clearly last month when the annual World Health Assembly of the WHO adopted the Framework Convention on Tobacco Control (FCTC) on May 21 in Geneva after four years of protracted negotiations interspersed with hot bargaining.
This landmark event, which received widespread publicity in the western press, was more or less ignored by our media. Few newspapers reported it, probably because we have more important things than the adverse health effects of tobacco to worry about.
The significance of the Framework Convention lies in the fact that it is the first step towards setting up a legal instrument to provide cover to tobacco control measures. When it comes into force — on the ninetieth day following the date of deposit of the fortieth instrument of ratification, to quote the treaty — it will provide for restrictions on tobacco advertising and sponsorships, tougher health warnings and ban on smoking in public places. The WHO sees this as an important move towards protecting “present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”.
It is appalling that in a country where a high birth rate downgrades human life and where people die in large numbers on account of avoidable causes — preventable lifestyle diseases, crime, accidents, etc. — smoking is not perceived as a serious health hazard. As for the rights of the non-smokers, it is pointed out that the air we breathe is already so polluted that a little cigarette smoke could hardly make it any worse. This cynical and fatalistic attitude, especially of the smokers, does not however absolve the policymakers and the leaders of opinion of their responsibility in the matter.
According to the Human Development Report 2002, on an average the annual cigarette consumption per adult in Pakistan is 620 (it is 119 in India and 232 in Bangladesh). What is actually more worrying is that in spite of the awareness created by anti-smoking campaigns, the trend is growing (cigarette consumption was shown to be 532 in UNDP’s 2001 report) and more so among children and adolescents.
Not surprisingly, the incidence of tobacco-related deaths in Pakistan is also on the rise and nearly 99,000 people die every year because of diseases caused by smoking, such as cancer, cardiovascular diseases, respiratory disorders, etc.
Not surprisingly, the thrust of the anti-tobacco campaign in Pakistan has been towards the consumers. It is the smoker who is expected to know better and show greater responsibility in the matter. That would explain the apathy towards the FCTC which focuses on the policymakers and manufacturers.
The anti-smoking campaigners and the health professionals have sought to mobilize the citizens against cigarettes. But the fact is that it is the tobacco lobby that needs to be curbed. This has so far proved to be a losing battle. That is because an approach which seeks to persuade a person who has already joined the smokers’ club to kick the habit is infinitely more difficult than preventing him from becoming a smoker in the first place.
The cigarette companies know this. That is why their campaigns are directed at the youth who are susceptible to the glamourizing effect of cigarette advertising and the linking of tobacco to sports, as though the two go together.
Normally it is the government that should be protecting the interests of the public. But given the massive revenues the national exchequer collects from this sector — Rs18 billion in 2003-04 — would it try to kill the goose that lays the golden eggs? The pact seeks a total ban on advertising and promotion of tobacco in five years and this would obviously lead to a decline in the number of smokers and a fall in revenues.
The Framework Convention adopted last month amounts to a declaration of intent. But things can go wrong. Even when it comes into force, the parties will have to adopt domestic legislation to implement its provisions. That could take decades as our experience with the WHO code for baby food marketing has shown.
True, the government of Pakistan was quick to issue two ordinances, namely, the Prohibition of Smoking and Protection of Non-Smokers’ Health Ordinance 2003, and the Cigarette Printing of Warning Ordinance 2003 which became effective on May 31. The ordinances succeed similar ordinances promulgated in October 2002 which supposedly made government offices, airports, railway stations, restaurants and other public places smoke-free zones and prescribed a fine for violators.
Although the ordinances have ostensibly been in force since last year, they have made precious little impact on the incidence of smoking in the country. Sports sponsorship by tobacco companies, advertising of cigarettes in the media and other promotional activities have continued unchecked.
What is basically needed is an official policy which is not tobacco friendly. True the duties imposed are heavy — 38 per cent of the federal excise duties will come from the cigarette and tobacco in 2003-04 — but that does not affect sales as the figures show. According to the Pakistan Economic Survey 2002-03, nearly 36 billion cigarette sticks are produced in Pakistan and they obviously have a market.
The turnover of the tobacco companies exceeds the health budget of the government. The Pakistan Tobacco Company alone, which is the largest cigarette manufacturer in the country, recorded a gross turnover of Rs20.5 billion in 2002 and made a profit of Rs 420 million after tax deductions.
By virtue of the massive fiscal interest of the government in the tobacco sector, the cigarette companies feel encouraged to resort to aggressive marketing. How can one expect the consumers to resist the onslaught. A survey found that most of the juvenile smokers are aware of the hazards of smoking but have failed to quit it in spite of their best efforts. This is not strange. Tobacco consumption is addictive. The body gets used to it very fast, and attempts at giving it up cause severe withdrawal symptoms.
The Framework Convention points out that cigarettes and other products containing tobacco are engineered so as to create and maintain dependence. The compounds they contain and the smoke they produce are pharmacologically active, toxic, mutagenic and carcinogenic and that tobacco dependence is separately classified as a disorder in major international classifications of diseases.
Given the chemical elements of tobacco products, a practical approach would be to ensure that a young person who does not have an informed understanding of the serious implications of smoking is not exposed to cigarettes at all. Thus he will be denied the opportunity and temptation to get addicted to them. Cigarettes are highly addictive because the nicotine in them floods the nerve cell receptors and causes chemical changes in the brain which account for the withdrawal symptoms.
This phenomenon is something the cigarette manufacturers are fully aware of but choose to withhold this information from the public. They also know that the addictive process begins immediately when the first puff is taken.
With our legislators and policymakers locked in their struggle for political power, and the media cheering them on, one only wonders if the Pakistan government will have the time and willingness to sign and ratify the Convention when it is opened for signatures in Geneva on June 16.