Op-ed by Dr Rajesh Pandav, WHO Representative to Timor-Leste
Every year, on May 31, the World Health Organization (WHO) and global partners celebrate World No Tobacco Day (WNTD) to draw global attention to the tobacco epidemic. This year’s World No Tobacco Day aims to protect children and adolescents from industry manipulation and prevent nicotine and tobacco use amongst them by exposing deceitful strategies employed by the tobacco industry to promote tobacco use particularly among the young.
Tobacco products kill more than 8 million people every year. Tobacco and related industries must continuously find new consumers to replace the ones that their products have killed to maintain revenue. Tobacco companies spent over 8 billion in marketing and advertising and the world lost 8 million lives from causes related to tobacco use and exposure to second-hand smoke.
Tobacco use poses a grave challenge in Timor-Leste. Timorese are among the highest tobacco users in the world. Among the adults, 71% males and 29% females use tobacco in any form - smoked (e.g. cigarettes) and/or smokeless (e.g. Songhe). 9 out of 10 adults are exposed to second hand smoke at home. Non Communicable Diseases including cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are among the top ten causes of mortality. Timor-Leste is among the TB high burden countries.
The Global Youth Tobacco Survey (2019) conducted among school children aged 13-15 years old, shows an overall alarmingly high tobacco prevalence of 30.9% among adolescents, 42% among boys and 21% among girls. 67% of students exposed to second-hand smoke at home. Nearly 71% were exposed to tobacco smoke at public places. Youth have easy access to cigarettes. Approximately 63% of the smokers bought cigarettes from a store, shop, street vendor, or kiosk. 49.2% were not prevented from purchasing despite being minors.
The Global Youth Tobacco Survey (2019) also had some encouraging indications. The overall prevalence of tobacco product use has decreased from 42.4% in 2013 to 30.9% in 2019, and the overall prevalence of current cigarette smokers also decreased from 35% in 2013 to 22.5% in 2019. Further, proportion of students who reported noticing tobacco advertisement or promotion at the point of sale decreased from almost 80% in 2013 to 66% in 2019. Above all, more than 7 in 10 students who smoked tobacco expressed desire to quit smoking immediately. While 7 in 10 had attempted to stop smoking in the past 12 months.
Timor-Leste has made commendable progress to fight the tobacco epidemic. In 2016, a strong anti-tobacco legislation was passed. The law bans tobacco advertising and promotions; bans smoking in public spaces, public gatherings, offices, meeting venues and inside public transport such as taxis and microlets. The new law also prohibits the sale of tobacco products to children under the age of 16. Currently, Timor-Leste ranks number one in the world for having implemented the largest graphic health warning on cigarette warning.
However, further accelerated action is required for implementation of the anti- tobacco legislation This includes prohibition of sale of tobacco to minors and offering support with diagnostic, counseling, smoking cessation, and tobacco dependence treatments. It is important to protect adolescents from tobacco use by raising awareness about the harm it causes and by ensuring they don’t fall prey to deliberate tobacco and related industry tactics to hook them on nicotine and tobacco products.
Timor-Leste also has one of the youngest populations in the Asia-Pacific region. 74% of total population is below 35 years of age, indicating vast majority of the current tobacco users to be in the young age group. Empowering and equipping young people with skills to counter the powerful tobacco companies and their products is a strategic investment for health and development of the Nation. High prevalence of tobacco users, adults and adolescents necessitate tobacco cessation support. Appropriate cessation services are an essential component of any comprehensive tobacco control strategy. The extremely addictive nature of nicotine makes it difficult for most people to quit without some form of assistance.
Young people should stand up against tobacco and related industries aggressive and manipulative tactics that include:
- Using over 15,000 flavours, which appealing to children and adolescents
- Promotion of tobacco products and the distribution of free samples at popular events for young people.
- Advertising and product placement on movies and TV-shows and through social media platforms with paid influencers
It is also important to remember that:
- E-cigarette use increases risk of heart disease and lung disorders. Nicotine in e-cigarettes is a highly addictive drug and can damage children’s developing brains.
- Smoking shisha is just as harmful as other forms of tobacco use.
- Smokeless doesn’t mean that it’s harmless.
WHO calls on all young people to join the fight to become a tobacco-free generation.
Tobacco use is responsible for 25% of all cancer deaths globally. Use of nicotine and tobacco products increases the risk of cancer, cardiovascular and pulmonary disease. Over 1 million people die from second-hand smoke exposure every year.
Tobacco use also contributes to poverty- Poor households divert spending from basic necessities, such as food, education, and health, to tobacco. Countries and individuals also suffer huge economic loses from lost productivity due tobacco related illnesses and premature deaths (e.g. of breadwinners), and high costs of managing tobacco related morbidity. Furthermore, studies have shown that smokers are at higher risk of developing severe disease and dying from COVID-19.
The tobacco epidemic can only be defeated when each member of the community joins hands to accelerate efforts in the fight against tobacco. Families and communities should repeatedly remind the young about the dangers of tobacco use. Government needs to strengthen implementation of the tobacco legislation through strong inter-sectoral collaboration. Community support is crucial for successful implementation of a strong legislation. Youth need to be on alert and not succumb to the temptation provided by deceptive marketing of tobacco products. Health Professionals can use their influence especially with youth, children and adolescents by forewarning of the dangers of tobacco. The Ministry of Health needs to offer support with diagnostic, counseling, smoking cessation, and tobacco dependence treatments.