Dr Aung Tun
World No Tobacco Day is celebrated around the world every year on May 31. The day was created by the member states of the WHO in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. Every year, World No Tobacco Day is observed, with a different theme to cover the broad range of measures within the WHO Framework Convention on Tobacco Control (WHO FCTC).
The Tobacco Epidemic
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing around 6 million people a year. More than 5 million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke.
Nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.
In South Asia, approximately 1.2 million people die every year from tobacco use.
Tobacco damages not only the whole person but also the whole planet. The harm caused by the tobacco use is not limited to lung cancer, heart disease, and emphysema. Tobacco use exacerbates other non-communicable diseases, mental illness and substance abuse problems, as well as damages the environment and undermines human development.
Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.
The harm caused by Secondhand smoke
Exposure to secondhand smoke can cause many of the same diseases as active smoking. Secondhand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water-pipes. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.
There is no safe level of exposure to second-hand tobacco smoke.
In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight. Almost half of children regularly breathe air polluted by tobacco smoke in public places. Secondhand smoke causes more than 600 000 premature deaths per year. In 2004, children accounted for 28% of the deaths attributable to secondhand smoke.
Every person should be able to breathe tobacco-smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.
Tobacco use in Myanmar
National Tobacco Control Program of Department of Public Health has been implementing tobacco control activities in collaboration with related ministries; school-based tobacco control activities are being conducted in coordination with the Ministry of Education. Myanmar has been participating in the Global Tobacco Surveillance System and has conducted Global Youth Tobacco Surveys (GYTS) in 2001, 2004 2007 and 2011 and the Global School Personnel Surveys (GSPS) in 2004, 2007 and 2011. National Tobacco Control Program has already planned to conduct a new Global Youth Tobacco Survey (GYTS) in Myanmar this year.
The GYTS is a school-based survey of students aged 13-15 years. The GSPS is also a school-based survey of all school personnel from the schools that the GYTS was conducted. The GYTS and GSPS were conducted as a nation-wide survey in Myanmar.
According to Global Youth Tobacco survey (GYTTS, 2011), about 7% of school youths (13% of boys and 0.55% of girls) were currently smoking cigarette while about 17% (28% of boys and 7%% of girls) were currently using other tobacco products. Like the adult population, about 38% of them were also exposing to environmental tobacco smoke in public places. Between 2001 and2011, a significant reduction in the proportion of students currently smoked cigarettes is observed ( a fall from 13-15 year olds of 10.2% to 6.8%) but reported use of other tobacco products had increased during the period from 5.7% to 9.8%. The ability to purchase cigarettes in a store had reduced significantly from 72.9% to 39.2%; percent. There is no change in percent of students receiving education on dangers of tobacco. According to the National STEPS (The WHO STEPwise approach to Surveillance) survey 2009 showed that about 22% of people (45% of men and 8% of women) are currently smoking, about 30% of people (51% of men and 16% of women) are currently using smokeless tobacco and 39% of people are exposing to environmental tobacco smoke in work places.
World No Tobacco Day 2016
May 31 is World No Tobacco Day, a day designated by the World Health Organization to draw global attention to the tobacco epidemic and to advocate for strategies to reduce tobacco use. The theme for 2016 is “Get ready for plain packaging”. For this year’s campaign, WHO and the Secretariat of the WHO Frame work Convention on Tobacco Control are calling countries to get ready for plain (standardized) packing of tobacco products.
Plain packaging (also called standardized packaging) refers to “measures to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style (plain packaging).
Plain packaging has also been described as packaging that is “black and white or two other contrasting colours, as prescribed by national authorities; nothing other than a brand name, a product name and/or manufacturer’s name, contact details and the quantity of product in the packaging, without any logos or other features apart from health warnings, tax stamps and other government-mandated information or markings: prescribed font style and size; and standardized shape, size and materials. There should be no advertising or promotion inside or attached to the package or on individual cigarettes or other tobacco products.
Plain packing of tobacco products is an important demand reduction measure. It reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of advertising, limits misleading packaging and labeling, and increases the effectiveness of health warnings.
Guidelines for Implementation of Article 11 (packing and labeling of tobacco products) and Article 13 (Tobacco advertising, promotion and sponsorship) of the WHO Framework Convention on Tobacco Control(WHO FCTC) recommend that Parties consider adoption of plain packaging.
Specific goals of the 2016 campaign are that:
* Highlight the role of plain packaging as part of a comprehensive, multi-sectoral approach to tobacco control.
* Facilitate policy development by Member States and the globalization of plain packaging by providing informative, compelling and persuasive information.
* Encourage Member States to strengthen packaging and labeling measures and restrictions on advertising, promotion and sponsorship as they work towards plain packaging in a step-wise approach.
* Support Member States and civil society against tobacco industry interference in political processes leading to adoption of plain packaging laws.
Myanmar has been celebrating the World No Tobacco Day, both at Central and Regional/State level every year since 2000.
Tobacco Control Measures
relating to packaging and
labeling in Myanmar
The National Program on Tobacco Control was officially launched in January 2000 with the drafting and approval of the National Policy on Tobacco Control and Plan of action. In collaboration with Ministry of Education, Ministry of Health and Sports has launched the Tobacco Free School Program in 2003.The Tobacco Free Youth Program was also implemented by School and Youth Health Project since 2009 .
The Myanmar Tobacco Control Program has been implementing its activities in line with the six MPOWER policies recommended in the “WHO Report on the Global Tobacco Epidemic 2008”.
Myanmar has signed the WHO FCTC in October 2003 and ratified in April 2004.With the objectives of protecting and reducing the dangers of tobacco among the community and based on the provisions of the WHO FCTC, “The Control of Smoking and Consumption of Tobacco Product Law” was enacted in May, 2006 and it came into effect in May,
In accordance with new administrative structure, the National Tobacco Control Committee was reformed in January 2011, headed by the Minister for Health and included heads of related departments and chairpersons of several national NGOs as members. The Committee set guidelines for the tobacco control measures to be implemented in the country. Myanmar also attended the 5th session of the Conference of the Parties to the WHO FCTC (COP 5), held in Seoul, Korea from 12th to 17th November, 2012. At COP 5. Myanmar has signed the Protocol on Illicit Trade in Tobacco Products on the day of the opening ceremony on 10th January, 2013 at Geneva, and it was the 1st country of signatories in South East Asia Region. Over the past two years, Myanmar has strengthened the tobacco control cell within the Department of Public Health, worked with civil society to build support for tobacco control among the public, and partnered with related ministries and NGOs to prohibit all forms of direct and indirect advertising, promotion and sponsorship of tobacco.
In 2015 Cigarette taxes in Myanmar are levied at 120% (commercial tax) of taxable turnover.
A new legislation to print warning messages and illustrations of the health risks of tobacco use on all tobacco packages was announced by the Ministry of Health and Sports on February 29,2016. According to the legislation, the new packaging will feature images of the health consequences of tobacco use across 50 percent of the surface area, and text warnings in local language across 25 percent. Old packaging will be illegal from 1 September 2016.
Working Together for Tobacco Free Myanmar
Currently, the Ministry of Health and Sports is committed to promoting and maintaining the health status of Myanmar people through various health care services, with the support and participation of the related ministries and sectors, international and local NGOs and the community as a whole.
The Control of Smoking and Consumption of Tobacco Product Law was adopted on 4th May, 2006. The adoption of the law was a very significant milestone in the history of public health of Myanmar and was highly appreciated by the World Health Organization and anti-tobacco advocates.
There is a need to enforce school policy on tobacco and the need to provide training to school personnel on prevention of tobacco among the youth. Specifically youth-focused programs should be implemented as joint efforts between Ministry of Health and Sports and Ministry of Education in collaboration with related ministries.
Myanmar Tobacco Control Program also needs to set in place mechanisms to strengthen implementation and enforcement of existing tobacco control laws in Myanmar and to develop new regulations needed on key tobacco control policies to bring them in line with WHO FCTC provisions and best practices. The program is also required to build Myanmar’s capacity for tobacco control in the long-term.
Continued support and close collaboration from the WHO and other partners are essential in the struggle against tobacco epidemic in Myanmar. Civil society at national, regional and international levels are needed to play an important role in contributing to the success of tobacco control efforts in Myanmar including effective implementation of pictorial health warnings, plain packaging and labeling for all tobacco products.
Ref:1. 2016 WHO WNTD
2. The Tobacco Atlas, The
3. Health in Myanmar, MOH, 2014
Dr Aung Tun is a retired Pro-Rector of University of Community Health and the former Director (Public Health) of Department of Public Health.