By Dr Aung Tun
Every year, on 31 May, WHO and Partners celebrate World No Tobacco Day. The theme of 2020 is protection of younger generations, focusing on “protecting youth from industry manipulation and preventing them from tobacco and nicotine use. The specific goals of the World No Tobacco Day 2020 campaign are as follows:
n Unmask myths and expose manipulation tactics employed by the tobacco and related industries, particularly marketing tactics targeted at youth, including through the introduction of new and novel products, flavours and other attractive features;
n Provide young people with knowledge about the tobacco and related industries’ intentions and tactics to hook current and future generations on tobacco and nicotine products; and
n Enable influencers (in pop culture, on social media, in the home, or in the classroom) to protect and defend youth and catalyze change by engaging them in the fight against Big Tobacco.
Global Tobacco Epidemic
Tobacco epidemic is one of the world’s leading health threats, and a main risk factor for non-communicable diseases (NCDs) including: cancers, diabetes, chronic respiratory disease and cardiovascular disease. According to WHO’s new report on global tobacco use trends (2019), there are 1.3 billion tobacco users globally. Every year, more than 8 million people die from tobacco use, approximately half of its users. More than 7 million of those deaths are from direct tobacco use while around 1.2 million are due to non-smokers being exposed to second-hand smoke. Most tobacco-related deaths occur in low- and middle-income countries that are targets of intensive tobacco industry interference and marketing. Other key findings of the report included:
n Children and youth: Approximately 43 million children (aged 13-15) used tobacco in 2018 (14 million girls and 29 million boys).
n Women: The number of women using tobacco in 2018 was 244 million.
n Asian trends: WHO’s South East Asian Region has the highest rates of tobacco use, of more than 45% of males and females aged 15 years and over, but the trend is projected to decline rapidly to similar levels seen in the European and Western Pacific regions of around 25% by 2025.
n Poverty: Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco. The economic costs of tobacco use are substantial and include significant health care costs for treating the disease caused by tobacco use as well as the lost human capital that results from tobacco-attributable morbidity and mortality.
Tobacco use among young people in Myanmar
The global Youth Tobacco Survey (GYTS) was conducted in Myanmar at the national level in 2001, 2007, 2011 and 2016 to assess the prevalence of tobacco use among Myanmar youth. The 2016 GYTS, like its predecessors, was a national-level representative survey based on a sample of students 13–15 years of age enrolled in grades 9–11. The following points are key findings from this survey.
* Tobacco use: There has been no significant change in the prevalence of current use of any tobacco product (15.3% in 2007 to 13.6% in 2016). However, there was an increase in the prevalence of current cigarette smoking between 2007 and 2011 (from 4.9% to 8.3% overall, 8.5 to 17.0% in boys and 1.3% to 1.5% in girls) with no significant change in current smokeless tobacco use.
*Secondhand smoke : Exposure to secondhand smoke(SHS) in homes did not change significantly between 2007 and 2016. One third of the students were still exposed to SHS in these circumstances. In contrast, the reported exposure to SHS in enclosed public has declined significantly from 46.4% (all public places) in 2007 to 28.4% (enclosed public places) in 2016.
*Access and availability: Despite the ban on the sale of tobacco to minors, 54.5% of the smokers reported that they obtained cigarettes from a store, shop or street vendor and more worryingly about two-thirds reported that they were not prevented from buying those cigarettes because of their age; these indicators have remained largely unchanged over the years.
*Anti-tobacco messages : The percentage of students who saw anti-tobacco messages in the media dropped significantly from 93.4%in 2007 to 80.2% in 2016.
* Tobacco marketing : The percentage of students who saw someone using tobacco on TV or in videos or movies was high at 83.4%. Tobacco marketing has also declined. The percentage of students who were offered free tobacco products by tobacco companies and those who reported ownership of tobacco branded objects was found to be less than 6%.
Tobacco Industry Tactics to attract younger generations
Tobacco and related industries promote its products to potential smokers, including young people, to ensure the market for tobacco continues to increase and that dying smokers and those who quit smoking are replaced. The tobacco industry targets young people through misleading messages that help shape attitudes to tobacco use.
The tobacco Industry is targeting a new generation with their tricks and tactics as follows:
– Advertising in entertainment media like movies and TV shows -Attractive displays at children’s eye level, near toys sweets and sugary drinks
– Tobacco products ads that imitate popular memes to appeal to children and young adults
– Use of social media and sponsoring influencers to promote certain tobacco and vaping products ©Promotion
– Promotion of tobacco products at popular events for young people -Distribution of free samples and promotional materials to young people
– Apprenticeships and school and university scholarships for students, and other support for schools
– Sponsorship of major sporting events/teams, including placement of tobacco company logos
(e) Other marketing tactics
– Flavours appealing to children in smokeless tobacco, shisha and e-cigarettes
– Kiddie packs and single stick sales
Tobacco industry interference in Myanmar
The tobacco industry lobby is strong in Myanmar. According to the fourth Tobacco Industry (TI) Interference Index, Myanmar ranks third highest out of 9 ASEAN countries analyzed. According to the survey, TI interference in Myanmar increased from 2015 to 2016. Based on the report, the industry has worked to delay implementation of the 2016 legislation requiring pictorial health warnings on cigarette packs. There are still tobacco packs being sold which are not compliant with the requirement. Policymakers in Myanmar should consider strengthening safeguards against TI interference, for example by instituting a code of conduct for Government officials that requires disclosure of conflict of interests.
The Current Burden of Tobacco Use in Myanmar
Tobacco use undermines economic growth. In 2016, tobacco use caused 64,033 deaths in Myanmar ,56 per cent of which occurred among citizens under the age 70. As a result, Myanmar lost productive years in which those individuals would have contributed to the workforce. The economic losses in 2016 due to tobacco-related premature mortality are estimated at MMK 1.32 trillion.
While the costs of premature mortality are high, the consequences of tobacco use begin long before death. As individuals begin to suffer from tobacco-attributable diseases (e.g. heart disease, strokes, cancers), expensive medical care is required to treat them. Spending on medical treatment for illnesses caused by smoking cost the Government MMK 71.9 billion in 2016, and caused Myanmar citizens to spend MMK 226.7 billion in out-of-pocket (OOP) healthcare expenditures. In addition to generating healthcare costs, as individuals become sick, they are more likely to miss days of work (absenteeism) or to be less productive at work (presenteeism).
Finally, even in their healthy years, working smokers are less productive than non-smokers.
In total, tobacco use cost Myanmar’s economy MMK 2.62 trillion in 2016, equivalent to about 3.3 per cent of Myanmar’s GDP that year.
Recent developments of Tobacco Control in Myanmar
Myanmar signed the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003 and ratified the treaty the following year. Since that time, Myanmar has made significant progress in tobacco control. For example, it passed a strong tobacco control law in 2006 and has enacted several policies to reduce tobacco use, including: prohibiting smoking in many indoor public places, mandating that graphic warning labels cover 75 per cent of cigarette packs, and banning tobacco advertising on traditional and new forms of media (e.g., television, the internet). By legislating and funding these important measures, Myanmar is helping to curb the tobacco epidemic and has set the stage for strengthened efforts.
Myanmar is one of 15 countries worldwide receiving FCTC 2030 project support. The FCTC 2030 Project is a global initiative funded by the UK Government to support countries to strengthen FCTC implementation to achieve the Sustainable Development Goals (SDGs). In consultation with the Government of Myanmar, five FCTC provisions were selected to model within the investment case:
– Increasing tobacco taxation to reduce the affordability of tobacco products (FCTC Article 6);
– Enforcing bans on smoking in all public places to protect people from tobacco smoke (FCTC Article 8);
– Implementing plain packaging (FCTC Article 11: Guidelines for implementation);
– Instituting mass media campaigns against tobacco use (FCTC Article 12); and
– Implementing and enforcing a comprehensive ban on tobacco advertising, sponsorship, and promotion (FCTC Article 13).
Join the fight to become a tobacco-free generation
Young people need to be provided with information about the harms of tobacco use and tobacco industry marketing tactics. They have a right to protection from tobacco marketing and second-hand smoke.
Article 5.3 of the WHO FCTC requires countries to protect their tobacco control policies from the vested interests of the tobacco industry. Furthermore, implementation of the WHO FCTC requires Parties to take measures to protect youth against the harms of tobacco use.
The Ministry of Health and Sports remains committed to take more effective measures to reduce tobacco use among adolescents and to raise awareness on harmful effects of tobacco. Myanmar had already rolled out the “Five Year Strategic Plan for Young People’s Health (2016–2020)”, which recognizes the importance of improving adolescent health. These youth related policies will serve as one of the avenues to promote the agenda of reducing tobacco consumption among youth. Myanmar will also undertake the following actions.
– Develop and implement a code of conduct for government officials and civil servants for their interactions with tobacco industry, in line with Article 5.3 and its guidelines
– Continue to raise awareness on protection of public health policy from the vested interested of the tobacco industry among all government agencies and public officials, in collaboration with civil society
Ref: -Investment case for tobacco control in Myanmar: The Case for Investing in WHO FCTC Implementation, MOHS/WHO/UNDP/FCTC Secretariat/RTI Int. December 2018 – Report of Fifth Global Youth Tobacco Survey (GYTS), Myanmar, MOHS/WHO, 2016 -Report on global tobacco use trends, WHO, 2019 -The Tobacco Atlas, 6th Edition, American Cancer Society, 2018 – Word No Tobacco Day Tool Kit, WHO, 2020