Misdirected policies an issue in control of tobacco use in Southeast Asia
In a report for The Lancet Regional Health—Southeast Asia, a research team argued that policies to address public health issues, such as tobacco use in the region, should address local needs and not be based on assumptions formulated from high-income countries.
Researchers argue that smokeless tobacco use has been largely misunderstood and neglected, leading to significant public health challenges, such as cancers of the mouth and throat, a leading cause of death among men in the region.
It highlights that the tuberculosis epidemic has been fueled by smoking, but that this link has been overlooked, which has led to policies on TB control, for example, that do not include tobacco control, and treatment for the disease does not offer support for quitting smoking.
Professor Kamran Siddiqi, from the University of York's Department of Health Sciences, said, "The South-East Asian region is at the epicenter of the global tobacco threat. Almost a third of all tobacco users in the world reside in 11 countries in this region.
"We have shown that progress in controlling tobacco use in South-East Asia is too slow, and one fundamental reason for this could be that health policies are based on certain assumptions that may not hold true in the context of the region.
"In particular the use of the term 'smoking' in scientific literature, policies and campaigns instead of tobacco is problematic, because in the South-East Asian region smokeless tobacco is more common than smoking, and as a result policies are not addressing the drivers for its use and how it is produced and sold."
Smokeless tobacco is produced in a variety of forms, and often by informal manufacturers in the region, resulting in products that are not standardized, and therefore have an increased risk to health. The researchers argue that the lack of understanding for the diverse tobacco supply chain has been blocking progress in tobacco control.
Another area highlighted in the report is second-hand smoke exposure of pregnant women to indoor smoking—caused predominantly by men—which is not only a threat to women but also to the health of newborn babies.
Professor Siddiqi said, "There are no policies to protect women from second-hand smoke exposure, which until addressed will continue to widen the gender health gap. Alongside the concerns for women, there is also evidence to suggest that there should be more attention paid to tobacco use in young people, where we have seen high levels of use among adolescents."
To address these challenges, the report outlines that there should be tobacco tax increases, comprehensive advertising bans, and the enforcement of bans on selling tobacco to and by minors.
A particular area that has been misunderstood, the report says, is the issue of e-cigarettes, which are gaining popularity in the region. The concerns around e-cigarettes, however, are often based in the context of high-income countries, but in South-East Asian countries the attention given to this new trend has the potential to divert policy away from the more progressed issues surrounding smokeless tobacco.
Professor Siddiqi said, "We are advising that policies need to account for certain nuances that arise from how local communities view tobacco, and avoid being misdirected by evidence that is largely based on high-income countries. What is clear is that these countries need to act fast, as the public health risks will only continue to grow."
More information: Kamran Siddiqi et al, Common assumptions in tobacco control that may not hold true for South-East Asia, The Lancet Regional Health—Southeast Asia (2022). DOI: 10.1016/j.lansea.2022.100088