There is a direct and irreconcilable conflict of interest
between tobacco industry and public health policy. This conflict of interest is
also enshrined in the preamble of the Article 5.3 of the global tobacco treaty
- formally called World Health Organization (WHO) Framework Convention on
The WHO Director-General Dr Margaret Chan had said at a
recent meeting in Moscow, "Giving any tobacco company a place at the
negotiation table [of global tobacco treaty] is akin to appointing a committee
of foxes to take care of your chickens."
As implementation of domestic tobacco control laws and
global tobacco treaty is advancing, tobacco industry is indeed facing the heat.
Not surprising, that the industry has sued governments when they have attempted
to implement life-saving tobacco control measures. Nepal is no exception. With
more than 11 lawsuits filed by the industry and its allies against the Nepalese
government's move to strictly enforce tobacco control laws, the Supreme Court
decision favouring the government is a beacon of hope.
"Tobacco industry interference has been a huge challenge in
Nepal's public health policy. Tobacco industry allies had filed more than 11
law suits in Supreme Court (one farmer organization had also filed a case) to
sue Nepal on introduction of pictorial graphic health warnings. But Supreme
Court verdict in favour of introduction of pictorial graphic health warnings on
all tobacco products has given a new force to implementation of tobacco control
laws. Supreme Court verdict was to implement the tobacco control laws
effectively as our Nepal assembly has passed" said Badri
Bahadur Khadka, Chief Health Education Administrator, at Ministry of Health and
Population, Government of Nepal.
Added Khadka: "Due to this bad experience of facing tobacco
industry interference while implementing effective life-saving tobacco control
laws in Nepal, we drafted domestic policy in our country's context on the lines
of the WHO FCTC Article 5.3, and submitted it to the Ministry of Health and
Population for final approval. Approval is in the process and soon we will get
success on it."
It is important to underline that domestic policy to
safeguard public health policy from tobacco industry interference was drafted
not just by Ministry of Health and Population but by more than 15 ministries in
Nepal in a series of consultative drafting sessions. "Tobacco control is a
multi-sectoral response so we need to effectively coordinate with other
ministries also, such as: Ministries of Information and Communication,
Agriculture, Education, Finance (both departments of customs and inland
revenue), youth and sports, Home Affairs, Health and Population, among others.
We need to frequently meet these ministries to effectively implement tobacco
control law" emphasized Khadka.
"After approval of this draft domestic policy in line with
WHO FCTC Article 5.3 by over 15 ministries we then submitted the final version
to Ministry of Health and Population. It is in the process of approval and soon
we will get that and implement it" said Khadka to Citizen News Service (CNS).
Union Against Tuberculosis and Lung Disease (The Union) has
played a leadership role in mobilizing governments of South and South-East
Asian nations to advance on tobacco control. Indonesia, Myanmar, Cambodia and
Nepal are some examples of the robust tobacco control work done despite stiff
challenges by Tara. "We need WHO FCTC Article 5.3 to protect the current
achievements that Nepal has made on tobacco control. We must not lose the gains
made in public health and succumb to industry interference. Domestic policies
in lines of WHO FCTC Article 5.3 will ensure that we continue to effectively
implement and enforce the current domestic tobacco control law in Nepal. Health
Secretary of Nepal has shared government's commitment that 5.3 directives will
be released as soon as possible."
"Tobacco industry's strategies are very similar whether
they are in small or big countries but owing to government's commitment their
interference in health policy is checked in Nepal and we need to enforce 5.3 in
Nepal as soon as possible" reassured Shanta Bahadur Shrestha, Secretary,
Ministry of Health and Population, Government of Nepal.
"Ratification of WHO FCTC by Nepal in 2006 had spiralled
into a range of actions on the ground in Nepal with stronger domestic
legislations and directives on tobacco control. Despite challenges Nepal has
been successful in implementing domestic tobacco control laws. Several
ministries other than that of health and population are also coordinating to
implement tobacco control laws and advance life-saving public health measures.
For example, Ministry of Finance in Nepal is increasing excise duty on tobacco
every year. Likewise duty-free tobacco and alcohol both are banned in
Nepal," said Shrestha. Studies show that by increasing taxes, tobacco
consumers decrease and number of young people initiating tobacco use also
He added: "It is easier to regulate (organized) cigarette
industry in Nepal as there are laws and regulations. But smokeless tobacco
industry is unorganized and usually a small scale industry, which is difficult
to regulate. Open borders between India and Nepal also pose a challenge. For
example bordering states of India have banned smokeless tobacco forms such as
Gutkha but Nepal has not banned Gutkha. Gutkha production happens on the
India-Nepal border and we are not able to regulate it or tax it in Nepal."
Gutkha was banned in several Indian states because Food Safety and Standards
Act (FSSA) of India banned any food item containing nicotine (and Gutkha was
regulated as a mouth freshener, a food item).
Tobacco control is not just the mandate of health ministry
rather warrants coordination between a range of ministries and sectors.
"Assistant Chief District Officer (CDO) is the key authority to implement
tobacco control in the district. Out of 75 districts some officers are very
active in implementing tobacco control laws but some are not due to other commitments.
Ministry of Home Affairs supervises these officers. There needs to be more
interdepartmental coordination" said Kedar Bahadur Bogati, Joint Secretary,
Ministry of Health and Population, Government of Nepal.
Smoking and Smokeless Tobacco Use Banned
Nepal has taken a major leap by banning use of smoking forms
of tobacco as well as of smokeless tobacco forms in public places. "Tobacco
Control and Regulatory Act 2011 bans use of all forms of tobacco (both smoking
and smokeless tobacco use) at public places. Public places include public
transports also" said Bogati.
Nepal moved early to find innovative means to domestically
fund tobacco control. "Health service tax fund provision for tobacco control is
very helpful. It is not a huge amount but at least we have a special fund to
manage tobacco control programmes in the country" said Bogati
Khadka shared that Nepal has demonstrated leadership in
South Asian region in implementing strong pictorial graphic health warnings on
all tobacco products. Till mid-October 2014, India ranked 136th in
implementation of pictorial graphic health warnings but Nepal was on 4th rank
with warnings spanning over 75% of total display area of a tobacco pack. India
had covered only 0% of total display area of a tobacco pack till mid October
2014 when its policy changed for the better and notifications to cover 85% of
total display area with warnings from 1st April 2015
hitting headlines. Hookah restaurants with water pipe smoking are gaining
popularity among young people and pose huge challenge.
Tara Singh Bam of The Union pointed out that Nepalese
government also has a stake in tobacco industry despite which it has
prioritised public health. "Despite some conflict of interest, government
is advancing measures for tobacco control with sincerity. Effective
implementation of all the tobacco control provisions that exist in current laws
in Nepal is a top priority. For example, 75% pictorial warnings, complete ban
on tobacco use at all public places including public transport, even in the
private transportation, are couple of strong measures that exist in Nepal.
Nepal's smokefree laws also ban smoking in homes as well.
That is also an unique provision in the law. Currently, I
can see an appreciative leadership is being demonstrated by Honourable Khagraj
Adikari, Minister of Health and Population in advancing tobacco control in
Nepal. In short span of time since 2007 onwards Nepal has managed to show good
leadership on tobacco control."
Tara emphasized that domestic tobacco control laws are
complementing the obligations of global tobacco control treaty that Nepal has
as a ratifying country. Tara added: "Tobacco control law mandates
government of Nepal to allocate at least 25% ($ 4.1 million) of amounts to
health tax fund from the total excise tax levied on smoking and tobacco
products. Health tax fund is used to make effective implementation of tobacco
control measures, health educations and promotion, research and treatment of
tobacco related diseases. This provision in the tobacco control law is an
another example to sustain and maintain tobacco control efforts in Nepal.
However, an effective monitoring framework to account health tax fund is
urgently needed." Tara further added that government action are needed for
an immediate endorsement of WHO FCTC Article 5.3 to stop tobacco industry
interference, improvement of pictorial health warning at the highest level, and
increase tax and prices on tobacco products."
Shrestha, Nepal's Secretary for Health and Population,
remarked that "All political leaders want to control tobacco. We have
strong political will. Health minister is himself inspecting the market to
check illicit tobacco trade - few days back his team had seized 18 tonnes of
illegal tobacco. There is solid commitment from the government. Very few
country delegations are led by their health secretary at the Sixth Session of
the Conference of the Parties to the WHO FCTC. Nepalese delegation is led by
its Health Secretary that shows a high level commitment."
Shrestha also pointed out the positive partnership of the
government with civil society and appreciated international partners'
contributions such as International Union Against Tuberculosis and Lung Disease
(The Union) in advancing public health measures country-wide.
45th Union World Conference on Lung Health in Barcelona,
Spain and 16th World Conference on Tobacco or Health (16th WCTOH) are two major
meetings ahead of us that will aim to strengthen implementation of tobacco
control globally. These events will provide more opportunities for governments,
civil society and other stakeholders to share their experiences of not only how
tobacco industry is not letting them progress fast enough in rolling out
life-saving tobacco control measures, but also how are they using WHO FCTC
Article 5.3 and other such mechanisms to check the industry interference and
advance public health. Nepal is certainly leading the fight to check industry
interference in public health policy in the South Asian region and has lessons
to share with other countries globally.
Ref: Bobby Ramakant, Citizen News Service