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 WHO Framework Convention on Tobacco Control). 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 law suits 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.
Khadka added: “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” Khadka emphasized.
“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” Khadka told Citizen News Service (CNS).
Tara Singh Bam from International 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 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,” Shrestha said. Studies show that by increasing taxes, tobacco consumers decrease and number of young people initiating tobacco use also drops.
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” Bogati said.
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” Bogati said.
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 challenges.
Tara Singh Bam of The Union pointed out that the Nepalese government also has a stake in the 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 is 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.