Path to a Smokefree Future

As we are now in the month of World No Tobacco Day, which falls on May 31 every year, it is pertinent to review the smoking prevalence in Pakistan. Unfortunately, smoking prevalence remains a significant public health concern. The adult smoking rate is estimated to be around 20.2%, with approximately 15.6 million smokers in the country. Tobacco use continues to contribute to a substantial burden on the healthcare system.

The critical question is that how Pakistan can move forward towards a smokefree status. A country is considered to have achieved smokefree status when smoking rates drop to a minimal level, typically below 5% of the population.

Countries that have made significant progress toward smokefree status include New Zealand, which set a goal to be smokefree by 2025, and Sweden, which has one of the lowest smoking rates globally.

For achieving the status of smokefree, a country has to take a number of measures. The first is to have comprehensive smokefree laws. Unfortunately, Pakistan lacks comprehensive tobacco control laws both at the federal and provincial levels. The country has not moved beyond the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance, 2002. It bans smoking in public places, prohibits tobacco advertising, and restricts the sale of tobacco products to minors. However, this law is silent on the provision of cessation services, which is a critical factor in bringing down the smoking prevalence, especially among the adult smokers.

According to WHO, high taxation on tobacco products discourages consumption. Pakistan increased taxes on locally manufactured cigarettes in February 2023. However, illicit, and smuggled cigarettes are significantly harming the formal cigarette manufacturing sector. The formal tobacco industry, which contributes nearly 98% of the sector’s total tax revenue, is facing pressure due to the proliferation of untaxed and unregulated cigarette sales.

Strict advertising bans preventing tobacco promotion. This is one area where Pakistan has successfully banned all cigarette advertisement. Gone are the days when the cigarette brands would sponsor major sporting events.

Though effective smoking cessation programs help smokers in quitting successfully, Pakistan failed to provide this support. There is a lack of structured quit programs, counseling services, and accessible nicotine replacement therapies (NRTs). Public hospitals rarely offer dedicated smoking cessation programs, and private healthcare options are often expensive. Additionally, low awareness of cessation methods and limited government funding exacerbate the issue. The absence of evidence-based quitlines and professional counseling further reduces quit success rates.

Public awareness campaigns educating citizens on the harms of smoking are conspicuous by their absence. This is despite the fact that today communication technology has provided numerous avenues for instant access to large populations.

Over the last one decade Pakistan has witnessed the emergence of alternative nicotine products such as the electronic cigarettes, vapes, nicotine pouches, and heated tobacco products. Pakistan lacks a comprehensive regulatory framework for these alternative nicotine products. The absence of regulation means that public health authorities cannot assess product safety or enforce quality standards, potentially limiting harm reduction efforts. Some experts argue that introducing a structured policy could help reduce smoking prevalence while ensuring consumer protection.

This is a grim scenario. It needs to be changed for ensuring a healthy Pakistan.

Pakistan needs to reassess its journey to achieving the smokefree status. There is an urgent need for new laws on tobacco control at federal and provincial levels to address emerging issues such as taxation, and sensible regulation of alternative tobacco products. Additionally, the provinces need to have their own tobacco control laws, a missing link after the health sector was delegated to provinces in 2010 after the passage of the 18th constitutional amendment. Comprehensive tobacco control laws and their strict implementation will help Pakistan take first step towards achieving the smokefree status.

The world is moving towards a future without the smoke of cigarettes. And that future is not far. Therefore, ending smoking in Pakistan is a possibility which can be achieved in the near future.