Pakistan Must Confront Its Smoking Crisis

• Pakistan produced around 94.328 billion cigarettes in 2024.
• Pakistan has more than 22 million tobacco users, including around 14 million smokers.
• Existing tobacco control regulations are often weakly implemented.
• Clear policies are needed for electronic cigarettes and nicotine pouches.
• Smoking creates major health, economic and environmental costs.
• About one-fourth of smokers attempt to quit each year, but fewer than 3% successfully quit.
• Structured quit programmes, counselling and accessible NRT remain limited.
• Federal, provincial and local authorities should expand smoking cessation services.
• Doctors and other health professionals have an important role in helping adult smokers quit.

Smoking continues to affect millions of people in Pakistan and creates health, household, economic and environmental costs. Helping smokers quit can reduce these harms while strengthening existing tobacco control efforts.

Smoking contributes to preventable disease, premature death and the growing burden of non-communicable diseases in Pakistan. Accessible cessation services can help reduce this long-term public health burden.

The article supports stronger implementation of tobacco control laws, clear regulation of alternative tobacco products and wider access to evidence-based smoking cessation support at federal, provincial and local levels.

This explainer is based on the supplied ARI internal article. The complete article text is kept from the supplied document, while the summaries and key points are prepared in simple language for general readers in Pakistan.

In 2024, around 94.328 billion cigarettes were produced in Pakistan. In other words, on average 6,738 cigarette sticks for every smoker or 337 packets annually. A scary picture for a country like Pakistan which has more than 22 million tobacco users, including 14 million smokers.

However, scarier is the fact that despite all the successes against smoking over the last two decades, the epidemic is a major public health issue in the country. Pakistan banned advertisement of smoking way back in 1997, a huge step forward, when the Lahore High Court ruled that the cigarette and tobacco advertising on electronic media and television violated or conflicted with the public's fundamental right to life under Article 9 of the constitution. Critically, the verdict marked a step forward in tobacco control initiatives, as Pakistan introduced the ordinance against smoking in 2002 and ratified the Framework Convention on Tobacco Control (FCTC) in early 2005.

Almost three decades on, GATS 2024 reported decrease in smoking since 2014, it is still part of daily life in Pakistan as there has not been much movement forward with regards to lawmaking on tobacco use. The implementation of regulations on smoking remain weak or simply absent.

As in the rest of the world, Pakistan witnessed the introduction of the alternative tobacco products such as electronic cigarettes and nicotine pouches over the last decade. With no policy and regulations guiding the use of the alternative tobacco products, there is more confusion than clarity.

According to the Tobacco Atlas, 147,283 people die from smoking every year while the annual cost of illness attributable to smoking in Pakistan annual is 422.86 billion rupees. This encompasses direct healthcare expenditures as well as indirect costs arising from lost productivity due to illness and premature death and adversely affecting public and fiscal health of the country.

Worryingly spending on tobacco is diverting household resources from essential needs that could lift families out of poverty. In Pakistan, a smoker typically spends 5.12% of GDP per capita every year to purchase 100 packs of the most popular cigarettes. Environmental impact of smoking is on the rise. Each year, an estimated 8,068 tons of cigarette butts in Pakistan end up as toxic waste. Additionally, the National Assembly was recently informed that tobacco use is one of the main major risks contributing to the increasing burden of non-communicable diseases (NCDs). Minister for National Health Services Mustafa Kamal told the National Assembly that the rising prevalence of unhealthy dietary practices, including the increasing consumption of ultra-processed foods and sugar-sweetened beverages, along with physical inactivity, tobacco use, and obesity, are the major risk factors contributing to increasing NCDs burden.

Adult smokers need a helping hand, especially those who have been unable to quit smoking despite multiple attempts. Every year one-fourth of the smokers in Pakistan make an attempt to quit smoking, but only less than three percent successfully give up this habit.

According to the US National Cancer Institute, “smoking cessation lowers the risk of cancer and other serious health problems. Counseling, behavior therapy, medicines, and nicotine-containing products, such as nicotine patches, gum, lozenges, inhalers, and nasal sprays, may be used to help a person quit smoking.”

Every smoker, at some point in life, wants to quit smoking. At this occasion, a smoker should have knowledge and access to smoking cessation programs at the local levels. 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 quit-lines and professional counseling further reduces quit success rates.

There is a need to establish accessible quit-smoking programs at the federal, provincial and local levels, which should be backed by counselling and nicotine replacement therapies for those struggling to quit. The role of health professionals, mainly doctors, is critical in helping adult smokers quit. It is essential that doctors are sensitized on tobacco harm reduction and made part of the efforts to highlight this concept and how it can assist in reducing smoking prevalence.