Addressing smokeless tobacco crisis in Pakistan: A call for comprehensive regulation
Pakistan faces a critical public health crisis due to widespread smokeless tobacco (SLT) use. Despite being a party to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), which mandates clear health warnings and discourages deceptive packaging, Pakistan has not implemented effective regulatory measures for SLT products. This lack of oversight allows the tobacco industry to continue harmful practices. Comprehensive regulation is urgently needed to address the public health risks posed by SLT, a category of non-combustible tobacco products that includes items like Naswar and chewing tobacco, which are popular in South Asia.
SLT poses serious health risks, containing high levels of carcinogens like Tobacco-Specific Nitrosamines (TSNAs). Classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), SLT is strongly linked to oral, gastrointestinal, and cardiovascular diseases, and significantly increases mortality rates.
In Pakistan, about 13% of the population uses SLT, with particularly high consumption among men, women with low educational attainment, and adolescents aged 13-15. SLT use was responsible for nearly 18,711 deaths and a substantial loss of disability-adjusted life years (DALYs) in 2017 alone.
The SLT market in Pakistan is dominated by locally produced, inexpensive products, making them widely accessible, particularly to vulnerable populations. Disturbingly, many of these products are sold near educational institutions, exacerbating their accessibility to minors. Despite the high consumption rates, SLT products are largely unregulated, with approximately 95% of Naswar sold without any health warnings or content disclosure. This violates FCTC provisions and exposes consumers to significant health risks without adequate information.
While Pakistan has made strides in regulating smoking, SLT remains neglected, creating a regulatory void. Many SLT products are produced without oversight, leading to unsafe manufacturing practices, including the use of harmful additives. Additionally, there is no taxation framework for SLT, unlike for cigarettes, which allows manufacturers to operate with fewer economic constraints and limits government revenue that could be used for public health initiatives.
Pakistan must urgently reform its tobacco control policies to include SLT to address these regulatory gaps. Key recommendations include: Expanding existing tobacco legislation to cover all forms of tobacco, including SLT; implementing ingredient disclosure requirements and setting limits on harmful substances like TSNAs; introducing mandatory packaging regulations with graphic health warnings to inform consumers of SLT’s dangers; establishing a licensing regime for SLT manufacturers and retailers to ensure compliance with safety standards; and implementing a taxation framework for SLT to reduce consumption and increase government revenue.
Additionally, the government should support tobacco growers and manufacturers in transitioning to alternative livelihoods to mitigate the economic impact of reduced SLT use. Monitoring frameworks must also be updated to track SLT consumption and market practices more effectively. Prioritizing data collection on the health and economic costs associated with SLT will support evidence-based policymaking.
In conclusion, the health risks posed by SLT in Pakistan are severe, and comprehensive regulation is essential to protect public health. Without swift action, the country risks perpetuating a cycle of dependency on harmful tobacco products, endangering future generations. By adopting the recommended reforms, Pakistan can move toward a healthier future and align its tobacco control policies with global best practices.
