Keywords: smoking ban, policy, World Health Organization.
Tobacco smoking is one of the world’s largest health problems. Cancer, stroke, heart disease, diabetes ― it is just a small part of consequences of smoking [1]. Around 100 million deaths in 20 th century happened because of smoking [2]. That is why, governments of different countries are using various methods to prevent smoking among population. Unfortunately, not all governments success with it; in this essay an example of such government will be discussed.
Historically Kiribati has the highest percent of smoking people in the world. In 2016 according to WHO (World Health Organization) almost half (47.8 %) of population over 15 smoked, and their cigarette consumption per capita was 1,396. Every day average Kiribati smoker consumes 3–4 cigarettes a day, this leads to 22.81 % of all men’s and 14.52 % of all women’s deaths in the country. Another big problem of Kiribati is child smoking — 3.6 % of boys and 1 % of girls 10–14 y.o. smoke. [3]
There were several attempts of Kiribati’s government to warn people of health consequences of smoking, but according to statistics policy was inefficient. This essay will discuss reasons of it and propose changes in smoking ban policy, which may improve situation in the country.
Literature review
Our research aim is to look up to tobacco policies and their effectiveness and apply it in Kiribati. In order to discover correlations, we found statistics from different regions. Through the analysis of data and policies behind, practice theoretical solutions for Kiribati cultural and economic state.
– DailyMail report on “Smoking ban spurs 400,000 people to quit the habit” [4]
The article shows effectiveness of banning smoking in public facilities. At least 400,000 people in England quitted this harmful habit as a result of this policy, prevalence of smoking was boosted from 1,6 per cent up to 5,5 per cent. While the aim of smoke free legislation was to provide protection from the harm of second-hand smoke, it is good news that it has motivated smokers to get rid of their habit. Nevertheless, England is known as front runner of CCTV and high penalties, can be such measures be applied to Kiribati island in the middle of the Pacific Ocean? Unlikely, our focus must be towards to possible economic or cultural changes.
– “Regional Action Plan for the Tobacco Free Initiative in the Western Pacific” by World health organization. [5]
This work observes various legal instruments, which may be applied in the Oceania region in order to improve smoking statistics. From the basic education and propaganda, up to law changes and infrastructure development. Article have verity of data from already applied polices and possible future development and new proposals.
Moreover, is a scientific evidence that smoking does not only affect the smoker negatively. It also affects all the people around those who smoke, because when people smoke in pubic, the smoke travels everywhere through the air, and the negative effects of this smoke affects all living, breathing creatures.
There were several attempts to warn people of health consequences of smoking; however, they were not successful because about half the adult population cannot read. What is more, smoking is prohibited only in healthcare facilities, government facilities and some of indoor offices. If Kiribati wants to fight successfully with smoking, current policy should become stricter. Analyzing already implemented policies and verity of policies from other regions, we will improve and adopt measures especially for Kiribati islands.
Data observation
Historically Kiribati has the highest percent of smoking people in the world. In 2016 according to WHO (World Health Organization) almost half (47.8 %) of population over 15 smoked, and their cigarette consumption per capita was 1,396. Every day average Kiribati smoker consumes 3–4 cigarettes a day, this leads to 22.81 % of all men’s and 14.52 % of all women’s deaths in the country. Another big problem of Kribati is child smoking — 3.6 % of boys and 1 % of girls 10–14 y.o. smoke. It increases probability of having heart and lung diseases, stroke, different types of cancer and many others. [5]
According to The Tobacco Atlas [3], a free online resource and companion book that map the nature and magnitude of the tobacco epidemic and chart a course toward clear, proven solutions, there are four main harmful consequences of tobacco products:
– Tobacco harms the health, the treasury, and the spirit of Kiribati. Every year, more than 208 of its people are killed by tobacco-caused disease. Still, more than 250 children (10–14 years old) and 26220 adults (15+ years old) continue to use tobacco each day. Complacency in the face of the tobacco epidemic insulates the tobacco industry in Kiribati and ensures that tobacco's death toll will grow every year. Tobacco control advocates must reach out to other communities and resources to strengthen their efforts and create change.
– Buying tobacco robs families of the resources they may need to rise out of poverty. A smoker in Kiribati would have to spend 49.93 % of their average income (measured by per capita GDP) to purchase 10 of the most popular cigarettes to smoke daily each year!
– Cigarette butts are the most commonly discarded pieces of waste worldwide. It is estimated that 49 tonnes of butts and packs wind up as toxic trash in Kiribati each year. This is roughly equivalent to the weight of 10 endangered African elephants.
– People living with mental illness are nearly twice as likely to smoke as other individuals.
What is more, from The Tobacco Atlas and WHO’s Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) we collected information about current Kiribati’s smoking ban policy and instruments recommended by World Health Organization:
|
№ |
Instrument name |
Current Policy |
WHO Recommendations |
|
1 |
Smoke free areas |
Current smoke free areas: – Healthcare Facilities – Government Facilities – Indoor Offices |
The best practice is to propose smoke free areas in all public places |
|
2 |
Offering help for smokers |
Government provides at least one cost covered quitting resource. National quit line is not established. |
There should be a National quit line. Both NRT and cessation-services should be cost-covered. |
|
3 |
Tobacco products packaging |
In Kiribati there are no obligations for manufacturers to produce plain packaging. Warning label is in a form of text, and it must cover at least 30 % of package. |
WHO recommends a plain, standardized pack with a large health warning |
|
4 |
Enforce Bans on Advertising |
Ad ban compliance percent is high: there are 5 out of 7 possible direct ad bans and 8 out of 10 possible indirect ad bans |
Ban on all forms of direct and indirect advertising is the best practice |
|
5 |
Taxes on tobacco products |
Only 35 % of Retail Price is Excise Tax |
Minimum 70 % of Retail Price is Excise Tax |
Discussion section
Our research goal was to analyze reasons for dramatic smoking statistics in Kiribati and propose changes, which may improve the situation. The first smoking ban instrument we want to talk about is proposing smoking free areas. This policy is actively used in many countries. According to WHO recommendations smoking should be prohibited in all public places. In Kiribati the situation is pessimistic: smoke free areas are created only in healthcare and government facilities and some private offices. That means that people can smoke without any consequences on streets, restaurants, and all education facilities. Such an approach creates an opportunity for passive smoking, which according to WHO is as harmful as classic smoking. Government may begin prohibiting smoking in schools and universities and gradually forbid it in all public places.
Next instrument we are going to analyze is regulation of tobacco product packaging. The WHO standard is a plain standardized pack with a large health warning on it. The problem with colorful packaging, as in Kiribati's case, is that it attracts children’s attention. What is more, the only warning on a package is a text, covering only 30 % of the package. Most smokers probably would not draw any attention to it. One of the most important changes we may propose is to place a picture with consequences of smoking as a warning, it also should covet at least 50 % of the package. We believe that new package design will bring more attention to health problems, which people may have after continuous smoking.
Even though Kiribati’s government is prohibiting tobacco advertising, it does not run anti-smoking and anti-tobacco media campaigns. Quitting resources are also not well developed: there is no national quitting program, but there are NRT (nicotine replacement therapy) and cessation services, at least one of which is cost covered. One of the last steps in smoking ban reform is to launch a national smoking quitting campaign. We should focus on young smokers and advertise this campaign in schools and universities.
Another worldwide practice in smoking ban policies is taxes on tobacco products: they are twice lower than recommended. World Health Organization established a minimum tax on retail price of 70 %, nonetheless Kiribati only taxes 35 % from retail price. For the tobacco industry Kiribati is a plum. It is less costly to sell tobacco products and with the lower price, demand for tobacco products rise dramatically. This might be the main cause of doubled tobacco consumption compared to other Western Pacific countries. Government may begin to slowly raise taxes on tobacco products and use this money on smoking ban reform implementation.
Last issue we want to talk about is prohibition of direct and indirect advertising of smoking and tobacco smoking. In Kiribati it is not allowed to run tobacco commercials on radio or television, nor any billboard advertisement. Furthermore, any form of sponsorship or contribution that can be identified with tobacco products. Any informal distribution measures like internet sales or through the mail is not allowed. Sales and promotional discounts are prohibited as well. Such measures are not something extraordinary, they are obligatory in most of the world. This is the most advanced policy in Kiribati, so we can only propose to control advertising campaigns stricter to avoid law violation.
Conclusion
Through our research we discovered few possible solutions for Kiribati’s smoking problem. In conclusion we would like to suggest measures to be implemented and probable outcomes of such.
Kiribati as a country located on multiple islands has problem with controlling of tobacco advertising and distribution. We would like to implement stricter measures on advertising. Firstly, oblige tobacco products to have warning covers with pictures and take at least 50 % of the package. Secondly, rise penalties for tobacco advertising. Another important measure to be applied is rising tobacco products taxes. Right now, they are twice lower than world standards. That is what to be changed in order to rise prices and lower the demand. Thirdly we suggest prohibiting indoor smoking.
Our expected goals are lowering tobacco consumers in more than twice. As most of the population are not educated to read, they are not aware of the consequences of tobacco consumption. By labeling pack, the right way, we expect people to recognize the harm and change their behaviors. Furthermore, most of Kiribati population is below poverty level, rising the tax will prevent many people of buying cigarettes on a daily basis.
To conclude, people of Kiribati will resist, but such measures must be taken before more people are affected.
References:
- https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm#:~:text=Smoking %20causes %20cancer %2C %20heart %20disease,immune %20system %2C %20including %20rheumatoid %20arthritis.
- https://www.nature.com/articles/nrc2703
- https://tobaccoatlas.org/country/kiribati/
- http://www.dailymail.co.uk/health/article-1030575/Smoking-ban-spurs-400–000-people-quit-habit.html
- https://apps.who.int/iris/rest/bitstreams/1246808/ret..
- https://ourworldindata.org/smoking
