Pakistan has one of the largest populations of tobacco users in the world, with over 22 million adults ages 18 or older smoking cigarettes, water pipes, or some other tobacco product. Almost one-third (32.4%) of men and 5.7% of women smoke tobacco, and 15.9% of adult Pakistanis are daily smokers. Despite bans in recent years, millions of adults use some form of smokeless tobacco product, including gutka, naswar and paan. Youth tobacco use is an emerging problem in Pakistan. Recent surveys of in-school youth ages 13 through 15 years found prevalence rates of current use of some tobacco products between 6.1% in Lahore and 14.1% in Karachi. In locations where these surveys have been conducted multiple times, youth tobacco use is higher in the most recent survey than in earlier surveys. About one in five youth tobacco users consume cigarettes.
Also of concern is the relatively high smoking prevalence among girls. If unchecked, there could be significant increases in smoking prevalence among women in future years. Available data sources suggest that overall cigarette consumption has been rising in Pakistan over most of the past two decades, before falling in recent years, with per capita cigarette smoking rising by over 85% between 1993 and 2007. In more recent years, Executive Summary declines in per capita consumption have accompanied rising cigarette taxes and prices coupled with the implementation of stronger tobacco control policies. Given high levels of tobacco use, Pakistan faces considerable health and economic consequences from tobacco.
Over 100,000 deaths are attributed to tobacco use each year, with the majority of these deaths resulting from lung and other cancers, strokes, ischemic heart and other cardiovascular diseases, and respiratory disease,increasing aging incidence of oral cancer resulting from smokeless tobacco use is of particular concern and led to a ban on the sale and purchase of certain smokeless products in parts of the country (gutka and Mainpuri in Sind province in 2011). While country-specific estimates are not available, the death and disease caused by tobacco use impose significant economic costs, including the costs of health care services to treat the diseases caused by tobacco use and the lost productivity that results from absences and premature death among tobacco users.
Pakistan was the 10th largest tobacco-growing country in the world in 2011, producing more than 100,000 tonnes of tobacco, continuing a long-time slow upward trend in tobacco growing. Tobacco is grown throughout the country, with more than three-quarters of the country’s tobacco grown in the Khyber Pakhtunkhwa province (KPK); other key growing areas are located in Punjab and Balochistan. Pakistan is a net exporter of tobacco leaf, but most tobacco grown in the county is used in local tobacco product manufacturing.
Tobacco smoking and other forms of tobacco use impose a large and growing public health burden globally and in Pakistan. Globally, tobacco use currently causes 5.4 million premature deaths each year, and if current trends are unchecked, one billion people will die from tobacco use in the 21st century.
While the health hazards of tobacco are often discussed the negative effects of tobacco cultivation are least talked about. According to WHO every year the tobacco industry costs the world more than 8 million human lives, 600 million trees, 200 000 hectares of land, 22 billion tonnes of water and 84 million tonnes of CO2. The majority of tobacco is grown in low-and-middle-income countries, where water and farmland are often desperately needed to produce food for the region. Instead, they are being used to grow deadly tobacco plants, while more and more land is being cleared of forests.
The WHO report “Tobacco: Poisoning our planet” highlights that the industry’s carbon footprint from production, processing and transporting tobacco is equivalent to one-fifth of the CO2 produced by the commercial airline industry each year, further contributing to global warming. Tobacco products are the most littered item on the planet, containing over 7000 toxic chemicals, which leech into our environment when discarded. Roughly 4.5 trillion cigarette filters pollute our oceans, rivers, city sidewalks, parks, soil and beaches every yearProducts like cigarettes, smokeless tobacco and e-cigarettes also add to the build-up of plastic pollution. Cigarette filters contain microplastics and make up the second-highest form of plastic pollution worldwide.
In Khyber Pakhtunkhwa and across Pakistanpolicymakers, industry groups, farmers and other stakeholders must reckon with and address the vast environmental impacts of tobacco cultivation on the environment of Pakistan. Tobacco cultivation leads to deforestation and soil degradation. Tobacco manufacturing is a hugely energy-intensive process that depletes water, uses excess fossil fuels and metal resources, and produces an array of toxic solvents, slurries, oils, plastics, and chemicals. Cigarette butts are by far the largest single type of litter by count, while indiscriminate use of plastic pouches for smokeless tobacco is an emerging environmental concern in many countries of the Region. Tobacco smoke pollutes indoor and outdoor environments and remains a pervasive and persistent source of toxicants long after the cigarette has been extinguished.
We all share the burden. From start to finish, the tobacco life-cycle damages health and well-being deplete and degrades the environment, and diminishes efforts to promote sustainable and inclusive social and economic development. It impedes our ability to achieve Sustainable Development Goals. Together, we must strengthen existing tobacco control measures – including legal and regulatory mechanisms, as well as tobacco cessation services, especially at the primary level – and implement the high-impact, evidence-based and cost-effective countermeasures outlined in the WHO FCTC and MPOWER package, reducing not only demand but also supply.
The author is a human rights activist and Tweets @QamarNaseemPak