KARACHI: Physicians representing over 150 health and research facilities in the country have submitted an appeal to the prime minister asking him to enforce the anti-tobacco law in letter and spirit and order enlargement of the size of pictorial warning on cigarette packs to 85 per cent of the cover as announced by the government last year, Dawn learnt on Sunday.

They called upon the government to hike tax on all tobacco products, introduce pictorial warnings on packs of smokeless tobacco as well, implement the ban on selling tobacco products to the underage, ban the use of shisha, stop all forms of tobacco advertisement and instruct the Pakistan Electronic Media Regulatory Authority not to allow transmission of smoking scenes in TV shows and drama serials.

The appeal, coinciding with World No Tobacco Day on May 31, was meant to serve as a reminder to the government to fulfill its obligations towards public health, sources said.

“Pakistan is on the verge of a health and economic disaster due to rapid rise in the use of tobacco. The costs of tobacco use far outweigh any potential economic benefit.

“We, the health professionals, who see the victims of tobacco every day in our clinical practice, are very concerned about the growing morbidity and mortality from the widespread use of tobacco.

“Through this letter, we make a humble request to the ministries concerned to take measures to control tobacco epidemic in the country,” says the letter recently submitted to the prime minister secretariat.

Asking the government not to bow to the pressure of the tobacco industry, health experts argued that tobacco use put a huge direct and indirect burden on the economy via substantial healthcare expenditure on tobacco-related diseases and through loss of productivity by the workforce that was affected by tobacco related illnesses.

“A favourite argument offered by the tobacco industry against tobacco control is the stimulus it provides to the economy by generating employment and revenue. This does not hold up to scrutiny. In Pakistan, every year, Rs800 million are burnt away in cigarette use and an equal, if not higher, amount is spent on consuming smokeless tobacco (in the form of paan, gutka, naswar etc).

“Huge amounts of foreign exchange are also wasted in importing costly medicines to treat the diseases caused by tobacco use. Tobacco use hurts disproportionately the poor and deepens poverty in the country by siphoning off money needed for basic necessities such as food, shelter and education. In short, if it is our goal to have a healthy population and a productive workforce, tobacco control is essential,” the letter says.

Citing a report of the World Health Organisation released in 2015, experts say that tobacco epidemic is one of the biggest public health threats the world has ever faced, killing around six million people annually. In Pakistan, it claims 100,000 lives every year.

According to them, tobacco use leads to a number of diseases including lung and oral cancer, the top two culprits for cancer related deaths in males. It is also a major risk factor for heart attacks, strokes, pneumonia and chronic obstructive pulmonary disease.

Tobacco smoke is a complex mixture of gas and particles that contains over 4,000 chemicals, at least 60 of which are known to cause cancer.

Experts regret that the government is yet to implement the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance, which came into effect in year 2002.

“In most enlightened countries, significant measures have been taken to control the tobacco epidemic.

Implementation of clean air laws, heavy taxation on tobacco products (cigarette prices in Pakistan are among the lowest in the world), public education on the hazards of tobacco and pictorial warning on cigarette packs are a few examples of such measures.

“Unfortunately, and dare we say shamefully, Pakistan is lagging behind the rest of the world in its tobacco control efforts. To date, no action has been taken to make public places smoke-free as envisaged by the ordinance. According to the WHO, more than 600,000 people die every year by being exposed to second-hand smoking. Enforcement of this ordinance, hence, becomes critical.”

The doctors who signed the appeal campaign initiated by the National Alliance for Tobacco Control represented Shaukat Khanum Memorial Cancer Hospital and Research Centre, King Edward Medical University, Lahore; Punjab Institute of Cardiology, Lahore; Jinnah Hospital, Lahore; Gulab Devi Postgraduate Medical Institute, Lahore; Allama Iqbal Medical College, Lahore; Sheikh Zayed Medical College and Hospital, Rahimyar Khan; Ojha Institute of Chest Disease, Karachi; Jinnah Postgraduate Medical Centre, Karachi; National Institute of Child Health, Karachi; Liaquat National Hospital, Karachi; Aga Khan University, Karachi; Abbasi Shaheed Hospital, Karachi; Korangi Medical Centre, TB Control Programme (Sindh), Karachi Medical and Dental College, OMI Hospital, Dow University of Health Sciences, Karachi; and the Lady Reading Hospital, Peshawar.

Published in Dawn, May 30th, 2016