Comment: One of Maldives’ biggest killers entirely preventable

It is indeed sad that one of the biggest killers of people in Maldives is an addiction that is entirely preventable, but requires a good will to act from everyone.

In 2010, the Government of Maldives, in a commendable move, passed a Tobacco Control Law and in January 2013 introduced its first regulation to reduce the amount of public real estate on which smokers can indulge in their harmful habit – it banned smoking cigarettes inside all government buildings, private restaurants, cafes and other public places.

It further bans smoking tobacco at rehabilitation centres, children’s parks and spaces often visited by children, aboard transport vehicles and at any area where residents have to wait in a line to receive services. Individual violators can be fined MRF500 and proprietors MRF1000 for not enforcing the law on their premises.

Of course, with any law, enforcement is key and we know that the government is aware of the need to encourage law enforcement to not only uphold the law but to become better educated on the details. WHO has suggested incentivising law enforcement so that they will take a more active role in upholding this crucial piece of legislation. There is work to be done to gazette certain provisions, and provide support for more training and awareness-raising activities.

The statistics themselves are alarming enough:

• According to the 2009 Maldives Demographic and Health Survey (DHS), 42 percent of people in the between the ages of 20-24 are smokers in the country, one of the highest in the region.
• Although importation figures are showing some decline, in 2011 about 454 million cigarette sticks were imported. This represents a retail value of about MVR 910 million.
• Globally – tobacco kills nearly 5.4 million people each year; and by 2030 it will kill more than 8 million people each year.
• If no serious action is taken, up to 1 billion people could die from tobacco use in the 21st century.

There is well-established evidence: tobacco kills and its use carries many negative effects on health and quality of life.

However, despite efforts globally by governments, NGOs and individuals to curb tobacco smoking, it is no secret that the opposition backing the tobacco industry is well-organised and well-funded. Some of the firms will stop at nothing to silence the anti-tobacco lobby. Even for small nations such as Maldives, introducing anti-tobacco legislation and measures can face fierce resistance from those who promote their commercial interests.

The theme of World No Tobacco Day 2013 is “Tobacco advertising, promotion and sponsorship.” The WHO position is clear: all forms of tobacco advertising, promotion and sponsorship should be banned – full stop. We believe that banning tobacco advertising, promotion and sponsorship is one of the most effective ways to reduce tobacco use. In fact, this is a requirement under Article 13 of the WHO Framework Convention for Tobacco Control (FCTC), the international treaty that was developed in response to the globalisation of the tobacco epidemic.

Why is this measure so important? Nearly three in four children between the ages of 13 and 15 are exposed to pro-cigarette ads on billboards and to pro-tobacco messages at sports and other events.

The link between such messages and the uptake of the habit are indisputable. Our figures show that a comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7 percent, with some countries experiencing a decline in consumption of up to 16 percent.

I commend the Government of Maldives for introducing a total ban on tobacco advertising, promotion and sponsorship. The Tobacco Control Law (Law15/2010), with the first regulation introduced in January 2013 and more underway, provides a base for reinforcing such a ban.

I know that the Government of Maldives is taking this matter very seriously and continues to place an importance on introducing a full set of regulations, coordination of efforts in multiple sectors and educating small traders and communities on the provisions of the law.

The evidence is clear: such bans work and help us to protect our youth from this deadly addiction.
The time to act is now.

Dr Magtymova is the World Health Organisation (WHO) Representative to the Republic of Maldives.

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