Ahmed Lizneen was just 14 when he first smoked. What started as an “experiment for fun” has now become a habit – he has struggled to quit over the years, but to no avail.
“It was my friends who gave the cigarette to me first. I had it for fun. Then I also started buying. Not the whole pack, but a few cigarettes at a time as it was cheaper. Slowly it became an addiction. I tried to stop many times, but just could not,” Lizneen explained.
Alarmingly high tobacco consumption
Statistics reveal an alarming proportion of the Maldivian population – especially youth – have succumbed by one of the biggest public health threats the world has ever faced: the tobacco epidemic.
The Center for Community Health and Disease Control (CCHDC) estimates that the 44 percent of the total population use tobacco, mainly by smoking.
According to the Maldives Demography and Health Survey (MDHS) 2009, 42 percent of people in the age group 20-24 are smokers while 20 percent of 15-19 years age group smoke.
Similar findings in a 2007 Global Youth Tobacco Survey (GYTS) showed that nice percent of the surveyed students are either smokers or have smoked in the past – while 48.7 percent students are exposed to second-hand smoke at home and 69.4 percent of students are exposed to it elsewhere.
A worrying trend has been observed with rising numbers of girls becoming smokers.
Statistics show that overall tobacco use prevalence is high compared to international standard with 57 percent of men and 29 percent of women having used some form of tobacco.
Based on customs data, in 2010 alone 346 million cigarettes were imported into the Maldives at a cost of Rf124 million (US$8 million) – a disproportionate figure considering the 350,000 populace. In 2009, Rf110 million was spent to import 348 million cigarettes – mostly included well known brands such as marlborough, camel, and mild seven.
Based on those figures, the average Maldivian smoker consumes 2312 cigarettes a year – six a day.
Leading public health experts have raised their voice on the issue.
Former Director General of the CCHDC Dr Ahmed Jamsheed wrote on his blog in July 201 that the “available statistics on smoking in the Maldives are alarming”.
“The Maldives still seems to be on the rising curve of the tobacco epidemic (we can still change this) and it will take several years to peak and show the full health impact of smoking and tobacco products. There is a lag of many years between the health effects of tobacco and the time people start smoking,” he wrote.
Meanwhile Ahmed Afaal, a public health service manager and tobacco prevalence researcher, says much needs to be done to control the growing “menace”.
“To protect the majority of the smoking Maldivians from death before they reach their potential life expectancy, strong laws are needed to reduce the supply and demand for tobacco,” he wrote on his blog in October 2011. “We are way behind!”
Tobbaco products price increased
In a bid to control the rising demand curve, legislation was passed in 2011, increasing the 50 percent import tariff on cigarettes by four fold.
With the increase of import tariff by 200 percent the price of cigarettes doubled, subsequently raising complaints from “tobacco addicts”.
Unlike many countries which already impose strict supply controls and high prices on tobacco products, the Maldives has long enjoyed cheap rates with a pack easily available from shops between Rf18-25 (US$1.16-1.62), subject to brand, while a single cigarette costs one rufiya.
Following rise in import duty in the Maldives, the cheapest brand is available at almost Rf35 (US$2.27) and a single cigarette costs almost two or three rufiya.
By comparision, a pack of cheap cigarettes costs the equivalent of Rf66 in the USA, Rf112 in the UK and Rf158 in Australia.
To understand how the smoking habits have changed since the price hike, Minivan News interviewed five smokers aged between 18-40.
Every respondent claimed the daily number of cigarettes smoked remain unchanged, although one who is 20 years old claimed to have reduced it a “little”.
“I finish a pack [almost 20] everyday,” a 35 year-old said. “It is really difficult since the price has increased but I can’t control it. Sometimes I smoke secretly because my wife does not like it”
However, during the interview which was conducted at a café’, the man cancelled an order for a cigarette pack after the waiter mentioned the price. “It’s way too costly at the restaurants,” he says.
Lizneen, 24, also claims his smoking habits still remain same – almost 10-20 cigarettes per day.
However, he revealed an interesting trend among the smokers: “We don’t share anymore,” he explained. “There are some smokers who take one or two from others, but because it’s expensive now most who buy cigarette packs hide it or do not smoke in front others who ask for smokes. I do that. My friends too”.
Meanwhile, another 28 year-old who spoke to Minivan News said the change in price “brought no change to my demand and habit”.
“I started smoking at the age of 15 to make my Dad angry for abandoning us while we were still studying. I tried to quit for my wife because she did not like it. But I gave up trying because she left me,” he said.
An 18 year-old, who similarly started smoking at a young age, claimed he would “continue to smoke even if the price increases to Rf100”.
“I can’t stop even if I want to. So why try? There is nowhere I can go to get help. I don’t even know where I can get the help,” he said. “Nobody even cares. It’s all politics now.”
Deputy Director at the CCHDC Hassan Mohamed, who also heads the Tobacco Control Unit, observed that tobacco use is a “global menace” which has been rooted in the Maldives “since our forefathers’ time.”
Laws have been passed to control tobacco use over the generations, with the first to be enacted in 1942, while the latest Tobacco Act passed through the existing parliament in 2010.
However, Mohamed argues that “law itself does not solve the issue” and it is the implementation, collaboration and taking initiative that will help to make the Maldives “tobacco free”.
Acknowledging that the existing Tobacco Control Act is “weak” and has “limitations” that have to be bridged by legislation which are now under review, he pointed out that the laws are adequate and the fight against tobacco can be continued.
He added that the rise in cigarette prices has been a “positive move” and will reduce demand in the long run, acting as a heavy barrier to the recruitment of new or potential smokers.
“Affordability is the key factor that determines smoking habits. When the price increases, depending on the threshold, research has shown that smokers do tend to quit,” Mohamed observed. “Since the price hike, we have received phone calls from the islands and to our office from people asking for help to quit smoking.”
Meanwhile, he said that the introduction of four pieces of legislation currently under review would provide more control over the tobacco supply chain, with zero advertising, strict packaging guidelines and heavy penalties in addition to enhanced protection of second-hand smokers with the banning of smoking in stated public areas.
“The legislation would prohibit sale of single cigarettes,” he claimed, pointing out that Health Ministry requires support from other authorities as it had limited jurisdiction over businesses.
He observed initiatives to treat tobacco addicts are limited and an increased effort is required through civil society and community.
Work is also underway to provide quit smoking services, targeted to begin this year. “We have already trained some people. We will soon open a cessation clinic in Male’ and run a four month pilot project,” Mohamed added.
However, he says the Maldives is facing a “global menace” with multi billion dollar multinationals deliberately exploiting consumers health and well-being to make profits.
“We must keep in mind that in the Maldives we are also fighting against a multi-billion dollar industry. There will be pressures from the global arena and from factors exclusive to Maldives,” Mohamed said. “But we can fight it.”