Two Decades of Tobacco Control in South-East Asia: Gains, Gaps, and the Road Ahead

The article, based on the “Two Decades of WHO FCTC Implementation in South-East Asia Region” report, discusses the progress and challenges in implementing the Framework Convention on Tobacco Control (FCTC) in the South-East Asia Region. While there has been a decline in tobacco use, several barriers—including industry interference, the rise of novel products, and the illicit tobacco trade—continue to impede full implementation. Success stories from Thailand, Nepal, and Bangladesh provide valuable insights, but a stronger regional commitment is needed to meet the 2025 targets.

The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) has been a cornerstone in global efforts to combat the tobacco epidemic. In a comprehensive review, the report titled “Two Decades of WHO FCTC Implementation in South-East Asia Region” assesses the progress, challenges, and success stories of the FCTC implementation in the South-East Asia Region over the past twenty years. With a focus on public health, the document highlights how this region—home to some of the highest tobacco consumption rates in the world—has responded to the pressing issue of tobacco use.

Tobacco Use in the South-East Asia Region

Despite significant strides, tobacco use remains a leading cause of noncommunicable diseases (NCDs) in the region. The numbers are staggering: by 2022, around 411 million adults were using tobacco products, and 280 million of these were smokeless tobacco users, accounting for 77 percent of the global smokeless tobacco market. These figures illustrate the immense public health burden that tobacco continues to pose in the region.

From 2000 to 2022, the region witnessed a significant decline in tobacco use prevalence. Among men, the rate dropped from 68.9 percent to 43.7 percent, and among women, from 33.5 percent to 9.4 percent. However, the report underscores that these declines are insufficient to meet the target of a 30 percent reduction by 2025, a benchmark set under the NCD Global Action Plan. This shortfall signals that while the region has made progress, much work remains.

Challenges in Implementation: Industry Interference and Novel Products

One of the major hurdles in effective tobacco control implementation is the persistent interference from the tobacco industry. The industry has been known to use various tactics to weaken policies and slow the adoption of stricter regulations. The influence is pervasive, hindering efforts to create robust tobacco control environments across several member states.

Moreover, the rise of novel tobacco products, such as electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs), is creating new challenges, particularly among youth. These products, often marketed as safer alternatives, are gaining popularity in the region, complicating traditional tobacco control strategies. The report warns that without urgent regulatory interventions, these emerging products could potentially reverse the hard-earned gains of the past two decades.

Success Stories: Leading by Example

Despite these challenges, several countries in the region have pioneered effective strategies that could serve as models for others. Thailand and Nepal, for example, have shown remarkable progress in implementing WHO FCTC provisions. Thailand’s Health Promotion Foundation, which channels funds from tobacco and alcohol taxes into public health initiatives, has significantly contributed to reducing tobacco consumption.

In Bangladesh, the National Tobacco Control Cell has successfully used tobacco tax revenues to support health programs and awareness campaigns. These initiatives not only demonstrate the importance of dedicated funding but also highlight how strategic investments can amplify the impact of tobacco control policies.

The report also points to Bhutan’s comprehensive approach to combat illicit tobacco trade and Sri Lanka’s pilot project to reduce tobacco cultivation. Both countries have shown that a mix of legislative measures, community engagement, and targeted campaigns can yield tangible results.

The Way Forward: Bridging the Gaps

While progress is evident, the report calls for an acceleration in the implementation of FCTC measures. The way forward includes:

Strengthening Smoke-Free Laws and Raising Taxes: Countries must implement comprehensive smoke-free laws and increase taxation on all forms of tobacco to reduce affordability and consumption.

Targeted Interventions for Youth: With novel products appealing to younger demographics, there is a need for stronger youth-focused strategies, including public awareness campaigns and strict regulations on advertising.

Addressing Illicit Trade: Cross-border illicit trade in tobacco products remains a critical challenge, particularly in countries with porous borders. A unified regional strategy is needed to tackle this issue.

Support for Tobacco Farmers: Promoting economically viable alternatives for tobacco growers is essential to reduce supply and transition affected communities towards more sustainable livelihoods.

The Southeast Asia Region has made commendable progress over the past two decades in its fight against tobacco use, yet gaps in implementation and enforcement remain. With more than 411 million tobacco users in the region, a stronger commitment is needed to meet the 2025 target. The WHO report advocates for increased political will, stricter adherence to FCTC guidelines, and greater regional collaboration to sustain and expand the gains achieved so far. As the region looks ahead, it must focus on innovative solutions, robust policy implementation, and unwavering dedication to public health.