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Tobacco control: UK gains; Thailand stalls

“There (are two types) of people in this world — the people that take and those that get took. ” – I Care A Lot.

About 1.3 billion people around the globe currently use tobacco products, leading to –get this –eight million deaths per year.

Thus, it is no surprise that the burden of tobacco-related death and illness makes tobacco regulation a priority for policymakers and public health organizations.

Tobacco regulation or control refers to a group of policies that rule over tobacco manufacturers, distributors, sellers, and individuals.

Each country or region has its own set of policies that govern consumer access to tobacco products, and these policies have a direct impact on tobacco use profiles.

Globally, the distribution of tobacco users skews towards low- and middle-income countries, with 80 percent of them living in one of these regions.

And just as the prevalence of tobacco use by country is not uniform, neither are tobacco regulations.

In general, more onerous regulatory frameworks are associated with lower levels of tobacco use among a country’s population.

However, not all regulatory frameworks are created equal, and even the countries most praised for their tobacco regulations do not always see large reductions in tobacco use among their populations.

For example, The United Kingdom and Thailand are both praised for their regulation of tobacco.

Both countries are parties to the World Health Organization Framework Convention on Tobacco Control, an international treaty that signals a country’s commitment to regulatory strategies that decrease demand for tobacco products and promote the highest standards of health for their populations.

However, the two countries have taken very different approaches to tobacco control, especially regarding novel tobacco products such as electronic nicotine delivery systems, which include electronic cigarettes and heated tobacco products.

Thailand took the prohibitionist approach promoted by the World Health Organization, the same “quit-or-die” approach being pushed by Bloomberg Philanthropies around the world including the Philippines through giving grants to local regulatory agencies, such as the Food and Drug Administration.

Smoking rate in Thailand has a stagnated while in the UK, which used a different approach to discouraging it, the smoking rate is in decline.

The UK is recognized as an exceptional example of tobacco use surveillance, and monitoring – the British measure smoking prevalence and demographics annually via nationally representative surveys.

By gender, a higher proportion of men (16.5 percent) in the UK smoke than women (13 percent).

There are also disparities by socioeconomic status: a quarter of people working in manual occupations smoke, whereas only a tenth of people in managerial or “professional” occupations smokes.

Smoking is most prevalent among people ages 25-34.

But since 2011, smoking rates have been slowly declining, decreasing from 20 percent in 2011 to about 15 percent in 2018.

The UK has been most successful at decreasing smoking rates among young adults ages 18-24, seeing a nine-point reduction in their smoking rate between 2011 and 2019.

Similarly, Thailand has implemented many tobacco-control policies supported by international public health organizations, including the WHO; however, Thai tobacco-use surveillance programs are less consistent than those in the UK.

Additionally, according to population-based surveillance surveys, Thailand’s smoking rates have declined much more slowly.

In 2011, about 21 percent of the Thai population smoked combustible cigarettes, and—according to the most current nationally representative data—by 2017 the rate had only decreased to 19 percent.

Another difference between the smoking rates in Thailand and the UK is the prevalence of smoking among women. As in the UK, fewer women smoke than men; however, women smoke at much lower rates in Thailand.

Based on 2014 data, only 1.8 percent of women in Thailand smoke, as compared to 35.8 percent of men.

Another key difference between the two nations is that many Thai smokers use roll-your-own combustible cigarettes instead of commercially manufactured products.

According to analyses of the 2014 data, 54 percent of Thai smokers smoke at least one roll-your-own cigarette per day, and 16 percent smoke more than 11 per day, suggesting almost exclusive use of roll-your-own products.

What is tying down the Thais and what keeps the Brits on top of the situation?

And is there a lesson here for health policymakers and industry regulators in the Philippines?

In the first place, is it fair to compare a First World country with a developing nation, a still-emerging economy in the campaign to eliminate such harmful consumption of tobacco products?

Most people would say otherwise.

The UK has undoubtedly more in terms of resources, expertise, and the level of sophistication and/or awareness among the population on the dangers of unhealthy lifestyles compared to the Thais.

It is a tricky path filled with stumbling blocks, slippery slopes, daunting obstacles, false leads, and even hidden traps that could lead an inquisitive mind astray.

“Comparisons between two countries on different continents, with different cultures and different affluence, are often wrought with inaccuracies,” admitted study on harm reduction.

The study by R Street Institute (RSI) noted: “While the UK and Thailand adopted similar approaches to reduce the smoking rates of combustible tobacco products, the UK has seen a more substantial decline in cigarette use than Thailand.”

“This may be due in part to the one area where the two nations’ approaches differ: e-cigarette use. Unlike the UK, which acknowledges the role of e-cigarettes in overall tobacco control strategies and affirms the health benefits of smokers switching to e-cigarettes, Thailand recently reaffirmed its ban on electronic nicotine delivery systems,” according to RSI.

RSI is a nonprofit, nonpartisan, public policy research organization. Its mission is to engage in policy research and outreach to promote free markets and limited, effective government.

However, RSI said the way the two countries approach novel tobacco products, including e-cigarettes, differed “significantly”.

“It is likely this differentiating factor that moved the smoking rates down in the United Kingdom,” the RSI policy study said.

RSI senior harm-reduction fellow Alec Ulasevich and former research fellow Chelsea Boyd found that adopting the UK model may help Thailand to reduce its cigarette smoking rates, leading to improvements in overall population health.

The two researchers noted the British approach to smoking cessation, which endorses harm reduction through the use of better alternatives to combustible cigarettes in contrast to the Thai policy of banning e-cigs and messaging against their use.

“The United Kingdom’s approach to cessation which endorses harm reduction through the use of safer alternatives to combustible cigarettes stands in contrast to the Thailand policy of banning e-cigarettes and messaging against their use. It is likely this differentiating factor that moved the smoking rates down in the United Kingdom,” said Ulasevich and Boyd.

They found that:

* tobacco-control efforts stalled in Thailand, seeing little decrease in the number of smokers of combustible cigarettes for a number of years, whereas the UK has seen a decline in the number of cigarette smokers;

* unlike the UK which acknowledges the role of e-cigs in overall tobacco-control strategies and affirms the health benefits of smokers switching to e-cigs, Thailand reaffirmed its ban on vapes; and,

* adopting the UK model may help Thailand to cut its cigarette smoking rates leading to improvements in overall population health.

Given all the above, it should be a walk in the park for Philippine health policymakers and food and drug regulators to decide which model to adopt.

Earlier, an alliance of consumer THR advocates in the Asia Pacific region has expressed its firm support to local vaping groups advocating for fair and reasonable regulation of e-cigs and HTPs in the country.

“Access to safer nicotine products such as e-cigarettes among adults who wish to use such products in lieu of combustible tobacco is a human right. We urge the Department of Health and Philippine Food and Drug Administration to acknowledge the scientific evidence supporting the reduced harm of electronic cigarettes and to not severely restrict their availability to adults based on outdated and scientifically flawed opinions,” according to a position paper released by the Coalition of Asia Pacific Tobacco Harm Reduction Advocates.

CAPHRA members include consumer organizations from Australia, Indonesia, Malaysia, New Zealand, the Philippines, and Thailand.

It called on government agencies and public health officials to accept peer-reviewed scientific studies on e-cigarettes and their effects on human health. “Public health officials have a mandated responsibility to provide evidence-based guidance on adult smokers’ access to such products so they can be informed of available harm-reduced options.”

Behold God’s glory and seek His mercy.

Pause and pray, people.