To breathe freely…

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As we all know tobacco smoke is a cause for concern. For those who smoke, it is most often a habit that they cannot or don’t want to get rid of. Many smokers pay no attention to the people around them and make it a habit of smoking in public places. While smoking is seriously harmful to one’s health, it can also badly affect those who are close by and those who are directly exposed to the smoke.

Through the phenomenon called second hand smoking or passive smoking, tobacco smoke has affected the lives of many who don’t smoke but have been exposed to smokers around them. Now with the introduction of a project by the National Authority on Tobacco and Alcohol (NATA) non-smokers can finally be free of second hand smoking and the serious harm caused to their health. 

In addressing this serious issue NATA Sri Lanka in partnership with the World Health Organisation (WHO) has initiated a project to implement 362 Smoke Free Zones (SFZs) in Sri Lanka in order to protect the general public from tobacco smoke.     

Chairman of NATA Dr. Samadhi Rajapaksa told Ceylon Today that he wanted to establish 362 Tobacco Free Zones around the country, where each Medical Officer of Health (MOH) area should have at least one Tobacco Free Zone.

“NATA has already initiated that and the Public Health Inspector (PHI) from the relevant area is in charge of this project with the supervision of the MOH of the relevant area. The Provincial Director Generals of the Health Services are very happy and keen on this and also the Regional Directors of Health Services (RDHS) because this is a joint project with NATA and the Ministry of Health, and WHO funded,” Dr. Rajapaksa explained.

Tobacco Free Zones

So, why should we entertain and encourage Tobacco Free Zones? “In a Tobacco Free Zone, vendors and boutiques cannot sell tobacco and tobacco-related products. So, mainly we are targeting smoking tobacco, such as cigarettes, beedi, and cigars among others. It should also include betel and other products which contains tobacco. If the vendors are not selling the people cannot buy it in a particular area,” Dr. Rajapaksa revealed the basic idea behind Tobacco Free Zones.

For example, people who live in this area do not smoke and the risk of being exposed to second hand smoking is absolutely zero. “Second hand smoking or passive smoking is dangerous and is the same as active smoking. There is no difference. So, if a father smokes inside or around the house, then the wife or mother and the children, elderly people, everybody gets exposed to second hand smoking, which has the same effect like active smoking,” Dr. Rajapaksa explained.

He went on to say that in Sri Lanka overall tobacco prevalence has decreased or reduced up to 9.1 per cent and in 2019 it was 15 per cent according to the Global Adult Tobacco Survey. “This is amazing. There are only very few countries in the world that achieve this much. Sri Lanka is doing very well on tobacco control. There is a Sri Lankan report which says about second hand smoking. In Sri Lanka it is mostly the male population that is smoking. The female population is hardly smoking. But there are some key factors,” Dr. Rajapaksa said.

Women and girls are targeted through tobacco industry advertisements with associated smoking with gender equality, female empowerment and liberation, and stress relief and weight loss, he said, adding that these are the targets of the tobacco industry. “The tobacco industry in Sri Lanka hires young women to do promotion of their brands – a part of their strategy to undermine tobacco against women using tobacco in the country where only 0.04 per cent of women smoke in Sri Lanka. Young women are paid by the tobacco industry and they go in front of international schools, universities shopping malls and smoke to glamourize and normalise the tobacco smoking among females,” Dr. Rajapaksa explained.

Second hand smoke

According to Dr. Rajapaksa, tobacco use and exposure to second hand smoke is harmful for pregnant women and increase the risk of low birth rate and other health issues. “Over 60 per cent of Sri Lankan pregnant women report daily exposure to tobacco smoke. Among the 60 per cent of those exposed daily, 59 per cent are exposed to smoking because their husbands smoke inside the house. During pregnancy males are under stress because they have no sexual life, so they are smoking. This is a very bad situation. That is why we are creating these Tobacco Free Zones where you will not be exposed to tobacco smoke, especially children,” Dr. Rajapaksa explained.

He also said that our teenagers are in a very vulnerable age group. “When the father smokes the young teens imitate how the father smokes. Peer pressure is also a cause. During a study it was revealed that children smoke because their parents smoke or they are in a smoking area. When we create Tobacco Free Zones that atmosphere is not there. Elderly persons won’t smoke because they are prohibited from smoking. So we can protect the children. The PHIs are very keen and have taken the initiative,” Dr. Rajapaksa said.

We are going to do an audit, he said, after one year on these Tobacco Free Zones. “This is not only a health issue, it also is an economic issue. Giving up smoking helps to save money and improve social wellbeing. When these bad habits go away they will live a good life in happy villages. As a country we are leading in this concept and other countries are taking examples from us. Some countries are surprised that we have Tobacco Free Zones because this is not an easy task. First you have to create the awareness so they know what the health issues are,” Dr. Rajapaksa explained.

He went on to say the programme was initiated in May 2022 in commemoration of World Tobacco Day 2022. “I walked around and covered almost every district. We had lots of awareness programmes with PHI officers. From Jaffna to Matara and from Batticaloa to Puttalam everywhere throughout the country we have covered. The sacred City of Anuradhapura was declared a Tobacco Free Zone. The Mihintale area was declared as a Tobacco Free Zone to commemorate Poson. We are hoping to declare other religious places as well such as Kataragama, the Nallur Temple, and the Madu Church. From time to time we will declare areas as Tobacco Free Zones,” Dr. Rajapaksa said.

Bad for health and economy

Some areas are small and some are big and in the future we can expand it, he says, adding that when Tobacco Free Zones are declared the people can protect those areas and can help to expand it as well. “Many people understand that this is bad not only for their health but for the economy as well. For their social life tobacco is very bad. Religious leaders, Principals, the Police and Government officers are very supportive of this programme. A big majority is in support of this programme including the media. So many articles are published voluntarily by the media in support of this as one of their responsibilities. Our vision is a Tobacco Free Sri Lanka. So, we can go in that direction with this great initiative,” Dr. Rajapaksa explained.          

Convener of Biodiversity Conservation and Research Circle of Sri Lanka and Researcher on Smoke Free Zones Supun Lahiru Prakash has introduced a 10-step process for establishing Smoke Free Zones in Sri the Lankan context.

“Exposure to second hand tobacco smoke is a serious threat to the health of the general public, causing death and disease in non-smoking adults and children. It is a mixture of two forms of smoke produced from burning tobacco products such as cigarettes, cigars, or pipes, and smoke that has been exhaled, or breathed out, by the person smoking. Second hand smoke can persist indoors at potentially harmful levels for long periods after smoking even one cigarette. There is no safe level of exposure identified to second hand smoke,” Prakash said.

He said in adults, second hand smoke causes serious cardiovascular and respiratory diseases such as coronary heart disease, lung cancer, and stroke and in addition, it causes low birth weight in pregnant women and sudden death in infants. “At least half of the children regularly breathe the air, polluted from tobacco smoke in public settings. Ear infections, more frequent and severe asthma attacks, respiratory symptoms (coughing, sneezing, and shortness of breath) and respiratory infections (bronchitis and pneumonia) are some of the health issues caused by second hand smoke to children,” Prakash explained.

Premature deaths per annum

He added that second hand smoke causes about 890,000 premature deaths per annum and children accounted for 28 per cent of the deaths attributed to second hand smoke in 2004. “Therefore, eliminating smoking at all homes, worksites, and public places is essential in order to fully protect non-smokers from second hand smoke. There are different strategies employed in combating tobacco-related health issues all over the world. The World Health Organisation Framework Convention for Tobacco Control (WHO-FCTC) promotes smoke-free cities as an effective tobacco control strategy,” Prakash said.

Sri Lanka was the fifth country in the South-east Asian Region to sign the FCTC, he said, and the first country in the region to ratify it. “According to the guidance of WHO-FCTC, National Authority on Tobacco and Alcohol Act, No. 27 of 2006 was enacted in Sri Lanka, supporting preventive measures regarding alcohol and tobacco use. In Sri Lanka, while the overall smoking prevalence has shown a downward trend, second hand smoke exposure at home remains a significant problem, despite the recent laws enacted to prohibit smoking in public places,” Prakash explained.

He said women and children are highly vulnerable and it is they who inevitably breathe in second hand smoke due to the high prevalence of male household members who use tobacco. “The NATA of Sri Lanka has taken the initiative in carrying out a national programme for establishing SFZs for combating second hand smoke with the help of PHIs who are the main coordinators at the grass root level in 2015. During 2015 to November 2019, there were 253 SFZs established in 102 MOH divisions in 20 districts of nine provinces,” Prakash said.

He went on to say this is the highest number of SFZs established in 2018 which was 95, followed by 63 SFZs in 2019, 55 SFZs in 2016, and 35 SFZs in 2017. “96 per cent of SFZs were sustained up to the end of 2019. However, the attention given by the PHIs was lost due to the COVID-19 pandemic. The attempt to establish SFZs in the island again by the NATA should be very much appreciated,” Prakash said.

(Pix courtesy NATA)

By Risidra Mendis