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Sanaysay Tungkol sa Nationwide Smoking Ban

Hindi dahil sa amoy nito o sa dating ng taong gumagamit, ngunit dahil sa nakababahalang epekto nito sa ating kalusugan — gumagamit ka man nito o hindi.

Napapanahon na ang nationwide smoking ban sapagkat lalong tumataas ang bilang ng mga Pilipinong nasasawi dahil sa mga sakit na may kinalaman sa baga, at ang isa sa mga sanhi nito ay ang sigarilyo.

Ang itinuturong dahilan, ang paninigarilyo. Dahil hindi agad nakikita ang komplikasyon ng paninigarilyo tulad ng unti-unting pagkasira ng baga, ay hindi naaagapan ang gamutan sa mga tinatamaan ng komplikasyon.

Kaya naman kung nais nating mapababa ang problema sa mga sakit na may kinalaman sa baga, dapat nang ipatupad ang nationwide smoking ban bago mas maraming baga pa ang maupos na parang sigarilyo.

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Sapat at epektibo nga ba ang mga smoking ban?

( Original article in English  by Mikael Angelo Francisco; translation by Pearl Uy)  Iba’t ibang stratehiya na ang naisagawa upang tulungan ang mga naninigarilyong huminto sa kanilang bisyo — kabilang na rito ang pag-usbong ng e-cigarettes, na pinangangambahan ng mga ekspertong magdadala ng panibagong krisis pangkalusugan — ngunit ang pinakatinding aksyong isinakatuparan ng maraming mga pamahalaan sa buong mundo ay ang pagbabawal ng paninigarilyo sa mga pampublikong lugar.

Hindi na bago ang ideya ng pagbabawal ng paninigarilyo sa Pilipinas. Sa katunayan, ang Tobacco Regulation Act of 2003 ay ipinagbabawal ang paninigarilyo sa mga pampublikong lugar. Kabilang dito ang mga paaralan, ospital, opisinang pampamahalaan, at pampublikong terminal. Maliban dito, nilagdaan ni Pangulong Rodrigo Duterte — isang maninigarilyo rin noon — ang Executive Order No. 26 noong Mayo 16, 2017, kung saan isinusulong ang pagtaguyod ng “smoke-free environments in public and enclosed places” sa pamamagitan ng pagkakaroon ng mga DSA (designated smoking area) para sa mga naninigarilyo. Kadalasang matatagpuan ang mga DSA sa mga bar, nightclub, iilang opisina, at pampublikong sasakyang pangtubig.

Sa kasalukuyan, isinusulong sa kongreso ang isang panukala na naglalayong palawakin ang nasasakupang batas ng Tobacco Regulation Act of 2003 sa pamamagitan ng pagpapalawak ng sakop nito sa lahat ng klase ng indoor public smoking. Ang tanong: Tunay nga bang epektibo ang smoking ban? Napipigilan nga ba talaga nito ang patuloy na paninigarilyo ng karamihan? At higit sa lahat, sapat na ba ito upang mabigyang-solusyon ang malawakang suliranin sa paninigarilyo?

Paninigarilyo sa bansa

Sa kabila ng samu’t saring aksyong inilapat ng mga mambabatas ng bansa upang solusyonan ang problema sa tabako, nananatiling mataas ang porsyento ng mga gumagamit nito.

Ayon sa isang istatistika mula noong 2015, mahigit ¼ ng populasyon ng mga Pilipino edad 15 pataas ang gumagamit ng produktong tabako; 40% nito ay kalalakihan, habang 5% ay kababaihan. Sa kabilang banda, ipinapakita sa isang pag-aaral mula noong 2017 na 16% ng mga Pilipino edad 13 hanggang 15 ang gumagamit ng produktong tabako, habang 12% ay gumagamit ng sigarilyo.

Ayon naman isang pagsusuri mula noong 2020, sanhi ng pagkamatay ng halos 110,000 Pilipino kada taon ang mga sakit mula sa paggamit ng tabako. Ang patuloy na paggamit ng tabako ay sinasabing nagdulot sa higit 23% na pagkamatay ng mga kalalakihan, habang 12% naman ay para sa kababaihan. Ang usok naman na nagmumula sa tabako — kabilang ang secondhand smoke — ang sinsabing dahilan ng 21.8% na kabuuang bilang ng pagkamatay ng kalalakihan, at 9.7% sa kababaihan.

Sa kaparehong taon na naaprubahan ang Tobacco Regulation Act, nilagdaan ng bansa ang Framework Convention on Tobacco Control ng World Health Organization (WHO), ang kauna-unahang kasunduan ukol sa pampublikong kalusugan. Lumagda ang 167 iba pang mga bansa upang itaguyod ang “common goals” ukol sa regulasyon ng tabako, pagtataguyod ng “minimum standards for tobacco control policy”, pagsusulong ng mga bagong batas upang puksain ang passive smoking sa mga pampublikong lugar, transportasyon, at opisina, at lutasin ang problema sa patuloy na pagpuslit ng tabako at iba pang “cross-border challenges” na kinabibilangan ng mga ito.

Suliranin ng lahat

Halos isang siglo na ang nakalipas nang nagsimula ang usapin tungkol sa panganib na dulot ng paninigarilyo ng tabako, ngunit nananatili pa rin itong isang pandaigdigang suliranin. Isang halimbawa na nito ang nangyari noong taong 1898, kung saan si Hermann Rottman, isang estudyanteng nag-aaral ng medisina, ang nagmungkahi na maaaring magdulot ng kanser sa baga ang tabako batay sa biglaang pagdami ng bilang ng mga trabahador sa mga pabrika ng tabako na nagkaroon ng tumor sa baga.

Subalit, mali ang ideya ni Rottman na alikabok mula sa tabako ang sanhi ng kanilang pagkakasakit. Paglipas ng labing-apat na taon, naitama rin ito ng isang Amerikanong doktor matapos pag-aralan ang matinding pagtaas ng bilang ng may kanser sa baga. Gayunpaman, ipinahayag pa rin nito ang pangangailangan sa higit na malalim na pananaliksik, at ipinahiwatig na maaaring ang pagsabay sa paninigarilyo ng labis na pag-inom ang maaaring magdulot nito. Sa sumunod na dekada, nagkaroon din ng samu’t saring paliwanag ang ibang mga eksperto sa maaaring magdulot ng sakit sa basa, kabilang ang polusyon sa hangin at alikabok mula sa aspalto. Sa paglipas ng panahon, naging malinaw na paggamit ng tabako ang pinakamatinding nagdudulot ng sakit sa baga.

Ayon sa WHO, hindi kinakailangang manigarilyo ng tabako upang magkasakit o mamatay dahil dito. Batay sa kanilang pag-aaral, mahigit-kumulang 600,000 sa anim na milyong kaso ng pagkamatay na may kaugnayan sa tabako ay dahil sa secondhand o passive smoking.

Bukod sa hindi kaaya-aya ang pagsinghot ng usok mula sa paninigarilyo, delikado rin ito. Ang mga carcinogenic (cancer-causing) compound katulad ng formaldehyde, toluene, at vinyl chloride ay ilan lamang sa 7,000 nakamamatay na kemikal na maaaring magmula sa sigarilyo sa oras na sindihan ito ng tao. May mga katibayang nagtuturo sa secondhand smoke inhalation bilang pangunahing salik sa pagpapataas ng posyentong ang isang tao’y magkaroon ng brain tumor, heart disease, stroke, at iba’t ibang uri ng kanser.

Kasaysayan ng mga smoking ban

Bago pa man naipalaganap ang impormasyon tungkol sa pinsalang maaaring maidulot ng paggamit ng tabako ay mayroon nang mga smoking ban. Ayon sa iba’t ibang pag-aaral, ipinagbabawal na ang paninigarilyo mula noong ika-16 at ika-17 na siglo pa lamang. Pinagbawalan ng mga simbahan sa Mexico ang mga pari na manigarilyo noong 1575, habang idineklara naman ng Japan na iligal ang paggamit ng tabako 45 na taon makalipas nito. Sa kabilang banda, higit na naging marahas ang patakaran ng mga lider ng Tsina noong 1600, kung saan maaari nilang pugutan ng ulo ang mga mahuhuling nagtitinda o gumagamit ng tabako.

Partikular na bocal sa pagbatikos ng paggamit ng tabako si King James I mula sa Inglatera. Bukod sa pagpapataw ng napakataas na buwis dito, sinulat niya ang mga sumusunod sa kaniyang treatise na pinamagatang “A Counterblaste to Tobacco” noong 1604:

“Ang paninigarilyo ng tabako ay hindi kaaya-aya, masangsang sa ilong, masama para sa pag-iisip, at delikado para sa baga. Katulad ito ng kilabot na hatid ng napakaitim na usok na tila mula sa walang-hanggang bangin.” ( “[Smoking tobacco is] a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless.” )

Sa Estados Unidos, ipinasa ang isang batas sa Massachusetts noong 1632 na nagbabawal ng paninigarilyo sa mga pampublikong lugar. Sa paglipas ng panahon, napabilang ang California at New York sa mga mga estadong nagpataw ng mahigpit na mga regulasyon ukol sa paninigarilyo sa pampublikong mga lugar.

Pagdating ng ika-20 na siglo, kung saan higit na kapansin-pansin ang peligro na dulot ng paninigarilyo, pati ang mga Nazi ay umaksyon na rin. Mula sa unang mga bahagi ng 1930s patungo sa gitnang bahagi ng 1940s, mahigpit na ipinagbawal ng mga puwersa ni Adolf Hitler ang pag-aalok ng tabako at paninigarilyo sa pampublikong lugar. Nagbigay din ang mga ito ng malaking pondo para sa pagsasaliksik upang mas mapag-aralan ang kaugnayan ng paggamit ng tabako at kanser sa baga. Gayunpaman, kinakailangang maintindihan na ang nagtulak sa inisyatibong ito ng mga Nazi ay hindi kawanggawa, kundi para mapanatili ang diumano’y “racial and bodily purity” ng tinagurian nilang “Aryan race” na lubos nilang pinahalagahan.

Sa kabila ng pagdami ng mga siyentipikong ebidensya na nagtuturo sa paninigarilyo bilang sanhi ng mga nakamamatay na sakit — kabilang ang isang 1964 na report mula sa U.S. Surgeon General, na kauna-unahang nakapagpakita ng malinaw na koneksyon sa pagitan ng kanser sa baga at paninigarilyo — patuloy pa rin ang mamamayan sa paninigarilyo. Sa katunayan, umabot sa 635.1 bilyong piraso ng sigarilyo ang naibenta noong 1980, kahit na noong mga panahong iyo’y nagsimula nang lumaganap ang anti-smoking movement.

Kanya-kanyang diskarte ang iba’t ibang bansa sa pagbabawal ng paninigarilyo upang tuluyang wakasan ang pinsalang hatid nito. Lumikha ng kasaysayan ang Ireland noong Marso 29, 2004, sapagkat sila ang unang bansang tuluyang ipinagbawal ang paninigarilyo sa mga pampublikong lugar. Matapos ang isang taon, ang Bhutan naman ang naging kauna-unahang bansang tuluyang ipinagbawal ang paninigarilyo.

Tunay nga bang epektibo ang mga smoking ban?

Maraming siyentipikong ebidensya ang nagpapatunay na epektibo ang pagbabawal ng paninigarilyo, lalo sa mga opisina at paaralan.

Isang sarbey mula sa 1999 na kinabibilangan ng “nationally representative sample” ng 97,882 mga manggagawang “indoor” mula sa Estados Unidos ang nagpakita na nabawasan ng anim na porsyento ang paninigarilyo sa mga opisinang tuluyang ipinagbawal ang paninigarilyo. Dagdag pa rito, bumaba din ng 14% ang araw-araw na paninigarilyo ng mga taong nagtatrabaho. Sa kabila nito, mapapansin din ang pagbaba ng epekto nito sa mga opisinang nagtalaga ng lugar kung saan maaaring manigarilyo. Sa kabuuan, natuklasan ng mga mananaliksik na nakatutulong ang mga polisiya sa pagbabawal ng paninigarilyo sa halos lahat ng industriya, at iminungkahing magreresulta sa pagbaba ng 10% ng patuloy na paninigarilyo kung tuluyan itong ipagbabawal sa mga opisina.

Isang pagsasaliksik din mula 2011 na inilathala sa pahayagang Preventive Medicine ang nagpakita na epektibo ang pagbabawal ng paninigarilyo sa mga paaralan upang mabawasan ang paninigarilyo ng mga estudyante. Sa loob ng dalawang taon, ikinumpara ng mga may-akda ng pananaliksik ang mga pag-uugali ng mga estudyante mula sa dalawang paaralan: isang may “campus-wide smoke-free air policy,” at isang wala nito. Natuklasan nilang tunay na naapektuhan ng pagbabawal sa paninigarilyo ang mga pananaw at aksyon ng mga mag-aaral ukol dito; higit nilang naunawaan ang maaaring maging masamang epekto ng paninigarilyo, na naghikayat sa kanilang layuan ang bisyong ito.

Nagbunga din ng mga positibong resulta ang pagbabawal ng paninigarilyo sa loob ng mga kabahayan, batay sa mga natuklasang sa isang pag-aaral noong 2013 mula sa University of California, San Diego School of Medicine na sinuri ang 1,718 naninigarilyo sa California. Ipinaliwanag ng may-akda ng pag-aaral na si Dr. Wael K. Al-Delaimy na:

“Kapag tuluyang ipinagbawal ang paninigarilyo sa loob ng mga kabahayan, natuklasan naming higit na nababawasan ang paggamit ng tabako at nahihikayat ang mga maninigarilyong huminto, kumpara sa kung hahayaan silang manigarilyo sa iilang parte ng kanilang mga bahay.” (“When there’s a total smoking ban in the home, we found that smokers are more likely to reduce tobacco consumption and attempt to quit than when they’re allowed to smoke in some parts of the house.”)

Naobserbahan ni Al-Delaimy at ng kanyang mga kapwa may-akda ang kaparehong kaugalian ng mga naninigarilyo sa mga lugar na ipinagbawal din ang paninigarilyo. Epektibo umano sa pagpapabago ng ugali sa paninigarilyo ng mga kababaihan at mga may edad 65 pataas ang tuluyang pagbabawal ng paninigarilyo sa mga kabahayan, habang mapapansin din ang pagbaba ng paninigarilyo ng mga kalalakihan sa mga lungsod na nagsagawa ng mga city-wide smoking ban.

Sa isang pagsusuri noong 2016 ng 77 pag-aaral tungkol sa mga smoking ban, napagtuklasan ng mga mananaliksik na may mabisang ebidensyang nagpatunay na bumaba ang mga kaso ng nagkaroon ng sakit sa puso at namatay dulot ng mga sakit galing sa paninigarilyo. Dagdag pa rito, higit na bumaba ang mga dinala sa ospital dahil sa sakit sa puso sa mga populasyong kinabibilangan ng mga hindi naninigarilyo. Bumaba din ang bilang ng mga buntis na naninigarilyo, na nagresulta naman sa pagbaba ng secondhand smoke exposure para sa mga bata. Ayon din sa lima sa anim na pag-aaral, may kinalaman ang pagbaba ng mga pasyenteng dinala sa ospital dahil sa stroke sa pagbabawal ng paninigarilyo.

Panghuli, napag-alaman din mula sa samu’t saring pag-aaral ng mga mananaliksik mula sa United Kingdom na bumaba hanggang 93% ang lebel ng polusyon sa hangin noong 2007 sa mga bansang nagsagawa ng pagbabawal ng paninigarilyo sa mga pampublikong lugar, opisina, at mga sasakyang ginagamit sa trabaho. Higit ding bumaba ang bilang ng mga pasyenteng inatake sa puso at dinala sa ospital. Bumaba rin noong 2010 ang bilang ng mga bata sa Scotland na dinala sa ospital dulot ng asthma, na siyang pumigil sa patuloy na pagtaas ng mga kaso nito bago ang smoking ban.

Sapat ba ang pagkakaroon ng mas mahigpit na pagbabawal sa paninigarilyo?

Ayon sa Executive Order (EO) ni Duterte mula 2017, may mahigpit na parusa at mataas na multa sa mga magtatangkang manigarilyo sa mga lugar na hindi ng designated smoking areas (kabilang ang mga paaralan, recreational facilities, ospital, clinic, at kainan): maaaring magbayad ng 10,000 piso at makulong ng hanggang apat na buwan ang mga mahuhuli. Ayon sa mga pag-uulat, hindi nagtagal at nabago ang kaugalian ng mga mahilig manigarilyo sa mga pampublikong lugar. Ibinalita ng ilang mga news outlet na kapansin-pansin ang pagbaba ng bilang ng mga ito anim na buwan matapos ipahayag ang EO ng pangulo.

Gayunpaman, sa isang bansang may 16.5 milyong gumagamit ng tabako (mula sa data noong 2015), hindi sapat ang pagkakaroon lamang ng mas mahigpit na pagbabawal sa paninigarilyo upang bigyang-solusyon ang kasalukuyang problema sa tabako.

Sa isang panayam noong 2017, ibinahagi ni Dr. Glynna Ong-Cabrera, direktor ng Smoking Cessation sa Lung Center of the Philippines, ang ilang paraan upang tuluyang huminto sa bisyo ang mga naninigarilyo. Bukod sa pagbibigay ng malinaw na rason at pagtatakda ng araw na kinakailangang nilang huminto, nakatutulong din umano ang pagkakaroon ng kapamilya’t kaibigan na maaari nilang kausapin sa oras na makaramdam sila na gusto nilang manigarilyo muli.

“Nakikita ko ang paninigarilyo bilang paunang problema lamang. May higit na matinding problema [kung bakit naninigarilyo ang mga tao].” ( “I see smoking as the tip of the iceberg. There’s an underlying problem [as to why people smoke].” )

Bagama’t sinusuportahan ng siyensya ang pagiging epektibo ng mga smoking ban, mahalagang alalahanin din na higit sa lahat, ang pagnanais ng mga maninigarilyo na tigilan ang masamang bisyo ang pinakamahalaga, magsagawa man ng pagbabawal dito o hindi.

Parte ang istoryang ito sa Cycle 5 ng “Nagbabagang Kuwento: Covering a Smoke-Free PH Media Fellowship” mula sa Probe Media Foundation Inc. (PMFI) at Campaign for Tobacco-Free Kids (CFTK). Ang mga pananaw at opinyon mababasa sa istoryang ito ay maaaring hindi mula sa kabuuan ng PMFI at CTFK.

• https://asia.nikkei.com/Politics/Duterte-s-smoking-ban-proves-a-success-in-Manila
• https://doh.gov.ph/Tobacco-Control-Key-facts-and-Figures
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• https://www.evidentlycochrane.net/national-smoking-bans-are-good-for-your-health/
• https://www.flipscience.ph/health/philippines-science-evidence-based-vaping-regulations/
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Philippines implements nationwide smoking ban in public areas from Sunday

MANILA (THE PHILIPPINE DAILY INQUIRER/ASIA NEWS NETWORK) - The nationwide smoking ban in public areas in the Philippines went into effect on Sunday (July 23).

Smoking is prohibited in public spaces such as schools, recreational facilities, elevators, stairwells, areas with fire hazards, hospitals, clinics and food preparation areas.

"This Executive Order is another milestone where the government gives priority to the right to protect public health," Philippine presidential spokesman Ernesto Abella said in a press statement.

Executive Order (EO) No. 26, or the nationwide smoking ban in public areas, was signed by President Rodrigo Duterte on May 16.

"The implementation of this EO is a realisation of our dream of a tobacco-free future," the spokesman said.

"Together, let us give our full cooperation and support to the smoke-free establishments in public and enclosed places."

Health Secretary Pauline Ubial said, in a statement on July 17, that the local government units would take the lead in enforcing the nationwide smoking ban, and should form their respective smoke-free task force.

Under the new ban, designated smoking areas will be provided, which will be open and separate spaces with proper ventilation.

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Duterte Orders Strict Smoking Ban in Philippines, and Asks Citizens to Help

By Felipe Villamor

• May 18, 2017

MANILA — President Rodrigo Duterte, who has overseen a deadly campaign to eradicate drug use in the Philippines, has now ordered a strict public ban on smoking and called on citizens to help the local authorities apprehend smokers.

The executive order, signed this week and made public on Thursday, forbids the use of tobacco, including electronic cigarettes, in all public spaces, even sidewalks. It also prohibits anyone under 18 from “using, selling or buying cigarettes or tobacco products.”

More than a quarter of Filipinos smoke, according to a 2015 World Health Organization report , including 11 percent of minors.

The nationwide measure, known as Executive Order 26, is similar to the near universal smoking ban Mr. Duterte put in place in Davao City in 2002, when he was the city’s mayor. A former smoker, Mr. Duterte quit cigarettes and drinking decades ago , when he was found to have two rare conditions, Barrett’s esophagus and Buerger’s disease.

According to the new order, tobacco cannot be sold within 100 meters, or about 330 feet, of schools, playgrounds or anywhere children might gather. Municipalities must also designate smoking areas that are far from these places, and away from elevators, stairwells, gas stations, health centers and wherever food is prepared. “No smoking” signs are to be posted in all public places.

The order also called on civilians to join a “Smoke Free Task Force to help carry out the provisions of this order” and apprehend and charge violators.

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Addressing the tobacco epidemic in the Philippines: progress since ratification of the WHO FCTC

1 International Union Against Tuberculosis and Lung Disease, Edinburgh Office,  Edinburgh, United Kingdom

2 Republic of the Philippines Department of Health, Manila, The Philippines

3 Framework Convention on Tobacco Control Alliance Philippines, Manila, The Philippines

4 Metropolitan Manila Development Authority, Manila, The Philippines

F. Trinidad

5 World Health Organization–Western Pacific Region, Manila, The Philippines

U. Dorotheo

6 South-East Asia Tobacco Control Alliance, Bangkok, Thailand

R. Yapchiongco

7 World Lung Foundation, New York, New York, USA

Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.

L’emploi de tabac est la principale cause évitable de décès et on estime qu’il tue chaque année plus de 5 millions de personnes au niveau mondial. L’utilisation de tabac et l’exposition à la fumée secondaire posent un problème majeur de santé publique aux Philippines. Les politiques efficientes de lutte contre le tabagisme sont garanties dans la Convention Cadre de Lutte contre la Tabagisme (FCTC) de l’Organisation Mondiale de la Santé (OMS), un traité international d’application légale obligatoire qui a été ratifié par les Philippines en 2005. Depuis 2007, Bloomberg Philanthropies a soutenu l’accélération de la réduction de l’utilisation de tabac dans beaucoup de pays, notamment les Philippines. On discute les progrès observés aux Philippines en insistant particulièrement sur la période faisant suite à la ratification de la FCTC de l’OMS et en se focalisant particulièrement sur le programme de dons financé par l’Initiative Bloomberg. En dépit de progrès significatifs, on identifie des défis majeurs auxquels il faut répondre à l’avenir, si l’on veut alléger le fardeau social économique et sanitaire provenant de l’épidémie de tabagisme.

El consumo de tabaco representa la principal causa prevenible de mortalidad y se calcula que provoca la muerte de más de 5 millones de personas cada año en todo el mundo. El tabaquismo y la exposición pasiva al humo del tabaco plantean un problema mayor de salud pública en las Filipinas. El Convenio Marco para el Control del Tabaco (FCTC) de la Organización Mundial de la Salud (OMS) consagra las políticas eficaces de control del tabaquismo; este tratado internacional jurídicamente vinculante fue ratificado por las Filipinas en el 2005. Desde el 2007, la iniciativa Bloomberg Philanthropies ha apoyado una disminución acelerada del tabaquismo en muchos países, incluidas las Filipinas. En el presente artículo se examinan los progresos alcanzados en este país, con especial interés en el período posterior a la ratificación del FCTC de la OMS y se hace hincapié en el programa de subsidios financiado por la Iniciativa Bloomberg. Pese a los considerables progresos alcanzados, se destacan retos importantes que exigen una respuesta en el futuro, si se busca aliviar la carga social, sanitaria y económica que representa la epidemia de tabaquismo.

Non-communicable diseases (NCDs) pose one of the main health challenges of the twenty-first century; of the estimated 57 million global deaths in 2008, 36 million (63%) were due to NCDs. 1 From the Global Burden of Disease projections, an estimated 2.6 million people died from NCDs in the 10 Association of South-East Asian Nations (ASEAN) countries, and the mortality rate adjusted to age per 100 000 population is high in low-income countries. 2 , 3 The largest proportion of NCD deaths is caused by cardiovascular disease (48%), followed by cancers (21%) and chronic respiratory diseases (12%).

Tobacco use is an important behavioural risk factor that is responsible for 12% of male deaths and 6% of female deaths in the world. 4 Exposure to second-hand smoke (SHS) is estimated to cause more than 600 000 premature deaths annually. These include 166 000 deaths from lower respiratory infections, 35 800 from asthma (1100 from asthma in children), 21 000 from lung cancer and 379 000 from ischaemic heart disease in adults. This disease burden amounts in total to about 10.9 million disability-adjusted life years. Of all deaths attributable to SHS, 28% occur in children and 47% in women. 5 Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million people each year worldwide; if current trends persist, tobacco will kill more than 8 million people worldwide each year by the year 2030, with 80% of these premature deaths in low- and middle-income countries. 6 , 7 In the Philippines, tobacco kills at least 87 600 Filipinos per year (240 deaths every day); one third of these are men in the most productive age of their lives. 8

The most effective tobacco control policies are contained in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), 9 which is the first global health treaty, and encapsulated in the corresponding MPOWER policy package. 10 In the Philippines, the FCTC was ratified in 2005 by the Senate and signed by the President, i.e., the ratification itself went through a legislative process. Parties to this legally binding international treaty must enact new laws or amend existing ones so that they are consistent with the FCTC. Progress in implementation of the FCTC is monitored and reported by the WHO. 6 , 7 , 11 The South-East Asia Tobacco Control Alliance also publishes reports on FCTC implementation ( http://www.seatca.org/ ). Since 2007, Bloomberg Philanthropies has supported the implementation of proven policies to accelerate the reduction of tobacco use worldwide; as of 2012, the total commitment confirmed under this initiative is more than US$600 million; 12 the Philippines has received some US$5 million through grants to government and civil society under this initiative. 13 Discussion in the peer-reviewed literature of tobacco control and related issues specifically with respect to the Philippines has been limited to date, with some noteworthy exceptions. 14 – 23 This article provides an overview of progress in the country since the 2005 ratification of the WHO FCTC to the end of 2012, and provides a particular focus on the grants programme funded under the Bloomberg Initiative.

TOBACCO USE IN THE PHILIPPINES

The Philippines is the world’s twelfth most popu-lous country, with projected population estimates of 101.8 million by 2015 and over 132.5 million by 2040. 24 Total health expenditure per capita is estimated at US$66. 1 The tobacco industry in the country has been described as ‘the strongest tobacco lobby in Asia’. 20 The Philippines has one of the highest per capita levels of cigarette consumption among the ASEAN countries, well above the ASEAN average (873 cigarettes). 25 Tobacco use, exposure to SHS and pervasive marketing of tobacco products pose a major public health problem in the country, according to recent data: 26 , 27

• 28.3% (17.3 million Filipinos) of the adult population currently smoke (males 47.6%, females 9.0%);
• 48.8% (29.8 million Filipinos) allow smoking in their homes;
• 36.9% of adult workers report exposure to tobacco smoke in enclosed areas at their workplace in the past month;
• exposure to SHS was 55.3% in public transport, 33.6% in restaurants, 25.5% in government buildings and 7.6% in health care facilities; and
• 96.2% of smokers bought their last cigarettes in a store and 53.7% of adults said they had noticed cigarette marketing in stores where cigarettes are sold.

PROGRESS IN TOBACCO CONTROL IN THE PHILIPPINES

The Philippines started to implement tobacco control efforts in 1987 and has intensified them over time. Since then, despite the strong lobbying of the tobacco industry, the country has successfully passed the Republic Act 9211 (Tobacco Regulation Act of 2003); despite several shortcomings, this Act was designed to promote a healthy environment and protect citizens from the hazards of tobacco smoke, inform the public of the health risks associated with cigarette smoking and tobacco use, regulate and subsequently ban all tobacco advertisement and sponsorships, except at point of sale, regulate labelling of tobacco products, and protect young people from being initiated to cigarette smoking and tobacco use through access restrictions.

The country ratified the WHO FCTC in 2005. 8 In 2009, the WHO Regional Office for the Western Pacific released a Regional Action Plan (RAP) for the Tobacco Free Initiative in the Western Pacific. The RAP had four overall indicators to be achieved by 2014: 1) all countries to have developed a national action plan and national coordinating mechanism, 2) all parties in the Region to have ratified all WHO FCTC protocols, 3) reliable data on adult and youth tobacco use to be available in all countries, and 4) the prevalence of adult and youth current tobacco use (smoking and smokeless) to be reduced by 10% from the most recent base-line. The RAP set out specific actions for countries and suggested country-level indicators; it was and remains an important influence on tobacco control activities within countries in the Region, including the Philippines. 28

The Bloomberg Initiative to Reduce Tobacco Use was designed to accelerate the reduction of tobacco use worldwide through the implementation in particular of WHO FCTC/MPOWER strategies. One important stream of investment under this initiative is the Grants Program, which is jointly managed on behalf of Bloomberg Philanthropies by the International Union Against Tuberculosis and Lung Disease (The Union) and the Campaign for Tobacco-Free Kids. Details about grants awarded, on the publicly available Program website, indicate that for the funding period commencing July 2007 and ending June 2014, some 23 grants were awarded to both non-governmental and governmental organisations in the Philippines, with a total investment in excess of US$4.9 million. 13 The key historical progression points of tobacco control in the country are illustrated in Figure 1 .

Philippines tobacco control timeline, 1987–2012. Adapted from the WHO Joint National Capacity Assessment Report. 8 DOH = Department of Health; WHO = World Health Organization; FCTC = Framework Convention on Tobacco Control; LTFRB = Land Transportation Franchising and Regulatory Board; PUVs = public utility vehicles; FDA = Food and Drug Administration; CSC = Civil Service Commission; JMC = Joint Memorandum Circular; NTCCO = National Tobacco Control Coordinating Office; NTCS = National Tobacco Control Strategy.

In mid-2011, a group of national, international and WHO health experts, in collaboration with a team from the Republic of the Philippines Department of Health (DOH), assessed the country’s tobacco control efforts in implementing the WHO FCTC. The assessment considered existing tobacco epidemiological data, as well as the status and present development efforts of key tobacco control measures undertaken by the government in collaboration with other sectors. The report of this Joint National Capacity Assessment on the Implementation of Effective Tobacco Control Policies identified some of the key achievements as well as significant challenges to the continued progress of tobacco control in the country. 8 Figure 1 , showing the Philippines tobacco control timeline 1987–2012, is adapted from the report of the Joint National Capacity Assessment. Points of progress since FCTC ratification include the 2009 Food and Drug Administration (FDA) law RA9711, which allowed for the FDA to regulate tobacco and tobacco products; the 2010 issuance of CSC-DOH No. 2010-01 ( Joint Memorandum Circular Civil Service Commission [CSC] and DOH, which promulgates the policy on protection of the bureaucracy from tobacco industry interference, covering all national and local government officials and employees); the 2011 issuance of DOH DO (Department Order) 2011–0029, which established the National Tobacco Control Coordinating Office (NTCCO) within the DOH, and the 2012 launch of the Philippines first National Tobacco Control Strategy (NTCS).

The achievements and challenges of tobacco control in the Philippines from the perspective of Joint National Capacity Assessment are presented in Table 1 . Note that the challenge of addressing tobacco industry interference in government policy through full implementation of Article 5.3 is in addition to those identified explicitly in the Joint National Capacity Assessment; the report does nonetheless point out (page 19) that it was ‘clearly stated by interviewed stakeholders that the tobacco industry’s ubiquitous presence in the decision-making process could be the main obstacle in taking effective tobacco control measures to protect the health of the Filipinos’. We agree with this perspective, and felt that the addition of a specific item on tobacco industry interference was justified. Another addition is the amendment of the national tobacco control act RA9211 to be consistent with WHO FCTC; central issues here are as follows: 1) the composition of the Interagency Committee on Tobacco (created by RA 9211) is inclusive of the Philippine Tobacco Institute and thus blatantly in conflict with WHO FCTC Article 5.3; 2) the current law allows the establishment of designated smoking areas, either indoors or outdoors, in public places, which not only creates a challenge for enforcement but also fails to protect public health effectively; 3) the definition of public places needs to be refined to include confined and open public places (the law has a definition for an enclosed area but none for a confined area); and 4) the current provisions on health warnings and advertising bans are not FCTC-consistent.

Key achievements to 2012 and challenges ahead for tobacco control in the Philippines

FCTC = Framework Convention on Tobacco Control; TAPS = tobacco advertising, promotion and sponsorship; MDG = Millennium Development Goals; DOH = Department of Health; WHO = World Health Organization.

Progress can also be considered in terms of the level of implementation of FCTC and MPOWER strategies ( http://www.who.int/tobacco/mpower/en/ ); data on the status of global tobacco control policy implementation and the countries’ level of attainment of the six MPOWER measures have been produced by the WHO in 2011, 11 with previous iterations in 2009 7 and 2008. 6 Based on these data and on the report of the Joint National Capacity Assessment, 8 it is our view that partial implementation has been achieved across all MPOWER components, except in O (offer help to quit tobacco use) and E (enforce bans on tobacco advertising, promotion and sponsorship), where implementation has been minimal. It is our view that full implementation has yet to be achieved in any one of the six components.

The framework of the NTCS ( Figure 2 ) and a summary description of the grants awarded under the Bloomberg Initiative to Reduce Tobacco Use ( Table 2 ) are shown here. More details on the specific grants and organisations are available online. 13

Framework of the Philippines National Tobacco Control Strategy to 2016. Source: Philippines Department of Health. 29 WHO = World Health Organization; FCTC = Framework Convention on Tobacco Control.

Overview of the main grants awarded to the governmental and non-governmental sectors in the Philippines under the Bloomberg Initiative to Reduce Tobacco Use 2007–2012

TAPS = tobacco advertising, promotion and sponsorship; DOH = Department of Health; FCTC = Framework Convention on Tobacco Control; WHO = World Health Organization.

Note that the purpose of one Bloomberg grant described in Figure 2 was to support the establishment of the NTCCO within the DOH and the development of an NTCS, both of which were achieved. In addition, the grant to Action for Economic Reforms had a specific focus on taxation reform which, with the consolidated efforts of the Filipino tobacco control constituency, was substantially achieved on 11 December 2012, when Congress ratified the so-called ‘Sin Tax’ bill. 30 President Aquino signed the Sin Tax reform bill into law on Thursday 20 December 2012, and it came into effect on 1 January 2013. For cigarettes (machine packed) the tax rate prescribed in the first year of implementation is 1) PHP12.00 (1 Philippine Peso [PHP] = US$0.024) per pack if the net retail price (excluding the excise tax and the value-added tax) is PHP11.50 and below per pack, and 2) PHP25.00 per pack if the net retail price (excluding the excise tax and the value-added tax) is more than PHP11.50 per pack. The Act stipulates higher tax rates in subsequent years, and also states that ‘the proper tax classification of cigarettes, whether registered before or after the effectivity of this Act, shall be determined every two (2) years’. 31

The Union has also, under the Bloomberg Initiative, recently negotiated a new grant with the CSC of the Philippines. Working to ensure protection of the civil service against tobacco industry interference (in line with Article 5.3 of the WHO-FCTC), the CSC will use a policy instrument known as CSC-DOH Joint Memorandum Circular 2010-01 as a cornerstone, drawing also on recently developed resources such as the FCTC Article 5.3 Toolkit: Guidance for Governments on Preventing Tobacco Industry Interference, published by The Union in 2012 and available online. 32 It should be noted that this Joint Memorandum Circular applies to elected officials as well as the rest of the civil service.

Tobacco use places an unacceptable burden on public health in the Philippines. In the 12 minutes or so taken to read this article, two Filipinos will have died from tobacco-related disease—the tobacco epidemic kills at least 87 600 Filipinos per year, or 10 every hour. 8 Efforts to tackle the epidemic have shown promise, especially since the ratification of the WHO FCTC in 2005. Although it is difficult to provide conclusive supporting evidence of cause and effect, it is arguable that the close to US$5 million in grants provided under the Bloomberg Initiative to Reduce Tobacco Use has made a contribution towards accelerating the implementation of effective tobacco control policies; it is now time to build on these successes in a sustainable way that does not rely so heavily on philanthropic donors. The launch of the country’s first NTCS and the progression of an improved taxation policy are recent and very encouraging signs of progress. Ensuring that the laws of the country are fully WHO FCTC-consistent must be given a higher priority, and the new NTCS appears to do just that. Recent robust efforts by the CSC and DOH to tackle tobacco industry interference in the civil service are also on the right track. Given the very strong tobacco industry presence in the Philippines, the daily challenges faced in advocating for WHO FCTC consistent policy measures are many and varied. A full account of these challenges is beyond the scope of this article; however, the cautionary observation by Alechnowicz and Chapman in 2004, 21 that the tobacco industry in the Philippines is ‘the strongest tobacco lobby in Asia’, still appears to be true. Tackling pervasive industry influence must be near the very top of all public policy makers’ lists of future actions, as are efforts to ensure the implementation of efficient and impactful public education and mass media campaigns.

Acknowledgments

The authors are grateful to the following people who provided comments or suggestions on earlier drafts of the manuscript: M Allen, M Balane, B del Rosario, M Derilo, I Escartin, S P Mercado, T Roda, F Santa Ana, L Tagunicar, P Ubial, X Yin.

Funding towards the writing of this paper was provided by Bloomberg Philanthropies under the Bloomberg Initiative and through the Initiative’s partner organisations.

The views expressed are those of the authors and not necessarily of the affiliated organisations.

Conflict of interest: none declared.

Essay on Nationwide Smoking Ban

Students are often asked to write an essay on Nationwide Smoking Ban in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Nationwide Smoking Ban

What is a nationwide smoking ban.

A nationwide smoking ban is a law that stops people from smoking in public areas across a whole country. It means no one can smoke in places like restaurants, parks, and offices. This rule is made to protect everyone from the bad effects of smoking.

Benefits of the Ban

This ban is good for health. It reduces diseases caused by smoking, like lung cancer. It also helps people who don’t smoke stay healthy because they don’t breathe in smoke from others.

Impact on Smokers and Society

The ban encourages smokers to quit, which can be tough. But it makes the air cleaner for all, and that’s a big win for the health of the people and the country.

250 Words Essay on Nationwide Smoking Ban

A nationwide smoking ban is a law that stops people from smoking in public places all over a country. This means no one can smoke in places like restaurants, offices, or parks. The main goal is to protect people from the smoke that comes from cigarettes, which can be harmful to everyone’s health.

Why is Smoking Harmful?

A smoking ban can make the air cleaner and healthier for everyone. It can also encourage smokers to smoke less or quit altogether. This can save lives and reduce the number of people getting sick because of smoking. Hospitals might also have fewer patients with smoking-related problems, which saves money and resources.

Challenges of the Ban

Making a smoking ban work is not always easy. Some people who smoke might find it hard to change their habits. Businesses like bars and clubs might worry about losing customers. The government needs to help people understand why the ban is important and offer support to those who want to stop smoking.

A nationwide smoking ban is important for keeping everyone healthy. It helps protect people from the dangers of smoking and secondhand smoke. While it can be tough to get used to at first, the benefits of having clean air and healthier lives are worth it.

500 Words Essay on Nationwide Smoking Ban

A nationwide smoking ban is a law that stops people from smoking tobacco in public places across a whole country. This means no one can smoke in places like restaurants, offices, and parks. The idea is to protect everyone’s health, including those who do not smoke. This kind of ban is also known as a smoke-free law.

Why Do We Need a Smoking Ban?

Smoking is bad for health. It can cause sickness like cancer and heart disease not just in people who smoke but also in those who breathe in the smoke, known as secondhand smoke. Children and people who are sick are especially at risk. By banning smoking in public, everyone can breathe cleaner air, stay healthier, and sick people can get better without breathing smoke.

The Benefits of a Smoking Ban

How does a smoking ban work.

A smoking ban works by making rules that say where people can and cannot smoke. Signs are put up to tell people about the rules. Police and other officials help make sure people follow the rules. If someone breaks the rule, they might have to pay money as a fine.

Challenges of a Smoking Ban

Even though a smoking ban is good for health, it can be hard to put in place. Some people who smoke feel it is not fair to tell them where they can smoke. Businesses that sell cigarettes might make less money. Also, it takes time and effort to teach people about the new rules and why they are important.

What People Think About Smoking Bans

A nationwide smoking ban is a big step towards better health for everyone. It helps make sure that the air we all breathe is clean and safe. It can also help people live longer and healthier lives by preventing diseases caused by smoking. Even though it might be tough to start, a smoking ban is a good idea for the health of all people in a country. It’s like making a rule that helps protect everyone, just like wearing seatbelts in cars. It is important for everyone to understand why a smoking ban is good and to help each other follow the rules.

That’s it! I hope the essay helped you.

Happy studying!

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