Activists in Bangladesh are calling for a tobacco tax to fight the climbing death toll from non-communicable diseases (NCDs) caused by smoking, especially an inexpensive cigarette called a “bidi”, made of tobacco flakes and usually rolled in leaves from local trees.
“There is a need to reduce consumption through higher taxation because tobacco in any form - bidi, cigarette or smokeless [tobacco products like snuff or chewing tobacco] - brings deadly health harms, and bidi, being the poor man’s cigarette, is consumed more than [factory-made] cigarettes,” said Rajika Jayatilake, an associate director of the US-based NGO, Campaign for Tobacco-Free Kids.
The government’s Global Adult Tobacco Survey (GATS) reported that more than 40 percent of adults smoked tobacco in 2009, with 11 percent smoking “bidi” cigarettes, a popular substitute for pre-packaged cigarettes in rural areas.
Bidi smoking rose by over 80 percent between 1997 and 2010, compared to an overall increase in cigarette smoking of some 40 percent during the same period, according to a 2012 study published by the Paris-based International Union Against Tuberculosis and Lung Disease.
The authors note that tobacco use in Bangladesh is going up, mainly because it carries a low tax and the ingredients are cheap, making it more affordable than other cigarettes. Four bidi cigarettes cost 1 taka, or 1 US cent, while a pack of 25 costs at most 7 cents. The study concluded that taxing bidis could force 3.4 million adult bidi smokers to quit and prevent another 3.5 million young people from taking up the habit.
Tobacco causes close to 57,000 deaths and disables 382,000 people in Bangladesh annually.
It is not just the cigarettes that are lethal, but also the working conditions in factories producing the bidis said Jayatilake. “The health harms of bidis go beyond bidi smokers to bidi workers - men, women, even kids work in unacceptable conditions and hazardous environments to roll bidis.”
A study in April 2012 of bidi consumption and production in Bangladesh by Campaign for Tobacco-Free Kids estimated that 220,000 people were working in bidi factories - including unpaid women and children - who are constantly exposed to tobacco dust and other toxic chemicals. Coughing, chest pains, vomiting and headaches are common among bidi workers.
The Directorate General of Health Services (DGHS) says six out of 10 deaths in Bangladesh are linked to NCDs, including heart disease, stroke, diabetes, chronic respiratory diseases and cancer.
Changing diets and life styles, tobacco use, indoor air pollution and lack of health awareness are all contributing factors.
“We have to make everyone understand that NCDs are widespread… Similar to [the] magnitude of the rate of maternal mortality, the mortality rate due to NCDs is of equal gravity,” said A K M Jafar Ullah, deputy programme manager of NCDs and arsenic at the DGHS.
A report by the UN World Health Organization in 2011 pointed out that 648 women per 100,000 people died from NCDs in 2008 - three times the maternal mortality ratio of 194 deaths per 100,000 live births in 2010.