Health Policy Watch are Morally Lost on Bangladesh

There is a big difference between knowing what to think and knowing how to think. Too often, this failure makes people and organisations blind to simple facts or apply basic morality to their opinions. Today, we present to you a special case where a non-profit has become so detached from reality that it’s bordering on contempt for the people they’re meant to protect.

Recently, Bangladesh has implemented an amendment to its Smoking and Using of Tobacco Products (Control) Act 2005, which essentially uses the WHO FCTC baseline framework. In 2013, another amendment expanded public smoke-free areas, added public health warnings on packets, and brought smokeless tobacco under the definition of “tobacco products”. That last part is important.

In recent years, the country held consultations that addressed issues such as how to deal with vapes and other novel tobacco products, the impact of retail controls, and concerns around digital marketing. This amendment was passed late last year and initially promised to expand the definition of “tobacco products” to include goods that don’t contain tobacco, such as vapes and pouches.

At the time, there was no doubt much mirth and clinking of glasses among the tobacco control apparatchiks. However, come March, some outlets reported a reversal of the vape and pouch ban. Now, it’s been announced that recently elected Prime Minister Tarique Rahman’s administration has prioritised the health of its citizens over enacting a WHO/Bloomberg-funded prohibition, and will not include vapes and pouches under the new measures.

Bangladesh’s smokeless tobacco problem

The thing is, Bangladesh has a massive smokeless tobacco problem. However, it has nothing to do with snus or nicotine pouches.

Products like Zarda, Gul, Sada Pata, and Khoinee, as well as betel quid with tobacco, are immensely popular in the region, with recent estimates suggesting an adult prevalence of as high as 27%. Data suggests that 18% of adults smoke combustible cigarettes, with data suggesting a considerable amount of dual use across the products suggested above.

Recent stats suggest that tobacco kills 161,000 people each year in Bangladesh. Additionally, 1.5 million people suffer from tobacco-related illness per annum. With figures like this, it’s no surprise to read that tobacco use is Bangladesh’s largest cause of preventable death.

Many of the local products are as lethal as cigarettes. They have well-established links to cancer and contain excessively harmful levels of lead, cadmium, chromium, and more.

If ever there were a region crying out for regulated tobacco-free products like vapes or pouches, this is it. Yet, when rumblings of these products being excluded from the Act emerged, anti-tobacco groups said they were “alarmed”.

What is the point of these groups anymore?

History shows that smoking and tobacco use are often deeply embedded in culture. Education and stigma only get you so far, and if you want to really impact the prevalence of harmful options, it’s essential to give the public access to harm-reduction products.

Submitting to an ideology shrinks and distorts the reality before you. To suggest not banning harm-reduction is a “major gap” in the Act is either a breakdown in moral clarity or the claims of a set of employees totally beholden to their funders' whims. Of course, it could be both.

In an ideal world, Bangladesh’s smokeless tobacco problem would turn into a nicotine pouch “problem”. Countless lives would be saved, with many more vastly improved thanks to improved health and greater economic productivity. Groups like Health Policy Watch need to ask themselves what they are even doing anymore.