Strong local actions are pivotal to reduce NCDs, TB and tobacco use in Bangladesh

Shobha Shukla *

Strong local actions are pivotal to reduce NCDs, TB and tobacco use in Bangladesh

Unless global goals do not become a reality in the lives of every person worldwide, we will fail to deliver on those promises. Local actions are key. That is why the Mayors of several municipalities in Bangladesh and other local government leaders and experts had united to form the Bangladesh Mayors’ Alliance for Healthy Cities in 2019.

"Well-coordinated actions at the local level are building blocks to deliver on global goals. If all local governments of all municipalities in Bangladesh work towards reducing (and eventually ending) tobacco use and TB, and preventing non-communicable diseases (NCDs), we will be able to deliver on the promises made by Bangladesh's honourable Prime Minister," said Barrister Shameem Haider Patwary, Member of Parliament of Bangladesh and co-convener of Asia Pacific Parliamentarians Caucus for Health and Development (APCAT Parliamentarians).

Barrister Patwary was addressing the 3rd Mayors' Summit of Bangladesh held in Cox's Bazar during 21-22 July 2023 om the theme "United efforts for healthy cities." The Summit was co-hosted by the Cox's Bazar Municipality, National Tobacco Control Cell (NTCC), Ministry of Health and Family Welfare of Bangladesh, Bangladesh Mayor Alliance for Healthy Cities, International Union Against Tuberculosis and Lung Disease (The Union), Asia Pacific Cities Alliance for Health and Development (APCAT), AID Foundation, Tobacco Control and Research Cell (TCRC) of Bangladesh and others.

One Health approach is key to boost pandemic preparedness

"United efforts at all levels are vital if we are to end TB, or tobacco use, or prevent NCDs. Major risk factors of life-threatening and chronic NCDs (over 70% of deaths are attributed to NCDs worldwide) and TB (the deadliest of infectious diseases in most low- and middle-income nations) are common: such as tobacco, alcohol, malnutrition, obesity, lack of physical activity, etc.

That is why, united, and well-coordinated efforts at the local level assume an overwhelming importance so that local people can stay healthy, prevent infections, and reduce the risk of NCDs,” said Dr Tara Singh Bam, Asia Pacific Director of International Union Against TB and Lung Disease (The Union).

"Mayors play a critical role in tobacco control by implementing and enforcing policies, raising public awareness, and creating smoke-free environments in their cities to protect the health of their citizens" added Dr Bam. “Mayors’ role is also critical to address and prevent any pandemic through One Health approach,” emphasized Dr Tara Singh Bam.

According to the latest WHO Global TB Report, undernourishment was the biggest risk factor for people getting sick with TB in Bangladesh in 2021, followed by tobacco use as the second biggest risk factor. Other risk factors included diabetes, alcohol and HIV.

Bangladesh aims to be tobacco-free by 2040

Bangladesh’s Prime Minister has promised to make the country tobacco-free by 2040, said SM Sirajul Haque, Mayor of Tangail in Bangladesh. He said that we cannot create a smart Bangladesh unless children and adults alike make smart decisions which are good for them and for the country. If people use tobacco then they will be unhealthy and also cause havoc on their family.

Staying away from tobacco use is vital. That is why he is encouraging those who use tobacco in his Tangail region to quit tobacco use by benefitting from tobacco cessation services. Tobacco retail is not allowed within 100 metres of educational institutions and to those who are under 18 years of age, he added.

Tobacco use in Bangladesh has reduced in the past 20 years as per the World Health Organization (WHO) Global Health Data Observatory. From 57.6% in 2000, tobacco use has come down to 34.7% in 2020. However, tobacco consumption in Cox’s Bazar was found to be higher than the national average at 43.4%.

Tobacco use is a major public health challenge in Bangladesh, with high rates of both smoking and smokeless tobacco use. Smokeless tobacco use is particularly prevalent in Bangladesh, with over 20 million people using various forms of smokeless tobacco, like jarda and gul . Tobacco consumption in Bangladesh has significant health consequences, as it is a leading cause of NCDs such as cancers, cardiovascular diseases (heart diseases and stroke), and chronic respiratory diseases. Additionally, tobacco use has significant economic costs, both in terms of direct healthcare costs and lost productivity.

Bangladesh is the 3rd biggest tobacco growing country in the southeast Asia region of the WHO (after India and Indonesia). Land under tobacco cultivation had seen a substantial rise in Bangladesh during 2008 and 2015, but now dedicated efforts of the Bangladesh government have led to success in farmers choosing not to grow tobacco, but rather opt for cultivating other crops. Bangladesh has ratified the global tobacco treaty (formally called the WHO Framework Convention on Tobacco Control or FCTC), Article 17 of which calls upon governments to promote economically viable alternatives for tobacco workers, growers and individual sellers.

According to the WHO, farmers in India, Sri Lanka, Bangladesh, and Indonesia are gradually taking to alternate crops that are equally or more profitable. One of the reasons for farmers giving up tobacco cultivation is the high input costs and declining domestic and international demand.

Tobacco Cultivation Control Policy of Bangladesh, 2017, has set targets to reduce tobacco cultivation at all stages by 2040. In early 2020, Bangladesh Bank notified all its branches not to sanction loans for tobacco farming- both contractual or direct. It is also increasing credit flow to farmers switching to alternative crops.

Several surveys have already identified alternative crops for different cropping seasons and for different geographical areas. Alternatives include French beans, potato, melon, sweet gourd, chilli, eggplant, groundnut, tomato, wheat, garlic, masur, mustard and leafy amaranthus, radish, coriander, okra, bitter gourd, beans, spinach and cabbage.

A report stated that farmers in water-scarce northern Bangladesh are shifting away from tobacco to grow tea, sunflower and mustard, which use less water and offer greater profits.

Strengthening leadership commitment

This Mayor’s Summit aimed to enhance mayors' leadership role by prioritizing prevention of tobacco use, TB and NCDs, within the framework of strategic and operational planning, as well as in policy, fiscal, and legislative instruments. There need to be strong mechanisms to ensure that mayors and leaders at local level are held accountable for safeguarding the development and implementation of public health policies from undue influence of unhealthy commodity industries.

This will involve promoting transparency, enforcing strict guidelines, and cultivating strong public-private partnerships to effectively implement programmes, while also monitoring their performance and effectiveness.