Wednesday, 5 July 2017

Prohibition news: Bhutan edition

Unless you count the so-called Islamic State, only one country in the world has a ban on tobacco sales. Starting in January 2011, Bhutan experimented with prohibition and started throwing people in jail for possession.

The ban was passed in 2004, but was not toughened up until later. At the time, the Lancet cheered on the self-styled happiest nation in the world, saying: 'That is what we call progress' and predicted that 'the tobacco-free age is just around the corner.'

Bhutan was already considered one of the blue-eyed eyes boys of 'public health' in 2003 and had already received the a WHO commendation as Tobacco Control reported...

Under the vibrant leadership and guidance of the Minister of Health and Education these campaigns paved the way for a coordinated and multi-sectoral initiative for tobacco control activities in the country. His Excellency’s initiatives in the area of tobacco control have already been recognised by WHO.
We have seen before that congratulations from the WHO on anti-smoking activity can be a curse and so it was in Bhutan. Full prohibition was introduced in 2011 and - who would have guessed?! - it didn't work out so well. A study published that year found...

'... a thriving black market and significant and increasing tobacco smuggling… 23.7% of students had used any tobacco products (not limited to cigarettes) in the last 30 days… tobacco use for adults has not ended or is even close to ending… cigarette prohibition is instrumental in encouraging smuggling and black markets… The results of this study provide an important lesson learned for health practitioners and advocates considering or advocating, albeit gradual, but total cigarette ban as a public policy.'

Another survey published last year noted that...

Despite a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004, two nationwide surveys conducted in 2012 and 2013 reported high tobacco use in Bhutan.

There was talk of repealing the ban but that doesn't seem to have happened. Instead, this has happened...

Bhutan has the highest share (24.6 percent) of smokers in Southeast Asia, reports Kuensel, citing a report by the World Health Organization on the mental health of adolescents in the region.

Despite the country’s complete ban on tobacco sales, tobacco use remains high among 13 to 17-year-olds, who constitute 9.4 percent of the population.

At 29.3 percent, Bhutan also has the highest share of adolescents using other tobacco products, followed by Timor-Leste (27.1 percent) and Thailand (14 percent).

Not bad for a country that had a one per cent smoking rate in 2003. Another big 'public health' win!

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