- NATA partners with WHO to establish smoke-free zones
The National Authority on Tobacco and Alcohol Sri Lanka (NATA) in partnership with the World Health Organisation (WHO) initiated a project to implement 362 Smoke-Free Zones (SFZs) in Sri Lanka in order to protect the general public from tobacco smoke.
In conversation with Brunch, NATA Chairman Samadhi Rajapaksa said exposure to second-hand tobacco smoke is a serious threat to one’s health, as it causes death and disease in non-smoking adults and children.
According to him, half of our children are regularly exposed to secondhand tobacco smoke (SHS) in public settings, and therefore, eliminating smoking at all homes, work sites, and public places is needed. Despite multiple measures by successive governments to bring down tobacco smoking prevalence in Sri Lanka, the presence of tobacco is still considerably high among certain groups, according to a report.
Risks of secondhand smoke
Exposure to SHS is a serious threat to the health of the general public, causing death and disease in non-smoking adults and children, Rajapaksa noted. Explaining further, he stated that it is a mixture of two forms of smoke – smoke produced from burning tobacco products such as cigarettes, cigars, or pipes, and smoke that has been exhaled or breathed out by the person smoking. SHS can persist indoors at potentially harmful levels for long periods following the smoking of even one cigarette.
“There is no safe level of exposure identified to SHS. In adults, SHS causes serious cardiovascular and respiratory diseases such as coronary heart disease, lung cancer, and stroke. In addition, it causes low birth weight in pregnant women and sudden death in infants,” he stated, adding that at least half of the children in the country regularly breathe air polluted from tobacco smoke in public settings. Ear infections, more frequent and severe asthma attacks, respiratory symptoms (coughing, sneezing, and shortness of breath), and respiratory infections (bronchitis and pneumonia) are some of the health issues caused by SHS among children.
He also informed us that SHS causes about 890,000 premature deaths per annum. Children accounted for 28% of the deaths attributable to SHS in 2004, and therefore, eliminating smoking at all homes, worksites, and public places is essential in order to fully protect non-smokers from SHS. “There are different strategies employed in combatting tobacco-related health issues all over the world,” he informed us, pointing towards the WHO Framework Convention for Tobacco Control (WHO-FCTC), which promotes smoke-free cities as an effective tobacco control strategy.
Sri Lanka was the fifth country in the Southeast Asian region to sign the Framework Convention for Tobacco Control and the first country in the region to ratify it. According to the guidance of WHO-FCTC, National Authority on Tobacco and Alcohol Act, No. 27 of 2006 was enacted in Sri Lanka supporting preventive measures regarding alcohol and tobacco use.
Combatting SHS
While the overall smoking prevalence has shown a downward trend in Sri Lanka, SHS exposure at home remains a significant problem, despite the recent laws enacted to prohibit smoking in public places. Women and children are highly vulnerable; it is they who inevitably breathe in SHS due to the high prevalence of male household members who use tobacco. The NATA has taken the initiative in carrying out a national programme for establishing SFZs to combat SHS with the help of public health inspectors (PHIs) who were the main co-ordinators at the grass root level in 2015.
From 2015 to November 2019, there were 253 SFZs established in 102 Medical Officer of Health divisions in 20 districts of the nine provinces. The highest number of SFZs was established in 2018 (95) followed by 2019 (63), 2016 (55), and 2017 (35). Ninety-six percent (96%) of SFZs were sustained up to the end of 2019; however, the attention given by PHIs lessened due to the Covid-19 pandemic. However, he noted that the attempt to re-establish SFZs in the island by the NATA should be very much appreciated.
Ten steps to establish SFZs
Researcher on Smoke-Free Zones Supun Lahiru Prakash introduced a 10-step process for establishing SFZs in Sri Lanka. The first step, he stated, is always discussing with supervising officers and colleagues, and this is very important as there is a statistically significant relationship between their enthusiasm and the sustainability of the project. Then, he added that the identification of boundaries of the proposed SFZ should be conducted according to the available resources and capacities.
According to Prakash, factors explored in the SWOT (strengths, weaknesses, opportunities, and threats) matrix could be used in this regard.
“Stakeholders can select a zone where strengths and opportunities are high, whereas the weaknesses and threats are comparatively less, after which, a survey should be conducted to collect more data; and analysing the gathered data will be beneficial to plan the project,” he explained.
The next step, according to Prakash, would be discussions with trade unions and other stakeholders, to create a steering committee and set targets.
“The study found that trade unions play a key role in establishing SFZs in Sri Lanka. Therefore, discussions with them are essential,” he added. Besides this, he believes that discussions with constructive groups identified by the study will positively affect the sustainability of the SFZs.
Step five would be to create awareness among the community. “It is important to strengthen the stakeholders and have better participation to achieve the targets,” Prakash commented, explaining that the studied SFZs have used various methods such as public lectures, distribution of leaflets, house-to-house awareness, displaying posters and billboards, street dramas, school debating competitions, art competitions, and anti-tobacco walks to create awareness among communities.
“A timeline should be set up to allow traders to finish available stocks of tobacco products,” he suggested, adding that PHIs can take legal action against those who violate the National Authority on Tobacco and Alcohol Act No. 27 of 2006. “It will be helpful to improve the morale of the stakeholders. Stakeholders must be appreciated during the project tenure for the sustainability of the SFZ.”
Giving certificates and awards, being praised by religious leaders, and being respected by school and dharma school children are among the suggested means of achieving this goal, he noted.
He also added that encouraging women and children to boycott shops where tobacco products are sold will be effective. Furthermore, continuing to raise awareness among stakeholders is essential.
Continuous follow-ups for early detection of problems and taking remedial actions is the last step. Meanwhile, continuous attention has to be paid to the reasons for deteriorating success, as well as to avoid destructive groups.
“Developing strengths and opportunities while minimising the weaknesses and threats are essential steps to create a supportive environment prior to establishing SFZs,” he said, adding that assistance of all constructive groups could be used for the project, and that it is crucial to avoid destructive groups as much as possible to sustain the SFZs.
