Tobacco Single Largest Preventable Cause of Death


By: Prof Javaid Khan FRCP(Edin) Aga Khan University



Tobacco use is the single largest preventable cause of disease, disability and death in Pakistan. According to estimates 100,000 people die every year in this country as a result of tobacco use.

The “Prohibition of Smoking and Protection of Non Smoker Health Law” was passed by the federal cabinet in 2002. According to this law smoking was prohibited at all public places including hotels, restaurants, cafes and restrictions were placed on tobacco advertising as well as on the sale of tobacco to minors.  A resolution against smoking shisha in restaurants and public places was also passed by the Sindh Assembly earlier this year. Despite claims by the Commissioner of Karachi through various national newspapers regarding the province-wide ban on shisha, this law has yet to be translated into action, and hundreds of restaurants continue to propagate this heinous addiction, destroying the health of Pakistani youth.

In countries where anti-tobacco laws are implemented, the prevalence of smoking has declined significantly, and as a direct consequence of this, so have the diseases attributed to active and passive smoking. Unfortunately, not much effort has been invested on the implementation of anti-tobacco laws in this country, despite of their existence in the legislation. Recently, on a visit to Islamabad and Lahore, I was appalled by blatant violations of the law at many reputable hotels and restaurants. Even more unsettling was the helplessness of the Civil Aviation authority to execute the smoking ban at the Lahore airport, where smoking enthusiasts sacrilegiously puffed away. The situation was not very different at the Karachi airport, with people smoking at a coffee shop situated in the center of the domestic departure lounge.

Furthermore, according to the current law all universities are supposed to be smoke free zones, but the silence of the vice chancellors on the rising trend of smoking within the universities and the lack of effort to put the smoking ban into effect is disheartening to note. Let’s not forget, silence is equivalent to acquiescence.

Last year we carried out a research in which tobacco smoke pollution (TSP) was measured at various restaurants and cafes in major cities of Pakistan. What was shocking about the results was the very high level of TSP at cafes where shisha was being served. In another research done on the university student populace of Karachi we found that almost 50% of the youth is now addicted to shisha.

As a Professor of Chest Medicine, I am concerned about the rising incidence of respiratory diseases in the country. More than 50% of the lung diseases are preventable if only smoking is avoided. Through this letter I request the concerned authorities to take appropriate steps for the implementation of anti-smoking laws of the country. Our future generations will not forgive us for the apathy we are showing towards the control of tobacco; the most powerful addictive substance available in the world today.



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