Kuwait rarely tops regional rankings, so when the country’s name appears among the top in a regional index it should normally elicit loud ululations of joy.However, when the country’s top billing is for per capita tobacco consumption, the only people who will cheer are the tobacco companies. Certainly, the tens of thousands of people in Kuwait, as well as the hundreds of millions worldwide, who suffer from the direct and indirect effect of tobacco and related products, have no reason to ululate or celebrate.

The latest iteration of the global ‘Tobacco Atlas’ released in mid-May, reveals that annual per capita consumption of cigarettes in Kuwait is a whopping 1,849 cigarettes. This ranks Kuwait second in the Middle-East region, next only to Lebanon, where average per capita consumption is 1,955 cigarettes, but ahead of Libya, which ranked third regionally with 1,764 cigarettes consumed per capita annually. By comparison, the average per capita consumption of cigarettes in Saudi Arabia is 485, and that in the United Arab Emirates is 438.

Now in its seventh-edition, the ‘Tobacco Atlas’ — a joint anti-tobacco initiative by leading global public health organization, Vital Strategies, and the Tobacconomics team at the University of Illinois at Chicago (UIC) in the United States — makes for a compelling read from start to finish.

Data from the Tobacco Atlas show that nearly nine million people around the world succumbed to smoking and tobacco related illnesses in 2019. Despite this sobering fact, more than 1.3 billion people worldwide still smoke tobacco, while an additional 200 million use other tobacco products. This finding reiterates studies by the World Health Organization (WHO) and others that show tobacco consumption impacts the lives of nearly 20 percent of the current global population, and that 23 percent of adults worldwide are tobacco users.

Estimates on the prevalence of smoking In Kuwait by the WHO notes that close to 18 percent of the adult population smoke cigarettes or other tobacco-related products. Even more alarming for Kuwait is the high prevalence of smoking among adolescents in Kuwait. A cross-sectional study published in 2020 on tobacco usage among adolescents in 11th and 12th grades in Kuwait revealed that 68 percent of male and 21 percent of female students smoke or had used tobacco products at one time or another. The mean-age for initiation of smoking in Kuwait was also found to be 17.5 years.

To replenish the large number of smokers who annually fall victim to their noxious products, tobacco companies have increasingly been targeting young children and adolescents in countries with lax anti-smoking regulations. Younger children are especially vulnerable to tactics employed by tobacco companies that lure them to begin smoking, as many of them do not understand, or underestimate, the harmful health consequences of tobacco use.

The Global Youth Tobacco Surveillance (GYTS), an initiative by the WHO focuses on youth aged 13-15 and collects information on their interaction with tobacco in schools, and their exposure to enticements to begin smoking. The GYTS survey initiated in 2016 by the Ministry of Health (MoH) in Kuwait found startingly that 24 percent of boys, and 10 percent of girls in this age group currently used tobacco products of one form or another.

The survey further showed that the percentage of students who saw anti-smoking advertisements was 59 percent, while those who saw pro-tobacco messages was 39 percent. The study also revealed that 93 percent of current cigarette smokers in this age group obtained cigarettes by buying them from a store, shop, or vendor, and that 78 percent were not denied the product because of their young age.

Relative to a similar study conducted in 2001, there was a drop in prevalence of smoking among both boys and girls, as well as their exposure to pro-tobacco campaigns over the interim 15 years. While this is encouraging, the rise in number of students enrolled in schools over this period means that the lower ratio is not reflected in the actual number of those becoming lured to smoking at a young age.

Nonetheless, much of the reduction in smoking prevalence recorded among children in recent years can be attributed to greater awareness on the deleterious impact of tobacco products on health, as well as from increased monitoring by parents and school authorities of their wards, and more stringent and robust application of laws and rules regulating advertising, and sale of tobacco products to those below the age of 21.

Kuwait has had anti-smoking laws since the mid-1990s. Article 3 of Law 15 of 1995 states that: “The sale or presentation of cigarettes and types of tobacco and its derivatives to people below the age of 21 in shops, markets and means of transportations shall be prohibited.” Article 6 of the same law also states: “Promotions and advertising for cigarettes and other tobacco products in all their forms is prohibited in the country.” However, many of these recommendations were not implemented, and even when they are introduced there has been very little robust enforcement of the law, or at best half-hearted token gestures.

Assertive anti-smoking policies by states, campaigns by civil society organizations, and greater awareness among the public of the harmful effects of tobacco have led to a reduction in the prevalence of tobacco usage in many countries over the past two decades. Nevertheless, the rise in global population during this period also means that the decrease in prevalence has not translated into a significant lowering in the number of people whose lives are impacted by the direct and indirect use of tobacco and related products.

In 2020, despite emergence of the COVID-19 pandemic, global tobacco companies sold more than five trillion cigarettes worldwide, raking-in over US$60 billion in annual gross profits.Tobacco industry’s marketing and sales of cigarettes and allied products leads to catastrophic results for individuals, families, public health systems, and to the economies of countries worldwide.In 2019, the consumption of tobacco products led to nearly $2 trillion in economic damages globally.

The US-based Institute for Health Metrics and Evaluation (IHME) in their annual Global Burden of Disease study for 2019, estimates that 8.7 million people die prematurely from tobacco use every year. Of those deaths 7.7 million were attributed to direct consequences of smoking, while 1.3 million non-smokers also died from exposure to second-hand smoke. The IHME database on Kuwait shows that smoking was among the leading risk factors for death in the country, with 1,524 people losing their lives to smoking in 2019, and an additional 357 dying from exposure to second-hand smoke.

Data from the Tobacco Atlas and other international sites on tobacco usage serves as an eye-opener on global tobacco companies and on the functioning of their unscrupulous industry that makes humongous annual profits from knowingly producing and purveying deadly products that damages the health and kills their consumers. To address the tobacco epidemic WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Four years later in 2007, WHO launched MPOWER, a cost-effective initiative that countries could introduce to scale up implementation of provisions of the WHO FCTC.

Among the six MPOWER measures outlined by WHO is one to increase taxes on tobacco and related products. A sufficiently large tax increase plays a significant role in lowering the prevalence of smoking, as it will raise tobacco product prices and make them less affordable, thereby discouraging initiation, encouraging quitting, and driving down consumption.

Unfortunately it tends to be the least implemented of the MPOWER steps. Political pressure from tobacco company lobbyists, and unfounded fears raised by the tobacco industry of job losses among local workers engaged in production and marketing of tobacco, as well as loss of tax revenues, have detracted many governments from imposing or increasing taxes on tobacco and related products.

As part of its FCTC initiative, the WHO recommends that excise taxes make up at least three-quarters of the price of the most popular brands of tobacco. Despite the Gulf Cooperation Council (GCC) agreement in 2016 to implement a harmonized excise tax at the rate of 100 percent of retail price on all tobacco products. Kuwait has been reluctant to introduce any such excise taxes. However, In April it was reported that the government was now considering imposing a selective tax of 10 to 25 percent on a handful of goods, including tobacco and related products.

Anti-tobacco organizations and campaigners have often called for implementing a specific, uniform excise tax of at least 100 percent on all tobacco products, which should be gradually increased in line with the country’s GDP growth.The relationship between excise tax on tobacco products, the price of a popular cigarette brand packet and smoking prevalence in a country was evident in a recent study conducted among GCC states. In Kuwait, which levies zero excise tax on tobacco, the price of a popular packet of cigarettes is $2.78, and the prevalence of smoking among the adult population is 18 percent.

In the other five GCC states that have introduced 100 percent excise tax on tobacco, the price of a similar brand of cigarette and the smoking prevalence among adults were as follows: In Bahrain, a cigarette pack cost $6.12 and prevalence of smoking was 13 percent; in Oman it was respectively $5.72 and 7 percent; Qatar it was $6.04 and 10 percent prevalence; Saudi Arabia it cost $6.69 and 11 percent; and in the UAE it was $5.78 and prevalence of smoking is 9 percent. The zero excise duty and low price of a pack of cigarettes, certainly had an influence on the high prevalence of smoking in Kuwait relative to other GCC states.

It needs to be pointed out that even the100 percent excise tax imposed by other GCC countries is still less than that recommended by the WHO. For example, the100 percent excise tax on tobacco leads to only a 50 percent increase in the total retail price of a packet of cigarettes, which is less than the WHO’s recommended figure of 75 percent. The 25 percent excise duty that Kuwait is considering is unlikely to discourage current smokers or wannabe smokers from reaching for a pack at their nearest ‘Bakala’.

World No Tobacco Day, observed on 31 May every year, is an opportunity to raise public awareness on the damage and death caused by consuming any kind of tobacco products. It is also a chance to highlight the fallacious argument touted by tobacco companies on so-called ‘safe alternatives’ to cigarette smoking such as e-cigarettes and smokeless cigarettes.

Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), commonly referred to as e-cigarettes, heat a liquid to create an aerosol that users then inhale. These liquids do not contain tobacco, but many contain nicotine, the addictive chemical in tobacco, as well as other chemicals and remain unsafe and harmful to health. Remember, there is no such thing as a safe tobacco product; the best safety measure is to stop smoking now, or even better, never start smoking as a child or adult.

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