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Hospitals to ban tobacco- chewing on premises
The increasing prevalence of oral cancer due to smokeless tobacco use among Sri Lankans, mostly the poor and disadvantaged, has pushed the Government to take more measures to control the habit of betel-chewing in hospital premises.
Betel-chewing and smokeless tobacco use is rising among the poor. Pic by Indika Handuwala
A Health Ministry directive to all regional and base hospitals and Medical Health Offices has announced a ban on chewing and selling of betel quid, tobacco and arecanut products.
But medical doctors say the ban should be extended to all public and private institutions.
The National Cancer Registry 2015 shows that one in every 10 Sri Lankans risks cancer in his or her lifetime. The registry also says that one in every 10 has a lifetime risk of cancer. The incidence of cancer in Sri Lanka standardised to world standard population in 2009 was 86.4 and 89.1 per 100,000 men and women.
The National Authority on Tobacco and Alcohol supported by the Sri Lanka Medical Association in its health intervention and technology assessment programme, said that 25 percent of men and 5 percent of women use smokeless tobacco products in Sri Lanka.
It has been scientifically proven that cancer due to tobacco is a preventable cause of premature death.
The World Health Organisation said that in 2014 six million people died of tobacco related illness worldwide of which 70% belonged to the middle and low income social strata.
A global youth survey 2015 done in Sri Lanka covering 1,505 children between the ages of 13 and 15 years in 65 classrooms in 30 schools revealed that 7.1% use tobacco with betel and 2.5% use smokeless tobacco products.
Smokeless tobacco related cancers include lip, oral cavity, pharynx, lung and oesophagus.
Dr Hemantha Amarasinghe, of the Institute of Oral Health, Maharagama, who is also consultant in community dentistry and convenor of the smokeless tobacco sub committee of the National Authority on Tobacco and Alcohol, said that the earlier ban did not cover betel-chewing.
The new initiative will stop people from spitting in hospital premises. This should be extended to all government institutions, he said.
In a gazette notice in September 2016, the Government imposed a ban on the manufacture, sale and possession of all smokeless tobacco. This included smokeless tobacco products and mixtures that contain tobacco, including the tobacco strips in the betel quid.
Dr Hemantha said that about 2,400 new oral cancer patients report every year with 95% of them being habitual betel chewers. The National Cancer Registry also said that on average, three people die every day from oral cancer.
The National Authority on Tobacco and Alcohol, in collaboration with the expert committee on tobacco, alcohol and illicit drugs of the Sri Lanka Medical Association and the WHO did a survey STEP 2015 — on risk factor surveillance of chronic diseases and found 26% males and 5% females used smokeless tobacco products.
The WHO Global Youth Tobacco Survey 2015 among youths of 13 to 15 years, found that 4.2% boys and 0.5% girls have taken smokeless tobacco at least once during the 30 days before the survey.
The survey found that among those above 30 years old, who live in the villages and estates in the Sabragamuwa province, 53.7% chewed betel every day.
Dr Amarasinghe said that betel chewing is highly prevalent among bus drivers and three-wheeler drivers. Even university students are chewing tobacco.
“Although the import of smokeless tobacco products have been banned, the chewing continues. The users know where to buy the smokeless tobacco products,’’ he said.
Smokeless tobacco products such as babul, beeda, pampara are smuggled into the country from Pakistan and India. Locally manufactured smokeless tobacco is also available.
The economic cost of caring for cancer patients runs into billions. Dr Amarasinghe, in a research paper published in the BMJ journal, said an estimated US$12.6 million is spent on smokeless tobacco-related cancers for out-patients and for hospital patients.
The total spent on tobacco-related cancer in 2015 was US$121.2 million 16.06% of the total amount allocated (US$754.81 million) in 2015 for the health sector.
The director of the expert committee on alcohol and illicit drugs, Dr Sanjeewa Ranaweera, said that the Government had taken a bold step by breaking cultural barriers that prevented the banning of the betel quid. “It went soft on the traditional habit, but now it is in the right direction,’’ he said.
He said that most oral cancer patients come from rural areas and are poor. Betel-chewing and smokeless tobacco use is rising among the poor.
He also supports the restrictions on betel chewing in hospital premises, but adds that the ban should be extended to all other institutions even to private institutions.
Dr Mahesh Rajasuriya of the Centre for Combating Tobacco, said that the tobacco industry, battered by the ban on commercials, is now targeting the youth.
“All tobacco use should end. This ban should be extended to a total ban and also to all smokers in the country,’’ he said.
| Ban on sale and chewing in school premises soon | |
| The sale and chewing of betel and arecanut in school premises will be banned soon, a senior official said. The National Cancer Control Programme (NCCP) will soon be sending out letters to schools countrywide banning the betel quid and arecanut chewing and selling in school premises in a bid to curb betel chewing and smokeless tobacco use among schoolchildren. Consultant Dentistry of the NCCP, Dr. Prasanna Jayasekera said that letters will be sent out to all schools to ban the habit of chewing betel among principals, class teachers and children. |