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Profile on Smoke-free Environments in the South-East Asia Region World Health Organization, Regional Office for South-East Asia. Profile of Smoke-free Environments in South East Asia Region. 1. Environmental Pollution - analysis. 2. Tobacco Smoke Pollution - statistics and numerical data. 3. Bangladesh. 4. Bhutan. 5. Democratic People’s Republic of Korea. 6. India. 7. Indonesia. 8. Maldives. 9. Myanmar. 10. Nepal. 11. Sri Lanka. 12. Thailand. 13. Democratic Republic of Timor-Leste. ISBN 978-92-9022-245-3 (NLM classification: WA 754) © World Health Organization 2007 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for South-East Asia, application should be made to the Regional Office for South-East Asia, World Health House, Mahatma Gandhi Road, Indraprastha Estate, New Delhi 110002, India The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontier or boundaries. For technical information, please contact: Tobacco Free Initiative World Health Organization Regional Office for South-East Asia New Delhi, India Email: [email protected] Printed in India FOREWORD am pleased to note that a publication entitled “Profile on Smoke-free Environments I in South-East Asia Region” is being released on the occasion of World No-Tobacco Day 2007 the theme for which is “Smoke-Free Environments”. Research in the South- East Asia Region suggests that exposure to second-hand smoke (SHS) among the population, in general and among women and children in particular, both at home, at public places and at workplaces is a cause for grave concern in the Region. Tobacco use and exposure to SHS are also major contributors to the huge burden of tobacco disease in the Region. Although existing measures in Member States of the Region to control smoking and to protect people from exposure to SHS are inadequate, it is encouraging to note that the campaign for smoke-free environments is growing and gaining ground across the Region. Member States in the Region are developing and strengthening measures to protect the population from exposure to SHS. However, the policies and legislation in this regard need to be adequate and effective to ensure a smoke-free environment. This “Profile on Smoke-free Environments in South-East Asia Region” provides an overview of the situation on smoke-free policies in the Region as a whole and highlights the existing measures in this area and their comparative analysis. The document should serve as a reference guide for countries to learn about the best practices in the Region. Countries may also consider adapting some of the best practices as needed for developing and strengthening their own mechanisms to achieve this year’s World No-Tobacco Day theme of “Smoke-free Environments”. Samlee Plianbangchang, M.D., Dr. P.H. Regional Director C O N T E N T S Executive Summary __________________________________________________________________ 7 Introduction ________________________________________________________________________ 9 Smoke-free Environments in the South-East Asia Region ___________________________________ 11 Country Situation ___________________________________________________________________ 15 Bangladesh _____________________________________________________________________ 15 Bhutan _________________________________________________________________________ 16 DPR Korea ______________________________________________________________________ 17 India ___________________________________________________________________________ 17 Indonesia _______________________________________________________________________ 20 Maldives _______________________________________________________________________ 20 Myanmar _______________________________________________________________________ 20 Nepal __________________________________________________________________________ 21 Sri Lanka _______________________________________________________________________ 21 Thailand ________________________________________________________________________ 22 Timor-Leste _____________________________________________________________________ 23 Conclusion ________________________________________________________________________ 25 Bibliography _______________________________________________________________________ 27 Executive Summary he level of exposure to second-hand smoke (SHS) by adopting and implementing effective legislative, Tamong women and children inside homes and executive, administrative and other measures. in public places is alarming in the South-East Asia While Bangladesh, India, Myanmar, Sri Lanka and Region. Since most of the adult males smoke inside Thailand have enacted tobacco control legislation, homes and in public places in the presence of children which, among other things, ban smoking in schools, and women, pregnant mothers and adult male hospitals, workplaces and public places. Bhutan, DPR nonsmokers are also exposed to SHS in the Region. Korea, Indonesia, Maldives and Nepal in the Region also have laws in the form of a decree or executive An estimated 25 million school children are exposed order or cabinet decision to protect people from to second-hand smoke in public places in the Region. second-hand smoke. Besides these government Most students, however, would favour a ban on initiatives, campaigns for smoke-free environments smoking in public and workplaces. Tobacco use and are also being spearheaded by the private sector exposure to SHS are major contributors to the chronic and communities. However, most of these measures disease burden in the Region. If these trends continue, are partial and do not provide for a complete ban. South-East Asia would become one of the most Moreover, their implementation and enforcement affected Regions by the tobacco epidemic. need to be more effective. The campaign for smoke-free environments is gaining Making environments 100 % smoke-free is the most ground across the Region. A growing number of effective way to protect the public, including women, countries are now declaring more and more places children, and people at their workplaces from exposure as smoke free. Article 8 of the WHO Framework to second-hand tobacco smoke. Countries in the Convention on Tobacco Control (FCTC) to which 10 Region need to develop and strengthen smoke-free out of 11 member countries in the Region are Party, policies and legislation and enforce the same to reduce provides for protection from exposure to tobacco exposure to second-hand smoke not only to protect smoke in indoor workplaces, public transport, indoor the health of non-smokers and the public in general public places and, as appropriate, other public places but also for overall health development in the Region. Introduction econd-hand smoke (SHS) is a mixture of thousands It is found that common smoking and non-smoking Sof chemicals, at least 250 of which are known areas, or smoking rooms in buildings with a common to cause cancer in humans. There is no safe level of ventilation system, contaminate the clean air. exposure to SHS. Exposure to SHS causes serious Increased ventilation can increase the comfort level disease and death in the non-smoking population. The but does not provide adequate protection from most recent major report on SHS risks was released toxins generated by SHS. A ventilation system that in September, 2005 by the California Environmental could clear the air of smoke would need to have the Protection Agency’s Air Resources Board. In the adult force of a hurricane which is not the case in practice. population, SHS causes lung cancer; nasal sinus cancer; The only effective way to provide protection from breast cancer in younger (primarily pre-menopausal) SHS is to make all indoor environments completely women, heart disease and heart attacks, asthma smoke-free. induction and exacerbation. The report also stated that SHS harms children, infants and reproductive health Increased awareness of the considerable health risks through acute lower respiratory tract illness (such as posed by SHS in public places and concern for public pneumonia and bronchitis), asthma induction and safety have led to an active global movement to exacerbation, chronic respiratory symptoms, middle impose a total ban on smoking in public places. An ear infection, lower birth weight babies and Sudden increasing number of places and entities around the Infant Death Syndrome (SIDS). world are being declared smoke-free by adopting provisions for necessary policy and legislation that Just as tobacco companies refuse to acknowledge provide for fines and penalties for violating these that SHS is harmful, they also claim that smoke-free measures. However, due to enforcement, smoking in environments will harm businesses like restaurants public places is still prevalent in most countries in and bars. On the contrary, dozens of studies of sales, the Region. tax and employment data from smoke-free businesses show without exception that smoke-free laws have This document provides information on smoke-free either a neutral or a positive impact on their revenue. laws in countries of the