Can the horror show spook smokers?

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Vietnam gets serious about kicking the smoking habit with a new law imposing stricter restrictions and stiffer fines, but self-awareness is still key, experts say

A motorcyclist stops to buy cigarettes from a street tobacco vendor in downtown Hanoi on June 19, 2012.  The Law on Prevention and Control of Tobacco Harm, which takes effect on May 1, imposes strict requirements on smokers, retailers, service and public facilities and cigarette manufacturers. Photo: AFP 

Dang Minh Tuan is not afraid of death, but the former soldier has seen something that scares him even more.

Media reports showing graphic images that will soon be carried on all cigarette packets in Vietnam have made him rethink his smoking habit.

"People have been warning that smoking causes diseases. I used to joke that everyone will die one day or the other. But it is frightening to think that my lungs can be just like in the picture," said the 44-year-old driver in Ho Chi Minh City, who has been smoking for more than 20 years.

"It has been my own way of entertaining myself. But thinking about spending all our savings on the sickbed, and ruining the schooling and future of my two daughters is a different thing," he said.

Tuan is among the millions who authorities are hoping will be influenced into kicking their habit as Vietnam takes major steps towards trying to reduce the number of smokers in the country.

The Law on Prevention and Control of Tobacco Harm, which takes effect on May 1, imposes strict requirements on smokers, retailers, service and public facilities and cigarette manufacturers.

A decree expected to take effect on July 1 spells out stiffer fines for violating the law.

The government and experts are optimistic about these actions despite a previous ban on smoking in public places, in place since 2010, not having been enforced with any serious intent.

Last week, the Ministry of Health held a conference to launch the Law on Prevention and Control of Tobacco Harm and the National Strategy on Tobacco Harm Prevention.

The strategy aims to reduce the smoking prevalence among young adults (aged 15-24) from 26 percent in 2011 to 18 percent by 2020.

The proportion of smoking among men is expected to reduce from 47 percent in 2011 to 39 percent by 2020 and below 1.4 percent among women by 2020.

Leading killer

At the conference, Deputy Heath Minister Nguyen Thi Xuyen said Vietnam is among 15 countries with the highest rates of smokers in the world.

"On average, one out of two adult males (from 15 years old) is a tobacco user. Nearly eight million Vietnamese workers regularly inhale second hand smoke at working places, and around 47 million people are exposed to passive smoking at home," she said.

Research by the Health Strategy and Policy Institute in 2011 showed that nearly 11 percent of deaths in males were caused by tobacco-related diseases.

In Vietnam, diseases rooted in tobacco use, including stroke, coronary heart disease, chronic obstructive pulmonary disease, and lung cancer are the leading causes of death for both men and women in the country, according to a 2011 report by the health ministry.

The report found tobacco has cost more than 1.5 million years of healthy living of Vietnamese people and the annual treatment costs for common tobacco-rooted diseases is more than VND2 trillion (US$96 million).

According to the World Health Organization (WHO), smoking kills around 40,000 people in Vietnam every year and the fatality is expected to increase to 70,000 by 2030.

At the K Hospital in Hanoi, a central hospital specialized in treating cancer and tumors, almost all lung cancer patients have a smoking background.

"There are around 7,000 harmful chemicals in tobacco, of which 70 are carcinogens. That explains why most cases of lung cancer involve smoking," said Nguyen Huy Quang, director of the Legal Department under the health ministry.

Self-awareness is key

Although the new law is tougher and carries stiffer penalties, Quang said the expected results rely mostly on increased awareness among smokers.

"It is certainly difficult because smoking violation in public places is common," he told the media on the sidelines of last week's conference. "Thus, we are promoting self-awareness among the residents [of the dangers of smoking]."

Quang said only a dozen people have been punished for violating a 2010 ban on smoking at public places, and the new law does not focus on fines as a deterrent.

"Actually, this is a very special violation because it happens in a very short period of time - of around one or two minutes or just one or two breaths. The minor violations happen on a large scale, though."

He said strict measures will focus more on the role of people responsible at public places and workplaces, cigarette manufacturers and retailers, than on the smokers.

Communication priority

Hailing Vietnam's latest efforts to reduce the number of smokers in Vietnam and announcing their optimism about their impacts, experts are calling on local authorities to get proactive and achieve better results.

They want better education campaigns, increased taxes and benchmark cigarette prices.

"Right now the priority is to conduct communication activities to raise awareness of the public to have a smoke free environment and be protected from dangerous second hand smoke," said Takeshi Kasai, the WHO representative for Vietnam.

"We need to encourage voluntary compliance with the law and the mass media"¦ will play an important role in the communication process," he said.

Kasai said he was optimistic about enforcement of the new law: "The enforcement is feasible, as we can see with the case of enforcing the helmet law in Vietnam few years ago. The authority knows best how to enforce the law."

He said the WHO recommends the combination of strong mass media campaigns and regular inspections and punishment of owners/managers of workplaces and public places where the smoking ban is frequently violated. 

Kasai urged the government to implement a package of various other measures including tax increases, bans on advertising, promotion and sponsorship and providing smoking cessation support. 

Jorge Alday, associate director of policy and communications at the New York-based NGO World Lung Foundation, said relevant agencies should undertake strict surveillance from the very beginning to ensure thorough enforcement of the new laws.

"It is important that business owners, teachers, public transport operators and others see that violations will not be tolerated. If a pattern of compliance can be set right at the beginning, enforcement can become self-sustaining."

He said the government can use mass media to inform consumers that they now have a right to be protected from second-hand smoke, and to provide mechanisms for them to report violations.

Alday said a lot of international evidence proved that pictorial pack warnings are very effective at making smokers aware of the harms of tobacco.

"When people truly understand the harms, they are more likely to try and quit. And the more times a smoker tries to quit, the more likely he or she will succeed," he said.

At a recent conference on tobacco harms held by the Vietnam office of HealthBridge - a Canada-based NGO working to improve the health of vulnerable populations, a cancer patient at the K Hospital said he had not been aware of specific harmful impacts of cigarette.

"Maybe I could have avoided the serious disease if I had known that smoking causes lung cancer. The pack only writes smoking is harmful but does not clearly say how harmful."


- Complete ban on both indoor and outdoor smoking: health facilities and educational institutions (tertiary institutions will only apply an indoor ban), childcare facilities, entertainment areas designated for children and areas with high risk of fire and explosion

- Complete ban on indoor smoking: workplaces (including restaurants), universities and colleges and other public places.

- Ban on indoor smoking but a designated smoking area with "separate space and ventilation" is allowed at: airport boarding areas, bars, karaoke lounges, discos, hotels and guesthouses.


- Cigarette packs have to carry stipulated pictorial health warnings taking up 50 percent of the pack's surface area by mid-August for soft packs and mid-December for hard packs.

- By May 2016, the number of cigarettes in a pack must not be fewer than 20, except for cigars and cigarettes produced for export.

- Person in charge at points of sale shall be responsible for displaying a notice that clearly says no sales to children under 18. The display of more than one pack, one carton or box of one cigarette brand is prohibited at all points of sale.

- Organizations, individuals shall not organize or allow sale of tobacco within 100 meters of daycare centers, kindergartens, elementary schools, secondary schools, high schools, medical institutes, hospitals, maternity homes, preventive medicine centers and communal health stations.

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