𝐓𝐡𝐞 𝐈𝐦𝐩𝐚𝐜𝐭 𝐨𝐟 𝐋𝐢𝐟𝐭𝐢𝐧𝐠 𝐭𝐡𝐞 𝐓𝐨𝐛𝐚𝐜𝐜𝐨 𝐁𝐚𝐧 𝐢𝐧 𝐁𝐡𝐮𝐭𝐚𝐧: 𝐀 𝐌𝐮𝐥𝐭𝐢𝐟𝐚𝐜𝐞𝐭𝐞𝐝 𝐏𝐞𝐫𝐬𝐩𝐞𝐜𝐭𝐢𝐯𝐞

…𝒍𝒊𝒇𝒕𝒊𝒏𝒈 𝒕𝒐𝒃𝒂𝒄𝒄𝒐 𝒃𝒂𝒏 𝒉𝒂𝒔 𝒍𝒆𝒅 𝒕𝒐 𝒎𝒊𝒙𝒆𝒅 𝒆𝒇𝒇𝒆𝒄𝒕𝒔, 𝒃𝒂𝒍𝒂𝒏𝒄𝒊𝒏𝒈 𝒓𝒆𝒅𝒖𝒄𝒆𝒅 𝒊𝒍𝒍𝒆𝒈𝒂𝒍 𝒕𝒓𝒂𝒅𝒆 𝒘𝒊𝒕𝒉 𝒓𝒊𝒔𝒊𝒏𝒈 𝒑𝒖𝒃𝒍𝒊𝒄 𝒉𝒆𝒂𝒍𝒕𝒉 𝒂𝒏𝒅 𝒆𝒏𝒗𝒊𝒓𝒐𝒏𝒎𝒆𝒏𝒕𝒂𝒍 𝒄𝒐𝒏𝒄𝒆𝒓𝒏𝒔.

By Pema Chozom

In July 2021, Bhutan took a significant step by lifting its long-standing ban on the sale of tobacco products, a prohibition enforced since 2004. This policy shift aimed to reduce the illegal trade of tobacco and address public health concerns exacerbated by the COVID-19 pandemic. Three years later, the effects of this policy change are visible across various facets of Bhutanese society.

From a personal standpoint, the lifting of the ban has elicited mixed reactions. Pema, a 28-year-old shopkeeper in Thimphu, expressed relief over the decision. “Previously, customers had to turn to the black market to obtain tobacco products, often at exorbitant prices. They can now buy these legally, ensuring higher quality and safety. For many people, the legal availability of tobacco has reduced financial stress and the risks associated with illegal products.”
Sanjana, a 31-year-old who owns a pan shop in Thimphu, said, “Yes, our business is doing well. There are increasing numbers of customers who buy cigarettes or chewing tobacco. However, I am concerned about the number of children who come to buy these products because the majority of them are very young and may be in school. But I cannot risk losing my customers because I need to make a living too.”

“I am well aware of the litter and waste management issues that can arise. I tell my customers to smoke in the corner and properly dispose of their cigarette butts in the trash. I clean the area in front of my shop every morning,” she added.
While business owners share a little relief over the lifting of the tobacco ban, parents of young children are concerned about its easy accessibility.

Wangchuk, a 45-year-old single father of two, expressed his views as a concerned father. He said, “Today, it has become a sort of trend among the youth to start smoking at a young age. Some people stick to smoking, while others progress to using other drugs. I have a son in lower secondary school, and I am concerned that he will become involved as well. It is easily accessible, and you never know when he will start using one.”

Dema, a 39-year-old mother of three, expressed her concerns, “Tobacco products are easily accessible in the market. I am concerned about the impact it may have on young children. Teenagers now have easier access to cigarettes, and I am concerned about the long-term health consequences.”

Tobacco use poses serious public health risks, affecting almost every organ in the body. It is a leading cause of respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), cardiovascular diseases, cancers, and oral health problems. Smoking has a negative impact on reproductive health, weakens the immune system, accelerates skin aging, and increases overall mortality.

Efforts to reduce tobacco use through public health initiatives are critical in addressing these serious health consequences. Quitting smoking is the most effective way to improve health and lower the risk of these serious conditions.

The social implications of lifting the tobacco ban are complex and multifaceted. Choki Dorji, a 22-year-old from Samdrup Jongkhar, noticed a shift in social norms regarding tobacco consumption. He admitted, “It has become a habit for me, but I have not noticed any changes in my health so far despite sharing an environment with smoker friends. However, I have seen an increase in tobacco consumption in communities, particularly among youth, as a result of peer pressure and legality. Smoking was stigmatized prior to the ban’s lifting. It is becoming more acceptable, and I am seeing more of my peers smoking openly.”

Jigme Gyeltshen, a 21-year-old from Bumthang, is a regular smoker who has expressed his concerns. He said, “As a regular smoker, tobacco use has become a part of my daily routine. The lifting of the tobacco ban has had an impact on people’s social attitudes, both positively and negatively. Tobacco use was once highly stigmatized and prohibited by law, but now that it is easily accessible and ubiquitous, people have accepted us and shared positive affirmations to help us quit this bad habit, allowing smokers like me to control our habits. On the darker side, youths as young as 14 to 21 years old are seen smoking due to its easy availability in the market, low cost, peer pressure, and Western influences, which leads to habitual use.”

“I have seen numerous cigarette butts and packets littering toilets, restaurants, and public areas, resulting in unsanitary conditions. This increased availability of tobacco products has a negative impact on nonsmokers and undermines environmental sustainability,” he added.

Melan Rai, a 20-year-old from Chhukha, said, “I personally do not use tobacco. However, I see that students as young as lower secondary school have begun to participate.”

“Higher tobacco consumption has increased environmental stress. Cigarette butts, cigarette, and chewing tobacco packets can be found throughout the town. I am more concerned about how public smoking can potentially harm others in society. Many studies have found that smoking is more harmful to passive smokers than active smokers. It has been shown that passive smokers can develop general health risks ranging from allergies or irritation, headaches and nausea, to respiratory problems and cancer at worst,” he said. His concerns highlight the ongoing debate over balancing accessibility with the need to protect public health.

Sangay, a 26-year-old healthcare professional from Lhuentse working in Thimphu, stated, “I am deeply concerned about the rise in tobacco consumption because of the profound implications for public health. Tobacco use is the leading cause of preventable diseases, including lung cancer, heart disease, and COPD. The growing number of young people starting to smoke is particularly concerning, as early initiation leads to higher rates of addiction and long-term health issues. Furthermore, the health risks do not only affect smokers; secondhand smoke poses serious health risks to nonsmokers, including children and pregnant women, resulting in respiratory infections and other serious conditions.” This normalization of tobacco use is a cause for concern among health advocates, who fear it could lead to higher smoking rates and associated health issues.

Conversely, Kinga, a 27-year-old healthcare professional from Paro working in Phuentsholing, argues that the regulation of tobacco sales has brought some positive changes. “By legalizing and regulating tobacco, we have been able to implement strict age verification procedures and health warning labels on packaging. These measures were impossible to implement when sales were illegal,” she explained. In some respects, the transition to a regulated market has enabled better tobacco control and education.

The environmental consequences of increased tobacco sales have not gone unnoticed. Bhutan, known for its commitment to environmental conservation, is facing new challenges as legal tobacco consumption grows. The Thromde Office stated, “Since Bhutan lifted its ban on tobacco sales in July 2021, there have been noticeable changes in tobacco-related litter in public areas. The increased availability of tobacco products has led to increased public consumption, resulting in an increase in discarded cigarette butts and packaging, particularly in shops and public places. This trend is consistent with the overall increase in tobacco use.”

One of the most noticeable effects is an increase in tobacco-related litter. Cigarette butts, packaging, and other tobacco product waste are increasingly common in public areas. These items contribute to land pollution, particularly cigarette filters, which are made of cellulose acetate, a type of plastic that degrades slowly and can remain in the environment for many years. Cigarette butts frequently end up in waterways as a result of direct disposal or runoff. These butts contain harmful substances like nicotine, heavy metals, and other chemicals that can leach into bodies of water, endangering aquatic life and contaminating drinking water sources.

Furthermore, improperly discarded cigarette butts can start fires, particularly in forested or dry areas. These fires can cause significant environmental damage, such as habitat destruction and biodiversity loss.
“Cigarette butts are difficult to clean up completely due to their small size and frequently remain on the ground even after thorough cleaning. People should not dispose of them carelessly. Organizations must determine which public places should prohibit smoking and designate specific smoking areas. People are now smoking wherever they want,” he added.

There are efforts underway to address these environmental concerns. The government has launched public awareness campaigns about the environmental dangers of tobacco waste and is working to impose stricter littering penalties.
The Bhutan Food and Drug Regulatory Authority (BFADRA) is responsible for regulating and controlling food and drug safety, ensuring adherence to standards to safeguard public health.

According to a BFADRA inspector, “The Tobacco Control Act of Bhutan, 2010, prohibited the purchase and sale of tobacco products and imposed strict import restrictions, but allowed individuals to import limited quantities for personal use subject to heavy taxes. However, when the tobacco ban was lifted in 2021, the prohibition on buying and selling tobacco was also lifted, causing a number of issues. We now face difficulties enforcing public smoking bans, and the number of smokers appears to be increasing. Our limited staff is struggling to manage this growing issue across the country.”

“Currently, public smoking, which is prohibited and subject to penalties, is widespread. We have been conducting awareness campaigns in various districts, informing people about no-smoking zones and the corresponding fines for violations. There is a common misconception that since the tobacco ban was lifted, public smoking is now legal. This is incorrect. Tobacco sales are permitted, but smoking in public places is still prohibited. We have notified the public of this through various means, including broadcasting the tobacco law,” he added.

“We continue to advocate and educate the public about the dangers of public smoking, as well as the effects on nonsmokers and the overall health and environment. It is crucial to implement and enforce these measures to reduce tobacco consumption and mitigate its negative effects. Education and awareness campaigns play an important role in promoting smoking cessation and encouraging healthier lifestyle choices,” he concluded.

Three years after the tobacco ban was lifted, Bhutan finds itself at a crossroads. While the decision to lift the ban has had some positive effects, such as reducing illegal trade and ensuring safer products, the increase in tobacco consumption, particularly among young people, is a cause for concern. The public health risks associated with tobacco use remain significant, and the social and environmental consequences are undeniable.

To tackle these challenges effectively, Bhutan needs to delicately balance regulatory measures with comprehensive public health education. It is imperative to intensify efforts in raising awareness about the hazards of smoking, particularly among young people. Strict enforcement of no-smoking areas and robust litter control strategies are crucial steps to minimize the environmental repercussions.