Thursday, July 3, 2003

THIMPU, Bhutan — The Himalayan kingdom of Bhutan is well on the way to becoming the first nation on earth to completely ban the use of tobacco, hot on the heels of the recently adopted global Framework Convention on Tobacco Control, the world’s first anti-smoking treaty.

Bhutan Health Minister Sangay Ngedup told the World Health Assembly in Geneva last month that his nation of 2 million inhabitants is aiming to be smoke-free by the end of the year.

“We will not spare any efforts to stamp out smoking,” he said. “We will set a great example for all other countries to follow.”

Bhutan has adopted an anti-smoking approach combining tradition, religious persuasion and saturation health education across the country to curb the smoking habits of its citizens.

Today, 19 of the country’s 20 districts have declared themselves tobacco-free, and Bhutan has become the first country to ban the sale of tobacco in its airport duty-free stores.

A devout Buddhist nation, Bhutan draws from its religious history to wage a campaign against smoking. In 1629, the warrior monk and founder of modern Bhutan, Shabdrung Ngawang Namgyal, introduced the world’s first-ever prohibition on smoking and chewing tobacco when he banned it from all government buildings and religious centers.

Since then smoking has never been encouraged in Bhutan, but like all developing countries it witnessed a steady increase in smokers during the latter half of the past century as it became exposed to aggressive marketing and ready supply from global tobacco companies.

“Smoking was becoming a serious issue for our country, and the rapid rise in the cancers and other smoking-related diseases was a major economic burden on our public health system,” said Bhutan’s director of health, Dr. Gado Tshering.

Bhutan’s health authorities began to claw back in the war against tobacco when they hit on a novel approach of teaming health workers with religious leaders to travel the country in an influential “Health and Religion Project,” beginning in 1997.

Dr. Gado said the aim of the project was to go to every village and explain to people that smoking is not only bad from a health point of view, but is also a serious religious sin.

“There is no doubt that having the two elements working together, and with strong and vocal support from the king and other government leaders, has led to a large proportion of people giving up smoking,” he said.

Health workers estimated that there may be as few as 25,000 smokers left in the country, down from almost 300,000 a decade ago.

One of those who has given up cigarettes in recent times is Paro resident Chheda Dukpa, a smoker for 17 years.

“We were being told that smoking was bad for our health, but when the district lama came in 2000 and told me I was smoking too much and that it was a big sin, then I promised I would never smoke again, and I never did,” he said.

“It has been great for my health, economically and also for my religious purity.”

The government is proud of its anti-smoking success; evident in the fact that 92 percent of the country is now tobacco-free, with all the prohibitions having been at the instigation of local communities themselves.

“It has never been the government’s policy to bring in strict laws,” said Dasho Pem Dorji, governor of the central district of Wangdiphodrang. “Community leaders came to me in 1999 asking to ban the sale of tobacco, so we drew up a bylaw and introduced fines. It has worked really well, and we haven’t caught anyone in two years.”

Health authorities now have their sights firmly set on the last remaining area where tobacco is legally available, the nation’s capital city, Thimpu.

Health Minister Ngedup acknowledges that Thimpu, with its large youth population, will be tough, with smoking popular in bars and clubs filled with young Bhutanese.

“Nobody can tell me not to smoke,” said Tsehring Dorji, 19, partying with friends at a trendy new nightclub. “It is my right to do what I want.” His friends, all of whom were smoking, agreed.

Still, the social stigma attached to smoking has pushed cigarettes off the shelves of major stores in the city, and tobacco products are available only under the counter from small suburban shops.

“I don’t like to display the cigarettes as people come and tell me not to sell them, and I am ashamed, but people still want to buy them,” said Jaya, a local shopkeeper. “Many people look guilty now, and most buy their cigarettes at night.”

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