More than eight million deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.

Smoking tobacco is second only to high blood pressure as a cause of worldwide mortality. In Jamaica the death rate from non-communicable diseases (NCDs) was about 6.6 times that for communicable diseases. Tobacco was responsible for 11 per cent of all NCDS compared with three per cent of all communicable disease related deaths.

The Jamaica Health and Lifestyle survey (2016-17) (UWI) found the adult prevalence of smoking to be 15 per cent. The NCDA Global School-based Student Health Survey 2017 (13-17 years old) found that the percentage of students who currently used any tobacco products was 15.6 per cent and that the current use of e-cigarettes was 11.7 per cent. The health effects of tobacco use are well documented. This is a very serious public health problem facing us in Jamaica. What is being done in Jamaica to halt and reverse this very concerning trend? Why has it taken almost 20 years since signing the World Health Organization (WHO) tobacco control treaty for evidence-based measures which can halt and reverse this trend to be fully implemented?

Jamaica signalled its intention to protect its population from the impact of tobacco use in 2003 when the country signed the WHO Framework Convention on Tobacco Control (FCTC); a legally binding treaty. A decade later, in 2013, Jamaica implemented the Public Health (Tobacco Control) Regulations which met some of the country’s obligations under the WHO FCTC. This included the provision of smoke-free environments in public places and the implementation of graphic health warnings of cigarette packages.

Following the implementation of the Public Health (Tobacco Control) Regulations in 2013 and its amendment in 2014, a Needs Assessment, led by the Convention Secretariat of the WHO/FCTC, PAHO, the UN Country Team and the Ministry of Health informed the proposal of the Tobacco Control Act (2020) which would improve upon the current Regulations and move closer to satisfying all the obligations of the country in accordance with the WHO FCTC in protecting the present and future generations from the devasting health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.

The proposed Tobacco Control Act recognises that tobacco and e-cigarette consumption require strict monitoring and control measures to achieve the highest standard of health for all. The proposed comprehensive tobacco control legislation was tabled in the House of Representatives on December 1, 2020 and was referred to a parliamentary joint select committee (JSC) for review. This process started in February 2021. There have been delays and the anticipated conclusion of the deliberations by the end of 2022 did not materialise. There was a four-month delay from October to March with the most recent scheduled meeting being again postponed.

The JCTC acknowledges that there may be challenges facing the joint select committee which contribute to delays in the scheduled sittings. We also acknowledge the obligation to demonstrate diligence and strong technical competence in drafting and reviewing the legislation. However, the JCTC is extremely concerned about the continued delay in the legislative process.

Despite some claims in the public space that the Bill is being rushed without due care, it is important to recognise that the process of developing comprehensive tobacco control policy in Jamaica has spanned almost two decades. As such, we share the frustration expressed by the chair at the last sitting of the joint select committee. Notwithstanding the constraints, the legislative process appears to prioritise other types of legislation as opposed to public health legislation. The JCTC notes with concern that each day where there is a lack of comprehensive tobacco control legislation the population is left more vulnerable to the devasting effects of tobacco and nicotine consumption.

There are some misleading arguments circulating relating to the proposed ban on Tobacco Advertisement, Promotion and Sponsorship (TAPS). It is opined that proposed measures to restrict tobacco advertising are overly restrictive and that display bans increase illicit trade which leads to loss of Government revenue. Based on the evidence, these positions are flawed. Display bans have been implemented in many countries, and studies have found that they are effective in reducing smoking prevalence and tobacco use among young people.

The aim of the provisions in the Tobacco Control Bill regarding the ban on TAPS is to protect public health by preventing the marketing of these deadly products, in particular to the youth. It is claimed that illicit cigarette sales represent 21 per cent of the total cigarette market. However, there is no evidence to support this assertion. On the contrary, a study by the Ministry of Finance in 2017 showed that Jamaica’s share of illicit cigarettes was at roughly 8.7 per cent of the total cigarette market. Illicit trade in tobacco products is a border control issue.

There are also efforts to exclude the further regulation of electronic nicotine delivery systems (ENDS) and related products such as e-cigarettes from the proposed legislation. E-cigarettes are not harmless. They contain nicotine, which is addictive as well as numerous harmful chemicals which can cause respiratory problems. It is important to regulate these products and in doing so protect our youth. The WHO has advised that countries which have not banned e-cigarettes should regulate them as harmful products.

Notwithstanding the challenges, tobacco control legislation has been successfully implemented in several countries worldwide. According to the Report on Tobacco Control for the region of the Americas 2022, the implementation of tobacco control laws has resulted in a reduction in prevalence of current tobacco consumption from 28 per cent in 2000 to 16.3 per cent in 2020 — covering 4.7 billion of the world’s population. It is important to note that tobacco control interventions have a 15-year return on investment at 5.37; meaning that for every Jamaican dollar invested in tobacco control, one can expect to see $5.37 return. The economic cost of smoking-attributable diseases in Jamaica is approximately $48.5 billion annually. Tobacco control legislation also makes economic sense.

According to the Jamaica Charter of Rights and Freedom, every citizen has “the right to enjoy a healthy and productive environment free from the threat of injury or damage from environmental abuse and degradation of the ecological heritage.”

Tobacco products are harmful to physical health and the environment not only during their use, but also in the growing of tobacco and in the manufacturing process. Citizens have a right to be protected from tobacco’s deadly effects.

The JCTC fully supports the measures included in the Tobacco Control Bill; measures which are in keeping with Jamaica’s obligations under the WHO/FCTC. We look forward to the legislative process moving forward and be given a sense of urgency that this serious public health issue deserves.

Dr Aggrey Irons is chairman of the Jamaica Coalition for Tobacco Control.