Located in northwest Pakistan, Khyber Pakhtoonkwhaa (KP) has traditionally been known as one of the country’s most important tobacco growing regions. It is home to both the Pakistan Tobacco Company and the Khyber Tobacco Company, which has been operational for fifty years. Along with wheat, maize, rice, and a variety of fruits, tobacco has been an important cash crop for Pakistan even though it is grown on just 0.21 percent of the country’s total irrigated land. Its value may be soon be in decline as public health advocates have secured an important tobacco control victory in this unlikely region.
On 15 December 2020, the provincial government received approval for a tobacco control roadmap meant to be incorporated into all health programmes under the Directorate of General Health Services guidance. While this change is, of course, unlikely to occur overnight, KP has taken a critically important first step in limiting the harmful effects of tobacco.
“Khyber Pakhtoonkwhaa has historically been a very challenging environment—a difficult place to secure strong support for and implementation of tobacco control policies,” said The Union’s technical advisor Khurram Hashmi. “Pakistan became a party to the Framework Convention on Tobacco Control (FCTC) in 2005, but the tobacco growing regions in particular have opposed and been particularly averse, for a good fifteen years, to creating legislation and promoting practices that protect Pakistanis from the dangers of smoking.”
The first provincial tobacco control cell (KP-TCC) was established in 2013, with technical support from The Union. Over the subsequent seven years, advocates faced significant challenges. There is generally strong support for the tobacco industry, and parliamentarians, politicians, and other influential stakeholders are involved in the entire tobacco supply chain—from farming and manufacturing to trading (including cross border smuggling) and selling. Policy makers also have a vested interest in tobacco cultivation, viewing it as important to agriculture and trade.
“We have no doubt the tobacco industry and its front groups will renounce the roadmap and work tirelessly to refute it,” said Hashmi. “But this really is a remarkable achievement and just might be the beginning of KP turning the tide on an epidemic that kills over 100,000 Pakistanis every year.”
Working in close collaboration with The Union, the KP-TCC spent the period between 2018-2019 drafting the roadmap based on the World Health Organization’s MPOWER strategies. Project partner Tobacco Smoke Free Project (TSFP) and civil society organizations Human Resource Development Organization (HRDO) and Society for Alternative Media and Research (SAMAR) also made important contributions. The final product enumerates several key activities and mandates: data collection via survey to determine the extent of KP’s tobacco epidemic; creation of proper district-level M&E systems to ensure enforcement of comprehensive TC and smokefree policies; measures to address passive or secondhand smoke; cessation support at major health facilities; tobacco control messaging in all public health projects and media campaigns; support for the federal government’s plain packaging/pack reform initiative; and enforcement of all tobacco control laws, including tobacco advertising promotion and sales and pictorial health warnings.