The [in]effectiveness of anti-smoking campaigns

Encouragement, espousing healthier lifestyles may work better than the current policies.

Unsplash | JJ Shev

Unsplash | JJ Shev

With at least MVR30 million raked in as revenue in September alone, the tobacco tax has been faring quite well, although this may not be the objective behind imposing the tax. Receipts of MVR27 million through the sole tax on cigarettes is no meagre number, in the essence of imposing healthier lifestyles on Maldivians. However, the question that remains is, what else has been done?

Since early 2019, three clinics specifically aimed at smoking cessation treatment and programs have been opened in the capital to much fanfare. The clinics report successes, and the Solih Administration has done yet another important task in improving the lives of Maldivians. Yet, realising the numbers have jumped from MVR19 million in August to MVR27 million in September 2021, in terms of import taxes on cigarettes, the impact of such clinics is questionable.

Tobacco smoking is a global pandemic, which is paralleled with the use of dangerous, ‘hard’ drugs, given how tobacco is a narcotic substance. For generations, WHO has been campaigning and imposing pressure on national governments to bring a halt to this problem, and the Maldives has been, on the face of it, trying as well. From increasing the price of a single cigarette from MVR0.30 to MVR5.00 over the course of a decade and half, a deterrent effect was expected. On top of that, pasting grotesque imagery depicting the effects of smoking on smokers and even their children, was another requirement that was followed by Maldivian administrations.

Yet the numbers haven’t been seen to decrease. The Global Youth Tobacco Survey done on the Maldivian populace showed alarming numbers of children and young adults who were entangled by the nicotine snare, and even by 2019, the numbers did not seem to adhere to the expectations. Fear and increased awareness of the risks as deterrents were obviously not working.

Multiple campaigns have taken place over the decades, year in, year out, in an attempt to decrease the number of smokers. Laws have been passed but barely enforced, such as the restriction of smoking within certain vicinities of occupied buildings, ban on smoking at eateries and institutions, yet the numbers still do not budge. 

Imposing such laws have never been the primary or even secondary priority for the Maldives Police Service, as their traffic violation work precedes all other responsibilities (that is a story for another day). The lack of Police involvement ended up with eateries blatantly displaying posters yet allowing smoking in the open area spaces, rendering the restrictions useless.

Does the Solih Administration not notice the abhorrent failure of these policies?

Smoking is a way of escape, the nicotine in the tobacco giving the smoker a temporary boost in dopamine, the feel-good hormone. When a person smokes, nicotine reaches the brain within about ten seconds. At first, nicotine improves mood and concentration, decreases anger and stress, relaxes muscles and reduces appetite. Regular doses of nicotine lead to changes in the brain, which then lead to nicotine withdrawal symptoms when the supply of nicotine decreases. Smoking temporarily reduces these withdrawal symptoms and can therefore reinforce the habit. This cycle is how most smokers become nicotine dependent.

The addiction is most prevalent when it takes complete hold of the individual, causing them bodily pain and yearning if their required dose of nicotine is not met. Prolonged smoking leads to health complications, lung cancer mainly, and also increases anxiety levels, on top of the fact that dependancy increases with usage over time as well. The fact that people still come back to this, regardless of the scientifically viable evidence of the ill-effects of smoking, requires a fresh perspective on this matter.

Deterrence under the fear of taxation, higher costs, the illegality of selling single cigarettes, and the periodic television campaigns are being trumped by a much wider, deeper-entrenched issue. It has been assumed that adults turn to smoking due to mental health issues, mainly depression, although the idea that smoking causes depression has also been purported. 

However, to be adventurous, one can draw a much longer connection between the substandard living conditions in the highly congested Malé, low income, high living costs, all coming together in a the life of a middle-income adult Maldivian, which would lead to deteriorating mental health. While these situations stay unchanged, a legal form of escapism would, inevitably, be the temporary, chemically-induced joy of a cigarette.

Deterrence has not worked. Higher costs have not stopped smokers from still managing to squeeze an extra bit out of their pay-checks to see through their dependancy. A bicycle as a reward for stopping smoking has not made the impact expected. To tackle the problem of nicotine addiction, it may help to treat smokers as patients rather than delinquents, through compassion rather than shame. This approach has worked in countries where dangerous recreational drugs crippled societies, when addiction was decriminalised and addicts treated as victims.

Bright red signboards warning of fines only motivate smokers to be sneakier in their habits. Stomach-turning imagery on cigarette packs motivate smokers to get personalised cases for their cigarette packs. The ever-present damages to health is ignored, or worse, accepted.

An alternative would be to remove those red signboards and replace them with designated smoking areas. These areas don’t have be extremely uncomfortable, rather, built with convenience and easy access. Thus far, anyone would assume this would promote smoking, but what could be different is what is displayed at such designated areas. Posters describing healthier alternatives, messages describing quitting methods, and then hotlines for those wishing to learn more. Photos should include joyful living in the absence of the habit, encouraging people to quit rather than attempting feebly to discourage the masses from their ‘opium’, so to speak.

In this highly digitised world, a mobile phone application can be developed by the Maldivian healthcare operators that are designed with Maldivians in mind. Multiple international software exists, but by being more ‘Dhivehi’ centric, it would build a closer link with the victims of this addiction. This application can actually increase the level of awareness of authorities on the numbers of smokers and their habits, helping them develop further programs and approaches that are more effective.

If the addiction to nicotine-based projects can be seen as a mental health issue rather than a criminal act in certain situations, changes may be seen. Constant red posters, shame and guilt-tripping only breeds resentment rather than the desired effect. Making smoking a taboo increases the peer-pressure element on the younger victims, and these victims would prefer to hide their habits from their family members, further ostracising them from seeking the help they need.

This is one major societal problem that could be handled with a different approach, a different perspective. Those in power owe it to the people to do more comprehensive studies, and to see the root causes of the problem without solely resorting to treating the symptoms. If the struggle against smoking can be handled better, this may open the doors for better management of all other domestic and societal problems as well.

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