Maintain Smoke-Free Public Places

Despite the regulation mandating smoke-free public spaces, tobacco use remains highly prevalent in Nepal. This is due to the lack of effective implementation and enforcement. Recent studies revealed widespread non-compliance with smoke-free public places laws, posing significant hurdles in the efforts to combat tobacco use. This failure to comply poses a serious risk to public health, particularly for children, women, and the elderly, who are more vulnerable to the hazards of secondhand and thirdhand smoke. 

Tobacco use continues to be a leading cause of preventable deaths across the globe, with Nepal being no different. Annually, around 27,000 people in Nepal die as a result of illnesses associated with tobacco. Nepal’s STEPS Survey 2019 reveals that 28.9 per cent of adults (15-69 years of age) were current users of tobacco, which is 3.8 million total populations. Secondhand smoke, which comprises over 7,000 chemicals, including 70 recognised carcinogens and harmful substances like hydrogen cyanide and arsenic, is harmful in any quantity and can lead to severe health complications such as heart disease, lung cancer, and stroke in adults, as well as Sudden Infant Death Syndrome (SIDS), respiratory problems, and ear infections in children. In Nepal, 22.5 per cent of adults (3.7 million) were exposed to second-hand smoke at their workplace, and an even higher proportion of 33.5 per cent (5.5 million) faced exposure in their homes.

In 2006, Nepal ratified the WHO Framework Convention on Tobacco Control (FCTC) and adopted the Tobacco Product (Control and Regulatory) Act in 2011 to oversee the reduction, control, and regulation of the import, production, sale, distribution, and use of tobacco products. As per the act, public areas include educational facilities, places of worship, restaurants and hotels, government buildings, healthcare institutions, public transport, industries, ticketing counters, childcare facilities, orphanages, senior citizen homes, parks, airports, department stores, public restrooms, hostels, cinema theatres, and sports venues such as stadiums, gyms, or swimming pools. Offenders may face penalties if found guilty. 

A study conducted in Biratnagar Metropolitan City found that just over half (56.4 per cent) of spaces adhered to the law, with particularly low compliance (26.3 per cent) in high-traffic areas such as restaurants and shopping centres. The study also revealed the lack of "no smoking" signage at entrances, active smoking by owners/managers/staff, and the type of establishment. Although many establishments posted signs of "no smoking," the content frequently fell short of regulatory requirements. Many notices only discouraged smoking rather than outright banned it, which highlights the need for effective communication strategies.

Likewise, the observational study conducted in 7 provincial headquarters of Nepal exposed noncompliance with smoke-free public place laws. Notably, 40 per cent of public places were observed using tobacco products in outdoor spaces, and 76 per cent were found selling tobacco products within 100 meters of public premises. The compliance was found comparatively lower in Madesh, Bagmati, and Karnali Provinces. 

These studies urge for more robust enforcement of the current laws and focused actions to improve compliance. Smoking in public places not only poses a risk to public health but also reinforces smoking habits among young people, perpetuating a cycle of tobacco addiction that harms community wellness and places a burden on healthcare systems. 

In order to create a smoke-free environment, we need a multi-sectoral approach for stricter enforcement of existing laws and regulations. Community sensitisation and youth awareness campaigns should be incorporated as an intervention at the grassroots level. We need to make the most of social media, public service announcements, youth involvement, and community outreach to raise awareness, particularly highlighting the health dangers facing vulnerable groups.

After federalism was introduced in 2015 in Nepal, the local government had the authority to develop and enforce policies based on their need and context. The local government could initiate and take the lead in their respective areas. 

It is necessary to devise targeted strategies in sectors with low levels of compliance, such as restaurants and entertainment venues. These may include educational initiatives and collaborations with business owners. The provincial and federal governments play a critical role in prioritising the tobacco consumption widespread and setting the framework for smoke-free initiatives. Comprehensive national legislation providing minimum standards for smoke-free environments is needed. Specific indicators for smoke-free compliance could be established and assessed, like visible signage, designated spaces, etc. This would allow implementing bodies to enforce stricter measures.

It is essential to conduct regular inspections and impose penalties for infractions to ensure adherence to regulations. A systematic technique should be followed by the enforcement mechanism, like a warning for the first breach, graded fines for subsequent violations, and possible license suspension for persistent non-compliance. The local authority should explicitly define clear guidelines on penalty amounts, payment procedures, and appeal mechanisms. For a sustainable funding mechanism, collected fines could be directed towards tobacco control initiatives and enforcement actions. The enforcement body could socially audit information on compliance rate, enforcement actions, and innovative approaches to maintain accountability and transparency. Likewise, an establishment of display with clear “no smoking” signs that comply with legal standards as mentioned by the Act should be mandatory in all public places. 

The other frontline educators in the fight for smoke-free public places are health care professionals. They could provide brief advice, smoking cessation help, and take an active part in lobbying campaigns, legislators with evidence-based information. Whereas health institutions could amplify effect by allocating budget on educating health workers on tobacco cessation and control initiatives.

A multi-stakeholder committee at the local level, including health officials, educators, business representatives, public vehicle vendors, and community members, could be established to monitor and review implementation and address challenges. By enhancing enforcement, refining signage, and applying sector-specific approaches, Nepal can make considerable progress toward achieving smoke-free public areas and safeguarding the health of its citizens.

(The author is a public health practitioner.)