Tobacco is the world’s leading cause of preventable death, killing nearly 8 million persons every year. It claims around 3.1 million lives in the World Health Organization (WHO) South-East Asia (SEA) Region alone, which is also amongst the largest producers and consumers of tobacco products. India and Indonesia are among the top five producers of tobacco in the world.

Tobacco is closely linked to poverty and development in the Region. Large-scale tobacco use puts additional burden on national economies. Moreover, with the Region shouldering a high burden of tuberculosis, tobacco control assumes a critical role both at the regional and country level. Tobacco is also a major risk factor for leading non-communicable diseases (NCD) including cancers, cardiovascular diseases, chronic lung diseases and diabetes mellitus.

Out of approximately 1245 million adult tobacco users globally, around 411 million (33%) reside across the Region. More significantly, over 280 million smokeless tobacco users, or 77% of the global total, and around 11 million adolescent tobacco users, or 30% of the global total, currently reside in the Region.

Tobacco-Free Initiative (TFI) at the SEA Regional Office of the WHO has been in the forefront of guiding tobacco control activities across the Member States in the Region. It is coordinating global and regional actions against tobacco to improve health outcomes of people through an innovative multi-sectoral response. All countries in the Region (except Indonesia) are Parties to the WHO Framework Convention on Tobacco Control (FCTC). India and Sri Lanka are Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products. All countries are striving to implement the ‘WHO MPOWER’ package and ‘Best Buys’ for prevention and control of tobacco in letter and spirit. 

As per the fifth edition of the WHO global report on trends in prevalence of tobacco use 2000–2030, the SEA Region is the only WHO Region with sufficient survey data in all Member States to allow measurement and projection of tobacco use trends over the period 2000–2030. On current trends, two countries in the Region (India and Nepal) are likely to achieve at least a 30% relative reduction in tobacco use by 2025, assuming they are able to continue implementing tobacco control measures at the current pace or faster. Only one country (Indonesia) is likely to experience an increase in prevalence, whereas the remaining eight countries of the Region are likely to achieve a decrease in prevalence, albeit less than 30%. 

The Region is doing reasonably well in combating the current tobacco epidemic. To give a perspective, the current tobacco use prevalence decreased from 68.9% in the year 2000 to around 43.7% in the year 2022 among adult men and from 33.5% in the year 2000 to around 9.4% in the year 2022 among adult women. Still, in the year 2022, the Region has the highest average tobacco use prevalence rates among adults globally.

The growing use of novel and emerging nicotine and tobacco products (NENTPs) such as electronic cigarettes or the electronic nicotine delivery systems (ENDS), electronic nonnicotine delivery systems (ENNDS), heated tobacco products (HTPs) and nicotine pouches (NPs), particularly among youth across the Region is particularly worrisome. Also, sheesha/hukkah is becoming increasingly popular among youth in many countries. ENDS are banned in DPR Korea, India, Nepal, Sri Lanka, Thailand and Timor-Leste; these products are regulated in Maldives. DPR Korea, India and Timor-Leste in the SEA Region have completely banned HTPs. 

The Region has shown exemplary leadership in implementing Graphic Health Warnings on tobacco packs. With only one country (Thailand) in the best practice group (large warnings with all appropriate characteristics) in 2011, the Region has incrementally progressed and has as many as seven countries (Bangladesh, India, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) in the elite group in 2023. While Maldives, Nepal and Timor-Leste display the largest-sized health warnings in the world, Thailand is the first country in Asia to implement Plain Packaging on tobacco packs. 

Goal

The Tobacco Free Initiative (TFI) at the SEA Regional Office of the WHO is working towards protecting the present and future generations from the devastating health, social, economic and environmental consequences of tobacco consumption and exposure to tobacco smoke. Our aim is to steadily reduce the prevalence of tobacco use and exposure to second-hand smoke. This is being done by implementing evidence-based tobacco control policies and measures including WHO FCTC, WHO MPOWER Package and Best Buys to meet the WHO GPW 13, NCD Action Plan and Sustainable Development Goals (SDG) targets.