Efforts by the government of Bangladesh to ban public smoking have done little to ease tobacco consumption in the country.
As in neighboring India and Pakistan (and many other developing countries), the culture of smoking is deeply rooted in Bangladesh, particularly among men, regardless of social class or income.
According to data from the World Health Organization, at least 43 percent of Bangladeshi adults above the age of 18 consume tobacco in form or another. (Smoking rates are generally declining in the West.)
On the whole, 44.7 percent of Bangladeshi men and 1.5 percent of women currently smoke tobacco. Moreover, 63 percent of workers are exposed to tobacco smoke at the workplace.
Generally speaking, lower income Bangladeshis smoke more than middle- or upper-income residents, although rates remain high across the board.
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About 57,000 people die of tobacco-related illnesses every year, while 300,000 suffer disabilities in Bangladesh.
Of greater concern, now women -- long prohibited by cultural norms -- are now starting to smoke in greater numbers.
Interestingly, while Islam (Bangladesh’s predominant faith) bans vices like liquor, premarital sex and gambling, it does not explicitly prohibit tobacco use, thereby removing any stigma (at least for men).
Last month, the Canadian Cancer Society chided Bangladeshi officials for failing to introduce photographs showing the dangers of smoking on cigarette packs (as many other countries have done to deter smoking).
"Although 1.1 billion people have been covered by the adoption of the most effective tobacco-control policies since 2008, 83 percent of the world's population are not covered by two or more of these policies," said Gary Giovino of the University at Buffalo School of Public Health.
Within Bangladesh itself, the government has been slow to enforce an anti-tobacco law passed in 2005.
Beyond the deleterious health effects of direct smoking, health advocate Syed Mahbubul Alam said about 10 million women are hurt by second-hand smoking in public places in Bangladesh.
But smoking provides a wide swath of Bangladeshi society (where poverty is pervasive) a cheap form of relaxation. For those who cannot afford regular cigarette packs, especially in rural regions, a homemade smoke called “bidi” (which comprises tobacco flakes rolled in leaves) is available at a cost that is less than a penny.
“There is a need to reduce consumption through higher taxation, because tobacco in any form -- bidi, cigarette or smokeless [snuff or chewing tobacco] -- brings deadly health [consequences], and bidi, being the poor man’s cigarette, is consumed more than [factory-made] cigarettes,” said Rajika Jayatilake, an associate director of U.S.-based NGO Campaign for Tobacco-Free Kids.
According to a study by the Paris-based International Union Against Tuberculosis and Lung Disease, bidi smoking jumped by more than 80 percent between 1997 and 2010 in Bangladesh.
Low tobacco taxes in Bangladesh exacerbate the problem.
The study noted that by taxing bidis, 3.4 million adult smokers would quit and prevent another 3.5 million youths from lighting up.
The cost of factory-made cigarettes is also very cheap -- a pack of 20 cigs in Bangladesh costs only 68 cents, versus $10 in the U.S.
A government study indicated that two-thirds of smokers in Bangladesh start the habit prior to their 17th birthday, suggesting the strong pull of tobacco advertising on youth.
"They [are] hooked up to tobacco, as they find it available and believe they will look more attractive and have more friends," Dr. Iqbal Kabir, coordinator of National Tobacco Control Cell, or NTCC, told BDNews24. "We [in Bangladesh] face [a] dual problem -- large production and high consumption.”
Bangladesh’s immigrant diaspora in the West is also enamored of smoking.
"Around half the UK's Bangladeshi men smoke cigarettes,” Cancer Research UK said.
“When compared with their white counterparts, Bangladeshi men have a 20 percent higher rate of smoking. In public health terms, it's vital that we understand why so many more of these men smoke and develop culturally sensitive ways to work with this community."
Researchers in the UK found that smoking is not only a core part of Bangladeshi (and South Asian) culture but is also promoted by Bollywood movies that depict tobacco use as macho and attractive.
"Bollywood films, which are popular among the UK's South Asians, often show their leading men with a cigarette in their hand as did the Hollywood films of the '40s and '50s," Cancer Research said.
"If the handsome hero is the one seen lighting up in these films, it gives smoking a positive image -- and one that can affect those watching."