Clear The Air News Tobacco Blog Rotating Header Image

Myanmar

Stubbing out tobacco usage

Myanmar is experiencing tremendous economic growth. With a young, growing population and a liberalised economy, it has been slated as one of 20 “markets of the future” that will offer the most opportunities for consumer goods companies.

http://www.mmtimes.com/index.php/opinion/24471-stubbing-out-tobacco-usage.html

Tobacco has been identified as one of Myanmar’s top 20 key industries. Its market size is worth an estimated US$450 million – up there with dairy products and dried processed foods. The compound annual growth rate from 2013-18 for tobacco is 16 percent, overtaking apparel (14pc) and consumer appliances and electronics (15pc).

With market liberalisation, British American Tobacco (BAT) re-entered Myanmar in 2013 a decade after it exited the country. When re-establishing itself in the country, it announced that it will invest $50 million in a tobacco manufacturing factory. BAT already has a significant 22pc market share in the growing cigarette market.

Myanmar currently has over six million smokers. Like other Asian countries, a high percentage – 44pc – of adult men smoke. This number is set to increase given the growing adolescent smoking population.

In 2010 cigarette sales in Myanmar were about 13 billion sticks, but these sales are projected to almost double to 25 billion sticks in 2018. Myanmar’s projection is the highest increase among all ASEAN countries. This is bad news for the public health system given that Myanmar already has more than 70,000 tobacco-related deaths annually. Myanmar also has the lowest Human Development Index among Asian countries with a global ranking of 148 out of 188 and public health expenditure is a low 1.8pc of GDP.

Myanmar is a typical developing country in that the bulk of smokers are from the lower-income category. Cigarettes are also extremely cheap in Myanmar and within easy reach for the poor. The most popular pack of cigarettes costs only $0.57. A survey on smoking indicates that about 40pc of Myanmar’s youths can purchase cigarettes from a store. Even more worrying is that 15pc of non-smoking youths have indicated that they intend to start smoking next year – again the highest percentage in the ASEAN region.

Myanmar has some basic tobacco control measures in place to address the problem. Since ratifying the global tobacco treaty in 2004 – the WHO Framework Convention on Tobacco Control (FCTC) – the country has passed legislation banning all tobacco advertising and making public places smoke-free, but there is still plenty of room for improvement.

Myanmar needs to further increase taxes on tobacco products and put it out of reach for the poor and youths. While tobacco advertising and promotions are banned, there are loop holes that can be exploited. Myanmar faces sleek marketing tactics from transnational tobacco companies who take advantage of government officials’ inexperience.

For example, in 2016 Myanmar passed legislation requiring a pictorial health warning on tobacco packs. Japan Tobacco International placed an announcement in a newspaper in October on how it will be complying with the Health Ministry’s requirements. The announcement showed photos of all its packs with and without the pictorial health warnings – an outright advertisement for its brands.

Penalties for violations are miniscule for wealthy tobacco companies. Even if authorities act against a company for non-compliance of pictorial health warnings, the fine is a paltry $7.95 for the first offence.

This is where civil society groups come into play, they should play a more prominent role in exposing the unethical and exploitative practices of transnational tobacco companies operating in Myanmar.

It is important for Myanmar to keep abreast of ASEAN countries’ achievements on tobacco control measures. Most countries have already banned advertising at points of sale. Brunei, Thailand and Singapore have banned pack displays at retail outlets.

These are the next steps for tobacco control in Myanmar. But Myanmar lacks the resources needed for enforcement – particularly staff. It is the only country in the ASEAN region that has not committed national funds for tobacco control efforts. Strengthening tobacco control measures and allocating more resources to enforcement will send a strong message to the public and private sector that the government is serious about protecting public health from the ravages of tobacco.

Myanmar ranks last in ASEAN tobacco control study

With out-of-date policies, cheap access, and ubiquitous usage, Myanmar ranks last in tobacco control, according to a survey of the region released last week.

http://www.mmtimes.com/index.php/national-news/23722-myanmar-ranks-last-in-asean-tobacco-control-study.html

The Southeast Asia Tobacco Control Alliance (SEATCA) study measures each of the ASEAN countries’ implementation of the World Health Organization (WHO) framework for tobacco control. Myanmar scored 45.7 out of 100, falling just behind the Philippines and Laos. Singapore topped the list with a score of 80.5.

Myanmar adopted the Control of Smoking and Consumption of Tobacco Product Law on May 4, 2006, to reduce the number of people using tobacco and tobacco-related products. The law contains rules on non-smoking areas and regulations to control the sale, production and advertising of tobacco products.

However, according to the SEATCA survey, Myanmar lags behind other countries in its banning of smoking in indoor workspaces, including bars and restaurants, and indoor public places. It is the only country that has not regularly updated its tobacco control policy and strategy, according to the study.

While it falls in the middle of the pack for taxation of tobacco products, Myanmar stands alone as the only country in the region that does not spend any public money on tobacco control, according to the study. And, despite the taxation, cigarettes are still fairly cheap: K2000 for a pack of Regular Marl¬boros and K800 for a pack of Red Ruby, the most popular brand in the country. Red Ruby’s are the cheapest cigarettes in the region.

The country is also middling in its ability to provide education or cessation programs.

According to the report, the government does not allow tobacco industry officials to sit on government committees or advisory groups that are deciding health policy.

However, the government does give preferential treatment to the tobacco industry, according to the report.

Like many of the other countries in the region, regulation of tobacco advertising and sponsorship goes unenforced in many mediums. Tobacco ads are banned in television, movies, print media, and billboards but there is no enforcement of tobacco advertising bans on the internet.

Regulations on the packaging of tobacco products, on the other hand, are fairly strong when compared with other countries in the region. A majority of the packaging is dedicated to raising awareness about the dangers of using tobacco.

In February, the government announced that new regulations would go into effect on September 1, requiring that health warnings and graphic photos illustrating the dangers of tobacco use must appear on all brands of cigarette and other tobacco products manufactured in Myanmar.

However, the tobacco companies asked for a six-month reprieve. The Department of Public Health told The Myanmar Times that following appeals from the companies – which cited a lack of awareness among retailers that they could face punishment if they sell incorrectly packaged products – the rules would not go into effect until February 2017.

Once the new law is in full effect, anyone involved in the production, distribution or sale of tobacco products that do not contain a graphic warning label could be subject to a fine of between K10,000 (US$7.95) and K30,000 for a first offence.

According to a 2014 survey, the rate of tobacco use in Myanmar is 26.1 percent of the population, including 43.8pc of men and 8.4pc of women.

Anti-tobacco law to be upgraded with harsher punishments, fines

One decade after a law to control tobacco use went into effect, the government is finally pledging to give teeth to the legislation. Violators could face increased fines and even prison time, health officials warn.

http://www.mmtimes.com/index.php/national-news/22333-anti-tobacco-law-to-be-upgraded-with-harsher-punishments-fines.html

Dr Thuzar Chit Tin, director of the Ministry of Health and Sport, said the 2006 Control of Smoking and Consumption of Tobacco Products Law is in the process of being updated, with fines raised to reflect the current economy and act as a bigger disincentive.

Under the existing law, advertising tobacco products, distributing cigars, cigarettes or other tobacco products free of charge, sponsoring sports and other exhibitions, or publicising tobacco by any means is subject to a fine ranging from K20,000 to K50,000 for the first offence, rising to a maximum of K200,000 or two years in prison for subsequent offences. Penalties also apply to anyone who tries to obstruct or assault officials trying to prevent smoking in a no-smoking zone.

“Amendments will be made to the law to upgrade the punishments” and bring them into conformity with current conditions, said Dr Thuzar Chit Tin on September 1.

Myanmar launched a tobacco-free program in 1980, after introducing its first anti-smoking legislation in 1959 with an act that banned smoking in theatres.

Though the consumption of cigarettes and tobacco products decreased in 2007 after the control of smoking law came into effect, usage subsequently increased, apparently in part because of lax enforcement, particularly with regard to the ban on selling cigarettes within 100 feet (30.5 metres) of a school, or selling single cigarettes. Tobacco companies were among the first to quickly enter the country after the government began relaxing import restrictions.

According to a 2014 survey, the rate of tobacco use in Myanmar is 26.1 percent of the population, including 43.8pc of men and 8.4pc of women. About 80pc of smokers use tobacco every day. About 7pc of students smoke, and 17pc use cigars or other forms of tobacco.

The rate of betel use is higher, with 43pc of the population consuming betel, including 62pc of men and 24.1pc of women.

One of the problems in countering consumption, Dr Thuzar Chit Tin said, is that tobacco, betel and pickled tea leaves are considered traditional leisure activities, and their use seems to be rising. “We need to educate the public about the dangers of smoking,” she said.

However, she said, the tobacco industry is very powerful and influential compared to the resources available to the government. “The tobacco industry influences policymakers and the media. They have the financial resources to ensure that what the industry says gets better media coverage than the information we provide.”

She added that the updated law could also apply some of the tax derived from tobacco products to the health sector and to public education drives intended to reduce smoking.

In 2010 the government doubled the tax on cigarettes to 100 percent, while taxes on other tobacco products, including cheroots, were raised to 50pc in 2012. Additionally, shops are required to charge a 5pc sales tax. But according to the Internal Revenue Department, most cigarette producers do not pay the tax because of a lack of enforcement.

But measures to scale up the warning labels on tobacco products have gained traction. In 2014, the Myanmar Cigarette and Tobacco Products Consumption Controlling Central Committee added picture and text health on packaging and branding tobacco products. In June, the Ministry of Health announced that warning labels must appear on all brands of tobacco products in Myanmar from September.

The ministry released a notification in February calling for the implementation of the 2006 law. But the six-month period that was to have elapsed before enforcement began has been extended a further six months following appeals from the industry. The law is now expected to come fully into force in March 2017.

Translation by Thiri Min Htun

With return of Big Tobacco to Myanmar, smoking rates on the rise

Since the return of Big Tobacco to Myanmar en masse in 2013, smoking rates have increased markedly. Tobacco control experts warn that the firms’ sophisticated strategies are likely to push more people into the clutches of addiction.

http://sea-globe.com/myanmar-big-tobacco/

From the backseat of a traffic-stranded cab attempting to travel from Yangon’s airport to a city hotel, Myanmar’s burgeoning love affair with cigarettes quickly starts coming into focus.

Vendors peer into car windows, peddling cigarettes. Calling one over, the cab driver buys two individual filter tips and lights up, eagerly espousing the low cost of his favourite brand, Red Ruby.

In the city’s central downtown area, kiosks selling everything from a single brand to a staggering array of tobacco products are situated on nearly every street corner. And the smokers aren’t far behind. Cigarette vendor Sein Win, 46, is adamant that more people have taken up the habit in recent years, although this has not translated into an increase in customers – he blames the sheer number of salespeople trying to ride the boom. “My sales rate is lower than before because there are new vendors opening,” he said.

While many in the country have traditionally preferred chewing betelnut or smoking cheroots – local cigars that turn popular teashops into a haze of smoke as customers puff away with aplomb – Myanmar is currently seeing a rapid increase in the popularity of manufactured cigarettes as political change swings open the country’s doors to investment.

Tobacco firms were among the first global brands to descend upon Myanmar in 2013 after its quasi-civilian government began implementing reforms. Japan Tobacco International (JTI), British American Tobacco (BAT) and the state-owned China Tobacco now all have a presence there.

It’s little wonder. According to the WHO, 45% of adult males and 8% of women used some form of tobacco each day in Myanmar in 2012, although just a tiny fraction – an estimated 4% – smoked cigarettes, meaning that a large potential market was ripe for the taking. Meanwhile, in 2013, market research firm Euromonitor identified Myanmar as one of the top 20 potential markets for consumer goods companies globally, on account of increased investment along with population growth – and named tobacco as one of the seven key industries in the nation of about 55 million people.

According to Than Sein, the president of People’s Health Foundation in Myanmar, there are now 62 brands of cigarettes clamouring for a share of the country’s tobacco market, compared to the 10 or 15 brands that were available in the 1990s.

Judith Mackay, a senior advisor at Vital Strategies who has been a leading advocate for tobacco control for 30 years, said that as smoking rates have fallen in developed countries, Big Tobacco has turned its attentions to new horizons.
“They really tend to go all out to get any smokers they can,” she said. “The low- and middle-income countries are particular targets.”

“Typically, these markets have high smoking rates and, in many cases, are trying to attract investment,” added Ross Mackenzie, a public health expert at Macquarie University in Sydney. “Transnational tobacco corporations take advantage of globalised production and distribution networks and economies of scale to promote their brands.”

BAT, which had a joint venture with a military-owned company until leaving Myanmar in 2003 following a concerted campaign by overseas human rights activists, has invested $50m to build its factory on the outskirts of Yangon to begin producing its London brand of cigarettes – the top-selling brand before Red Ruby took its mantle in the intervening years.

“THE FOREIGN TOBACCO COMPANIES BRING IN VERY SOPHISTICATED ADVERTISING, PROMOTION AND SPONSORSHIP THAT THE [LOCAL] MONOPOLIES DON’T HAVE”

The return of BAT, and establishment of others, is “highly significant” in terms of changing cigarette consumption habits, according to Mackay, who said these transnational tobacco companies were on a different level to government-affiliated firms and monopolies. “The foreign tobacco companies bring in a new scenario of very sophisticated advertising, promotion and sponsorship, which in general the monopolies don’t have; they bring with them much more sophisticated obstruction to legislation.”

According to May Myat Cho, the Myanmar country coordinator for the Southeast Asia Tobacco Control Alliance (SEATCA), official sentinel surveys clearly show that male smoking rates dipped from a peak of 48.6% in 2003, the year BAT left Myanmar, before climbing to 46.8% when the firm returned in 2013 and increasing sharply to 60.3% last year.

Similarly, the surveys showed female smoking rates were at 13.7% in 2003, but this had increased to 18% in 2015.

Women and young people, in particular, are in the crosshairs for tobacco firms. Vendor Sein Win said most of his customers are aged between 15 and 20, but his youngest is just ten years old. “There is no age limitation for selling cigarettes here. If an underage person comes and asks to buy cigarettes, we have to sell to them. We don’t want any problems.”

He is mistaken: Myanmar banned the sale of tobacco to minors aged under 18 in 2006, when the government introduced a tobacco control law that also prohibits all forms of tobacco advertising, the sale of individual cigarettes and requires health warnings be printed on tobacco products.

However, according to experts, Big Tobacco is using myriad tactics to circumvent this legislation, which, despite government efforts, is not being implemented by authorities on the ground. “They take advantage of limited and/or poorly [enforced] tobacco control regulations in aggressive marketing campaigns that include some combination of traditional advertising and sponsorship of sports, music and cultural events, which can also lead to access to policymakers,” MacKenzie said of the firms’ strategies globally.

In a recent interview with Frontier Myanmar magazine, BAT Myanmar managing director Rehan Baig denied that his company was using advertising in the country.

SEATCA’s Myat Cho disputed this, saying that as well as selling and distributing cigarettes at teashops and restaurants, “they are also distributing complimentary napkins, ashtrays and lighters at teashops, and actually with the brands [visible]”. She added that cigarette kiosks often display promotion posters and some companies, she cited JTI in particular, were known to distribute free cigarettes at major religious festivals – both practices that are outlawed.

One of the more insidious, less-well-known avenues used by Big Tobacco to influence government policy is via the International Tax and Investment Centre (ITIC), which Mackay described as a “front organisation” for the alcohol, tobacco, oil and food industries that sets up secretive meetings with government officials worldwide to pressure them into keeping taxes low. She added that there is plenty of evidence the organisation is active in Myanmar.

“They have their meetings in the House of Lords in London; they’re a very, very powerful group of retired finance ministers and customs officials, and they’re using other front organisations and challenging governments. And when they get into a country, particularly, it seems to get even worse,” she said. “What they do is, they work with the ministry of finance, so the health people often… have no knowledge of them,” she added.

Despite this, Myat Cho is optimistic that the country’s new health minister, Myint Htwe, a former director of the non-communicable diseases department at the WHO’s regional office, will draw upon his experience to tackle tobacco use in Myanmar. Last year, the government increased taxes on tobacco products from 50% to 60%, and pictorial health warnings – shown to be effective in deterring smokers in other countries – are due to be introduced in September.

“The tobacco industry already wrote letters to the Ministry of Health to delay the implementation, so we’re expecting those challenges, but we’re working closely with the ministry and providing our assistance [with] whatever they need, so I think it will be effective,” she said. “And also the taxes on tobacco changed from ex-factory price to retail price, so the revenue will be increased, but whether it will be immediately effective on the reduction of smoking – they need to increase the tax higher.”

Regardless, in-country production, which makes cigarettes much cheaper and more accessible than foreign imports, is ramping up. At the height of military rule in the 1990s, approximately 500m sticks were produced in the country annually, according to official government statistics provided by SEATCA. This jumped to 3 billion by 2005, and it is estimated that 5 billion were manufactured last year. An increasing tide of production is difficult to stem, especially while the novice government has serious political, economic and social challenges it must now manage.

“The difficulty is that tobacco tends to be a rather low priority” in comparison to other issues, said Mackay. “The other difficulty is that, up to now, countries like Myanmar have been fighting infectious diseases such as TB, malaria and maternal mortality and infant mortality. They have no or very little experience dealing with the sophisticated tobacco companies; it’s a different paradigm, dealing with a vector that is not a mosquito, that is not a bacteria.”

The upshot, she added, is that a growing number of people in Myanmar are likely to take up cigarettes or swap their traditional tobacco for manufactured filter tips. “We’re certainly not talking within a year or two, but I would suspect if you were to review this in ten years’ time, you certainly might find a shift in the cigarettes people are smoking, particularly the young, and particularly the better educated; that would be the pattern.”

University student Kaung Htet Lin, 16, started smoking about a year ago amid peer pressure. Now, he struggles to kick the habit. “I want to quit, but I can’t because if someone smokes in front of me, I want to smoke and inhale too,” he said.

And in his changing preferences – from a local brand to one owned by tobacco giant BAT – could lie an early glimpse of the future: “Mostly I smoked Red Ruby; now I’m smoking Lucky Strike.”

Smoke gets in your eyes

The long, strange history of global tobacco use

Some smoke it, some chew it, others curse it. Regardless of its toxic health effects, tobacco has been a global pastime for centuries. Its origins are in the Americas, where the World Health Organisation (WHO) claims cultivation of the plant began as early as 6,000 BCE. Within 150 years of European settlers arriving to the ‘New World’, the tobacco plant was being used around the globe.

While in past centuries snuff and cigars were among the more popular methods of enjoying tobacco, the early 1900s ushered in mass cigarette production, and the modern cigarette was born in 1913 with R.J. Reynolds’ Camel brand. Smoking subsequently grew in popularity throughout the 20th century.

In 1951, however, the first large-scale study of the relationship between smoking and lung cancer was produced, followed by mounting evidence of the associated health risks. Smoking rates in industrial countries have dropped off significantly over the past 60 years, but tobacco use in the developing world remains a major health concern.

The WHO predicts that tobacco use will cause 8.4 million deaths annually by 2020, 70% of which will occur in developing countries.

With return of Big Tobacco to Myanmar, smoking rates on the rise

Since the return of Big Tobacco to Myanmar en masse in 2013, smoking rates have increased markedly. Tobacco control experts warn that the firms’ sophisticated strategies are likely to push more people into the clutches of addiction

http://sea-globe.com/myanmar-big-tobacco/

From the backseat of a traffic-stranded cab attempting to travel from Yangon’s airport to a city hotel, Myanmar’s burgeoning love affair with cigarettes quickly starts coming into focus.

Vendors peer into car windows, peddling cigarettes. Calling one over, the cab driver buys two individual filter tips and lights up, eagerly espousing the low cost of his favourite brand, Red Ruby.

In the city’s central downtown area, kiosks selling everything from a single brand to a staggering array of tobacco products are situated on nearly every street corner. And the smokers aren’t far behind. Cigarette vendor Sein Win, 46, is adamant that more people have taken up the habit in recent years, although this has not translated into an increase in customers – he blames the sheer number of salespeople trying to ride the boom. “My sales rate is lower than before because there are new vendors opening,” he said.

While many in the country have traditionally preferred chewing betelnut or smoking cheroots – local cigars that turn popular teashops into a haze of smoke as customers puff away with aplomb – Myanmar is currently seeing a rapid increase in the popularity of manufactured cigarettes as political change swings open the country’s doors to investment.

Tobacco firms were among the first global brands to descend upon Myanmar in 2013 after its quasi-civilian government began implementing reforms. Japan Tobacco International (JTI), British American Tobacco (BAT) and the state-owned China Tobacco now all have a presence there.

It’s little wonder. According to the WHO, 45% of adult males and 8% of women used some form of tobacco each day in Myanmar in 2012, although just a tiny fraction – an estimated 4% – smoked cigarettes, meaning that a large potential market was ripe for the taking. Meanwhile, in 2013, market research firm Euromonitor identified Myanmar as one of the top 20 potential markets for consumer goods companies globally, on account of increased investment along with population growth – and named tobacco as one of the seven key industries in the nation of about 55 million people.

According to Than Sein, the president of People’s Health Foundation in Myanmar, there are now 62 brands of cigarettes clamouring for a share of the country’s tobacco market, compared to the 10 or 15 brands that were available in the 1990s.

Judith Mackay, a senior advisor at Vital Strategies who has been a leading advocate for tobacco control for 30 years, said that as smoking rates have fallen in developed countries, Big Tobacco has turned its attentions to new horizons. “They really tend to go all out to get any smokers they can,” she said. “The low- and middle-income countries are particular targets.”

“Typically, these markets have high smoking rates and, in many cases, are trying to attract investment,” added Ross Mackenzie, a public health expert at Macquarie University in Sydney. “Transnational tobacco corporations take advantage of globalised production and distribution networks and economies of scale to promote their brands.”

BAT, which had a joint venture with a military-owned company until leaving Myanmar in 2003 following a concerted campaign by overseas human rights activists, has invested $50m to build its factory on the outskirts of Yangon to begin producing its London brand of cigarettes – the top-selling brand before Red Ruby took its mantle in the intervening years.

“The foreign tobacco companies bring in very sophisticated advertising, promotion and sponsorship that the [local] monopolies don’t have”

The return of BAT, and establishment of others, is “highly significant” in terms of changing cigarette consumption habits, according to Mackay, who said these transnational tobacco companies were on a different level to government-affiliated firms and monopolies. “The foreign tobacco companies bring in a new scenario of very sophisticated advertising, promotion and sponsorship, which in general the monopolies don’t have; they bring with them much more sophisticated obstruction to legislation.”

According to May Myat Cho, the Myanmar country coordinator for the Southeast Asia Tobacco Control Alliance (SEATCA), official sentinel surveys clearly show that male smoking rates dipped from a peak of 48.6% in 2003, the year BAT left Myanmar, before climbing to 46.8% when the firm returned in 2013 and increasing sharply to 60.3% last year.

Similarly, the surveys showed female smoking rates were at 13.7% in 2003, but this had increased to 18% in 2015.

Women and young people, in particular, are in the crosshairs for tobacco firms. Vendor Sein Win said most of his customers are aged between 15 and 20, but his youngest is just ten years old. “There is no age limitation for selling cigarettes here. If an underage person comes and asks to buy cigarettes, we have to sell to them. We don’t want any problems.”

He is mistaken: Myanmar banned the sale of tobacco to minors aged under 18 in 2006, when the government introduced a tobacco control law that also prohibits all forms of tobacco advertising, the sale of individual cigarettes and requires health warnings be printed on tobacco products.

However, according to experts, Big Tobacco is using myriad tactics to circumvent this legislation, which, despite government efforts, is not being implemented by authorities on the ground. “They take advantage of limited and/or poorly [enforced] tobacco control regulations in aggressive marketing campaigns that include some combination of traditional advertising and sponsorship of sports, music and cultural events, which can also lead to access to policymakers,” MacKenzie said of the firms’ strategies globally.

In a recent interview with Frontier Myanmar magazine, BAT Myanmar managing director Rehan Baig denied that his company was using advertising in the country. SEATCA’s Myat Cho disputed this, saying that as well as selling and distributing cigarettes at teashops and restaurants, “they are also distributing complimentary napkins, ashtrays and lighters at teashops, and actually with the brands [visible]”. She added that cigarette kiosks often display promotion posters and some companies, she cited JTI in particular, were known to distribute free cigarettes at major religious festivals – both practices that are outlawed.

One of the more insidious, less-well-known avenues used by Big Tobacco to influence government policy is via the International Tax and Investment Centre (ITIC), which Mackay described as a “front organisation” for the alcohol, tobacco, oil and food industries that sets up secretive meetings with government officials worldwide to pressure them into keeping taxes low. She added that there is plenty of evidence the organisation is active in Myanmar.

“They have their meetings in the House of Lords in London; they’re a very, very powerful group of retired finance ministers and customs officials, and they’re using other front organisations and challenging governments. And when they get into a country, particularly, it seems to get even worse,” she said. “What they do is, they work with the ministry of finance, so the health people often… have no knowledge of them,” she added.

Despite this, Myat Cho is optimistic that the country’s new health minister, Myint Htwe, a former director of the non-communicable diseases department at the WHO’s regional office, will draw upon his experience to tackle tobacco use in Myanmar. Last year, the government increased taxes on tobacco products from 50% to 60%, and pictorial health warnings – shown to be effective in deterring smokers in other countries – are due to be introduced in September.

“The tobacco industry already wrote letters to the Ministry of Health to delay the implementation, so we’re expecting those challenges, but we’re working closely with the ministry and providing our assistance [with] whatever they need, so I think it will be effective,” she said. “And also the taxes on tobacco changed from ex-factory price to retail price, so the revenue will be increased, but whether it will be immediately effective on the reduction of smoking – they need to increase the tax higher.”

Regardless, in-country production, which makes cigarettes much cheaper and more accessible than foreign imports, is ramping up. At the height of military rule in the 1990s, approximately 500m sticks were produced in the country annually, according to official government statistics provided by SEATCA. This jumped to 3 billion by 2005, and it is estimated that 5 billion were manufactured last year. An increasing tide of production is difficult to stem, especially while the novice government has serious political, economic and social challenges it must now manage.

“The difficulty is that tobacco tends to be a rather low priority” in comparison to other issues, said Mackay. “The other difficulty is that, up to now, countries like Myanmar have been fighting infectious diseases such as TB, malaria and maternal mortality and infant mortality. They have no or very little experience dealing with the sophisticated tobacco companies; it’s a different paradigm, dealing with a vector that is not a mosquito, that is not a bacteria.”

The upshot, she added, is that a growing number of people in Myanmar are likely to take up cigarettes or swap their traditional tobacco for manufactured filter tips. “We’re certainly not talking within a year or two, but I would suspect if you were to review this in ten years’ time, you certainly might find a shift in the cigarettes people are smoking, particularly the young, and particularly the better educated; that would be the pattern.”

University student Kaung Htet Lin, 16, started smoking about a year ago amid peer pressure. Now, he struggles to kick the habit. “I want to quit, but I can’t because if someone smokes in front of me, I want to smoke and inhale too,” he said.

And in his changing preferences – from a local brand to one owned by tobacco giant BAT – could lie an early glimpse of the future: “Mostly I smoked Red Ruby; now I’m smoking Lucky Strike.”

Smoke gets in your eyes

The long, strange history of global tobacco use

Some smoke it, some chew it, others curse it. Regardless of its toxic health effects, tobacco has been a global pastime for centuries. Its origins are in the Americas, where the World Health Organisation (WHO) claims cultivation of the plant began as early as 6,000 BCE. Within 150 years of European settlers arriving to the ‘New World’, the tobacco plant was being used around the globe.

While in past centuries snuff and cigars were among the more popular methods of enjoying tobacco, the early 1900s ushered in mass cigarette production, and the modern cigarette was born in 1913 with R.J. Reynolds’ Camel brand. Smoking subsequently grew in popularity throughout the 20th century.

In 1951, however, the first large-scale study of the relationship between smoking and lung cancer was produced, followed by mounting evidence of the associated health risks. Smoking rates in industrial countries have dropped off significantly over the past 60 years, but tobacco use in the developing world remains a major health concern. The WHO predicts that tobacco use will cause 8.4 million deaths annually by 2020, 70% of which will occur in developing countries.