Date of Award

11-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr Maryam Huda

Second Advisor

Dr Romaina Iqbal

Third Advisor

Mr Atif Riaz

Department

Community Health Sciences

Abstract

Background: Smokeless tobacco, prevalent in Pakistan, poses severe health risks, including cancer and cardiovascular issues. Despite its harm, it has received limited attention in taxation policies, unlike cigarettes. Studies emphasize the need for effective taxation to curb its use, given its significant health and economic burden. Lack of urgency surrounding smokeless tobacco control and informal sector production hinder control efforts. This research aims to address these gaps, urging implementation of taxation policies to mitigate smokeless tobacco's harmful effects in Pakistan.
Objectives: The objective of this study was to explore policymakers' perspective regarding the necessity of implementing smokeless tobacco taxation in Pakistan. It also aimed to evaluate the methods and challenges associated with enforcing such taxation policies.
Methodology: The study adopted a Qualitative Exploratory design and used Key Informant Interviews to collect information and perspectives of policymakers on the topic of smokeless tobacco taxation in Pakistan. A semi-structured interview guide was developed to conduct these Key Informant Interviews. The study was conducted in Pakistan, with participants based in various cities, who worked for government agencies such as Federal Board of Revenue, Ministry of National Health Services Regulations and Coordination, as well as public health experts from agencies academia and non-governmental organizations involved in tobacco control. A total of eleven in-depth interviews were conducted, and the data were collected during October 2023 to November 2023. The audio-recordings were transcribed and translated, and thematic data analysis was carried out by identifying main codes and categories.
Findings: Seven key themes were formulated including: the prevalence of smokeless tobacco use, the importance of education and awareness in smokeless tobacco control, health impacts, economic implications and taxation, challenges in implementation of taxation policy, data-driven advocacy, and recommendations for the way forward. The discussion underscored crucial gaps in Pakistan's tobacco regulation, particularly the focus on cigarettes while leaving other products unregulated. Implementing smokeless tobacco taxation could offset health costs, especially in Khyber Pakhtunkhwa and Sindh. However, barriers like political will and the absence of a regulatory body hinder effective implementation, allowing uncontrolled trade and smuggling. Advocating a multi-sectoral strategy, participants stressed the need for a manufacturer mapping network to manage smokeless tobacco distribution effectively.
Conclusion: The study highlights the significant public health concerns related to the prevalence and impact of smokeless tobacco use in Pakistan, particularly among the lower economic strata. Societal norms deeply ingrained in smokeless tobacco use pose challenges for comprehensive intervention strategies. Inadequate policy and regulatory frameworks focused primarily on cigarettes leave a regulatory gap for smokeless tobacco. Despite challenges, policymakers advocate for smokeless tobacco taxation to reduce prevalence and generate revenue for healthcare, acknowledging its potential economic benefits. Implementing effective policies and taxation schemes faces hurdles such as industry resistance, illicit trade, enforcement difficulties, and the lack of comprehensive data. Therefore, a collaborative effort among regulatory agencies policy making in relation to smokeless tobacco control. Mitigating the impact of smokeless tobacco in Pakistan requires a multifaceted approach, including strong policy frameworks, effective taxation, and data-driven advocacy.

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1

Last Page

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