Vietnam’s Tobacco Problem

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In a small street-side cafe deep within Hanoi’s labyrinthine Old Quarter, a group of middle-aged men sit drinking bitter iced tea, swapping stories, and smoking from a huge bamboo water pipe. Their attention is caught by a foreign tourist ordering a drink at a nearby table, and one of them beckons in broken English for him to join the group.

“You smoke, my friend?” he asks, pointing to the pipe. “It’s very good. Very strong. Makes you strong too.” Apologetic, the visitor refuses. “But you are in Vietnam,” the man insists, breaking into a broad gap-filled smile of yellowing teeth. “Men smoke here.”

In Vietnam, the consumption of tobacco has a longstanding history: from the traditional chewing of tobacco leaves, to the unstoppable rise of manufactured cigarettes in the late 20th century, to the recently growing taste for shisha. As home to over 15 million smokers, Vietnam is one of the 15 top consumers of tobacco in the world.

The fug of tobacco smoke is ubiquitous in the country’s myriad cafes, bars and restaurants. A high-tar cigarette is widely deemed the perfect companion to a coffee or beer, particularly among Vietnamese men, 47.4 percent of whom are smokers according to the WHO’s 2010 Global Adult Tobacco Survey.

The habit is widely seen as fun, social, and deeply entwined with Vietnamese history and culture – national icon Ho Chi Minh was himself well known to be a regular smoker – and consumers spend more than $1 billion on tobacco products every year. For domestic cigarette companies and their transnational partners, the situation could hardly be better. For health campaigners though, the situation could hardly be worse.

The cost of all this smoking to the nation’s heath has only emerged from the haze in the last few years, and the statistics make shocking reading. The WHO believes that smoking kills 40,000 people every year in the country, making it one of the leading causes of death. Non-smokers are believed to contribute heavily to that figure, with an estimated 33 million Vietnamese people passively exposed to smoke at home.

The country’s Deputy Health Minister, Nguyen Thi Xuan, has estimated that every year the cost of healthcare treatment for lung cancer and other major smoking-related diseases is upwards of $110 million. For a country which has become so driven by development – Vietnam has one of the fastest growing economies in the world, despite suffering from the global recession – the cost both financially and in lost working hours is hugely damaging.

So what is being done to tackle the problem?

A little over a year ago, the Law on Prevention and Control of Tobacco Harms was approved by an overwhelming majority of the legislative National Assembly and announced to much fanfare in the state-run media. Vietnam’s leaders, long reserved on the issue, seemed to be finally taking a stand. Among other regulations, the law bans smoking in certain public places, the sale of cigarettes to minors, and any advertising of tobacco products.

Unfortunately, a walk through the Old Quarter quickly reveals that few are abiding by these new rules. Cigarette smoke can currently be found engulfing several bars showing World Cup games, with hundreds of fans lighting up and clouding the projection screens in thick smog. Very few segregated smoking areas exist in these popular and pokey venues, despite the requirements of the law.

In one such establishment, the owner seems unbothered by the transgression. “The smoking law isn’t really enforced to be honest. I think the police have an attitude of không sao [no problem] and look the other way.” Several others in the bar claim to be unaware of any such regulations even existing.

This lack of knowledge, despite the initial newspaper coverage that accompanied the law’s launch, has led to the ascendance of numerous campaign groups committed to making the message impossible to ignore. They have taken to the internet to reach Vietnamese web users, who spend an average of 2.4 hours on social media every day.

In February this year, the international non-profit World Lung Foundation joined with the country’s health ministry and the Ho Cho Minh Communist Youth Union to instigate a campaign called “For a Smoke-Free Life.” The idea was to encourage people to submit their own videos, photos and posters showing the benefits of a Vietnam free of tobacco. To mark World No Tobacco Day on May 31, the winners were chosen by a panel of judges and Facebook users themselves, with some of the most “liked” entries aired on national television.

In a press release, the foundation argued: “A significant body of scientific evidence shows hard-hitting communication campaigns can compel tobacco users to quit, increase knowledge of the health risks of tobacco use and second-hand smoke, and promote behaviour change – including compliance with smoke-free laws – in both smokers and non-smokers.”

While struggling to engage Vietnam’s older smokers, who tend not to be web-savvy, the campaign did indeed catch the imagination of thousands of young adults and students. Strategists see this as a particularly crucial demographic, with the health ministry believing that approximately 22 percent of Vietnamese aged between 16 and 24 years old already smoke. Most of them are on Facebook, with 94 percent of the site’s 8 million Vietnamese users under the age of 35.

Huong Nguyen, a young Hanoi teacher and avid social media user who joined the voting, has no doubt of the future potential in online campaigning. “It is definitely a good way to share information in Vietnam. We have more than 31 million internet users now, so it makes sense to use these channels to directly reach more people, more quickly and more effectively.”

One way in which smoke-free campaign videos have been sparking online debate is by showing the negative impacts smoking can have on two pivotal Vietnamese values: family and wellbeing.

Strong health, both spiritual and physical, is important to Vietnamese people, who regularly preach the value of a good diet, ample sleep, sensible winter dressing, and regular exercise. Entries to the competition turned to gory images and damning statistics to remove any doubt about the damage tobacco can cause to the healthy ideal.

Meanwhile, the World Lung Foundation has turned to its own willfully unsubtle TV campaigns – such as the graphic “Cigarettes Are Eating Your Baby Alive” – to show how the habit can endanger families as well as individuals, shaking the deeply-rooted cultural belief that smoking is a strong, cool and masculine trait.

However, for all the early success of social media campaigning, plenty of factors still discourage people from quitting. Cigarette alternatives such as nicotine patches and e-cigarettes are not widely available and remain unpopular, providing no competition to Vietnamese cigarette brands which, at less than $1 per pack, are among the cheapest in the world.

“I want to quit, as I only smoke to relax and socialize and I know it’s bad for my health,” admits Pham Quang Huy, a police officer in the capital who started smoking at the age of 15. “But it’s really hard for people to stop when cigarettes are so cheap and available on every street.”

Vietnam’s tobacco excise tax is approximately 40 percent of the retail price; among the lowest in the region. The health and finance ministries want to hit manufacturers, and subsequently consumers, by raising excise taxes on tobacco from the current 65 percent to 75 percent in July next year, and by a further 10 percentage points in 2018.

Unfortunately, ministerial wrangling means that the measure is far from certain to be enforced. All Vietnamese cigarette companies are run by an organ of the party or state, essentially meaning that a government that profits from selling tobacco products is also in control of preventing smoking.

For example, the ministries of finance and health have to implement the tobacco law alongside the industry and trade ministry, which runs the market leading Vietnam National Tobacco Corporation (Vinataba). The firm’s director, Vu Van Cuong, has publicly criticized the proposed tax hike, suggesting it will hit jobs and revenue while encouraging the rise of poor-quality contraband tobacco products across borders. What emerges is a picture of different factions of government fighting for their own interests.

Despite the obstacles, campaigners remain hopeful that things will change. Something has to: the WHO estimates that the annual death toll from smoking will hit 70,000 by 2030 if things remain as they are. For groups like the World Lung Foundation, the hard work has just begun.

Back at the Old Quarter cafe, the smiling smoker offers his bamboo pipe to his new foreign friend one final time. Following another polite refusal, he shakes his head, puts down his glass of green tea and takes a drag himself. His eyes close as he deeply inhales the acrid fumes, his face a picture of enjoyment. Moments later he bursts into a violent, racking cough, projecting a dark lump of phlegm onto the pavement. He waits a whole thirty seconds before taking another puff.

Kim Megson is a Hanoi-based freelance writer.

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