Tobacco kills, but its consumption is still widespread, making it a major public health problem of Nepal. Although the country has enacted different policies and strategies, tobacco consumption still remains high, especially among the youth, with as many as 27,000 premature deaths, or about 15 per cent of all deaths, attributed to tobacco-related diseases in the country. A fifth of the population regularly consumes tobacco, which is higher than in other low-income countries. This puts a heavy burden on the health services for the treatment of tobacco-related diseases, namely ischemic heart disease, chronic respiratory disease and cardiovascular disease, the top killers in Nepal, not to mention lung and other forms of cancer. Studies show that tobacco consumption is higher among men, illiterate and poor people, especially those living in the rural areas.

Thus Nepal's ability to control tobacco consumption in the country would contribute greatly to alleviating poverty and improve their quality of life.

It's not that the government has not done anything to control tobacco consumption in the country. Over the years, it has initiated both tax and non-tax measures to bring down tobacco use. It's been ages since we last saw advertisements related to cigarettes and other forms of tobacco in the media. Nepal's law requiring 90 per cent coverage of a tobacco product with pictorial health warnings and messages is the largest in the world. Nepal's law bans smoking in public places, work places and public transport.

Nepal has been raising awareness campaigns about the hazards of tobacco use on radio, television and print regularly while introducing brief interventions aimed at helping tobacco users to quit. Only designated shops with licenses are allowed to sell tobacco products. Taxes on tobacco (and alcohol) are raised almost ritually year after year to discourage its use, which generates good revenue for the government.

However, it is not enough to merely have provisions required by the World Health Organisation in place if we want to see tobacco use dip sharply in the country. Increasing taxation on tobacco products, strict policy implementation and interventions targeting high-risk groups require strong political will.

Tobacco taxation of about 30 per cent is less than half of the 70 per cent demanded by the WHO. Tobacco use is affordable for the Nepalis with average wages increasing at a higher rate than its prices. There is also poor compliance of smoke-free zones and weak monitoring of tobacco sales, with outlets freely selling cigarettes and other tobacco products to children.

Adults apart, what is worrisome is that there are about 21,000 children aged 10-14 who consume tobacco.

In recent years, with cigarette sales falling in the developed world, tobacco companies have come up with new products – e-cigarettes and heated-tobacco products, promoted as modified-risk tobacco products – targeting the youths. They have also become a fad among the youngsters in Nepal, with cafes in Kathmandu offering such services. Since Nepalis spend a good percentage of their income on tobacco products, control of their use would save them a lot of money while also improving their health.

Threats of landslides

As Nepal is a hilly and mountainous country, landslides during the rainy season displace hundreds of families across the country every year. Incidents of landslides have gone up due to haphazard construction of rural roads without giving a hoot about the fragile topography. A construction trend had started after 1995 when the then government launched the 'build our own villages ourselves' with financial support from the central government. Most of the budget earmarked for the programme, which still continues, was poured into building roads without carrying out detailed engineering design and taking into account the fragile terrain.

A report from the far-flung district of Bajura states that as many as 137 families in Himali Rural Municipality have already been displaced by landslides, and many others are also at high risk of soil erosion as a result of the haphazard use of heavy machinery for opening road tracks, which are not blacktopped for many years. The use of heavy machinery can destabilise the fragile terrain, resulting in mudslides during the monsoon. We need to learn a lesson from the Lamosanghu-Jiri Road, where the Swiss project used no heavy equipment while building it decades ago. A version of this article appears in the print on July 30 2021, of The Himalayan Times.