Nepal vs Kenya: Two Nations tackling a growing menace

Walking through Kathmandu's Thamel shopping district, a vibrant tourist market filled with colourful cashmere clothing and shops selling hiking gear, visitors can't help but notice something else permeating the atmosphere - cigarette smoke. Despite the capital's clean streets, minimal traffic, and the gentle hum of scooters that contrasts with Nairobi's noisy motorbikes, tobacco use casts a shadow over Nepal's otherwise serene urban landscape. From teenagers to elderly citizens, public smoking is ambiguous. Cigarette butts dot the pavements, while the distinct smell of tobacco follows pedestrians past bus stops, shopfronts, and markets. In many restaurants, ashtrays sit prominently on tables - often filled with cigarette butts - a clear indication of how deeply normalised smoking has become in Nepalese society. "Here smoking is not illegal, it is just prohibited in some areas," explains Siroj Miraj, a restaurant worker in Kathmandu. "For instance, some restaurants allow smoking outside, but you cannot smoke inside while people are eating. In our restaurant, we don't allow people to smoke inside." Nepal has one of the highest smoking prevalence rates in the South Asian region. According to the World Health Organisation (WHO), approximately 27 per cent of Nepal's adult population smokes-more than a quarter of the country's 30 million citizens-with significantly higher rates among men. This contrasts with Kenya, where smoking prevalence stands at about 13 per cent of the adult population. In Kenya, a significantly larger proportion of men smoke tobacco compared to women. A 2020 study by Statista showed that roughly 17 per cent of men smoked, while only 0.9 per cent of women aged 15 and older did. Overall, tobacco use is more prevalent among men, with studies indicating that in 2022, more men than women used different tobacco products, with manufactured cigarettes having the highest prevalence rate among men. When Kenyan men aged 15 to 49 were asked how often they smoked, 7.8 per cent said they smoked on a daily basis, 3.3 per cent only smoked occasionally, and 88.9 per cent were non-smokers. Age group Among men between 50 and 54, 23.3 per cent smoked on a daily basis, while 4.8 per cent smoked occasionally. 71.9 per cent of men in that age group were non-smokers. Overall, 8.6 per cent of men aged 15 - 54 smoked daily, 3.4 smoked occasionally, and 88 per cent did not smoke. The prevalence of smoking in Kenya differed by county, with Meru County having the highest percentage of smokers at 28.4 per cent. Other counties with high smoking rates include Murang'a, at 27.3 per cent; Tharaka Nithi (25.6 per cent); Embu, (25.6 per cent); Makueni (25 per cent); Isiolo (23.8 per cent); Kitui (20.6 per cent), and Mombasa (0.3 per cent). Nepal faces a dual burden of smoking and smokeless tobacco use, with the latter accounting for 18 per cent of combined adult consumption. Interestingly, smokeless tobacco use exceeds smoking among adult males (33.3 per cent vs. 28 per cent), while among females, smoking is more prevalent than smokeless tobacco use (7.5 per cent vs. 4.9 per cent). According to Kenyan experts Kenya is making notable strides in tobacco control, even as new nicotine products like vapes and electronic cigarettes pose fresh challenges. Yvonne Olando, Director of Public Education and Advocacy at the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) says the country has seen a decline in traditional cigarette smoking, thanks to robust measures under the WHO Framework Convention on Tobacco Control (FCTC). "While conventional cigarette use is going down, we are now battling newer products like vapes, which have proven highly addictive-sometimes even more than traditional tobacco," she said. To address this, a bill is currently before Parliament to classify vapes and similar products as tobacco substances under Kenyan law. Dr Olando noted that Kenya has implemented clear smoking restrictions, including designated smoking zones meant to deter use. "These areas are deliberately uncomfortable to discourage smoking. People must understand-public spaces, including homes with visitors, are protected under the Tobacco Control Act." On enforcement, NACADA has intensified crackdowns, not just on shisha but also on vapes and nicotine pouches like Velo, which are not approved for use in Kenya. Tobacco remains the second most abused substance in the country after alcohol, and is a leading contributor to non-communicable diseases such as cancer, diabetes, and hypertension. "Taxation remains a powerful deterrent, especially among youth," Olando added. According to WHO's 2023 report, tobacco use in Nepal presents a significant public health challenge, with approximately 29 per cent of adults aged 15 to 69 currently using tobacco products. A stark gender disparity exists, with 48 per cent of males and 12 per cent of females using tobacco, while among youths aged 13-15, prevalence stands at 9.5 per cent for boys and 4.8 per cent for girls. The legal age to purchase and consume tobacco in Nepal is 18. However, many young people begin smoking much earlier. As it is not uncommon to see children as young as 10 already picking up the habit. Though underage smoking is prohibited by law, weak enforcement mechanisms and strong peer influence make it widespread and difficult to control. "Living here, I have seen young people smoking, as young as ten years old," says 45-year-old Nirmal Purja a restaurant owner in Kathmandu. "The shopkeepers, despite knowing it's illegal to sell cigarettes to minors, still do because they want to make money. Some assume these children have been sent by their elders." For Purja to accommodate his customers he allows smoking. "Youth smoking stems from peer influence, curiosity, defiance, and a lack of strict enforcement of smoking regulations," He says, lighting his cigarette. Male deaths The health consequences are severe, with The Tobacco Atlas reporting that 12.6 per cent of adult male deaths and 9.2 per cent of adult female deaths are tobacco-related. In 2021, tobacco was responsible for an estimated 28,100 deaths in Nepal-more than 75 each day-accounting for 23.7 per cent of total deaths. This makes tobacco the third-highest risk factor for death and disability in the country. A 2019 study published in the Journal of Nepal Health Research Council found that smoking-related diseases, particularly chronic obstructive pulmonary disease (COPD), are among the leading causes of hospital admissions in Nepal. The research also highlighted that healthcare costs for smoking-related illnesses create significant financial burdens for families, often pushing them below the poverty line. Beyond the human cost, smoking severely impacts Nepal's economy imposing a staggering economic burden of 32.8 billion Nepalese rupees (more than $235 million) annually through healthcare expenditures and productivity losses from illness and premature death. The financial strain on individuals is equally concerning-smokers in Nepal must spend approximately 22.3 per cent of GDP per capita to purchase 100 packs of the most popular cigarettes yearly, keeping many families trapped in poverty. In February 2025, Nepal's Ministry of Health and Population passed a groundbreaking directive increasing the size of health warnings on tobacco packaging from 90 per cent to 100 per cent. This landmark decision makes Nepal the first country worldwide to mandate full-coverage health warnings on tobacco packaging. Pictorial health warnings are proven to be one of the most effective and low-cost measures to alert the public about the dangers of tobacco use. The new requirements, set to take effect in August 2025, aim to further discourage tobacco use by ensuring all tobacco product packaging features clear and prominent warning messages with vivid images depicting the harmful effects of tobacco consumption. The directive, an amendment of the 2014 Directive on Printing Warning Messages and Pictures on Boxes, Packets, Wrappers, Cartons, Parcels, and Packaging Materials of Tobacco Products, represents one of the world's most stringent packaging regulations. It mandates that cigarette packaging must dedicate 80 per cent of the principal display area to pictorial health warnings and 20 per cent to text warnings at the top, with manufacturers required to rotate five different graphic warning images equally across products. For chewing tobacco products like Khaini and Gutkha, 60 per cent of packaging must show pictorial warnings, with 20 per cent dedicated to text warnings at both top and bottom. Bidi packaging follows similar requirements to cigarettes, with 80 per cent pictorial warnings and 20 per cent text warnings, though with only two rotational images required. The provision further requires all packaging to use Pantone 448 C (a drab dark brown) background-a colour specifically chosen for its unappealing nature and already adopted in countries like Australia, the UK, and France-with brand names relegated only to the bottom of packs. "Nepal has set a global benchmark by adopting 100 per cent health warnings on tobacco packaging," said Dr Tara Singh Bam, Director of Tobacco Control at Vital Strategies' Asia Pacific office in Singapore. "This policy is a powerful tool to prevent smoking among youth, encourage tobacco users to quit, and emphasise the dangers of tobacco use. It is a highly cost-effective intervention that not only saves lives and reduces health care costs but also helps to denormalise tobacco in communities. This remarkable achievement is a testament to the strong political commitment and timely actions of Nepal's Ministry of Health and Population." However, despite progressive policies on paper, implementation remains a challenge.

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