Cities and NCDs: The struggle toward a smoke-free Kathmandu

A man smokes while reading a book in Kathmandu, Nepal. Photo by: Hendrik Terbeck / CC BY-NC-SA

MANILA — In 1993, the government of Nepal signed into law the Motor Vehicles and Transport Management Act, which bans smoking in public transportation. That was followed by the ratification of the World Health Organization’s Framework Convention on Tobacco Control in 2006 banning advertisement and mandating warning labels, and the 2011 passage of comprehensive tobacco control law that covers a number of these provisions, including an expansion of the smoking ban to a number of public spaces, as well as in the workplace.

Good policy doesn’t always ensure effective implementation however.

A peek into Bloomberg's new public health initiative 

The Partnership for Healthy Cities was launched as part of Michael Bloomberg's appointment as World Health Organization global ambassador for noncommunicable diseases. But it has much to reveal about how Bloomberg's foundation works in the area of public health.

About 18.5 percent of the respondents in the 2013 Noncommunicable Diseases Risk Factors STEPS Survey in Nepal smoke tobacco, while 17.8 percent consume smokeless tobacco, such as khaini, which is a combination of dried tobacco leaves, lime paste, and betel nut.

Meanwhile, the Nepal Demographic and Health Survey of 2016 found that 16.5 percent of Nepal’s population aged 15 years and older are using tobacco.

Neither survey gives a breakdown of tobacco usage per city, but it underscores the difficulty of enforcing existing tobacco control regulations, said Kathmandu Mayor Bidya Sundar Shakya. Shakya says tobacco use is a “major problem” in the country, and has social, environmental, economic, and health implications. Tobacco is a common risk factor for cardiovascular and chronic respiratory diseases as well as cancers, including lung cancer.

In 2016, according to the latest Tobacco Atlas, 15.68 percent of men, and 14.14 percent of women died from tobacco-related illness.

But in his city, Shakya has an ambition: To achieve an 85 percent compliance rate with smoking bans at work and in public spaces within the year, and eventually, make the city smoke free.

To do that, he is currently seeking support under Bloomberg Philanthropies’ Partnership for Healthy Cities to explore the different ways to effectively enforce the law, such as building the capacities of enforcement agencies;  engaging consumer associations, shopping centers, and the hotel and restaurant industry; mobilizing the media in an information drive; boosting the city’s compliance monitoring and implementation; and ramping up support from council members across the city’s 32 wards.

Shakya is under no illusion it will be easy, however. Such sweeping reforms will take time, consistent effort, and the development of the right enabling environment.

Some people in Kathmandu have tried — but failed — to quit smoking or using tobacco, he said, due to lack of a suitable environment. People’s changed behavior is also going to be key.

“Unless the people themselves change their attitude or judgment towards the negative results of tobacco use, implementation of the law alone will not suffice in the control of smoking and tobacco use,” the mayor said.

This is part of a miniseries on how cities are tackling NCDs in the line up to the third United Nations high-level meeting on NCDs. The cities featured here are all part of Bloomberg Philanthropies’ Partnership for Healthy Cities.

For more coverage of NCDs, visit the Taking the Pulse series here.

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.