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‘We know that we are making significant progress because the tobacco industry has really stepped up its game, challenging everything we do,’ says Dr Fouad Aslam, The Union’s focal point for tobacco control in Pakistan. The country’s high and Supreme Court dockets currently feature a raft of cases contesting strong new policies proven to reduce tobacco use.

Within this challenging and combative environment, Aslam has been building a comprehensive network of influencers to advance this vital area of public health. When he joined The Union in 2008, there were very few people working in tobacco control in Pakistan, and very little awareness that reducing tobacco use should be a priority for public health. Now there are two key government organisations mandated to work in this area: the National Tobacco Control Cell and Smokefree Islamabad, as well as many active civil society organisations.

‘When we began the government and civil society were completely at odds on tobacco control, actively working against each other,’ says Aslam. ‘Over the years we have helped to develop a network of tobacco control experts, advocates and policymakers who work together to get this important work done.’

This dynamic relationship is well illustrated by the current legal battle over graphic health warnings. The Ministry of Health (MOH) was strongly lobbied by the tobacco industry and its powerful representatives (including a top British diplomat) to renege on their commitment to increase graphic health warnings on tobacco packaging from 40 per cent coverage to 85 per cent coverage of the total surface area. A committee was duly formed, comprising members of the MOH and Federal Bureau of Finance [FBR], to review the evidence and make a final decision. The committee offered a watered down and unworkable version of the law that would be impossible to implement – namely a 10 per cent increase in size, year-on-year, for the next three years.

‘When civil society challenged this decision in court, it gave the Ministry of Health the platform to say that it did support the 85 per cent law, but that the Finance Ministry did not. It also enabled them to present the incontrovertible evidence behind their stance again,’ says Aslam. ‘Although this lobbying has clearly been a successful delaying tactic on the part of the tobacco industry, I am confident that the correct outcome will be reached if advocates and policy-makers for public health continue to work together in this way.’

Although Pakistan still has one of the highest rates of tobacco consumption – over 19 per cent of the adult population – Aslam has seen significant change for the better in recent years.

‘In the 1990s tobacco advertising was rampant – it was everywhere! Now this has been banned, along with smoking in public places, and because of these things people are far more aware of the harms of tobacco use. The challenge now is to get the message out to those living in rural areas. We are working on a mass media campaign to achieve this.’

It was this passion for getting life-saving information to people in rural communities that first triggered Aslam’s interest in public health. While working as a medical doctor, he was devastated to see a small child die from dehydration after cholera had broken out in her village. Because no one in the community knew how to prevent or treat extreme dehydration, the child was taken many kilometres on foot to the clinic where he was working. By the time she arrived, there was nothing the doctors could do.

‘This harrowing experience was soon followed by the death of my uncle from lung cancer. It was also horrific because, at that time, there weren’t any really effective treatments. This spurred me on to pursue a career in preventive health and ultimately tobacco control.’

Aslam decided to augment his medical training with a Masters in Public Health, which he received from Tulane University in New Orleans. Shortly after his return to Pakistan, the Bloomberg Initiative to Reduce Tobacco Use was launched, and he successfully applied for the focal point post at The Union.

During his tenure, Aslam has seen Pakistan progress across all the World Health Organization’s key tobacco control measures, MPOWER. Tobacco taxes have risen every year from 2008 until the present; tobacco advertising has been banned, along with smoking in public places; graphic health warnings were introduced and are projected to be enlarged; to name but a few. But the progress, Aslam values the most is the spirit of collaboration that has been built between influential government departments and civil society organisations.

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The Tobacco Control Department is based at The Union Europe Office, Edinburgh, registered charity no. SC039880
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