HANOI, – At a ‘tra da’ (iced tea) stand in Hanoi’s Truc Bach area, men in baggy white singlets sit on low plastic stools drinking strong green tea poured from a chipped porcelain tea pot.
A hissing squeal cuts over the revving of a motorbike one street down as one of the men pulls smoke through his ‘thouc lao’, a traditional bamboo water pipe. It is popular mainly with older men and farmers, not the city’s trendy youth.
The stall owner sells bags of rough tobacco for 2,000 Vietnam dong – or less than 10 U.S. cents.
In Vietnamese tobacco is called ‘thouc la’, which means ‘medicinal leaves’. Given a reported 40,000 die each year from lung cancer, it is not the most apposite name.
Huong – who only gave one name – has been smoking “more than 30 years.” He smokes cigarettes too, though prefers his ‘thouc la’.
The staggering, though apparently still conservative, official death rate for lung cancer does not worry him. “I look at Uncle Ho. He died at 79, and (yet) smoked two or four bags a day, so I’m not scared,” he said.
Huong typifies the male-smoking population of Vietnam, considered one of the biggest in the world: 56 percent of the country’s estimated 86 million population. The figure could be higher, said health officials who spoke with IPS. China, Malaysia and Laos all record higher figures, according to the World Health Organization (WHO).
“It’s a huge burden to the health system,” Dr Nguyen Tuan Lam of the Tobacco Free Initiative of WHO told IPS in a telephone interview. He believes the official number of lung cancer deaths is massively underreported, saying it could be closer to 70,000. Compare this figure with the incidence of traffic accidents, often called a “hidden epidemic” in the motorcycle-riding South-east Asian country, which accounted for a comparatively lower 12,000 deaths in 2008.
Compared to men, there are extremely few female smokers in Vietnam. In fact, the communist nation has one of the lowest female smoking rates in the world at 2.1 percent of the population.
“The attitude here is that only naughty girls smoke. It’s not ladylike and it’s not nice,” said Lam.
Since Vietnam ratified the WHO Framework Convention on Tobacco Control in December 2004, it has banned all forms of advertising, increased taxes on cigarettes and last year added larger warning labels to packaging.
In late August government announced that starting Jan. 1, 2010, smoking would be prohibited in public places (though ‘public’ remains undefined) while tariffs on tobacco products and imported cigarettes would be raised (although by how much it did not say).
Nguyen Duc Hieu, 27, said he is in favour of higher taxes on cigarettes. “It’s ok, it’s the right decision. It won’t affect the price that much, and in many countries the tax is much higher,” said the information technology professional, who smokes a pack and a half a day of one of the higher-end cigarette brands preferred by the younger male population.
Currently, cigarettes are taxed at 32 percent. A packet of ‘Vinataba’, a popular, heavy-tar brand, costs around 10,000 Vietnam dong (50 U.S. cents), while a packet of ‘Thanh Long’, another brand, sells for just 3,000 to 4,000 Vietnam dong (16 to 22 U.S. cents).
Vietnam introduced five different warnings last year that are displayed on 30 percent of the pack – the international standard – but left out graphic warnings such as pictures of rotten lungs or hearts. It is a positive change, said Lam, though still not as good as the recommendations of WHO.
Unlike Singapore, Thailand, Hong Kong and Malaysia, Vietnam is not yet in WHO’s list of countries that have already required pictorial warnings on cigarette packages.
Article 11 of the WHO tobacco treaty as well and the guidelines subsequently adopted in Nov. 2008 “have put the spotlight on the inclusion of pictures on tobacco package health warnings,” says the international organisation on its website.
“The Ministry of Health did design some pictorial warnings… but the tobacco companies took action to stop it from happening. From our understanding, there is a fairly strong level of lobbying,” said Lam. Many Vietnamese cigarette brands are made by state-owned companies.
“Health warning labels on tobacco products constitute the most cost-effective tool for educating smokers and non-smokers alike about the health risks of tobacco use,” states WHO.
It remains unclear how much awareness has been generated by government’s efforts to curb smoking. K Hospital, Vietnam’s leading cancer-treatment centre, surveyed some 12,000 people and found only 37 percent had much knowledge of cancer treatment. Thanh Nien News, a leading Vietnamese daily, reported that 67 percent thought it was a “death sentence’. Others believe awareness is much higher.
According to Pham Quang Huy, an administrator at K Hospital, the institution treated 2,031 cases of lung cancer between 2006 and 2007 (more recent statistics were not available). However, the hospital has no records of how many died. Once a patient is “ready to die,” they go home to their family. There is no follow-up by the hospital.
Huy could not say how many cases were smoking-related.
Unlike Vietnam’s road toll, where motorbike drivers and passengers all had to begin wearing helmets in December 2007 or face fines, a public awareness campaign will not be as easy. Such things are also costly.
Lam believes that “Thailand (which is known for its strong anti-smoking laws) is a good example for Vietnam.” With awareness campaigns and stiff fines for people smoking in banned areas, things may change and smoking levels will drop. But “it will not happen overnight,” he said.
Huy is optimistic for different reasons. He said more people go to the 500-bed hospital that he manages, where three to a bed in the wards is common. “They care about their health more than in the past. They have more money (to pay for health services) than in the past,” he said.
That may be so, but until the Vietnamese stop smoking, cancer cases will continue to rise.
By Helen Clark, Sept.30