Bhutan banned smoking and it didn’t go so well

 Oklahoma City: The world watched as Bhutan enforced a blanket ban on tobacco: could the solution be as effective as it was simple? In 2021 the World Health Organization (WHO) described tobacco use as “one of the biggest public health threats the world has ever faced”. Prohibition of tobacco seems like a clear solution, then: ban tobacco, problem solved. But the experience of the Himalayan Kingdom of Bhutan shows a ban is more complicated than it might seem and provides fodder for the long-term debate over whether incremental regulatory and tax policies or prohibition and abolition, will stop tobacco use.

Bhutan enacted a national ban on the domestic sale, promotion, cultivation, and distribution of tobacco products in 2004, and created a 100 percent tax on small amounts of tobacco products legally imported into Bhutan for personal consumption. Those who used tobacco illegally were fined. Two reasons were given for this 2004 neo-prohibitionist law: protecting public health, and recognizing that tobacco consumption is contrary to Buddhist Dharma (law). By 2006, surveys showed Bhutanese had continued to smoke, purchasing black-market tobacco products.

The WHO’s Global Youth Tobacco Survey of people aged 13 to 15 showed that 23.7 percent of young Bhutanese had used tobacco in the last 30 days. In 2010, as the illegal smuggling of tobacco products into Bhutan remained robust, the government beefed up the 2004 prohibition. The 2010 amendment continued to ban the sale, cultivation, promotion, and distribution of tobacco – but now this was a fourth-degree felony. Someone found cultivating, supplying, harvesting, or distributing tobacco faced mandatory imprisonment of three to five years.

It also became a fourth-degree felony to have more than a “permissible amount”, as determined by the Bhutan Tobacco Control Board, or to show tobacco use in domestic videos, movies, or other cultural presentations, except to counter tobacco use. But the tougher stance did not last long. In 2011 Bhutanese Prime Minister Jigme Thinley declared that due to ”the pain and the suffering” the 2010 law had caused – including 59 felony arrests – the Bhutanese government would amend it in the next legislative session. A 2012 amendment changed possession of fewer than three times the defined tobacco limit to a petty misdemeanor, and possession of three to four times the defined limit to a misdemeanor. Possession of four times the limit remained a fourth-degree felony.

In 2013 the WHO again surveyed Bhutanese youth and found that smokeless tobacco use had increased from 9.4 percent in 2009 to 21.6 percent. Any type of tobacco use had increased from 18.8 percent in 2009 to 30.3 percent – the highest in the region as well as globally.

In 2014 the most recent national survey for adult tobacco use found about 25 percent of adults used tobacco, mostly smokeless tobacco. In 2019 tobacco use remained high, with 22.2 percent of 13- to 15-year-olds using tobacco products. Following the outbreak of COVID-19, smugglers bringing in tobacco were found to be driving up case numbers. Responding to this different public health emergency, the government repealed the ban on the sale, distribution, and importation of tobacco for commercial purposes.

Meanwhile, the ban on domestic tobacco cultivation, production, and manufacture remains. The Bhutan government also pledged to begin vigorous public health education campaigns on the dangers of tobacco use as well as tobacco-cessation programs such as nicotine-replacement approaches. Bhutan’s experience shows solving and reversing tobacco use is more complicated than simply prohibiting or abolishing tobacco. Tobacco use did not decline under the ban but instead remained robust for both youths and adults over a long period. Smuggling remained vigorous as demand for tobacco products continued to be strong.

Bhutan provides an important lesson for other nations considering tobacco bans. Curtailing demand for tobacco products through tobacco regulation, taxes, and stop-smoking programs remains an important approach to counter tobacco use. Recognizing this, the Bhutanese government has pledged to engage in effective anti-smoking and public-health media campaigns and medical tobacco-cessation efforts.

The lesson from Bhutan appears to be that the simplest method is not necessarily the most effective.