Southeast Asia, once identified as the world's epicenter for tobacco consumption, has emerged as a global leader in reducing tobacco use, dramatically shifting the landscape of public health. The region has achieved remarkable progress, exceeding international targets and contributing significantly to the worldwide decline in tobacco prevalence. This success, however, is tempered by persistent challenges, including the rise of new nicotine products and the enduring presence of smokeless tobacco, necessitating continued vigilance and robust policy implementation.
A Region on the Path to Quitting
In a significant public health triumph, the World Health Organization (WHO) South-East Asia Region has made the fastest global strides in curbing tobacco use. The region surpassed the global target of a 30% reduction in tobacco use by 2021, four years ahead of schedule, with prevalence among men nearly halving from 70% in 2000 to 37% in 2024. This impressive decline accounts for over half of the global reduction in tobacco users. Once boasting the highest tobacco use per capita, the region has now yielded that distinction to Europe. The concerted efforts in Southeast Asia have played a crucial role in averting millions of premature deaths globally.
Policy Power: Strategies Behind the Success
The substantial decline in tobacco use across Southeast Asia is a testament to the implementation of strong, evidence-based tobacco control policies. A cornerstone of these initiatives has been the widespread adoption of large graphic health warnings on tobacco product packaging. Countries such as Bangladesh, India, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste have taken a leading role, with some displaying the largest health warnings globally. Thailand further distinguished itself by becoming the first country in Asia to implement plain packaging for tobacco products by the end of 2020.
Beyond packaging, robust legislative measures have been pivotal. Many nations in the region have enforced comprehensive bans on direct and indirect tobacco advertising, promotion, and sponsorship (TAPS), with Maldives and Nepal notably achieving extensive coverage in this regard. Taxation has also proven to be an effective tool; Sri Lanka and Thailand, for instance, levy taxes that constitute at least 75% of the retail price of the most popular cigarette brands, a strategy proven to deter consumption, especially among youth.
Moreover, the creation of smoke-free environments has gained traction. While all Southeast Asian countries have implemented some form of smoke-free policies, efforts range from comprehensive national laws to localized initiatives. Landmark locations like Cambodia's Angkor Archaeological Park, Vietnam's Hoi An, and Malaysia's George Town have successfully become smoke-free zones, enhancing public health and attracting tourism. Bangladesh stands out as a regional leader, exhibiting one of the steepest declines in tobacco use through sustained anti-tobacco policies, including tax increases, public awareness campaigns, and restrictions on advertising and public smoking.
The Persistent Perils: New Threats and Old Habits
Despite the celebrated progress, the battle against tobacco in Southeast Asia is far from over. The region continues to grapple with a significant burden of tobacco use, hosting approximately a quarter of the world's tobacco users, totaling over 322 million adults and 8.6 million adolescents. A particularly alarming trend is the rising prevalence of smokeless tobacco, especially among women and young individuals. Adult women using smokeless tobacco now outnumber female smokers in the region. Bangladesh, for example, notes that while smoking is common among men, a substantial portion of its tobacco users rely on smokeless forms, contributing to the region having the world's highest prevalence of smokeless tobacco use, estimated at 21.1% among adults in 2024.
A burgeoning threat comes from the aggressive marketing and increasing use of novel and emerging nicotine and tobacco products (NENTPs), such as e-cigarettes and heated tobacco products. The prevalence of e-cigarette use in Southeast Asia is notably high, averaging 21.1%, presenting a growing health concern, particularly among the youth. This development risks undermining decades of progress in tobacco control, as these products are often marketed in ways that appeal to younger demographics. Inconsistent policies and varying rationales concerning Tobacco Harm Reduction (THR) interventions across countries further complicate the regulatory landscape for these new products.
The tobacco industry's persistent influence remains a significant hurdle. Transnational tobacco companies have historically employed tactics such as positioning themselves as good corporate citizens, lobbying against regulations, and even litigation, to delay or dilute effective tobacco control measures. Furthermore, economic dependence on tobacco production in certain areas within the region poses challenges for implementing comprehensive bans and promoting alternative livelihoods for farmers.
Beyond Statistics: Human Stories and Economic Gains
The human impact of tobacco control efforts is profound. While specific stories of individuals successfully quitting tobacco with support from cessation clinics and family underscore the personal triumphs, the broader public health benefits are immense. Tobacco remains the world's leading preventable cause of death, contributing to 71% of global noncommunicable disease (NCD) fatalities. Effective tobacco control is therefore critical to achieving the Sustainable Development Goal of a one-third reduction in premature NCD deaths by 2030.
Beyond health, there are significant economic advantages to tobacco control. Highlighting the economic benefits has proven to be a compelling argument for governments in low- and middle-income countries to prioritize tobacco control, countering the industry's narrative of economic ruin. Increased tobacco taxes, for example, not only deter consumption but also generate revenue that can be reinvested into public health programs.
Sustaining the Momentum
Southeast Asia's journey in curbing tobacco use serves as a powerful model for other regions, demonstrating what can be achieved through strong political commitment, comprehensive policies, and community engagement. While remarkable progress has been made, the fight is ongoing. Addressing the surge in smokeless tobacco use, effectively regulating emerging nicotine products, and countering the persistent interference of the tobacco industry are crucial next steps. Continued international cooperation, sustained national investment in public health initiatives, and unwavering vigilance are essential to protect future generations from the devastating health consequences of tobacco and to maintain the region's hard-won gains.
