Effective tobacco control measures in Bangladesh require a whole-of-government approach

Abstract: In many low- and middle-income countries, the implementation of tobacco control measures is disorganized, and the activities of the various departments involved are often inadequately aligned with policy aims. This paper discusses some fragmented and conflicting approaches to tobacco control measures in Bangladesh, and how these can undermine public health interventions. The paper argues in favor of a whole-of-government approach. The Framework Convention on Tobacco Control (FCTC) created an unprecedented opportunity to reduce the use of tobacco substantially. While tobacco use declined in most countries that had signed the FCTC, including Bangladesh, the fragmented approach of various government departments and organizations in the country is hindering the proper implementation of tobacco control measures. There is tension between groups that focus on economic development, livelihood, and public health. There is also considerable uncertainty among government officials and an inadequate focus on several crucial aspects such as tobacco cessation services. However, in this rapidly developing country, where there are serious concerns around developing the economy and reducing poverty, it is challenging to separate tobacco control efforts from the promises of employment and tax revenues from tobacco industries. Indeed, this may well overshadow the tobacco control measures. It is necessary, then, to consider the complexity of this issue in Bangladesh by looking at the entire system and to adopt a whole-of-government approach to address the opposing forces. As an FCTC signatory, Bangladesh is obligated to implement tobacco control measures. However, it may not be possible to do this properly without a whole-of-government approach.