15 September 2017:
“I can’t eat anything. It even hurts when I drink,” says a man in his 40’s, in front of the camera. The man has a deformed chin and has suffered oral cancer as a consequence of his addiction to betel. He has been chewing the stuff since he was 18. “I wish no one will suffer as I did,” he concludes. The video clip ends. A slogan appears on screen: ‘Avoid chewing betel so you don’t regret your life choices.’
If we believe the statistics, then plenty of people in Myanmar have made some pretty bad “life choices”. Nearly 7 million adults chew betel nut filled with tobacco regularly and most of non-communicable diseases, such as cancers, are linked to tobacco use. Betel products are chewed by a tenth of the world population. Myanmar has decided to make that portion slimmer.
The poor 40-year-old man is the face of the government’s first national campaign to reduce betel chewing in Myanmar. The plan has been in the works since May 2016, a month after Daw Aung San Suu Kyi took office.
Poster from the anti-betel campaign. Photo: supplied
“Today, the use of betel tobacco products is increasing in Myanmar,” declared the State Counselor via state media. The objective of the campaign is twofold: reducing health risks and making sure that Myanmar’s streets are kept clean, instead of a contaminated constant murder scene.
“Educating people to the dangers of tobacco on TV has been tried before. But smokers are still smoking cigarettes, chewers are still chewing and sellers are still selling,” says a betel seller in Kyauktada township who has been in the business for 32 years.
“This time [it] is different,” says U Than Sein from People’s Health Foundation. “We choose the effective way by following the former examples of other countries.” The new campaign is indeed inspired by successful examples from India and Thailand where government-sponsored advertisement campaigns disseminated the voices of victims of betel chewing.
If the campaign is successful, Myanmar could well be rolling back on centuries of tradition.
Going nut for the betel
Betel quid were already chewed in the palaces of the Myanmar Kings. In villages, people used to chew betel nut as a digestive medicine. The practice was still very popular in the 90’s. “At that time, even grandmothers fed their grandchild the betel that they had just chewed,” remembers U Than Sein, the president of People’s Health Foundation.
“But no one suffered any disease back then, because the ingredients used in betel production were more natural,” he adds. Indeed in the 90’s, tobacco made its ways into the folded betel leaves as well as chemicals imported from India.
It is not the first time that betel has been on the radar of the authorities. Betel chewing has always been forbidden by decree in government buildings and public spaces like schools and hospitals. Selling near them is also prohibited.
But prohibition is not the main drive here. Rather, Myanmar is trying to convince users to quit. One betel addict reckons it will work. “People mostly obey because they have an interest to. Here, the interest is to protect their health. I think presenting things this way will be effective. I personally plan not to chew betel again, but habits die hard,” says Ko Aung Naing Oo who has been chewing for 12 years now.
The government campaign will last for 6 weeks. Two videos and one radio clip will be playing on loop in Yangon where 75 percent of the population owns a TV, but also Mandalay (50pc) and Magwe (30pc). Posters will also be displayed across the country.
A sample of 100 people from different ages and genders will be surveyed to gauge how effective the campaign was. “The result of the survey will help with a second campaign”, U Than Sein from People’s Health Foundation added.
Put your money where your mouth is
The government is making this campaign a flagship policy. “We will focus on the reducing the number of users within this 2017-2021 National Health Plan”, said minister of Health and Sports. The youth will be their first priority.
U Than Sein stresses that the government did not put a penny in the US$200,000 campaign – all the money comes from Vital Strategies (a global public health organization).
In fact, the public authorities have been pretty bad at reining in the tobacco industry. According to one study from the Southeast Asia Tobacco Control Alliance (SEATCA), Myanmar ranks last in tobacco control in the region – the best pupil being Singapore.
Among ASEAN, Myanmar is the only country that has not regularly updated its tobacco control policy and strategy. It is also the only country which doesn’t spend any public money on tobacco control according to the study.
7 million adults chew betel nut filled with tobacco regularly.
He also points out that the 2006 Control of Smoking and Consumption of Tobacco Product Law is not effective for reducing betel quid chewing issue. The legislation mainly focuses on cigarettes, creating a loophole for betel quid, even though they are tobacco products.
Much to chew on. And spit. Don’t forget to spit.