87,600 Filipinos die every year of tobacco-related diseases
‘It really could feel like everyone who is not a smoker is out to get you. Whenever, wherever you get the urge to smoke.’
DAVAO CITY–There is always a constant sense of paranoia among smokers in this city.
And it’s easy to spot them. That included myself in the not-so-distant past.
Always on the lookout, we wear wary expressions on our faces, with a hand cupping a lit cigarette between the thumb and the index finger.
We may feign a cough as we bring the cupped hand to our face, before belching out a stream of white smoke we vainly try to disperse by fanning it out with the other hand.
Indeed, this city’s tough anti-smoking ordinance has made nervous wrecks among smokers.
And we had compelling reasons to be afraid.
As per the amended Comprehensive Anti-Smoking Ordinance, or Ordinance 367 series of 2012, a brainchild of then mayor and now President Rodrigo Roa Duterte, getting caught for the first time would mean a fine of P1,000, and/or an imprisonment of one month.
A second strike would mean a P2,500-fine, and possibly with two months’ jail time.
A third offense leads to a P5,000-fine, and/or four months of imprisonment.
And the penalty won’t be meted out to just the offender. The establishment where the smoker would be caught violating the ordinance in risks losing its business permit.
On flights coming into this city, airlines announce the non-smoking policy upon touch down at the Francisco Bangoy International Airport. Smoking areas are defined to be at least 10 to 20 meters away from the nearest doorway of establishments, lest smokers congregate at areas just outside these areas where other people may pass through, defeating the purpose of them not being able to inhale secondhand smoke. Entertainment areas, such as bars and restaurants, are also among the sites where smoking is illegal.
Convenience stores do not sell cigarettes.
As a rule of thumb, it is illegal to smoke anywhere there is a roof.
Thus, designated smoking areas (if there are any) do not have umbrellas, tables, or chairs that offer comfort to encourage smokers.
But while the ordinance may be considered one of the toughest in the world, there is still a considerable number of smokers in this city, many of whom even have the audacity to smoke in broad daylight. At night, alleys and dimly lit portions of the streets are the ideal places to smoke.
And if you’re a local resident, chances are you already know the “safe havens” to get your nicotine fix.
Of course, we, smokers, watch each other’s back.
There was an instance when a member of the elite Task Force Davao pleaded with me not to take a photograph of him smoking when we were in one of the city’s “secret smoking havens.” He only got an assurance that I wasn’t going to squeal on him when I showed him that I, too, was holding a lit cigarette.
As a general rule, it’s a no-no to smoke in public utility vehicles, restaurants, bars, and other public venues, even open spaces that are near the doors of these establishments.
And if you are fortunate enough to find a designated outdoor space where you can smoke, it’s likely that it will be a “roofless, seatless area (as prescribed by the ordinance) and at least 10 meters away from any establishment.
That’s why it is also not uncommon to see some smokers braving the rain just to be able to smoke.
And who are they on the lookout for?
Aside from the police, agents of the city government’s powerful Anti-Smoking Task Force (ASTF) and even civilians, who are deputized by the ASTF.
That’s why you can take it from me, it really could feel like everyone who is not a smoker is out to get you. Whenever, wherever you get the urge to smoke.
In 2016 alone, the Davao City Police Office (DCPO) recorded 3,343 operations conducted in the city’s anti-smoking drive. The San Pedro Police Station, alone, arrested 1,082 smokers last year. The Mobile Police Group, which has a wider coverage around the city, came in second, with 980 arrests made, according to DCPO spokesperson Sr. Insp. Catherine dela Rey.
But those numbers could be more as the local ordinance allows deputized civilians to mete out fines on those caught violating the law.
The amended Comprehensive Anti-Smoking Ordinance was passed after Duterte sought for the revival of laws on the smoking ban that were not being implemented in the past. In fact, it was an amendment to an ordinance passed 10 years before.
Dr. Domilyn Villareiz, who used to head the city’s Anti-Smoking Task Force (ASTF), said that the ordinance had had five versions in all.
The first version, which was passed by the city council in 1964, banned smoking only inside cinemas. In 1987, the local government prohibited smoking inside government offices and public utility vehicles. And in 1996, the city government banned smoking inside restaurants and accommodation establishments such as hotels.
“He was asking, ‘Ano na ang nangyari sa ibang (what happened to the other) ordinances?’” Villareiz said in an interview. “The ordinances were sleeping; they were not being enforced.”
Villareiz, who had seen the ordinance through its inception to its current status, has now gone on to fight in a bigger arenas as part of the Southeast Asia Tobacco Control Alliance (SEATCA) and as the secretary-general of the Smoke-free Cities ASEAN Network (SCAN).
According to her, the city’s policy against smoking has become a template for other such policies crafted in cities here in the Philippines and abroad.
Giving the ordinance more teeth
In 2012, Villareiz and other fellow health advocates were tasked by Duterte in re-crafting the already strict local smoking ban law, increasing fines to the maximum P5,000 for third time offenders, and including electronic cigaretttes and Vapes among the prohibited items.
I myself transitioned from cigarettes to Vapes in an attempt to cut the habit.
Eventually, the bold ordinance, fuelled by wide public support and strong political will from local leaders, would earn the city the distinction of becoming the first smoke-free metropolitan city in Southeast Asia, during the first smoke-free regional workshop on anti-smoking in the ASEAN that was held here in 2013. This was among the many accolades that the city gained over the years because of the implementation of the ordinance.
As such, the ordinance has gained a second look from those who wished to have the policy replicated nationwide.
A few weeks ago, Agriculture Secretary Emmanuel Pinol revealed that President Rodrigo Duterte was already considering to sign an Executive Order imposing a smoking ban nationwide. The EO will reportedly be patterned after the ordinance that imposed the strict smoking ban in this city, Pinol posted on his Facebook account.
Health Secretary Paulyn Jean B. Rosell-Ubial had said earlier this week that Duterte was likely to sign the EO anytime.
But as of press time, there was no word yet from Malacanang on the EO.
Sources said that Duterte was still making sure that the EO would not allow the designation of smoking areas inside buildings “which may be in an open space or a separate area with proper ventilation.”
This means that, technically, indoor smoking areas may be established.
Culture of aversion to cigarettes
All told, the ordinance has since cultivated a culture among Davao City’s citizens of always calling attention to compliance with the ordinance.
There are also signs that some smokers, stubborn as they may be on not kicking an obviously unhealthy habit, are finally giving in. Jessica Madrazo, who runs the Davao collective of advocacy group Dakila as its managing director, has decided to stop smoking, a vice she picked up when she was still in high school.
“I still want to have more kids,” she said. “At my age, smoking would give me fewer chances.” She is 33 years old, and the mother of a 14-year-old.
Madrazo, however, said that she was finding it difficult to drop the habit. “When I’m stressed at work, I get the urge to smoke. I get frustrated when I go beyond my supposed dwindling numbers (of sticks smoked). But I try to bounce back and try again,” she said.
In Manila, a fellow Dabawenyo in government is making a similar commitment. Ramon Cualoping III, assistant secretary at the Presidential Communications Office, announced through his Facebook page he would be quitting cold turkey after news broke of the possible signing of the EO.
“Ang hirap (It’s hard),” Cualoping tells The Manila Bulletin. “After I quit, all I could think about was smoking again.”
Despite her involvement in SCAN’s advocacy, Villareiz considers the crusade more of a reality check instead of a war.
“87,600 Filipinos die every year of tobacco-related diseases,” she said, citing data from the World Health Organization (WHO).
The same study noted that the Philippine government has suffered losses of P188 billion because of tobacco-related health care expenses and losses in productivity.
During the crafting of the 2012 amendments to the Davao ordinance, initial data placed cigarettes as among the causes of the top causes of death among Filipinos.
First among these is heart disease, followed by diseases related to the vascular system, with cancer ranking third.
Local studies recorded larger figures. From 2011 to 2013, there was a consistent rise in the number of deaths related with diseases associated with smoking, according to the 2013 Philippine Health Statistics study conducted by the government.
Deaths from heart disease, according to the data of percentages per one million deaths, rose from 103,170 in 2011 to 118,740 in 2013. Deaths caused by malignant neoplasms or cancer, meanwhile, rose from 52.4 percent to 54.7 percent. Villareiz noted that there were 12 different types of cancer attributed to smoking, with cancer of the trachea, bronchus, and lungs being the most common.
A survey among male and female Filipinos, which was completed in 2015, noted that there was a rise in the percentage of smokers from a sample survey of teenagers.
In the survey, Filipinos aged 13 to 15 were asked questions including smoking practices.
In 2011, there were only around 13.7 percent of those interviewed who said they were tobacco users. But just four years later, the number already rose to 16 percent.
As far as health advocates are concerned, cigarette smokers are lured into the habit because of advertising, among other factors. The nationwide study showed a rise in the number of smokers despite a lower incidence of exposure of non-smokers to secondhand cigarette smoke.
The study showed that among those interviewed, 57.9 percent were exposed to smoke in 2011, compared to a drop to 54.2 percent in 2015 when more stringent laws against tobacco advertisement were already in-place.
Smoking in public utility vehicles, particularly jeepneys, dropped from 55.3 percent in 2011 to 37.6 percent in 2015.
Restaurant smoking also dropped, with 21.9 percent of respondents reporting exposure to cigarette smoke in 2015, compared to 33.5 percent in 2011.
The figures also show that while some cities, municipalities, and provinces have 100 percent, smoke-free areas, there were places that either did not have the smoking ban ordinances, or were not implementing the laws.
2nd in southeast Asia
The SEATCA noted that Southeast Asia is host to around 10 percent of the world’s smokers.
A bulk of the smokers in the region comes from Indonesia, at 53.4 percent of the total 628 million population in the region in 2015. From that figure, the Philippines ranks second, at 13.5 percent, followed by Vietnam (12.7 percent), Thailand (8.9 percent), Myanmar (5.1 percent), Malaysia (4.07 percent), Cambodia (1.4 percent), Laos (.67 percent), Singapore (.3 percent), and Brunei (0.06 percent).
Eventually, the city’s definition for enclosed and partially enclosed areas was adopted not only in the national law, but also in the policies crafted across Southeast Asia.
The city’s definition includes areas that have roofs, with or without walls.
According to Villareiz, the policy direction for the first revival of the anti-smoking ordinance was the practice’s effect to non-smokers.
Children were being subjected to secondhand smoke, while restaurant and bar waiters were regularly fumigated by their customers. “So (Duterte) asked the city council to draft an ordinance.” The city council responded, with Councilor Bonifacio Militar submitting a comprehensive proposal come 2002.
Along the way, since the city’s implementation of the ordinance, the city has earned accolades for its anti-smoking policy.
In 2007, the city received an award from the SEATCA for the ordinance.
In 2009, the city received its first award from the Global Smoke-Free Partnership for the ASTF’s exemplary leadership.
From 2010 to 2012, the city became a Hall of Famer awardee of the Department of Health.
“Ang dami na naming nagawa,” Villareiz said.
The different sectors, including health and religious groups, even post streamers every year, counting the number of years that the ordinance has successfully curbed smoking. “Every year, people will remember that we are enforcing the ordinance,” she noted.
As with the planned national EO, Villareiz suggested an intensive three to six months of information campaign nationwide.
“The mayors should also have the political will to enforce tobacco control because they will be prioritizing the health of the people,” she said.
Villareiz cited the case of Davao where, aside from Duterte’s staunch stand against smoking, “the people saw the ordinance as beneficial to their health.
“There was, of course, a small sector that questioned the policy at first. But eventually, we were able to win them,” she said. In commercial and entertainment establishments, management was trained to take the lead in discouraging smoking.
Villareiz said she dreams of the day when her advocacy could spread into entire generations refusing to get hooked into the smoking habit.
In other countries, she said, stores do not sell tobacco products to children and other youth. In some areas, it is illegal even in private homes and vehicles to smoke, especially when there are children.
“When you start the youth with awareness campaigns, they will become your advocates,” she said.
As one of the methods, the ASTF enjoined pre-schoolers enrolled in the city’s Project Home pre-schools to convince their parents to kick the habit. Asked about her motivation, Villareiz said there was no personal reason why she took the task to heart after being assigned by then-Mayor Duterte and current Mayor Sara Duterte-Carpio.
But in the hinterlands, where she once served as the rural health physician under the City Health Office, she saw for herself how the poor suffered from diseases such as tuberculosis.
“At the time, increasing na rin ang number of TB patients, and most of them are smokers,” she said. “Most of them are below poverty line, and they spend so much for cigarettes, and they don’t know how much they already spend for the cigarettes they use.”
In fact, there was an instance when they computed the total number of cigarette packs consumed since they started smoking, according to Villareiz.
It startled not a few of them when they came up with a total of P100,000.
“Naa na unta tay balay karon (If we had saved the money, we could have had our own home),” she quoted one of the patients. She said SCAN is aiming for a smoke-free Philippines come 2025, with hundreds of LGUs currently approaching legislation banning smoking.
“Smoke-free,” she said, “is defined as areas that regulate the use and ban the sale of the products in certain areas, much like the Davao City model.”