Impactful Advocacy Strategies for Tobacco Consumption in Rural Bangladesh: The Socio-Cultural Context

Abstract

Tobacco consumption is an integral part of the daily lives of many men as well as women in rural regions of Bangladesh. The paper looks at specific chars (riverine islands) in Northern Bangladesh, where significant use of tobacco consumption is observed, which lead to serious health implications and intergenerational poverty. Despite anti-tobacco campaigns and interventions, tobacco consumption has relatively increased in these rural regions. The paper analyses the qualitative aspect of tobacco consumption, especially the role of socio-cultural norms in shaping smoking consumption and what measures could be taken for tobacco consumption prevention using the socio-cultural context. Several highly inter-related themes were found that had a direct influence on smoking patterns. These include tobacco company incentives (rewards or coupons for buying tobacco), socializing (observing peers and parents smoke and also as a rite of passage), social exchange (offering tobacco as hospitality and in exchange for labor), geographic stresses (resettlement due to river erosion and crop destruction due to seasonal floods), and perspectives on health (beliefs about how tobacco helps increase labor productivity). All these variables combined represent the embeddedness of tobacco practices in socio-economic and cultural practices. The general anti-tobacco campaigns and advocacy strategies misunderstand tobacco as the root of the problem. Rather, this research found that tobacco use is more like a symptom of larger socio-economic problems. The prevalence of tobacco use is found to be greater among those struck by the poverty and instability of life in the region; the same people who are susceptible to health inequality by way of lack of access and finances, thus carrying a heavier disease burden. Traditions of tobacco use is intimately intertwined with the social norms, culture, and health beliefs of people. The combined lack of education and access to health facilities has led to an acute lack of risk perception of the harms of tobacco use, and therefore disinterest in intent to quit. Tobacco in some areas is also economically important in the region as a source of livelihood. Anti-tobacco strategies must consider the socio-economic context around tobacco and center changing social norms and family values around tobacco consumption, rather than advertisement or simple education on the ills of tobacco. As such, anti-tobacco efforts should involve the community, committed local leaders, and stakeholders, in order to be effective.