Reliance on revenue generated from tobacco is one of the fundamental barriers to effective tobacco control in Pakistan. The tobacco control component of the National Action Plan for Non-Communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) deems it critical to address this issue. A range of policy and environmental strategies are part of this comprehensive effort; these involve regulating access and limiting demand through restrictions on advertising, marketing, promotion and through price and taxation. The NAP-NCD also encompasses community and school interventions, enforcement of tobacco control policies, cessation programmes, mass media counter-marketing campaigns for both prevention and cessation, and surveillance and evaluation of efforts. As part of NAP-NCD, surveillance of tobacco use has been integrated with a population-based NCD surveillance system. Featuring tobacco prominently as part of an NCD behavioural change strategy and providing wide-ranging information relevant to all aspects of tobacco prevention and control and smoking cessation have been identified as priority area in NAP-NCD. Other priority areas include the gradual phasing out of all types of advertising and eventually a complete ban on advertising; allocation of resources for policy and operational research around tobacco and building capacity in the health system in support of tobacco control. NAP-NCD also stresses on the need to develop and enforce legislation on smuggling contrabands and counterfeiting and legislation to subject tobacco to stringent regulations governing pharmaceutical products. The adoption of measures to discourage tobacco cultivation and assist with crop diversification; integration of guidance on tobacco use cessation into health services and insuring the availability and access to nicotine replacement therapy are also part of NAP-NCD.
The National Action Plan for Non-communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) integrates prevention and control of cancers with a comprehensive NCD prevention framework with a specific emphasis on tobacco, diet and physical activity as cross-cutting risks. The programme prioritizes on sustainable institutional support for mature cancer registries in order to facilitate cancer surveillance; prevention of cancers and early detection as part of an integrated NCD behavioural change communication strategy and building capacity in the health system for cancer prevention and control. The programme's research agenda also includes appropriate studies to bridge critical gaps in evidence relating to appropriate and cost-effective strategies for preventing common cancers in Pakistan. To contain exposure to carcinogenic agents in the environment and in worksites, NAP-NCD stresses on the transparent enforcement of National Environmental Quality Standards; the institution to take proactive measures to contain potential risks to cancers in industrial settings; stricter enforcement of labour laws, stringent regulations governing chemical handling and the active incorporation of preventive health in the mandate of organizations providing health coverage for the labour workforce. It has also been deemed essential to study cancer trends in defined industrial settings at high-risk and to identify causal associations in order to delineate precise targets for preventive interventions in the native setting. NAP-NCD stresses on the development of institutional mechanisms with a regulatory function for cancer control; these include a National Cancer Control Council, with the mandate to uphold ethics and principles and guidelines on technical matters and a National Occupational Safety and Health Association. The Plan also prioritizes on pain relief and palliative care alongside prevention and control efforts and stresses on the need to integrate prevention efforts into health services as a sustainable and evidence-based activity.
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