Tackling the death toll of betel quid chewing

A national campaign against betel chewing that was launched by the Ministry of Health and Sports on September 11 is an important step towards saving lives but it needs to be part of an integrated, long-term approach.


ANYONE WHO has visited Myanmar has seen the dark red spots on its pavement. These blobs of red saliva are the most visible symptom of one of the nation’s favorite pastimes: chewing betel quid. Known as kun-ya, these packages of betel leaf containing areca nut, slake lime and raw and cured tobacco are literally sold on every street corner.

Red stains are a nuisance but there are other, more serious consequences of tobacco usage and chewing betel quid. According to the International Agency for Research on Cancer, all of the ingredients in a betel quid are known carcinogens, or cancer-causing agents. In Myanmar, betel quids are a major cause of oral and laryngeal cancers.

Worldwide, tobacco kills more than 7 million people each year. In Myanmar, more than 56,400 people die from tobacco-related disease. Tobacco usage, including betel quid chewing, is the cause of death of 13.2 percent of men and 12 percent of women in our country. It is the single greatest preventable cause of death and disease.

These numbers are alarming, particularly as they are higher than the average in other low-income countries in Asia. Tobacco-related illness places a significant economic burden on families and societies in Myanmar, and is a major threat to sustainable and equitable development.

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How widespread is the usage of tobacco and betel quid in Myanmar? In 2014, 43.8 percent of adult men – those aged 15 and above – and 8.4 percent of women smoked tobacco, and 62.2 percent of men and 24.1 percent of women used smokeless tobacco (mainly betel quid). It is not only adults, though; 11 percent of boys and 2 percent of girls aged 13 to 15 years used betel quid. Judging from this, the future looks bleak.

If we look abroad, though, we can find recipes to curb the epidemic.

In many respects Taiwan has shown Myanmar the way. The government of Taiwan estimates that it has reduced the use of betel quid among men by nearly half through a comprehensive set of policies that include free screenings to rapidly diagnose betel quid chewing-related cancers and funding programs to help people quit betel quid chewing for good. The Taiwanese government also offered subsidies to farmers to cut down their betel nut trees and plant alternative crops.

In China, Indonesia and the Philippines, farmers have also been encouraged to switch from tobacco. These farmers have been able to increase their earnings by growing food crops instead.

Encouraging betel nut producers and betel leaf farmers to switch to other crops – to mango and bamboo, for instance, to meet growing domestic and international demand – could also serve as a model for Myanmar. Moreover, this would be in line with the WHO Framework Convention Tobacco Control, which stipulates that reducing tobacco growing as a key policy recommendation. Myanmar signed up to the WHO FCTC in 2004.

September 11 was an important day in the fight against betel quid chewing. On that day the Ministry of Health and Sports launched a campaign, in collaboration with the People’s Health Foundation, that can be considered to be the first step on the long road to reducing the use of betel quid. The slogan of the campaign clearly indicates what is at stake: Avoid betel chewing, so you don’t regret your life choices.

For six weeks, TV and radio spots illustrating the harm that betel chewing can do will be shown on national TV and radio, and during movie screenings at the Mingalar Cinemas chain. It is a hard-hitting campaign, with testimonials of patients suffering from oral cancer as its cornerstone. This approach has proven effective in other developing countries but is unique to Myanmar.

The aim of the campaign is to make betel chewers and their families aware of the harm of betel quid chewing, and to change knowledge, attitudes and behaviour.

Of course, harmful habits established over many years don’t change overnight. This campaign and the banning of betel chewing in government offices, schools and hospitals in May 2016 are important first steps. But betel quid chewing is a national health problem that merits a long-term approach combining education, regulation, enforcement and economic alternatives.

Only if we address the problem from all angles over a long period of time will we be able to decrease the death toll from chewing betel quid.

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