NON-COMMUNICABLE DISEASES

The World Health Organization has reported that most smokers start smoking before the age 18, and

almost a quarter of these individuals begin using tobacco before the age of 10. Currently there is an

estimated of 1.3 million people smoke worldwide and 84% of these smokers live in developing

countries.

Smoking has been associated with increased mortality from several diseases. It is known to be

responsible for 90% of all lung cancer cases, 75% of chronic bronchitis and emphysema and 25% of

ischemic heart disease globally.

In Brunei Darussalam, non-communicable diseases were estimated to account for 82% of all deaths

in 2011. The top four causes of death in Brunei Darussalam were cancer, cardiovascular diseases,

diabetes mellitus and cerebrovascular diseases.

In 2013, Brunei Darussalam National Multisectoral Action Plan for the Prevention and Control of

Non-communicable diseases (BruMAP-NCD) 2013-208 was developed to prevent and control NCDs

through enabling healthier environments as well as reducing risk factors and better management.

The goal is fully aligned with global target of a 25% relative reduction in premature mortality from

NCDs by 2025 which has been translated to 18% relative reduction by 2018 in Brunei Darussalam.

There are 2 strategic themes: improving health through enabling environment and healthy choices

and improving health through enhancing the continuum of care for NCD, with five objectives.

Objective 1: To reduce tobacco use

Objective 2: To promote balanced and healthy diet

Objective 3: To increase physical activity

Objective 4: To identify people at risk for NCDs and manage effectively

Objective 5: To improve the quality of care and outcome of NCDs management

FIGURE 1: BruMAP-NCD FRAMEWORK 2013-2018

REDUCE TOBACCO USE

National targets for reduce of tobacco use in Brunei Darussalam under the BruMAP-NCD are:

A 30% relative reduction in prevalence of current tobacco use in persons aged 15 above by

2018

All public places to be smoker-free by 2018

TOBACCO CONTROL MEASURES

BRUNEI DARUSSALAM

Brunei Darussalam has been implementing Tobacco Control Initiatives since early 1970s in which

there was a voluntary ban of tobacco advertising on National Television and Radio. Progress of

Tobacco Control Initiatives in Brunei Darussalam is shown in table 1 below.

YEAR TOBACCO CONTROL INITIATIVES

1976 Voluntary ban of advertising on national TV and radio

1991 Written health warnings mandated on cigarette packs

1994 Smoke-free government buildings

Increased tobacco tax by 200%

1998 Non-smoking flights on Royal Brunei Airlines

2002 Smoke-free school buildings

2004 Ratification of WHO FCTC in June 2004

Islamic perspective on smoking made public

2005 Tobacco Act 13 June 2005

First Smoking Cessation Clinic

2007 Tobacco Regulation 18 July 2007

2008 Pictorial Health warnings (50%) on 1 December 2008

2009 National Committee on Tobacco Control established and chaired by Minister of Health

2010 New amendment on Tobacco Regulation

Increased tobacco tax by 300%

2012 Expansion of smoke-free public places

Pictorial Health warnings (75%)

2013 Increased fine from $150 to $300 for first offence

TABLE 1: TOBACCO CONTROL INITIATIVES IN BRUNEI DARUSSALAM

Brunei Darussalam signed and ratified the World Health Organization Framework Convention On

Tobacco Control (WHO FCTC) in June 2004. For effective implementation of the WHO FCTC by the

member States, WHO recommended the six MPOWER policies to reduce demand for tobacco:

M - Monitor tobacco use and prevention policies

P - Protect people from tobacco smoke

O - Offer help to quit

W - Warn people about danger of tobacco smoke

E - Enforce ban on advertising, promotion and sponsorships

R - Raise taxes to reduce demand

TOBACCO ORDER 2005

FIGURE 2: TOBACCO ORDER 2005

TOBACCO ORDER 2005

Control the use of tobacco products

Control the sale, promotion, packaging and trade description of

tobacco products

Prohibit advertisements

relating to smoking

Protect persons below age of 18 years Control of smoking for

those below age of 18 years

Prohibit smoking in specified places and

vehicles

Duties of managers and operators

GLOBAL YOUTH TOBACCO SURVEY (GYTS) 2013

Global Youth Tobacco Survey was conducted in 2013: a total of 1,574 eligible students in grades 7-11

completed the survey, of which 917 were aged 13-15 years. Results are as follows:

FIGURE 3: PREVALENCE OF TOBACCO USE AMONG 13-15 YEARS OLD

FIGURE 4: EXPOSURE TO SECONDHAND SMOKE AMONG 13-15 YEARS OLD

TOBACCO QUESTIONS FOR SURVEY (TQS) 2014

Tobacco Questions for Surveys (TQS), a shortened version of the Global Adults Tobacco Survey

(mini GATS), is a global standard for systematically monitoring adult tobacco prevalence and

tracking key tobacco control indicators. It was part of Knowledge, Attitude and Perceptions on

NCD Survey carried out from December 2014 until January 2015. There were a total of 1294

completed individual interviews. Results are as follows:

FIGURE 5: PREVALENCE OF TOBACCO USE AMONG ADULTS AGED 15 YEARS ABOVE

FIGURE 6: EXPOSURE TO SECONDHAND SMOKE AMONG ADULTS AGED 15 YEARS ABOVE

PROTECT PEOPLE FROM SECONDHAND SMOKE

Prohibition of smoking in specified places and vehicles: any person who smokes in the specified

places and vehicles is guilty of an offence and will be liable to a fixed compound of $300 for the first

offence.

FIGURE 7: SMOKE-FREE PUBLIC PLACES IN BRUNEI DARUSSALAM

Smoke-free public places also covers 6 meter parameter from any commercial building lines which

includes pathways and parking spaces as demonstrated in Figure 10 below:

FIGURE 8: 6 METER BAN FROM ANY COMMERCIAL BUILDINGS

The Health Enforcement Unit under the Ministry of Health Brunei Darussalam performs regular

inspection at the prohibited places and attended to complaints and reports made by public, and are

eligible to issue penalty to smoking offenders.

Section Details of offence Compound

6(2) Sale of tobacco product imitation 1st offence: $300

2nd offence: $500

10(1) Underage smoking 1st offence: counseling at Smoking

Cessation Clinic

2nd offence: $100

12(3) Sale of tobacco product without license $500.00

14(2) Smoking in prohibited places 1st offence: $300

2nd offence: $500

15(3) Managers fail to show notice of prohibition

(No Smoking sign)

1st offence: $300

2nd offence: $500

16(4) Managers fail to do their responsibilities 1st offence: $300

2nd offence: $500

TABLE 2: OFFENCES UNDER TOBACCO ORDER 2005 THAT ARE LIABLE TO COMPOUND

OFFER HELP TO QUIT TOBACCO SMOKING

The community smoking cessation services were first established in 4 different community health

centres in 2005 to provide support services for smokers who wish to quit smoking through group

and individual counseling as well as pharmacotherapy when necessary.

Most of the services are nurse-led by a 'Smoking Cessation Counselor' (nurses who have been

trained to provide cessation services), with prescription for pharmacotherapy by a general

practitioner or a physician, when required. The service provides an intensive smoking cessation

programme which runs for 6 months including free counseling/ consultations and pharmacotherapy

namely Nicotine patch, Nicotine Lozenges and Varenicline. The success rate for smoking cessation

services since 2005 to 2014 is 20 to 30%.

Smoking Cessation Counseling Workshops for health professionals and other relevant stakeholders

are also organized by Health Promotion Centre annually, to:

increase their knowledge on various aspects of smoking

cessation including current effective pharmacotherapies,

improve their skills and competencies to deliver

standardized smoking cessation brief 5 ‘A’s advice,

support and services,

share information on the global tobacco epidemics and

its impact on health,

discuss on the tobacco control measures in Brunei

Darussalam

The 2005 Clinical Practice Guideline on Smoking Cessation for Health

Professionals has also been revised in 2014 and has been distributed

to all health centres. The revised guideline provides updated evidence-

based recommendations on interventions to treat tobacco use and

dependence. The objective of this guideline is to assist all health

professionals to identify and assess the tobacco use status of every

patient and to deliver evidence-based effective tobacco use and

dependence treatments.

TABLE 3: COMMUNITY SMOKING CESSATION SERVICES IN BRUNEI DARUSSALAM

HEALTH CENTRES DAY OF SERVICE CONTACT NO.

Bandar Seri Begawan Monday (pm) 2230038, 2230046, 2230035

Jubli Perak Sengkurong Saturday (pm) 2661067, 2661068, 2661069,

2661415

Pengiran Anak Puteri Hajah

Muta-Wakkilah Hayatul Bolkiah,

Gadong

Saturday (pm) 2428241, 2428248, 2424991,

Berakas ‘A’ Tuesday (pm) &

Saturday (pm)

2340808, 2340809, 2340810,

2340811, 2340812, 2340813

Berakas ‘B’ Tuesday (pm) 2340815, 2340816

Pengiran Anak Puteri Hajah

Rashidah Sa’adatul Bolkiah

Sungai Asam

Tuesday (pm) 2201593, 2201594

Muara Saturday (pm) 2770177, 2770175, 2770176,

2772991

Jubli Emas Bunut Tuesday (am) 2650450, 2655073, 2655074

Pangkalan Batu Saturday (pm) 2683991

Pusat Pergigian Negara Thursday (pm) 2380430/433

Pekan Tutong Saturday (pm) 4260812

Telisai Thursday (pm) 4244456

Lamunin Saturday (pm) 4237397

Sungai Kelugos Saturday (pm) 4240646

Kuala Belait Saturday (pm) 3335331

Seria Wednesday (am) 3222564, 3222651

Sungai Liang Thursday (pm) 3230428, 3230438

Hospital Pengiran Isteri Hajah

Mariam, Temburong

Saturday (am /pm) 5221210

Morning session: 8:30 am until 12:00pm

Afternoon session: 2:00 pm until 4:30pm

FOR FURTHER INFORMATION:

PLEASE CONTACT HEALTHLINE 145 OR SCC HOTLINE 8882005

In June 2015, Health Promotion Centre has launched a mobile application for smoking cessation

named “Sihat Tanpa Rokok” or STaR. STaR is the health ministry’s latest effort to further reduce

smoking and raise awareness on the negative impacts of the habit nationwide.

The app provides real-time information from the HPC about ongoing tobacco usage, trends and its

dangers, as well as recommending ways to stop smoking. Another feature of the app is its function

that allows users who intend to stop smoking to keep track of the number of days that have passed

since they quit the habit. It also shows the estimated amount of money they would have saved

through doing so. STaR provides users with the option to create individual profiles, and includes a

chat function allowing like-minded users to interact with one another online.

WARNING PEOPLE ON DANGER OF SMOKING

Health messages on cigarette packaging deliver important information directly to smokers. The

message is repeated and reinforced every time a smoker reaches for a cigarette. Brunei’s pictorial

health warning has increased from 50% to 75% in 2012.

Sustained use of mass media campaigns contributes to population-level decreases in smoking

prevalence by increasing knowledge about the harm of tobacco use, encouraging quit attempts and

preventing young people from taking up the habit.

Health Promotion Centre, Ministry of Health does anti-tobacco public education via mass media in

conjunction with World No Tobacco Day annually, including incorporating anti-tobacco education via

the Non-communicable Diseases Awareness Campaign, giving health talks to schools and

government and private offices and providing exhibitions in strategic public places in the country.

FIGURE 9: KNOWLEDGE AND PERCEPTIONS ON HARMS OF SECONDHAND SMOKE AMONG YOUTH 13-15 YEARS OLD (GYTS 2013)

FIGURE 10 : KNOWLEDGE AND PERCEPTIONS ON HARMS OF SMOKING AMONG ADULTS AGED 15 AND ABOVE (KAPSNCD 2014)

In July 2004, the State Mufti issued a fatwa (religious edict) declaring that smoking is haram

(prohibited in Islam) and has been gazetted in 2014 and since has become a law under the Religious

Act under the Ministry of Religious Affairs jurisdiction, and is only applicable to Muslims residing in

Brunei Darussalam.

BAN ON ADVERTISING, PROMOTION AND SPONSORSHIP

Bans on advertising, promotion and sponsorship deny the tobacco industry one of its tools to recruit

new tobacco users to replace those who have quit or died, to maintain or increase use among

current users, to reduce tobacco users’ willingness to quit and to encourage former users to start

using tobacco again. Advertising bans also help reduce the social acceptability of smoking and

tobacco use.

Brunei Darussalam has a comprehensive bans on direct tobacco advertising, promotion and

sponsorship including advertising on national television, radio and printed media and also at point-

of-sale. Brunei Darussalam also does not allow corporate-social responsibility activities from tobacco

industry.

FIGURE 11: BANS ON TOBACCO ADVERTISING, PROMOTION AND SPONSPORSHIP IN ASEAN

RAISE TAXES TO REDUCE DEMAND

Increases in tobacco taxes that lead to higher cigarette prices encourage smokers to quit, increase

successful quit attempts, reduce the number of cigarettes smoke per person and pevent initiation

among youth. Youth, minorities, and low-income smokers are more likely than others to quit or

smoke less in response to cigarette price increases. Because cigarette prices influence youth smoking

initiation, increases in price significantly reduce long-term trends in cigarette consumption.

Brunei increased tobacco taxes in November 2010 via the Customs Import Duty Order

(Amendments) 2010 and Excise Duty Order (Amendments) 2010 and duty-free tobacco products are

also prohibited.

TABLE 4 : TOBACCO TAXES IN BRUNEI DARUSSALAM

FIGURE 12 : TOBACCO TAX BURDEN AS PERCENTAGE OF RETAIL PRICE

REGULATIONS OF E-CIGARETTES OR VAPE UNDER THE TOBACCO ORDER 2005