By R. Perera
At a recent workshop conducted by the National Authority on Tobacco and Alcohol (NATA), dental academic Prof. A.A. Hemantha K. Amarasinghe highlighted the persistent public health challenge posed by smokeless tobacco and areca nut consumption. He stated that tobacco and alcohol are each linked to around 200 diseases, and roughly 110 people die every day in Sri Lanka as a result of their consumption.
While cigarette smoking and alcohol use have shown a modest decline, Prof. Amarasinghe observed that chewing betel leaves, often mixed with tobacco, has not decreased despite ongoing awareness and control efforts. He stated that nine oral cancer patients are reported daily due to the use of betel quid. This enduring habit carries serious consequences.
The Lives Saved Report on Sri Lanka (2025) reveals that, oral-pharyngeal cancers, which affect the mouth and throat, account for over 15 percent of all reported cancers in Sri Lanka, making them among the leading causes of cancer-related deaths in the country.
Despite smokeless tobacco products being banned since 2016, the report notes that 34 percent of adults aged 35 to 44 and nearly 48 percent of those aged 65 to 74 continue to chew betel or areca nut products, often combined with tobacco. These practices are deeply culturally embedded and highly addictive.
The impact extends beyond health. Sri Lanka produces around 67,000 tons of areca nuts annually, ranking fifth in the world, with many rural families depending on the crop for income. This economic dependence makes regulation and behaviour change particularly challenging. Yet the Lives Saved Report warns that continuing with the current approach to tobacco control will cost thousands of lives every year.
The report also outlines the potential for a science-based, harm-reduction strategy. By combining stricter regulation of smokeless tobacco and areca-nut products, robust public education, and access to safer nicotine alternatives, the country could save up to 85,000 lives by 2060.
A crucial aspect highlighted in the report is the concept of off ramping, which creates a transition pathway for adult smokers addicted to smokeless tobacco products to move towards less harmful, regulated nicotine alternatives. Off-ramping recognises that while immediate cessation may not be achievable for everyone, providing access to safer, science-backed options can significantly reduce health risks and prevent relapse into more harmful use.
ENDS