Addressing smokeless tobacco and building research capacity in South Asia

ASTRA is a world-class, international and interdisciplinary group, aiming to reduce the substantial burden of disease caused by smokeless tobacco. Smokeless tobacco is responsible for thousands of deaths per year, but has so far been neglected in policy and research. ASTRA’s international teams will carry out policy research and develop interventions to address the problems caused by smokeless tobacco use in South Asia. Our focus is on Bangladesh, India and Pakistan, where 80% of the world’s 300 million smokeless tobacco users live, and where the most harmful types of smokeless tobacco are favoured. ASTRA is a three-year programme, with a budget of £2M. Dr Subhash Pokhrel and Ms Kathryn Coyle from Health Economics Theme are leading Economics study within ASTRA with an aim to quantify the healthcare costs of smokeless tobacco use in Bangladesh, India and Pakistan.

Aims of ASTRA:

  • To gather evidence about how the policies recommended by the WHO-FCTC are being developed and implemented for smokeless tobacco in LMICs. This part of the programme will focus on young people, since 90% of ST users start their habit during adolescence.
  • To develop and evaluate interventions, such as behavioural support or medicines, to help adult ST users to quit.
  • To build capacity, by training research teams at LMIC institutions to conduct high quality applied health research in Bangladesh, Pakistan and India.
  • To use this capacity to support wider tobacco control efforts in the South Asia region.

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Meet the Principal Investigator(s) for the project

Professor Subhash Pokhrel
Professor Subhash Pokhrel - Generating evidence that helps governments invest better in public health Subhash Pokhrel is a Professor of Public Health Economics and Lead of the Health Economics Research Group (HERG) at Brunel University London. His research helps governments and health systems make evidence-informed investment decisions in public health - from tobacco control and breastfeeding promotion to physical activity and multimorbidity. With over 4,000 citations and experience across four continents, his work bridges rigorous economic analysis with real-world policy impact. Subhash's career spans more than two decades of research at the intersection of health economics, evidence synthesis, and public health policy - with work informing decisions at local, national, and international levels. His research is organised around two complementary themes: supporting health systems to deliver efficient, equitable healthcare, and strengthening health research systems to ensure research feeds into policymaking where it matters most. A key focus of his work has been the economic case for public health investment. He led the development of the NICE Public Health Return on Investment (ROI) Tools - practical, customisable models used by local authorities across England to justify investment in tobacco control. Building on this, he coordinated EQUIPT, a €2 million European Commission-funded, 11-country study that extended the ROI approach to tobacco control decisions across Europe. His contributions to public health policy are recognised in two REF2021 impact case studies: one on supporting tobacco control decision-making, and another on informing policies around breastfeeding promotion. He is the lead author of ROI in Public Health Policy: Supporting Decision Making (Palgrave Macmillan, 2017). Subhash has also contributed significantly to global health research. He has worked in multiple low- and middle-income countries - including Nepal, India, Bangladesh, Pakistan, Ghana, Burkina Faso, Brazil, and Indonesia - and collaborated with the World Health Organisation to strengthen National Health Research Systems. He co-produced a WHO review of evidence on policies and tools for strengthening national health research systems. As a member of external committees including NICE Technology Appraisal, NIHR PGfAHR, and SPI-B (the Scientific Pandemic Insights Group on Behaviours during COVID-19), he has contributed to decisions on medical technology funding, applied health research, and pandemic behavioural policy. Subhash has trained and supervised numerous doctoral researchers investigating topics from integrated care in the UK and obesity in West Africa to long-COVID in Ghana and the economics of physical activity in LMICs. Subhash would like to hear from you if you are interested in exploring: (a) what strengthens health systems to improve population health; or (b) how health research systems can be designed to generate and apply evidence more effectively. Find Subhash on: 🎓 Google Scholar  ðŸ”¬ ORCID   ðŸ”— ResearchGate   ðŸ“š BURA (Brunel Repository)   ðŸ’¼ LinkedIn

Related Research Group(s)

medic

Health Economics (HERG) - Our strategic focus is on economic evaluation and systematic reviews of a broad range of clinical and health service technologies by providing high-quality, applied, policy-relevant research, as well as developing and refining methods to increase the rigour and relevance of such studies.


Partnering with confidence

Organisations interested in our research can partner with us with confidence backed by an external and independent benchmark: The Knowledge Exchange Framework. Read more.


Project last modified 02/10/2023