Often, betel nut sellers, who are outside the formal economy, have few other economic alternatives to generate income.
Money from betel nut sales often goes towards school fees and food, medicine and other household expenses.
By totally banning betel nut consumption, household incomes may decline, contributing to increased poverty, as the ability to afford household necessities also decreases.
Policy initiatives to curb demand, such as through regulation and legislation,Including the banning of its sale, also present its own sets of problems.
"A more appropriate platform for action might be a public awareness, education, communication and advocacy." (World Health Organization).
This might include strengthening communication and advocacy activities by using role models to convey the important messages of the dangers of betel nut, particularly the link to cancer.
The cancer link to chewing betel nut was emphasized in a warning issued by the WHO and broadcast by Radio New Zealand on 17 April 2019.
Quoting from the news bulletin the message relating to the health risk of chewing betel nut and cancer was evident.
"The combination of betel nut and tobacco is heightening dangers to health because both substances contain cancer causing agents and are addictive, the World Health Organisation (WHO) says.
"A recent meeting in Palau heard rates of oral cancer in under 40-year-olds who use both substances is escalating.
"It also heard children as young as six are chewing betel nut in some countries.
A technical officer at the WHO in Fiji, Ada Moadsiria, said some people chewed betel nut with tobacco while others smoked soon after chewing the nut, which has psychoactive properties.
"Co-use raised the danger to health, Dr Moadsiria said.
"The nicotine in the tobacco is already an addictive substance but then arecoline, which is found in betel nut, is actually also causing dopamine release and therefore dependence on this product," she said.
"So, not only is it increasing risk of cancer but it's also increasing risk of addictiveness."
"The WHO is working with Pacific governments to identify policies and legislation to address public health concerns related to betel nut, Dr Moadsiria said.
"The WHO also has free online courses for health professionals to help them learn more about how to identify betel nut use and signs of oral cancer among their patients, she said."