TOBACCO KILLS DON'T BE DUPED.pdf
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The Great
Tobacco
Conspiracy -
World Health Organization
^nnth-Fact Acta Raninn
Dr Uton Muchtar Rafei, Reg
WHO South-East Asia Region
Tobacco is the only consumer product that kills when used as
intended by the manufacturer. Currently, tobacco kills 4 million
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people a year globally. By 2020, tobacco is predicted to
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become the leading cause of death and disability, killing 10
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million people every year, 70% of them in developing countries.
Tobacco-related mortality and disease burden in the WHO
.. . * Wl South-East Asia Region are already unacceptably high. Unless
systematic and sustained action is taken now, the situation is bound to get
aggravated.
The good news is that reliable and effective measures to reduce tobacco use
are available. The bad news is that these measures are only partially adopted
and implemented in SEAR countries. The tobacco industry seems to have
influenced many governments to believe that effective control measures will
be detrimental to their economies. This deception must be exposed.
Tobacco is a socioeconomic and developmental issue and, as such, should
not be left to health professionals alone. Tobacco control encompasses many
areas, including law, economics, environment, as well as the media. A largescale collaborative effort is urgently needed to address the problem. Multi
sectoral collaboration and integrated strategies are imperative. Sectors,
.-.eluding the government, NGOs, and the private sector, should realize that
.ebacco control ultimately benefits all substantially.
'any professionals, have key roles to play in tobacco control. Mediapersons
lould realize how the tobacco industry used them to create misconceptions.
tey must expose the ploys of the tobacco industry to delay effective action to
rluce tobacco consumption and, at the same time, highlight the magnitude
tobacco-related harm. Economists should present the benefits of tobacco
jntrol measures on government revenue, employment, productivity and the
ist of health care. Legal experts should actively lobby for effective legislation
nd implementation of existing laws that protect all individuals. Together, we
■_hould act to save the millions of children who are today the main target of the
tobacco industry.
This information package highlights the magnitude and dimensions of the
problem, the strategies that can be adopted to address them and some of the
obstacles to effective tobacco control. Most of all, it provides information for
advocacy and action by countries to help stem the epidemic caused by tobacco
consumption before it is too late.
Industry efforts to expand tobacco use
aggravates health problems
Global patterns
Of the nearly 1.15 billion smokers in the world today, low and middle
income countries account for 82% of all smokers. While smoking
prevalence is declining steadily in most high income countries, the
tobacco epidemic is expanding in developing countries.
Tobacco use presently causes four million deaths everywhere,
worldwide - around 11,000 deaths every day. The number of deaths in
the next three decades are projected at 10 million annually. 70% of
these will occur in developing countries.
Patterns in WHO South-East Asia Region
Tobacco consumption
The South-East Asia Region has consistently had the second highest
(2.8%) annual growth rate in adult per capita cigarette consumption
among the six WHO Regions.
India and Indonesia rank third and seventh respectively among the
leading producers of unmanufactured tobacco in the world. Indonesia
has the fourth largest number of smokers in the world, while in India
and Thailand it has been estimated that there are approximately 240
million and 11 million tobacco users respectively. In Bangladesh there
are an estimated 20 million smokers, 5 million of them women.
In the Region, tobacco is used in many forms and in a variety
of social and cultural contexts. Cigarettes account for less than
one-third of the total tobacco consumption in the Region. Also
consumed are bidis, keeyos, cigars, cheroots, chutta, hookahs,
pan, pan-masala, mawa, creamy stuff, gundi, mishri, gudhaku,
betel-quid, and snuff, among others.
Disease burden
Nicotine levels of up to 3.2 mg and tar levels of up to 50 mg have been
reported in tobacco products (eg. bidis, kreteks and white cigarettes)
in the Region. In many developed countries, the accepted levels are
less than 1.4 mg of nicotine and 15 mg of tar. Consequently tobacco
causes more damage to smokers in the Region.
Tobacco-related illnesses such as cancer, cardiovascular diseases and
respiratory diseases are already major problems in most countries.
There are an estimated 12 million cases of preventable tobacco related
illnesses each year in India. Approximately halt of all cancers in men
in India are tobacco related, while over 60% of those suffering from
heart disease below the age of 40 years are smokers. In Sri Lanka, it
is estimated that over 43% of reported cancers are tobacco related.
Oral cancer is the most prevalent form of cancer in Sri Lanka and
cardio-vascular disease is the leading cause of death.Thailand reports
10,000 cases of tobacco related lung cancers each year, while 70% of
those treated for acute heart attack in Bangladesh are smokers.
In India, tobacco attributable mortality has been estimated to be around
600,000 per year while in Indonesia, it was estimated to be 192,000 in
1992. Tuberculosis, already widely prevalent in the Region, has been
shown to be further exacerbated by tobacco use.
Countries in the Region are already coping with a double burden of
disease - both communicable and noncommunicable. The projected
Increase in tobacco related illnesses will mean that the already
overstretched health care systems of countries will have to handle
an ever increasing disease burden, which may affect the efficiency
of the health services.
MHBH
Targeting Youth
The tobacco industry has been targeting youth for decades. In the
words of a Philip Morris executive: “hitting the youth can be more
efficient even though the cost to reach them is higher, because they
are willing to experiment, they have more influence over others in
their age group than they will later in life, and they are far more loyal
to their starting brand."
The search for new, young smokers was not only conducted by Philip
Morris. The tobacco industry is aware that to maintain and increase
their sales, they need to ensure that more people start smoking. The
industry needs to lure new smokers to replace the ones who die due
to tobacco use. 11,000 new tobacco users are needed each day, to
replace those that die, to keep the sales of the tobacco industry intact.
The younger the age when smoking begins, the longer the smoking
cycle. Young persons are also more vulnerable because they are likely
to be less aware of the addictive nature of nicotine and the harmful
effects of tobacco consumption.
In most developing countries, including countries of WHO South-East
Asia Region, a significant percentage of the population belongs to the
adolescent and younger age groups. It is established that almost all
tobacco users commence use before the age of 18 years. Therefore
the young in developing countries are now increasingly being targeted
by the tobacco industry to increase sales, in order to offset their losses
in the developed countries.
The number of adolescents using tobacco in the Region is already a
cause for concern.
• India reports 5 million child smokers with 55,000 children starling
regular tobacco use every year.
• Thailand reports 52,000 of those less than 20 years starting to smoke
every year.
• In Indonesia, a 1995 survey showed one-third of school children
between the ages of 15 and 19 years smoke. Based on this trend it
has been estimated that 2.5 million out of the 8.5 million children in
Indonesia will become regular smokers.
• In Myanmar, a survey in 1993 found that 44.6% of urban school
children consumed tobacco.
• In 1997, a survey among school children in Bangladesh showed that
23% of those in the 15-16 year age group smoked.
• in Sri Lanka, a survey in 1992 found that over 15% of those who
smoked some time in their lives, had their first smoke by the age of
11 years.
By the time young persons become young adults and realize that they
have become dependent on tobacco, it is already too late.
Many children are conditioned to perceive smoking as glamourous,
sophisticated, an adult habit, a status symbol and a sign of
rebelliousness through tobacco advertising and sponsorships.
A study carried out in India showed that despite a high level of
knowledge about the adverse effects of tobacco, cricket sponsorship
by tobacco companies increased children’s likelihood of
experimentation with tobacco, creating false impressions between
smoking and sport.
Many marketing strategies that target young people have been
prohibited in developed countries. But, the industry keeps on targeting
children in developing countries.
Only powerful advocacy combined with appropriate and
effective policies and legislation can protect our vulnerable
youth against the huge onslaught of tobacco advertising and
promotion.
The tobacco industry has known of the dangers of tobacco for a long
time Yet they have consistently denied this. Over the years the tobacco
industry has built up a powerful lobby in most countries that has
influenced all efforts to curb tobacco use. The disparity between what
they knew, what they said and what they did is deplorable.
1.
What they said: “Health effects of tobacco are not proven"
What they knew:
An internal document from as far back as 1953 states'
"Studies of clinical data tend to confirm the relationship between
heavy and prolonged tobacco smoking and incidence of cancer of
the lung.”
C Teague. RJ Reynolds. Survey of Cancer Research with Emphasis Upon Possible
Carcinogens from Tobacco. 1953. 2 February (Source Action on Smoking and Health. Tobacco
Explained The truth about the tobacco industry in its own words. ASH. UK 1998)
2.
What they said: “Tobacco is not addictive”
What they knew:
“Nicotine is addictive. We are, then, in the business of selling
nicotine, an addictive drug.”
Addison Yeaman from Brown and Williamson, 1963
A. Yeaman. Implications of Battelle Hippo 1 & 11 and the Griffith Filter. 1963. 17 July. Memo
(1802.05) (Source Action on Smoking and Health Tobacco Explained The truth about the
tobacco industry in its own words. ASH. UK 1998)
3.
What they said: “Smoking is an adult choice and freedom of choice
should be respected"
What they knew.
A Former scientist of British American Tobacco indicates:
“It has been suggested that cigarette smoking is the most addictive
drug. Certainly large numbers of people will continue to smoke
because they can’t give it up. If they could they would do so. They
can no longer be said to make an adult choice.”
Dr S J Green. Transcript of Note By SJ Green, 1980, 1 January (Pollock 129] (Source Action
on Smoking and Health. Tobacco Explained The truth about the tobacco industry in its own
words. ASH. UK 1998)
4.
What they said: "Advertising does not increase consumption"
Emerson Foote, former Chairman of McCann-Erickson, which handled
US$20m of tobacco industry advertising accounts asserts:
“ 1 am always amused by the suggestion that advertising, a function
that has been shown to increase consumption of virtually every other
product, somehow miraculously fails to work for tobacco products."
L Heise. Unhealthy Alliance. World Watch, 1988, October. p20. (Source: Action on Smoking
and Health Tobacco Explained. The truth about the tobacco industry in its own words. ASH,
UK 1998)
5.
What they said: “We do not market our products to children”
What they did:
Dave Goerlitz, lead model for RJ Reynolds for seven years, says his
marketing brief was to:
“attract young smokers to replace the older ones who were dying or
quitting ...I was part of a scam, selling an Image to young boys. My
job was to get half a million kids to smoke by 1995”.
J. di Giovanni, Cancer Country - Who's Lucky Now?, The Sunday Times, 1992, 2 August, pl2
(C 7.5] (Source Action on Smoking and Health. Tobacco Explained. The truth about the tobacco
industry In its own words. ASH. UK 1998)
Terence Sullivan, a sales representative in Florida for RJ Reynolds,
laments:
“We were targeting kids, and I said at the time it was unethical and
maybe illegal, but I was told it was just company policy."
PJ Hilts, Smokescreen - The Truth Behind the Tobacco Industry Cover-Up. 1996, Adison Wesley,
96-8 (Source Action on Smoking and Health Tobacco Explained. The truth about the tobacco
industry in their own workds. ASH, UK 1998)
Policy makers can make a judgement on the tobacco industry
by looking at the industry's own documents and statements
from those who worked for the industry.
king the tobacco industry’s ec
arguments
me luuacuo muusiry nas arguea lor aecaaes tnat curtailing its growth,
production and sale would be detrimental to national economies
These are all lies, and the industry knows it. Consider the real facts:
The tobacco industry argues that It brings substantial revenues to
governments:
Econometric studies undertaken by the World Bank have established
that tobacco is a net loss to almost all economies. While the money
that the governments collect on excise and taxes may be substantial,
the direct and indirect losses caused by tobacco consumption are,
indeed, much larger.
Consider the high direct costs of medical care for tobacco related
illnesses, absenteeism from work, loss of productivity and related
income loss, premature deaths, and the perpetuation of poverty.
Then there are other substantial costs. These include the cost of
reduced quality of life for smokers, and all those affected by second
hand smoke, as well as the suffering of those who have to face the
loss of a loved one in the prime of their lives.
The cost to economies:
In India, the cost of major diseases due to tobacco use such as cancers,
heart disease and respiratory diseases in 1999 was estimated to be
USS 6.5 billion. This was more than the sales value of all tobacco
products in the country, and considerably more than the tobacco taxes.
The cost to individuals and families:
It is estimated that in some countries of the South-East Asia Region,
persons of the low socioeconomic group may spend as much as a third
of their income on tobacco products. This accentuates other
consequences of poverty such as lack of education, basic sanitary
facilities and malnutrition.
The industry argues that increasing taxes on tobacco will reduce
government revenue.
On the contrary, increased tobacco taxes can, in fact result in:
• Increase in government revenue.
• Significant decrease in smoking by poorer socio-economic groups.
• Significant decrease in smoking among young people.
• Delayed onset of smoking by young people.
• Reduced consumption by current smokers.
• Decrease in the number of ex-smokers restarting use.
The tobacco industry claims that measures to control tobacco
consumption will reduce the number of jobs in a country:
There is no correlation between cigarette production and the
employment generated. As has been demonstrated in several European
countries, if the number of jobs in the tobacco industry decreases in
the near future, it will be more because of mechanization and increased
productivity rather than effective tobacco control measures.
Econometric studies have also shown that even if the tobacco industry
was totally eliminated, there would be hardly any negative impact on a
country's economy. This is because the money spent on tobacco will
be spent instead on other products and services, which will generate
a greater demand for those products and services, which, in turn, will
generate more employment. A study in Bangladesh estimated that there
would be a net increase of 18.7% in the number of jobs if all tobacco
consumption was eliminated in that country.
The tobacco industry claims that increase in cigarette prices will
increase smuggling:
The issue of smuggling is used by the industry to stop governments
from increasing tobacco prices. However it has been demonstrated
that the magnitude of smuggling to a country does not depend on the
level of taxation alone. In some countries with high taxes, smuggling
is rare, while in some countries with low taxes smuggling is common.
In some cases, manufacturers themselves encourage smuggling
because smuggled cigarettes are cheaper than taxed ones and they
can, thus, realise higher profits.
tacco industry does not spar
ecology, either.
A healthy environment is a pre-requisite for healthy lives. Factors that
threaten the environment and bio-diversity in fact, threaten the lives
of all living beings. The environment should be considered an asset
by countries. Even if countries in the Region are poor economically,
they are still wealthy in terms of nature and natural resources.
Therefore, environmental consequences of tobacco should be taken
seriously to prevent further losses to the natural riches of the countries.
The cost of tobacco should not only be measured in terms of human
lives lost or affected. Other losses are due to deforestation, soil
erosion, and the direct and indirect effects of chemicals used for
tobacco cultivation.
It has been documented that globally an estimated 200,000 hectares
of forests and woodlands are destroyed by tobacco production each
year. Unfortunately, deforestation due to tobacco mainly occurs in
developing countries.
It is estimated that every year, 7000 billion tonnes of paper is used
for wrapping cigarettes. However, according to the tobacco industry's
reports, this accounts for only 16% of the industry’s overall use of forest
resources.
Curing accounts for the major portion of the tobacco industry’s
exploitation of wood, with 69% of wood being consumed as fuel wood
used for curing, and 15% used for construction of curing barns.
Studies from various regions show that more than 10 kg of wood is
needed to cure I kg of Virginia tobacco. For countries in WHO’s SouthEast Asia Region, the fuel wood-deficits are estimated to be very high.
The situation is aggravated by the increasing production of tobacco,
leading to severe deforestation with serious ecological consequences
such as loss of bio-diversity and soil erosion.
In Bangladesh, the use of wood for tobacco production alone
is estimated to be responsible for over 30% of the annual
deforestation.
Tobacco depletes soil nutrients faster than other crops, particularly
where soils are characterized by their low nutrient content. This should
be an important consideration in countries of this Region. When tobacco
is cultivated on the same land repeatedly with minimal rotation, there
is a tendency for soil to become exhausted, and for crop pests to
become endemic. These are some of the reasons why tobacco
cultivation requires high inputs of hazardous pesticides and chemical
fertilizers.
The large workforce of women and children engaged in tobacco
cultivation in the Region are not equipped to be protected from
occupational health hazards arising from exposure to pesticides.
Exposure in early life can lead to a range of problems including mental
impairment, damage to the nervous system, reproductive defects and
cancer. In addition, these chemicals remain in the water table and are
hazardous to the health of rural populations.
Moving away from tobacco farming
Though there are many who may argue that diversification from tobacco
farming is not viable, pilot projects on alternative crops have been
successful. A Tobacco crop-substitution programme was launched in
Bangladesh by the Bangladesh Cancer Society to reduce local
dependence on tobacco cultivation as a means of livelihood. It was
also used as a key strategy for the primary prevention of tobacco-related
cancers. It started with a modest project in a rural community of 15,000
people in Kushtia district where tobacco cultivation was widespread,
and three quarters of adults were tobacco users.
Three years later, In 1992, studies indicated that the
prevalence of tobacco use had fallen dramatically from
baseline levels. The crop substitution programme too had
been successful and the new crops were yielding better
profits. In addition, new employment opportunities had also
been generated. So, there are viable options for alternative
livelihoods.
Tobacco industry strategies to lure women
Women are being increasingly targeted by the tobacco industry in their
effort to shore up their declining sales graphs, particularly in
developing countries. Sophisticated marketing strategies are being
used by the tobacco industry targeted at women. Even in the West.
trends show that while tobacco use is actually declining among men,
it is steadily increasing among women. The industry promotes “female”
brands, and tries to tempt younger women.
A journal of the tobacco trade. Tobacco Reporter, gave its vision of
the future, in 1982:
“ ... Women smokers are likely to increase as a percentage of the
total. Women are adopting more dominant roles in society: they have
increased spending power, they live longer than men. And as a recent
official report showed, they seem to be less influenced by the anti
smoking campaigns than their male counterparts.
The tobacco industry has long been researching on how best to use
advertising imagery to market to women An RJ Reynolds study showed
that
“With the exceptions of career women and single women who work
to support themselves, all female segments In the present study
reacted positively to advertising imagery associated with the
following dimensions: intimacy and closeness, tenderness and
gentleness, loving, caring, sharing
Career women reacted most
positively to imagery associated with elegance and success."
Compared to other WHO Regions, the prevalence of tobacco use
among females may seem relatively low in percentage terms, but in
actual terms, these low rates translate into millions of users.
• In Bangladesh it is reported that over 5 million women smoke.
Between 1980 and 1993, smoking prevalence among men decreased
from 67% to 60%, but the prevalence among women increased
fifteen fold
• In India it is estimated that 45 million women use tobacco.
• In Nepal, a 1988 study showed that 71.7% of the women in a high
mountain area (Jumla), and 58.9% of the women in the plains
(Terai), smoked.
• The incidence of lung cancer in women in the northern part of
Thailand is among the highest in the world. A link with tobacco
smoking is suggested by similarly raised rates in women, of cancers
of the larynx and pancreas.
• According to a 1997 national survey in Maldives 29.4% of females
over 16 years of age smoked.
• Sri Lanka and Indonesia report relatively low levels of tobacco use
among women.
In addition to these tobacco related problems that both men and women
suffer from, women suffer from gender-specific problems:
Tobacco use puts women at greater risk of breast cancer and cervical
cancer. Women are also more prone to premature menopause,
unsuccessful pregnancy and impaired fertility. Oral contraceptives
combined with smoking also increases the risk of heart disease and
stroke in relatively younger women Female smokers are more
susceptible to osteoporosis or “brittle bones". In India, where betel quid
chewing is widespread among women, oral cancer is more common
among women than breast-cancer, and tobacco-related cancers
account for one-fourth of cancers among women
Women who smoke during pregnancy also expose their unborn child
to the effects of nicotine and other constituents of cigarettes. Cigarette
smoking is a leading cause of underweight newborns. Maternal
smoking during pregnancy may also adversely affect the child’s long
term growth, intellectual development and behavioural characteristics.
Preventing any further increase in cigarette consumption and
reducing tobacco use among women could be one of the most
cost-effective means to alleviate the burden of
noncommunicable diseases and poor reproductive health
outcomes among women in the WHO South-East Asia Region,
now and in the future.
Despite the grim picture of the current status of tobacco use and
tobacco-related harm in the Region, there is good news. This relates
to the tried and tested measures that reduce tobacco consumption and
tobacco-related harm. Some tobacco control measures that have been
implemented in the countries of the South-East Asia Region include:
• Bangladesh has banned tobacco advertising in most media.
• Bhutan has declared seven of its districts tobacco free.
• In India, tobacco advertising is banned in state controlled media
and health warnings are mandatory. The capital territory of Delhi
has banned cigarette sales to minors and smoking in public places
and in government buildings.
o Tobacco advertising is banned in Maldives with several islands
declared tobacco free.
o In Myanmar, tobacco advertising in electronic media is not permitted
and health warnings are mandatory.
o Nepal has designated a part of the tobacco tax collected to health
promotion including tobacco control activities. There is also a ban
on tobacco advertising in the electronic media, and health warnings
are mandatory.
o No-smoking flights on both domestic and international flights have
been introduced in some countries including India, Indonesia and
Thailand.
• Both government and nongovernmental organizations are actively
involved in demand reduction programmes at the community level
in some countries.
Unfortunately, the impact of these measures have been limited. A range
of measures implemented in tandem, within a comprehensive tobacco
control policy to reduce tobacco consumption backed by legislation,
is imperative. Two countries of the Region, Thailand and Sri Lanka
have adopted comprehensive tobacco control policies. There is an
urgent need for other countries also to adopt a comprehensive national
■-•rategy for tobacco control.
The strategy should include, among others, the following:
1. Setting up a National Multisectoral body
Implementation of action on tobacco control should not be considered
the responsibility of a single or a few government agencies. A
multisectoral body which could provide direction and mobilize
necessary support and resources of other sectors for tobacco control
should be set up to coordinate and facilitate tobacco control action at
the country level.
2. Health promotion and health education
Tobacco control measures require strong public support for effective
implementation. Therefore education on issues related to tobacco is
essential to create social environments supportive of the adoption of
comprehensive tobacco control policies, supported by relevant
cessation programmes.
3. Adopting appropriate fiscal measures
Tax increases will reduce smoking in the poorer socio-economic groups
who bear a heavier disease burden, reduce smoking among the young,
delay the onset of smoking by the young, reduce consumption by
current smokers, and reduce the number of ex-smokers restarting use
Regular increase of taxes will reduce the affordability of all types of
tobacco products.
4.
Setting up a Health Promotion Fund, based on a levy on
tobacco products
A specific tax on the sale price of tobacco products should be instituted
to ensure the financial sustainability of tobacco control programmes.
In our Region, Nepal imposed such a health promotion tax several years
ago. Thailand has also taken steps to initiate such a fund.
5.
Discontinuation of advertising, promotions and
sponsorships
All direct and indirect advertising, promotions and sponsorships used
to attract young smokers, increase consumption of those already
consuming tobacco and delay cessation of use should be banned
Evaluations indicate that significant and sustained reductions in
smoking occur following such restrictions.
6.
Restricting availability and accessibility of tobacco
products
Restricting the availability and accessibility of tobacco products is an
approach to lower the rates of initiation to tobacco use. This means
disallowing sales of tobacco products in and around venues meant
primarily for young people, restricting vending machines that dispense
tobacco products and banning production and sale of specific tobacco
products. A minimal age for smoking should also be strictly
implemented, evaluated and strengthened.
7.
Adopting measures for consumer protection
Serious attention needs to be paid to providing prominent, precise
consumer protection information on tobacco products Other
information such as tar and nicotine levels, disclosure of ingredients
and additives should also be made mandatory.
8.
Protecting health of non-users
Prolonged exposure to environmental tobacco smoke (ETS) causes
tobacco-related diseases in children and non-smoking adults. Tobacco-
free environments should therefore be created in public places, in
public transport, at work places and in homes
9.
Providing support for tobacco users to quit
If even a small proportion of the hundreds of millions of current users
cease tobacco use, substantial short and long-term health and
economic benefits will accrue Therefore, cessation of tobacco use is
one of the most important areas that need to be addressed.
10.
Addressing smuggling and illicit production
Smuggling and illicit production are issues that needs to be addressed
by individual countries as well as by countries in the Region as a group.
11.
Continuing research
Operational research including quantification of the magnitude of
consumption, and consequences of tobacco use, environmental
consequences, monitoring trends in consumption, research on
behavioural pathways, assessing the impact on vulnerable groups,
advocacy research and evaluation of tobacco control interventions,
should be given priority.
12.
Supporting the Framework Convention on tobacco
control
Member Countries should actively participate in the development and
negotiation of the WHO Framework Convention on Tobacco Control
and related protocols, and its subsequent implementation.
13.
Provision of alternative livelihoods
Governments must plan for agricultural diversification and
diversification from agriculture to other livelihoods in the long term, to
address fears of long or short-term loss of jobs.
Tobacco use can be reduced only by adopting and
Implementing a comprehensive range of measures
concurrently.
nmontal tobacco smoke en
nonsmokers also
I Irmo is growing ovldonco that connects exposure to smoking with a
tiigluri risk of mortality. Scientists have found over the past two decades
that I nvlronmontnl Tobacco Smoke (ETS) effects the health of nonsmokers living or working around people who smoke. So the tobacco
industry's quest to recruit more smokers will cause many more deaths
of people other than tobacco users. ETS is made up of toxic and
carcinogenic agents which are emitted primarily from the burning end
ol a tobacco product as the smoker waits to take the next puff. This is
called side-stream smoke. ETS also consists of mainstream smoke,
which is exhaled by the smoker.
WHO estimates that about 700 million children, almost half of all
children worldwide, live in a home where one parent is a smoker. The
tragic impact of ETS on child health translates into a huge burden as:
Children exposed to environmental tobacco smoke:
• Suffer more coughs and colds and from more lower respiratory tract
infections such as bronchitis and pneumonia
• have an increased chance of developing asthma, triggering off or
making existing asthma worse
• have an increased risk of developing
can lead to reduced hearing
middle-ear infections which
• are at increased risk of lymphoma (cancer of white blood cells) and
brain tumors during childhood
Smoking during pregnancy significantly increases the
chances of:
• the infant dying of sudden infant death syndrome
• spontaneous abortions
• delivering a pre-term baby
■ delivering a low birth-weight baby
• Impairing the child's long term growth and intellectual development.
In Nepal, the high incidence of respiratory tract infection among
children under five years is linked with smoke from cigarettes and
cooking in enclosed areas. Environmental tobacco smoke and maternal
smoking compromises the health of children even before they are born,
of growing children living among a constant cloud of smoke in their
environment, and of adults exposed to ETS in their living or working
environment.
Studies carried out in 25 different worksites in the USA in 1997
concluded that non-smokers working in ETS choked environments have
a double risk of developing lung cancers and heart diseases than their
non -smoking counterparts who are not exposed to ETS.
The US Environment Protection Agency concludes that ETS is a Class
A carcinogen. It estimates that ETS is responsible for 3000 lung cancers
annually among non-smokers in USA, whilst contributing up to 300,000
cases annually of respiratory illness in infants and children younger
than 18 months Currently, an estimated 45,000 deaths each year due
to heart diseases among non-smokers are attributed to passive
smoking.
• The USA spends USS 1 billion every year for ETS-related health
problems.
• In the South-East Asia Region, the nicotine and tar levels of
cigarettes, bidis, and kreteks are high.
• Laws banning smoking in public places are not well enforced
• There is a general lack of laws prohibiting smoking in overcrowded
and enclosed working and dwelling spaces.
• The knowledge and awareness of the harmful effects of
environmental tobacco and cooking smoke is sparse.
All these factors put non-smokers at higher risk of tobacco-related
diseases.
There is therefore an urgent need to highlight strong public
policies to protect non-smokers and children from exposure
to tobacco smoke.
1
2
Abedian I. et al. (Eds.) Economics of tobacco control. Towards an optimal
policy mix. Applied Research Centre. University of Cape Town, South Africa,
1998.
Buck D. et al. Summary and discussion on tobacco and jobs. Impact of falling
consumption on employment in the UK. London and York, Society for the Study
of Addiction and Centre for Health Economics, 1995.
3
Cholatt-Traquet C. Evaluating tobacco control activities: Experience and
Guiding Principles. World Health Organization, Geneva 1995
4
Geist H.J Global assessment of deforestation related to tobacco farming,
Tobacco Control 1999,8:18-28
5.
Indian Council of Medical Research Cost of Tobacco Related Diseases, 1999.
6.
International Agency on Tobacco and Health Bulletin No 73, December 1997
quoting a study of Centre of Health Economics, York University, Society for
the Study of Addiction United Kingdom
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Regional Adviser, Health Promotion and Education
World Health Organization
Regional Office for South-East Asia
World Health House
indraprastha Estate, New Delhi -110 002, India
Tel: 00-91 -11 -331 7804-23 Fax: 00-91 -11 -331 8412
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