The global tobacco epidemic kills more than seven million people each year, of which close to 900,000 are non-smokers dying from breathing second-hand smoke. Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as, cigarettes and beedis. There are more than 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer. Tobacco use is addictive, alters the neurochemistry of the brain, causes long-term adverse health consequences and often leads to illness and death.
Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development. As many adults give up smoking every year, tobacco companies are increasingly targeting the youth, including girls and young women, as a new market.
The focus of World No Tobacco Day 2018, which falls on May 31 (Thursday) is “Tobacco and heart disease” under the catchy slogan “Tobacco Breaks Hearts”. World No Tobacco Day 2018 will focus on the impact tobacco has on the cardiovascular health of people worldwide. Tobacco use is an important risk factor for the development of coronary heart disease, stroke, and peripheral vascular disease. The campaign is spearheaded by the World Health Organization (WHO). The WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force in February 2005 and has today 181 State Parties (including Sri Lanka) covering more than 90% of the world’s population.
Despite the known harms of tobacco to heart health, and the availability of solutions to reduce related death and disease, knowledge among large sections of the public that tobacco is one of the leading causes of Cardiovascular Diseases (CVD) is low. Cardiovascular diseases kill more people than any other cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12 percent of all heart disease deaths.
Tobacco use is the second leading cause of CVD, after high blood pressure. It is also the leading cause of lung cancer. According to the U.S. Centres for Disease Control and Prevention (CDC), tobacco smoking is the top risk factor for lung cancer, with 90 percent of cases attributed to tobacco use. More than 70% of all lung cancer patients throughout the world are smokers or ex-smokers. Indeed, the health cost of tobacco consumption is immense and negates any revenue gained through taxes on tobacco on tobacco products as many countries including Sri Lanka treat diseases caused by tobacco free of charge under their free healthcare systems.
Governments have been urged to reduce tobacco use and protect people from NCDs by taking several measures. Sri Lanka has complied with most of these measures which include: tobacco use and prevention policies; Protecting people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces and public transport; Offering help to quit tobacco; Warning about the dangers of tobacco by implementing plain/standardized packaging, and/or large graphic health warnings on all tobacco packages, and implementing effective anti-tobacco mass media campaigns that inform the public about the harms of tobacco use and second-hand smoke exposure; Enforcing comprehensive bans on tobacco advertising, promotion and sponsorship and raising taxes on tobacco products and make them less affordable.
It has been observed that hard-hitting anti-tobacco advertisements and graphic pack warnings – especially, those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit. Seventy eight countries (including Sri Lanka) , representing 47% of the world’s population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs. Australia was the first country to introduce plain packaging back in 2012, which bans the use of all trademarks on tobacco packaging and requires that all tobacco products be sold in virtually identical, government-designed packaging. Sri Lanka has also introduced plain packaging.
Studies have shown that tobacco taxes are the most cost-effective way to reduce tobacco use, especially, among the young and poor people. A tax increase that increases tobacco prices by 10 percent decreases tobacco consumption by about 4 percent in high-income countries and about 5 percent in low- and middle-income countries. High tobacco taxes are rarely implemented. Only 32 countries, with 10% of the world’s population, have introduced taxes on tobacco products so that more than 75% of the retail price is tax.
Sri Lanka does have several other progressive measures aimed at discouraging tobacco consumption such as, prohibiting tobacco sales to those under 21, severely restricting all forms of advertising including Point of Sale advertising and limiting smoking in most public places. Plans are also afoot to ban the sale of ‘loose’ cigarettes without delay. The availability of loose cigarettes encourages consumption because the price is affordable when one buys 2-3 cigarettes. However, if cigarettes are sold only in unopened packet form, not many will be tempted to spend at least Rs.1,150 for a packet, at once.
Another aspect of tobacco control that gets little attention is the danger posed by illicit tobacco. It is estimated that 1 in every 10 cigarettes and tobacco products consumed globally is illicit. Each year, more than 400 billion cigarettes are illegally sold globally, making it the most widely smuggled product in the world.
The illicit market is supported by various players, ranging from petty peddlers to organized criminal networks involved in arms and human trafficking.
These illegal manufacturers do not employ the quality control measures usually adopted by the legal manufacturers, making them even more harmful to smokers and others. Governments also lose revenue as illicit tobacco is often smuggled in, denying revenue at the point of entry and point of sale. All entry points must be thoroughly secured and smuggling avenues closed – the same measures used to contain narcotics such as heroin, must be pursued in the case of illicit tobacco.
The cinema and teledrama industry must also take care not to show scenes that may glamourize smoking, leading youngsters to believe that it is a fashionable thing to do. If such scenes are shown, a warning must be displayed every time.
The media should play a bigger role in vilifying tobacco and alerting the public to the dangers posed by tobacco through lung cancer and heart disease. If we can veer the youngsters away from tobacco, the future generations will be free of the tobacco scourge.