Ever since 1950, World Health Day has been celebrated every year on April 7 with a different theme - each theme reflecting a priority area of current concern to the public health of the world at large and identified by the World Health Organization (WHO) as deserving the highest attention by health authorities. This year the theme chosen for World Health Day 2022 is “Our Planet Our Health”, which focuses global attention on urgent actions needed to keep humans and the planet healthy and to global action towards creating societies focused on the well-being of all who inhabit this planet.
That the theme has been well chosen and is also very appropriate at this time around, is backed by recent data and evidence from the WHO, which in its latest report estimates that more than 13 million deaths around the world each year are due to avoidable environmental causes, including the climate crisis, which is the single biggest health threat facing humanity. The fact that the WHO has decided to focus on this specific theme at a time when the world at large including Sri Lanka is in the midst of a Covid-19 pandemic besides a surge in other diseases like cancer, asthma, heart disease, underlines the relationship between a polluted environment and our own well being.
A few days ahead of World Health day, The Sunday Observer spoke to Senior Professor of Forensic Medicine, General Sir John Kotelawala Defence University, Ratmalana, and Emeritus Professor of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo and a former Chairman of the National Dangerous Drugs Control Board, Professor Ravindra Fernando to find out what factors contributed to environmental pollution, the link between the toxic air we breathe and our own health, and most importantly how we can prevent or at least drastically reduce the impacts caused from a planet where the level of pollution is increasing four-fold daily.
Excerpts
Q: Reducing environmental pollution is currently one of the biggest challenges facing the world and the subject of many recent forums and public discussions. What are some of the main contributory factors leading to this?
A. It is estimated that over 90 percent of people breathe unhealthy air resulting from burning of fossil fuels. Global warming is seeing mosquitoes spread diseases farther and faster than ever before. Extreme weather events, land degradation and water scarcity are displacing people and affecting their health. Pollution and plastics are found at the bottom of our deepest oceans, the highest mountains, and have made their way into our food chain. Systems that produce highly processed, unhealthy foods and beverages are driving a wave of obesity, increasing cancer and heart disease while generating a third of global greenhouse gas emissions.
Q: What part does cigarette smoking play in adding to such pollution?
A. Cigarette smoking causes environmental pollution by releasing toxic air pollutants into the atmosphere. The cigarette butts also litter the environment and the toxic chemicals in the residues seep into soils and waterways, thereby causing soil and water pollution. The immense harm caused by smoking to users are well-known and widely-accepted. But it is equally important to remember that smoking hurts more than just smokers. Through deforestation, cigarette butt litter and air pollution, it harms the entire planet.
Q: Apart from causing harm to the environment, tell us how smoking affects the human body and adversely impacts on our wellbeing?
A. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. In addition, smoking reduces the blood supply to the bones and to many other body tissues. The nicotine in cigarettes slows production of bone-producing cells, called osteoblasts. Smoking decreases the body’s absorption of calcium, which is necessary for vital cellular functions and bone health.
Q: Smokers often complain of creams in the leg. Why?
A. Smoker’s leg is the term for Peripheral arterial disease (PAD) that affects the lower limbs, causing leg pain and cramping. The condition results from the buildup of plaque in the arteries and, in rare cases, the development of blood clots.
Q: What about mental health? Is there a link between smoking and mental health?
A. Smoking has been associated with a range of mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer. To cite some studies, Tobacco smokers are at increased risk of psychotic disorders such as schizophrenia, according to University of Queensland researchers. Their review of eight long-running studies has found strong evidence of an association between smoking and mental illness, which they suggest is most likely caused by nicotine.
Q: If a pregnant woman smokes will it have a harmful effect on her foetus?
A. Yes. Smoking during pregnancy affects the Reproductive system and health of a pregnant woman and could lead to her having premature and low birth-weight babies.
Q: The Centre for Disease Control (CDC of USA) has stated that tobacco use causes almost six million deaths per year and harms nearly every organ in the body. Thankfully, almost everybody is now aware of this, but the full scope of the harm caused by tobacco cannot be appreciated without considering the impact smoking has on the environment. Your comments?
A. This is a multi-faceted issue, with the link between smoking and the environment encompassing issues related to air pollution, the impacts of the growing of tobacco and the effect of the widespread littering of cigarette butts. If nothing else, this all goes to show that a tobacco-free world would be greener, too.
Q: “Second hand smoking” - For our readers’ benefit can you explain what it is and how it affects the environment apart from our own health?
A. Second-hand smoke is widely recognised as a cause of disease in both humans and animals, but for the issue of smoking and the environment, the most important impact is how it affects air quality overall. Air pollution comes from a variety of sources, but some are more avoidable than others. For instance, pollution from vehicles is a significant issue for air quality around the world, but with so many people depending on cars, trucks and other pollution sources for their jobs and to transport materials they need, this is a hard issue to solve.
Q: So that means?
A. It means that smoking is not necessary for the functioning of society, and in general is detrimental to it. Abundant evidence from various sources show marked improvements in air quality when smoking is banned. For example, when New York instituted a state-wide smoke-free law, levels of fine particulate matter in 20 locations studied decreased by 84 percent and many other locations show similar results around the world.
Q: What is the role of tobacco growers in this scenario? How much are they to blame for environmental degradation that is happening both abroad and in Sri Lanka?
A. Arguably the most important thing for the relationship between smoking and the environment is the impact of growing tobacco. Tobacco is grown as a mono-crop, and this means that large amounts of fertiliser and pesticides, especially herbicides are used when growing it. This can be hazardous to the environment, but the biggest issue is the risks to workers on tobacco farms. This can be mitigated with strong regulations, but unfortunately, tobacco is often grown in countries with very few controls to protect workers. However, the biggest impact of smoking on the environment is deforestation to provide land for the growing of tobacco or building purposes . It is estimated that 200,000 hectares of land are cleared annually to make room for tobacco cultivation.
Q: There is yet another issue related to smoking and the environment. This relates to what happens to the remainder of cigarettes after they are smoked. It has been said that Cigarette butts are one of the most littered items throughout the world, with an estimated 4 trillion butts littered across the world each year! Do you agree?
A. It is well known that cigarette butts are not biodegradable, but they do break into smaller pieces under the influence of ultraviolet radiation from the sun.
Cigarette butts also leach chemicals such as nicotine, arsenic, heavy metals and others like ethyl phenol into the environment. As well as the direct effects on animals that ingest the cigarette butts, the chemicals released into the environment can indirectly damage animals, particularly marine animals. This is more serious because even cigarettes thrown on to the street far away from bodies of water can get swept into drains and find their way into the water system.
Q: As an authority on this subject do you have any lasting solutions to offer for this problem?
A. Smoking and the environment are intimately linked, and coming up with a way to solve the various problems should be our priority. The simplest solution is to reduce the number of smokers in society. This would reduce the demand for tobacco, which would eventually lead to less of it being grown, and also to less cigarette butts being littered.
However, there are other, more targeted strategies that can be used. For example, providing more places for smokers to dispose of their cigarette butts would reduce the issue of littering. Establishing rules governing the use of harmful pesticides on tobacco farms could help exposed workers. It is important to remember that the impacts of smoking on the environment are wide-ranging and hard to tackle. As challenging as it may be, the most reliable solution to the problem is to take steps to move towards a smoke-free world.
Q: Do you see this as possible in the near future?
A. While the Covid-19 pandemic showed us the healing power of medical science, it also highlighted the inequities in our world. The pandemic has revealed weaknesses in all areas of society and underlined the urgency of creating sustainable well-being societies committed to achieving equitable health now and for future generations, without breaching ecological limits.
The present design of the economy has led to inequitable distribution of income, wealth and power, with too many people still living in poverty. A well-being economy should have human well-being, equity and ecological sustainability as its goals.
These goals should be translated into long-term investments, well-being budgets, social protection and legal and fiscal strategies. Breaking these cycles of destruction for the planet and human health requires legislative action, corporate reform and individuals to be supported and incentivised to make healthy choices.
Q: Finally, have you a message for those already addicted to smoking and those tempted to take their first smoke in this post Covid period?
A. When you stop smoking, your body and brain have to get used to not having nicotine. This can be uncomfortable, but nicotine withdrawal cannot hurt you – unless you give in and have a cigarette! Over time, withdrawal symptoms will fade as long as you stay smoke free.