The global tobacco epidemic kills nearly six million people each year, of which more than 6,00,000 are non-smokers dying from breathing second-hand smoke. Unless we act, the epidemic will kill more than eight million people every year by 2030.
More than 80 per cent of these preventable deaths will be among people living in low- and middle-income countries, where the burden of tobacco-related illness and death is more.
Every year, on May 31, the World Health Organisation (WHO) and partners mark the World No Tobacco Day highlighting the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption. The theme for the World No Tobacco Day 2013 is ‘Ban Tobacco advertising, promotion and sponsorship’. The ultimate goal of the day is to protect the present and future generations not only from these devastating health consequences but also against the social, environmental and economic scourges of tobacco use and exposure to tobacco smoke.
Tobacco products are made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed or snuffed. All contain the highly addictive psychoactive ingredient, nicotine. Despite the overwhelming evidence of the harmful effects of smoking, tobacco use has increased in developing countries and become one of the most profound global health challenges.
Tobacco has been used in India for centuries. The early forms of tobacco were limited to chewing tobacco leaves or smoking tobacco. Today, several products made of, or containing tobacco, are available in the market. Nicotine is a drug found in tobacco which is highly addictive. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine. Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases and cardiovascular diseases. Despite the known health problems associated with tobacco use, adolescents continue to initiate and develop regular patterns of tobacco use.
Globally, adult tobacco consumption is strongly associated with poverty, with those in lower socioeconomic classes using tobacco at higher rates. Although there are many factors contributing to predicted tobacco use, socioeconomic status is the single greatest predictor.
In India, only 20 per cent of the total tobacco consumption is in the form of cigarettes. Bidis account for the largest proportion, at about 40 per cent of the total. Bidis contain higher concentrations of nicotine than both filtered and unfiltered cigarettes and have equally deleterious effects on health. Also, due to extensive use of chewing tobacco, India has the most cases of oral cancer in the world, with 83,000 incident cases and 46,000 deaths annually. These cancers are steadily increasing and occurring more frequently among younger people. A recent research has demonstrated that smoking increases the risk of death among patients with tuberculosis (TB) and causes 200,000 extra deaths due to TB. An estimated 65 per cent of all adult Indian men and 33 per cent of adult Indian women use some form of tobacco.
Millions of people in India use chewing tobacco. With India undergoing a tremendous economic and epidemiologic transition, tobacco consumption is increasing rapidly among urban youth. Nearly all tobacco use begins during youth and young adulthood. These young individuals progress from smoking occasionally to smoking every day. Secondhand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes and bidis.
The World Health Survey (WHS) conducted by the WHO has found that 46.7 per cent of poor men smoke in India as against 21.8 per cent of rich men. In developing countries, many of the poorest smokers spend significant amounts of their incomes on tobacco instead of basic human needs such as food, shelter, healthcare and education. It is because smoking regulates mood, manages stress and copes up with the strains of material deprivation.
An adult tobacco survey in India done recently by the Health Ministry and the WHO found that smokers in India spend an average of Rs 399 on cigarettes and Rs 93 on bidis monthly. According to the Planning Commission of India, as many as 354 million people or 29 per cent of the population currently live below the poverty line, which is defined by a monthly income of anything below 672 rupees for rural India and 859 rupees for urban labourers.
Smoking is, therefore, a powerful mediator of the association between poverty and mortality. This is because the poor and less educated are less aware of the health hazards of smoking and, thus, more likely to adopt this harmful practice.
There is no safe level of exposure to secondhand tobacco smoke. In adults, secondhand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death.
Despite increased efforts in tobacco control over the last several decades, smoking continues to be the number one cause of preventable diseases and deaths. Furthermore, tobacco is directly related to and contributes to poverty. According to the WHO, tobacco use contributes to huge economic losses for individuals, families, communities and entire countries.
Tobacco also creates economic costs that extend beyond the direct cost of related illnesses and productivity losses, including healthcare expenditures from active and passive smokers, employee absenteeism, reduced labour productivity, IJre damage due to careless smokers, increased cleaning costs and widespread environmental damages.
Tobacco users have higher medical expenses due to tobacco-related illnesses and tend to die at younger ages, leaving their families with loss of income, medical bills and other expenses related to their illnesses and deaths.
The immediate and long-term benefits of smoking cessation extend to men and women of all income and education levels but are more pronounced among low socioeconomic status (SES) adults. While cessation may seem near impossible for many low SES individuals, there are several effective tools that can control use. Tobacco control policy can have a significant impact on reducing smoking rates and health consequences of smoking among low SES individuals. There is a need to continue raising awareness and remind people of the law. Ultimately, governmental leadership at state and city levels would be crucial to the ongoing success of the smoke-free law.
Every person should be able to breathe smoke-free air. Smoke-free laws protect the health of smokers and nonsmokers. Mass media campaigns can also reduce tobacco consumption by influencing people to protect nonsmokers and convincing youths to stop using tobacco.
It is high time to control smoking for low-income people. Smoking is bad for physical and mental health. Many poor people with depression smoke as they find no alternative for relax and entertainment. When a person smokes, a dose of nicotine reaches the brain within about 10 seconds. At first, nicotine improves mood and concentration, decreases anger and stress, relaxes muscles and reduces appetite. But this effect is short-term. Smoking puts one at even greater risk of physical ill health. Any short-term benefits that smoking seems to have are outweighed by the higher rates of smoking-related physical health problems such as lung cancer and heart diseases. Nicotine replacement therapy can help smokers stop smoking and they should think of better opportunity of livelihood.
A number of countries have legislations restricting tobacco. The Government of India has launched the new National Tobacco Control Programme (NTCP) to implement the anti-tobacco laws and sensitise all stakeholders, which would reduce the prevalence of smoking among the lower socioeconomic groups. Besides, a comprehensive ban of all tobacco advertising, promotion and sponsorship is required for all people to live a tobacco-free healthy life.
(Dr Mayarani Praharaj works at the Department of Architecture, College of Engineering and Technology, Bhubaneswar)