TOBACCO & HEALTHY IN THE WORLD
Introduction
Health and education are the basis of economic productivity. Healthy
populations are critical for poverty reduction, economic growth and long-term
development.
In addition to the traditional burden of communicable diseases, developing
countries today are faced with a huge increase in noncommunicable diseases, mental
illness and violence and injuries. Tobacco is a major contributor to these diseases,
which now account for more than half the disease burden in those countries. This
alarming increase threatens to undermine their economic and social development.
Tobacco is cultivated in many regions around the world and can be legally
purchased in all countries. The dried leaf of the plant Nicotiana tabacum is used for
smoking, chewing or snuff. Contrary to what many believe, tobacco use and its
attributable deaths are not a bane that afflicts developed countries primarily.
In June 1995, representatives of 22 international organizations and other
individuals met in Bellagio to examine the implications of current global trends in tobacco
production and consumption for sustainable development, especially in developing
countries. The meeting participants concluded that tobacco posed a major challenge
not just to health but to social and economic development and environmental
sustainability. The participants recommended that tobacco control be more widely
recognized as a development priority, and expressed concern that it was not on the
agenda of most development agencies.1
Health impact and burden of disease
attributable to tobacco usei
Currently, an estimated 4.9 million deaths per year are caused by tobacco.
Without further action, it is predicted that in 2020 the mortality burden attributable to
tobacco will increase two-fold. Approximately 70% of these deaths will occur in
developing countries. Together with HIV/AIDS, tobacco use is the fastest growing cause
of death in the world and is set to become the leading cause of premature death in the
2020s.
The past few decades have seen dramatic increases in smoking in developing
countries, especially among males.2 This contrasts with steady but slow decreases,
mostly among males, in many industrialized countries. Smoking rates are on the rise
in some low and middle income countries, especially among young people and women,
and they remain relatively high in most of the former socialist economies. Smoking
substantially increases the mortality risk from lung cancer, upper aerodigestive and other
cancers, heart disease, stroke, chronic respiratory disease and a range of other medical
conditions (see Table 1).3 In populations where smoking has been common for many
decades, tobacco use accounts for a substantial proportion of all mortality.4
Recent epidemiological studies illustrate the magnitude of the tobacco epidemic
in developing countries. In China, for example, if current smoking patterns persist,
approximately 100 million of the 300 million Chinese males now aged 0-29 will die as
a result of tobacco use. Significantly, tobacco use was found to be a major cause of the
mortality caused by tuberculosis in China. Tobacco’s adverse effects are not limited to
cigarette-smoking. In India, bidi smoking and tobacco quid chewing were shown to play
a significant role in the development of fatal diseases.5
Table 1: Tobacco use related diseases
Principal diseases caused in part by smoking
Cancers of mouth, pharynx and larynx
Cancer of oesophagus
Cancer of lung
Cancer of pancreas
Cancer of bladder
Ischaemic heart disease
Hypertension
Myocardial degeneration
Pulmonary heart diseasea
Other heart disease
Aortic aneurysm
Peripheral vascular disease
Arteriosclerosis
Cerebral vascular disease
Chronic bronchitis and emphysema
Pulmonary tuberculosis
Asthma
Pneumonia
Other respiratory disease
Cancer of lip
Crohn's disease
Cancer of nose
Osteoporosis
Cancer of stomach
Periodontitis
Cancer of pelvis of kidney
Tobacco amblyopia
Cancer of body of the kidney
Age-related macular degeneration
Myeloid leukaemia
Reduced fecundity
Reduced growth of fetus
Each day more than 13,000 people die prematurely because of tobacco use.
This figure is expected to almost double by the year 2020. Countries at all levels of
development are victims of the tobacco epidemic. The health impact alone of tobacco
warrants significant investment in strong tobacco control programmes. However, the
health consequences of tobacco use are only one facet of the tobacco epidemic. The
following factors heighten the importance of acting swiftly:
· The poor and uneducated are more likely to be victims of tobacco use;
· The burden of disease associated with tobacco use is increasingly borne by
developing countries;
· Tobacco use can contribute to malnutrition;
· The growing of tobacco leaves can have devastating health consequences
for farmers, and workers –especially children:
· Tobacco farming has been shown to contribute to deforestation;
There are signs of hope. Just recently the Organisation for Economic Cooperation
and Development (OECD) Development Assistance Committee (DAC)
adopted a key Reference Document on Poverty and Health which specifically mentions
the profound effect of tobacco use on poverty and malnutrition in low-income countries,
when poor families purchase addictive tobacco rather than food. In the words of Dr Gro
Harlem Brundtland, the time has come to "involve the highest levels of Government and
the highest levels of opinion leaders in their efforts to build on the present momentum,
secure commitment, and reap the significant health and economic benefits that can be
achieved from a reduction in tobacco use."
