Photo: Vignesh Kamath/Research Matters
Puff…went up the smoke – into the air that he and his family breathed. He was a smoking gun, quite literally, whenever he held the cigarette between his fingers. His lungs were filled with tar and his teeth had worn out. He looked out of the window staring aimlessly with a pale face – what had he done to himself? A charismatic, successful young man that he once was, now on a hospital bed, out of job and diagnosed with oral cancer. Was it regret on his face? Was it the untold pain? Was it something more?
This is perhaps the tale of every smoker addicted to the abuse of tobacco. According to a report by the World Health Organization (WHO), tobacco kills nearly 6 million people each year. While that may not be too surprising, the fact that more than six lakh people are non-smokers who die from passive smoking might send a chill down your spine! As though this was not bad enough, the WHO estimates that more than 8 million deaths by 2030 could be attributed to tobacco, if there is no action taken to prevent it.
It is for this reason that WHO observes May 31st of every year as the ‘World No Tobacco day’ – a day to spread awareness among communities on the harmful effect of tobacco. It is in fact one of eight official global public health campaigns marked by WHO and the only one attributed to substance abuse. The theme for this year is ‘Tobacco – a threat to development’ – recognizing that tobacco poses an enormous threat to the sustainable development of countries, including that to health and economic well being of the people.
How does tobacco affect your health?
Tobacco comes from the leaves of the tobacco plant that belongs to the same family as brinjals, tomatoes and potatoes. It is thought to have grown in the Americas as early as 1400–1000 BC, and was used by the Native American tribes as a commodity for trade. With the arrival of Europeans, the use of tobacco became widespread across the world. Its popularity as a substance for recreational use can be attributed to the chemical nicotine, which is a stimulant. Today, tobacco is cultivated just like other agricultural crops.
India is the third biggest producer in the world with 0.25% of cultivated land used for the purpose. It is commonly consumed in the form of beedis, cigarettes, chewing tobacco, cigars, gutka, hookah, snuff and snus. The Global Adult Tobacco Survey conducted in 2010 across India concluded that 34.6% adults above the age of 15 years consume tobacco, with 47.9 % males and 20.3% females. It pointed out that tobacco consumption is increasing at an unabated rate with rural India witnessing a high consumption compared to the urban areas. Also, there is a high prevalence of unregulated sale of tobacco leaves which people roll into cigars or chew it directly.
Research has shown that the use tobacco is directly associated with non-communicable diseases such as cardiovascular diseases, cancers and lung diseases. Among the many health issues caused by tobacco consumption, oral cancer due to tobacco consumption is on the rise with an estimated 130,000 people succumbing to oral cancer in India annually.
But how does tobacco kill? Tobacco has more than 5000 chemicals of which nicotine is an important one. Nicotine stimulates heart muscles causing an increase in the heart rate and release of chemical messengers in brain such as dopamine, serotonin, etc. These messengers cause relaxation, calmness and alertness of the mind, leading to tobacco addiction over repeated use. When tobacco is burnt, it releases carbon monoxide into the blood, which reduces its oxygen carrying capacity, leading to shortness in breath and other lung diseases. The tar in tobacco made up of benzopyrene and other chemicals such as formaldehyde, hydrogen cyanide, lead, arsenic, ammonia and others -- all of which are known to cause cancers by changing the DNA changes and activate cancer causing genes known as oncogenes.
Tobacco’s effects on the nation’s purse
The use of tobacco not only affects an individual’s health but also costs national economies enormously through increased health-care costs and decreased productivity. Many studies have shown that tobacco use is highest among the poor and it worsens health inequalities and exacerbates poverty, as the poorest people spend on tobacco in lieu of essentials such as food, education and health care. In some of the poorest countries in Africa, nearly 15% of the household income is spent on tobacco!
Tobacco production also takes a toll on a nation’s economy. Today tobacco is grown in about 3.8 million hectares of agricultural land – equivalent to the area of Bhutan. About 90% of that is often grown in countries where undernourishment and child labour persist. Take for instance Malawi, a leading tobacco-producing country. In 2008, while 27% of its population was undernourished, each hectare of land devoted to tobacco produced one ton of tobacco leaf; which otherwise would have 14.6 tons of potatoes! In Viet Nam, smokers spent 3.6 times more on tobacco than on education in 2003.
Rampant child labour in the tobacco industry deceives many from opportunities to pursue education. Since a few transnational companies dominate the global cigarette production, the producing countries or its population remain impoverished. The tobacco business worsens low and middle-income countries’ balance of trade, destroys its human capital and diverts resources into a product that significantly drains the government and household finances.
Controlling the tobacco addiction
Controlling tobacco use can break the cycle of poverty, contribute to end hunger and promote sustainable agriculture and economic growth. “The problem of tobacco is a social issue concerned with government, policy makers, industry, and importantly consumers. The socio-behavioural determinants of the health have to be addressed in order to tackle this issue”, says Dr. Vikrant Mohanty, who heads the Tobacco Cessation Clinic (TCC) at Maulana Azad Dental College, New Delhi. While tobacco cessation at an individual level requires behavioural support, non-pharmacological approaches and clinical care, large-scale anti-tobacco campaigns require a concerted effort by the government and people to reduce the burden at all levels.
All countries benefit from successfully controlling the abuse of tobacco as it protects their citizens from the harms of tobacco use and reduces its toll on national economies. Hence, tobacco control has been a part of the United Nation’s crucial Sustainable Development Agenda. WHO has also developed the ‘WHO Framework Convention on Tobacco Control’, (FCTC), an international public health treaty developed to tackle the global tobacco epidemic by enforcing countries to curb foreign investment in tobacco, tobacco advertising and promotion, illicit trade, etc.
Fiscal policies have been enforced across the world in many countries to reduce tobacco consumption. In Australia, tobacco consumption among 14 year olds has fallen to 13% in 2013 as compared to 24% in 1991, because of periodic increase in tobacco tax, graphic warnings, plain packaging, tobacco ban in public places, etc. In India, the national tobacco control programme was successful in passing a ban on smoking in public places, prohibition of direct and indirect advertisement, promotion and sponsorship of cigarette and other tobacco products and ban on sale of tobacco products to a person below 18 years of age.
Sunita Tomar, a young woman from Madhya Pradesh, was the face of anti-tobacco campaign launched by Ministry of Health and Family Welfare in India until her death in April 2015. Being diagnosed with oral cancer herself, she strongly urged others to stay away from all types of tobacco. “Nobody should suffer from what I suffered”, she often said. Sunita Tomar’s case is one such example among the millions whose development is affected by tobacco. Given these factors, it is imperative to reflect on how tobacco affects individuals, families, communities and even countries, and understand that tobacco is truly a threat to development.