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Beating tobacco for good

by Editor's Desk

Stamping out tobacco use can help countries prevent millions of people falling dying from tobacco-related diseases, combat poverty and interestingly, according to a first-ever World Health Organization (WHO) report, reduce large-scale degradation of the environment.

The WHO is highlighting how tobacco threatens the development of nations worldwide this time and is pursuing governments to implement strong measures to control tobacco use. These include banning marketing and advertising of tobacco, promoting plain packaging of tobacco products, raising excise taxes and making indoor public places and workplaces smoke-free.



Health and financial costs

Tobacco use kills over 7 million people every year and costs households and governments more than US$ 1.4 trillion in terms of healthcare expenditure and lost productivity.

“Tobacco threatens us all,” said Director General, WHO, Dr Margaret Chan and added, “tobacco exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air.”

Dr Chan said: “…by taking robust tobacco control measures, governments can safeguard their countries’ futures by protecting tobacco users and non-users from these deadly products, generating revenues to fund health and other social services, and saving their environments from the ravages tobacco causes.”

Tobacco blemishes the environment too

The WHO report titled Tobacco and its environmental impact: An overview, also shows the impact of this product on nature. Tobacco waste contains over 7,000 potent toxic chemicals that poison the environment, obviously including carcinogens.

Tobacco smoke emissions contribute thousands of tons of carcinogens, toxicants and greenhouse gases to the environment. That apart, tobacco waste is the largest type of litter by count globally.

As many as 10 billion of the 15 billion cigarettes sold daily are disposed of in open. Cigarette butts account for almost 40% of all items collected in coastal and urban clean-ups.

“Many governments are taking action against tobacco, from banning advertising and marketing to introducing plain packaging for tobacco products, and smoke-free work and public places,” said Assistant Director-General for NCDs and Mental Health, WHO, Dr Oleg Chestno. “…one of the least used, but most effective, tobacco control measures to help countries address development needs is through increasing tobacco tax and prices.”

Governments collect nearly US$ 270 billion in tobacco excise tax revenues each year, but this could increase by over 50%, generating an additional US$ 141 billion, simply from raising taxes on cigarettes by just US$ 0.80 per pack (equivalent to one international dollar) in all countries. Increased tobacco taxation revenues will strengthen domestic resource mobilization, creating the fiscal space needed for countries to meet development priorities under the 2030 Agenda.

The menace of smokeless tobacco

That apart, the consumption of smokeless tobacco that is directly related to the incidence of oral cancer is alarmingly high. India, as per the WHO Country profiles, has one of the highest proportions of oral cancer in the world and the unfortunate fact is that the numbers are still soaring.

This disproportionate incidence of oral cancer has been related to the high proportion of tobacco chewers, a habit unique to Indians. Oral cancer accounts for one-third of the total cancer cases and almost 90% of the patients are tobacco chewers. This is true across a broad spectrum of people, rich and poor, male and female, old and young.

The statistics are startling. Mere 20% of the total tobacco consumed in India is in the form of cigarettes, around 40% is in the form of bidis and the remaining 40% is consumed as chewing tobacco, pan masala, bidi, cigar, hookah, sheesha, tobacco chewing, clove cigarettes and snuff. These products contain putrefied tobacco, paraffin, areca nut, lime, catechu, and 230 permitted additives and flavors including known carcinogens.

Around 65% of all Indian men use at least one form of tobacco. For women, the usage statistics ranged between 15% in rural Gujarat and 67% in Andhra Pradesh, the overall prevalence being 3% for bidi and cigarette smoking.

What is alarming is that fully one-third of all women use at least one form of tobacco and in Mumbai, 57.5% of women use it but solely in the smokeless form.

Most people have no idea that consuming smokeless tobacco is as dangerous as smoking and while packets of pan masala do bear health warnings, they are rendered almost invisible by the bright shiny packaging and the small size of the warnings. Consequently, unlike smoking, which must be hidden from adults, children can openly consume pan masalas.

The fact is that smokeless tobacco has been directly related to the incidence of oral cancer. The first signs are the appearance of patches and sores in the mouth or tongue, followed by submucous fibrosis and difficulty in opening the mouth fully. At this stage the signs are reversible, but if left untreated will almost certainly develop into cancer. The abuse of smokeless tobacco resulted in cases of submucous fibrosis among patients who spoke of their ignorance of the dangers they had exposed themselves to.

It may be mentioned here that as per a recent Delhi University report there are nearly 274.9 million tobacco users in India; 163.7 million smokeless tobacco (SLT) users, 68.9 million smokers and 42.3 million combined users; SLT usage being particularly dominant in the unorganized sector (Global Adult Tobacco Survey, 2009-10). Compared to NFHS-3 (2005-06), NFHS-4 (2015-16) data indicate a reduction in tobacco use among adults (men: 57% to 44.5%; women: 10.8% to 6.8%).

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