What is the most important health issue that needs quick action? The dubious distinction goes to the need to phase out sale of tobacco and tobacco products.
If we do not act swiftly now, we can expect one billion deaths from smoking and other forms of tobacco use by the end of this century. Over 80% of these deaths will be in low- and middle-income countries; the devastating economic and social burden of tobacco illness will affect them in the coming decades.
On March 13, 2015, Robert Beaglehole, Ruth Bonita, Derek Yach, Judith Mackay and K Srinath Reddy, leading public health researchers from New Zealand, USA, China and India pleaded for phasing out the sale of tobacco by 2040 in a major new series in The Lancet, a British medical journal.
They proposed that UN should call a high- level meeting on tobacco use to galvanize global action to achieve a tobacco free world (where less that 5 % of the adults use tobacco) based on new strategies and new resources. They asserted that such a “turbo-charged approach will achieve a tobacco-free world by 2040 where tobacco is out of sight, out of mind, and out of fashion—yet not prohibited”.
Release of The Lancet series marks the ten-year anniversary of the WHO Framework Convention on Tobacco Control. It coincides with the 16th World Conference on Tobacco or Health, the world’s largest gathering of tobacco control advocates, policy makers, researchers, public health and clinical experts. at Abu Dhabi, UAE, from March 17-21, 2015.
In a second paper in the Journal, researchers from China disclosed tobacco use as a leading risk factor for non-communicable diseases in China. It has to discipline more than 300 million smokers and care for 740 million non-smokers exposed to second-hand smoke. The authors attributed 1.4 million deaths in China in 2010 to tobacco use.
In China, the state-owned Chinese National Tobacco Company controls tobacco production. The fact that the same agency effectively controls production, sales, and regulation of tobacco hindered effective implementation of tobacco control measures.
Another paper revealed that during the most recent decade (2000–10), the prevalence of tobacco smoking in men fell in 125 (72%) countries, and in women fell in 156 (88%) countries. If these trends continue, only 37 (21%) countries are on track to achieve their targets for men and 88 (49%) are on track for women, and there would be an estimated 1·1 billion current tobacco smokers in 2025. The study predicted rapid increases in Africa for men and in the eastern Mediterranean for both men and women, suggesting the need for enhanced measures for tobacco control in these regions.
India which is the third largest producer of tobacco and the second largest consumer of tobacco products worldwide has reasons to worry. There are 275 million adult tobacco users in India. From 1980 to 2012, the number of smokers increased from 74.5 million to 110.2 million. Sadly, women smokers increased from 5.3 million to 12.2 million.
The finding in the March 2011 issue of the Indian Journal of Medical Research that 537 out of 4786 (11.2%) students of class 7 to 12 (age: 11-19 yr) in Noida city used tobacco in some form or other is an eye opener. No stake holder can ignore the horrendous reality.
Acting against tobacco is easier said than done.
Tobacco lobby has hidden influence. Recently, a Parliamentary panel set up to decide on India’s commitment to increase the size of pictorial warnings on cigarette and bidi packets decided against the proposal. The pearls of wisdom expressed by the chairman and some members of the panel starkly revealed their conflict of interest.
Their weird views: “Bidis are natural products (sic) and are very small as compared to cigarettes. As such, bidis should not be compared with cigarettes as far as rules are concerned”; “there is very little tobacco in each bidi, hence the harmful effects are nil as compared to cigarettes and chewing tobacco”; “what people find in Abu Dhabi does not apply to India. There is no work done in India to show that bidi and smokeless tobacco (meaning ghutka etc) cause cancer”; another view is that “some people who smoke 60 cigarettes a day and are yet cancer-free.”
Mercifully, Government removed the members with clear conflict of interest from the panel.
In a telling article in The Hindu daily (April 9, 2015), Dr D Balasubramanian, an eminent scientist, lucidly exposed the ignorance of the panel by listing the phenomenal amount of work done in India.
In its fact sheet no 339, updated on May 2014, WHO declared that tobacco kills up to half of its users.
This conclusion may change. A large Australian study of more than 200,000 people published in BMC Medicine on February 24, 2015 independently confirms that up to two in every three smokers will die from their habit if they continue to smoke.
The message from the study according to Scott Walsberger, Tobacco Control Manager at Cancer Council, New South Wales is: “It’s never too late to quit? no matter what your age, or how much you smoke”.