Mir Misba Sultan & Dr. Bilal A. Bhat
Tobacco for ages has been popular and its use is significantly increasing in spite of alarming health hazards. However, so far a lot has been known about its disadvantages, but still tobacco is grown, developed, advertised, marketed, and sold to earn a big chunk of the financial cake. It is one of the great sources of revenue for the government as excise duty. Tobacco derived from the leaves of the genus Nicotiana, a plant from the night-shade family, was first discovered by the native people of Mesoamerica and South America and later introduced to Europe and the rest of the world. Early in tobacco’s history, it was used as a cure-all remedy, for dressing wounds, reducing pain, and even for tooth aches. Archeological studies suggest the use of tobacco in around first century BC, when Maya people of Central America used tobacco leaves for smoking, in sacred and religious ceremonies. Tobacco had already long been used in the Americas by the time European settlers arrived and took the practice to Europe, where it became popular. Tobacco either smoked or smokeless is a silent, relentless killer that is responsible for the ill health of not only the consumer but also the family due to second – hand – smoke, especially for young children and pregnant women, and loss of life at a younger age. Smoking cigarettes affects the respiratory system, the circulatory system, the reproductive system, the skin, and the eyes, and it increases the risk of many different cancers. This is why it’s so important for young people to stay away from smoking and vaping. The statistical data revealed by World Health Organization (WHO) indicates that the tobacco epidemic is one of the biggest public health threats, killing more than 7 million people a year. Cigarettes are smoked by over 1.1 billion people globally. More than 7 million of those deaths are the result of direct tobacco use while around 890,000 deaths are the result of non-smokers being exposed to second-hand smoke. Globally there are around 1 billion smokers today, two-thirds of whom live in the following 15 low‐ and middle‐income countries (in order by number of smokers): China, India, Indonesia, Russia, Bangladesh, Brazil, Mexico, Turkey, Pakistan, Egypt, Ukraine, Philippines, Thailand, Vietnam and Poland. Without urgent action, deaths from tobacco could reach 8 million by 2030, more than 80 percent of which will be among people living in these low- and middle-income countries. Keeping in mind that tobacco is the single most preventable cause of death on planet earth today, the World Health Organization unified the international community behind a global public health treaty, formally known as the WHO Framework Convention on Tobacco Control (FCTC). The FCTC enshrines the world’s most effective tobacco control measures, and could save 200 million lives by 2050 if fully implemented. Article 5.3 of this treaty–which states that the tobacco industry has an irreconcilable conflict of interest with public health–is the backbone and the treaty cannot succeed if industry interference is not rooted out. Also, a comprehensive ban of advertising and promotion is required under Article 13 of the FCTC for all parties ratifying the treaty. Statistics show that the removal alone can save lives by reducing tobacco consumption by an average of 7 percent. Yet, to date only 19 of the 176 signatory countries to the convention have fully comprehensive bans on advertising and promotion, thus fully protecting a mere 425 million people—6 percent of the world’s population–from exposure to the tobacco industry tactics. The primary purpose of advertising, promotion and sponsorships is to encourage youth to begin smoking and to keep current users hooked. Children are three times more sensitive to tobacco marketing than adults and are more likely to be influenced to smoke by marketing than by their peers. In fact, almost 90 percent of smokers smoked their first cigarette before the age of 18, and almost 25 percent of these began smoking before the age of 10. Hence they form a primary target for the tobacco industry’s lethal marketing tactics. Eliminating Big Tobacco’s ability to market its deadly products can stop new users from joining the bandwagon, saving millions of lives in the process. The biggest challenge is ending the tobacco industry’s exploitation with a ban on their interference, political donations and Corporate Social Responsibility. The big tobacco’s lethal marketing strategies date back to 1955 when Philip Morris, the producer of Marlboro cigarettes, introduced the image of the rugged cowboy—the famous Marlboro Man—which increased the sale of its filtered cigarettes by more than 3000 percent within one year. The Marlboro Man is an example of a global-marketing strategy that pushed Philip Morris International to become the industry leader. However, few will remember that two of the actors Wayne McClaren and David McClean who portrayed the ‘Marlboro Man’ died of lung cancer. Studies show that smoking is the main cause of lung cancer cases, both in smokers and second hand smokers. Several types of carcinogens have been found in cigarettes. Even as more and more countries adopt stringent tobacco control laws, tobacco companies are investing huge amounts of money in sophisticated chicanery to promote their products through surrogate advertising, sponsorships of social events, and engaging in their so-called corporate social responsibility activities intended to improve their image as socially acceptable entities and to persuade governments not to introduce policies that will reduce tobacco sales. In India, Godfrey Phillips India Ltd is one of the largest players in the Indian cigarette industry. It manufactures some of the most popular brands in the country like FS1, Four Square, Red and White, Cavanders, and also manufactures and distributes the iconic brand Marlboro under a license agreement with Philip Morris.
Cigarette smoking is a toxic and carcinogenic mixture of more than 7,000 chemicals which badly affect the body. Among these substances, cigarette contains over 250 toxic substances and 70 carcinogens – substances that promote cancer formation such as acetaldehyde, aromatic amines, arsenic, benzene and formaldehyde. Apart from lung cancer, smoking can potentially cause other serious health problems such as cardiovascular and neurological diseases. Smoking can potentially cause other cancers including breast cancer and bladder cancer. More importantly, nonsmokers (secondhand smokers) who are exposed to smoke at home, at work or environment increase their risk of developing lung cancer. Non-smokers who breathe in second hand smoke take in nicotine and other toxic chemicals similar to smokers do. If women are exposed to second-hand smoke during pregnancy, both mothers and babies are put at greater risk to develop the abnormalities. Some of the health conditions associated with being exposed to second-hand smoke are a miscarriage, low birth weight, preterm birth, birth defects of the mouth and lip, learning or behavioral deficiencies in the child and Sudden Infant Death Syndrome (SIDS). Lung cancer is one of the commonest cancers and cause of cancer related deaths all over the world with 1.8 million deaths per year. It accounts for 13 per cent of all new cancer cases and 19 per cent of cancer related deaths worldwide. Indians as mentioned first in Atharva veda have been pioneers in smoking since 2000 BC when cannabis was smoked. There are about 120 million active smokers in India and they constitute approximately 12% of worldwide smokers. Before cigarettes were manufactured smoking was done with chillums or pipes. Hookah smoking is still prevalent in villages where the smoke passes through a water container before inhalation. Smokeless tobacco is more commonly used in India than cigarette or bidis (tobacco rolled in leaf). A statutory health warning was introduced on cigarette packs in 1975 in India and Cigarette and other Tobacco Products Act (COPTA) was enforced in May 2004. However, the published estimates show that 35% of males still smoke and the incidence of smoking is increasing amongst females. About 80% of children below the age of 16 years have used some form of tobacco and about 50% may continue to do so in their adulthood. In India, lung cancer constitutes 6.9 per cent of all new cancer cases and 9.3 per cent of all cancer related deaths in both sexes, it is the commonest cancer and cause of cancer related mortality in men, with the highest reported incidences from Mizoram in both males and females (Age adjusted rate 28.3 and 28.7 per 100,000 population in males and females, respectively). The time trends of lung cancer show a significant rise in Delhi, Chennai and Bengaluru in both sexes. The incidence and pattern of lung cancer differ as per geographic region and ethnicity and largely reflect the prevalence and pattern of smoking. The overall 5-year survival rate of lung cancer is dismal with approximately 15 per cent in developed countries and 5 per cent in developing countries.
The ultimate goal of celebrating world no tobacco day is to protect present and future generations not only from devastating health consequences, but also against the social, environmental and economic scourges of tobacco use and exposure to tobacco smoke. We have to work together to achieve a world free of tobacco-related addiction, death and disease.
Although lung cancer does not rank number 1 in terms of its incidence, it remains the most common cause of cancer deaths. Since lung cancer might not produce any warning signs and symptoms in its early stages, it has been frequently caught when disease has already progressed with metastasis (spread) to other organs in the body. Compared to other cancers with higher incidence rates e.g. breast cancer and prostate cancer, survival rate and life expectancy of lung cancer seems to be lower due to poor prognosis. Therefore, smoke prevention and cessation is the best possible way to remain healthy. It is important to note that during early phase, lung cancer may not cause any specific signs and symptoms until it has spread presented with advanced manifestations. However, some patients with early lung cancer might have symptoms. The most common symptoms of lung cancer are: A chronic cough, Coughing up blood or rust-colored sputum (spit or phlegm), Chest pain which is often worse with deep breathing or coughing, Shortness of breath or wheezing, Hoarseness, Weight loss and loss of appetite and Fatigue and weakness. In addition, bone pain is possible symptom, representing advanced or metastatic stage. To early screen lung cancer without any signs and symptoms, people with high risk of lung cancer should consider annual lung cancer screening using low-dose CT (computerized tomography) scan to find lung cancer at an earlier stage even before symptoms arise. The early detection significantly increases the chances of being cured and results in a better quality of life. High risk groups are defined as having at least a 30 pack-year history of smoking and currently smoke or having smoke quitting within the past 15 years. A pack year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, 30 pack-year is equal to smoking 2 packs (40 cigarettes) per day for 15 years. On the one hand smoking is jeopardizing the lives of millions of Indians by selling tobacco, while on the other hand it unashamedly professes to enrich and energize the society through its social responsibility initiatives like the annual Godfrey Phillips Bravery Awards which purport to honor the uncommon acts of physical valor, social service and humanitarian deeds of the common man. There seems to be a fundamental conflict of interest between the goals of the tobacco industry and the goals of governments in promoting public health. Tobacco industry interference has time and again weakened and delayed the enforcement of public health policies around the world. In India strong pictorial warnings on tobacco packs have been diluted and/or their implementation postponed several times in the past under immense lobbying from the tobacco industry. The Indian Ministry of Health and Family Welfare admitted to the Central Information Commission that it is the tobacco industry pressure that is not letting it implement tobacco control health policies effectively. It is the responsibility of the governments to lead and fund tobacco control in their countries with a view to make the attainment of effective tobacco control much easier and sustainable in the years to come. World No Tobacco Day is celebrated around the world every year on May 31. The Member States of the World Health Organization created World No Tobacco Day in 1987 in order to spread awareness about the harmful effects of tobacco use. It all began when WHO passed a resolution on 15 May 1987 to celebrate the World No Smoking Day on 7 April 1988. This date also marked the 40th anniversary of WHO. The aim was to draw people’s attention to the adverse effects of tobacco. People all around the world were urged to refrain from using tobacco in any form for 24 hours. This was supposed to encourage and support individuals to quit or at least reduce tobacco usage in the longer run. In 1988, another resolution was passed to celebrate the World No Tobacco Day on May 31st every year. Every year, individuals, organisations – both governmental and non-governmental, and stakeholders from diverse sectors come together as part of this campaign. On this internationally celebrated day, WHO and other state and public health organisations want to draw global attention to the tobacco epidemic and the preventable death and disease it causes. Every year, WHO promotes a special theme related to tobacco consumption and its impact on health and on society. The theme then becomes the main component around which the entire campaign is conceptualised. The focus of this year’s World No Tobacco Day, May 31, 2020 is on protecting young people from the marketing of big tobacco companies and helping them avoid using tobacco and nicotine. WHO is also working to expose myths and the ways tobacco companies market their products to young people. They are encouraging famous people, the media, and other influencers including parents and teachers to protect young people from these harmful messages. According to WHO, tobacco companies use many ways to appeal to young people like Flavors, Design, Unproven Claims, Endorsements, Point-of-sale, Movies and More and Vending machines. WHO also publishes and distributes posters, press releases, websites, brochures and fliers. These are widely circulated among the public by member nations and allied organisations. It is alarming to see the rate at which tobacco consumption is rising. Tobacco not only has ruinous effects on one’s body and health, but it also wrecks a person’s life completely. The negative impacts of tobacco-use have been noticed in individuals’ health, finance and family life. The addiction to tobacco is a physical response that often interferes with one’s life and worship. For example, smoking is clearly forbidden for Muslims during the daytime fast of Ramadan. In every religious place smoking is prohibited. The Prophet Muhammad, peace be upon him, is reported to have said, ‘Do not harm yourselves or others.’ The ultimate goal of celebrating world no tobacco day is to protect present and future generations not only from devastating health consequences, but also against the social, environmental and economic scourges of tobacco use and exposure to tobacco smoke. We have to work together to achieve a world free of tobacco-related addiction, death and disease.
(The authors write regularly for “Kashmir Horizon”. Views are their own, [email protected])