Every year the world celebrates May 31st as a No Tobacco Day. The campaign against tobacco largely owes its origin to the first official report of the US Surgeon General in 1964 who identified smoking as a health hazard of sufficient importance and identified many causal relationships and smoking-disease associations. Several US Surgeon General’s reports have been published since then and over one-third of a century later, smoking todate remains the leading cause of preventable premature death.
It has now been estimated that from the 1990 level of 2.6 percent of all disease-burden worldwide, tobacco is exported to increase its share to just under 9 percent of the total burden in 2020 killing more people than any single disease.
The scenario for the developing countries is much worse. The World Bank assessment of the tobacco issue in 1993 clearly states that “unless smoking behaviour changes, three decades from now, premature deaths caused by tobacco in the developing world will exceed the expected deaths from AIDS, tuberculosis and complications of child birth combined”.
The awareness on tobacco hazards spread rather fast in the United States and Europe. It is the third World which is going to sustain the trauma for long. An analyst had very correctly stated that the tobacco industry has got a good buffer – no matter how badly things go in the United States, international sales will carry them along.
Although one has talked about it repeatedly, it is always useful to recall the enormous health problems with which tobacco is either related causally or associated promotionally. It is an important cause of cancers of not only the respiratory tract such as mouth, pharynx, larynx, trachea and lungs, but also of oesophagus, stomach and even of distant organs such as the urinary bladder. It can even promote cancers of blood and of almost any other organ of the body. It causes chronic bronchitis and emphysema subsequently resulting in chronic respiratory debility, failure and death. It contributes to about a quarter of cases of coronary heart disease, cerebral stroke and peripheral vascular diseases. It increases the incidence of respiratory infections especially amongst the children. It can cause abortion and low birth weight of a newborn baby in case a pregnant woman smokes. A prolonged exposure of a nonsmoker to smoking from others can also cause problems such as cough and precipitation of an acute attack in an asthmatic individual, worsening of angina in a patient with heart disease or pneumonia in even a young healthy child.
It is because of these associations that tobacco has been identified as almost a disease in itself. According to Dr Brundtland, the WHO Director General, tobacco is a communicated disease – communicated through advertising.
It is rather unfortunate that advertising has caught the fancy of many young minds. There is no better exposition of this strategy than that by Allan Landers, who for years was the macho man for “Winston” – the tobacco company: “They make you believe that if you smoke, you are going to be sexy, attractive, successful, accepted by your peers, rocking and macho, cool and sassy. They project this image in every media – from day-time movies to night-time movies, magazines and even cartoon characters”. Landers had realised his follies in advertising after he had suffered from consequences of smoking. He is now a dedicated tobacco control activist.
The stories of tobacco enthusiasts turning into no-tobacco activists after becoming victims of this poison are endless. The list includes the celebrated Dr Jeffrey Wigand, a farmer executive of Brown & Williamson, whose true story, “The Insider” depicted in a CBS television “60 Minutes” had shook entire America.
What is most depressing about the tobacco story is not necessarily its disease potential, but an enormous amount of misery it brings to the families of its victims in particular and the societies of these poor developing countries in general. It poses a huge economic burden, not only by way of expenditure on tobacco products, but more because of the costs of management and huge losses due to disability and early deaths from the smoking related diseases.
In modern times when information is easily disseminated, there is no reason to accept what has proven to be dangerous the world over. We must also benefit from the results of this global research.