Tobacco endgame is imperative for sustainable development

Dr Sophia Thomas, CNS Correspondent, India
It was my first clinical posting in the oral medicine department as a final year BDS (dental) student. A patient walked into the clinic nervously. He was a migrant daily wage construction worker in his late 20’s, married with 2 children. He complained of pain and multiple ulcers in the mouth. Upon careful examination, it looked like a case of oral cancer. I enquired about his smoking history and he admitted to have been smoking since he was 13 years old and also consumed chewable tobacco.

A few medical tests confirmed the diagnosis of cancer. Although he was successfully treated, surgery and follow up treatment devastated him financially. His children stopped attending school, since they could not afford the school fees. In desperation, he moved back to his village, along with his family, to an uncertain future.

This was my first experience catering to an oral cancer patient, and certainly not my last one. Since then, I have come in contact with many patients diagnosed with oral cancer coming from different walks of life, socio-economic status, age and gender, even though the poor and women suffered the most when affected with this dreadful disease. Are we doing enough to prevent deaths and life altering consequences of tobacco use?

Spreading awareness and hosting events, which serve as platforms to facilitate discussions in bringing out the evils of tobacco and those propagating it, is crucial in our fight for a tobacco free world. Citizen News Service, in association with key partners, recently hosted a webinar in the lead up to the World No Tobacco Day 2017, dedicating it to the memory of late Yul Francisco Dorado, a fearless tobacco control and human rights leader from Bogota, Colombia and late Ms Amteshwar Kaur, a tobacco control advocate and founder of Generation Saviour Association of India.

A recent WHO report states that, tobacco kills up to half of its users. Tobacco kills more than 7 million people globally each year. More than 6 million of those deaths are due to direct tobacco use, while around 890,000 are the result of non-smokers being exposed to second-hand smoke. Nearly 80% of the world's smokers live in low- and middle-income countries. In India, about 900,000 people die each year from tobacco use. Also, 60% of all deaths in the country are caused by Non Communicable Diseases (NCDs), for which tobacco use is one of the major risk factors.

Tobacco-NCD link

Explaining the consequences of tobacco consumption, Professor (Dr) Rama Kant, WHO Director General's WNTD Awardee 2005, and President of Association of Surgeons of India, said that “Tobacco consumption is strongly linked to deaths due to heart disease and stroke and cancers of various types - lung cancer, oral cancer, etc. Smoking doubles the risk of developing diabetes, affects passive smokers, and worsens chronic respiratory diseases, which could lead to death and disability.”

Tobacco, TB and poverty

There is a positive correlation of high-burden TB and high-burden tobacco use countries, with 5 countries featuring in both the top 10 high-burden TB and top 10 high-burden tobacco use countries. 40% of the TB burden in India may be attributed to smoking. Dr. Rama Kant emphasized on the troubling relationship between tobacco and poverty. He said that tobacco use can worsen poverty (expenditure owing to tobacco consumption and health care costs for tobacco related illnesses are significantly higher in the low income households) and poverty can worsen tobacco use (people turn to tobacco use to help relieve the stress of living in poverty, tobacco industry targets impoverished communities with advertising and incentives to switch to tobacco crops).

Tobacco control in Philippines

Michelle Syonne Reyes Palmones, Technical Advisor (Philippines), International Union Against TB and Lung Disease (The Union), shared some noteworthy policy interventions of Philippines in curbing tobacco use—like the The Sin Tax Law (which has helped to address public health issues relating to alcohol and tobacco consumption and finance the Universal Health Care programme of the government), the Red Orchid Awards for 100% tobacco-free provinces, municipalities, cities, government offices/hospitals, improved pictorial heath warnings on both sides of tobacco packs, etc.  All these reforms have led to a significant decline in tobacco use, reduction in exposure to tobacco smoke in public spaces, and an increase in number of smokers trying to quit smoking than before. This is an encouraging example for other countries to curb tobacco use, which can, in turn, help them achieve the sustainable development goals (SDGs) by 2030.

Tobacco industry interference

The greatest challenge is to fight the corrupt and devious advances of the tobacco industry, which has globally infiltrated national economies. Cloe Franko, Senior International Organizer, Challenge Big Tobacco, Corporate Accountability International, and Network for Accountability of Tobacco Transnationals (NATT) leadership, reflected that, “Tobacco industry interference is the greatest impediment to implementation of FCTC. This interference takes the form of lobbying, bribery, conflicts of interest- both financial and otherwise- and mobilising front groups. Tobacco industry interference stalls implementation of FCTC, impedes good governance, and has huge economic toll and costs lives.” Ms Cloe proposed that these problems can be countered by the judicial use of Articles 5.3 and 19 of the FCTC. Article 5.3 addresses tobacco industry interference and its implementation will advance good governance and pave the way for demand reduction. Article 19 addressing the tobacco industry liability will help in recouping healthcare costs and stop abusive and illicit behaviour of the tobacco industry.

This year’s theme for World No Tobacco Day is ‘Tobacco-A threat to development’. And indeed a threat it is. Tobacco users not only deprive their families of income, raise the cost of health care and hinder economic development, but even pay with their own lives due to this often lethal addiction.

Dr Sophia Thomas, Citizen News Service - CNS
June 5, 2017