Tip of the iceberg? Not just a health hazard, tobacco devastates development

Shobha Shukla, CNS (Citizen News Service)

(हिंदी) Tobacco kills over 7 million people annually. Every tobacco-related disease is preventable, and every tobacco related untimely death could have been averted.

The mountainous tobacco-related disease and death pandemic, which is knowingly propelled by the tobacco industry, could have been prevented. More importantly, if we take into account how tobacco damages our world, it will become more than evident that tobacco health hazards and untimely deaths are only the tip of the iceberg.

That is why the World Health Organization (WHO) had focussed the World No Tobacco Day 2017 on the theme of tobacco is a threat to sustainable development. WHO had said that "Action to stamp out tobacco use can help countries prevent millions of people falling ill and dying from tobacco-related disease, combat poverty and, according to a first-ever WHO report, reduce large-scale environmental degradation."
"Tobacco threatens us all," had said the then WHO Director-General Dr Margaret Chan. "Tobacco exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air."
Dr Tara Singh Bam, Deputy Regional Director (Asia Pacific), International Union Against Tuberculosis and Lung Disease (The Union), and member of the WHO Civil Society Working Group for the Third UN High-Level Meeting on Non-Communicable Diseases (NCDs) around the 73rd UN General Assembly, was on the panel of experts of CNS Webinar on 24th August 2018 on the theme: "Why 73rd UN General Assembly must not ignore tobacco control?"  (click here for Webinar recording, podcast).

Later this month, heads of 190 countries who will attend the 73rd United Nations General Assembly in September 2018 will debate on the theme around "sustainable societies". Equally noteworthy are two UN High Level Meetings (UNHLMs) happening on 26th and 27th September respectively, to #endTB and #beatNCDs. Tobacco is not just a risk factor for TB and many non-communicable diseases (NCDs), but also threatens sustainable development.

Dr Tara Singh Bam emphasized "Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare expenditure and lost productivity."

He added: "Tobacco is a a public health disaster and a cross-cutting development issue. That is why over 180 countries have ratified the legally-binding global tobacco treaty (formally called the WHO Framework Convention on Tobacco Control or WHO FCTC). Implementation of this global tobacco treaty is building up the much needed momentum in the fight against tobacco and providing the foundation for elimination of tobacco."

Do not let 'fox guard chickens'

Not surprising that tobacco industry is conniving to block, delay, dilute or water down implementation of this global tobacco treaty. In 2014, then WHO Director General Dr Margaret Chan had said to CNS around the intergovernmental meeting of the WHO FCTC: "I have never shied away from embracing WHO's position as tobacco industry's number one enemy. As implementation of the WHO FCTC reaches new heights, the tobacco industry fights back harder and through every possible channel, no matter how devious those channels and practices are." Dr Chan had rightly told the governments in this meeting to 'not let fox guard chickens', pointing to tobacco industry interference in global tobacco treaty negotiations.

In November 2015, BBC exposed cases of British American Tobacco (BAT) employees bribing officials in East African countries, including Rwanda and Burundi, in an effort to undermine anti-tobacco laws.

Dr Bam shared that tobacco industry often works covertly, hiding behind their front groups like business groups, scientific organizations, etc. Ironically, Philip Morris, world's biggest tobacco industry, has funded Foundation for a 'Smoke-Free' World. They have joined hands with American Chamber of Commerce, which is now trying to manipulate the science and block any policy decisions on tobacco control,  especially in Asia Pacific countries. They are putting their products in the market to attract children. Tobacco pushes more than 200 million people in poverty.

Despite industry's tactics to grow profits, tobacco control is working!

Dr Tara Singh Bam called upon for urgent and stringent implementation of the global tobacco treaty and other evidence-based public health laws and policies without any further delay. "It is time to implement, enforce and monitor closely. It is also time for all governments, civil society organizations and other professional bodies to unitedly counter tobacco industry's false arguments and ban all organizations thriving on tobacco products. This is the only way to save 7 million lives every year. Now is the time to strike the final blow for elimination of tobacco. Bloomberg Philanthropies is played a major game changing role in this process."

Professor (Dr) Rama Kant, WHO Director General's Awardee for tobacco control and former President of Association of Surgeons of India and former Vice President of SAARC Surgeons body, had founded Indian Society Against Smoking and has been leading tobacco control activities since 1976. He shared in CNS Webinar that "India, where tobacco use is at alarming levels and tobacco-related disease-burden too is among the highest in the world, has been successful in implementing the Cigarette and Other Tobacco Products Act (COTPA 2003) in line with the global tobacco treaty. The latest Global Adult Tobacco Survey 2016-2017 study proved that barring only 3 states of India (Assam, Tripura and Manipur), rest of entire country has shown a decline of 6% in tobacco use. Tobacco use in India declined from 34.6% to 28.6% between 2009-10 and 2016-17. Some states like Nagaland could successfully bring down the tobacco use from 31.5% to 13.2%. In Sikkim, tobacco use dipped from 41.6% to 17.9%."

India's noted cardiologist and heart disease researcher who had chaired the national experts' committee that developed country's first-ever national guidelines for management of heart attacks, Professor (Dr) Rishi Sethi, was also on the CNS webinar panel of experts. He is a senior intervention cardiologist at King George's Medical University (KGMU).

Prof Rishi Sethi said that "The WHO data shows that most of the deaths will happen from cardiovascular diseases (CVDs) and tobacco is one of the modifiable risk factors to prevent this. Any modification in tobacco consumption and smoking patterns will have a direct effect on CVDs and mortality related to it. Oral tobacco consumption, alone, without any other cardio vascular risk factors, leads to acute coronary syndrome (as is evident from data of 170 of my patients). US Surgeon General’s report of 2014 states that reduction in smoking prevalence over the past 50 years, from 50% to 20.5% in men and from 33% to 15.3% in women, is one of the major factors for decline in CVDs in USA." USA has not ratified the FCTC but implementing evidence-based tobacco control measures are saving lives.

Asia Pacific puts tobacco and development in spotlight

During 12-15 September 2018, Indonesia will host the 12th Asia Pacific Conference on Tobacco or Health (12th APACT) - an important opportunity to learn why tobacco control is vital for progressing on UN Sustainable Development Goals (SDGs). All countries in the Asia Pacific region as well as in the world have promised to deliver on SDGs by 2030.
Dr Nurul Luntungan, Secretary General of 12th APACT was also on the webinar panel of experts. Dr Nurul stressed on how implementation of tobacco control in Indonesia is facing lot of challenges from tobacco industry. Indonesia has not yet ratified the global tobacco treaty (WHO FCTC) but there has been appreciable progress in advancing tobacco control-for instance the price of cigarettes has been hiked, smokefree laws and pictorial graphic health warnings on tobacco packs are in place since 5 years. Increasing number of districts in Indonesia are banning tobacco advertising. "Tobacco industry is very powerful in this country. So it requires much more commitment from the people, from civil society and from the government at sub-national level to advance public health measures for tobacco control" she said.

Indonesia has not yet ratified the global tobacco treaty but it has committed to achieve the SDGs by 2030. Implementing the global tobacco treaty is clearly enshrined in the SDGs as a strategy to achieve the global goals for sustainable development, said Dr Nurul Luntungan.

UNGA and UNHLMs must prioritize #NoTobacco

Tobacco indeed is a threat to development. As aptly emphasised by the WHO, in addition to saving lives, tobacco control can break the cycle of poverty, contribute to ending hunger, promote sustainable agriculture and economic growth, and combat climate change. no wonder tobacco control is intrinsically embedded in the Sustainable Development Agenda 2030 of leaving no one behind. The 73rd UN General Assembly, as well as the forthcoming UNHLMs to #endTB and #beatNCDs, simply cannot ignore tobacco control, as it is so integral to their agendas.

Shobha Shukla, CNS (Citizen News Service)
1 September 2018 
(Shobha Shukla is the Managing Editor of CNS (Citizen News Service). Follow her on Twitter @Shobha1Shukla or @CNS_Health or visit www.citizen-news.org)
Central Chronicle, Editorial Page, 3rd September 2018

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