Killer Tobacco: A production or a consumption problem?

Beryl Osindo, CNS Correspondent, Kenya
Ending tobacco consumption and production is imperative to the attainment of health justice. It is probably the only solution to the reduction of tobacco-related illnesses that kill a whopping 8 million people annually.

While it might be commonplace that tobacco consumption is directly linked to 2/3 of cancers, Dr Kerstin Schotte, Medical officer, Department for prevention of NCDs at the WHO, emphasised at a recent webinar, organised by Citizen News Service, that, “There is still a lack of knowledge about the dangers of tobacco in general public. Results of the Global Adult Tobacco Survey show that in some low and middle income countries, more than 50% of the respondents were not even aware that tobacco use causes cardiovascular diseases (CVDs).”

In Kenya, Amref Health Africa has been on the forefront of addressing the burden of infectious as well as non-communicable diseases (NCDs). The organization was a key player during the World Congress of Cardiology and Cardiovascular Health 2018 whose main theme was to discuss CVDs that are responsible for an estimated 31% of all deaths worldwide. This narrative is vital because tobacco control did not receive prominence during this important meet. It is difficult to understand how we can achieve the sustainable development goal of reducing premature mortality from NCDs (including CVDs) by one third by 2030, without addressing tobacco control. Endgame of tobacco is vital to prevent all tobacco related NCDs and other diseases.

Tobacco, the Cancer Narrative, and Non-Communicable Diseases:

Sub-Saharan Africa is one of the regions most affected by tobacco consumption and its subsequent effects. Kenya in particular is not making sufficient progress towards addressing the relationship between tobacco use and NCDs, and chances are that the country might not achieve its SDG targets by 2030. Health is everyone’s business and NCDs are to a large extent communicable in the sense that they not only affect the patient, but also the entire family or community that interacts with the smoker in one way or the other. For instance, a tobacco user not only promotes second-hand-smoking, but also becomes a burden to the family that has to take care of him/ her once she/he develops cancer or any other tobacco-related disease. Evidently, tobacco conversations must go beyond the development of cancer, and address the overall impact of tobacco on the entire human body. Over 7000 harmful chemicals are present in tobacco, 70 of which can cause various types of cancers. So ill effects of tobacco are widespread and not limited to terminal illnesses. Tobacco also devastates the environment. Cigarette butts are biggest human-made contaminants of oceans globally. The smoke from cigarettes, water pipes, hookahs etc. pollutes the air we breathe.

A Gateway Substance:

Tobacco is a gateway substance because of its addictive nature. Smokers are more likely to crave for (and abuse) other substances, including alcohol and illicit drugs, in comparison to non-smokers. This must raise eyebrows, especially with the introduction of electronic cigarettes and IQOS products, which the tobacco companies are churning out and falsely touting them as being less harmful than traditional cigarettes. In fact, there is no safe level or form of tobacco consumption. Tobacco is devastating in any form—be it conventional cigarettes, e-cigarettes, heat not burn or IQOS  products, chewing or smokeless tobacco. All forms of tobacco products are dangerous. Even second-hand-smokers are predisposed to pneumonia, asthma, TB, cardiovascular diseases and several other preventable illnesses.

Are we getting there?

When people (and governments) understand the dangers of tobacco use, they are likely to take radical measures that can save lives. As pointed out by noted cardiologist Dr Rishi Sethi, a US Surgeon General report from 2013-14 states that reduction in smoking in US men from 50% to 20% and US women from 33% to 15%, is one of the major factors contributing  to a decline in cardiovascular diseases in the country. This will go a long way in reducing NCD deaths by 25% by 2025.

Tobacco has been glorified (thanks to the tireless efforts of the tobacco industry) for its use for recreational purposes, anxiety management and weight control. It is high time countries start weighing the consequences of the carcinogens present in tobacco before promoting its use. In fact over 180 countries have ratified the global tobacco treaty (WHO Framework Convention on Tobacco Control). Several countries are taking measures for end game of tobacco to become a reality. These include ban on smoking in public places to protect non-smokers from second hand smoke; ban on advertisements of tobacco products; raising taxes on tobacco products; gory graphic health warning images on tobacco/ cigarette packs; plain packaging; etc. But no single measure by itself is enough to show tangible results at a global or national level. We have to use all of them and more. it is time to address tobacco related issues politically and collaboratively. Commitment from individuals and the nations is necessary. We cannot succeed, unless strong governments are willing to collectively fight tobacco production, distribution, and consumption.

Beryl Osindo, Citizen News Service - CNS
June 5, 2019