THE TOBACCO EPIDEMIC: A CRISIS OF STARTLING DIMENSIONS
World Health Organization Statement for World No-Tobacco Day - May 31, 1998
Tobacco kills nearly 10,000 people every day
The facts speak for themselves. Tobacco use worldwide has reached the proportion of a global epidemic with little sign of abatement. Each year, tobacco causes about three and a half million deaths throughout the world. This translates to nearly ten thousand deaths per day. Based on current trends, this will increase to ten million annual deaths during the 2020s or 2030s, with seven million of these deaths occurring in developing countries. Based on current patterns of consumption, it is predicted that over 500 million people currently alive will be killed by tobacco.
In developed countries, where smoking became widespread during the 1940s and 1950s, the catastrophic effect of past smoking trends can now be seen. About 20% of all deaths occurring at present in developed countries are due to tobacco. By 2020, it is predicted that tobacco use will cause over 12% of all deaths globally. By 2020, it is predicted that tobacco will cause more deaths worldwide than HIV, tuberculosis, maternal mortality, motor vehicle accidents, suicide and homicide combined.
HOW TOBACCO AFFECTS YOUNG PEOPLE
Tobacco affects young people in an extraordinary number of ways. Due to environmental tobacco smoke (ETS) and maternal smoking, children's health may even be compromised from before the time they are born. In many countries, children may grow up in a haze of tobacco smoke, wreaking further havoc with their health. Household money that is spent on tobacco reduces the amount available for food, education and medical care. Children may also suffer the emotional pain and financial insecurity that comes from the loss of a parent or caretaker who dies an untimely death due to tobacco.
On another level are the pervasive pressures for young people to use tobacco. People everywhere seem to be smoking. Attractive advertisements and exciting tobacco promotions are difficult to resist. Especially when the price is affordable, and it's no problem for minors to buy tobacco.
Even if the health risks are understood, the message that tobacco kills is not very relevant to young smokers, who believe themselves to be immortal. By the time they are ready to quit smoking, addiction has taken hold. These factors all contribute to the grim statistics. Based on current trends, about 250 million children alive in the world today will eventually be killed by tobacco.
WHO believes that every child has the right to grow up without tobacco. This means without the rampant pressures to use tobacco, which in many countries emanates from all corners. There is a need to change the environment to one where non-smoking is considered normal social behviour and where the choice not to smoke is the easier choice.
Tobacco is fast becoming a greater cause of death and disability than any single disease. Research shows that the risks from smoking are substantially higher than previously thought. With prolonged smoking, smokers have a death rate about three times higher than non-smokers at all ages starting from young adulthood. On average, smokers who begin smoking in adolescence and continue to smoke regularly have a 50% chance of dying from tobacco. And half of these will die in middle age, before age seventy, losing around 22 years of normal life expectancy. Therefore, a lifelong smoker is as likely to die as a direct result of tobacco use as from all other potential causes of death combined.
Tobacco is a known or probable cause of about 25 diseases, and the sheer scale of its impact on global disease burden is still not fully appreciated. For example, it is well know that tobacco is the most important cause of lung cancer. Less known is the fact that tobacco kills more people through many other diseases, including cancers in other parts of the body, heart disease, stroke, emphysema and other chronic diseases. Studies in the United Kingdom have shown that smokers in their 30s and 40s are five times more likely to have a heart attack than non-smokers.
TOBACCO USE IS A KNOWN OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
•Lip, oral cavity and pharynx
•Oesophagus
•Pancreas
•Larynx
•Lung, trachea and bronchus
•Urinary bladder
•Kidney and other urinary organs
Cardiovascular diseases:
•Rheumatic heart disease
•Hypertension
•Ischaemic heart disease
•Pulmonary heart disease
•Other heart diseases
•Cerebrovascular diseases
•Atherosclerosis
•Aortic aneurysm
•Other arterial diseases
Respiratory diseases:
•Tuberculosis
•Pneumonia and influenza
•Bronchitis and emphysema
•Asthma
•Chronic airway obstruction
Paediatric diseases:
•Low birth weight
•Respiratory distress syndrome
•Newborn respiratory conditions
•Sudden infant death syndrome
Lung cancer and other diseases caused by passive smoking
Fires caused by smoking materials
According to WHO estimates, there are around 1.1 billion smokers in the world--about one-third of the global population aged 15 years and over. Of these, 800 million are in developing ountries. Data suggest that, globally, approximately 47% of men and 12% of women smoke. In developing countries, 48% of men and 7% of women smoke, while in developed countries, 42% of men smoke as do 24% of women. By the mid 2020s, the transfer of the tobacco epidemic from rich to poor countries will be well advanced, with only about 15% of the world's smokers living in rich countries. Health care facilities in poorer countries will be hopelessly inadequate to cope with this epidemic.
In certain regions, the health consequences of tobacco use are particularly devastating. In the Former Socialist Economies, around 17% of all deaths in 1995 were due to tobacco use. This figure is expected to increase so that in 2020, more than 22% of all deaths in this region will be due to tobacco. In 1995, it was estimated that 41% of all deaths among men aged 35-69 years in this region were caused by tobacco.
There has occured a shifting of the tobacco epidemic. The apparent success in tobacco control in some countries has been negated by growth in tobacco use in less developed countries. So, globally there has been no net progress in reducing tobacco consumption. In absolute figures, the biggest and sharpest increases in disease burden are expected in India and China, where the use of tobacco has grown most steeply. In China alone, where there are about 300 million smokers, new data show there are already about three-quarters of a million deaths a year caused by tobacco. Based on current trends, of all the children and young people under the age of 20 years alive today in China, at least 50 million of these will eventually die prematurely because of tobacco use.
Although life expectancy for both sexes is predicted to rise, in many countries, the gap between them is growing significantly due to the large number of men who smoke and die of tobacco-related diseases. However, the number of women and girls who smoke is also rising, and so too will the number of tobacco-related deaths among women.
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HEALTH BENEFITS OF QUITTING SMOKING
•One year after quitting, the risk of coronary heart disease (CHD) decreases by 50%, and within 15 years, the relative risk of dying from CHD for an ex-smoker approaches that of a long-time non-smoker.
•The relative risk of developing lung cancer, chronic obstructive lung diseases, and stroke also decreases, but more slowly.
•Ten to fourteen years after smoking cessation, the risk of mortality from cancer decreases to nearly that of those who have never smoked.
•Quitting smoking benefits health, no matter at what age one quits.
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ENVIRONMENTAL TOBACCO SMOKE SERIOUSLY DAMAGES HEALTH OF NON-SMOKERS
Environmental tobacco smoke (ETS) contains basically all of the same carcinogens and toxic agents that are inhaled directly by smokers. Evidence is quickly mounting as to the serious health consequences of ETS, both for adults and for children. These findings make a strong case for swift and tough policies to limit smoking in public places.
Exposure to ETS is a cause of disease, including lung cancer and possibly coronary heart disease in healthy non-smokers. Prolonged exposure to environmental tobacco smoke increases the risks of lung cancer and heart disease in healthy adults, possibly by as much as 20-30%.
ETS can also result in aggravated asthmatic conditions, impaired blood circulation, bronchitis and pneumonia. It also is a frequent cause of eye and nasal irritation.
Health consequences of ETS particular to young people:
Children exposed to ETS
•get more coughs and colds and are more likely to suffer acute upper and lower respiratory tract infections. One study showed that children exposed to ETS during the first 18 months of life have a 60% increase in the risk of developing lower respiratory illnesses such as croup, bronchitis, bronchiolitis and pneumonia.
•have an increased chance of developing asthma. If they already have asthma, second-hand smoke can bring on asthma attacks and make them worse.
•are at risk of impaired lung function, and may have breathing problems in the future.
•have an increased frequency of middle-ear infections, which can lead to reduced hearing.
•Babies born to women who smoke during pregnancy, as well as those infants exposed to ETS have a significantly greater risk of dying of sudden infant death syndrome (SIDS).
Smokeless tobacco use - A growing addiction
Smokeless tobacco is used in many forms around the world. In the United States and parts of Europe, it is marketed as chewing tobacco and as oral snuff . In south and south east Asia, it is most commonly consumed in a ‘betel quid' or ‘pan' consisting of tobacco flakes, mixed with powdered or chopped areca nut, slaked lime and catechu, wrapped in a betel leaf. This practice is a part of culture and tradition. Smokeless tobacco use has also been reported in parts of Africa and the former Soviet Union. In India, the more recent trend of chewing prepacked powdered areca nut with tobacco, lime and catechu (termed ‘pan masala') has started to replace the habit of betel quid chewing. In Sudan, "toombak" is used orally, while "nass" is widely used in Central Asian republics.
Although the term "smokeless tobacco" is commonly used for tobacco products used orally, this is a term promoted by the tobacco industry that suggests that the product is harmless. To avoid that innocuous connotation, the term "spit tobacco" is increasingly used in countries such as the United States.
In the United States, recent surveys have shown alarming increases in use of spit tobacco among children and younger adults . This increase is primarily due to the growing popularity of oral snuff use among teenage and young adolescent males. It is estimated that in one million adolescent boys in the USA use spit tobacco. Spit tobacco is also used by many athletes, particularly baseball players, who are often role models for these boys. Other populations with notable patterns of spit tobacco consumption are south and southeast Asian immigrant communities in the United States and the United Kingdom. These groups continue to use spit tobacco products manufactured and imported from the Indian subcontinent.
Use of smokeless tobacco, including snuff and chewing tobacco varieties, has been established to cause oral cancer (one of the ten leading cancers worldwide), irreversible gingival recession, other oral pathologies, nicotine addiction and cardiovascular diseases. Smokeless tobacco and betel quid chewing, particularly with tobacco, is the most common cause of oral cancer in high ncidence regions, and ranks globally as the greatest single risk factor for oral cancer. There have been cases of six year old children in India with submucous fibrosis, a precancerous condition . In south and southeast Asia, more than 100,000 new cases of oral cancer are diagnosed annually. Some 1,700 and 30,000 cases of oral cancer are diagnosed in the UK and the USA respectively, each year. It is believed that as many as 75% of oral cancers diagnosed in the United States are attributed to regular use of smokeless tobacco products and alcohol combined.