Alcohol, tooth-rotting fizzy drinks, lardburgers, fast cars – the world is full of fun stuff that isn’t very good for us. So is it fair to single out cigarettes for demonisation?
Patricia Lambert, Director of the Campaign for Tobacco-Free Kids, certainly believes so. At first glance, Lambert appears no more formidable than a nice lady on the PTA, but when she speaks on tobacco control, a steely quality enters her well-modulated voice.
It is because of her considerable resolve, said Yussuf Saloojee, Executive Director of the National Council Against Smoking, introducing Lambert at the 38th Union World Conference on Lung Health in Cape Town, that a journalist was once inspired to refer to her as a “neo-Nazi nanny”.
Are stalwarts of the anti-tobacco lobby indeed shrill lifestyle fascists wasting their energies on an irrelevant cause, or are they correct to target smoking as one of the most crucial public health issues of our time? Some of Lambert's highly convincing arguments follow here.
A smokeless planet?
Lambert was at the conference to speak on the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), the first co-ordinated global effort to reduce tobacco use, and the world’s first public health treaty.
And nothing less than a full-scale planetary effort will do, says Lambert, who has been instrumental in developing the FCTC since it was first proposed, “Because the transnational tobacco industries have no use for national borders. They will sell their product to satisfy their shareholders any where they can and any how they can.”
The objective of the FCTC is “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”, and here Lambert likes to draw everyone’s attention to the word “devastating”.
“People who draft international treaties aren’t given to flowery language; these documents are, as a rule, on the dry side. But we needed expressive language to stress the impact of tobacco on the world.
Devastating: that word was selected to be deliberately strong by the 190 countries who negotiated the convention, because that was how we saw it.”
It’s just not normal
Two oft-repeated arguments by the anti-tobacco lobby as to why tobacco deserves special demon status:
A cigarette is the only legally available consumer product that kills through normal use.
There is no safe level of exposure to tobacco smoke.
Says Lambert: “Just in case we forget: this isn’t a normal, ordinary consumer product. It kills 50% of the people who use it. With each breath, a smoker takes in 4000 chemicals, 50 of which are known carcinogens.
"When posed the question: ‘If a cigarette were invented today, would any regulatory authority on earth licence it for human consumption?’ I’ve never had any such authority give an answer that wasn’t a flat 'No'.”
Unequivocal health message
The medical community changes its mind frequently – as a result of the nature of scientific research, which, when progressing as it should, constantly checks and modifies itself as new evidence from studies arises.
But there are some areas in medicine where the evidence is so overwhelming that the public health message has remained the same for years now, as in: Eat your Greens, Keep Moving, oh, and – Rather Don’t Smoke.
In the same way that the evidence on the health effects of smoking began to mount mid-20th century and increasingly stilled dissenting voices, the research on the negative impact of passive smoking is now steadily convincing the doubters.
What tobacco costs the world
Lost lives: Currently, close on 5 million people die each year as a result of smoking. By 2030, that figure will have doubled: 10 million deaths. Of these, 70% will occur in developing countries.
“This staggering projected increase in death and disease in developing countries, compared to the relatively small increase in developed countries, is another indication that international control is really the only way to go,” says Lambert.
“There has been a tendency in Africa – and I’m sure in other developing countries – to say that tobacco control is something that rich countries should be doing. But if the burden of disease is coming our way, as developing countries the only prudent and responsible thing we can do is make sure that we initiate and maintain the strongest tobacco control measures possible.”
Poverty: “Tobacco control, rather than being a luxury that only rich nations can afford, is now a necessity that all countries must address.” - WHO report: Tobacco and Poverty: A Vicious Cycle, 2004.
Tobacco consumption is highest among the poor, who spend a larger proportion of their income on tobacco. It further exacerbates poverty due to healthcare costs, illness and premature death.
The costs to government and society are also severe: “The tobacco industry always tells us they bring in huge amounts of tax – they don’t; they only collect it,” says Lambert. “The World Bank estimates that the economic cost of tobacco use is more than 11 times greater than the economic benefits.”
Annual tobacco-attributable health care costs are estimated at between 6% and 15% of total health care costs.
In addition, productivity is greatly decreased by illness and premature death. If current trends persist, about 500 million people alive today will eventually be killed by tobacco, and half will die in their productive middle years. Most smokers lose 20 to 25 years of life.
Environmental damage: Tobacco production causes considerable environmental damage in terms of deforestation and carbon emissions – especially, as Lambert points out, in countries in Africa where tobacco is cured by burning wood.
Towards 100% smoke-free
To date, 151 countries – including South Africa – have acceded to or ratified the FTCT. Its key elements include:
Raising taxes and prices of tobacco products
Banning tobacco advertising, promotion and sponsorship
Changing the packaging and labelling to depict health risks
Protection from exposure to tobacco smoke
The ultimate aim of these measures is 100% smoke-free, i.e. no smoking in all work and public environments.
- Olivia Rose-Innes, Health24, updated January 2012
How far is SA along the road towards 100% smoke-free?