Tobacco use is barrier to sustainable development-WHO Director

Dr. Tedros Adhanom Ghebreyesus, WHO Director General, says tobacco use is a barrier to sustainable development on all fronts.

He made the remark in Cape Town, South Africa, March 7 during the 17th World Conference on Health or Tobacco, WCTOH. The event is placed under the theme: “Uniting the World for a Tobacco Free Generation.”

During the event, the WHO Director joined various speakers to appeal for a renewed focus on tobacco control policies to help users quit and to prevent non-users from becoming addicted.

Michael Bloomberg and Bloomberg Philanthropies, all  organisers of the event said, “international collaboration is vital for tracking tobacco use, which remains the world’s leading preventable cause of death, killing more than seven million people each year.”

They disclosed that global tobacco control measures have saved nearly 35 million lives around the world, even though; tobacco industry is pushing to find new users.

Various participants attended the event were of the opinion that the event will serve as avenue “to address this epidemic by working together to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. Tobacco has no benefits to humanity whatsoever as the tobacco industry is poisoning people to death,”

Given that tobacco use kills more than seven million people worldwide each year, stakeholders at the event proposed that to save lives, governments across the globe must stand up to the tobacco industry and fully implement the proven strategies called for by the tobacco control treaty, the FCTC. These include significant tobacco tax increases, comprehensive smoke-free laws, advertising bans and large, graphic health warnings.

“Now is the time for leaders to implement strong policies proven to protect their citizens from tobacco,” he appealed.

Courtesy:Journal du Cameroun

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India home to a high proportion of young smokers

Data from the Global Tobacco Atlas released recently indicates that despite lowering tobacco use in recent years, India is home to an estimated 625,000 child smokers in the age group of 10 to 14 years. More than 932,600 Indian lives are lost to tobacco-related diseases every year. Further, the economic burden of smoking is very high in India and this includes both direct cost of healthcare and the indirect cost of lost productivity.

Use of tobacco is one of the leading causes of cardiovascular diseases, stroke, pulmonary diseases and certain types of cancers.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “One of the major causes for continued tobacco consumption in India is the fact that it is a part of the country’s social culture. Kids start smoking even before they’re old enough to think about the risks; after starting they rapidly become addicted to smoking and then regret it later. Smoking aggravates bone loss and is a risk factor for hip fracture. It is responsible for more than 10% of heart blockage diseases all over the world and 33% of all cardiac deaths. Any form of tobacco like snuff, chewing, and dipping varieties which are not burnt can be termed as smokeless, another variant that is harmful to health. Smokeless forms also contain sugar and prolonged usage can adversely affect control of blood sugar levels in patients with diabetes.”

It is a common practice in India to use SLT mixed with areca nut. Areca nut itself is classified as a class one carcinogenic and also causes other adverse health effects.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, ‘If you do not quit, you may die’. A statement worded as this may inadvertently sound discouraging to the patient. While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.”

HCFI tips to quit this habit.

· Try short-acting nicotine replacement therapies such as nicotine gum, lozenges, nasal sprays, or inhalers. These can help overcome intense cravings.

· Identify the trigger situation, which makes you smoke. Have a plan in place to avoid these or get through them alternatively.

· Chew on sugarless gum or hard candy, or munch raw carrots, celery, nuts or sunflower seeds instead of tobacco.

· Get physically active. Short bursts of physical activity such as running up and down the stairs a few times can make a tobacco craving go away.

One approach to smoking cessation is the five-step algorithm called the “5 A’s” (Ask, Advise, Assess, Assist, Arrange)

All smokers should be advised to quit smoking.

Even brief advice to quit has been shown to increase quit rates.

Smokers be managed with a combination of behavioral support and pharmacologic therapy

Combination therapy is superior to either behavioral intervention or pharmacologic therapy alone.

Courtesy:The Health Site

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Campaign launched to warn of dangerous link between tobacco and TB

The Ministry of Health and Family Welfare (MoHFW), during the End-TB Summit here, has re-launched 'Cough,' a national mass media campaign to warn citizens about the links between TB and tobacco use.

'Cough' shows that tobacco consumption and exposure to secondhand tobacco smoke increases the risk of TB and of dying from the disease. A key barrier to timely diagnosis and treatment among smokers is the assumption that a cough is related to their smoking. This campaign encourages smokers to visit their doctor to confirm whether a persistent cough is a sign of TB.

TB killed 432,000 Indians in 2016 - more than 1,183 every day. The government aims to eradicate TB from India by 2025, five years ahead of the global TB elimination target of 2030. The campaign, which is designed to create support for TB eradication, encourage smokers to quit, and increase timely diagnosis and treatment of TB, was developed and implemented with technical support from Vital Strategies.

"Most TB deaths in India occur among young, economically productive adults and the disease is one of the top five causes of death among people aged 30-69 years," said Jose Luis Castro, President and Chief Executive Officer, Vital Strategies.

"India's tobacco epidemic is contributing to this burden. 'Cough' will support progress towards the target of eliminating TB by 2025 by encouraging smokers to quit and ensuring that smokers and those exposed to secondhand smoke visit the doctor about a persistent cough. This is a life-saving message and we congratulate MoHFW on the re-launch of this important campaign," added Castro.

When 'Cough' first launched on World No Tobacco Day in 2017, India became the first country in the world to run a national tobacco control campaign that highlights the increased risk of TB and dying from TB linked to smoking tobacco (cigarettes or bidis) or exposure to second hand smoke.

The public service announcement (PSA) graphically shows that while a smoker's cough tells the smoker they have a health problem, a persistent cough over two weeks or more could indicate that problem is TB. The PSA shows a father smoking and coughing beside his daughter, noting that exposure to second-hand smoke brings the same risks. It ends with the stark warning that "Every bidi cigarette brings you and those around you closer to TB."

Courtesy :Deccan Chronicle

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The Global Economic Burden of Tobacco: An Interview with Dr. Mark Parascandola

NCI recently released The Economics of Tobacco and Tobacco Control, the latest in a series of monographs on tobacco use and tobacco control. Produced in collaboration with the World Health Organization, the new report examines the current research surrounding the economics of tobacco control in many countries around the world.

In this interview, Mark Parascandola, Ph.D., of NCI’s Tobacco Control Research Branch, discusses the findings.

How is this report different from others in the series of monographs on tobacco control?

The NCI Tobacco Control Monograph series aims to provide ongoing and timely information about emerging public health issues in smoking and tobacco use control. This particular monograph is the first in the series to focus entirely on tobacco control from an economic perspective. Additionally, while some of our previous monographs focus primarily on data and experience from the United States, this report, completed in collaboration with the World Health Organization (WHO), takes a global perspective.

Economic tools can be applied to tobacco control in a variety of ways. For instance, researchers can assess the impact of tax and price on tobacco use, measure the economic costs of tobacco use, characterize the manufacturing and trade of tobacco products, and consider how information and tobacco control policies influence consumer demand for tobacco products.

What are the economic costs of tobacco use around the world?

The report found that the use of tobacco burdens economies with more than US$1 trillion annually in health care costs and lost productivity. In addition to early death, tobacco users are more likely to suffer from debilitating diseases that may prevent them from working, as well as burdening family members and other caregivers. We also found that among poor households, tobacco use can exacerbate poverty by increasing health care costs, reducing incomes, and decreasing productivity, as well as by diverting limited family resources away from basic needs.

Are there any negative economic effects from reducing tobacco use, such as reduced income for tobacco farmers?

The report found that, overall, tobacco control does not harm economies. The number of jobs dependent on tobacco has already been falling in most countries, largely due to technological innovation, and for most countries tobacco control measures will have only a modest impact on employment. Additionally, there is now a large body of evidence from many countries demonstrating that smokefree policies do not adversely affect hospitality businesses, such as bars and restaurants.

Where do most of the world’s current smokers live?

There are an estimated 1.1 billion tobacco smokers aged 15 years or older worldwide, and 80% of them live in low- and middle-income countries‎. Due to its large population and smoking prevalence, China accounts for 40% of the world’s cigarette consumption. But Russia, the United States, and Indonesia are also relatively high tobacco consumers.

Has there been progress in reducing tobacco use globally over the past decade?

One of the major conclusions of this report is that progress is being made in controlling the global tobacco epidemic. In high-income countries like the United States, this progress has been going on over several decades. But in recent years, following the WHO Framework Convention on Tobacco ControlExit Disclaimer, many low- and middle-income countries have also been implementing effective tobacco control measures.

Are there effective interventions available now to reduce tobacco use and the harmful effects of tobacco use?

Yes. Research from around the world has demonstrated the effectiveness of evidence-based interventions to reduce tobacco use, including significant tobacco tax and price increases, comprehensive bans on tobacco industry marketing, prominent pictorial health-warning labels, smokefree policies, and cessation programs. Additionally, research demonstrates that these interventions are highly cost effective.

However, these interventions remain underutilized. Global tobacco excise taxes generated nearly US$269 billion in government revenues in 2013-2014, yet governments spent less than US$1 billion during that period on tobacco control.

What did you learn by including data on low- and middle-income countries in this report?

One of the major contributions of this report was to analyze recent data‎ from low- and middle-income countries in addition to data from high-income countries. Interestingly, we found that certain tobacco-control tools, such as raising taxes on tobacco products, can be just as effective in low- and middle-income countries as they are in high-income countries.

What areas of new research are needed?

While there are effective interventions to reduce tobacco use, ongoing research is needed to further understand the economics of tobacco control, particularly in low- and middle-income countries. Key priorities include further research on the effects of tobacco taxation and pricing, on interrelationships between tobacco use and poverty, on illicit trade, on economically viable alternatives to tobacco growing and manufacturing, and on the implementation and evaluation of the WHO Framework Convention on Tobacco Control.

Is there a take-home message from this report?

Above all, the research summarized in this monograph confirms that evidence-based tobacco control interventions make sense from an economic as well as a public health standpoint. Concerns that tobacco control will have adverse economic effects are not supported by the evidence. Given the enormous health and economic consequences of tobacco use and the rapidly evolving global market for tobacco, these interventions are needed now more urgently than ever.

National Cancer Institute

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Smoking Costs Nearly 2% of World's GDP, Tobacco Control Measures Needed

Smoking consumes almost six per cent of the world's total spend on healthcare and nearly two per cent of global GDP, a new research has found.

In 2012 the total cost amounted to $1,436 billion, with nearly 40 per cent of this sum borne by developing countries. The four BRIC countries -- Brazil, Russia, India and China -- accounted for 25 per cent of it, the findings showed.

These findings highlight the urgent need for all countries to implement comprehensive tobacco control measures to address these economic costs," the researchers said.

The detrimental impact of smoking on national health systems and economies has been widely studied since the 1960s, but most of these studies have focused exclusively on high income countries, the researchers noted.

So Mark Goodchild from World Health Organization (WHO) and colleagues wanted to include low and middle income countries to come up with more accurate estimates of the total global cost.

And so they included data from 152 countries representing 97 per cent of the world's smokers.

They used the 'cost of illness' approach, first devised in 1960. This divides the economic impact of an illness into direct costs, such as hospital admissions and treatment, and indirect costs representing the value of productivity lost to death and disability in current and future years, for a given year.

The direct and indirect costs are then added up to provide the overall societal cost, usually expressed as a percentage of annual gross domestic product (GDP).

The researchers used data from sources such as the WHO and the World Bank to uncover information on the proportion of ill health and death attributable to smoking, national employment rates, and GDP for each of the 152 countries, to inform their calculations.

These showed that in 2012, diseases caused by smoking accounted for 12 per cent (2.1 million) of all deaths among working age adults aged 30-69, according to the study published in the journal Tobacco Control.

This figure included 1.4 million adults who would have been in the workforce.

The number of working years lost because of smoking related ill health added up to 26.8 million, 18 million of which were lost to death with the remainder lost to disability.

In terms of health spend attributable to smoking, this totalled $422 billion, equivalent to nearly six per cent of the global total.

The researchers pointed out that their calculations did not include the health and economic harms caused by second hand smoke or smokeless forms of tobacco, and that their estimates of lost productivity applied only to those who were economically active.

Source: News18

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Economic burden from tobacco-induced heart diseases highest in Kerala amongst southern states

Cardiovascular diseases (CVDs) account for a staggering Rs 226 crore economic burden annually, the highest among four major tobacco-induced ailments in Kerala, contributing to 51 per cent of total direct medical costs.

Significantly, the total direct medical costs from tobacco-induced CVDs in Kerala are the highest among south Indian states, says a latest report.

The report is based on study called ‘Economic Burden of Tobacco Related Diseases in India’ developed by Public Health Foundation of India (PHFI) with support from the Union Ministry of Health & Family Welfare and the World Health Organisation (WHO).

The study report covers both direct medical costs and indirect morbidity costs of four specific diseases – CVDs, cancer, tuberculosis, and respiratory disease.

The direct medical costs from tobacco-related heart diseases in neighbouring Tamil Nadu is 46 per cent, while those in Andhra Pradesh and Karnataka are at 48 and 40 per cent, respectively.

Smoking tobacco contributes to the highest economic burden among Kerala males with direct costs of Rs 123.5 crores, and indirect costs of Rs 62.7 crores.  

The report estimated the economic costs on persons in the 35–69 age group in 2011.

Direct medical costs include direct healthcare expenditure for inpatient hospitalisation or outpatient visits such as medicines, diagnostic tests, bed charges, and surgeon’s fees. Indirect costs accrue from expenses on transportation and lodging for caregivers and loss of household income due to inpatient hospitalisation, besides costs from premature deaths. 

According to the Global Adult Tobacco Survey (GATS) 2009-10, the global standard to systematically monitor adult tobacco use, 35.5 per cent of males use tobacco in some form, 27.9 per cent males smoke and 13.1 per cent use smokeless tobacco products.

The economic burden study has suggested a host of measures to deal with the tobacco menace. These include strengthening implementation of Indian tobacco control law, COTPA, 2003 and imposing uniform taxes on all tobacco products like cigarettes and bidis. It has also recommended prohibition of sale and manufacture of all forms of smokeless tobacco products/chewing tobacco and high visibility public awareness campaigns to consistently reach out to different target audiences.

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How do much does a smoker lose?

Source: India Today

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Economic costs of tobacco use: Kerala surpasses neighbours

Kerala has emerged as a leader of sorts in South India with the huge economic burden it shoulders on account of tobacco use. God’s Own Country has left behind its tobacco cultivating neighbours – Karnataka and Tamil Nadu, reveals the findings of a major recent national study conducted to estimate the economic dimensions of tobacco use.

The study supported by the Union Ministry of Health & Family Welfare and the World Health Organisation brings out that the economic resources lost in treating and managing four major tobacco-induced diseases is nearly 75 per cent more than Karnataka. While Kerala burns out Rs 545.4 crores, it is Rs 314.7 crores in Karnataka.

Monetary resources lost due to tobacco use in Tamil Nadu is nearly 17 per cent lesser than Kerala, at Rs 467 crores.

The report following the study called ‘Economic Burden of Tobacco Related Diseases in India’ developed by the Public Health Foundation of India has estimated the economic costs on persons aged 35 – 69 in the year 2011. It has estimated both direct medical costs and indirect morbidity costs in two categories – all tobacco-induced diseases, and four specific diseases – cardiovascular diseases (CVDs); cancer, tuberculosis and respiratory disease.

Direct medical costs include direct healthcare expenditure for inpatient hospitalisation or outpatient visits such as medicines, diagnostic tests, bed charges and surgeon’s fees. Indirect costs accrue from expenses incurred on transportation and lodging charges for caregivers, loss of household income due to inpatient hospitalisation, besides costs from premature death. 

A similar pattern prevails with regard to economic burden of tobacco use from all diseases, with Kerala facing a greater pinch than Karnataka and Tamil Nadu. The economic cost in Kerala on all diseases is Rs 1513.7 crores, as against Rs 983.1 crores in Karnataka and Rs 1171.3 crores in Tamil Nadu.

In line with consumption patterns, tobacco-induced costs are higher among Kerala males as compared to females. Among males, higher costs – both direct and indirect – accrue from smoking tobacco products as against smokeless tobacco products.

On four diseases specifically, tobacco use among Kerala males causes a loss of Rs 518.9 crores, which is nearly 90 per cent more than in Karnataka and 40 per cent more than in Tamil Nadu. Tobacco induced economic costs among Kerala females is Rs 26.4 crores.

Kerala’s saving grace is Andhra Pradesh, a major tobacco producing state in India, which leads with the highest economic burden due to tobacco use among southern states.

The study, among others, recommends prioritisation of tobacco control measures such as strengthening implementation of Indian tobacco control law, COTPA, 2003; uniform taxes on all tobacco products such as cigarettes and bidis; prohibition on sale and manufacture of all forms of smokeless tobacco products/chewing tobacco and high visibility public awareness campaigns to consistently reach different target audiences.

The Value Added Tax on cigarettes in Kerala is 22 per cent and bidis are not taxed at all.

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