Tobacco Use a Deadly Choice for Millions Worldwide

An anti-smoking activist dressed as an executioner carries a giant cigarette in Budapest, Hungary, to promote World Anti-smoking Day.By Erika Gebel
Staff Writer

Tobacco Use a Deadly Choice for Millions Worldwide
U.S. philanthropists funding programs to help break the lethal habit

Washington -- Is money the solution to a burgeoning, and self-inflicted, world health problem?

New York City Mayor Michael Bloomberg and Microsoft Corporation co-founder Bill Gates are aiming to find out with their recently announced combined investment of $500 million to support programs and policies in developing countries to break a deadly habit: tobacco use.

Worldwide more than a billion people smoke, roughly one in four adults. Smoking also is a risk factor for six of the eight leading causes of death globally, including cancer and heart disease. Smoking tobacco kills more than any other single agent and is responsible for the deaths of up to half the people who indulge. In 2008, smoking will kill more than 5 million people, more than AIDS, tuberculosis and malaria combined.


Tobacco smoking affects not only the smoker, but also those in the vicinity of the smoker. Exposure to secondhand smoke, either at the home or in the workplace, increases the chance of heart disease by 25 percent to 30 percent and raises the risk of lung cancer by 20 percent to 30 percent, according to the U.S. Department of Health and Human Services. Secondhand smoke is especially hazardous for children, increasing their risks for respiratory illnesses and sudden infant death syndrome, according to the National Institute on Drug Abuse.

Although smoking rates have decreased in high-income parts of the world in recent years, smoking rates are climbing in low- and middle-income regions, which are home to 80 percent of the world’s smokers.

HEALTH CONSEQUENCES

In the United States, cigarette smoking accounts for approximately 438,000 deaths, or almost one in five deaths, each year, according to the Centers for Disease Control and Prevention (CDC). It also costs the U.S. economy $193 billion annually in lost productivity and spending on health care.

Tobacco smoke is hazardous because it contains a number of unhealthy chemicals, including some 60 carcinogens (cancer-causing agents), tar, arsenic, carbon monoxide and nicotine. Nicotine is highly addictive, and therefore partly responsible for the frequency with which smokers feel compelled to light up. Without regular doses of nicotine, a smoker experiences unpleasant withdrawal symptoms that make quitting difficult.

According to the World Health Organization (WHO), by the year 2030, tobacco deaths worldwide will reach 8 million a year -- totaling 1 billion deaths in the 21st century -- unless steps are taken to combat the problem. Declining smoking rates in high-income countries show effective strategies to combat tobacco use are at work. The challenge lies in applying those methods to the developing world.

INTERNATIONAL COOPERATION

The CDC has partnered with the WHO to create the Global Tobacco Surveillance System, which includes a number of surveys to monitor tobacco use, including one that assesses young people. The information collected through the surveys can be used to target particular regions for smoking cessation programs.

The U.S. government helped negotiate the Framework Convention on Tobacco Control (FCTC), adopted May 21, 2003, by the WHO. The FCTC aims to address “the global problem of tobacco use and covers issues such as youth access to tobacco, tobacco advertising and marketing, price of tobacco products, environmental tobacco smoke, smuggling, surveillance and research,” according to the CDC.

Building on the FCTC, the WHO in 2008 created the MPOWER package, a proven control strategy for reducing tobacco usage. Even though the strategy has reduced smoking in the United States, only 5 percent of the rest of the world uses any of the components of MPOWER. The Gates and Bloomberg funds will help bring MPOWER to at-risk nations.


A poster listing some health consequences of smoking is part of an anti-smoking campaign by the New York State Department of Health.MPOWER has six components:

• Monitor tobacco use and prevention policies,

• Protect people from tobacco smoke,

• Offer people help to quit tobacco use,

• Warn about the dangers of tobacco,

• Enforce bans on tobacco advertising, promotion and sponsorship, and

• Raise taxes on tobacco.

Monitoring gives region-specific information on the extent of the epidemic and can suggest which anti-smoking policies would be the most effective in the region.

The second element includes enacting and enforcing smoking bans in public spaces to protect people from secondhand smoke. The success of this type of law is evident across the United States, as more and more cities and states are banning smoking from public places as well as private businesses, including restaurants and bars.

According to the WHO, only nine countries have services for people who wish to quit smoking. Such services are considered essential because smoking is addictive and people who wish to quit may need help. Quitting smoking can be facilitated by nicotine supplementation agents, such as nicotine patches or nicotine gum. In addition, pharmaceutical agents have been developed that deal directly with the brain’s addiction centers.

Placing warning labels on cigarette packages to detail the dangers of smoking might help increase awareness of smoke-related health hazards. In addition, removing descriptors aimed at making cigarettes seem more benign -- such as “light” or “low-tar” -- is also a goal of MPOWER. Research has shown that light or low-tar cigarettes are just as deadly as their full-flavored brethren.

Banning tobacco advertisement would make it more difficult for tobacco companies to promote cigarettes and gain new customers.

Finally, raising taxes on tobacco is the most effective way to curb usage, since increasing cost prevents smoking and encourages people to quit, according to the WHO.

More information about the MPOWER package is available on the WHO Web site.

For additional information on the Gates-Bloomberg cooperation against tobacco, see the press release on the Bill & Melinda Gates Foundation Web site.
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