Medicosnext
Smoking leads to disease and disability and harms nearly every organ of the body … Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. (U.S. CDC)
Additionally, “Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.”
Globally, more than one in five cancer deaths are due to smoking. Here are some more statistics: while 35% of men in the world smoke, a little over 6% of women do so. The latest estimates of the W.H.O. is that, 8.7 million people die prematurely due to smoking, which makes up 15% of all global deaths. What’s more, 1.3 million of these are non-smokers who die an early death due to secondhand smoke. Despite such dire warnings, one has to wonder why the manufacture of cigarettes has not been banned yet.
“Why do we still permit tobacco use?” asks one article in the NCBI journal (Autumn 2015, https://bit.ly/3oDji0K),wherein), wherein, the author states: “Governments enjoy tobacco revenue and are willing to continue to allow disease and death from tobacco smoking.” In 2014, taxes as a share of cigarette price in Nepal was 46.6%, in India: 66.1%, U.S.A.: 42.9%, and China: 47.8%, just to give a few examples. Another reason cited is: “One of the main arguments for the continuance of tobacco sales is that the government should not dictate what vices the public engages in.”
However, successive steps have been taken by many countries to discourage smoking, which has certainly been successful in reducing the number of smokers worldwide. Today, advertising of tobacco products has been banned in most countries around the world. The U.S.A. banned cigarette advertising on television and radio from January 2, 1971. In 1991, the E.U. banned all tobacco advertising and sponsorship on television, and in July 2005, extended the ban to cover other forms of media such as the internet, print media, radio, and sports events.
March 2004 was an important month as far as smoking bans was concerned. On March 29, 2004, Ireland became the first nation to legislate the creation of smoke-free workplaces, as well as bars and restaurants. Similar legislation was implemented soon after by many countries, including New Zealand, Uganda, Norway, Sweden, Malta, Italy, etc.. In the same year (2004), Bhutan became the first country in the world to ban the sale of tobacco and make it illegal to smoke in public places. In 2010, it implemented the Tobacco Control Act to ban the cultivation, manufacturing, and trade of tobacco products (King’s Think Tank, https://bit.ly/3DGNi06). The same year, Uruguay became the first nation in South America to ban smoking in the workplace, as well as in public places, restaurants, and bars. In India, smoking was banned in public places from October 2, 2008.
In Nepal, advertisement of tobacco products was banned in both electronic and print media in 1998 and 2000, respectively. On April 29, 2011, the country implemented the Tobacco Control and Regulation Act 2068, banning smoking in airports, hotels, restaurants, government offices, and other public places from August 7, 2011. The act also required cigarette manufacturers to have graphic warnings on the packs (covering at least 75%) about the adverse effects of smoking (some countries require that tobacco products be packed in plain, dark brown packaging with warning labels). Indeed, how the tide has turned from the time when it was the government’s priority (before 1990) to increase the production of tobacco to fulfill national demand; Janakpur Cigarette Factory was established in 1965 and was one of the most lucrative government-run industries in the country. There was also once a Tobacco Development Board to increase the productivity of tobacco!
On February 27, 2005, the W.H.O enacted the Framework Convention on Tobacco Control (FCTC), which requires that all 182 signatory countries must ban advertising of tobacco products. Nepal is also a signatory to the convention. In 2007, it introduced a method to further enhance implementation of its goals through MPOWER—1. Monitor tobacco use and prevention policies, 2. Protect people from tobacco use, 3. Offer help to quit tobacco use, 4. Warn about the dangers of tobacco, 5. Enforce bans on tobacco advertising, promotion and sponsorship, and 6. Raise taxes on tobacco.
Now, fast forwarding to December 2021, the headlines is that New Zealand will be enacting a law soon that would ban the sale of tobacco. “New Zealand to ban tobacco sale to people born after 2008—The government plans to introduce a law that, starting in 2027, will lift the smoking age by a year every year.” (Al Jazeera, Dec 9, 2021, https://bit.ly/3s0SZU6). There will also be tougher restrictions on tobacco advertising, along with a significant reduction in the number of shops that can sell tobacco products.
“New Zealand Plans to Eventually Ban All Cigarette Sales—The proposed legislation, which is expected to become law next year, would leave current smokers free to continue buying cigarettes. But it would gradually raise the smoking age, year by year, until it covers the entire population. Starting in 2023, anyone under age 15 would be barred for life from buying cigarettes. So, for instance, in 2050, people 42 and older would still be able to buy tobacco products, but anyone younger would not.” (The New York Times, Dec 9, 2021, https://nyti.ms/31DHasz).
As a matter of general interest, the most smokers are in the following countries, with around 40% of the population being smokers: Kiribati, Montenegro, Greece, Timor, Nauru, Indonesia, Russia, Bosnia and Herzegovina, Serbia, and Chile. The least numbers of smokers (less than 5% of the population) are found in Ethiopia, Ghana, Peru, and Honduras.
E-cigarettes
E-cigarettes are devices that heat a liquid to create an aerosol which is then inhaled by the user. The main constituents are propylene glycol, with or without glycerol, and flavoring agents, usually with nicotine. According to the European Public Health Association (EUPHA), “While the vapor from e-cigarettes does not contain some of the harmful substances in traditional cigarettes, it does contain different harmful substances not found in traditional cigarettes, so the health effects of using both can be expected to be greater than either alone.” The WHO, in 2016, noted that, “While e-cigarettes might be less harmful than conventional cigarettes, they still pose important risks to health.” Since e-cigarettes have only recently come into wide use, long-term data is limited.
Unlike traditional cigarettes, e-cigarettes do not produce tar, the main cause of lung cancer; however, they produce formaldehyde, a known carcinogen, above the recommended levels. The use of e-cigarettes has also been linked to lung disease, and its use is known to adversely affect the cardiovascular system. The EUPHA concludes that while the health risks of e-cigarettes remain uncertain, they cannot be considered to be safe, and that, while e-cigarettes may help some smokers quit, for most others, e-cigarettes in fact depress quitting.
As for the U.S.CDC, here is their bottom line on the subject: “1. E-cigarettes have the potential to benefit adults who smoke and who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products. 2. E-cigarettes are not safe for youth, young adults, pregnant adults, as well as adults who do not currently use tobacco products, and 3.While e-cigarettes have the potential to benefit some people and harm others, scientists still have a lot to learn about whether e-cigarettes are effective in helping adults quit smoking.”
As per the Stanton Glantz blog (Commentary on tobacco, cannabis, and public health), 47 countries, including Nepal, Bhutan, Sri Lanka, India, and Bangladesh, have so far banned e-cigarettes, partially or completely.
