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| Tuesday, 25 May 2004 |
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Going down with smoke by Lionel Wijesiri WHO sponsored "No Tobacco Day" falls on May 31, and this year's theme is "Smoking and Poverty". Much has been written, and spoken, about the adverse effects of smoking. Yet in a country where over 20,000 people die a year due to tobacco consumption, I believe more should be written and more should be spoken of the dangerous habit. UNICEF estimates that over 200 million children aged under five years in low income countries are malnourished, and that malnutrition contributes to about six million deaths among these children each year.
Tobacco taxes comprise a significant proportion of total Government revenue. In 1988, tobacco excise tax amounted to Rs. 2600 million and by 2003, it shot up to Rs. 21000 million. Tobacco advertisements are not allowed in the electronic media but we can often see indirect smoking promotional scenes in tele-dramas. In the printed media, the company vigorously advertises its products glamorously targeting younger generation. Although some statistics exist on tobacco use and household expenditures as part of national household expenditure data collection, we are unaware of any serious research specific to this area in Sri Lanka. Tobacco has remained an issue of health and drug addiction, rather than being investigated in its relation to poverty. National Transport Commission introduced some years ago a ban on smoking inside public transport. In 1992, a Presidential Task Force was appointed for the formulation of a National Health Policy who made recommendations for the control of smoking. In 1997, another Presidential Task Force was appointed who prepared a National programme on tobacco. A number of NGOs too, are involved in tobacco reduction programmes. All these programmes were carried out half-heartedly and proper evaluations were rarely done. Survey What we need today is a national survey to try to find out why the "quit smoking" message is failing to change the smoking habits of the people in our country. Two important main questions need to be answered. What motivates our smokers to try to stop smoking? What outside help would assist them to quit? Naturally, the issue is complex. Researchers might find it helpful to look separately at those who aren't considering giving up; those who are preparing to give up; those who are currently trying; those who have successfully given up and those who have never started smoking. Each of these groups can reveal to us vital information, which we can use to devise health initiatives. We will be able to see what the root of the problem is - whether low-income smokers are trying to quit but not succeeding or whether quitting is something they don't even think about. From their results, researchers can identify a range of health initiatives and pilot these with low-income smokers to get feedback on what is effective and practical. Research Tobacco addiction has major consequences for a low-income country like Sri Lanka. Smoking, and its effects on health, is increasingly concentrated among the poor. Smoking is more common among poor, uneducated males worldwide and many in these areas are unaware of the health consequences of smoking. In Sri Lanka for instance, in addition to 20,000 deaths a year, 50 per cent of heart diseases and 40 per cent of cancers are caused by tobacco cancers. A high percentage of strokes, chronic obstruction pulmonary diseases and 80 per cent of lung diseases are also due to the use of tobacco. Apart from this, nearly 2000 people die due to diseases caused by tobacco smoking. Research has shown that tobacco addiction is rapidly spreading to poor countries. The same addiction that became the number one preventable cause of death in Western countries is making inroads abroad. Reports from the World Health Organization (WHO) indicate the growth of tobacco deaths based on current smoking patterns is expected to rise to one billion in the 21st century in contrast to 100 million in the 20th century. Measures What can we do? A global study, Tobacco Control in Developing Countries, published in 2000, and co-edited by Dr. Jha, and Professor Frank Chaloupka from the University of Chicago, Illinois, examines reducing the demand for tobacco through tax increases, cessation programs and non-price measures such as advertising bans and health education efforts. The study shows that higher tobacco taxes are highly effective at decreasing the number of people who start smoking and increasing the numbers of people who quit. Since the poor are more responsive to price increases they are more likely to quit if prices go up. Also, using revenues from higher cigarette taxes for health services could produce "double health gains" - reduced tobacco consumption and increases access to health service. Some economists, particularly in the USA, would argue that people should be allowed to make free choices about their personal expenditures, no matter how it affects them and their families. However, there are various flaws to that argument. First, increasing tobacco taxes does not represent coercion; there is no clear conflict between raising taxes and respecting people's free choice. Second, a conflict with free choice comes with the addictive nature of tobacco: once a person becomes addicted, he or she can no longer be said to choose freely whether or not to spend money on tobacco. Tobacco advertising, while not coercion, influences purchasing decisions, particularly in the absence of information about the harm of tobacco; the combination of a comprehensive ban on tobacco promotion, some mass education, and increased taxes would encourage the poor to spend their money more wisely. Third, freedom of choice does not supersede other human rights; Governments have the right, and one may even suggest the obligation, to encourage the poor to utilise their scarce resources for basic goods for themselves and their family, rather than on items like tobacco and alcohol. Long-term effects Beyond the short term links between poverty and tobacco use, there are also long-term effects that arise because of the higher risks of illness that tobacco users face, and the particular vulnerability of poor families to illness, especially of the breadwinner. In a low-income country like Sri Lanka, very few people are covered by health insurance or unemployment benefits. Illness and death, and the consequent loss of the income of a breadwinner, can be devastating for a family living close to, or below, the poverty line. Many poor people have few or no assets, apart from their ability to work. The poorer, less educated and less skilled people are the more likely it is that their livelihood entails physical work. The implications of high prevalence of tobacco use among men with low education and low incomes, which raises their relative risks of serious diseases and premature death are grave. Policies and interventions to help poor smokers quit, and to discourage others from starting are an important part of national effort to improve the health and well-being of our poor people. |
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Produced by Lake House |
Coexisting with this extreme poverty is a thriving tobacco industry.
The use of cigarettes, chewing tobacco and beedis is widespread. Ceylon
Tobacco Company, which owns the controlling share of our tobacco monopoly,
is a ubiquitous presence through its glossy media advertising, cigarette
display cases, and storefront signs.
