Tobacco: A threat to human health

Dr Jintu Sarma

(The writer can be reached at drjintusarma@gmail.com)

World No Tobacco Day (WNTD), observed annually on May 31st, is a crucial global awareness campaign spearheaded by the World Health Organization (WHO). It serves as a powerful reminder of the devastating health, social, environmental, and economic consequences of tobacco use and a rallying cry for collective action to combat the global tobacco epidemic. The concept of a “World No-Smoking Day” was initially proposed by the WHO’s World Health Assembly in 1987, with the first observance on April 7, 1988.

Recognizing the persistent and escalating threat of tobacco, the World Health Assembly formally designated May 31st as World No Tobacco Day in 1988 with Resolution WHA 42.19. Since then, the WHO and its partners worldwide have marked this day with various campaigns and initiatives, each year focusing on a specific theme to highlight different facets of tobacco control. Tobacco use stands as one of the most pervasive and preventable global health threats of our time. Far from being a mere personal habit, it is a complex public health crisis with devastating consequences for human health, economies, and sustainable development worldwide. With millions succumbing to tobacco-related illnesses each year, understanding the multifaceted nature of this threat and its profound impact on human well-being is paramount. The direct impact of tobacco on human health is catastrophic and well documented. Tobacco smoke contains over 7,000 chemicals, at least 250 of which are known to be toxic, and more than 70 are proven carcinogens. This lethal cocktail wreaks havoc on nearly every organ system in the body. Foremost among the health consequences are respiratory diseases like chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis, which progressively debilitate lung function. Tobacco is also the leading cause of lung cancer and significantly increases the risk of numerous other cancers, including those of the mouth, throat, oesophagus, bladder, pancreas, kidney, liver, and cervix. Beyond cancer and respiratory ailments, tobacco profoundly affects the cardiovascular system, leading to heart disease, stroke, and peripheral arterial disease. It damages blood vessels, raises blood pressure, and reduces the oxygen-carrying capacity of the blood, significantly increasing the risk of heart attacks and other cardiovascular events. The impact extends to other vital systems, impairing the immune system, increasing susceptibility to infections, contributing to diabetes, and causing reproductive health issues in both men and women, including reduced fertility and increased risks during pregnancy. Even vision and oral health are compromised, with links to blindness and severe gum disease. The threat of tobacco extends beyond direct users, as millions of non-smokers are exposed to the dangers of second-hand smoke. This involuntary exposure, often occurring in homes and public spaces, significantly increases the risk of heart disease, lung cancer, and respiratory infections in adults. Children, in particular, are highly vulnerable to secondhand smoke, facing increased risks of sudden infant death syndrome (SIDS), respiratory infections, asthma attacks, and middle ear infections. The global burden of tobacco-related diseases is staggering. The World Health Organization (WHO) estimates that tobacco kills over 8 million people annually, including 1.3 million non-smokers due to secondhand smoke exposure. This figure makes tobacco the single greatest cause of preventable death worldwide. The majority of these deaths occur in low- and middle-income countries, which are often the targets of intensive tobacco industry marketing, exacerbating health inequalities and hindering development efforts. Beyond the immeasurable human suffering, tobacco imposes a substantial economic burden on societies. Healthcare systems are strained by the immense costs of treating tobacco-related illnesses, including hospitalisations, medications, and long-term care. Furthermore, indirect costs such as lost productivity due to premature death, disability, and absenteeism from work add significantly to the economic toll. Studies have estimated the global economic cost of smoking-attributable diseases to be in the trillions of dollars annually, representing a significant drain on national economies that could otherwise be invested in education, infrastructure, or other public health initiatives. Recognizing the immense scale of this global threat, concerted efforts have been made to implement tobacco control policies. The WHO Framework Convention on Tobacco Control (FCTC), a landmark international treaty, provides a comprehensive framework for countries to reduce tobacco demand and supply. Key measures include monitoring tobacco use, protecting people from tobacco smoke through smoke-free laws, offering help to quit tobacco use, warning about the dangers of tobacco through graphic health warnings and plain packaging, enforcing bans on tobacco advertising, promotion, and sponsorship, and raising taxes on tobacco products. India, the world’s second-largest tobacco producer and consumer, grapples with a formidable public health challenge posed by tobacco use. Despite significant legislative efforts and public awareness campaigns, tobacco consumption remains alarmingly high, exacting a devastating toll on human health and imposing an immense economic burden on the nation. The Indian health scenario, therefore, is inextricably linked to its complex and deeply entrenched tobacco problem. The Global Adult Tobacco Survey (GATS) India 2016-17 revealed that more than one-third (35%) of adults in India use tobacco in some form. This translates to an estimated 274.9 million tobacco users. A unique characteristic of India’s tobacco problem is the high prevalence of smokeless tobacco (SLT) use, with 21% of adults using only SLT, compared to 9% who only smoke. Khaini (tobacco-lime mixture), gutkha (tobacco, lime, and areca nut mixture), and betel quid with tobacco are among the most commonly used smokeless products. While smoking is more prevalent among males (24%), smokeless tobacco use is also significant among females (18%). Bidis, traditional hand-rolled cigarettes, are more widely consumed than factory-made cigarettes, especially in rural areas. The mean age of initiation for daily tobacco use is alarmingly low, at 17.8 years for those aged 20-34, with two in every five daily users in this age group having started before turning 18. The Indian health scenario is deeply impacted by the widespread use of tobacco. While legislative frameworks and national programmes are in place, the sheer scale and complexity of the problem demand sustained, multi-pronged efforts. A holistic approach that combines strict enforcement of existing laws, robust public awareness campaigns, accessible cessation services, and a strong focus on preventing initiation among youth is crucial. Addressing the unique challenges posed by smokeless tobacco and the informal sector will be key to mitigating the devastating health and economic consequences of tobacco, ultimately paving the way for a healthier and more productive India.