A threat to development

Dr Sushil Kumar Sharma
World No Tobacco Day is a campaign run by the World Health Organization (WHO). The aim of this campaign is to inform the public about the health risks associated with Tobacco use and advocating for effective policies to reduce its consumption. Each year, the WHO selects a theme for the day in order to create a more unified global message for WNTD. This theme then becomes the central component of the WHO’s tobacco-related agenda for the following year. The WHO oversees the creation and distribution of publicity materials related to the theme, including brochures, fliers, posters, websites, and press releases. Gauging the global implications caused by the tobacco use on sustainable development, encompassing the health and economic well-being of citizens in all countries, this year WNTD theme is “Tobacco- a threat to development.”
Tobacco use is a threat to any person, regardless of gender, age, race, cultural or educational background. It brings suffering, disease, and death, impoverishing families and national economies.
Prevalence
* Consumption of tobacco products is increasing globally with the greatest increase in the developing world. Tobacco kills almost 6 million people each year, more than 5 million of whom are users and ex users, and more than 600,000 of whom are non smokers exposed to second hand smoke. This annual death toll would rise to more than 8 million by 2030.
* Tobacco use costs national economies enormously through increased health-care costs and decreased productivity. It worsens health inequalities and exacerbates poverty, as the poorest people spend less on essentials such as food, education and health care. Some 80% of premature deaths from tobacco occur in low- or middle-income countries, which face increased challenges to achieving their development goals.
* Tobacco growing requires large amounts of pesticides and fertilizers, which can be toxic and pollute water supplies. Each year, tobacco growing uses 4.3 million hectares of land, resulting in global deforestation between 2% and 4%. Tobacco manufacturing also produces over 2 million tonnes of solid waste.
* The WHO Framework Convention on Tobacco Control (WHO FCTC) guides the global fight against the tobacco epidemic. The WHO FCTC is an international treaty with 180 Parties (179 countries and the European Union). Today, more than half the world’s countries, representing nearly 40% of the world’s population (2.8 billion people), have implemented at least one of the WHO FCTC’s most cost-effective measures to the highest level. An increasing number of countries are creating firewalls to ward off interference from the tobacco industry in government tobacco control policy.
* Through increasing cigarette taxes worldwide by US$1, an extra US$190 billion could be raised for development. High tobacco taxes contribute to revenue generation for governments, reduce demand for tobacco, and offer an important revenue stream to finance development activities.
Harmful effects of Smoking
Smokers loose at least one decade of life expectancy as compared to non smokers. The risk of death from cigarette smoking continues to increase in women and increased risk are nearly identical for men and women. Compared with non smokers smoking increase the risk of both coronary heart disease and stroke to two to fourfold.  Ischemic heart diseases underlies 35-40% of all smoking related deaths, with an additional 8% attributable to second hand smoke exposure. Cigarette smoking can promote vasoconstriction resulting in greater risk of developing symptomatic peripheral vascular disease, abdominal aortic aneurysm among smokers and non-smokers. Second hand smoke exposure also is associated with heart diseases in nonsmoking adults. Non smokers exposed to second hand smoke at home or work increases their heart disease risk by 25-30% .
Smoking increases the risk of CHD seminal studies linking smoking and Heart diseases appeared by the middle of 20th century. The 1964 Surgeon General report reaffirm the epidemiologic relation and by 1983 The Surgeon General had firmly established cigarette smoking as the leading avoidable cause of CVD. Smoking doubles the incidence of CHD and Increases CHD mortality by 50% and that these risk increase with age and the number of Cigarette smoked. Women incur similar increases in the relative risk for CHD. Smoking rates continues to rise worldwide with the greatest increase in the developing world. Among smokers 35yrs of age or older who die of smoking related causes 33% die of CVD.
E- Cigarette- emerging trend
The recent decline in smoking has accompanied a rapid growth in the use of alternative nicotine products among young people and young adults. Electronic cigarettes also known as E- cigarettes, e-cigs, etc., is one such innovation.  The modern e-cigarettes was invented in 2003 by Chinese pharmacist Hon Lik.  Reasons for using e-cig involves trying to quit smoking, reduce risk and save money, though many use them recreationally. Unfortunately, majority of users still smoke tobacco, causing concerns that dual use may delay or deter quitting.
Benefits of smoking cessation – Observational studies demonstrate clear benefits of smoking cessation .Smokers who quit reduce their excess risk of 50%  within  first two years of cessation with much of this gain in the first few months this period is followed by more gradual decline , with the risk of former smokers approaching that of never smokers after 3 – 5 years .The gain in life expectancy are large and the earlier in life an individual stop smoking the larger the potential gain, A 35 yrs old male smoker for example May add 3 yrs to his life expectancy on cessation.
In order to help smokers to quit smoking , combination of multiple counseling  session in addition to  medication  increase the success rate .Seven first line pharmaco therapies that reliably increase long time smoking abstinence were also identified  such as sustain release bupropion  hydrochloride , five Nicotine replacement therapies (Gum patch, Inhaler, Nasal spray and lozenges) and Varenicline.
Low success rate in smoking cessation continue to challenge clinicians. Preventing smoking in the first place should receive greater emphasis. Community education and physician based primary prevention remains the most important component of any smoking reduction strategy. Last but not the least this epidemic can be resolved by becoming aware of the devastating effects of tobacco and its products, learning about the proven effective tobacco control measures, national programmes and legislations prevailing in the home country and then engaging completely to halt the epidemic to move toward a tobacco-free environment.
(The author is HoD Cardiology GMCH Jammu)
feedbackexcelsior@gmail.com

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