Awareness and government support have helped reduce the habbit of smoking all across the globe. Then why is Pakistan still in the backwaters?

ALL over the world, the habit of smoking is on the decline. Awareness coupled with health conscience governments are making sure that our future generations at least know the dangers of smoking. However, here in Pakistan, the situation is absolutely disheartening.

Instead of following global trends the habit of smoking is on the rise in this part of the world. But the saddest fact is that neither the public nor the anybody from the private sector has shown any concern to this growing problem. Subsequently, the rate of cancer patients is progressively increasing here.

Smoking is considered to be one of the biggest causes of death; others in the same league are HIV, Aids and tuberculosis. But as is common knowledge, it isn’t only the smokers that are at risk, so are those in close proximity of the smoker.

The death rate of a smoker is two to three times higher than a non-smoker. If this continues, then about 500 million currently (10 per cent of the world population) will eventually die within a span of three to four years! What people should also realize is that early age smoking presents a greater health risk, due to which life expectancy reduces by 20 to 25 years, meaning an early age smoker will die of young age as a result of cigarette smoking.

Not so long ago, a large portion of America’s population was addicted to smoking. In 1993 25 per cent of the people in the US were certified smokers. However, that number is on the decline and just three years back, it was down to 22 per cent in the year 2001. A survey by the US centers of diseases control and prevention shows that previously 46.2 million Americans smoked and of those smokers 15.3 million had given up smoking. School going children in America are made aware through special programs about the hazards of smoking. Such activities have proved immensely helpful as there is a marked decline in smoking in school going children.

PAKISTAN: In our country, the tobacco industry has traditionally been a huge contributor to the GDP (four per cent) contributing no less than Rs27.5 billion every year. At the same time the industry is one of largest employers (one million Pakistanis earn their living here). Also the industry has one of the largest yields in the country. Nevertheless, there has been growing concern over the years about the ill-effects of cigarette smoking and its impact on health and the well being of Pakistanis. Respiratory diseases ranging from the mouth to oropharynx, nasopharynx larynx, trachea and lungs are the cause of approximately 90 per cent of lung cancer attributable to cigarette smoking. According to the Pediatric Association of Pakistan, every day more than a 1000 children between the ages of six and 16 start smoking. It has also been estimated that more than third and almost four per cent of women in the country are smokers. Astonishingly enough, the government spends only $20,000 on anti-smoking messages while cigarette companies spend millions of dollars every year on tobacco advertising. Anti-tobacco groups accuse the government of being swayed by the tobacco industry which they say is because of the immense tax revenue that is collect from the industry. According to independent estimates, the Government of Pakistan collected over $300 million in tobacco tax in the year 1990. I am quite sure this figure must have multiplied many times by now. But these are all short-term benefits.

The long term healthcare problems of an average Pakistani devastated by smoking are too scary to even ponder. Tobacco contains 43 known cancer-causing chemicals. Cigarettes contain material like arsenic (deadly rat poison), tar, carbon monoxide and nicotine or carcinogenic chemicals. Of all the cancers such as breast cancer, prostrate, larynx, oral cavity, hypo pharynx and intestine, lung cancer has a higher death ratio. Unfortunately very little attention has been paid to the problem of lung cancer in Pakistan.

While on a survey in the rural areas of Sindh, I along with a team visited thirteen villages and small towns. We discovered that the people there were addicted to similar harmful substances like beeri, naswaar, tobacco sprinkled pan, cigarette, chaalia, gutka (imported form India), tobacco sniff, tobacco in gingivolabial fold. Much to our surprise, the ratio of tobacco and allied substances are prevalent and predominant in thickly populated villages as compared to urban areas where we found cigarette and chalia used more frequently.

In urban areas almost seventy per cent of males and thirty per cent of females use tobacco in either form. An examination of a thousand cases of various pathologies of oral cavity, oro pharynx, larynx, lungs, revealed twenty cases of carcinoma of oral cavity, larynx, hypo pharynx and lungs, all due to smoking tobacco. Sub mucus fibrosis (SMF) of oral cavity was also seen in chaalia (beetle nut) user. This too is a pre-cancerous condition.

The public as well as private sector is largely ignorant about the hazards of tobacco usage and so far no concrete steps have been taken to curb this disaster. On the contrary the electronic and the print media are constantly publishing cigarette and chaalia advertisements, advertisements that should be discouraged. The ban on the sale of tobacco to people of less than 18 years of age should be strictly enforced.

One encouraging role of the present government was not to allow smoking during the Pakistan and Sri Lanka cricket match at Karachi’s National Stadium last year. Such similar steps should be taken in educating our people. Seminars and symposia should be conducted and a survey of various areas of Pakistan to get rid of this cancerous agent, that leads to death of many innocent lives should be conducted. Being a developing country, it is estimated that Rs22 billion worth of cigarettes are smoked every year in Pakistan. This astounding figure and other risk factors of smoking was very well highlighted in a Peshawar conference on cardiology. Overall ninety per cent of heart diseases such as high blood pressure, myocardial infarction and other heart related diseases could be avoided by quitting smoking and performing physical activities. Cigarette smoking also causes constriction of blood vessels particularly supplying the vital organs such as heart, brain and genitalia, causing impotency at an early age. It will be imperative and encouraging on part of the government to implement an anti-smoking law duly passed by the National Assembly and Senate that discourages the establishment of tobacco industries. It also discourages the use of smoking in restaurants, offices, school, colleges, universities and other public places. Also a ban on the use of such advertisements on electronic media should be enacted and enforced. On an average a smoker loses a day of his/her life every week.

A 747 Jumbo aircraft holds 350 passengers. If we were to equate the deaths caused by lung cancer, then 440 Jumbo 747s would have to be dropped out of the sky this year to equal the deaths caused by lung cancer. And all of us know that 440 plane crashes would draw more attention than lung cancer. If 440 planes comprising of 350 passengers each crashed every year, most of us would think really hard before getting on a plane, harder than people think before they start smoking.

 

Global regulations

Legal position of smoking in various countries of the world:

• Austria: There is no ban on smoking in restaurants, but a ban exists in offices and other work places.

• Cyprus: Smoking is banned on 30 per cent seats in the restaurants.

• Finland: Smoking is banned in public areas and offices.

• Norway: Restricted smoking is allowed in 50 per cent of the hotels and restaurants.

• France: Smoking is banned in public places, but restaurants and bars have non-smoking areas.

• Switzerland: Hotels have a program and joy of life, includes areas of non-smoking.

• United Kingdom: There is no ban on smoking, however, there is a strong presence of courtesy of choice program.

• USA: In America, local communities and municipalities have imposed a ban.

• Canada: A law has been promulgated by states and municipalities, which have banned smoking in the restaurants and bars. With the result that the restaurants have shown a 50 per cent drop in the business.

• China and Cuba: They have not banned smoking in public places.

• Singapore: Smoking is totally banned in air-conditioned food and beverage outlets and meetings and banquets.

• Malaysia: There is no ban, but hotels have adopted courtesy of choice program.