By Carol Aloysius
Sri Lanka has become a land of smokers. Whether it is smoking the pipe or cigarettes and thus directly inhaling the deadly fumes into one’s lungs, or else breathing the same noxious fumes from someone else smoking in the same room, tobacco inhaling in this country is on a sharp rise.
In a growing number of young people including school-children it has become a fashion statement to smoke cigarettes, without realizing the terrible impacts on their health. For tobacco smoking causes severe respiratory problems and lays the foundation for a number of chronic non communicable diseases in the very young and adolescents, which one usually associates with those we consider ‘senior citizens’ of over 55 years of age.
Sri Lanka was not the only country to adopt this new anti-social trend, starting at a very young age. The Global Youth Tobacco survey conducted in 2007 is an eye opener to the growing incidence of young smokers across the world: 5.1% youth between 13-15 years regularly smoke, they were already chain smokers: 39.5% of them smoked before the age of 10 years and 8.6% were current users of other tobacco products. The survey also revealed another more sinister aspect of this habit: that 65.9% of people are exposed to second hand smoke in public places.
In an interview with this writer on the causes for NCDs in Sri Lanka, sometime ago, Dr. Lakshman Ranasinghe, a well-known Consultant Paediatrician & General Practitioner’s comments on this aspect is worth recalling. He said:

“It’s appalling that despite all the public awareness programmes on this subject and even laws being passed to curb smoking, the incidence of smoking is still very high – not just among the lower socio economic classes but in every class of society. Even though there are laws to control smoking in public places, you find people smoking everywhere - on the roads, in supermarkets and in their homes. As there are no laws to prevent people smoking in their own homes, a lot of children become victims of passive smoking. Since passing laws against smoking inside one’s home are bound to raise human rights issues, it is thus the responsibility of adults not to smoke at home and expose their children and others, to the danger of passive smoking”.
In 2008 the WHO Report on the Global Tobacco Epidemic stated that 29.9% males and 2.5% females were smokers. It further stated a little known fact about an emerging health issue: Tobacco use was the 2nd leading cause for Non Communicable Diseases related deaths and disabilities, which incidentally are also the main cause for hospitalizations in Sri Lanka. These included heart attack, stroke, cancer, lung ailment and other serious illnesses.

With the current incidence of NCDs now rising to unprecedented levels and the burden of treatment growing heavier by the minute for the health ministry and the ageing population who are most at risk of these diseases now comprising 20% of the country’s population, health authorities have now shifted their focus from curing these diseases to preventing them, which in turn will also pave the way for a healthier nation. One of the tools being employed by health officials is to raise awareness among the public on the topic with the help of the media.
This subject was discussed at length along with other relevant topics at a recent seminar held at the Health Education Bureau on World No Tobacco Day. The main theme discussed was “The WHO Framework Convention on Tobacco Control’. Speakers at the media seminar, discussed the trends in tobacco consumption and its effects, the steps now being taken by the authorities to arrest this trend, and the WHO Framework Convention on Tobacco Control (WHO FCTC) the world’s foremost tobacco control instrument.

History of WHO FCTC
The WHO Convention on Tobacco Control (FCTC) is the first ever treaty aimed at controlling tobacco use world wide.
Explaining its significance in relation to general public health, the speakers said that it represented, a signal achievement in the advancement of public health. Although it has been in force only since 2005, it is already one of the most rapidly and widely embraced treaties in the history of the UN, with more 170 parties agreeing to abide by it. An evidence-based treaty, they said that, It reaffirms the right of all people to the highest standard of health, and provides new legal dimensions for co-operation in tobacco control.

Explaining why this year’s theme on World No Tobacco Day was on this particular issue, they said that it was because the WHO desired to highlight the treaty’s overall importance, to stress parties’ obligations under the treaty, and also promote the essential role of the Conference of the Parties, the treaty’s central organ and governing body. In addition it wished to highlight the WHO’s supporting role in the countries’ efforts to meet those obligations. It was also pointed out that the world needs the WHO FCTC as much, if not more than it did in 1996 when the World Health Assembly adopted a resolution calling for an international framework convention on tobacco control, as Tobacco use is the leading preventable cause of death.

Discussing the obligations of the treaty in detail, they said that as with any other treaty, the WHO FCTC confers legal obligations on its parties – i.e. on the countries that have formally acceded to it.
These obligations are to:
* Protect public health policies from commercial and other vested interests of the tobacco industry.
* Adopt price and tax measures to reduce the demand for tobacco.
*Protect people from exposure to tobacco smoke
* Regulate contents of tobacco products
* Regulate tobacco product disclosures
* Regulate packaging and labeling of tobacco products
* Warn people about the dangers of tobacco
* Control the illicit trade in tobacco products
* Ban sales to minors
* Support economically viable alternatives to tobacco growing

Impacts of tobacco smoke
Discussing the adverse impacts of tobacco smoke, especially in relation to non communicable diseases, the speakers reiterated that such diseases were now a major emerging health issue in Sri Lanka and other countries both western and in the Asian region.

“Tobacco use is the leading preventable cause of death”, they noted. This year more than five million people will die from a tobacco-related heart attack, stroke, cancer, a lung ailment of some other serious chronic disease that could have been prevented, according to WHO statistics. These figures however are just the tip of the iceberg since they deal with actual tobacco smokers. It does not include the rapidly rising number of people who die simply from the exposure to second hand smoke - passive smoking, as we sometimes call it. “Do you know,” they asked the media, “that over 600,000 people will die from second hand smoke? Or that more than a quarter of these victims will be children?”

Fielding questions from the media as to how many people die of smoke related illnesses in our own country, they said, “Recent surveys show that over 20% people die due to a tobacco related illness every year in Sri Lanka. And despite all the anti smoking laws in force, the numbers are on the rise. Over 350 deaths that take place in hospitals daily are due to NCDs”.

So what will this global tobacco epidemic be like in the next say two decades or so? Has the positive steps both to raise awareness on the hazards of smoking and give teeth to existing legal enactments banning advertisements, sales, control illicit trade etc, reduced the incidence of tobacco smoking across the world?
The reply to this question was discouraging to say the least.
“Unfortunately such measures don’t seem to have had much effect. In fact, the WHO estimates that the annual global death toll from tobacco use , could rise to as high as 8 million by the year 2030.”
And by the end of this century?
“The death toll could be around 1 billion . In the 20th century it killed 100 million persons. We can arrest this trend if those taking this hard drug, stop doing so immediately”.

The speakers also raised awareness on a little known fact about tobacco smoke: Namely, that it harms nearly every organ of the body- from the lungs, heart, and blood vessels, to the liver, eyes, ( cataracts), brain, to the feet ( leading to amputation of the foot in the case of a patient who has developed diabetes due to smoking tobacco.
“Cigarette smoking is the biggest cause of lung cancer deaths, while chewing tobacco is the main cause for oral cancer. If you study the percentages of people who die of lung cancer here and elsewhere in the world, you will find that around 87-88% of such deaths are directly caused by smoking tobacco.”
A smoker’s lungs when he/she inhales tobacco smoke, collects vast amounts of chemical poisons. There are more than 4,000 of such chemicals in tobacco smoke, of which 400 are directly said to cause cancer”.
Intervention measures by GOSL

So what has Sri Lanka done about it?
“It is because of this close link between tobacco use and NCDs that the government decided to re-focus its health priorities, and to address the issues of NCD’s while at the same time introduced legislation for more effective control of tobacco use. Sri Lanka’s high political commitment to tobacco control, did not start the other day. Our country was the first in the South East Asia Region to ratify the WHO FCTC.” a speaker said. He said that in 2006, the country enacted a National Tobacco Control Act of its own and established the National Authority on Tobacco & Alcohol (NATA) to implement the Act. The country also has a national tobacco control manager at central level who guides the Provincial Directors of Health on tobacco related issues. The policies on NCDs and health promotion have already been developed. The national policy and strategy for tobacco control is also being developed in order to effectively implement the Act. Furthermore, NATA has been assigned with the special responsibility of implementing the Act, and currently is focusing on issues related to prohibition of sale of tobacco to minors, smoke free areas in public places and completely ban advertisements on tobacco and tobacco products.”

More recently, in 2010 on World No Tobacco Day, NATA also launched a Tobacco and Alcohol Toll Free Quit line -1948- by the Minister of Health., at the National Blood Centre. The facility was established to offer help free of charge to those who wish to quit the use of tobacco and alcohol as well as provide advice for those who required information on mental, physical, social and economic harms caused by the use of these hard drugs. This facility was being offered to the general public in order to take the country towards a healthy society free of the alcohol and tobacco menace, the Health Minister is reported to have said on the occasion..
Answering a question on whether there was to be a total ban on smoking in public places, a speaker said that the National Tobacco & Alcohol Act had been sent to the Attorney General for amendment to make smoking in public illegal. “As soon as it gets Cabinet approval we will enforce it”, he said. He added that all the nine government departments and agencies that are ex-officio members of NATA are involved in this project. They include the ministries of Health, Justice, Education, Media, Trade, Sports and Youth Affairs and National Dangerous Drugs Control, as well as the Excise Dept. and the IGP.

The underlying message was that cigarette smoking is very dangerous habit as it could kill not just the smoker but those inhaling the fumes from the same room. One of the greatest dangers of tobacco smoking was that it could lead to non communicable diseases that would take their toll in later years and strike earlier than usual. It was also highlighted that the tobacco in the cigarette would impact on the essential organs of the human thereby reducing one’s life span. The prime and foremost organs that are affected by the smoking are lungs and heart. These two organs are drastically affected which would impede the normal health of the person. Speakers also highlighted the fact that blood vessels are damaged in smokers because of the nicotine and carbon monoxide presence. Lung cancer would be the prime disease caused because of cigarette smoking. The blood vessels are severely damaged and even the plaque materials are get deposited in the walls of the heart. Strokes, heart diseases, and skin diseases are the major diseases that are of smoking. If smoking continues for prolonged periods , the chances are for higher death rates.
“The time to quit smoking is now. Quit now and live a healthy life, free of smoke related non communicable diseases,” was their final message to the media.

Substances that kill
Cigarette companies in the US declared a list of substances that their cigarettes could contain:
The cigarette ingredient list given by the five contains 599 substances. These substances release over 4,000 chemicals when burned in a cigarette. Out of these 43 are carcinogenic (cancer causing) compounds and another 400 are toxic.