Mir Lutful Kabir Saadi
Secondhand smoke is simply other people’s tobacco smoke. Wherever people smoke, there is secondhand smoke in the air. There is no doubt breathing second-hand tobacco smoke (SHS) is dreadfully dangerous to health. It causes cancer, as well as many serious respiratory and cardiovascular diseases in children and adults, often leading to death. Tobacco is the second major cause of death in the world and there is also no safe level of human exposure to second-hand tobacco smoke.
Tobacco use is a major preventable cause of premature death and disease worldwide. Inhalation of secondhand smoke is sometimes called passive smoking. The costs of second-hand smoke are not limited to the burden of diseases. Exposure also imposes economic costs on individuals, businesses and the society as a whole. These include primarily direct and indirect medical costs, but also productivity losses.
Secondhand smoke hangs around for ages and most of it is invisible and neutral. Smoking in a car is even worse because all of the smoke is concentrated into a small space. Interestingly people cannot see or smell 85 per cent of secondhand smoke. So, no matter how much one tries to avoid it, it is pointless. When inhaled secondhand smoke increases one’s risk of getting lung cancer by 24 per cent and heart disease by 25 per cent. Secondhand smoke is a dangerous cocktail of huge chemicals, including 69 cancer-causing chemicals, such as arsenic, benzene and formaldehyde.
Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces where people burn tobacco products such as cigarettes, bidis and water pipes. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer. The World Health Organisation (WHO) estimates that around 700 million children, or almost half of the world’s children, breathe air polluted by tobacco smoke, particularly at home. Currently, approximately 5.4 million people die each year due to tobacco-related illnesses—a figure expected to increase to more than 8 million a year by 2030.
There is no safe level of exposure to second-hand tobacco smoke. In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight. Almost half of children regularly breathe air polluted by tobacco smoke in public places. Over 40 per cent of children have at least one smoking parent. Second-hand smoke causes more than 600,000 premature deaths per year.
Second-hand tobacco smoke (SHS) has officially been classified a carcinogenic — cancer causing — in humans. It also causes severe acute and chronic heart disease. Other adult conditions linked to SHS are bronchitis, pneumonia, asthma, and in children: lower respiratory infections, asthma, middle ear infection, sudden infant death syndrome and low birth weight for babies of women exposed to SHS during pregnancy.
Tobacco and poverty are inextricably linked. Many studies have shown that in the poorest households in some low-income countries, like Bangladesh as much as 10 per cent of total household expenditure is on tobacco. This means that these families have less money to spend on basic items such as food, education and health care. In addition to its direct health effects, tobacco leads to malnutrition, increased health care costs and premature death. It also contributes to a higher illiteracy rate, since money that could have been used for education is spent on tobacco instead. Unfortunately tobacco’s role in exacerbating poverty has been largely ignored by researchers in both fields.
Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development. In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to “green tobacco sickness”, which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves. Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease means death has just begun.
It was reported in the media that tobacco cultivation and deforestation in Bangladesh hill districts go hand in hand. Hills are deforested to collect firewood, cure leaves and give wider land for tobacco farming. A study named “Tobacco and Poverty: Observations from India and Bangladesh” prepared by PATH Canada suggests that tobacco growing is a significant cause of deforestation in Bangladesh, accounting for over 30 per cent of annual deforestation, putting the country third internationally in terms of the severity of the problem, after South Korea 45 per cent and Uruguay 40 per cent.
According to the Health Ministry of Bangladesh among all adults, 45 per cent were exposed to SHS in public places. Males (69.4 per cent) were more exposed than females (20.8 per cent). Restaurants (27.6 per cent) and public transportation (26.3 per cent) were the most common places people were exposed to SHS. Among all persons engaged in some occupation who work in indoor areas, 63 per cent (11.5 million) were exposed to SHS in indoor areas of the workplace, and among non-smokers, 75.7 per cent (5.1 million) were exposed to SHS at these workplaces.
The World Health Organisation (WHO), committed to fighting the global tobacco epidemic has a Framework Convention on Tobacco Control. According to WHO about half of Bangladeshi men and one-fifth of women use tobacco in either smoking or smokeless form. Bangladesh, being a member of WHO, made an anti-smoking law named “Smoking and Tobacco Usage (Control) Act” in March 2005, which prohibits publication of advertisements of tobacco products in newspapers, electronic media, books, magazines and cinemas. It has become one of the most widely embraced treaties in the history of the United Nations with 178 Parties covering 89 per cent of the world’s population.
The WHO Framework Convention is WHO’s most important tobacco control tool and a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance. The law also bans smoking in public places and transport means with a provision of penalty which increased from fifty taka to three hundred taka. In Bangladesh, the awareness level about the harmful effects of tobacco is awfully low. Though very slowly, however the situation has been improving because of these measures.
WHO revealed that there are an estimated 20 million tobacco users in Bangladesh, 5 million of them are women. These estimates include smokeless tobacco also. A considerable amount of tobacco is produced in Bangladesh. Bangladesh was world’s one of the top tobacco producers, and continues to be the 4th largest producer of cigarettes in the region. Tobacco-related illnesses such as cancer, cardiovascular and respiratory diseases are already major problems in Bangladesh as in most countries of this region. Most of the victims in which heart attacks occur below the age of 40 are heavy smokers.
In many parts of the world comprehensive smokefree legislation has proved to be effective in protecting people from the health risks of secondhand smoke. For example, research published in The Journal of the American Medical Association found rapid and significant improvement in respiratory health of bartenders after the implementation smokefree workplace legislation in California. There is considerable evidence from countries that have already introduced smokefree laws that the impact on business can be positive.
New York’s Smokefree Air Act came into effect in March 2003. After the first year, a report found that business tax receipts in restaurants and bars were up by 8.7 per cent. Ireland (2004), Norway (2004), New Zealand (2004), Scotland (2006), England (2007) and various Canadian territories and Australian states are examples of places which have introduced comprehensive smokefree legislation. California has had state-wide smokefree public places since 1998. Now, over thirty US states have smokefree legislation that require completely smokefree restaurants and bars. China’s capital city of Beijing also adopted a historic tobacco control law that will make Beijing one of the world’s largest smoke-free cities. Beijing’s bold action will reduce smoking and secondhand smoke exposure in this city of 21 million and provides powerful momentum for urgently-needed nationwide action to reduce tobacco use and its deadly toll in China.
Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit. Massive mass media campaigns may reduce tobacco consumption, by influencing people to protect non-smokers and convincing youths to stop using tobacco. An efficient and systematic surveillance mechanism to monitor the epidemic is one of the essential components of a comprehensive tobacco control programme. Among smokers who are aware of the dangers of tobacco, most want to quit. Counseling and medication can more than double the chance that a smoker who tries to quit will succeed. Tobacco poses a major challenge not only to health, but also to economic development of the country. Every person has right to breath smoke free, germ-free air. Everyone should be able to breathe tobacco-smoke-free air, clean air and fresh air.
(Mir Lutful Kabir Saadi, General Secretary Bangladesh Science Writers and Journalists Forum (member, World Federation of Science Journalists); Fellow, 21st Century Trust, UK)
Mir Lutful Kabir Saadi