Vector Issue 10 - 2009

Smoking and Tobacco’s Impact on the
Developing World: The World’s Top Health Priority
Words Cam Hollows, Medical student, University of Sydney
“In the 20th century, the tobacco epidemic killed 100 million people worldwide…
during the 21st century, it could kill One Billion.”
“Reversing this entirely preventable epidemic must now rank as a top priority for
public health and for political leaders in every country of the world.”
Dr Margaret Chan, WHO Director-General (1)
www.ghn.amsa.org.au
// Image by Vivekchugh (sxc.hu)
1. Organization WH. WHO Report on the Global
Tobacco Epidemic, 2008: the MPOWER package.
Geneva: World Health Organization2008 Contract No.:
ISBN 9789241596282.
2. The Global Fund to Fight AIDS TaM. The Global
Fund to Fight AIDS, Tuberculosis and Malaria: Annual
Report 2008. Vernier, Switzerland: The Global Fund to
Fight AIDS, Tuberculosis and Malaria2008 2008 Contract
No.: 92-9224-163-X (ISBN).
3. UNAIDS. UNAIDS Report on the global AIDS
epidemic: 2008. Geneva, Switzerland: UNAIDS2008
August 2008 Contract No.: 978 92 9 173711 6.
4. Organization WH. WHO Report 2009: Global
Tuberculosis Control Epidemiology,
Strategy, Financing. Geneva, Switzerland: World
Health Organization2009 Contract No.: 978 92 4 156380
2.
5. Organization WH. WHO 2008 World Malaria
Report. Geneva, Switzerland: World Health Organization2008
Contract No.: 978 92 4 156369 7.
6. Nations TU. The Millennium Development Goals
Report 2208. New York, USA: United Nations2008
August 2008 Contract No.: 9789211011739.
7. Chapman S. Public Health Advocacy and
Tobacco Control: Making Smoking History. Oxord:
Blackwell Books; 2007.
These statements are on
the opening page of the
World Health Organization
Report on the
Global Tobacco Epidemic, 2008.
Tobacco use is recognized as
harmful throughout the medical
profession. The links of smoking
with increased incidence of
cardio-vascular disease, peripheral
vascular disease, respiratory
diseases, many cancers, as well as
effects on reproductive health (to
name but a few) have also been
clearly established. Recently, new
data have made clear just how
harmful smoking is in a global
epidemiological sense and the
disproportionate impact it has on
health in developing countries.
Tobacco use currently kills around
5.4 million people every year. To put
this in perspective, in 2005 HIV/AIDS,
TB & Malaria (the diseases targeted
in Millennium Development Goal 6)
killed approximately 4.2 million together
(2-6). Whilst I am aware of the dangers
of impetus splitting, and I would
not for a second want to detract from
the importance of programs combating
these diseases (particularly having had
falciparum malaria myself!), the huge
impact of tobacco related disease cannot
be ignored. It is estimated that smoking
related deaths will rise to as much
as 8 million every year by 2030. These
mortality data are of course not the full
picture and as medical students our own
clinical experience should allow us to extrapolate
the burden of associate morbidities.
We should also pause for thought
as to the resource demands imposed by
smoking in already stretched systems.
Whilst the individual circumstance
is often tragic and coupled with physiological
and psychological addiction,
the reality is that diseases occurring
due to tobacco use are entirely preventable.
Tobacco is the only product on
the planet which if used according to
the manufacturer’s instructions kills
half of the people who use it (7).
The unfortunate reality for those
of us working in global health is that
over 80% of smoking related deaths
are occurring in the developing world
(1). But the burden goes further than
the morbidity, mortality and economic
impact. For the poor, money spent on
tobacco means money not spent on
basic necessities such as food, shelter,
education and health care. In one study
in Bangladesh low-income families
were spending as much as ten times on
tobacco as they were on their children’s
education (1). Given our awareness of
the importance of education in health
and sustainable development, and the
prevalence of extreme poverty, this sort
of study should chill us to the very core.
In Australia, tobacco control is a
public health success story. That our
rates of smoking are so low and rates of
tobacco related disease are dropping is
to be lauded (7). Most other countries
in the world are much worse off than
we are in terms of what they can spend
on tobacco control. Whether we are
interested in it or not, the problems of
tobacco related illness cannot be ignored;
the numbers and impacts are simply too
large. So where and when we can, we
must remember to add tobacco control to
our list of priorities as we try to address
the challenges of equitable and sustainable
health in the developing world.
8 vector november 2009