November is Lung Cancer Awareness month. So what better time to check back on a global health scourge that has slipped from the headlines, but still wreaks havoc worldwide. I’m talking, of course, about cigarette smoking. Although public attention to the issue has slipped, smoking still kills 5 million people a year worldwide, more than twice as many as HIV/AIDS, says psychologist Geoffrey Fong, Ph.D., a senior investigator at the Ontario Institute for Cancer Research in Waterloo, Ontario. As a result, public health advocates have stepped up a worldwide campaign in recent years to snuff out cigarette smoking and save millions of lives.
For decades in the United States, Mad Men puffed away in their offices, crooners crooned in smoky clubs, and the Marlboro Man and Virginia Slims models hooked millions of people on cigarettes. The American public slowly woke up to the mortal dangers of cigarette smoke, and today, thanks to warning labels, cigarette taxes, advertising bans and public-health messages, U.S. smoking rates have fallen dramatically. But in many nations, this public health progress has not been duplicated, and even in the United States, one in five people still smoke and efforts to reduce smoking have stalled.
Smoking harms in a plethora of ways, some well known, some less so. It more than doubles the rate of coronary heart disease and stroke, raises the rate of lung cancer by a factor of 13, and hikes the rate of chronic obstructive pulmonary disease by more than 12-fold, according to the U.S. Centers for Disease Control and Prevention. It’s been clearly linked to infertility, pre-term delivery, still birth and sudden infant death syndrome, and it lowers bone density in older women and leads to more hip fractures, the CDC says.
Smoking also harms indirectly, sometimes in surprising ways. More than 90 million nonsmoking Americans, including more than half of U.S.. children between 3 and 11 are exposed to secondhand smoke, according to the CDC. More surprisingly, smoking has been linked to unemployment. In France, only 20 percent of the overall population smokes, compared to a 50 percent rate of smoking among that nation’s umeployed.
Smoking’s carnage is greatest in lower and middle-income countries, with China among the hardest hit. Some 250 million smokers—one third of the world’s total—live in China, and the Chinese Centers for Disease Control and Prevention reports that smoking is already linked to more than 1 million deaths a year in that nation, according to a report by Xinhua, the government-run news service. More than half of men smoke, and the tobacco industry is pushing for Chinese women to join them, says Andrew Hyland, Ph.D., a research scientist at Roswell Cancer Institute and deputy editor of the journal Tobacco Control. And 75 percent of Chinese smokers have no plan to quit smoking, according to a survey that Fong and his colleagues reported in the October issue of Tobacco Control.
Rates are sky-high in China in part because smoking is socially acceptable there, Hyland says. The Chinese government also has a massive conflict of interest. China Tobacco, the nation’s tobacco producer, is state-owned, and tobacco taxes account for more than 7 percent of the Chinese GDP. “China is where the U.S. was 50 or 60 years ago” with respect to smoking, Hyland says.
To fight smoking, nations joined forces in 2006 to forge the first-ever global health treaty, the World Health Organization Framework Convention on Tobacco Control (FCTC). Today 168 nations have signed on to the FCTC to fight smoking and protect their citizens. (The United States is not among them. “Companies that make money by selling tobacco happen to be housed in the U.S.,” Hyland points out.)
In November the FCTC signatory nations met for a week in Punta del Este, Uruguay, to share tactics and gear up for the antismoking battle, says Fong, who attended the conference. The treaty requires nations to resort to scientifically proven antismoking policies. These include bans on cigarette advertising and promotion, high cigarette taxes, prominent labels on the cigarette pack, with both words and graphic images. The U.S. FDA, which just last year gained the authority to regulate tobacco, has adopted some of those tactics. In November they announced 36 proposed warning labels for cigarette packages, including one with a toe tag on a corpse.
FCTC-mandated policies also include laws mandating smoke-free public places. “As long as the government is diligent and educates people, you can have a highly successful law,” says Fong, who has investigated antismoking efforts worldwide. Sometimes surprisingly effective: In Ireland, Fong recalls, “People said, ‘Oh my goodness, making pubs free will destroy the culture.’” Now 96 percent of Irish pubs are smoke free, slashing damaging exposure to second hand smoke.
With health workers worldwide determined to snuff out smoking, there’s a lot of reason for hope, even in China. The recent survey by Fong’s team found that Chinese support for laws that mandate smoke-free public places squares with levels in countries where smoking levels have been slashed, such as Ireland and France. And the FCTC has made antismoking efforts front and center internationally. “It’s on every country’s agenda,” Fong concludes.
CONNECT THE DOTS:
The Centers for Disease Control and Prevention provides some grisly facts on smoking and secondhand smoke, if you want to know more about how bad for you they are. And you can read more about the WYO’s Framework Convention on Tobacco Control here.
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