Some smoke it to ‘relieve stress’, but for others it’s already a habit or quite dangerously a norm. Had it been a useful drug, it would have cured millions of people. But it’s a killer that takes your life before you become aware of the fact that it’s too late. Cigarettes, the only legalized product, that kills people when used in the way it’s supposed to be, continues to cause more harm to the society. As a result of being backed by a powerful industry, bringing down the consumption of tobacco is still a challenge faced by the authorities. Given that this is a country that appreciates and promotes healthy living, smoking now stands as a movable barrier, thanks to proper interventions. May 31 marks World No Tobacco Day and it will be celebrated this year under the theme ‘Tobacco and Heart Disease’. In view of this special event, several programmes have been organized to spearhead a mission and help people to quit this habit.
Progress in Sri Lanka
According to National Authority on Tobacco and Alcohol (NATA) Chairman Dr.Palitha Abeykoon the main focus has been on the work with regard to preventing the harm from tobacco use in general; more particularly from cigarettes and some forms of smokeless tobacco. “On the whole, considering what we said 15 years ago, Sri Lanka has been reasonably successful in reducing tobacco use when compared to several other countries within the Southeast Asian region,” he said in an interview with the Daily Mirror. “We have been successful, both in terms of reducing the prevalence with cigarettes as well as getting some of the legislation that is required to control the tobacco epidemic in place. The global work that has continued in the tobacco control field and working within an organized legal framework began only after implementing what is now called the Framework Convention on Tobacco Control (FCTC).
This was in 2003 and Sri Lanka was the first to sign it in our region apart form being the fourth to ratify it. The NATA was established by Parliament in 2006, but commenced functioning as an institution in 2007. During Professor Carlo Fonseka’s time, when he was a Government Servant, much legislation, such as a ban on advertisements promoting tobacco products and other approaches, were introduced. Since then we have been able to monitor the consumption of tobacco and brought down the prevalence of regular cigarette use to about 14-15% through small and larger scale surveys such as STEPs carried out by the World Health Organisation (WHO). This is a significant achievement when compared to Bhutan, where the sale and production of cigarettes are totally banned but tobacco products are smuggled in to the country. But our target is to bring down the prevalence of cigarettes use to below 10%, which means we will be considered as a country where tobacco isn’t a public health problem according to the guidelines of WHO. It’s still a problem, but it hasn’t become an epidemic. In this regard, during the past few years, we have been able to enact legislation on various features such as advertising, pictorial warnings, sales to minors, promotions and smokeless and illicit tobacco. The FCTC has 14 different provisions where legislative enactment is possible which is fairly good,” said Dr.Abeykoon.
This year’s theme for the World No Tobacco Day is ‘Tobacco and Heart Disease’ and it’s appropriate for us because of the 25,000 deaths that take place in Sri Lanka due to direct or indirect use of tobacco
The heart: The most valuable organ
The picture painted about the tobacco industry is extremely attractive to the point where even the Government believes that it generates more income and is profitable. “Tobacco consumption taxes the budget due to the rise in public health cost and loss of productivity,” Dr.Abeykoon continued. “People would feel ill and with absenteeism, early mortality and hardships faced by the family, the economic and social costs are tremendous. Now we have solid evidence and several other developed countries such as Australia and Brazil have done research. The tobacco companies make profit and not the Government. This year’s theme for the World No Tobacco Day is ‘Tobacco and Heart Disease’ and it’s appropriate for us because of the 25,000 deaths that take place in Sri Lanka due to direct or indirect use of tobacco. Almost 20% of these deaths are caused by some sort of cardiovascular problem. The heart includes the heart itself and conditions such as stroke and peripheral vascular diseases are caused by hypertension etc. These diseases are complex and we must not forget the fact that tobacco is a harmful product which affects all organs. The heart in Sinhalese is termed ‘hardhawasthuwa’ which is literally described as a treasure within the body and there is no other organ sharing the same etymology. Therefore it’s the most valuable organ in the body. If tobacco is affecting the heart and if 20% of the people are affected by tobacco I think it’s something that we need to take seriously. We have gotten together with the College of Cardiologists, Paediatricians, GMOA, Police and several other organisations to initiate a couple of programmes,” he said.
Speaking further, the doctor said that surprisingly there are 50 towns in Sri Lanka which don’t sell cigarettes. “It’s quite a remarkable outcome because once people realize the harm caused by this product, which even affects the baby in a mother’s womb if you are with a husband who smokes, people realize the consequences. If you look at the increasing number of cancers in the country it’s evident that a mutation exists somewhere and the carcinogens in tobacco are the main causes behind the indirect inhalation of tobacco. Even the cultivation and disposal of tobacco adds to this problem. There is no other product which kills you once you use it the way the manufacturer asks you to use it,”he affirmed.
Myth yet to be busted
In many encounters people relate how smoking relieves stress. But in reality, it doesn’t relieve any stress. According to Dr.Abeykoon smoking relieving stress is a myth. “It’s a message promoted in terms of marketing the product,” he added. “Smoking gets you addicted to it and the stress part vanishes. There’s peer pressure and other devious means of promoting the product, but this happens through the subtle communication among the tobacco companies. In reality, tobacco increases your stress by increasing your heart rate etc. Once you start smoking there’s a chemical change where the nucleus in the brain gets activated and gives a pleasurable sensation which is the same in the case of ingesting heroin and other drugs as well. Ultimately the brain will start demanding that it needs to be stimulated. Breaking it isn’t difficult and it needs a little will and help. There are many ways in which we could help people to drop this harmful habit. Back in the late ‘60s and ‘70s practically every male student used to smoke because people didn’t know the consequences of smoking then, not forgetting that it was a fashionable affair. During the past 20 years the Sri Lankan society fell prey to this habit, but we now realize that children in schools don’t smoke that much. During the past five or six years we did two Global Youth Tobacco Surveys for the benefit of school of children between ages 14 and 17 which has brought down smoking from 4%-2% between 2011 and 2016. This is indeed a good sign,” he said.
The numbers game
“In order to prompt people to buy cigarettes the companies would go to any extent,” Dr.Abeykoon warned. “They even increase the price like how it happened recently. Taxation was one of the lowest till 2016 and while the other countries were able to maintain it at a level that helped increase per capita income and inflation, the Sri Lankan tobacco companies were successful in getting the Finance Ministry officials to not believe in it. A cigarette was very much cheaper until the tax increase in 2016 compared to 2000. In 2000, with the average per capita income of a person which was around USD 800, one could buy around 8900 cigarettes. In 2015 when we knew that tobacco should be curtailed we could buy 10,500 cigarettes. Therefore although the price of the cigarette gradually increased it did keep up with the income of the people and the disposable income of the population. Therefore cigarettes actually became cheaper. The 2016 taxation measure brought it on par with the 2000 level. The only product that didn’t have a Value Added Tax (VAT) was tobacco. Your child’s food, the bread you eat and everything else had a VAT, but they managed to take it away from tobacco. We should be able to eliminate the consumption of cigarettes and not consider it as a public health problem in another 10 years, but it looks like this might be too late. This means that 250,000 people have died unnecessarily and we need to bring down the consumption of tobacco products immediately,” he warned.
Guarantee of harm versus warranty of rescue
He further said that tobacco is a good crop to grow from an economic standpoint since it’s controlled tightly by the tobacco companies. “They give loans, technical advice and fertiliser and there is a total by-back guarantee, so no one would want to move away from it,” added Dr.Abeykoon. “Farmers are willing to invest in alternative crops provided that they receive an equal income. But because children in schools learn about the harmful effects of smoking, adults are trying to refrain from smoking. But 960 hectares of tobacco farms were taken out and this is a good start. In time to come we hope that 10-15% of lands will not be used for tobacco farming. It’s easy to start treatment on chain smokers once they develop a chest pain. While people would deny facts regarding the harm caused through smoking, they also feel the pressure applied by their close associates as well. But given a choice they would want to kick this habit. One-on-one approaches are one of the most effective ways of helping a person to quit smoking. If you write down the amount of money spent on cigarettes in comparison to the money you need to purchase an essential item for your house, the former clearly is a useless ‘investment’. People should have the desire to stop the consumption of tobacco and it’s important to create this desire,” he said.
In conclusion, Dr. Abeykoon stressed on the importance of committing people to make May 31 a No Tobacco Day in the literal sense of the word. This means not to smoke or chew tobacco and most importantly not to sell these products. Although it’s a legitimate product, a humble appeal is being made from sellers to refrain from selling tobacco on this day.
(If you still don’t have the determination and courage to quit your habits, simply dial the quitline 1948 for expert assistance)