The tobacco epidemic is one of the biggest public health threats globally, being responsible for more than seven million deaths a year. More than six million of these deaths are the result of direct tobacco use, while around 890,000 are the result of non-smokers being exposed to passive smoking.
Every year, on May 31, the World Health Organisation marks World No Tobacco Day – to emphasise the health risks associated with tobacco use and to continue to advocate for effective policies to reduce tobacco consumption globally.
The focus of this year’s World No Tobacco Day is ‘Tobacco and heart disease’. The campaign will increase awareness on the known link between tobacco and heart and other cardiovascular diseases such as stroke. These are the world’s leading causes of death. The aim is for more action to be taken at all levels to protect public health and support people who smoke while protecting those who do not.
Strong evidence shows that tobacco use is an important risk factor in the development of coronary heart disease, stroke and peripheral vascular disease. Priority is given to this risk, as cardiovascular diseases kill more people than any other cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12 per cent of all heart disease deaths. Tobacco use is the second leading cause of cardiovascular disease, after high blood pressure.
Protection of people who do not smoke is crucial. Smoke-free laws protect the health of non-smokers. Indeed, passive smoking happens when people burn tobacco products and smoke fills the air. There are over 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.
The tobacco epidemic is responsible for more than seven million deaths a year
Smokers should not smoke in closed places or next to other people, as there is no safe level of exposure to passive smoke. In adults, passive smoking 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. Children are particularly affected.
WHO’s director general Tedros Adhanom Ghebreyesus said “most people know that using tobacco causes cancer and lung disease but many aren’t aware that tobacco also causes heart disease and stroke – the world’s leading killers – and on this World No Tobacco Day WHO is drawing attention to the fact that tobacco doesn’t just cause cancer, it quite literally breaks hearts”.
A combination of initiatives in Malta has led to an overall decrease in daily adult smoking over the years, with a prevalence rate of 26.1 per cent in 2002, 25.2 per cent in 2008 and to 18.9 per cent in 2015. But over time there has been a small increase in occasional smokers, which needs to be tackled as this may lead to daily smoking.
The European Survey Project on Alcohol and other Drugs (ESPAD) monitors smoking in 15- to 16-year-olds. The percentage of students who said they smoked in the last 30 days decreased over time, from a rate of 23 per cent in 2011 to 15 per cent in 2015.
The Health Behaviour study in school children showed that an average of 8.85 per cent of children aged 15 smoked at least once a week in 2010. This increased to 11.5 per cent in 2014. Smoking rates in 11- and 13-year-olds decreased over time. Smoking induces a high burden on the population, including morbidity and mortality. In 2016 it was estimated that the total number of deaths attributable to tobacco use was 417, which equates to 13.2 per cent of all deaths.
The World Health Organisation has published guidelines of the most cost-effective ways for countries to control tobacco. These strategies include banning of advertising, promotion and sponsorship of tobacco products; raising excise tobacco tax; banning smoking in public places, on public transport and at workplaces; including health messages/warnings on tobacco products; and effective mass media campaigns that educate the public about the harmful effects of smoking/tobacco use and second-hand smoke. Some countries have also implemented plain/standardised packaging.
Individual strategies to encourage smokers to quit the habit are also effective, and many countries, including Malta, support smokers to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed.
The programme offered in Malta by the Health Promotion and Disease Prevention Directorate has been evaluated and is shown to have supported many smokers to quit and to keep it up. The local tobacco quit line is 8007 3333.
Dr Charmaine Gauci is Superintendent of Public Health.