Studies bear out the theory that smoking is the world's deadliest addiction, and that it is spreading like wildfire among developing countries. Gamal Nkrumah reports on why the global anti-smoking campaign must not go up in smoke Click to view caption Studies bear out the theory that smoking is the world's deadliest addiction, and that it is spreading like wildfire among developing countries. Gamal Nkrumah reports on why the global anti-smoking campaign must not go up in smoke Like waking from a long fairy-tale sleep, sweet release from a smoking addiction is, I am told, sublime. But alas, not everyone partakes of that dream divine. "I don't know if I can quit or not. I have done everything possible, spent hundreds of dollars, but always find excuses," an African- American friend from Oakland, California, recently explained. "I lack a certain will power because in the back of my mind, I probably don't really want to quit even though at the same time I do want to quit." My friend, who has been smoking since she was a teenager, says she could not even quit when she had her two daughters -- despite knowing that it could have been a threat to their lives. Today, she suffers from the fatal disease emphysema, a chronic obstructive lung disease characterised by shortness of breath and primarily caused by tobacco smoking. Like all others struggling with addiction, of any kind, she says that it is all a matter of the mind. Her repeated attempts to quit, she says, have all been in vain. Cold turkey, special teas, therapy, hypnosis, nicotine gum, patches and prayer -- all to no avail. "I am at the point now that without the use of an inhaler, I can only walk about half a city block," she laments. Even the global anti-smoking campaign's most strenuous efforts cannot change the most determined chain-smokers' mind overnight. The problem, it seems, is that most smokers are very much in two minds whether or not to quit smoking. They know the side-effects and potential perils of this habit that kills millions and enfeebles many more, but nevertheless, 500 million people around the world continue to light up. The statistics are horrifying. Smoking is the leading cause of death and disability in the world today, claiming more lives than HIV/AIDS, tuberculosis, maternal mortality, motor vehicle accidents, suicide and homicide combined. Stranger still, because to popular imagination, AIDS and TB, road accidents and violent death seem far more dangerous a threat than smoking to humanity. Tobacco, however, causes four million premature deaths, mostly in poor countries -- those that can least afford the health care burden. And the situation, it appears, will only be getting worse. Forecasts point to the dramatic rise in Western tobacco companies targeting as consumers young people in the developing countries of the South. By 2020, the World Health Organisation (WHO) predicts that 84 per cent of all smokers will hail from the world's poorest nations. "The future growth markets for tobacco lie with women in industrialised countries and with young people in developing countries with rapid economic growth," explains Dr Gro Harlem Brundtland, director general of the WHO. According to WHO statistics, 42 per cent of men and 24 per cent of women in industrially- advanced countries, and 48 per cent of men and seven per cent of women in developing countries, are smokers. While the number of smokers in the West is declining, those in the South are significantly on the rise. It is to this end that global efforts aimed at arresting the rapid rise in the increasing incidence of smoking in developing countries are re- doubling. Launched under the auspices of the WHO and its Tobacco Free Initiative (TFI), the World No Tobacco Day falls on 31 May. "Why is it that nicotine replacement products are sold in the pharmacy with a prescription, whereas cigarettes -- the price delivery device of nicotine -- can be bought anywhere over the counter," Brundtland points out. "Why is it that a product which on average kills one out of every two of its consumers is hardly regulated at all," she adds. Something sinister is at work. Scientists have recently found evidence that smokers are at risk of accelerating the destruction of their brain cells. Smoking dampens cognitive performance, and leads to a higher rate of brain cell death. No chain smoker is a hypochondriac, however, and there is no point bombarding heavy smokers with voluminous medical and research statistics that reveal the dangers of smoking, and passive smoking. The disastrous impact of smoking parents on infants -- many of whom are passive smokers -- has been well documented, and is still unfolding. Many pregnant women smokers are unable to quit the habit, even with the full knowledge of the obvious dangers of smoking on the fetus' development. Some women quit smoking for the first three or four months of the pregnancy, generally acknowledged by the medical establishment as the most dangerous period. For most of my life, I regret to say, I have been a passive smoker. I detest smoking, but over the years, many of the people I love and work closely with have been chain smokers, including my wife, her closest friends, and some of mine. Rather philosophically, I have approached the problem with an open mind. Smokers do, after all, have the right to indulge in a habit deemed by many life's most pleasurable. Who is anyone, in essence, to deprive them of their indulgence? It has been a tough conclusion to live comfortably with, however -- the most trying test coming during my wife's pregnancy, and immediately after the birth of our two sons. I found it hard not to suspect that every cough, wheezing chest, and every bout of the flu, was a direct result of my wife's smoking. In most well to do families, where one, or both, of the couple smoke -- and space is not an issue, set aside a room, or balcony, where smoking is permitted. For the kids' sake, restrict smoking solely to that room -- a suggestion I make not as a writer, but as the father of two. It is not, of course, such an easy thing to do for the fast rising number of smokers in poor families, who have little room for their sizable families. They are also burdened by a lack of awareness on the detriments of passive smoking, and are subjected to higher pollution levels in their poorer, high-density residential areas. In these families, statistics show that the head of the family -- in many instances the husband and breadwinner -- feels it is his prerogative to indulge in a little light-up at the end of a day. Little do they realise how much damage they are inflicting on their loved ones' health. To intensify the debate against smoking, money is an issue that comes into play. For families on shoestring budgets, money spent on smoking can become a serious financial burden, a strain on the family and a constant cause of friction between smoking and non- smoking family members in low income groups. In many instances there is a direct correlation between feeding a family and buying an extra packet of cigarettes. And a habit, unfortunately, which youngsters fast pick up: the incidence of smoking among street children has become endemic in developing countries. Passive smoking, too, has emerged as a dangerous killer. It is estimated that at least 100 million passive smokers currently succumb to diseases associated with smoking. A non-smoking colleague at work commented that as a hypertensive passive smoker, she believes her blood pressure soars as she inhales the stifling smoke-choked offices of our very own Al-Ahram Weekly, with no proper ventilation. Perhaps it is simply psychosomatic? Perhaps, of course. But still, non-smokers have a right not to be bothered by smokers or suffer the consequences. And, while we have all heard of chain-smokers who have lived well into their nineties and never suffered a serious illness, we have also known or heard of non-smokers who have fallen victim to lung cancer. For many, smoking is about freedom and self- expression. For others, however, it is a pleasure that became an addiction, and turned into one hard to break. It is that, unfortunately, which becomes every smoker's crutch -- the reason why they cannot quit. For every lost cause, however, there are many success stories. My brother, sister and her husband have all quit smoking in the past couple of years. None have looked back, and they have never been healthier. Increased consumer awareness of the dangers of smoking in the West has reduced the numbers of smokers in most Western nations. In the US, the sale of tobacco fell by two percent on average over the past five years. Still, among ethnic minorities and especially young blacks and Hispanics, the relatively high incidence of smoking has not abated. The tobacco industry is one of the United State's oldest and most profitable businesses with domestic sales alone exceeding $45 billion. Hefty litigation costs, however, are making a dent in the profits. Still, tobacco is big business. Governments, too, profit from the sale of tobacco. It is estimated that the US Treasury, for example, pocketed $120 billion in tobacco taxes over the past decade. In the meantime, US and other Western tobacco firms hope to make up for the decline in Western markets by targeting developing countries of the South. Smoking, like obesity, has become more closely associated with poverty in the West; the Opium of the masses, and something of a status symbol among the poor and deprived. The wealthier and health conscious are quitting smoking in ever-increasing numbers. The poorer, problem- ridden, and more deprived members of society, find sad solace in smoking. In like manner, legal restrictions on smoking in public places in many Western countries have turned smokers into social pariahs. Smoking is now widely seen as an anti-social activity. This is sadly not the case in most developing countries, including Eastern Europe and the countries that make up the former Soviet Union -- where smoking is still considered a glamorous social activity. The gap in the perceptions of smoking and smokers between rich and poor, developed and underdeveloped countries, is fast widening. In the West, the forces of law and economics have come into full play. A series of prohibitively expensive lawsuits against tobacco companies in the US have badly bruised the tobacco industry there, even though tobacco farmers still enjoy a return per acre of $1,000 -- substantially higher than any other crop. Ingeniously, Western pharmaceutical companies have profited from the anti-smoking campaign in the West, and unscrupulously apply double standards in their marketing policies. The pharmaceutical giant multinational GlaxoSmithKline, for example, authorised the sale of the controversial anti-smoking drug Zyban in India and other developing countries. Dumping Zyban, banned in the US and Europe, and other dangerous anti-smoking drugs on poor and unsuspecting countries is yet another means of recouping lost revenue by the tobacco and pharmaceutical industries. Smoking is a choice, and its hazards, in effect, are choices too. And while the tobacco debate will never end, and the double standards will always be applied, I still believe there is something we can do; if not for ourselves, than at least for the people we love. Related stories: Tobacco, exposed 14 - 20 June 2001 Shrouded in smoke 25 February - 3 March 1999
