Tobacco's contribution to poverty not to be underestimated
– Minister Ramsammy
By Melanie Allicock
May 8, 2007
Little attention has been paid to the link between tobacco and poverty, but together they form a vicious cycle which is virtually inescapable.
Health Minister Dr Leslie Ramsammy underscored this point in a recent interview with this newspaper.
Tobacco tends to be consumed by those who are poorer, he noted, and in turn it contributes to poverty by loss of income, loss of productivity, disease and death. “Together, tobacco and poverty form a vicious cycle from which it is hard to escape.”
He pointed out that for the poor, money spent on tobacco is money not spent on basic necessities, such as food, shelter, education and health care.
He added that tobacco also contributes to the poverty of individuals and families, since tobacco users are at a much higher risk of falling ill and dying prematurely of cancers, heart attacks, respiratory diseases or other tobacco-related diseases, thus depriving families of much needed income and imposing additional health care costs.
The minister pointed out that despite recognition that concerted action must be taken to fight against the insidious effect of tobacco use on the health of smokers and those exposed to tobacco smoke, it has been a struggle for agreement to be reached on what actions need to be taken and how rapidly such actions should occur.
Noting that tobacco is a global problem and its ill-health effects have been a pandemic of long standing, he stressed that the main negative impact of tobacco is its addictive nature.
He stated that tobacco dependence is listed in the International Classification of Diseases.
Dr. Ramsammy explained that the instrument for international cooperation in the fight against tobacco is the Framework Convention on Tobacco Control (FCTC) and Guyana has been implementing the provisions of it.
Guyana has acceded to the Framework Convention on Tobacco Control.
This is an instrument of international law under which the world has committed to finally take concrete action to stem the tide of diseases and deaths, which tobacco use has caused worldwide.
The Convention came into force on February 27, 2005.
By ratifying the Convention, Guyana has joined Trinidad and Tobago , Canada , Honduras , Mexico , Panama , Peru , Uruguay and Chile , in the Americas .
The Convention is the first ever health treaty that is binding on countries that have ratified or acceded to it.
It was negotiated under the auspices of the World Health Organisation (WHO).
Dr. Ramsammy noted that tobacco has been an important part of the economy of many countries and the powerful tobacco industry's influence has a negative impact on strategies to reduce smoking.
The Convention represents the first public health treaty and the first coordinated global effort to reduce tobacco use which is the world's leading cause of preventable illnesses and death.
“The fact is that tobacco use is the leading preventable cause of death in the world,” he said. “Together with HIV/AIDS, they represent the two leading causes of preventable deaths that are still on the rise.”
He stated that the links between tobacco use and exposure to tobacco smoke and diseases, deaths and disability are no longer in dispute.
“There is little debate surrounding the health hazards associated with the use of tobacco. There are now almost 100,000 articles that have appeared in scientific journals on the pervasive range of health problems associated with tobacco use. Even the powerful tobacco industry now strongly admits to these linkages.”
The diseases associated with smoking are well documented, the Minister said, adding that it includes cancers of the lungs and other organs, heart diseases as well as circulatory and respiratory diseases such as emphysema.
He pointed out that in areas where tuberculosis is a problem, smokers face a greater risk of dying from tuberculosis than non-smokers.
Dr. Ramsammy cautioned that the ill effects of tobacco are not limited to those who smoke, as exposure to second-hand smoke is equally or even more dangerous.
Scientific evidence now shows clearly that babies born to smoking mothers have lower birth weights, face greater risks of respiratory disease and are more likely to die of Sudden Infant Death Syndrome than babies born to non-smokers.
Dr. Ramsammy is of the view that Guyana can take lessons from those countries that have or are becoming virtually smoke-free.
There are presently eight such countries: Cuba , Bhutan , Ireland , Italy , New Zealand , Norway , Sweden and Uganda .
Several countries have already begun taking tough measures to reduce smoking.
The UK and Northern Ireland have begun to implement policies pertaining to second-hand exposure to smoke in public places.
The Democratic People's Republic of Korea has doubled the price of tobacco products in order to reduce consumption.
Tanzania has banned smoking in public places.
Thailand is implementing aggressive anti-smuggling measures.
Worldwide, 47.5% of men and 10.3% of women smoke.
More than 1.3 billion people worldwide smoke or use tobacco products, with 84% coming from developing countries.
Unless there is a reversal, this number will increase to 1.6 billion by 2020, Dr. Ramsammy said.
“The most discouraging lesson as we look at the world situation is that overall smoking in developed countries has steadily fallen in the last two decades from 2,600 per adult in 1970 to about 2,000 in 1990, but has increased in low and middle-income countries, from 600 to 1,500 in the same period,” he said.
The use of tobacco products has more than doubled in the last two decades in low and middle-income countries.
The Minister noted that the tobacco industry will argue about the contributions to various countries' economies.
But he stated the fact is that the negative health impacts cost countries about $200B annually, according to the WHO.
And studies have shown that reduction of tobacco consumption has led to neutral or positive economic impacts in countries.
A recent World Bank report has shown that increased tax is the most effective way of reducing smoking, and that it also increases revenues in countries.
The report indicated that countries that raised taxes, even to very high levels, were not only able to accomplish reduction in the per capita consumption of cigarettes, but also to maintain or increase collected revenues from tobacco products.
Studies have also demonstrated that smokers are more likely to quit in a social environment that discourages tobacco use.
“Higher prices or tax on tobacco, smoke-free environments and strong warnings on cigarette packages that graphically inform smokers of the risks of smoking all discourage tobacco use,” he said. “Cessation programmes targeted at smokers help, but they do not have a strong impact on their own, without broader policy measures that change the social environment. Education, awareness programmes and provision of information are powerful tools. But we need to also consider where these things happen.”
He asserted that if children learn in school that smoking is harmful but leave the classroom to see cigarette ads in their neighbourhoods, tobacco products on sale on every corner, no restriction on purchases, and homes and public places where people smoke, the messages in the classrooms become lost.
“School and other health promotion programmes on smoking are effective only in an environment that reinforces the non-acceptability of tobacco use.”
Dr. Ramsammy declared that the issue of smuggling is crucial in any consideration of actions to be taken.
Researchers have estimated that some 30% or more than 355 billion cigarettes make their way illegally to consumers on an annual basis.
It is doubtful that any other consumer goods that are internationally traded reach this level of illicit trade, Dr. Ramsammy noted.
“The benefit of controlling smuggling is not principally that it reduces supply, but that it helps the effective implementation of price increases that reduce demand. The tragedy in all of this is that the tobacco industry has benefited from smuggling operations.”
According to the Minister, evidence has been provided to implicate some multinationals themselves in the prompting of smuggling activities.
Since 1997, several court cases and official investigations around the world have charged the tobacco industry with supplying smuggled cigarettes, or alleged industry liability through complicity in smuggling operations.
In 1998, an affiliate of RJ Reynolds International pleaded guilty to charges of helping smugglers to illegally re-route cigarettes into Canada .
Recently, Canada , Colombia , Ecuador , ten European Union countries, Honduras , and Belize filed lawsuits against international tobacco companies for smuggling.
The FCTC offers several possibilities in dealing with smuggling: it requires improved traceability of the goods and places greater responsibility for manufacturers to ensure legal entry into countries. It also dictates that countries must have a system of import and export licensing, and a ban is placed on duty-free sales.