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March 1998, Volume 48, Issue 3

Editorial

Tobacco

N.A. Jafarey  ( Ziauddin Medical University, Karachi. )

The harmful effects of tobacco on human health are well established, both for those who use it and for those who live or work with smokers (passive or second-hand smoking). The tobacco industiy which for long disputed that tobacco usage had any hamfful effects on health, now accepts that its products are harmful to human health and are a cause of a number of diseases. This however, does not mean that tobacco will soon disappear from the market and the problem of tobacco related diseases is over. Far from it. The economic clout of tobacco is very big. The marketing of tobacco depends on the fact that it is addictive. Once an individual becomes dependant on tobacco he or she finds it very difficult to give up. So it is a very profitable business. The industry is assured a captive clientele who will continue to buy the product at the industries price. The focus of all their advertising is therefore directed to inducing the young to pick up the habit. Once they are hooked they become life time customers. The second force that makes the tobacco industry so powerful is the revenue that the governments derive in different taxes. An idea of the size of these taxes can be made from the fact that during the year 1995-96 the cigarette and tobacco industry in Pakistan have paid Rs.11593.920 million as Central Excise Duty. In USA according to a recent article by Glenn Frankel published in Dawn”,. aside from heavy aviation parts, cigarettes were Americas most successful manufactured export in terms of the net balance of trade, It has been estimated that cigarette exports - largely to Western Europe and Latin America -accounted for 250,000 full timejobs in the United States and contributed more than $4 billion to the positive side of the trade ledger”1. These figures do not reflect the recent drive which has increased sales to Asian countries like Japan, South Korea, Taiwan, Thailand and China. The probable reason why American cigarettes have not been pushed so actively in our market is that Pakistan Tobacco Company is a subsidiary of the British American Tobacco Company.
In Pakistan and the other developing countries with weak anti- tobacco legislation the quantum of tobacco related diseases will increase overthe next decade ortwo. The number of cases of Cancer Lung, chronic obstructive lung disorders, myocardial infarction, all are expected to go up since the sales of cigarettes are increasing. In this issue a series of articles relating to tobacco arc being published. The first is a report on the extent of smoking among the Pakistani population. It is basedonthe NationalHealth Survey done from 1990 to 19942, The habit is about as common as it was in Karachi in early 1970’s3. The secondarticle highlights the cxtentofsmoking in a low income group of Karachi4. While the third by the same group of authors points out how in a low incOme family the money diverted towards the purchase of tobacco undermines the food purchasing capacity of the family5. Thus in low income families the use of tobacco by the head of the family contributes to malnutrition of the whole family particularly growing children and pregnant and lactating mothers.
In Western countries the power of an informed public opinion has made the use of tobacco socially unacceptable. Advertising and promotional activities particularly of sports are banned or are in the process of phasing out. With the wider availability of Nicotine chewing gums and patches ,those who can not quit the tobacco habit have been provided with an acceptable alternative. Nicotine is the major addictive ingredient among the 4000 plus compounds found in tobacco. Nicotine is not carcinogenic and its pharmacological effects are not as damaging as that of the whole tobacco. Thus in the coming years the number of tobacco users in North America and parts of Europe will fall drastically. For us this means a more aggressive push from American cigarette companies. In this part of the world it will take a long time to educate the public to the extent that it can influence the society and the government of the day to take meaningful action against the use of tobacco. Some years back the Ombudsman passed an order banning tobacco advertisements on TV and Radio. The government appealed against the order. At present another case asking for ban of tobacco advertisements is in the courts. Let us all hope it succeeds. The most insidious form of tobacco promotion is that through various sports and cultural events.Both are directed to the young. The ban on promotion of tobacco through sports and their advertisement on mass media is the first step if we want to reduce the number of tobacco related morbidity and mortality in Pakistan.

References

1. Frankel, G.,” US government used clout to pry open Asian markets for tobacco companies’. Dawn, 24th November, 1996.
2. Alam, S.E, PrevaIence and pattern of smoking in Pakistan, J.Pak.Med,Assoc., 1998:48:64-66.
3. Mahmood, Z., Jafarey, NA., Samiuddin. M, et at. J.Pak,Mcd.Assoc., 1974;24:222-2
4 Merchant, AT., Luby, S.P., Perveen, 0. moking among males in a low socioeconomic area of Karachi. J.Pak.Med.Assoc., 1998 ;48:62.63,
5. Merchant, AT, Luby, S.P., Perveen, 0. Smoking in Pakistan: More than cancer and heart disease. J.Pak.Med. Assoc., 48:77-79.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: