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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

The global tobacco epidemic

We’ve posted a fantastic article today from some students at Cardiff University on how homeless people are treated by the healthcare system. Among other things they highlight how important it is for future healthcare professionals to be aware of the needs of this group. Also, as it’s Friday, we’ve got our new Lancet digest summarising the issue released today. In the blog today we mention some of the recent developments in public health policy on smoking and tobacco use. Finally, it’s the start of the Medsin conference tomorrow so look out for more on that, including the winning articles, over the weekend…   

china2.jpg Photo courtesy of the Lancet

It’s an issue that is drummed into most of us so consistently it is almost painfully obvious – smoking is bad for you. But despite this and numerous public health campaigns, the fact remains that millions of people around the world use tobacco, in part due to low prices in many countries, lack of awareness of the risks and aggressive marketing. A WHO report on the global tobacco epidemic, released earlier this year, estimates that 1 in 10 adult deaths worldwide are due to tobacco. In the 20th century, 100 million people died from using tobacco and WHO extrapolate that this could rise to the calamitous figure of 1 billion in the 21st century if the issue is left unchecked. While tobacco use has been falling in many countries (for instance in the UK after the smoking ban) it remains high in others. In China 60% of men smoke, though interesting only 3% of women do, highlighting the involvement of cultural factors in the epidemic. As a worldwide trend, women in general are less likely to smoke. In a bid to tackle tobacco use there have been a few recent, interesting developments in legislation and policy which we would like to highlight. 

A conference gathered this week under the auspices of WHO in Geneva to discuss the issue of cigarette smuggling. The provision of illegal cigarettes at many times below the normal retail price can have a large impact on tobacco use. An article in the British Medical Journal earlier this month highlighted why it is so important to tackle tobacco smuggling from a public health perspective and this was reported in the news as smuggling causing over 4,000 extra smoking-related deaths per year in the UK.

In the US this week, federal advisors called for smokers aged 19-64 to be given the pneumococcal vaccine (against Streptococcus pneumoniae). The vaccine is usually only given to small children and the over-65s but smokers are known to be at a much higher risk than other adults (in fact half of all otherwise healthy adults with severe pneumococcal infections are smokers). If this is approved by the Center for Disease Control and Prevention, it will be the first smoker-orientated vaccination program, adding another level to the debate over how smokers should be handled by health systems. In further changes to tobacco legislation, a bill was passed by the House of Representatives in July to bring the tobacco industry under the control of the FDA and was praised by an editorial in the New England Journal of Medicine for being an important step towards tighter regulation.

Reducing tobacco consumption in low- and middle-income countries as well is a great challenge. In a few decades around 80% of smoking related deaths will be in developing countries and only 5% of the world’s countries (mainly richer ones) protect their populations from the harmful effects of tobacco through effective legislation, such as indoor smoking bans or taxation strategies (facts from WHO). The WHO report mentioned previously advocates a strategy based on MPOWER; Monitoring tobacco use and prevention (for instance there is almost no data on patterns of tobacco use in 2 out of 3 low-income countries); Protecting people from tobacco smoke (particularly children); Offering help to quit; Warning people of the dangers; Enforcing bans on tobacco advertising and sponsorship and Raising taxes on tobacco. These are laudable aims but require governments to put in place aggressive public health policies and reduce the influence of large tobacco companies – no easy task but one which will have big implications for global health.


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