HEALTH . WHO raises a smoke alarm

* Across the world, according to the World Health Organization (WHO), around 780 million people say they want to quit using tobacco, but only 30 per cent have access to tools that can help them do so

* The campaign seeks to develop a suitable environment by advocating strong smoking cessation policies, promoting awareness on various tactics implemented by tobacco industries (such as organising campaigns and engaging lobbyists to effect policy), and encouraging tobacco users to quit

* Health concerns triggered by the Covid-19 pandemic have led more people to opt for healthier lifestyles. It has been observed in on-going studies that the intention to quit tobacco has increased manifold

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The joke is an old one but always draws a laugh. “It’s easy to give up smoking,” says the wag. “I have done it so many times.” Those addicted to tobacco will know what that means: It is anything but easy to kick the habit.

Take the case of Anish Das (name changed), 42, an executive at a jewellery store in Kolkata, who wanted to give up smoking after he developed a minor heart problem in 2015. But despite repeated attempts to quit, he couldn’t. He just wasn’t motivated or determined enough, he says.

“Thinking is easy, but actually giving up tobacco needs support which I did not have,” says Das, who finally quit the habit in 2016.

Across the world, according to the World Health Organization (WHO), around 780 million people say they want to quit tobacco, but only 30 per cent have access to tools that can help them do so.

The global health body recently launched a campaign to help people stop using tobacco. It has engaged the community of those who have given up the habit in a campaign called Commit to Quit, launched on December 8, 2020.

“[In this campaign] WHO, together with partners, will create and build up digital communities where people can find the social support they need to quit. The focus will be on high burden countries [among others India, Bangladesh, Nigeria, Germany, Brazil, Russia and US] where the majority of the world’s tobacco users live,” the global body said in a statement.

Health experts have linked the habit of tobacco use to serious health problems. In India, as WHO points out, the use of tobacco (bidi, cigarette, zarda, khaini , gutkha and so on) is a major risk factor for cancer, lung disorders, cardiovascular ailments and stroke, and it leads to an annual death of 1.35 million people. About 267 million Indian adults use tobacco, according to a 2016-17 survey cited by WHO.

Quitting the habit, WHO emphasises, benefits an individual almost immediately. “After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within 2-12 weeks, your circulation improves and lung function increases. Within 1-9 months, coughing and shortness of breath decrease,” it says.

The campaign seeks to develop an environment suitable for quitting tobacco by advocating strong smoking cessation policies, promoting awareness on various tactics implemented by tobacco industries (such as organising campaigns and engaging lobbyists to effect policy), and encouraging tobacco users to quit. They are urged to avoid triggers such as parties or bars or stress-related issues.

“WHO calls on all governments to ensure their citizens have access to brief advice, toll-free quit lines, mobile and digital cessation services, nicotine replacement therapies and other tools that are proven to help people quit,” the global body says.

In a publication — More than 100 reasons to quit tobacco — released with the launch of the campaign, WHO also highlighted the hazards related to second-hand or passive smoking, and how it affects children in particular. Annually more than 1 million people die due to the exposure to second-hand smoke, says WHO. In children, second-hand smoke can lead to asthma and other respiratory diseases and ear infections.

Agnimita Giri Sarkar, paediatrician, Institute of Child Health, Kolkata, agrees that second-hand smoke makes children vulnerable to respiratory illnesses leading to increased mortality and morbidity. More important, she says, it leads them to start active smoking at an early age. “This is most commonly seen in adolescents and older children who imitate smoking as a mark of adulthood and glamour,” she stresses.

Health workers and those in self-help groups who work closely with families, especially in suburbs and villages, should be trained to spread messages on the adverse effects of smoke and school syllabi should cover the issue, too. “Children should learn how to say ‘NO’ to parents who smoke,” she adds.

Medics who deal with cancer patients in India have welcomed the Commit to Quit campaign. Shantanu Panja, ENT and head and neck cancer surgeon, Apollo Gleneagles Hospital, Kolkata, recommends that anti-tobacco support groups be created in Indian localities, spearheaded by people who have left tobacco successfully.

“The popular culture of glorifying icons using tobacco needs to be stopped and a culture of tobacco being ‘uncool’ needs to be propagated among the common masses. All this can happen with the collaboration of WHO,” he holds.

Anoop Narayanan V, assistant professor, NGSM Institute of Pharmaceutical Sciences, Mangaluru, advocates the use of the internet for an anti-tobacco campaign. “Since digital literacy is growing in [this country], after Covid-19 lockdowns, the attempts will be fruitful in achieving better outcomes than earlier,” he says. He adds that smokers should have more access to cessation centres, and such units should be spread across the country, especially in rural areas.

Health concerns triggered by the Covid-19 pandemic have led more people to opt for healthier lifestyles. It has been observed in on-going studies that the intention to quit tobacco has increased manifold, supplemented by government initiatives and public appeals on quitting tobacco and banning spitting in public spaces by the Indian Council of Medical Research (ICMR), says Shalini Singh, director, ICMR–National Institute of Cancer Prevention and Research (NICPR), Noida.

Clearly, quitting tobacco should not be an individual effort — as it was in the case of Kolkata resident Das — but a community one for it to succeed. Prashant K Singh, scientist, ICMR-NICPR, Noida, points out that community participation in tobacco cessation activities is crucial, as tobacco users will be more likely to engage in cessation programmes that are culturally-tailored and attuned to the needs of a community.

“The campaign may prove fruitful in reducing the stigma associated with tobacco use to enable users to seek help and social support vital in successful tobacco cessation,” he adds.

Das — and his father before him — would have benefited from a community campaign. Das quit the habit, but at a considerable cost. He finally gave up smoking after his father, a heavy smoker, died of lung cancer.

“After my father’s death, I have not had a single cigarette,” he says.

Sanjeet Bagcchi is a physician and independent writer based in Kolkata