Keisha Hill, Gleaner Writer
Six, six, six. Six million people die annually from cigarette smoking, 600,000 of those from passive or second-hand smoke and every six seconds someone dies from some kind of tobacco-related illness.
These are the statistics recorded for 2010 by the World Health Organisation (WHO) that also estimates that by 2030, tobacco-related deaths will total 10 million annually, with 70 per cent of deaths in developing countries.
On July 15, smoking was banned in public spaces across Jamaica and Minister of Health Dr Fenton Ferguson described it as the most far-reaching piece of public-health policy undertaken in recent times.
There were many concerns about the legislation and the applicable fines after Ferguson made the announcement in the House of Representatives in late June. He stated that smoking would be banned in all enclosed places, public transportation, workplaces, government buildings, health facilities, sports, athletics and recreational facilities, educational facilities, areas specifically for use by children, and places of collective use, such as bus stops.
It came as a shock and perhaps as a surprise to many, however, according to Michael Coombs, chief medical officer in the Ministry of Health, the regulations were long in coming as successive administrations tried unrelentingly to enact such a ban. Coombs indicated that if the ban was not imposed at this time, the country would have been in contravention of the WHO Framework Convention on Tobacco Control (FCTC).
"In 2003, 192 members of the 56th WHO Health Assembly unanimously adopted the FCTC aimed at curbing tobacco-related deaths and disease. WHO reports that the convention requires countries to impose restrictions on tobacco advertising, sponsorship and promotion, establish new labelling and clean indoor air controls and strengthen legislation to clamp down on tobacco smuggling," Coombs said.
He indicated that in 2005, through the Ministry of Health, Jamaica became the 74th country to ratify the Convention and the country should have had legislation in place by that year-end to reduce the harmful effects of tobacco use and by working to have stricter control and eventual reduction of tobacco consumption globally.
"The signatories of the FCTC are legally bound by the treaty's provisions. One of the provisions of this legislation is the banning of smoking in public places in order to protect the health of the population from the effects of second-hand tobacco smoke," Coombs said.
The treaty, he said, also has articles which address issues related to tobacco control, such as protection from exposure to tobacco smoke, price and tax measures to reduce the demand for tobacco, non-price measures to reduce the demand for tobacco, packaging and labelling of tobacco products, regulation of the contents of tobacco products, tobacco advertising, promotion and sponsorship, the provision of support for economically viable alternative activities and guidelines on interactions with the tobacco industry.
Statistics indicate that since 1980, the treatment of tobacco-related illnesses has set back Jamaica's health sector by US$4.38 billion. Coombs said cigarette smoking is the single largest preventable factor contributing to the country's burden of disease, disability and death. He said, for example, that the incident rates for lung cancer in Jamaica is five times higher for men than for women. This gender difference in the disease pattern is attributed to the higher prevalence of cigarette smoking among men, which results in more than 90 per cent of lung cancer deaths in men.
"Tobacco has been clearly established from research as a high-risk factor for non-communicable diseases (NCD). These factors are now recognised internationally under the WHO as a global pandemic, where high costs are incurred to governments including developing countries such as ours," Coombs said.
"It has been a real burden on the health sector in terms of the persons who have been diagnosed with these NCDs. All of this has really been a burden on our health services in terms of the costs to treat these persons. So clearly, one cannot avoid the logic of the argument that it is cost effective to reduce the risk of them having these conditions," he added.
Tobacco use research indicates that the population is also at risk for other illnesses such as cardiovascular diseases, emphysema, impotence in men and other vascular conditions. A recent study published in BMC Public Health on the association between smoking and chronic kidney diseases suggests that heavy cigarette smoking increases the risk of chronic kidney diseases overall and particularly for chronic kidney diseases classified as hypertensive nephropathy and diabetic nephropathy.
Data presented showed that tobacco products such as cigarettes eventually kill half of long-term users so about half of those who begin smoking at age 15 may develop lung cancer and other illnesses and die between 35 and 55-years-old. Statistics provided in 2010 by the National Council on Drug Abuse (NCDA) also show that there are nearly 600,000 smokers in Jamaica, of whom nearly 200,000 are women. The survey revealed that 13.4 per cent of students experience the desire to smoke a cigarette first thing in the morning. This level of addiction represents an increase from 3.8 per cent in 2000 and 5.9 per cent in 2006.
According to Ferguson, the essence of the policy is not about banning tobacco or cigarette smoking in public spaces. It is about a broader vision of a Jamaica 2030 that represents the regional hub for health and not just the region, but the Americas. It is also about the fight against non-communicable diseases, including high blood pressure, diabetes and cancer.
"As Jamaicans, we led the discussion at the World Health Assembly last year to get the NCDs to 25 per cent less avoidable deaths by 2025. Jamaica was there putting forward the resolution led by me in Geneva last year. It is part of a wider strategy for a national strategic plan on the NCDs," Ferguson said.
"Let me make it clear that my position is just not an anti-tobacco or anti-smoking position. My position is that of pro-health. As long as we can get our people to understand the dangers; what is happening with our pregnant mothers causing detachment of placenta, low-weight babies, deformed babies. And I keep reminding our people that it can also cause impotence," Ferguson added.
Essential risk factors
According to Ferguson, there are four essential risk factors associated with the NCDs.
"(They are) physical inactivity, improper diet and excessive alcohol, but tobacco use is the worst of all of them. Seven thousand chemical substances in a cigarette, 69 of them are carcinogenic - cancer causing. Nicotine is one of the most dangerous substances on Earth. It is addictive and, therefore, when we talk about smokers, it is not in the context of saying, 'I can just stop smoking'," Ferguson said.
Initially, persons found guilty of violating the law were liable for a fine of $50,000 and/or three months' imprisonment for the first offence. In the case of a second conviction, persons face up to $500,000 in fines and or jail time of six months, or up to 12 months' imprisonment for subsequent offences. However, because of concerns from some interest groups, the Ministry of Health has been reviewing the fines and penalties with Ferguson expected to make an announcement in Parliament in mid to late September.