Against smoking, also harm reduction is useful

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Smoking kills one person every six seconds and today it is under all respects one of the worst epidemic ever faced globally. The World Health Organisation estimated that almost 6 million people lose their lives each year due to damage from smoking. Among the victims, more than 600,000 are non-smokers exposed to passive smoking. By 2030 total deaths could increase to nearly 8 million per year and if the trend continues, which is what can be inferred from projections, in the twenty-first century smoking will have caused up to one billion deaths, especially hitting low and middle income countries, which already today account for 80% of smokers worldwide. They are, in fact, those who keep tobacco consumption up, despite in most western and high-income countries the smoking habit is declining.

These numbers are alarming; they were updated at the Global No Tobacco Day, celebrated on 31 May focusing, this year, on industry interference: an interesting topic to which we also paid attention at the 79th international convention of the Tobacco Merchants Association, which was held in Williamsburg, Virginia, from 20 to 22 May. It looks like a provocation, but it is not at all. While, on the one hand, the distance between tobacco producers and distributors and those who defend public health is natural and essential, on the other hand it is now clear that the fight against smoking cannot be won by simply raising additional barricades. As it is the case for another serious disease, obesity, also with smoking it is necessary to keep communication and consultation open with all the parties involved, including the industry, even more so in times such as these when new products are launched on the market, very popular but little known and totally unregulated. We are talking about the electronic cigarettes, for example: devices with rechargeable batteries that allow you to inhale the vapour of a solution that can, but not necessarily does, contain also nicotine. The look, gestures and feeling experienced during inhalation are similar to those typical of traditional cigarettes. As there is no combustion, however, the carcinogenic risk disappears.

Deadly ingredients

Not everyone knows, in fact, that it is the combustion and not the tobacco or nicotine, that are the main cause of cancer in smokers. For this reason in technical jargon a distinction is made between ingredients used for the manufacture of tobacco products and the constituents, namely chemicals released from combustion. It is the latter that are most harmful to health. To date over 5,000 have been identified, 70 of which are extremely dangerous. Examples of chemicals emitted by cigarette smoking, which were found to be carcinogenic, include among others, chromium, selenium, arsenic, nickel, lead, cadmium and many others. At present, however, some countries, including all the Member States of the European Union, require the measurement and maximum content levels for only three substances: nicotine (<1 mg / cigarette), carbon monoxide (<10mg/ cigarette), tar (<10 mg / cigarette).

Would an uncompromising approach make sense?

The road to full, detailed and accurate information to the consumer is still a long one and consumers all too often do not know exactly what they are inhaling when smoking. Not to mention the scarcity of reliable scientific information endorsed by public health agencies on new products that promise a reduced risk compared to that generated by combustion. Beyond electronic cigarettes, more and more popular and also for this reason a source of great controversy, it is appropriate to mention the Snus, moist tobacco powder for oral use, authorized in Sweden, where it almost supplanted cigarette consumption.

Scientific research has shown that the degree of risk associated with the use of electronic cigarettes and the Snus is much lower than that derived from cigarette combustion, but there is still a widespread mistrust towards the new products, and therefore the majority of governments are held back from legalizing their sale. Most of all, there is a reluctance to use these new devices as supportive therapy for people wishing to quit smoking. There are in fact two strategies to fight tobacco consumption: on the one hand the so-called quit-or-die which focuses exclusively on giving up and abstinence, on the other hand the approach that also envisages the use of modified risk products, aimed especially at those smokers who can not break the addiction to nicotine.

Notwithstanding that the main effort should be in any case the information targeted to discourage smoking initiation, as from primary school, we wonder whether a hardline approach would really make sense, . an approach that refuses to offer alternatives of proved reduced damage.

Taxes hurt smoking

Another critical subject: governments continue to allocate limited resources to control activities on tobacco consumption. Through the excise duty, they globally collect about 133 billion dollars but invest less than one, a discrepancy which is highest in low income countries. The income derived from taxes on tobacco is on average 154 times higher than the amount invested in control policies. In Italy in 2006, 95,829 tons of tobacco were consumed resulting in tax revenues of 9.7 billion euros. Taxes remain a very strong deterrent against tobacco consumption, especially among the young and the elderly. It is estimated that a 10% increase in the price of tobacco decreases consumption by about 4% in high-income countries and 8% in low-middle income countries.

Therefore it is the figures and data obtained from scientific studies that show us the right way forward: targeted campaigns since early school age, supportive care guaranteed by the national Health Service for those who intend to quit smoking, more detailed and transparent information on marketed products, increased taxation.

SMOKING IN ITALY (Source: Istat)

In 2010, 20% of the adult female population and 24% of the adult male population smoked, for a total of € 11 million. Among young people aged from 15 years, about 20% smoke at least once a week.The victims from smoking are 70,000 a year, 15% of total deaths recorded. For the treatment of patients suffering from diseases attributable to smoking:
- Hospital spending amounts to about 3.4 billion  (3,5 expenditure in 2005)
- total health expenditure is more than 7.5 billion (7.8% expenditure in 2005) 


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