Jaqueline
Issa
S trategies proposed by the W ord H ealth
O rganization for the com bat of sm oking
Servifo de Prevenfiio
do Instituto do Corafiio do Hospital
das CUnicas da Faculdade de Medicina da USP
1 . W o rld S c e n a rio :
S m o k in g is p re se n tly c o n sid e re d th e g re a te st a v o id a b le
risk fa c to r in th e p re v e n tio n o f d ise a se s. It is n o t a n a tu ra l
fa c to r lik e a v iru s o r a b a c te ria o r e v e n a fa c to r b ro u g h t a b o u t
b y a n a tu ra l c a ta stro p h e ; it is p ro d u c e d b y m a n . D e sp ite a lI
th e e v id e n c e o f th e h e a lth h a z a rd s c a u se d b y sm o k in g , its
e x iste n c e is p e rp e tu a te d b e c a u se o f stro n g e c o n o m ic in te
r-e sts.
T h e p re v a le n c e o f sm o k in g is v e ry h ig h in th e w o rld . It
re a c h e s 5 0 % o f th e a d u lt m a le p o p u la tio n . T h is p e rc e n ta g e is
fre q u e n tly se e n in d e v e lo p in g c o u n trie s, b u t it is a lso v e ry
h ig h in d e v e lo p e d c o u n trie s, w h e re it re a c h e s 4 1 % . In th e
fe m a le p o p u la tio n , th e situ a tio n is re v e rse d . A p p ro x im a te ly
o n ly 8 % o f th e w o m e n sm o k e in d e v e lo p in g c o u n try , w h e re a s
2 1 % o f th e m d o in d e v e lo p e d c o u n trie s.
T a b le I sh o w s th e p re v a le n c e o f sm o k in g in th e g e n e ra l
p o p u la tio n a n d a m o n g p h y sic ia n s in c e rta in c o u n trie s. E v e n
in c o u n trie s c o n sid e re d d e v e lo p e d , th e p re v a le n c e o f sm o k
-in g is h ig h in b o th th e g e n e ra l p o p u la tio n a s w e ll a s a m o n g
p h y sic ia n s. T h is c le a rly sh o w s th e w id e so c ia l a c c e p ta n c e o f
to b a c c o a s a d ru g . T h is a c c e p ta n c e is p ro p O ltio n a l to th e d e
-g re e o f a d v e rtisin -g c a m p a ig n s fa v o ra b le to c ig a re tte sm o k
-in g .
N o w a d a y s, d u e to m e a su re s a d o p te d in d e v e lo p e d c o u n
-trie s a im e d a t re stra in in g c ig a re tte a d v e rtisin g , to b a c c o c o m
-p a n y a d v e rtisin g in te re st h a s sh ifte d to L a tin A m e ric a , E a
st-e rn E u ro p st-e a n d A sia (C h in a ). W h e re a s to b a c c o c o n su m p tio n
d e c lin e d 1 3 % fro m 1 9 8 5 to 1 9 9 2 in d e v e lo p e d c o u n trie s, it
in c re a se d 2 0 % in C h in a .T h is m e a n s th a t fo r e a c h c ig a re tte
n o t lig h te d in d e v e lo p e d c o u n trie s, th re e w e re lig h te d in C h in a .
A n n u a l c ig a re tte c o n su m p tio n in th e 1 9 8 0 s d e c lin e d
2 ,8 0 0 c ig a re tte s/p e rso n /y e a r to 2 ,4 0 0 c ig a re tte s/p e rso n /y e a r
in th e d e v e lo p e d c o u n trie s, w h e re a s in d e v e lo p in g c o u n trie s
it ju m p e d fro m 1 ,1 5 0 c ig a re tte s/p e rso n /y e a r to 1 ,4 0 0 c ig a
-re tte s/p e rso n /y e a r in th e sa m e tim e p e rio d . .
2 . R e a s o n s fo r th e a d o p tio n o f m e a s u re s re s tric tin g
to b a c c o :
T h e W H O e stim a te s th a t th e re a re p re se n tly 1 .1 b ilIio n
sm o k e rs. W h e n o n e c o n sid e rs th a t 5 0 % o f th e m d ie a s a re
-su lt o f sm o k in g , it is e x p e c te d th a t 5 0 0 m illio n p e o p le d ie
b e c a u se o f to b a c c o . H a lf o f th e se d e a th s a re m id d le a g e in d
i-v id u a ls, w h ic h m e a n s a life e x p e c ta n c y re d u c tio n o f 2 0 to 2 5
y e a rs. P re se n tly , c ig a re tte sm o k in g is re sp o n sib le fo r 2 0 % o f
a lI d e a th s. It k ills 3 m ilIio n p e o p le e v e ry y e a r w o rld w id e . If
th e tre n d o f in c re a sin g c ig a re tte c o n su m p tio n p e rsists in th e
d e v e lo p in g c o u n trie s, 7 m illio n p e o p le p e r y e a r a re e x p e c te d
to d ie fro m sm o k in g in th e n e x t tw o d e c a d e s.
B . E c o n o m ic fe a tu re s
T h e se e a rly d e a th s a s w e ll a s th e h ig h m o rb id ity a sso c
i-a te d w ith c ig i-a re tte sm o k in g re su lt in h ig h e r c o sts fo r th e p u b
-lic h e a lth sy ste m o f a n y c o u n try , b e it ric h o r p o o r.
A c c o rd in g to H . B a rn u m , a W o rld B a n k e c o n o m ist, to
-b a c c o is c o n sid e re d th e g re a te st w a ste o f fin a n c ia l re so u rc e s
in th e w o rld ( I). In h is stu d y , B a rn u m d e te rm in e d th a t fo r a n
in c re a se in 1 0 0 to n s o f to b a c c o c o n su m e d p e r y e a r, a n a d d
i-tio n a l 6 5 0 d e a th s p e r y e a r w o u ld m e a n g e n e ra tin g lo sse s in
th e e x c e ss o f U .S . $ 2 7 .2 m illio n .
U .S . $ 2 0 0 b illio n a re lo st w o rld w id e o n a n a n n u a l b a sis
a s a re su lt o f sm o k in g -re la te d m o rb id ity a n d m o rta lity .
M a n u fa c tu rin g a c ig a re tte is g o o d b u sin e ss fo r to b a c c o
c o m p a n ie s. O n e k ilo g ra m o f to b a c c o is b o u g h t fro m th e to
-b a c c o g ro w e r fo r U .S . $ 1 .6 5 . A fte r th e d ry in g p ro c e ss, th e
sa m e k ilo g ra m w ilI c o st U .S . $ 3 .0 0 a n d it w ill b e e n o u g h to
m a k e 1 ,2 0 0 c ig a re tte s. C o n sid e rin g th a t m a n u fa c tu rin g is e n
-tire ly a u to m a te d a n d th a t th e p ro d u c t h a s a lo n g life , it is c le a r
th a t m a n u fa c tu rin g c o sts a re v e ry lo w . A d d itio n a lIy , th e re is
