The cost of smoking

Remember the story about one of the leaders of the reform movement - Marcelo H. del Pilar, about his last years in Spain when he suffered from extreme poverty, how he would miss his meals and keep himself warm during winter by smoking discarded cigarette butts he picked up in the streets? He suffered from tuberculosis and later died and was buried in a borrowed grave.

Believe it or not, but it is the poorest of the poor who smoke the most.

When you smoke, you don’t feel hungry. Cigarette smoking can dull or even kill your taste buds. Probably, you’ve heard stories about how some people who stopped smoking gained weight because food suddenly tastes better.

 According to a study by the Southeast Asia Tobacco Control Alliance (SEATCA), tobacco use is inextricably linked to poverty and it is the poor and the poorest who tend to consume tobacco the most. 

Also, in many countries, smoking prevalence is much higher among men with low education and in low-income groups, the Tobacco Control Atlas: ASEAN Region study reported.

Unfortunately, in many ways, tobacco and poverty are part of the same vicious cycle in which tobacco worsens poverty. The study pointed out that addiction to nicotine drives smokers to spend a large proportion of their income on tobacco instead of essential needs.

The money spent on tobacco reduces the amount of money available to spend on basic necessities such as food, health care, shelter, and education, it said.

Worse, the economic and societal costs of tobacco-related diseases are staggering and cost billions of dollars worldwide each year.

According to the SEATCA report, most ASEAN governments already spend significant amounts of their budgets for tobacco-related healthcare costs that are many times higher than the revenues gained from tobacco.

SEATCA figures show that in 2011, the Philippines spent P177 billion for the treatment of just four of over 30 tobacco-related diseases. The Department of Health budget for 2011 was P33.3 billion, while tobacco excise tax collections for that year, even with the most optimistic projections, were not even enough to cover the DOH budget shortfall. 

 Just recently, the Philippines hosted the 2nd Asia Harm Reduction Forum which gathered local and international experts from the fields of science, technology, policy and consumer advocacy from across Asia-Pacific as well as Europe and the United States.

Co-organized by Yayasan Pemerhati Kesehatan Publik Indonesia (YPKP - Indonesian Public Health Observer Foundation) and Harm Reduction Alliance of the Philippines (HARAP), the forum aims to promote awareness on the concept of harm reduction and its integration in public health policies in order to help reduce the number of smoking-related illnesses and deaths.  

 Harm reduction has been defined as a set of practical strategies designed to lessen the negative social and physical consequences associated with various human behaviors, both legal and illegal. It includes tobacco harm reduction, a public health strategy aimed at lowering smoking-related health risks to individuals and the wider population.

Observers note that many take for granted the fact that tobacco is the only legal product in the market that kills half of its regular users, along with hundreds of thousands of non-smokers exposed to secondhand tobacco smoke.

Unfortunately, the DOH, which looks to the World Health Organization (WHO) for guidance on tobacco control, remains highly skeptical of reduced-harm products such as e-cigarettes and heated tobacco products, among others.

According to the DOH, there is not enough evidence supporting the safety of e-cigarettes as a harm reduction alternative to tobacco smoking and as an effective smoking cessation aid. It has also expressed concern that e-cigarettes may undermine the motivation for smokers to quit and even serve as a gateway to smoking addiction among Filipino youths.

During the forum, it was observed that the “quit or die” approach that the WHO strongly recommends, which some say is an unethical position, does not work for all smokers so that it should consider reduced-harm products.

They also said that reduced-harm products provide a satisfying and less harmful option for smokers to get their nicotine fix without the harmful tar. E-cigarettes are at least 95 percent less harmful than cigarettes so that switching completely from smoking to vaping provides substantial health benefits. Of the about 16 million Filipino smokers, only a small percentage  want to quit smoking, and an even smaller number will actually stop smoking successfully. Nicotine replacement therapies are very unpopular among smokers because they don’t deliver enough nicotine and don’t provide the rituals associated with smoking which e-cigarettes provide.

It was also noted at the conference that increasing prices of cigarettes have not reduced smoking prevalence in Malaysia and that, instead, there was increased cigarette smuggling. In the United Kingdom, Japan and South Korea where alternative tobacco products are widely available, smoking prevalence rates have dropped sharply. In Singapore and Australia which have banned e-cigarettes, smoking prevalence rates have remained unchanged. There is no evidence supporting concerns that e-cigarettes serve as a gateway to smoking and that global data show that smoking prevalence rates have decreased among youths who use e-cigarettes.

They said tobacco harm reduction must be integrated in public health policies to help reduce smoking-related illnesses and deaths in the country.

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