SDG 3
Good Health and Well-Being
Tobacco is the leading cause of preventable death and disease worldwide. This directly contradicts the UN's third sustainable development goal of ensuring good health for all at all stages of life.
The harm of tobacco begins in childhood. Minors are frequently exposed to passive smoke. Passive smoke causes 600,000 deaths per year among non-smokers, and more than a quarter of these deaths are among children under the age of five.[1] In addition, third-hand smoke, i.e., nicotine particles that are deposited on clothes, carpets, walls or curtains and can persist for years, affects the health of children living in a home with a smoker.
This young population is particularly at risk. The brain continues to develop until the age of 25 and nicotine can affect the activity of brain cells.[2] This results in attention and memory problems, anxiety, irritability and impulsiveness.[3]
Most smokers are introduced to smoking in their teens. The deleterious health effects of smoking are felt almost instantly, sometimes within days of starting the habit. Cigarette smoke contains more than 7,000 chemicals, including the various components of tobacco (nicotine, lead, arsenic, hydrogen cyanide, formaldehyde and ammonia, to name a few), as well as the toxins generated by burning tobacco.
Inhalation of these products increases oxidative stress on the smoker's cells, causes inflammation, alters their lipid profile and makes their immune system less effective. Smokers are also more likely to develop serious respiratory diseases such as tuberculosis, asthma or dyspnoea (respiratory failure).[4] In the medium term, a smoker is at risk of developing type 2 diabetes, atherosclerosis (a deposit of plaque on the artery walls) or periodontitis (an inflammatory lesion in the mouth).[5]
Tobacco also has adverse effects on the health of farmers, who are exposed to many pesticides. Some develop green tobacco disease, a poisoning that occurs when the skin absorbs nicotine from the surface of moist tobacco plants. It manifests itself as dizziness, nausea, diarrhoea and general muscle weakness. In some cases, it requires hospitalisation.[6]
In tobacco-producing countries, such as Bangladesh, workers are exposed to the thick tobacco dust that circulates in cigarette factories. This damages their lungs and stunts the growth of the many children who work there.[7]
As people get older, the harmful effects of cigarettes become more pressing. Tobacco use is responsible for 90% of lung cancers and 25% of cancer deaths globally.[8] It causes cancers of the oesophagus, mouth and throat, stomach, liver and colon. These health impacts are directly correlated with the number of years spent smoking and the number of cigarettes smoked per day.
This link is less clear for chronic diseases caused by tobacco, which also tend to be more prevalent in older people. Smoking is an important risk factor for coronary heart disease. But smoking one cigarette a day is almost as dangerous as smoking twenty a day, as this alone increases the risk of a heart attack or stroke by 40%.
The danger is even greater when smoking is combined with other risk factors such as high cholesterol, untreated hypertension or diabetes mellitus. Overall, 20% of deaths from cardiovascular disease are caused by smoking.
Smokers are also at risk of developing lung and respiratory diseases, including chronic obstructive pulmonary disease, a chronic inflammation of the bronchial tubes that leads to progressive shortness of breath. Tobacco users are particularly affected by the coronavirus in the Covid-19 pandemic. Their rate of hospitalisation and death is significantly higher than that of non-smokers.[9]
Some cigarette users are also affected in their vision, with the emergence of cataracts or macular degeneration; others suffer from arthritis, and still others have problems with loss of bone density.[10]
Overall, smoking leads to eight million premature deaths worldwide annually. In Switzerland, this figure amounts to 9,500 deaths per year.[11] Given that the UN Sustainable Development Goals have committed to reducing the mortality rate from non-communicable diseases by 30% by 2030, a reduction in the number of smokers would have a particularly important impact on achieving this goal.
Despite the irrefutable impact of tobacco on health, the cigarette industry has long denied it, simply marketing light or filtered versions of their products. More recently, the industry has changed its tune, choosing instead to highlight innovations such as electronic cigarettes or heated tobacco products. However, the latter remain addictive, contain substances such as nicotine and their real effects on health are still poorly understood.
The most effective measure to limit the negative health effects of smoking is to reduce the number of smokers. However, the WHO Framework Convention on Tobacco Control provides a number of avenues for minimising the impact on health. These are essentially public policies with structural measures to limit tobacco consumption and its effects on health. These include the introduction of laws to limit the exposure of non-smokers to passive smoke, regulation of the ingredients of tobacco products and the obligation to make them public. Cigarette packs should also be banned from using terms such as "light", which gives the impression that they are not harmful, and should always include warnings about their health effects.[12]
[1] https://fctc.org/wp-content/uploads/2015/03/Tobacco_sustainable_development_190315.pdf
[2] Benowitz, Neal L. (2010): Nicotine addiction. In The New England journal of medicine 362 (24), pp. 2295–2303. DOI: 10.1056/NEJMra0809890
[3] U.S. Department of Health and Human Services (2016): E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General et Kutlu, Munir Gunes; Gould, Thomas J. (2015): Nicotine modulation of fear memories and anxiety: Implications for learning and anxiety disorders. In Biochemical pharmacology 97 (4), pp. 498–511. DOI: 10.1016/j.bcp.2015.07.029. et Hughes, John R. (2007): Effects of abstinence from tobacco: valid symptoms and time course. In Nicotine Tob Res 9 (3), pp. 315–327. DOI: 10.1080/14622200701188919. et Froeliger, Brett; Modlin, Leslie A.; Kozink, Rachel V.; Wang, Lihong; Garland, Eric L.; Addicott, Merideth A.; McClernon, F. Joseph (2013): Frontoparietal attentional network activation differs between smokers and nonsmokers during affective cognition. In Psychiatry research 211 (1), pp. 57–63. DOI: 10.1016/j.pscychresns.2012.05.002.
[4] Bonnie RJ, Stratton K, Kwan LY, editors. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Washington (DC): National Academies Press (US); 2015 Jul 23. 4, The Effects of Tobacco Use on Health.
[5] Ibid.
[6] Graen, Laura. (2018). Tobacco industry: Truly transformed or using SDGs as a smokescreen for old strategies?.
[7] Shoba John; Shailesh Vaite; Debra Efroymson (2003): Tobacco and Poverty Observations from India and Bangladesh. PATH Canada. Kanada.
[9] https://www.who.int/news-room/commentaries/detail/smoking-and-covid-19
[10] Bonnie RJ, Stratton K, Kwan LY, editors. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. Washington (DC): National Academies Press (US); 2015 Jul 23. 4, The Effects of Tobacco Use on Health.