Some leave the world in a cloud of smoke

Khadija had a feeling in her young heart that her father was not going with them for long.

She faced the wall in her tiny room and listened as her father went through another painful coughing, and she could hear spit in a special cup set aside for that purpose.

Although it was very late at night, sleep was far from her as she remembered the words of the doctor when he was leaving the house, who told them that at that stage, only a miracle could save her father.

Three months before, Khadija’s father was diagnosed with throat cancer, and although at her age she did not comprehend the implications, the somber mood on her mother’s face after the news convinced her that it must be a terrible disease.

Since she could remember, her father, a gentle giant who cared and loved her immensely, has been a chain smoker, something which irritated her mother and resulted in constant fights.

After months of wracking coughs and sleepless nights, her mother practically dragged her resistant father to the hospital, where after several tests they were informed that he had throat cancer, to them, it sounded like a death sentence.

No communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.

The main types of NCD are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

NCDs disproportionately affect people in low- and middle-income countries, where more than three quarters of global NCD deaths (31.4 million) occur.

Of the 1.13 billion smokers around the world, half of them will die from a tobacco-related disease, which in the vast majority of cases will be a non-communicable disease (NCD) like lung and heart disease or cancer.

Although the absolute number of smokers has continued to increase, tobacco control measures have proven to be effective in reducing the percentage of smokers around the world, which declined from 22.7 percent in 2007 to 17.5 percent in 2019.

Big tobacco companies have fought back to avoid losing market share and establish new markets in low-income countries, especially targeting youth with new tobacco products, e-cigarettes and vapes.

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the World Health Organization.

The WHO FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. The WHO FCTC represents a paradigm shift in developing a regulatory strategy to address addictive substances; in contrast to previous drug control treaties, the WHO FCTC asserts the importance of demand reduction strategies as well as supply issues.

“There is a widening health gap among and within countries and regions of the world in life expectancy, disease burden and quality of life that results primarily from a growing epidemic of NCD,” says Lutgard Kagaruki, the Tanzania Tobacco Control Forum (TTCF) Executive Director.

She says that the WHO FCTC was developed in response to the globalization of the tobacco epidemic, saying that the spread of the tobacco epidemic is facilitated through a variety of complex factors with cross-border effects, including trade liberalization and direct foreign investment.

Other factors such as global marketing, transnational tobacco advertising, promotion and sponsorship, and the international movement of contraband and counterfeit cigarettes have also contributed to the explosive increase in tobacco use.

According to the 2018 Tanzania Global Adult Tobacco Survey Report, tobacco use is a risk factor that cuts across all four main Non-Communicable Diseases (NCDs) categories – cancer, cardiovascular disease, chronic respiratory disease, and diabetes.

It is a major preventable cause of premature death and disease worldwide and it kills more than 7 million people a year globally.

Tanzania has a population of 61 million people, according to the 2022 population census, and it produces a large amount of tobacco products for export and for internal use.

The GATS Tanzania 2018 showed that there is a large proportion of passive smokers in the country (at workplaces 32.9 percent and at home 13.8 percent).

“Passive smoking is one of the major public health concerns in the country, therefore, establishing baseline information on key tobacco control indicators is critical to prevent and reduce tobacco use. There is no safe tobacco product, nor is there a safe level of consumption. Tobacco smoke contains up to 5000 chemicals, of which 70 are known to be carcinogenic,” says Ms Kagaruki.

Of all WHO regions (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia and Western Pacific), only Europe and the Americas have managed to reduce the total number of smokers over the last three decades.

Africa and the Eastern Mediterranean region, on the other hand, stand out as the regions where this same figure has increased the most in percentage terms – even doubled in the latter case.

The WHO Framework Convention on Tobacco Control (FCTC) aims to protect present and future generations from the devastating consequences of tobacco by providing a framework for tobacco control.

Some of the key measure that parties must implement to reduce the demand and supply of tobacco include a comprehensive ban on tobacco advertising, sponsorship and promotion.

Other measures should include strong health warnings on tobacco packaging that cover at least 30percent (and ideally 50percent) of the principal and protection from secondhand smoke in all indoor workplaces and public places and in public transportation.

“Strong political commitment is necessary to develop and support, at the national, regional and international levels, comprehensive multi-sectoral measures and coordinated responses,” concludes Ms Kagaruki.