According to a recent study involving 31 million people worldwide, smoking causes more than 5 million deaths per year and 80 percent of smokers live in developing countries. If cigarette smoking continues as it is today, it will claim 2030 million lives by 8. Lower income groups and young people (people between 15 and 44 years old) are the most affected by the tobacco pandemic, which deepens the gap between rich and poor.
The study, titled “Systematic review of the relationship between tobacco and poverty,” was carried out at the request of the World Health Organization (WHO) by the Institute of Clinical and Health Effectiveness (IECS), an Argentine non-profit organization that is dedicated to research, education and technical cooperation on health issues.
“This study is the first of its kind that quantitatively analyzes the impact of tobacco by social class and demonstrates that there is an inverse relationship between income level and tobacco consumption: the lower classes consume more than the upper classes. In the American continent, for example, smoking among the poor is 50 percent higher than among the wealthy classes," explains the Dr. Agustín Ciapponi, lead author of the study, specialist in clinical medicine, family medicine and coordinator of the Cochrane IECS Center.
The publication points out that the most accepted explanation for this phenomenon is known as the "Four Stages model." In this sense, Ciapponi assures: «First, smoking spreads quickly in the upper classes, which are the ones most open to innovation. It then spreads to the rest of the population (in a second and third stage). Then the upper classes stop smoking because they come into contact with the culture of health care and because they receive information about the harm that nicotine produces. This is how, in a fourth and final stage, smoking decreases in the upper classes and settles and consolidates in the lower classes.
“In low-income households, tobacco purchases represent 10,7 percent of family expenses,” the study notes. The proportion of income that goes to tobacco is higher in the lower classes (who have less income) than in the upper classes. Thus tobacco contributes to impoverishment.
But this is not the only cause that deepens the vulnerability of the most humble. This vulnerability is also evident in the fact that they cannot face the consequences of smoking like the more affluent groups. «Diseases such as lung cancer, heart attacks and chronic obstructive pulmonary disease (COPD) affect the poor more than the rich because the poorest are less covered by health systems. That is why smoking increases inequality in societies, the gap between rich and poor widens,” Ciapponi emphasizes.
«The inverse relationship that exists between income level and tobacco consumption (the higher the income, the lower the consumption) has increased in the last 20 years. In that period, tobacco consumption among women grew noticeably,” says Ciapponi. The specialist assures that, according to his research, men smoke more than women but that they are increasingly closer to the former. «That is not exactly a battle won in the war of the sexes. This is an enormous detriment to women's health because women are registering lung cancer more and more frequently," he exemplifies.
For their part, men are victims of marketing. They constitute the target at which cigarette advertisements are aimed. "Smoking is sold as a male habit linked to health, happiness, fitness, well-being, power and virility when in reality it leads to illness, premature death, sexual impotence and infertility," lists the report.
Ciapponi concludes: “To reduce the scope of this pandemic that affects Argentina and the entire world, we must implement all the strategies that have proven effective in stopping smoking. This means applying smoke-free policies, increasing taxes on cigarettes (it has been proven that this measure discourages consumption) and making legislation that restricts advertising even more rigorous.
It should be noted that Dr. Ciapponi conducted this study for the World Health Organization with a team of researchers made up of: Dr. Ariel Bardach, Dr. Demián Glujovsky, Dr. Patricia Aruj, Dr. Agustina Mazzoni, Dr. Bruno Linetzky, Lic. Daniel Comandé, Lic. Luz Gibbons, Dr. Brunilda Casetta and Lic. Joaquín Caporale.
THE CIGARETTE IN NUMBERS:
27% of the world's population smokes.
1 billion men and 250 million women smoke daily.
The average age of the tobacco user is 41 years.
82% of smokers live in low- and middle-income countries.
Lower class women and men smoke 1 and a half times more than upper class men.
10,7% of family expenses is allocated to the purchase of tobacco in low-income households.
2,8% of family expenses is spent on tobacco in Bangladesh (one of the poorest nations in the world). With that money, 500 calories a day could be added to children's diets, thus preventing the daily death of 350 children in that country.
16% of the income of poor families in Mexico goes to purchasing cigarettes.
TEXTUAL OF THE STUDY:
• «Women are now smoking more than before» (Page 6).
• "In the workplace, smokers have more medical expenses and less productivity than non-smokers." (Page 8).
• «Many of the health risks caused by smoking take decades to become evident. However, tobacco use can cause immediate harm to those who consume it and their families; and that damage increases every day. This is the damage that occurs when low-income families spend money on tobacco instead of investing in food or other essential goods. "In families living near the poverty line (or who have fallen below it), tobacco use can have a significant impact on health and nutrition." (Pages 6 and 7).
• “Tobacco is related to poverty through different mechanisms. According to some qualitative studies, it can be linked to: the stress that comes with lower class life, routine, loneliness, isolation, lack of opportunities in this sector and also because smoking in certain social and work environments is culturally accepted. ”. (Page 7).
• "The results of this study support the theory of vulnerability: tobacco causes greater damage among the most disadvantaged sectors." (Page 31).
• «There are long-term effects - related to the risk of suffering from diseases - that can be devastating for families living slightly above or below the poverty line. The poor are often employed in jobs that require greater physical effort. "If they get sick and can't go to work, both the family's income and food are at risk." (Page 33).
• «This research may be useful in establishing policy priorities and future efforts aimed at smoking cessation. "Efforts made to help low-income groups quit smoking will have an effect on both quality and life expectancy." (Page 33).
EXTRA INFO:
• With some regional exceptions (such as the practice of chewing tobacco in India and the consumption of kreteks in Indonesia), cigarettes are the most common method of tobacco consumption worldwide.
• The most common diseases attributable to its consumption are: lung cancer, heart attack, coronary heart disease, cardiovascular death, tooth loss, periodontitis, chronic obstructive disease (COPD) and low weight in newborns.
Doctor from the Faculty of Medicine of the University of Buenos Aires (UBA), specialist in Medical Clinic and Family Medicine. Master in Clinical Effectiveness (UBA).
Professor at the Faculty of Medicine of the UBA and the master's degree in Clinical Effectiveness at the same university.
Staff doctor and professor of the Family and Community Medicine service at the Italian Hospital of Buenos Aires. Scientific secretary of the Argentine Association of Family Medicine.
Coordinator of the Argentine Cochrane Center IECS (belonging to the Ibero-American Cochrane Network) and director of postgraduate courses on systematic reviews, meta-analysis and evidence-based medicine.
Member of the Clinical Research Committee of the Italian Hospital of Buenos Aires and the Cochrane Plus Library.
PRESS CONTACT: Mariana Comolli. Tel.: 4777-8767 // mcomolli@iecs.org.ar