Thursday, September 17, 2009

TOBACCO AND CARDIOVASCULAR IMPACT

WHAT IS TOBACCO?

Tobacco is made from the dried leaves of the tobacco plant. Tobacco smoke is a mixture of almost 4,000 different chemical compounds, including nicotine, tar, carbon monoxide, acetone, ammonia and hydrogen cyanide. Forty three of these chemicals have been proven to be carcinogenic (causing cancer).
Tobacco is ingested through smoking cigarettes, pipes and cigars. In the form of a fine powder, it may also be sniffed as snuff, or it is sometimes sold in blocks to be chewed. It can also be ingested through passive smoking.

Tobacco remains the single most preventable cause of death and disease in the United States today. Tobacco use is a major risk factor for heart disease and stroke. Between 1997 and 2001, smoking resulted in an estimated annual average of 137,979 deaths in the US from cardiovascular disease. In 1998, smoking related health care expenditures in the US were estimated at $75.5 billion.

After a steady decline in adult smokers since 1995, the adult smoking rate in Texas increased between 2006 and 2007 from 17.9 percent to 19.3 percent.3 The Texas high school smoking rate in 2007 (that is smoked cigarettes on one or more days during the past 30 days) was 21.1 percent compared to the Healthy People (HP) 2010 goal of 16 percent.

Epidemiologic studies have demonstrated that exposure to second-hand smoke is causally associated with coronary heart disease. Meta-analyses estimate that involuntary exposure to smoking increases the risk of heart attack by 25-35 percent.21 Many Texas communities are working to adopt or have already passed smoke-free ordinances that reduce exposure to second-hand smoke in public places, including bars and restaurants. Still, 75 percent of Texans are not protected by strong smoke-free ordinances that cover municipal workplaces, private workplaces, restaurants, bars in restaurants, and bars not in restaurants.

Tobacco-related health disparities are reflected in unequal treatment of tobacco use, incidence, morbidity, mortality, burden of illness, and access to resources. Racial/ethnic minorities, people with low socio economic status, and people with lower levels of education are at higher risk for tobacco use and exposure to second hand smoke, and they experience more tobacco related illness and death.22 In Texas, we see the highest rates of smoking among young adults between 18 and 29 (24.3 percent), males (21.9 percent), Whites (20.5 percent) and African Americans (21.4 percent).

The Texas Cancer Council, now the Cancer Prevention and Research Institute of Texas, a state agency charged with implementing the Texas Cancer Plan, published the Texas Tobacco Control Plan 2008, A Statewide Action Plan for Tobacco Prevention and Control in Texas (Tobacco Plan). Partners from across the state, including the Tobacco Prevention and Control Program at the DSHS; the American Cancer Society, High Plains Division; and many community level stakeholders are actively working to reduce tobacco use in Texas.

Investments in state-level, evidence-based prevention programs have produced significant reductions in cigarette consumption, demonstrating the need for fully funded state-wide tobacco prevention programs at levels recommended by the CDC. According to the Tobacco Plan, the most significant barrier to tobacco prevention and control in Texas is the lack of funding to implement these evidence-based programs. Currently, less than 1 percent of the 25 year estimate of $17.5 billion in Texas tobacco settlement funds has been invested in comprehensive community level programs.

THE BURDEN OF CARDIVASCULAR DISEASE AS REPORTED BY AMERICA HEART ASSOCIATION

WHAT IS CARDIOVASCULAR DISEASE?
Cardiovascular disease (CVD) refers to a group of diseases that target the heart and blood vessels and is the result of complex interactions between multiple inherited traits and environmental issues including diet, body weight, blood pressure, and lifestyle habits. This means that cardiovascular disease is largely preventable and, when diagnosed early, disease symptoms and risk factors can often be mitigated with lifestyle change and medication. Common forms of CVD include high blood pressure, coronary heart disease, stroke, and congestive heart failure.
A major cause of CVD is atherosclerosis, a general term for the thickening and hardening of the arteries. It is characterized by deposits of fatty substances, cholesterol, and cellular debris in the inner lining of an artery. The resulting buildup is called plaque, which can partially or completely occlude a vessel and may lead to heart attack or stroke. The most prevalent forms of heart disease and stroke, in which narrowed or blocked arteries result in decreased blood supply to the heart or brain, are referred to as ischemic heart disease and ischemic stroke.
Progress is being recorded in some countries where capacity has been built and developed to tackle the scourge of CVD, while countries, states and local communities in Africa still wallow in the grip of the menace of CVD. Factors affecting this decline in other parts of the world include more effective medical treatment and more emphasis on reducing controllable risk factors.
While CVD mortality rates have declined most developed countries of the world, the financial burden from CVD continues to rise. Together, heart disease and stroke remain the number one drain on health care resources. According to the American Heart association (AHA), the estimated direct and indirect cost of CVD in the US in 2008 will be $448.5 billion. In 2006, hospitalization charges for CVD and stroke in Texas were over $10 billion. Ischemic heart disease alone accounted for 60 percent of these charges.
Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.
Globally, cardiovascular diseases are the number one cause of death and is projected to remain so. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million due to stroke. About 80% of these deaths occurred in low- and middle-income countries. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).

PRIMARY CAUSES OF CARDIOVASCULAR DISEASE

High Blood Pressure: The relationship between blood pressure and risk for cardiovascular disease is well established and independent of other risk factors. High blood pressure is a factor in 67% of heart attacks, 77% of strokes, and 74% of heart failures. The higher the blood pressure becomes, the greater the risk for heart attack and heart failure. The presence of pre-hypertension signals the need for increased education and lifestyle modification to prevent or reduce the onset of hypertension. Recommended lifestyle changes include weight reduction, adoption of a good eating plan, sodium reduction, physical activity, and moderation of alcohol consumption. Combinations of lifestyle modifications can achieve optimum results.
High Blood Cholesterol: Reducing risk associated with high blood cholesterol involves reducing lifestyle risk factors such as obesity, physical inactivity, a diet high in saturated fats, excess alcohol consumption, and tobacco use. A diet high in carbohydrates (more than 60% of energy intake), certain diseases, certain drugs, and genetic causes are also associated with abnormal lipoprotein levels.
Diabetes: Diabetes, a major risk factor for cardiovascular disease, is a group of diseases marked by high levels of blood glucose and includes type 1, type 2, gestational, and other types resulting from specific genetic conditions. People with type 1 diabetes must monitor and control their blood glucose level by self administration of insulin. Those with type 2 diabetes can often control their blood glucose through diet, exercise, and oral medication. Diabetes self-management education is integral to effective medical care. According to the American Diabetes Association, it is important for patients and their providers to “make the link” between diabetes, heart disease, and stroke. Diabetes management involves not only control of blood glucose but also of blood pressure and cholesterol levels.
Tobacco use and exposure to second hand smoke: Tobacco remains the single most preventable cause of death and disease in the United States today. Tobacco use is a major risk factor for heart disease and stroke. Between 1997 and 2001, smoking resulted in an estimated annual average of 137,979 deaths in the US from cardiovascular disease. In 1998, smoking-related health care expenditures in the US were estimated at $75.5 billion. Tobacco-related health disparities are reflected in unequal treatment of tobacco use, incidence, morbidity, mortality, burden of illness, and access to resources. Racial/ethnic minorities, people with low socioeconomic status, and people with lower levels of education are at higher risk for tobacco use and exposure to second hand smoke, and they experience more tobacco related illness and death.
Overweight and Obesity: Premature death, heart disease, diabetes, cancer, respiratory problems, arthritis, and reproductive complications are among the health consequences of overweight and obesity. The incidence of heart disease, high blood pressure, and high cholesterol are higher in people who are overweight and obese. Risk factors for heart disease such as high cholesterol and high blood pressure are more prevalent in children and adolescents who are overweight.
Recent studies suggest that obesity, independent of other risk factors such as keeping active and not smoking, increases risk for acute coronary syndrome (symptoms associated with myocardial ischemia). Overweight and obesity classifications are determined by body mass index (BMI), a ratio of body weight (kg) to height (m)2. Overweight is defined, in adults, as a BMI between 25 and 29.9, while obesity in adults is defined as a BMI of 30 or higher.
Unhealthy eating: Nutrition plays an important role in an in¬dividual’s overall health and quality of life. A diet high in calories, saturated fat, and cholesterol and high in sodium or sugar is a major contributor to poor health. For reducing risk of CVD and stroke, the American Heart Association encourages people to know their daily caloric intake to help ensure calories eaten do not exceed calories burned through daily physical activity and consume nutrient rich foods that are high in vitamins, minerals, fiber, and other nutrients but low in calories. A diet high in fruits and vegetables is as¬sociated with better weight management and a reduced risk of chronic disease.
Lack of physical activities: Regular physical activity is associated with reduced risk for chronic disease and a healthier, longer life. Cardiovascular ben¬efits of regular physical activity include lower risk for heart disease, high blood pressure, stroke, abnormal blood choles¬terol and triglycer¬ides, type 2 diabetes, obesity and a second heart attack.

Tuesday, September 15, 2009

TOBACCO USE IN MOVIE PRODUCTION

The World Health Organisation made a global call in 2003 to the entertainment industry to stop promoting a product that kills every second regular user and a focus on Hollywood to keep tobacco off the screen, on that note it made “Smoking in Movies” the focus of that year’s World No Tobacco Day. Tobacco use kills about 5million people World wide annually and has been identified as a cancer causing product, the Motion Pictures industry has not been accused of causing cancer but they do not have to promote a product that does.
                                    Images Influence Kids

The influence of television images on kids became a factor that pivoted every presentation made on World No Tobacco Day 2003 and how young people especially are vulnerable to the glamorous images of smoking portrayed in many movies and television programmes. Every claim was backed up by several studies conducted by Researchers in Dartmouth Medical School, U.S.A. which says “kids who watch a lot of movies that show smoking are most likely to start smoking themselves, and have more positive attitudes about smoking”. Also the claim on the rise of smoking in movies especially the PG-13 targeted at impressionable adolescents was also an issue.
In 1998, tobacco companies in the U.S reached a major legal settlement with 46 States not to advertise to minors or pay film companies to use their products in movies and after this agreement it was discovered that tobacco use in movies increased by 50%. (Massachusetts Public Interest Research Group, 1998).

                                  Tobacco Deserve an R-Rating

The World Health Organisation is urging film executives to give any film that shows tobacco use an R-rating; which substantially reduces the probability that a kid will see the movie. The movie industry was called upon to take tobacco just as seriously as it takes profanity in movie rating, this does not otherwise mean censorship of movies. It simply means if there are bad things in movies, it should be properly labelled.

Tobacco continues to kill globally and films have a crucial role in promoting its use, say WHO. In India, a high number of deaths have been traced to tobacco use which has been made popular through movies and cinema. This has solely been blamed on Bollywood’s relationship with tobacco companies according to ‘Bollywood: Victim or Ally report’ conducted by the Tobacco Free Initiative of the World health Organisation (WHO) 2003. It was reported that in India, tobacco causes 800,000 deaths every year i.e. 2,200 people die each day, 90 die every hour out of the nearly 1 billion population of India.

It is also on record the damage done to the American society by tobacco marketers and producers who had a close working relationship with Hollywood to glamorise tobacco. This they were able to do using Hollywood, being the largest motion picture industry in the world until the legal settlement that 46 States in the U.S collectively signed with the tobacco companies on advert prohibition to minors. On realising the defeat they had suffered in the U.S court verdict and the effects it has on their sales and overall revenue, the tobacco companies leveraged on the ignorance of Bollywood of India being the second largest movie producers in the world. This resulted to so many deaths in India according to an earlier highlighted statistics before the intervention of anti-tobacco experts and advocates that led to the checkmating and prohibitions the tobacco companies suffered in India.

The Nollywood (the Nigerian movie industry), being the third largest movie market in the world had suddenly become the focus and we all can testify on how tobacco usage in our movies had gained popular acceptance at the peril of the teaming population of our youths who are potential smokers. Our actors and actresses are seen by this growing number of youths as role models and supermen and whatever they do is the seemingly right thing in the mind of these youths and if positive steps are not taken to educate the movie producers on the negative effects tobacco usage in movies has on the viewers, we might just be having a repeat of what happened in India and America.

Nigeria being a signatory to the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), the international treaty signed by Member-States of the United Nations and the European Community requires them to restrict advertising and sponsorship of tobacco products and outlaw smoking in public places, tobacco advertising and sponsorship of sporting events by tobacco companies. We cannot fold our hands to watch tobacco companies and their products work contrary to what we as a Nation are a signatory to. This may on the long run ruin the lives of our youths and our tomorrow leaders who the tobacco companies have made their target to remain in business.

                      Some tobacco effects on the Nation of India

India has a population of 1billion people with 250 million tobacco users. India is a major target by tobacco companies because of the vast population growth and it offers the biggest market to tobacco companies after Brazil.

Out of the 250 million tobacco users recorded in India, as many as 199.2 million people are between the ages 15-24, and this group is projected to grow to 231 million by 2013.

It has been recorded that one of the leading causes of preventable deaths in India today - heart disease, loss of breathing capacity (Emphysema) and cancer – which cost the country $5.5billion in 1999, is smoking. In contrast, the nationwide sales revenue of all tobacco products for that year was $4.88billion. Tobacco related diseases cost the country $2.7billion through the loss of productivity alone.
The tobacco companies only source of replacing smokers is to try and rope in thousands of younger adults and school children who they make sure light cigarette the first few times and thus get them hooked. If it fails to do that, big tobacco companies will start to die. It is like population that does not give birth which gradually dies a natural death.

Prof. Stanton Glantz, an America Smoke Free Movies Campaigner and Anti Tobacco Activist describes how over 40 years the tobacco industry knew nicotine was an addictive substance and it causes cancer, and yet withheld this information from the public.
The World Health Organisation has always preached the harmful effect of tobacco on young people and Nigeria being a signatory to the WHO Framework Convention on Tobacco Control (FCTC), advertising tobacco product is illegal. The WHO study has shown that smoking in films is an insidious form of advertisement as people, especially the youth, tend to emulate their film idols and take up to smoking.

                              Statements credited to Philip Morrison

The article quotes excerpts from several documents, among them a 1989 Philip Morris marketing plan which said: "We believe that most of the strong, positive images for cigarettes and smoking are created by cinema and television. We have seen the heroes smoking in Wall Street, Crocodile Dundee and Roger Rabbit. Mickey Rourkey, Mel Gibson and Goldie Hawn are forever seen, both on and off the screen, with a lit cigarette. It is reasonable to assume that films and personalities have more influence on consumers than a static poster of the letters from a B&H (Benson and Hedges) pack hung on a washing line under a dark and stormy sky. If branded cigarette advertising is to take full advantage of these images, it has to do more than simply achieve package recognition - it has to feed off and exploit the image source."

Another document, a draft speech prepared for the president of Philip Morris International to be read at a company international meeting, says: "Recently, anti-smoking groups have also had some early successes at eroding the social acceptability of smoking. Smoking is being positioned as an unfashionable, as well as unhealthy, custom. We must use every creative means at our disposal to reverse this destructive trend. I do feel heartened at the increasing number of occasions when I go to a movie and see a pack of cigarette in the hands of the leading character. This is in sharp contrast to the state of affairs just a few years ago when cigarettes rarely showed up in cinema. We must continue to exploit new opportunities to get cigarettes on screen and into the hands of smokers."

A 1981 memo from a researcher from the same company (quoted elsewhere) says: "Today's teenager is tomorrow's potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens.... The smoking patterns of teenagers are particularly important to Philip Morris."

THE ABSENCE OF OCCUPATIONAL HEALTH AND SAFETY LAWS IN NIGERIA

We strongly believe Nigeria has come of age to operate within the confines of globally accepted standards. Occupational Health and Safety has been made so crucial in functional systems in virtually every parts of the world with enabling laws guiding processes and policy formulations. These are in the true sense of it not necessarily local laws but careful implementation of numerous contents of several ILo conventions being domesticated into the local laws for safety of lives and properties in a given Nation. This is a global standard as obtainable in most countries of the world.
In our Nigeria context, we are groping in the dark, maiming and incapacitating the present and future active workforce of the country. Work places have become death traps, loss of loved ones to Occupational accidents are increasingly high without simple accident reporting of detection mechanism. Employers of labour are cashing on the lack of interest from our legislators to set up companies without a single safety policy or principles. The Asians investors who are known for owning and running production factories in Nigeria have so taken advantage of this at the expense of the Nigerian work populace. The saddening part of it all is that there is no law in place to prosecute these set of murderers of even press for claims, it is a common saying that "where there is no law there is no offence. This is a clear situation of the Nigerian system. Multinational Oil and Gas companies introduced Health and Safety into Nigeria and in our ignorance we thought it was an idea borne out of the magnanimity of these companies little did we know a "safe work place is a human right". The presence of these oil and gas companies is strong in the Niger Delta region so safety has a better representation in this region even though skeletal.
We were so elated when the modern-day thinking Governor of Lagos State, Mr. Babatunde Raji Fashola took the initiative of calling all stakeholders in the state to come for a forum on the discuss the setting up of Lagos State Safety Commission we were all happy but it has been quite a while now and nothing has been heard on that. We are also of the opinion that the whole idea must have met a strong brick wall because there are no enabling Federal Laws to support his initiatives.
We have a continuously sick President who i personally feel cannot withstand the pressure of his office based on his State of Health and this has become issues of national concern but if we have through Occupational Health and Safety model requested pre-qualification medical fitness test for all politicians before registering to get the ticket to run in an election, this present problem would not have caught up with the Nation Nigeria. During Etteh's saga we lost a member of the House of Representative to Cardiac arrest and unfortunately the late legislator was a qualified medical Doctor, a number of such cases abounds. We are itching for a National Safety Commission which will house and regulate other safety agencies under its operations such as Nigeria Occupational Safety and Health Administrators (NOSHA), National Hygiene Administrators, Hazardous Material Handling and Control Board etc. The Nation has a lot of revenue that can be derived from this but we have a set of slumbering leaders.
Time will not fail me to talk about the embarrassment we receive when we are writing international exams in health and safety and you are given a task to accomplish and you are told to liken it to the existing Occupational Health and Safety Laws of your country and you have no choice than to tell the institute you country does not have such laws. You do not know the shame.
In conclusion, I suggest the legislative arm of government takes a closer look into the ILO conventions and the Occupational Health and Safety Laws initiated and agreed upon by member nations including Nigeria. The law is supposed to protect the right of every Nigerian worker but they are all dying in droves.
A stitch in time saves nine goes a common saying.