The Dutch government banned smoking at workplaces since 2004 and in most public places since 2008.  This move was particularly unpopular with small bars and innkeepers, who mounted a grassroots campaign aimed at toppling existing smoking legislation.  As a result, the primary Dutch organisation responsible for campaigning against smoking, STIVORO, will lose its €2.7 million funding by 2013 and will need to raise funs to continue operation.  In addition, pharmaceutical nicotine patches, previously dispensed through the public health services, will no longer be available fre of charge.  Although smoking rates are slightly down from 2001 when an estimated 30 per cent of the population were smokers, smoking remains popular in the Netherlands; 27 per cent of the population were smokers in 2010.

According to the International Tobacco Control Policy Evaluation Project, Netherlands Survey, smokers in the Netherlands are the least well informed or concerned about both the hazards of smoking and the dangers of second-hand smoke exposure of the 12 countries surveyed.

Sources: The Lancet 379(9811): 121-2, 14 January 2012; The International Tobacco Control Policy Evaluation Project, Netherlands Survey, March, 2011 Report on Smokers’ Awareness of the Risks of Smoking and Second-hand Smoke; STIVORO, Annual Report 2009—2010.

But in what sense is this a ‘right’ to which anyone would freely wish to be entitled? Each year in the United States, 400,000 deaths are attributable to cigarette smoking alone, and another 50,000 citizens die prematurely from exposure to second-hand smoke. This number amounts to one fifth of deaths in the US and accounts for more deaths than HIV/AIDS, drug abuse and alcohol related deaths, automobile accidents, murders and suicides combined, according to the state of Virginia Department of Health.

The US Centre for Disease Control reported last year that men who smoke will become ten times more likely to die from bronchitis or emphysema and over 22 times more likely to die from lung cancer. In addition, smoking triples the risk of premature death from cardiovascular disease among middle age men.

As Peter Galuszka writes in the Washington Post, tobacco has been a powerful US industry since the first English colonies were established on her shores in Jamestown Virginia; this new effort on behalf of big tobacco extends and expands the industry battlefield in a new and insidious way.

Sources: Washington Post, 3 January 2011; CDC Factsheet, 21 March 2001 Tobacco Related Mortality (here >>); Virginia Tobacco Use Control Project Smoking Attributable Deaths in Virginia, 2008.

Tobacco, the world’s leading cause of preventable death, is estimated to be responsible for over 200,000 deaths each year in Brazil, including 45 per cent of heart-attack deaths and 30 per cent of deaths due to cancer. Smoking is the primary cause of many of the world’s preventable diseases, including cardiovascular disease, lung disease and cancers, killing 1/10 adults worldwide and is frequently the cause of the disease recorded as the cause of death, according to the WHO.  As Brazil is hosting both the 2014 Soccer World Cup and the 2016 Olympic Games, the nation has a crucial example to set through its leadership role on this issue.

Sources: The Washington Post, 15 December 2011; Campaign for Tobacco Free Kids, press release; Tobacco Free Center, Tobacco Policy Status (pre-ban) 12/2011; World Health Organization ‘Top Ten Causes of Death Fact Sheet’, June 2011.

Whether the WHO definitions or National Working Group on Obesity in China measures are used to define overweight and obesity, around 20 per cent of urban residents were overweight or obese, versus 3-7 per cent in the rural areas. The Yi are a minority national population in this area and are believed to be at higher risk.

Dramatic development of the Chinese economy during the past decades has wrought major lifestyle changes in the provinces that have led to an alarming increase in chronic disease risk factors such as  hypertension, and a major spike in diabetes rates. More sedentary lifestyles have become common and the epidemic status of obesity in this region coincides with both economic growth and rise in family income levels.  The agrarian lifestyle has given way to higher levels of education and higher income in urban areas but has not yet generated greater health. Significant among the research findings is that 60 per cent of the men participating in the study were smokers.

Researchers believe that the overall differences between the rural and urban groups may be explained in part by lifestyle and by socio-economic differences among the groups. They further add that a greater emphasis by the state on education and prevention strategies in urban settings will help to stem the tide of preventable disease that inevitably follows rising obesity levels.

Sources: Y Gao et al., ‘Prevalence of overweight and obesity among Chinese Yi nationality: a cross-sectional study’, BioMed Central Public Health, 13 December 2011; Stone Health News, 13 December 2011.

In a review the authors hail as the most comprehensive to date, evidence is presented which confirms that cancer is certainly not completely driven by either heredity or fate but rather can be influenced by our environment and behaviours.  Cancer typically has multiple causes and thus one cannot identify whether an individual’s cancer is caused by a particular disease vector, but understanding this can assist in predicting the number of potentially preventable cancers.

As the study analysed gender specific causes of cancers, the best recommendations for women are to avoid smoking, overweight and excess alcohol consumption; for men the top line recommends stopping smoking, increase consumption of fruit and vegetables and reduce alcohol intake.

Lead author is Professor Max Parkin, epidemiologist at the Wolfson Institute of Preventative Medicine, Queen Mary University, London.

An important fact to note here is that the probability of death before age 70 has been halved during the past 40 years and that during the next few decades it could be cut by half again with improvements in treatment and focusing attention on the avoidable causes of disease.

Sources: BBC Health, ‘Over 40% of Cancers Due to Lifestyle, Says Report‘, 7 December 2011; D.M. Parkin et al., ‘The fraction of cancer attributable to lifestyle and environment factors in the UK in 2010′, British Journal of Cancer 105:S2, 6 December 2011; NHS Choices, ‘Lifestyle changes could slash cancer rates, 7 December 2011; Cancer Research UK: Cigarettes, diet, alcohol and obesity behind more than 100,000 cancers (press release), 7 December 2011.

Source: health.gov.au, 21 November 2011.

Last April, the Australian government presented a proposal that involves requiring that all cigarettes sold be displayed without branded labels and in non-descript olive-green packaging, which smokers are reported to favour least, with graphic depictions of smoking-related illnesses.  Brand names will be displayed in a single, standard font and size. In October, Philip Morris, the cigarette manufacturer that holds eight of the top 15 selling brands, including the best-selling brand, Marlboro, lashed out at the proposal, and said they were preparing for legal battle if the plain-packaging bill becomes law.

The Financial Times reports that Hermann Waldeme, Phillip Morris’ CFO claims that there is ‘no evidence’ that removing logos from packaging reduces smoking either in general or among youth – a claim made in spite of evidence from studies demonstrating that plain packaging both decreases brand appeal and general pleasure derived from smoking.  Tobacco companies have raised challenges around the ‘forced removal of trademarks’ in terms of both commercial and intellectual property law, and international law.  But Prime Minister Julia Gillard says that she will not be intimidated by big tobacco.

Sources: Financial Times, 20 October 2011, BBC News online, 8 April 2011;  Sydney Morning Herald, 27 June 2011; Tobacco Control (BMJ,’Welcome to cardboard country: how plain packaging could change the subjective experience of smoking‘ (Melanie Wakefield, Centre for Behaviour Research in Cancer, Cancer Council Victoria, Melbourne, Australia)

This has been met with considerable resistance, however. Of the 200 couples reached by the campaign, only a few promised to hold non-smoking ceremonies, because – even among social groups who are fully aware of the health threat from tobacco – they feared losing face, or parental opposition.

More awareness-raising is being planned, perhaps including having celebrities to champion the no-smoking cause, or broadcasting tobacco-free weddings on the internet.

While there is still a very long way to go – cultures change only slowly – even these small steps are to be commended in a country where the majority of men still smoke.

Source: Xinhuanet.com, 5 October 2011.

The model used by the researchers estimated that very aggressive tobacco control (with a 1% decrease in smoking prevalence annually per year until it is eradicated) would avert 27 million smoking attributable deaths from tuberculosis by 2050. Conversely, the model estimated that if smoking prevalence rose from the current 20 per cent to 50 per cent of adults (a rate that is as observed in countries with high tobacco use), 34 million additional deaths from tuberculosis would occur by 2050.

Smoking is also slowing progress towards the achievement of the Millennium Development Goal to reduce TB by half from 1990 to 2015, which strengthens the case for linking the risk factors for non-communicable diseases more firmly into the successor to the MDGs.

Sources: S. Basu et al., ‘Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis’, BMJ (2011) 343; BBC News online, 5 October 2011.

The study followed 120,000 people who were aged between 55 and 69 in 1986, tracking them until 1996. According to Barbara Dinsdale at Heart Research UK, ‘Eating a Mediterranean diet has antioxidant and anti-inflammatory effects on the body … [and] these diets are lower in “bad” cholesterol and are helpful in controlling blood-sugar levels.’

Source: The Independent, 3 August 2011.