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The Hindu
01-06-2025
- Health
- The Hindu
Can mHealth and AI amp up tobacco cessation efforts?
If we compare the GATS 1 (Global Adult Tobacco Survey) with the GATS 2, all parameters related to tobacco cessation show a downward trend. While the sustained efforts by the government through implementation of national programs such as NTCP, COTPA, and NOHP; ratification of strategic frameworks such as WHO's MPOWER or FCTC; or multilateral collaboration with global health organisations, NGOs, and other stakeholders, the efforts fall short in responding to the tobacco scourge prevalent in the country. 28.6 % of the people aged 15 and above use tobacco in India, the use of smokeless forms being double that of smoked forms. This can be attributed to the social acceptability of smokeless tobacco (SLT), especially among women in old times. Tobacco continues to hold cultural value in local traditions, where it is offered to guests and gods with equal reverence. The second largest consumer—and third largest producer—of tobacco, India is home to 72.7 million smokers. It is responsible for 13.5 lakh deaths, 1.5 lakh cancers, 4.2 million heart diseases, and 3.7 million lung diseases every year. With a 20 % share of the global burden load, India is touted as the oral cancer capital of the world. Also Read | From tea stalls to tumours, tobacco affordability fuelling cancer epidemic in India Secondhand smoking (SHS), caused by the inhalation of toxic fumes when somebody is smoking in the vicinity, compounds the problem further. It contributes to 14% of total tobacco deaths, with the brunt falling squarely on the most vulnerable—women, children, and older people. Almost half of the non-smoking women and over one-third of pregnant women are exposed to tobacco smoke in India and Bangladesh. According to GATS 2, despite 85.6% of people being aware of the detrimental effects of SHS, 38.7% of people working at home and 30.2% working indoors were exposed to smoking. A 2023 report by WHO on global tobacco epidemic believes that physical distancing—whether it be designated smoke rooms (DSRs) or ventilation—fails to protect from the exposure of SHS. The smoke residues from 7000 chemicals, including over 70 carcinogenic substances, cling to physical surfaces long after a cigarette is stubbed out. Through case studies of popular smoke ban laws in Atlanta and Finland, WHO FCTC's Section 8 advocates for strict legislation for a smoke-free environment to protect our basic right to breathe in clean air. Also Read | Two decades after India's public smoking ban, challenges persist in tobacco control Dependency on tobacco Multiple studies have shown that dependence on tobacco and bidis significantly impairs individuals' ability to quit. The wide availability of locally-produced tobacco brands in India further complicates regulation of nicotine content. Moreover, Big Tobacco is frequently accused of deliberately maintaining high nicotine levels to promote addiction. Furthermore, the tobacco industry lobbying has actively obscured critical information and deflected public discourse from the health risks linked to tobacco use. This has resulted in manufacturing of narratives, such as conflating the harms of tobacco smoking with air pollution. What harm will one cigarette cause when the level of pollution amounts to breathing 20 cigarettes a day!? (While air pollution demands urgent action, the harm caused by cigarette smoke is 2 to 2.5 times greater, according to a Chinese study.) In the 1996 issue of Time Magazine, the president and CEO of Philip Morris was quoted saying that cigarettes are no more addictive than coffee or gummy bears. This impact on teenagers by Big Tobacco propaganda is concerning. 8.5% of young adolescents (between 13 and 15 years) consume tobacco in some form in India. With stylish names, flashy packaging, fancy brand ambassadors, and fun flavours, the tobacco industry preys on the young to initiate tobacco use as well as continue it. A WHO report highlighted the addition of sweetening agents, flavorings, bronchodilators, and additives such as levulinic acid and menthol to tobacco products—measures intended to reduce the harshness of nicotine and create a cooling effect in the throat. These modifications in taste, smell, and sensory appeal, experts believe, hype the demand of these products among the youth. Kicking the habit The GATS 2 survey revealed that out of the total people who wanted to quit, 70% had to do it alone, and most couldn't sustain it beyond a month. We must also realize that cessation is not a one-off thing but a continuum—the counselling must always be ongoing and adaptive. Pranav Ish, a pulmonologist at VMMC and Safdarjung Hospitals said even 2-3 minutes of reinforcement has worked wonders in his patients. GATS 2, however, reveals a dismal picture when it comes to the attitude of healthcare providers: only 31.7% of healthcare providers advised their patients to quit in the last month, and 48.8% in the last year. Aninda Debnath, assistant professor, Community Medicine, MAMC, Delhi, says that while a lot of programs related to tobacco cessation are in place, a critical look at their functioning and utilisation is important. The COTPA Act prohibits advertising of tobacco in any form; however, a study by Vital Strategies found 75 % of online surrogate marketing of tobacco on Meta platforms. Vikrant Mohanty, HoD and Project Head, National Resource Centre for Oral Health and Tobacco Cessation, MAIDS, Delhi, said: 'While the government is doing its bit through cessation services at primary level, dedicated counsellors in NCD clinics, dentist training under NOHP, a comprehensive approach with integration of stakeholders at various levels is the need of the hour. The dropout from follow-up still remains huge, and faith in the treatment low.' Also Read | Smokeless tobacco products contribute to over 50% of oral cancer cases in India, study finds AI to the rescue Traditional forms of counseling are, for one, not equitable—the social desirability bias kicks in when hospitals expect the patient to come back. Plus, affordability and accessibility to TCCs is an issue for most who come from lower to lower-middle classes and work in informal sectors or as daily wage workers. Researchers have found that the results of tobacco cessation have stagnated, or at times gone down, for people with social disadvantage. While mCessation in the form of encouraging text messages or telephonic counselling through NTQLS has been an innovative solution (as part of WHO's Be He@lthy, Be mobile), limited success has been observed. Some of the gaps in successful implementation of mHealth include voice recognition inaccuracies, network connectivity issues, poor digital literacy, shoddy interface, absence of personal connection, poor long-term engagement, and high attrition rates. Integrating mHealth with innovative solutions such as PSD (Persuasive Systems Design) or just-in-time-adaptive-intervention (JITAI) that deliver an intervention in moments of elevated need or receptivity has shown great promise. This is where AI can give us a leg up. Mohanty adds that large language models can bridge the gap of delivery, provide personalized healthcare systematically, capture data, and use them in improving the outcomes.' AI can be harnessed not only through chatbots but also indirectly to train healthcare professionals so they can assess, advise and follow-up with the patients rigorously. Dr. Debanath emphasised the importance of refresher training—a component often neglected—which can be made significantly more accessible and efficient with the help of AI.' Monika Arora, Vice President of Research and Health Promotion at PHFI, believes, 'Chatbots and virtual assistants powered by AI can provide round-the-clock support, track and monitor tobacco use behavior, offer evidence-based information, and deliver personalized motivational messages. AI can also utilize predictive analytics to identify individuals at higher risk of relapse and tailor interventions accordingly.' However, this can't happen in isolation. All the interviewees believed that AI should not be thought of as an alternative but as an adjunct to traditional strategies. Dr. Arora and others are working on an AI-based model under Project CARE, where the focus is on 'co-development with users and healthcare providers' who can come up with innovative and contextually relevant solutions. Also Read | The tobacco epidemic in India Digital literacy challenge However, all is not rosy with mHealth and AI. While mobile penetration in the country is good, the lack of digital literacy might act as a massive deterrent. Debnath shared a personal anecdote: 'My mother has a smartphone, but she uses it only for calling and WhatsApp.' Moreover, in this age of digital revolution, when we are always bombarded with text messages and the ubiquitous 'ting' of notifications, the impact of one more message needs to be looked at with a fair bit of skepticism. These newer innovations should be complemented with other time-tested strategies. Plain packaging, which was initiated by Australia for the first time in 2012—and was followed by a wave of countries—should be considered as the next step to challenge the growing empire of tobacco corporations. Stronger warnings, higher taxes, increasing the size of graphic warnings, banning e-cigarettes, and hiring brand ambassadors cam aid our efforts. Emerging approaches such as adaptive counseling, designed to provide stepped care that addresses patients' unmet needs and parallels chronic disease management, can also be considered. Dr. Ish added: 'It feels rewarding that a patient who could earlier smoke three cigarettes had to contend with only one due to high costs.' India has garnered international attention for its tobacco cessation program, but the sheer burden of tobacco warrants that we not only explore newer strategies while also ensuring rigorous implementation of the existing ones. (Kinshuk Gupta is a writer, journalist, and public health physician. His debut book is Yeh Dil Hai Ki Chor Darwaja. kinshuksameer@
Business Recorder
31-05-2025
- Health
- Business Recorder
World No Tobacco Day: WHO, GoP join hands to deal with devastating economic & health impacts
ISLAMABAD: The government of Pakistan and the World Health Organization (WHO) have joined hands to jointly collaborate to deal with the devastating economic and health impacts of tobacco, which annually results in the deaths of 164,000 people and financially cause Rs700 billion or $2.5 billion losses to the country. The development came here on the occasion of World No Tobacco Day jointly organised by the WHO and the Ministry of National Health Services. The participants emphasised that all tobacco products on the market, without exception and regardless of the manufacturer, are extremely harmful to health and pose serious risks to people of all ages including children and teenagers. Speaking on the occasion, Additional Secretary Health Laeeq Ahmad said that Pakistan was a proud signatory to the World Health Organization Framework Convention on Tobacco Control, Pakistan remains firmly committed to implementing comprehensive, evidence-based measures to reduce tobacco use. He thanked all partners, including WHO, for their unwavering support. 'Together, let us work towards a tobacco-free Pakistan, a nation where our people can live, work, and thrive in an environment that values health, safety, and well-being,' He said that Pakistan in collaboration with WHO and other partners was committed to work together on urgent and sustainable measures to save lives. Measures include long-term increased taxation, advertising bans, regulation on plan packaging and product design to reduce appeal – especially to vulnerable populations such as children and teenagers, tobacco and nicotine-free public spaces, strict enforcement of tobacco control laws, and medical support for those who want to quit. Research has shown that measures such as tobacco taxation are effective in increasing revenues for the government while also reducing consumption, tobacco-related diseases, and pressure on health systems. Pakistan ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004, and WHO provides continuous technical support to the Ministry of National Health Services Regulations and Coordination and the Federal Board of Revenue in areas such as tobacco tax policy and track-and-trace implementation. WHO Deputy Representative in Pakistan Ellen Thom said, 'The 164,000 people dead to tobacco every year are not just numbers. They are workers with families. They are sons and daughters. They are also teenagers and children, who are particularly vulnerable and an easy target for the advertisement of the tobacco industry. Let us unmask the appeal. Tobacco is not a candy; it is a killer, and we need to protect our children, our families, and our communities.' Copyright Business Recorder, 2025
Scoop
28-05-2025
- Health
- Scoop
Commitment To End Tobacco Must Translate To Bold Actions On The Ground
Commitment to end tobacco must translate to bold actions on the ground, said Dr Tara Singh Bam. He exhorted the new government of Indonesia to sign and ratify the global tobacco treaty (formally called the World Health Organization Framework Convention on Tobacco Control or WHO FCTC) in the interest of the health and wellbeing of its people. FCTC is the first international legally binding corporate accountability and public health treaty of the WHO to protect people from the devastating tobacco use. It was adopted by the World Health Assembly of the WHO on 21 May 2003 and entered into force on 27 February 2005. Currently, among the countries that are part of the United Nations, except 14, all of them have ratified the FCTC. Among the 14 countries that have not yet become a part of the global tobacco treaty, 6 have signed but not ratified it, and 8 have not even signed it - including Indonesia. Dr Tara Singh Bam was addressing the delegates of 10th Indonesian Conference on Tobacco Control (ICTOH 2025) including Vice President of Indonesia, Minister of Health of Indonesia, and other dignitaries. Dr Bam is the Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT) and serves as Asia Pacific Director (Tobacco Control), Vital Strategies. Indonesian conference was held just few days before the World No Tobacco Day 2025 and few weeks before the World Conference on Tobacco Control opens in Ireland next month. With highest male smoking rates globally in Indonesia, ratifying FCTC is an urgent priority With an Adult Smoking rate of 39%, Indonesia ranks among the top 5 countries with highest smoking rates. It also holds the dubious distinction of having 74.5% male smokers - highest in the world. It is also the only country in the Asia Pacific region that has not signed the FCTC. Dr Bam blames it on the intense influence of tobacco industry on the government. It lobbies with the government, including giving donations to political parties for their political campaigns. According to Dr Bam, in the absence of FCTC, the tobacco industry interference is all pervasive in Indonesia- at the central level, provincial level and local level. So, the first urgent thing to do is for the government to sign the FCTC in the interest of public health. Once the government ratifies the treaty, it will become mandatory for it to implement all the provisions of the treaty comprehensively, including FCTC Article 5.3, that mandates protection of public health policies from commercial and other vested interests of the tobacco industry, and take steps to ensure that tobacco industry interference does not undermine the implementation of tobacco control measures and public policy. 'Signing FCTC is all about political leadership, commitment and action. What I have seen in Indonesia is commitment, but there is not enough action on the ground. Action also means that the government has to sign and ratify the treaty. The government has to be honest to its people. We now have a new government and hopefully it will take this issue seriously and ratify the treaty," he hoped. Bright tobacco products, dark deadly intentions The theme of World No Tobacco day 2025 theme is 'Bright Products. Dark Intentions. Unmasking the Appeal: Exposing industry tactics on tobacco and nicotine products'. Dark intentions indeed! Throughout its lifecycle, tobacco pollutes the planet and damages the health of all people. Globally, about 35 lakh hectares of farm land are destroyed to grow tobacco every year. Deforestation caused by tobacco farming is estimated at 2 lakh hectares annually. Sustainable food production in poor and middle-income nations is jeopardised where tobacco is grown as a commercial crop. Tobacco use is one of the biggest (and yet entirely preventable) risk factors for major non-communicable diseases (NCDs) such as type-2 diabetes, cardiovascular diseases (such as heart diseases and stroke), cancers, chronic obstructive pulmonary disease (COPD), and arthritis, as well as for communicable diseases like TB and COVID-19. One in six NCD deaths and 27% of TB deaths globally are attributed to tobacco use. The economic losses are staggering too. The global economic cost of tobacco use is estimated at USD 1.85 trillion annually, equivalent to approximately 1.8% of the world's GDP. These are funds that could be used by governments for education, healthcare, and social benefit schemes for the good of the common public, especially the disadvantaged communities. Burden and Impact of tobacco use in Indonesia In Indonesia too, tobacco is the leading cause of preventable deaths, claiming over 270,000 lives annually, which is about 23.3% of the total deaths. It deepens poverty and hits the most vulnerable the hardest. Tobacco use is also the biggest risk factor for TB in Indonesia which has the 2nd highest burden of TB globally. Smoking is responsible for up to 30% of Indonesia's TB burden, or 319,000 TB cases each year. All this drains the country's exchequer by over IDR 450 trillion or approximately USD 29 billion annually. And yet, the tobacco industry continues to find new ways to dole out this poison in various forms to lure youngsters and children - by way of new nicotine products like e-cigarettes and flavoured tobacco products- that are rapidly gaining ground. It is high time to focus on challenging the misleading techniques employed by the tobacco industry to make their unsafe products appealing to their victims. Silver lining Although Indonesia is yet to sign the WHO FCTC, Indonesia's Ministry of Health supports the Asia Pacific Cities Alliance for Health and Development (APCAT),which is a unique alliance of mayors and sub-national leaders from 122 cities of 12 countries. APCAT is dedicated to advance tobacco control, prevention and control of NCDs and TB in the region, among addressing other compelling health and development priorities. Several Indonesian cities are members of APCAT, including Bogor, Denpasar, Klungkung, Bandar Lampung, East Jakarta, Pekalongan, Malang, and Balikpapan. Local governments of these cities have been doing inspiring work on the ground for tobacco control since several years now which has demonstrated commendable public health impact. This includes implementing 100% smoke-free policy in all public and work places; banning tobacco advertising, promotion and sponsorship; building policy advocacy to raise taxes and prices on tobacco, alcohol and other harmful products; safeguarding peoples' health from tobacco industry tactics; incorporating NCD prevention programmes into primary healthcare services, among others. The way forward to #endTobacco But this is not enough. Dr Bam rightly calls upon all levels of government, parliamentarians, and stakeholders to act decisively to align the local tobacco control efforts with global standards by committing to the ratification of the WHO FCTC. He acknowledges the Presidential Regulation No. 28 of 2024 (that covers a wide range of healthcare issues, including regulations on tobacco products and steps against electronic cigarettes) as a step forward in the right direction, but thinks it is not enough for the scale of the crisis the country is facing. 'It is our shared responsibility to protect public health policies from the vested interests of the tobacco companies. Both national and local governments must ensure that all tobacco control policies are developed and implemented, free from tobacco industry influence. The tools, the science, and the evidence are in our hands. What we need now is political will and courageous leadership," he said. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
National News
24-03-2025
- Health
- National News
Lebanon stands to gain $400 million by implementing strong tobacco control measures
NNA - Under the patronage of H.E. the Minister of Public Health, Dr. Rakan Nassereldine, the Ministry of Public Health, the World Health Organization (WHO), the WHO Framework Convention on Tobacco Control (WHO FCTC) and the United Nations Development Programme (UNDP) launched today the 'Tobacco Control Investment Case Study in Lebanon.' The launch event took place in Beirut, bringing together key stakeholders and experts in public health and economic development. The new investment case reveals that Lebanon could avert more than $400 million (LBP 15.2 trillion) in economic losses and save up to 40,000 lives over the next 15 years by implementing six key tobacco control policies recommended by the WHO Framework Convention on Tobacco Control (WHO FCTC). The study highlights the devastating economic and human cost of tobacco use in Lebanon, currently estimated at $140 million annually, equivalent to 1.9 percent of Lebanon's GDP. This burden includes significant healthcare expenditures, lost productivity, and substantial human development losses. Furthermore, the economic benefits of strengthening tobacco control in Lebanon greatly outweigh the costs of implementation, with LBP 15.2 trillion in benefits versus just LBP 177 billion in costs. His Excellency the Minister of Public Health of Lebanon, Dr. Rakan Nassereldine said: 'Today, we are presented with strong evidence showing that tobacco control is not only a health priority but also a sound economic investment. This study quantifies what we have long known: tobacco use is devastating to individual health, increasing the burden of non-communicable diseases such as cancer, heart disease, and respiratory illnesses. But beyond the human suffering, tobacco also imposes an enormous cost on our healthcare system, weakens productivity, and drains resources that Lebanon can no longer afford to lose.' Dr. Abdinasir Abubakar, WHO Representative in Lebanon emphasized that the national tobacco control law targeting to implement the various aspects of the WHO FCTC is an important public health measure that aims at improving people's health, preventing harm to non-smokers' health, and reducing the economic burden of smoking at the national level. He indicated that Lebanon stands as one of the top countries in the region for high smoking prevalence, highlighting an urgent need for decisive action in tobacco control. 'Integrating tobacco control into national economic recovery and growth plans and policies, will be critical in helping Lebanon achieve its economic goal' he said. Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO FCTC added: 'The findings of this investment case are clear. Strengthening tobacco control in Lebanon is not just a health imperative, it's an economic opportunity,' 'By taking decisive action now, we can significantly improve the lives of tens of thousands of Lebanese citizens and divert essential funds towards developmental priorities. We urge Lebanon to strengthen these life-saving measures in line with the WHO FCTC.' UNDP Deputy Resident Representative, Mr. Thair Shraideh emphasized the need for sustained efforts in tobacco control through policy reform and legislative advancements. 'Lebanon has made progress in tobacco control, but further action is needed to protect public health and drive sustainable development,' he said. 'At UNDP, we remain committed to supporting Lebanon in this journey, together with the government, WHO, and our partners. By strengthening legislative frameworks, advancing evidence-based policies, and fostering multi-sectoral collaboration, we can mitigate the economic and health impacts of tobacco use while promoting broader development goals that safeguard well-being and protect future generations.' According to the investment case, implemented in collaboration between the Ministry of Public Health, the UNDP global health team and WHO, implementing the WHO FCTC measures could save over 2,600 lives per year and allow Lebanon to reinvest savings from reduced healthcare expenditures and increased tobacco tax revenues into critical national development priorities. These include universal health coverage, social protection programs, and economic recovery efforts. Currently, more than 9,000 people die from tobacco-related illnesses per year in Lebanon, accounting for more than a quarter of all deaths in the country. Lebanon became a Party to the WHO FCTC in 2005, yet additional policy actions are required to fully leverage its benefits. The recommended policy actions include: Commit to fully implement the WHO FCTC. Strengthen tobacco tax structures and increase tax rates (WHO FCTC Article 6). Implement and enforce the other five tobacco control policies studied in this investment case: Create smoke-free public places and workplaces to protect people from the harms of tobacco smoke (WHO FCTC Article 8); Require graphic health warnings on tobacco product packaging that describes the harms of tobacco use (WHO FCTC Article 11); Plain packaging of tobacco products (WHO FCTC Guidelines for implementation of Article 11 and WHO FCTC Guidelines for implementation of Article 13); Promote and strengthen public awareness of tobacco control issues, including the health risks of tobacco use and tobacco smoke, addiction, and the benefits of cessation (WHO FCTC Article 12); and Promote cessation of tobacco use and treatment for tobacco dependence by training health professionals to provide brief advice to quit tobacco use (WHO FCTC Article 14). Strengthen multisectoral coordination for tobacco control in Lebanon by establishing a national coordination mechanism and bringing together various stakeholders (WHO FCTC Article 5.2a). Develop a national tobacco control strategy for Lebanon (WHO FCTC Article 5.1). Implement measures to protect public health policies from the commercial and other vested interests of the tobacco industry (WHO FCTC Article 5.3). Join the Protocol to Eliminate Illicit Trade in Tobacco Products, including by building capacity to combat illicit trade (Protocol and WHO FCTC Article 15). Identify opportunities to link the implementation of the WHO FCTC with wider sustainable development strategies. This initiative marks a further step in Lebanon's commitment to reducing tobacco-related health and economic burdens. -- WHO Lebanon
Al Jazeera
27-02-2025
- Health
- Al Jazeera
The tobacco epidemic is still one of the world's deadliest threats
In the past 20 years, tobacco use has dropped by one-third globally, and there are an estimated 118 million fewer tobacco users today compared with 2005. Why? In large part because 20 years ago this week, after years of negotiation, the WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force – one of the most widely embraced United Nations treaties in history. The WHO FCTC was, and remains, a landmark in international law: the first treaty negotiated under the WHO Constitution, incorporating multiple measures to control the demand and supply of tobacco. Today the convention has 183 parties, covering 90 percent of the world's population. More than 5.6 billion people are protected by the comprehensive implementation of at least one tobacco control measure. For example, 138 countries now require large pictorial health warnings on cigarette packages, and dozens of countries have implemented plain packaging rules that prohibit branding on cigarette packages, making them less attractive. In addition, 66 countries have implemented bans on tobacco advertising, promotion and sponsorship; more than one-quarter of the world's population is protected by bans on indoor smoking and other smoke-free laws; and increased taxes on tobacco products to reduce their affordability remains the most cost-effective tool to reduce consumption. Tobacco taxes can also raise government revenues for tobacco control and health financing. Furthermore, in 2018, an additional legal instrument entered into force: A protocol to eliminate all forms of illicit trade in tobacco products, which undermines control measures, diminishes tax revenue, and fuels criminal activities. Despite this progress, tobacco remains the world's leading cause of preventable death and a major driver of heart disease, stroke, cancer, chronic respiratory diseases, and diabetes. There remain about 1.3 billion tobacco users globally, prompted by a multibillion-dollar industry that peddles addictive and deadly products and profits from the suffering of those who use them. Faced with dwindling sales of cigarettes, the industry is turning to new products, such as e-cigarettes, which are falsely advertised as healthier alternatives – even though they generate toxic substances, some of which are known to cause cancer and some that increase the risk of heart and lung disorders. Tobacco manufacturers spare no effort in hooking millions of young people onto their products. Only 56 countries will reach the global goal of a 30 percent reduction in tobacco use by 2025. Tobacco is not only a health problem. It threatens sustainable development as a whole. The economic cost of smoking, in terms of health expenditures and productivity losses, is estimated at 1.8 percent of the world's annual gross domestic product. Our planet also counts among tobacco's victims. Roughly 4.5 trillion cigarette butts are discarded every year into our environment – the second highest form of plastic pollution in our world. Valuable agricultural land and water are wasted on growing tobacco instead of food. Production and consumption of tobacco also contribute to global warming, releasing 80 million tonnes of carbon dioxide into the air every year. For all these reasons, the WHO FCTC remains as relevant today as it did when it entered into force 20 years ago, although its implementation remains uneven across countries and many areas require strengthening. All countries can do more, including by banning tobacco sponsorship and advertising in traditional media and social media, and by protecting public health policies from tobacco industry interference. By fully implementing its provisions, countries can protect the health of their people, their economies, and their environment for decades to come.
