Impact of Smoking in a Tobacco Growing Developing Country

Abstract

The chapter outlines the impact of smoking aspects for a developing country whose economy is dependent on tobacco growing. On the environmental front, other than the pollution of the air by tobacco smoke; large tracts of forests are destroyed, and heavy losses are incurred due to perennial veld fires that would destroy properties, flora and  fauna, and in some instances human lives, when smoldering cigarette stubs are recklessly thrown away after smoking. Public health bill is shooting up in treating cancer caused through smoking, which has become the major killer disease ahead of HIV/AIDS in the country.

Socially, there has been a marked shift to youth of school going age resorting to smoking which has resulted in early risk behavior tendency including the uptake of alcohol, drugs and indulging in sex, due to excessive exposure to intense advertisement by the tobacco industry. Weak legal framework has done very little in enforcing tobacco smoking control, prohibition of public smoking legislation and sale of tobacco to the under aged individuals. It was noted that the deep seated view of the ever thriving tobacco industry as the mainstay of the economic exports, militates against the intended initiatives to reduce the smoking prevalence.

Keywords: smoking, cigarettes, tobacco, control, pollution, health, environment

1. Introduction

The smoking habit is started at an early age, it is carried on into adult life [1]. According to studies, once a person starts smoking, it becomes difficult to stop. Among those who continue to smoke throughout their lives, about half can be expected to die from a smoking-related cause, with half of those deaths occurring in middle age. Therefore, adolescents and school-aged children should be a primary focus for intervention strategies [1, 2]. There is need to pool together the evidence, technical support, and strategic alliances necessary to positively address the negative impact of tobacco and to encourage and support children and adolescents in leading healthy and active lives free of tobacco [1].

It is estimated that, of the 6.6 billion people on this planet, 1.3 billion are smokers and 1 billion of these are males. By 2030, tobacco is expected to be the single biggest cause of death worldwide causing more deaths than HIV, malaria, tuberculosis, maternal mortality, automobile crashes, homicides and suicides combined [1]. Furthermore, it is expected that tobacco-related diseases will account for 11 percent of all deaths in developing countries by 2025. No other consumer product has even come close to inflicting this degree of harm on the world community [2].

2. Background

Zimbabwe has a long history of tobacco growing. In 2012 the country was the top tobacco-producing nation in Africa, and in 2013 it was the sixth largest tobacco producer in the world [3]. According to Zimbabwe’s Tobacco Industry and Marketing Board, 98 % of Zimbabwe’s tobacco is exported, making it the country’s largest foreign currency generator (accounting for 10–43 % of the country’s gross domestic product).

Tobacco is a major source of employment. There are currently over 90,000 tobacco farmers, and tobacco growing is prioritized, despite widespread food insecurity and environmental degradation. As a result, despite widespread hunger in Zimbabwe, farmers are more likely to grow tobacco than grain [5].

The country recently joined the Framework Convention on Tobacco Control (FCTC) which obligates nations to implement a variety of tobacco control measures [3]. These entail the requirement for members to adopt and implement measures that address tobacco control in three domains – tobacco demand reduction, tobacco supply reduction, and protecting the environment [5]. To date, Zimbabwe has implemented several measures aimed at reducing tobacco demand, but fewer aimed at reducing tobacco supply or protecting the environment.

3. Tobacco smoking review

While daily smoking prevalence among women in Zimbabwe is relatively low (5 %), men’s smoking prevalence is much higher (33 %), reflecting the growing popularity of smoking among African men. There is a demonstrable need for tobacco control in the country. Zimbabwe has few tobacco control measures and one national tobacco control law, Statutory Instrument 264 of 2002 [3]. The consumption of cigarettes is associated with negative social, health and economic consequences, which affect both smokers and non-smokers alike.

It has been argued that, smoking caused diseases in African countries are lower than international standards; the rise in smoking prevalence suggests a looming epidemic of smoking related diseases. Information on tobacco use among young people is not available for most developing countries like Zimbabwe and the last survey was conducted ten years ago [1]. This means, if the effort on tobacco control is to succeed globally, progress has to be made in Zimbabwe too and the impact of intervention closely monitored and evaluated.

Current interventions entail health warnings are a requirement on cigarette packages, there are some designated smoke-free settings, and cigarettes are taxed at 60 % of the retail price. While there are laws to prevent tobacco sales to minors, young urban and rural dwellers report easy access [4]. Efforts being made at sending anti-smoking messages to the youths are being diluted by advertising 'positive' images of smoking. Urban residents are more exposed to both contradicting types of messages because they have access to televisions, newspapers and magazines [3,5]. Most billboards are erected and more sporting events, especially soccer matches, the most popular sporting events are held in urban areas.

Brazil, despite it being the world’s top tobacco producers, managed to successfully reduce tobacco use by 50 %, without adversely affecting its tobacco growing revenue coming from exports, since tobacco control measures that target internal tobacco use cause little conflict with export profits. This example suggests that Zimbabwe may also be able to implement tobacco control at home with insignificant impact on exports [4].

The FCTC has been slow to agree on a coherent and effective policy around supporting economically viable alternatives to tobacco growing and protecting the environment.

4. Economic impact of tobacco smoking

Zimbabwe is the largest grower of tobacco in Africa, and the 6th largest grower in the world. Tobacco plays a big role in Zimbabwe's economy. According to statistics by the UN's Food and Agriculture Organization, it is the country's largest export commodity - and its most valuable  one, accounting for nearly 10 percent of GDP [9].

Tobacco production recovered and peaked at 217 million kilograms in 2014 as given by Table 1 below. China purchased 54% of Zimbabwe's tobacco exports in 2015 [10].

Cigarette consumption per capita is mainly looking at the total annual cigarette consumption that is the number of consumed cigarette sticks divided by the total adult population aged 15 and over in the country. The Figure 2 shows the major declines in cigarette consumption that occurred in 1982, 1984, 1992 and 2005-2008. During 1982 and 1992 the consumption had declined due to presence of drought in the country, where consumers had diverted the need of purchasing more cigarettes to the purchasing of more food stuffs for themselves and family. In 2004 up to 2008 the economy was unstable, where the economy was declining; the Zimbabwean dollar was depreciating and presence of hyperinflation in the country [9]. A decline in the economy affected agricultural output which also affected the manufacturing industries in terms of reduction in output produced and the closing down of companies. The closing down of companies led to an increase in the number of individuals employed in the county, hence leading to a decrease in disposable income available which led to a decrease in consumption. In 2009-2011 came the introduction of the multicurrency system in the country, where an increase in consumption was recorded. From 2011-2015 Figure 2 shows a decline in consumption which was influenced by an increase in excise tax which lead to an increase in price, where the poor are the ones who are the most sensitive to a change in price [11].

In the country, the government fears that a tax increase on cigarette sales and other proven cost effective tobacco control measures will harm their economies in terms of revenue, job and income losses. Despite that the demand for cigarettes is inelastic, Zimbabwe is one of the countries that have the lowest excise tax on cigarettes in Africa at 40%, where it is below the recommended WHO excise tax rate of 75-80%, which could effectively reduce resulting demand [7, 8]. Many countries have taken measures to reduce cigarette smoking as a way of reducing tobacco related social costs.

In previous studies, it was concluded that a positive price elasticity of cigarettes implied that increasing tax on the tobacco product will only raise tax revenue and not reduce the demand for the consumption of the product.

Looking at the cigarettes and the addictive behavior associated with the product, the demand for cigarettes does not follow the essential laws of economics and the theory of demand. Thus the cigarettes being an addictive product, there is no demand influence on the change in price of the commodity. Instead, results showed that peer networks had a positive and significant influence on smoking intensity and participation, compared to excise tax and tobacco control policies introduced by the government.

5. Social impact of smoking

According to the WHO, (2008) smoking is recognized as one of the most preventable causes of premature death in developed countries where the smoking epidemic in developing countries is now becoming even more popular and accepted in society. These countries mostly concentrate on malnutrition and infectious diseases, and have a low priority when it comes to smoking.

It was established that the majority of smokers became addicted when they were still teenagers. The main reasons why the youth smoke is to look mature, to experiment and to be like their friends. This brings out another feature that smoking also provide a social reward, by making the consumer feel like they are part of a group which can provides a sense of comfort and acceptance at any age [17].

The consumption of cigarettes is increasing in the country. Adults also smoke when they have a lot of stress and pressures because of personal and economic problems. The reason for smoking being to feel relaxed or getting energy to get through one’s rough patch. While others smoke because they love smoking as it makes them feel good about themselves and gives them a sense of pleasure [10].

Provision of educational sections in the school curriculum is important to educate the youth on the short and long-term effects of smoking. Also an introduction of effective warning labels to be added to all tobacco products. The Government can introduce a system that sends texts messages to every individual using a cellular network just stating the effects of smoking and encouraging the receiver to stop smoking [1]. The Government should also provide cessation programs, medication to smokers to help them quit, and providing medical education informing smokers that quitting is cheaper than treating an illness that is caused by smoking.

6. Environmental impact

The tobacco industry damages the environment in ways that go far beyond the effects of the smoke that cigarettes put into the air. Tobacco growing, the manufacture of tobacco products and their delivery to retailers all have severe environmental consequences, including deforestation, the use of fossil fuels and the dumping or leaking of waste products into the natural environment [16]. From growing tobacco plants to the disposal of cigarette butts, the whole life cycle of a cigarette takes a heavy toll on the environment. The ecological impacts of tobacco are serious cause for concern, especially in a tobacco growing country like Zimbabwe.

6.1. Cigarette butts on the environment

6.1.1. Veld fires

Smoking in rural and commercial farming areas has been considered the cause of most veld fires that emanate from the disposal of discarded cigarette butts on dry grass. It was observed that farming land destroyed by veld fires in Zimbabwe amounted to 950 905 hectares in 2009, 1 152 413 hectares in 2010, 713 770 hectares in 2011 and 1 320 325 hectares in 2012, thereby posing serious challenges to environmental sustainability [11, 13].

As can be observed Figure 5, most veld fires occur through careless human activities that include improper disposal of cigarette stubs and the burning of vegetation during land preparation being the major causes of veld fires (Forsyth et al 2010).

The veld fires have been taking their toll on the environment in communal areas, destroying any damageable material. Trees, species of wildlife, farming land, livestock, human lives and livelihoods suffer under the severe threat posed by veld fires. The natural environment has seen the destruction of the fauna and flora whilst the loss of property, pollution and at times injury have been the order of the day in the human environment [12]. Veld fires also result in the decline of veld conditions and an increase in air pollution, thereby reducing the quality of air that people breathe. Fires also emit millions of tons of gases and particulate matter into the air, with serious consequences for human health and carbon balances that contribute to global climate change.

If not controlled, veld fires would result in an unclean environment, severe environmental degradation and diminished livelihoods [12]. This has resulted in severe destruction of the veld, affecting the flora and fauna. As such, veld fires also pose some danger to human life since communities depend on the same degraded environment [11]. Air and water pollution have been the result of such veld fires in the two districts, thereby creating health hazards that are due to the unsustainable environment.

As such, there is need to come up with sound interventions meant to protect, preserve and sustain the environment, such as the tobacco smoking control legislation to reduce veld fire incidence.

6.1.2. Water pollution

Tobacco product waste is the end point of the life cycle for tobacco products, and cigarette butts are by far the largest single type of litter by count. Tobacco waste ends up everywhere and it is a well-known public nuisance for many communities, especially those with few resources to remove it. Clean-up and disposal are costs of tobacco use that are not currently borne by manufacturers, distributors, or users of tobacco products [13]. The clean-up costs of tobacco waste, like discarded cigarette butts, is generally borne by municipalities, as are the associated disposal costs for waste including heavy metals and  poisons that leach from cigarette butts once in landfill, including arsenic.

Long after a cigarette has been extinguished it continues to cause environmental damage in the form of non-biodegradable butts – millions of kilograms of which are discarded every year. Cigarette butts are the most common item accumulating in local waste stream. Tossing a cigarette butt on the ground has since become one of the most accepted forms of littering globally and borders on a social norm for many smokers [15, 16]. The increase of butt disposal directly into the environment has been attributed as a side-effect of restrictions on smoking in workplaces, bars and restaurants.

Toxic chemicals in cigarette butts contribute to non-point source pollution when carried through storm drains by rainfall and urban runoff to dams, rivers, wetlands, and even underground sources of drinking water [13, 15]. Non-point source pollution has harmful effects on drinking water supplies.

Studies have also shown that harmful chemicals such as nicotine, arsenic, polycyclic aromatic hydrocarbons (PAHs) and heavy metals leach from discarded tobacco product waste, and can be acutely toxic to aquatic organisms such as fish [15]. A cigarette butt may look like the end of the damage brought by a cigarette, but there is still a way to go in addressing post-consumer waste clean-up and responsible disposal.

6.2. Deforestation

Tobacco farming has become the main cause of deforestation in countries such as Zimbabwe. There is evidence of substantial, and largely irreversible, losses of trees and other plant species caused by tobacco farming that make it a particular threat to biodiversity.

Tobacco control efforts aimed at the protection of the environment and health of persons represent another hurdle. Deforestation is a particularly significant problem for Zimbabwe, since flue-cured tobacco requires heat to process the leaves, and wood is used as a fuel supply [6].

After harvesting, tobacco is dried and cured to preserve it for storage, transport and processing. Indigenous trees are cut down to provide fuel for the curing process and construction of curing barns as given in Figure 7, as a crop it is responsible for damage to ancient forests.

7. Smoking impact on public health

No matter how one smokes it, tobacco is dangerous to one’s health. There are no safe substances in any tobacco products, from acetone and tar to nicotine and carbon monoxide. The substances you inhale do not just affect the lungs. They can affect your entire body. Tobacco smoke is incredibly harmful to your health. There is no safe way to smoke.

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. Quitting smoking lowers one’s risk for smoking-related diseases and can add years to one’s life. Smoking harms nearly every organ of the body and affects a person’s overall health [7]. Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost.

Regardless of the widespread knowledge of the harm caused by smoking, only little success has been achieved in tobacco control initiatives. It is estimated that there are currently 3.5 million deaths a year from tobacco, and this figure is expected to rise about 10 million by 2030 [8]. By that  date, 70% of the likely  deaths will be experienced in developing countries.

Tobacco use is distinguished from many other health problems by the presence of an aggressive, transnational tobacco industry whose goals are fundamentally incompatible with public health [3]. Like other industries, the tobacco industry not only seeks to promote use of its products and expand into new markets, but also seeks to weaken strong tobacco control policies and undermine public health advocacy efforts [4].

There is a strong relationship between smoking prevalence and lung cancer patterns. Because smoking is the major cause of lung cancer and lung cancer commonly takes 20 or more years to develop, smoking prevalence is an important predictor of future lung cancer patterns [7]. Likewise, today’s lung cancer patterns are a good indicator of the smoking prevalence of previous decades. When one takes up smoking, there is a greater chances of contracting cancer later in life. It can be assumed with accuracy that a majority of the youths that are current smokers would develop lung cancer before they reach the age of 35 [8]. Smoking can cause lung disease by damaging the airways and the small air sacs (alveoli) found in the lungs. Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis. If you have asthma, tobacco smoke can trigger an attack or make an attack worse [7].

There are also other diseases that are caused by smoking, such as heart diseases, strokes and a range of respiratory diseases. Smoking causes about 80% of all deaths from chronic obstructive pulmonary disease (COPD). Smoking damages blood vessels and can make them thicken and grow narrower. This makes the heart beat faster and one’s blood pressure go up. Clots can also form. A stroke occurs when a clot blocks the blood flow to part of your brain, and a blood vessel in or around your brain bursts[7, 8]. Blockages caused by smoking can also reduce blood flow to your legs and skin.

Smoking can affect bone health. Women past childbearing years who smoke have weaker bones than women who never smoked. They are also at greater risk for broken bones. Smoking affects the health of your teeth and gums and can cause tooth loss [7]. Smoking causes general adverse effects on the body, including inflammation and decreased immune function.

Some effort is being made to ban smoking in public places but at not an individual level. Very few are aware of the dangers of smoke from other people's cigarettes with yet fewer in favor of banning smoking in public places. This is unmistakably a lack of knowledge on the dangers of environmental tobacco smoke to one's health [9]. During the past two or so decades, research has been undertaken worldwide to reveal the evidence on the health effects of passive smoking. These studies have concluded that passive smoking increases the chances of contracting or aggravating a range of illnesses including:  cardiovascular disease, lung cancer as mentioned above, asthma (particularly in children), acute irritation of the respiratory tract, bronchitis, pneumonia and other chest illnesses in children [8].

One huge problem that cannot be overshadowed by the economic use of tobacco is its increased use by young people and the long-term effects to their health [1].

8. Outdoor air pollution by Environmental Tobacco Smoke (ETS)

Environmental tobacco smoke (ETS) could be described as the material in indoor air that originates from tobacco smoke. Breathing in ETS is known as passive smoking, second-hand smoke, or involuntary smoking [8]

Tobacco smoke consists of solid particles and gases. The solid particles make up about 10 percent of tobacco smoke and include "tar" and nicotine. The gases make up about 90 percent of tobacco smoke and the major gas present is carbon monoxide. Others include formaldehyde, acrolein, ammonia, nitrogen oxides, pyridine, hydrogen cyanide, vinyl chloride, N-nitrosodimethylamine, and acrylonitrile. Of these, formaldehyde, N- nitrosodi-methylamine and vinyl chloride are suspected or known carcinogens in humans. Acrylonitrile has been shown to cause cancer in animals [15, 16].

Environmental tobacco smoke (ETS) is composed of both mainstream and side stream smoke. ETS is diluted by the air in the room before it is inhaled and is therefore less concentrated than mainstream or side stream smoke. Every person – both smokers and non-smokers – in a room with ETS will have similar exposure because nearly 85 percent of ETS in a room comes from side stream smoke. The smoker is also exposed to mainstream smoke, but this exposure is limited to the time it takes to smoke a cigarette [8]. However, exposure to ETS remains constant for the entire time spent in that room.

Exposure to ETS has been estimated in terms of "cigarette equivalents". Cigarette equivalents can be measured by determining carboxyhemoglobin levels in blood. Carboxyhemoglobin is formed in the blood when someone inhales carbon monoxide. The hemoglobin in the blood that has oxygen bound to it is called oxyhemoglobin. It is the oxyhemoglobin that carries oxygen to the tissues. However, carbon monoxide has a much stronger attraction to hemoglobin than oxygen. Thus, inhaled carbon monoxide quickly replaces the oxygen in the oxyhemoglobin and binds to the hemoglobin to form carboxyhemoglobin which can be measured [7]. Various studies suggest that passive exposure to ETS over an eight-hour day is comparable to directly smoking one to three cigarettes.

While no single study can say that there is a 100% chance of health problems as a result of exposure to ETS, an association between ETS and various health conditions is considered very likely because there is:

• the proven link between heart diseases and lung cancer to active smoking,
• the presence of several known carcinogens in environmental tobacco smoke, and
• the general acceptance that the risks of certain diseases are directly related to the amount of tobacco smoke inhaled.

When evidence from various studies is combined, they indicate that exposure to ETS increases the number of lung cancers detected in non-smokers. Non-smoking co-workers of smokers have a relative risk of being affected. Non-smokers with heart disease (angina pectoris) exposed to ETS in ventilated and unventilated rooms had increased heart rates, elevated blood pressures and increased carbon monoxide in the blood. ETS aggravates allergy symptoms. It is generally more irritating to the respiratory tract of asthmatics and it can aggravate some asthmatic symptoms such as wheezing [3].

Many of the substances in cigarette smoke are very irritating to the eyes, throat and respiratory mucous membranes. A high proportion of non-smokers report eye irritation, headache, nasal discomfort, cough, sore throat, or sneezing when exposed to cigarette smoke. Eye irritation seems the main symptom during passive exposure to cigarette smoke.

9. Study observations and findings

The current smokers could have been exposed to their own smoking or they associated or frequented places where they could also smoke. Surprisingly though, not many smokers were in favor of banning smoking in public places, with less than half saying they were in favor. There were difficulties as some of the current smokers try to quit smoking in recent past, with no success.

However smokers often do not take into serious consideration the long-term consequences of smoking behaviors. For youths, the risks of tobacco use are perceived to be remote and are outweighed by what they see as the immediate benefits [5]. They tend to underestimate the addictiveness of nicotine and the difficulties associated with quitting, believing it is easier for young people to quit than adults.

Due to the proven association between high-risk behaviors like tobacco & drug abuse and HIV transmission, most of the school-based programs are now touching on the dangers of tobacco. Clear messages on the health hazards of smoking are not being adequately given within the school environment [18].

As government regulation, Chapter 5:06 of the Statute Law of Zimbabwe prohibits the sale of alcoholic beverages or tobacco products to persons below the age of 18. Most of the shopkeepers are well aware of the age restriction but due to the need for increased sales, they do not adhere to the requirements [19]. Because of lack of enforcement of this law, the practice is further worsened because the shopkeepers know that nobody will prosecute them. Public smoking is a criminal offence under the Section 81 of Forestry Act, but no smoker has been prosecuted under the Act.

The Health and Child Care Ministry has been using legislations such as the Public Health Act Chapter 15:09 of 1996 and the Statutory Instrument 264 of 2002 on smoking regulations, which stipulate that smoking in public places such as halls, public offices, buses, airlines, schools and commuter omnibuses is prohibited, to fight the scourge of public smoking. Besides drafting such policies, their enforcement and public awareness need to be considered.

10. Discussion on smoking impacts

The study showed that there is substantial burden of experimental smoking among adolescents. It was established that experimentation with danger is crucial to the adolescent experience and they start this as an act of rebellion or as a sign of maturity but it ends up being an addictive behavior later in life. Consistent with other studies, the prevalence of smoking was higher among males and the gap between males and females seemed not to be narrowing as previous studies intimated. This difference in prevalence between genders might be due to social and cultural acceptance of smoking among males rather than females in the country.

The low prevalence rate among the African Origin group could be explained by the economic situation in Zimbabwe which has left people without any disposable cash, especially those from high density areas. The issue of increase in the prevalence of smoking across age groups might be explained by the addictive nature of the habit and therefore students fail to stop and experience withdrawal symptoms during times of abstinence, therefore they continue smoking up to adulthood. It therefore follows that a program that successfully reduces youth smoking is likely to yield a good long-term public health benefit as most of these people who become smokers in adulthood start whilst they are still in their youth.

Issues related to planting alternative crops and reducing environmental and health damage from tobacco growing are contentious and complex and any proposed solutions are likely to pose challenges for the country, and are now officially involved in future discussions to be undertaken. In country the use of taxation has been embarked on as a form of tobacco control by the Ministry of Finance and Ministry of Health. Similar efforts could be made by environmental and health authorities, who already collaborate on shared concerns such as air pollution by introducing relevant penalties to reduce pollution.

11. Way forward in tobacco smoking control

Establishing Extended Producer Responsibility and Product Stewardship programs would also contribute to public health outcomes such as reducing tobacco use and increasing the cost of tobacco products; enacting new tobacco product regulations and labelling to make the product less marketable; and strengthening existing anti-litter and outdoor smoking bans. This could also include large campaigns to raise public awareness of the environmental effects of tobacco waste, building momentum for advocacy against their irresponsible disposal. Thus numerous criteria can be used to determine how tobacco product waste should adhere to Extended Producer Responsibility and Product Stewardship principles and standards [16].

Although assisting young people to avoid smoking is a widely endorsed goal of public health already, no adequate action has been taken to develop interventions that stop or reduce this habit and to make informed decisions in the country. Since the findings are almost similar to those found in Western countries, high cigarette prices and laws against youth access or adolescent tobacco education can be recommended as interventional strategies which work.

Furthermore, if health policy makers need to reduce the impact of tobacco related diseases like Tuberculosis, strategies for controlling tobacco use should be implemented now. Future studies should be implemented to monitor and evaluate the impact of the interventions.

12. Conclusion

Zimbabwe’s current economic hardship, its robust tobacco growing and distribution infrastructure, and continued world demand for tobacco suggest that the government will continue to prioritize tobacco production in the absence of incentives to do otherwise. There is need to have programs that highlight the dangers of smoking. Introduction of new tobacco control and prevention programs in the country, will save lives, reduce illnesses, and help reduce the economic burden associated with tobacco-related illness and lost productivity. According to available literature, non-smokers incur direct costs through passive smoking, where it has an impact on the non-smoker’s health and has greater risk on property damage by fires. The financial costs are incurred by individuals who are not exposed to smoke, which include public or private health care costs that are tobacco related.

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