India tops ‘no tobacco’ labelling, says WHO. But what about second-hand smoking?

Hundreds of enforcement drives, putting up ‘No Smoking’ signs, and communication about the effects of smoking as well as second-hand smoke resulted in a 27 per cent reduction in smoking in public places in Bengaluru. Earlier this year, the city received international recognition for its efforts, said a case study in the recently released report by the World Health Organisation (WHO) on the implementation of tobacco control measures.

Across the world, there are 300 million fewer smokers in the world today, with the prevalence of smoking declining from 22.8 per cent in 2007 to 17 per cent in 2021 due to these control efforts. Fifteen years ago, the inter-governmental organisation developed the MPOWER measures – monitor tobacco use and prevention policies, protect people from tobacco smoke, offer help to quit tobacco, warn about the dangers of tobacco, enforce bans on tobacco advertising, and raise taxes on tobacco products – to reduce the impact of tobacco on health.

In the fifteen years since the MPOWER measures were first introduced, 5.6 billion people in the world – or 71% of the entire population – are protected by at least one of the measures. This has increased from just five per cent of the population in 2008.

The number of countries implementing at least one MPOWER measure has increased from 44 countries in 2008 to 151 in 2022, according to the report. At least four countries – Brazil, Turkiye, the Netherlands, and Mauritius – have implemented all the measures. Eight other countries are just one policy away.

WHO urges all countries to put in place all of the MPOWER measures at a best-practice level to fight the tobacco epidemic, which kills 8.7 million people globally, and push back against the tobacco and nicotine industries, which lobby against these public health measures,” said Dr Ruediger Krech, WHO, Director for Health Promotion.

With a focus on second-hand smoking, the report says that almost 40 per cent of countries now have completely smoke-free indoor public spaces.

The report has some bad news as well. There are at least 44 countries in the world that still do not implement any of the MPOWER measures. There are also 53 countries that still do not completely ban smoking in healthcare facilities. And, only half of the countries have smoke-free workplaces and restaurants.

The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, warns of the dangers of e-cigarettes. In the report, he said, “But progress so far is being undermined by the tobacco industry’s aggressive promotion of e-cigarettes as a safer alternative to cigarettes. Young people, including those who never previously smoked, are a particular target. In fact, e-cigarettes are harmful to both the people using them and those around them, especially when used indoors.”

Why is it important to bring down exposure to second-hand smoke?

The recently released report focuses on second-hand smoking in order to protect bystanders from second-hand smoke by creating smoke-free public areas and also de-normalising the act of smoking in society.

Of the estimated 8.7 million tobacco-related deaths each year, 1.3 million happen in non-smokers exposed to second-hand smoke as per the Global Burden of Disease 2019 quoted by the report. Second-hand smoke has been linked to almost 400,000 deaths due to heart disease, over 250,000 deaths due to chronic obstructive pulmonary disease, over 150,000 deaths due to stroke and lower respiratory disease each, and over 100,000 deaths due to diabetes.

The report also adds that severe asthma, respiratory tract infections, and sudden infant death syndrome are all more common among children exposed to second-hand smoke. Around 51,000 deaths in children and adolescents under the age of 20 years are linked to exposure to second-hand smoke.