In the Philippines, under regulated advertising for tobacco products, cigarette brands have developed more creative products like packets of 10 sticks instead of the standard 20 to make them cheaper for consumers. Credit: Kara Santos/IPS

By Carey L. Biron
WASHINGTON, Sep 7 2013 (IPS)

Between concluding rounds of negotiations towards the Trans-Pacific Partnership (TPP), a major U.S.-proposed free trade agreement, a divisive fight has heated up over the extent to which countries should be allowed to regulate the sale of foreign – potentially far cheaper – tobacco products.

In duelling proposals offered during the latest round of negotiations, in Brunei late last month, the United States and Malaysia put forward starkly different approaches. While Washington is urging that tobacco products be given no special consideration, the Malaysian government has countered that these items should receive a special “carve-out”, exempting them from a broader lifting of trade restrictions.“When you lower tariffs on cigarettes, prices become cheaper, greater numbers of kids and poor people become addicted, and overall health gets worse.” -- Ellen R. Shaffer of the Centre for Policy Analysis

Now, critics of the U.S. proposal are hoping to emphasise the health implications of these proposals ahead of the next 12-country TPP talks, slated to take place here in Washington starting Sep. 18. The administration of President Barack Obama had initially hoped to have a final agreement text by October, but that now looks extremely unlikely.

“Under other trade agreements, tobacco companies are currently using their investment provisions to attack public health regulations,” Arthur Stamoulis, director of the Citizens Trade Campaign at Public Citizen, a Washington-based consumer watchdog, told IPS.

“For this reason, many feel there needs to be a broad carve-out in this agreement for tobacco, if public health is going to be protected. Fortunately, as negotiations get further along and the negotiators get into thornier issues, there’s a lot more people paying attention to these talks.”

New York Mayer Michael Bloomberg, a long-time proponent of greater tobacco control, recently suggested that the U.S. proposal could directly contribute to “tens of millions” of deaths globally.

The potential results of the U.S. proposal are fairly clear, with repeated evidence going back to at least the 1980s. For instance, according to findings by the Government Accountability Office, the U.S. Congress’s main watchdog, after international tobacco companies moved into South Korea in 1989, teenage smoking increased fourfold within the first year.

“There’s no question about it,” Ellen R. Shaffer, co-director of the Centre for Policy Analysis, a group focused on trade and health issues, told IPS. “When you lower tariffs on cigarettes, prices become cheaper, greater numbers of kids and poor people become addicted, and overall health gets worse.”

Chilling effect

Advocates of tougher restrictions are warning that the U.S. scheme would be particularly dangerous to developing countries. Not only could the proposal open these economies to potentially cheap cigarettes coming from other countries, but it would also make them vulnerable to expensive litigation from powerful tobacco interests if these countries try to impose trade restrictions.

Smoking rates in the United States and many other developed countries have come down dramatically in recent years, in part on the back of a unique wave of international agreement about tobacco’s deleterious health effects. Indeed, the world’s only international health accord, the Framework Convention on Tobacco Control, which entered into effect in 2005, has been ratified by 176 countries – including each of the dozen in the TPP negotiations, except for the United States.

Yet smoking rates are rising in many developing countries. With tobacco use having led to roughly 100 million deaths during the last century, experts now estimate that it could cause upwards of a billion deaths this century – more than 80 percent of which will likely be in developing and middle-income countries, according to the World Health Organisation.

In the TPP negotiations, the new U.S. position rescinds an earlier draft proposal that included an exemption for tobacco-control measures. Instead, the new proposal simply recognises that countries are allowed to put in place health regulations, similar to other treaties.

It also offers a compromise of sorts. If any tobacco-related trade dispute were to arise due to the imposition of health-related regulations, health officials would be encouraged to engage in consultations before any settlement process goes forward.

The U.S. Department of Health and Human Services has signed off on the new proposal, with the agency’s deputy secretary, Bill Corr, stating that the “proposed language … will make a difference for tobacco control and public-health efforts”.

Yet such provisions still constitute a “retreat … and fail to prevent tobacco control measures from being challenged as violations of trade agreements,” according to Susan M. Liss, executive director of the Campaign for Tobacco-Free Kids, a U.S. advocacy group, reflecting similar sentiments recently expressed by several U.S. health associations.

On the other hand, Liss said in a statement, the Malaysia proposal “is appropriate and necessary to stop the tobacco industry from continuing to challenge tobacco control measures as trade violations, a tactic the industry increasingly has used around the world to fight efforts to reduce tobacco use.”

Indeed, not only are countries such as the United States and Australia currently fighting lawsuits brought by tobacco companies against various tobacco-control laws, but such suits are increasingly being aimed at developing countries. Uruguay, for instance, is currently battling former tobacco giant Phillip Morris over a law that requires particular packaging for cigarettes.

“Developing countries are particularly at risk from these trade rules and challenges simply because they do not have the financial and legal wherewithal to defend against trade suits brought against governments,” the Center for Policy Analysis’s Shaffer says.

“The international tobacco industry has changed dramatically in recent years, and this constitutes a two-pronged strategy: first, to shoot down existing tobacco-control regulations and, second, to have a chilling effect on countries that may be thinking about instituting regulations.”

Shaffer, too, lauds the Malaysian government’s proposal, which she says has reportedly met with “some favourable reception, including reportedly from Japan, which would be encouraging given that country’s economic strength.”

Slippery slope?

Although tobacco no longer makes up a large percentage of the U.S. economy, pressure on the Obama administration surrounding the TPP negotiations has come from business interests worried about a “slippery slope” effect – that an exemption for cigarettes would eventually lead to additional exemptions for a range of other products.

The U.S. Chamber of Commerce, the country’s largest business lobby group, has been increasingly vocal in recent days on the TPP tobacco proposals.

“[We risk] opening Pandora’s box by setting a precedent that others will try to follow for additional ‘unique’ products in ways that could be very damaging to American workers, farmers, and companies,” John Murphy, the Chamber’s vice president for international affairs, wrote last week.

“Following this example, other governments may seek similar treatment for alcoholic beverages, snack foods, genetically-modified organisms (GMOs), or a range of other products – the export of which supports many American jobs.”

Despite the great strides made in Latin America with tobacco control legislation, the industry deploys a range of strategies to circumvent the restrictions imposed on cigarette advertising, social organisations and experts complain.

With tobacco product advertisements banned in every country in the region, companies are now targeting points of sale in their efforts to increase product visibility, and implementing corporate social responsibility programmes to maintain brand popularity.

These are among the findings of a recent multi-organisation report that looks at case studies from Mexico, Colombia, Argentina and Brazil documenting civil society’s reactions to the tobacco industry’s ploys in 2010-2012.

The report, issued in Spanish under the title “Health is non-negotiable; Civil society addresses the tobacco industry’s strategies in Latin America”, was prepared by the Argentine and Mexican chapters of the Inter-American Heart Foundation (Fundación Interamericana del Corazón, FIC) and Brazil’s Alliance for the Control of Tobacco Use (Aliança de Controle do Tabagismo, ACT), among other organisations.

Mariela Alderete, assistant director of FIC Argentina, told IPS that tobacco companies in her country were taking advantage of the lack of regulations necessary to properly enforce the tobacco control law passed in 2011.

“The regulations would help enormously in covering legal gaps regarding, for example, advertising or no smoking areas,” she said.

Argentina is the only South American nation that has not yet ratified the World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC), although it was signed by the government in 2003. Pressure from the country’s tobacco-growing provinces has delayed ratification, as they argue that the treaty’s provisions harm their local economies, despite the fact that they export 80 percent of their tobacco.

The report observes that in the last few years “great strides” have been made in the efforts to curb smoking in the region.

“However, the (tobacco) industry is deploying innovative strategies to reach new publics, violating or circumventing health policies” aimed at preventing tobacco-related diseases and deaths.

In some cases, identical strategies are used, repeating the same arguments that have been effectively refuted again and again by health bodies that call for tobacco control.

These strategies are aimed at preventing the passage or enforcement of anti-tobacco laws, says the study, published in late 2012 but virtually ignored by the media.

According to the report, tobacco companies hide behind “front groups,” typically small tobacco-growers, café, restaurant or bar proprietors, convenience store owners and licensed gaming operators, using them to protest these laws by highlighting the negative impacts that smoking limitations allegedly have on their businesses.

They also lobby legislators and other politicians, helping to finance their election campaigns or other initiatives, and they manipulate figures to cast doubt on effective measures for combating the addiction to smoking, such as increasing taxes on tobacco products.

Argentina banned tobacco advertising in 2011, with the exception of points of sale, under the Advertising, Promotion and Consumption of Tobacco Products Act. Last year, the Health Ministry also ordered tobacco companies to display graphic health warnings on their product labels, accompanied by texts such as “Smoking causes cancer” or “Smoking during pregnancy causes irreparable harm to your unborn child”.

But according to Alderete, these warnings are being made light of with the sale of cigarette cases that cover packs almost entirely, leaving only the brand visible and displaying a message that says “Lay off” over the mandatory images.

The creation of regulations for implementing the law has been delayed, among other reasons, because of opposition from the National Lottery, the state agency that controls licensed betting offices. These businesses demand that they be allowed to install air purifiers and ventilation systems and that smoking areas be authorised in their establishments.

“This is what the tobacco industry proposes in its Living Together in Harmony programme, but such systems are known to be ineffective and to violate the right to health of workers and non-smokers. The industry is using the National Lottery as a front” to push its agenda, Alderete said.

In Mexico, tobacco companies fought attempts to raise taxes that affect the price paid by consumers, arguing that increasing taxes would only boost cigarette smuggling, based on figures that contradicted government data.

While tobacco companies claimed in the media and through street campaigns that illegal cigarette imports had increased fivefold, official figures cited in the “Health is non-negotiable” report indicate that smuggling has shrunk “significantly” in recent years.

However, the last few years have also seen a rise in the number of shops and other points of sale that sell loose cigarettes and in some cases to minors, despite the law’s explicit ban, Erick Ochoa, an expert with FIC Mexico, told IPS.

“It’s pointless to ratify the Framework Agreement and have solid legislation if neither instruments are enforced in practice,” Ochoa stressed. “Good intentions are not enough. You need commitment from political leaders willing to draft solid regulations and make sure they’re enforced.”

The industry has also found ways of getting around tobacco control laws in Brazil, which was among the first to ban cigarette ads (in 2000). As the ban does not apply to advertising within points of sale, cigarettes, which were formerly only sold in kiosks, are now sold in bakeries, supermarkets, newsstands and nightclubs.

According to the report, in 2012 the Brazilian branch of the multinational corporation British American Tobacco (BAT) filed a lawsuit against ACT to force it to pull an anti-smoking television spot from the air, but the suit was thrown out of court.
Litigation was also the strategy chosen by the tobacco industry in Uruguay, where smoking is banned by law in all indoor public spaces since 2008 and a 2009 decree requires that health warnings cover 80 percent of the front and back of cigarette packs.

U.S.-based tobacco giant Philip Morris took legal action against the government of Uruguay under the Switzerland-Uruguay Bilateral Investment Treaty (BIT) at the World Bank’s International Centre for Settlement of Investment Disputes, claiming that the South American country’s regulatory measures violated the investment protection agreement signed in 1991 between the two countries.

But the government of the left-wing Frente Amplio coalition is not abandoning its anti-tobacco policy, which began in 2006 under the administration of former president Tabaré Vázquez, an oncologist.

In Colombia, where a full ban on tobacco product advertising and promotion is in force, two claims of unconstitutionality were brought against the ban, arguing that it violates the freedoms of economy and enterprise. But both actions were dismissed.

The tobacco companies operating in the country then focused their strategy on retailers, offering to sponsor activities of the National Federation of Retailers, with events across the country.

This involves financing gatherings of kiosk owners and small shopkeepers and organising contests, discounts, prizes and incentives for the sector. “They even offered university scholarships for their children,” Alderete said.

Non-governmental organisations, however, are more concerned with tobacco company sponsorship of campaigns against child labour, artistic and cultural events, or social reinsertion programmes for demobilised combatants (former left-wing guerrillas or far-right paramilitaries) and their families, which are often carried out in partnership with the state.

This funding explains why it is not uncommon to see cigarette-makers praised in the news for their social contributions.

“It’s a mockery of the absolute ban (on tobacco advertising), and it’s not seen as an advertising strategy,” the report says.

A recent World Health Organisation (WHO) survey revealed that poor people in India were twice as likely to smoke as the rich. Credit: K. S. Harikrishnan/IPS

By Mauro Teodori
THIRUVANANTHAPURAM, India , Nov 30 2012 (IPS)

Mujeeb Rahuman (39), a mason in the Venjaramoodu village in Thiruvananthapuram, the southernmost district in India’s coastal Kerala state, has been a chain smoker for the past twenty years.

Rahuman told IPS he spends “about 1,500 rupees (27 dollars) per month on cigarettes”, representing a large chunk out of his modest monthly income of 8,000 rupees (144 dollars). “I use them as a way to pass the time.”

But this habit is not as leisurely as it sounds. In fact, Rahuman embodies a growing addiction to tobacco among the poor in India, who are now developing higher rates of cancer and experiencing increased mortality rates.

A recent World Health Organisation (WHO) survey revealed that poor people in India were twice as likely to smoke as the rich.

According to the Planning Commission of India, as many as 354 million people – or 29 percent of the population – currently live below the poverty line, which is defined by a monthly income of anything below 672 rupees (roughly 12 dollars) for rural India and 859 rupees (about 15 dollars) for urban labourers.

The WHO survey, entitled ‘Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries’, reported that over a quarter of the country’s population of 1.2 billion people is addicted to tobacco, a habit influenced to a great extent by income.

For instance, the survey found that 46.7 percent of men in lower socioeconomic strata are smokers, compared to 21.8 percent of rich men.

Only 7.6 percent of Indian women smoke, but here, too, the discrepancy is stark: women in lower socioeconomic strata are four times more likely to smoke than their more affluent counterparts – 12.4 percent of women from a lower income bracket have taken up the habit, as opposed to just 3.1 percent of wealthy women.

This disparity does not merely represent a difference in lifestyle choices – it highlights the stress of poverty that leads to addiction and points to a growing health gap between the rich and poor in India.

The survey was initiated in response to reports that poorer people actually faced a greater risk of dying from smoking than more affluent people.

According to the WHO, the ‘smoking divide’ also deepens the gulf of income inequality, since the poor divert their limited wages away from housing, better food or healthcare towards the purchase of tobacco products.

The Mumbai-based Advocacy Forum for Tobacco Control listed various forms of tobacco products popular with the Indian masses including beedis, which account for 34 percent of tobacco products in the country; chuttas and cheroots, small rolls of tobacco leaves; Dhumtis, conical cigarettes created by rolling tobacco leaf in the leaf of another plant; and cigars.

Data from the National Sample Survey Office of India, under the ministry of statistics and programme implementation, shows that the price of beedis makes them a much more popular option – the cost of smoking cigarettes is 399 rupees (about seven dollars) per month, while beedi consumption costs as little as 93 rupees (close to two dollars), according to the Global Adult Tobacco Survey (GATS) for 2009-10.

In fact, 37 percent of rural households and 20 percent of urban households consume beedis, compared to just 3.7 and 9.6 percent respectively for cigarettes.

And meanwhile, the health impacts of tobacco consumption are growing increasingly more severe.

According to a book entitled ‘Kerala, Fifty Years and Beyond’, which documents Kerala’s impressive development record over the last five decades, tobacco has been identified as the leading cause of cancer in India, responsible for 40 to 50 percent of cancers in men and 20 percent of cancers in women.

“Tobacco chewing has resulted in a huge (medical) burden of oral cancer and oral precancerous conditions,” the book said.

Dr. R. Jayakrishnan, assistant professor at the community oncology division of the Regional Cancer Centre in Thiruvananthapuram, told IPS the leading cause of oral cancer was tobacco-related chewing, adding that most patients visiting the centre hail from low-income households.

“Today, 80 percent of lung cancer cases appear to be a result of smoking. The need of the hour is to develop prevention strategies that specifically focus on poor people,” he told IPS.

M. A. Oommen, a prominent Indian economist, told the media in Thiruvananthapuram recently, “While linking a high incidence of smoking with poverty is a simplistic correlation, the issue has to be tackled in a multi-pronged manner, such as giving incentives to the poor to get out of the habit, moral persuasion, a higher excise duty on tobacco products and structural reforms through better employment opportunities.”

A 2012 Asian Development Bank study predicted that increasing cigarette prices, by imposing higher taxes on manufacturers, would save more than 27 million lives in five Asian countries including India.

The Times of India recently reported that a 50 percent increase in cigarette prices in India will save 4.1 million people from the ravages of tobacco consumption, while a 100 percent increase in prices could prevent eight million deaths annually.

(END)

Tobacco use led to almost six million deaths in 2011, according to new research released here on Monday, of which nearly 80 percent were in low- and middle-income countries.

Philippine cigarettes are among the cheapest in the world, costing less than one U.S. dollar for a pack of 20. They are available right outside schools, in parks, in streets and other public places, and sold by vendors in single sticks for about two pesos. Credit: Kara Santos/IPS

Such trends, fuelled by tobacco industry tactics, are having a “devastating” impact on the global economy, health and development workers warned at the Washington launch of a new report tracking tobacco use worldwide. The findings are the results of nascent research into the links between development, economic growth and tobacco use.

“We have more and more data on these links,” Hana Ross, one of the lead authors of the new Tobacco Atlas, told IPS. “For instance, it appears that in Russia, gross domestic product would have grown by 1.0 to 1.5 percent faster over the past three decades if it weren’t for the tobacco-related costs. Once you start to accumulate over time, these numbers become huge.”

The tobacco industry’s products and “spurious legal challenges”, Peter Baldini, the CEO of the World Lung Foundation, said Monday, “hurt economies as much as they hurt people.”

According to the fourth edition of the Tobacco Atlas, put out by the American Cancer Society and the World Lung Foundation, tobacco use is the single most preventable cause of death in the world. It is also the only risk factor common to the four most significant non-communicable diseases, heart disease, cancer, respiratory disease and diabetes.

Several diseases exacerbated by smoking also inordinately affect developing countries. Between 2010 and 2050, for instance, 40 million smokers with tuberculosis are expected to die, with smoking estimated to directly cause 20 percent of all cases of TB worldwide.

“While smoking rates have been slowly declining in the United States and many other high-income nations during the past 25 years,” Baldini and John R. Seffrin, CEO of the American Cancer Society, write in the Atlas’s foreword, “they have been increasing in low-and middle-income nations, which are the least prepared to deal with the effects of tobacco-related disease.”

A development issue

Overall, a billion people are expected to die due to tobacco use over the course of the 21st century. That figure includes a significant proportion of victims of second-hand smoke, 75 percent of whom are women and children.

The tobacco industry’s role in dragging down health indicators weighs heavily on national and international efforts at strengthening health systems, experts warn. In the United States alone, cigarette smoking has been directly blamed for around 193 billion dollars in annual health-related costs (in 2000-04), half in lost productivity.

With health-care costs already unsustainably high in many Western countries, the future impact of smoking on the developing world is now increasingly worrying those in the development sector.

China is a case in point, not only due to its massive population but also for the uniquely high percentage of the population that smokes. Although the Chinese government, under significant international pressure, has moved to cut down on smoking in recent years, Chinese men, more than 60 percent of whom use tobacco, continue to smoke roughly a third of the world’s cigarettes.

And if Chinese women were to begin smoking at anywhere near that rate, the Atlas’s writers warn, “the country’s economy and health systems will be overwhelmed”.

“The World Bank is greatly concerned about tobacco because … it is increasingly becoming largely a developing world problem at a time when the developing world can least afford to add another health problem,” World Bank official Keith Hansen told journalists Monday. “We need to all have a unified message: Tobacco control is a development issue, and we will not lose revenue by addressing it.”

The World Bank is reportedly looking to begin putting increased focus on tobacco-related research and programming.

“With tobacco now poised to explode in developing countries and addict a new generation,” Hansen says, “urgent action is needed to make sure that these countries are able to put tobacco behind them and not become the centre of tobacco for the 21st century.”

The remaining 90 percent

The Atlas was first published a decade ago, in 2002, and over that period significant forward steps have been taken in the fight against tobacco use.

In 2003, the World Health Organisation (WHO) adopted the Framework Convention on Tobacco Control, which now covers 174 countries and more than 87 percent of the global population. The WHO has set a goal of a 40-percent reduction in daily smoking among adults by 2025.

A year ago, in September 2011, the United Nations held its first-ever high-level meeting on non-communicable diseases, where world leaders unanimously agreed to a plan that calls for strengthened international anti-tobacco collaboration.

Despite such steps, today nearly 90 percent of the world’s population remain unprotected by smoking-related legislation. And according to WHO Director-General Margaret Chan, “Measures to tackle the epidemic remain seriously underfunded.”

In fact, funding for tobacco control should have a significant advantage in at least two regards, says Ross, the Atlas’s co-author.

First, it offers national governments a largely untapped opportunity for a massively increased tax base. The WHO itself has recommended that tobacco taxes be placed at around 70 percent of cigarette retail prices, although only five countries have yet reached that target.

“In many cases, this is a simple matter of political will, as control measures are not necessarily expensive – most countries already have some kind of tax system in place,” Ross says. “There is an opportunity for the international community to help in building that political will as well as to offer technical advice for setting up, for instance, efficient taxation systems.”

In this regard, Ross says, positive examples are coming in particular from Southeast Asia, where she highlights new government moves in Thailand, as well as in Laos and Vietnam.

Second, anti-tobacco funding offers something that many such public programmes do not: fast, measurable results.

“If you get people to quit smoking, the impact on health is visible within the first six months,” Ross says. “Results are typically available very quickly, reflected in specific and measurable data. For better or worse, that’s important to both the donor community as well as national policymakers.”

Brazil spends some 10 billion dollars a year on health care for smokers – more than three times the tax revenue from the tobacco industry in this country, which is the world’s top exporter and second producer of tobacco.

The effects of tobacco consumption in Brazil can be measured by the economic impact, according to a study by the state Oswaldo Cruz Foundation (Fiocruz), dedicated to public health, and the Alliance for the Control of Tobacco Use (ACT), a civil society organisation.

The report “Carga das doenças tabaco-relacionadas para o Brasil”(Burden of tobacco-related diseases in Brazil), launched by ACT in Brasilia May 31, says the costs of treating smoking-related illnesses like cancer, heart disease, lung diseases and strokes is equivalent to 0.5 percent of GDP.

Graphic picture-based health warnings on cigarette packs can help prevent youngsters from starting to smoke. Credit:Kara Santos/IPS

ACT executive director Paula Johns told IPS that the study calculated the costs of treatment of the 15 main tobacco-related illnesses. But she pointed out that overall, smoking plays a role in 50 diseases.

“The tobacco industry takes no responsibility for the cost, and argues that it pays a lot in taxes. The burden of treating the diseases falls on the public health sector,” she said.

In 2011, the total tax revenue from Brazil’s tobacco industry amounted to three billion dollars, less than one-third of state expenditure on treating patients with tobacco-related ailments.

According to Johns, taxes on the sector should be at least tripled, to cover the costs that active and passive smokers will generate after two or three decades of smoking. “In addition, indirect costs like early retirement should be taken into account,” she said.

Brazil has a population of nearly 200 million, of whom 25 million people are smokers, 15 million of them men. But Johns said the bad news is that women and children are beginning to smoke more, and from an earlier age.

The aim of the study is to demonstrate the need for more regulation of the tobacco industry and for more investment in prevention measures to curb addiction to smoking.

“Prevention is not just about running educational campaigns; access to cigarettes must be made harder, with higher prices and fewer sales outlets,” Johns said.

A pack of cigarettes in Brazil now sells for three dollars.

The country is the world’s second largest tobacco producer, after China and ahead of India and the United States. Last year 85 percent of Brazil’s tobacco was sold abroad, making it the leading tobacco exporter, a position it has held since 1993. Foreign sales brought in 2.89 billion dollars.

The ACT study, the first to measure the economic impact of smoking in Brazil, describes the profile of the country’s smokers as predominantly black, poor, rural dwellers with limited education.

The study reported that 20 percent of smokers began before the age of 15, and most of the rest started before they were 19.

Another indicator that alarms the authorities struggling to reduce consumption is that 60 percent of teenagers who start smoking do so with cigarettes containing additives with flavours such as cherry, chocolate or mint.

Study coordinator Márcia Pinto said the economic cost to the state could be reduced to a minimum because all the diseases caused by smoking can be prevented.

“All that money could be invested in vaccination programmes, wider access to cancer diagnosis and treatment, and sanitation programmes,” Pinto, of the Fernandes Figueira Institute which is part of Fiocruz, told IPS.

Pinto, who coordinates a team of six researchers, has been studying different aspects of the tobacco industry for 12 years. She emphasises that measuring the cost of smoking for the country is essential in order to promote public policies to prevent children, teenagers and women from being drawn into consumption.

The expert pointed out that smoking is the cause of 90 percent of cases of lung diseases.

The study found that heart disease, followed by lung diseases including lung cancer, and strokes, accounted for 83 percent of smoking-related costs in the public health system.

In 2011, about 30 percent of the total budget of the National Health Fund (FNS) which manages the resources of the state unified health system (SUS) was devoted to treating smoking-related illnesses.

In spite of this, the study says, the average life expectancy of smokers is at least five years less than that of the general population.

“Smokers lose five years of their lives. Tobacco addiction is an illness, and it is also related to alcoholism and a sedentary lifestyle,” said Pinto.

The 10 billion dollars a year devoted to health care for smokers could be used instead to provide basic sanitation throughout Brazil, which will require an investment of six billion dollars a year over the next two decades, according to the environmental health department of the University of São Paulo.

The same figure represents half the annual budget of the Growth Acceleration Programme (PAC), the second phase of which was launched by President Dilma Rousseff to provide the infrastructure the country needs.

The emblematic social housing programme “Minha casa, minha vida” (My House, My Life), aimed at reducing the housing deficit, cost the government 6.2 billion dollars in 2011, considerably less than what smokers cost the public health system.

Smoking is responsible for the deaths of 5.4 million people worldwide every year, according to the World Health Organisation (WHO).

WHO predicts more fatalities in future: in 2030, deaths from smoking will total eight million, 80 percent of them in developing countries.

The global cost of smoking-related illnesses is 500 billion dollars a year, according to the American Cancer Society. (END)