A recent study by University College London has presented the results of its findings on the impact of smoking on life expectancy in rather dramatic terms. This study published in the Journal of Addiction has stated that smoking a single cigarette can reduce 20 minutes from a person’s life. Smoking a packet of 20 cigarettes can take away about 7 hours from the life of a person. This has come on top of US government warnings about alcohol’s links to cancer. Latest information on health risks of alcohol released by the US Centres for Disease Control and Prevention tells us that while about 20,000 adult persons die from alcohol related cancers in a year in the USA, as many as 25 times this number, or 522,000 (367,000 for women and 155,000 for men) to be precise, alcohol associated cancers occurred in the USA in 2021.

It is this larger number that is more relevant, and scary, in countries with lesser levels of health care access and early detection. The latest official information from the USA also establishes that at least seven cancers (and perhaps ten) are linked to alcohol. These seven cancers are – mouth, throat (pharynx), voice box (larynx), esophagus, colon and rectum, liver and breast (in women). In addition three other cancers have also been linked to alcohol by several studies, including pancreatic, stomach and prostate. Among men, the highest number of alcohol-related cancers are colorectal cancers while among women these are breast cancers. Further this latest information tells us that all drinks that contain alcohol, including red and white wine, beer and liquor, increase the risk of cancer. According to the WHO status reports on health and alcohol 2.5 to 3 million deaths are attributable to alcohol consumption globally in a year.

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The same report has pointed out that the harmful use of alcohol is a component cause of more than 200 diseases and injury conditions, the most notable being alcohol dependence, liver cirrhosis, cancers and injuries. In the age-group over 15 years, as many as 400 million people suffer from alcohol related disorders while 209 million suffer from alcohol dependence. The World Report on Violence and Health (WRVH) says that alcohol abuse may also be an important factor in depression. More ominously the WRVH report says that alcohol and drug abuse also play an important role in suicide. In the USA, at least one quarter of all suicides are reported to involve alcohol abuse.

Regarding social impacts the WRVH says that both from the perspective of the assaulter and the victim, alcohol and drug consumption increases the risk of sexual violence, including rape. According to a widely cited paper on ‘alcohol and sexual assaults’ by Antonia Abbey, Tina Zawacki and others of the National Institute of Alcohol Abuse and Alcoholism (USA), “at least one half of all violent crimes involved alcohol consumption by the perpetrator, the victim or both.” Sexual violence fits this pattern. Thus across disparate population studies, researchers consistently have found that approximately one half of all sexual assaults are committed by men who have been drinking alcohol.

According to the WHO, alcohol consumption in adolescents, especially binge drinking, negatively affects school performance, increased participation in crime and leads to risky sexual behaviour. The WRVH report says that reducing the availability of liquor can be an important community strategy to reduce crime and violence as research has shown alcohol to be an important situational factor that can precipitate violence. There are very heavy social costs of alcohol consumption in the form of various forms of violence, crime and disruption of relationships. The WHO status report has presented various estimates that have been made from time to time about financial implications of these social costs: * European Union (2003) – 125 billion euros * UK (2009) – 21 billion pounds * USA (2006) – 233 billion dollars * South Africa (2009) – 300 billion Rand (10-12 per cent of GNP) In terms of deaths caused in a year worldwide, tobacco is an even bigger culprit as according to WHO data, tobacco in its various forms caused as many as 8 million deaths in a year. Nicotine in tobacco is highly addictive.

Tobacco has been linked to 20 different types and subtypes of cancer, apart from being a causative factor for cardiovascular and other diseases. Second hand smoking, or impact of smoking on nearby persons, also causes 1.2 million deaths in a year. Smokeless tobacco has also emerged as a big health hazard, linked to cancer, stroke, heart disease and dental decay. Nicotine is absorbed more easily in smokeless tobacco. In recent times, when very serious concern was expressed regarding the increase in devastating health problems led by oral cancer due to the escalating consumption of smokeless tobacco and there were also court cases to check this followed by court directives to protect public health, some steps were initiated by the government which can be seen in prominent warning signs on pouches. However the manufacturers responded very shrewdly by separating the other ingredients called pan masala from tobacco in two pouches but in practice most vendors continue to sell the two pouches together which are then mixed by the user.

Thus in a clever way smokeless tobacco (SLT) with several harmful ingredients is being sold on a mass scale and the habit of consuming this has increased rapidly, not just among men but also among women and even children, creating the base of a public health disaster. This can be seen even in remote villages, and in cites this is most visible in working class colonies including among migrant workers. South Asia and nearby areas now constitute the biggest hub of SLT consumption. This region has experienced rapid increase in recent decades based on new attractively packaged and advertised branded products – often mixed, scented and sweetened with various other ingredients commonly known as pan masala or guthka.

According to the Global Adult Tobacco Survey Second Round 2016-17 (GATS 2), 21.4 per cent of adults in India consume SLT, and 85 per cent use it on a daily basis. Bangladesh, Pakistan, Nepal and Sri Lanka also report high use, ranging from 15 to 30 per cent for men, and somewhat lesser for women. SLT is linked to several serious health problems, most particularly oral cancer. India carries one-third of the global burden of oral cancer, much of which is linked to SLT. Oral cancer has emerged as the leading cancer among males in India, Bangladesh and Pakistan.

It is also the second most important cancer for women in India and Bangladesh. According to GLOBOCAN data, oral cancer accounts for over 16 per cent of all cancers and 12 per cent of all cancer mortality among males in India. According to a recent study by the Tata Memorial Centre as much as Rs 23 billion was spent on the treatment of oral cancer in India in 2020. Most affected are in the age-group 30- 50, often the sole earning members of their households. Cure at a late stage is very difficult but most of the cases are diagnosed late in India.

(The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include Protecting Earth for Children, Man over Machine and A Day in 2071.)