Whilst travelling recently, I noticed booths selling cigarettes at two well-known international airports in India. This, even though smoking is officially banned in public places. I recalled an incident of a few months ago. That day, while driving to work, I happened to pass by a young girl in a car who was being fined by two policemen for smoking in a supposedly public place ~ the confines of her own car! She looked terrified so I had stopped to enquire if all was well.

A crowd quickly gathered around us and there ensued a lively debate around whether someone’s car constituted a public space. My learning that day was that a personal car when driven out of the home and specially with its windows open, was deemed a public space. It was jarring to note how young college students who are not even earning must pay fines for lighting a cigarette whereas tobacco companies can openly indulge in tobacco sales in public places right under everyone’s noses with no adverse consequences.

On yet another journey, I noticed a special smoking room for passengers in the transit lounge of an overseas airport. I wondered about the necessity of pampering adults like this. Could grown-ups not be asked to desist from smoking for just a couple of hours? Contrast this with the strict enforcement of austerity for widows in India some years ago for example ~ where they were expected to suddenly change their entire lifestyle forever.

The powerful tobacco lobby has created an enormous market for itself. Millions spent on advertising helped generate the aura that (the addictive) smoking was somehow cool and smart. As a youngster, though I did not smoke, my list of favourite advertisements included the cowboy in a checked shirt welcoming people to ‘Marlboro country’ and one glorifying the special thin cigarettes for women ~ Virginia Slims ~ which had the tagline ‘you’ve come a long way, baby.’ People lit up to feel smart, and to attract a potential mate.

Today, about an eighth of the world’s population ~ 1.3 billion people-use tobacco and an overwhelming number of these (80 per cent) live in medium to lowincome countries. As the sales of cigarettes went up phenomenally ~ about 6 trillion cigarettes are currently manufactured every year ~ on the medical front, the rates of lung cancer, a truly rare occurrence in the beginning of the 20th century, increased concomitantly. The lungs, heart, and blood vessels are very vulnerable to the effects of inhaled tobacco smoke which contains harmful chemicals like nicotine, tar, etc. The spectrum of lung problems is vast: irritation of the airways causes a smoker’s cough (bronchitis); acute lung infections (pneumonia) as well as chronic structural lung changes (emphysema, chronic obstructive pulmonary disease) can occur; and of course, there is the dreaded lung cancer. Changes in the blood and vessel linings increase the chances of heart attacks, strokes, and peripheral circulatory problems.

Smoking impacts other organs like the eyes, causes cancers in multiple organs other than the lungs too, and increases the propensity to develop diabetes. About eight million deaths a year are attributed to tobacco. For a country like India which is reeling from a spurt in cancers in the North West (a likely fallout of pesticides and crop modifications used to bring about the ‘green revolution’), and is also known as the diabetic capital of the world with 77 million or so diabetics, we can ill afford the smoking addiction. India currently is the second largest consumer of tobacco products, after China, with 267 million adults using various forms of tobacco.

Along with vigorously promoting the sale of cigarettes, tobacco companies in the mid twentieth century actively suppressed information emerging out of scientific research that showed the link between lung cancer and smoking. This evidence had been painstakingly collected from diverse sources: large population studies; live animal experiments; cell pathology studies. Scientific scrutiny of the composition of cigarette smoke revealed that it contained numerous carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines, among others.

Realizing that their star product, tobacco, might well go out of fashion, even sworn rivals in the tobacco world colluded to protect their common source of profit. These companies created a deliberate smokescreen around the compelling scientific research showing that tobacco was harmful to health. They poured in money to induce other scientists to question these studies to ensure that the public remained in doubt. Their actions were clearly unconscionable, as they subtly promoted an addictive substance through behind-the-scenes manipulation. Criminal groups that openly and illegally peddled drugs were labelled cartels but these companies deliberately propagating an addictive item with full knowledge of its destructive potential got away with the less pejorative collective epithet of ‘lobbies’.

The stranglehold that the tobacco industry has on decision-makers ensures that the product is still sold freely albeit with a warning printed that smoking is injurious to health. The so called ‘safer’ alternatives to conventional smoking such as E-cigarettes are also harmful as their vapour contains nicotine and other toxic chemicals and they can be as addictive as regular cigarettes.

The ill effects of smoking reverberate far and wide, affecting not only the smoker, but those in the vicinity as well. Formal scientific studies have highlighted the perils of ‘passive smoking’ which refers to the smoke inhaled by a bystander close to a smoker. Passive smoke has been found to have a 2-4 times more toxic effect since it is inhaled into the lungs without going through any filter (as is found on the end of a cigarette). Though malnutrition, the early age of marriage of women, inadequate healthcare facilities and not enough health education are some of the factors blamed for the huge number of low-birth-weight babies in India, the contribution of passive smoking has not been highlighted to the extent it deserves. Pregnant women, even when very careful themselves, often have limited influence on the smoking habits of other family members. Inhaled smoke can impact foetal development negatively. According to the National Family Health Survey number 5 (19-21) the prevalence of low-birth-weight babies in India is 18 per cent.

Tobacco deserves far greater attention at climate change discussions for many reasons: it is not a soil friendly crop; the process of curing tobacco prior to consumption is expensive; the disposal of cigarette butts and packs adds greatly to toxic waste as well as creating plastic micro waste. The fine smoke particles that settle on surfaces around us like clothing, hair, carpets etc form the ‘thirdhand smoke.’ They can persist for a long while and can be acted upon by oxidants in the atmosphere to release carcinogens into the air such as tobacco specific nitrosamines and toxic aldehydes which pollute our environment.

Today, a significant number of people are suffering from long Covid (estimates put this between 7.5 to 45 per cent). Amongst general symptoms indicative of this like chronic fatigue, memory fog, insomnia etc, lie specific cardiovascular effects such as hypertension, tachycardia, and heart attacks. Many patients who have recovered from severe Covid have highly reduced lung capacities. Thus, people now are even more vulnerable to the ill effects of tobacco smoke than before. Moreover, smoking reduces a person’s general immunity ~ something one can ill afford in a pandemic and where millions are being spent on vaccines to boost immunity. So instead of putting our health and our environment on a slow burn, we can do away with smoking, and by this single impactful act save our civilization from literally going up in smoke!

(The writer is a Delhi-based medical practitioner)