The health hazards of smoking and secondhand smoke exposure

Banning Smoking in Public Places

In the present age of information explosion, almost everyone is aware of the harmful effects of smoking although the leading tobacco manufacturers have managed to confuse the issue through lobbying cleverly conducted media campaigns. That a large number of people still choose to smoke and inflict harm on their own bodies is partially attributable to the power of business corporations and the effectiveness of advertisement but highly unfortunate. What is more unfortunate, and in my opinion, absolutely unacceptable is the harm caused by smokers to the rest of us by smoking in public places. It is a practice that cannot be condoned by any stretch of the imagination. In this position paper, I shall argue why smoking should be banned in all public areas by outlining the health hazards of smoking and second hand smoke. The major arguments against such a ban shall also be discussed.

The Health Hazards of Smoking

Tobacco smoke contains a large number of chemicals in the form of particles and gases. The particles include toxins such as nicotine, tar, and benzene while the gases include harmful substances such as carbon monoxide, ammonia, formaldehyde, and hydrogen cyanide. Scientists have identified as many as 60 substances in tobacco smoke which cause cancer. Small wonder that the Environmental Protection Agency (EPA) in the U.S.A. has classified tobacco smoke as a carcinogen that ranks alongside poisonous substances like asbestos and arsenic. ("Q& A: Passive Smoking," 2004)

The harmful effects of smoking have long been recognized by doctors. Forty years ago, the U.S. Surgeon General released his first report on the health hazards of smoking. It announced the results of medical research available at the time that held smoking responsible for the definite cause of at least three diseases -- cancer of the lungs, cancer of the larynx and chronic bronchitis. Subsequent research concluded that smoking causes a number of other afflictions as well, e.g., cancers of the bladder, esophagus, mouth and throat; coronary heart and cardiovascular diseases; and sudden infant death syndrome.

The latest report by the Surgeon General, released in September 2004

reveals that the health hazards of smoking are far greater than were previously thought. The list of diseases caused by the use of tobacco smoking have now been considerably expanded to include cancers of the kidneys, stomach, cervix, and pancreas as well as leukemia, cataracts, pneumonia, and gum disease. Smoking has also been linked to suppression of the immune system and an overall decline in general health, contributing to conditions such as hip fractures, complications from diabetes, increased wound infections following surgery, and various reproductive problems. The reason for such a wide-ranging effect of smoking is due to the fact that some of the carcinogens contained in cigarette smoke, such as nicotine, are readily transported into the blood stream through the lung surface as well as the gastrointestinal tract and have the ability to latch on to a receptor present on every cell in our body. Tobacco smoke thus has the potential to affect each and every organ and every cell of the human body. The economic and social cost of smoking, as reflected in the figures quoted in the report make depressing reading. According to the report, smoking kills an estimated 440,000 Americans each year. On average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years. The economic toll exceeds $157 billion each year in the United States -- $75 billion in direct medical costs and $82 billion in lost productivity. Dr. Carmona, the Surgeon General summed up the findings of the report by remarking:

Since the 1964 surgeon general's report, more than 12 million people have died from smoking -- related illness. These include 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases, and 94,000 pre-natal deaths ... We've known for decades that smoking is bad for your health, but this [latest] report shows that it's even worse than we knew.

("The Health Consequences of Smoking," 2004)

How Do these Findings Relate to Passive Smoking?

In order to see how the above-mentioned ill-effects of smoking apply to second hand smoke, let us consider what 'passive smoking' actually is. In simple words, it is breathing in other people's cigarette smoke, which consists of "sidestream" smoke from the tip of a burning cigarette, and "mainstream" smoke that has been inhaled and then exhaled by the smoker. It has been estimated that sidestream smoke accounts for nearly 85% of the smoke in a room where smokers had been smoking. ("Q& A: Passive Smoking," 2004)

We find instances of passive smoking almost everywhere. It is estimated that about one-third of adults smoke in the United States. This means that about a similar percentage of American children are exposed to passive smoking in their homes. People visiting bars and restaurants, except in areas where smoking is banned breathe in a significant amount of tobacco smoke. One study found that in households where both parents smoke, young children have a 72% increased risk of respiratory illnesses and are more likely to be admitted to hospital for bronchitis and pneumonia in the first year of life.

The reason why 'second hand smoke' is almost as injurious as direct smoking is because the human blood has been shown to be very sensitive to even low doses of tobacco smoke, a fact reflected in the findings that even people who smoke occasionally and those who use 'low-tar' or 'light' cigarettes are as prone to health problems as the heavy or chain-smokers. Also the fact that the sidestream smoke which comes directly from cigarette constitutes the bulk of the smoke that passive smokers breathe in, makes second-hand smoke as deadly as the one inhaled by the smokers themselves. Hence it is only logical that the harmful effects of passive smoking should be comparable to that of direct smoking.

A recently released study by a team of researchers from St. George's Medical School and the Royal Free hospital in London which studied 4,792 men over 20 years found that exposure to passive smoking in the workplace and public places increase the risk of coronary heart disease by 50-60%. The results of the latest study are far more alarming than the findings of earlier studies that had indicated a 25-30% increased risk of heart disease due to passive smoking. This further underlines the hazards of exposure to second-hand smoke. ("Passive Smoke Risk Even Greater," 2004)

Other studies around the world such as a major review in 1998 by the British Government-appointed Scientific Committee on Tobacco and Health (SCOTH) came to a similar conclusion that passive smoking is a cause of lung cancer and heart disease in adult non-smokers, and a cause of respiratory disease, cot death, middle ear disease and asthmatic attacks in children. Some studies even suggest that passive smoking may affect children's mental development.

Despite these findings of major studies about the injurious effects of second hand smoke, pro-smoking lobbyists funded by major players in the tobacco industry continue to insist that such studies are unreliable and they have not proven conclusively that passive smoking is bad for health. They insist that there is insufficient scientific evidence to justify a total smoking ban in public places. The most they are willing to concede is that smoking and non-smoking areas may be ear-marked in public places and that good ventilation systems would eliminate any tobacco smoke that may cause annoyance to non-smokers.

The problem with this argument is that ventilation and non-smoking areas in public places just do not work. While ventilation may remove the apparent 'smokiness' in enclosed spaces it fails to remove the thousands of harmful chemicals present in smoke from such areas. After extensive tests of the air quality of public places having smoking and non-smoking areas, it was found that non-smoking areas offer little protection from second-hand smoke. At the very most ventilation reduced smoke levels by 50% and separate non-smoking rooms still retained high levels of cancer-causing chemicals. Hence, no-smoking areas can, at best, provide marginal reduction in the level of exposure of individuals to environmental tobacco smoke and are not the solution to the problem of passive smoking.

The Ethics of Smoking in Public Places

Some lobbyists for smoking argue that banning of smoking in public places is ethically wrong as it interferes with their freedom and fundamental rights. To my mind, such an argument is preposterous. Smoking in public places causes harm to others and even the strongest proponents of civil liberty and fundamental rights would not condone acts that harm others and force non-smokers to inhale smoke against their will. There is no doubt that an individual has a right to make the decision to smoke for him/herself, yet the smoker does not have the right to make that decision for anyone else; and once a smoker lights up in an indoor public place, the nonsmoker does not have a choice, and becomes an involuntary smoker

. While some people who are subjected to a smoke filled environment may have the choice of getting up and walking away, others such as workers in bars and restaurants do not have such a choice and it is these people, in fact, whose freedom is being compromised by the smokers.

The more serious ethical paradox related to smoking, perhaps, is the fact that despite the inconvertible fact that smoking is the single greatest preventable cause of death in the world, the tobacco industry continues to flourish all over the world. Even more seriously, cigarettes that contain higher than permissible limits of lethal contents are conveniently exported from the developed countries to the developing countries for the sake of profits.

Other Benefits of Smoking-Ban in Public Places

Apart from the health benefits to non-smokers of banning smoking in public places, it also has an important benefit which applies to everyone. Research studies have shown that in areas where such bans have been applied, the consumption of cigarettes has dropped significantly. This is especially true for areas that do not allow smoking in the workplace. The reason for the finding is obvious. People spend the longest time in the workplace and not smoking during that period reduces cigarette consumption. It has also been observed that abstaining from smoking for such long periods motivates a large number of smokers to quit the habit altogether. Some studies conducted in England, for instance, estimate that a comprehensive workplace smoking ban in the country is likely to reduce smoking prevalence by around 4 percentage points, i.e., reduce the smoking prevalence rate in England from the existing 27 per cent to 23 per cent. ("Factsheet No. 14," 2004) Similarly, a study published in the American Journal of Medicine (July 2004 edition) concludes that the first-year effect of making all workplaces in the U.S. smoke free would produce about 1.3 million new quitters and prevent over 950 million cigarette packs from being smoked annually. Moreover, the public opinion in most countries, including the U.S. And Britain overwhelmingly favors a ban on smoking in public places.

Reaction of the Tobacco Industry towards the Ban

Despite such overwhelming evidence about the negative effects of passive smoking as well as a favorable public opinion regarding banning smoking in public, legislation on smoking bans has been a laggard in most countries. The reason, again, is no great mystery. The tobacco industry spends a lot of its time and effort in derailing such actions. A study published in the June 2003 issue of Nicotine & Tobacco Research reveals the strategy adopted by the tobacco industry to foster a public perception that secondhand smoke is not harmful. The study quotes internal tobacco industry documents which show that the industry recruited supposedly "independent" scientists to "produce research or stimulate controversy" in such a way that the public perception about second hand smoke is altered in a way favorable to the tobacco industry.

Conclusion

As we saw in this paper, the harmful effects of smoking are common knowledge. What is less well-known is the harm that second-hand smoke or passive smoking causes to the non-smokers. Most of such harm is easily preventable by placing a strict ban on smoking in all public places including the workplace, restaurants, and bars. Some progress has been made in this direction through enactment of the required laws; a lot more needs to be done.