Smoking and PovertyInteraction with TB in the Developing World

Donald A Enarson

The Union Asia Pacific Region

9 July 2011

Learning Objectives

By the end of the session you will be able to:

� Confirm the association of tobacco and TB; � Outline the feasibility of smoking cessation

for TB patients;� Describe the plague of tobacco smoking and

its toll;� Explain how this impacts on health and

economics;� Identify the new directions of tobacco

marketing.

Association of TB and Smoking

� Disease and Active Smoking;

�Sub-Saharan Africa

�Western Pacific

�Southeast Asia

�Latin America

� Disease and Passive Smoking;

�Southeast Asia.

Smoking Cessation for TB patients

� Smoking cessation services are feasible and do not negatively affect TB care:� El Sony A, Slama K, Slieh M, Elhaj H, Adam K, Hassan A,

Enarson DA. Feasibility of brief tobacco cessation advice for tuberculosis patients: a study from Sudan. Int J Tuberc Lung Dis 2007; 11: 150-155

� There is a practical approach to smoking cessation for low-income countries� Slama K, Chiang C-Y, Enarson DA. Tobacco Cessation

Interventions for Tuberculosis Patients. A Guide for Low-Income Countries. Paris: International Union Against Tuberculoisis and Lung Disease. 2008, pp 57. ISBN 978-2-914365-31-4

Association of TB and Poverty

100

1000

10000

100000

1 10 100 1000

Estimated cases per 100,000 - 2002

GNI per capita

Norway

SwedenPoland

Romania

Thailand

Indonesia

Pakistan

WHO Global TB Report

Information on Smoking

� http://www.tobaccoatlas.org

Prevalence of Smoking by CountryProportion of Men who Smoke

60+ 40-59 20-39 <20

Afghanistan China France Sweden

Yemen Turkey New Zealand Canada

Russia Malaysia India Zambia

Ukraine Austria Ireland Senegal

Belarus Mongolia South Africa RD Congo

Indonesia Chile Egypt Nigeria

Portugal Brazil Ethiopia

Smoking by CountryFraction of Women to Men who Smoke

Afghanistan .21 China .06 France .73 Sweden 1.25

Yemen .38 Turkey .37 New Zealand .93 Canada .92

Russia .38 Malaysia .05 India .04 Zambia .12

Ukraine .36 Austria .86 Ireland .98 Senegal .04

Belarus .33 Mongolia .14 South Africa .31 RD Congo .06

Indonesia .06 Chile .72 Egypt .04 Nigeria .02

Portugal .76 Brazil .63 Ethiopia .07

Burden to Health from SmokingProportion of Deaths in Men from Tobacco

<10 10-19 20+

India Afghanistan Belarus New Zealand

Ethiopia Brazil Austria Ukraine

RD Congo Chile Sweden Turkey

Zambia Malaysia France

South Africa Indonesia Russia

China Canada

Egypt Portugal

Yemen Ireland

Burden to the Individual EconomyCost of a Pack per $1,000 GNI

0 1 2 3 4 5

Sweden

Russia

Canada

New Zealand

Malaysia

Indonesia

China

India

RD Congo

Ethiopia

Cost of a Pack per $1,000 GNI

Costs to the General EconomyTotal Estimated Costs

0 5000 10000 15000 20000

Canada

France

China

Egypt

South Africa

Indonesia

Sweden

Total Estimated Costs ($ millions)

Existing Market for Tobacco

0 100 200 300 400 500

China men

India men

Indonesia men

Russia men

China women

Brazil men

Turkey men

Russia women

Ukraine men

Millions of Smokers

Future Market for Tobacco

0 100 200 300 400 500 600 700

China women

India women

India men

China men

Indonesia women

Brazil women

Nigeria women

Brazil men

Nigeria men

Russia women

Millions of Potential Smokers

Effect of Cost on SmokingExcluding Industrialized Countries

0.01

0.1

1

10

0 20 40 60 80 100

% of Men who Smoke

Co

st

of

a P

ack p

er

$1,0

00

GN

I

Smoking and PovertyKey points

� Tobacco smoking is facilitated by ‘relative’ wealth;

� It can be a burden to both health and wealth;

� Future markets for tobacco will target women and selected developing countries.

TB, Smoking and PovertyKey points

� Tobacco control is important everywhere;

� It should be a priority for TB patients;

� It is feasible;

� The highest dual burden is in middle-income countries.