This document discusses the association between smoking, tuberculosis (TB), and poverty in developing countries. It outlines that smoking increases the risk of active TB disease and that passive smoking can also increase TB risk. The document then summarizes studies showing that smoking cessation services for TB patients are feasible and do not negatively impact TB treatment. Finally, it provides data on smoking prevalence, health and economic costs of smoking, and tobacco company marketing trends in different countries to demonstrate the heavy burden of smoking, especially in middle-income developing countries.
2. 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.
3. Association of TB and Smoking
Disease and Active Smoking;
Sub-Saharan Africa
Western Pacific
Southeast Asia
Latin America
Disease and Passive Smoking;
Southeast Asia.
4. 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
5. Association of TB and Poverty
100000
Norway
G NI per capita
Sweden
10000 Poland
Thailand
Romania
1000 Indonesia
Pakistan
100
1 10 100 1000
Estimated cases per 100,000 - 2002
WHO Global TB Report
7. Prevalence of Smoking by Country
Proportion 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
8. Smoking by Country
Fraction 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
9. Burden to Health from Smoking
Proportion 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
10. Burden to the Individual Economy
Cost of a Pack per $1,000 GNI
Ethiopia
RD Congo
India
China
Indonesia
Malaysia
New Zealand
Canada
Russia
Sweden
0 1 2 3 4 5
Cost of a Pack per $1,000 GNI
11. Costs to the General Economy
Total Estimated Costs
Sweden
Indonesia
South Africa
Egypt
China
France
Canada
0 5000 10000 15000 20000
Total Estimated Costs ($ millions)
12. Existing Market for Tobacco
Ukraine men
Russia women
Turkey men
Brazil men
China women
Russia men
Indonesia men
India men
China men
0 100 200 300 400 500
Millions of Smokers
13. Future Market for Tobacco
Russia women
Nigeria men
Brazil men
Nigeria women
Brazil women
Indonesia women
China men
India men
India women
China women
0 100 200 300 400 500 600 700
Millions of Potential Smokers
14. Effect of Cost on Smoking
Excluding Industrialized Countries
10
Cost of a Pack per $1,000
1
GNI
0.1
0.01
0 20 40 60 80 100
% of Men who Smoke
15. Smoking and Poverty
Key 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.
16. TB, Smoking and Poverty
Key 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.