Smokers take heed: a new study shows that passive smoking is responsible for more than 600,000 deaths each year worldwide, representing 1% of all deaths. Tragically, 165,000 of these deaths are among children. The results are published online in The Lancet journal, presented by a team of experts from Finland, New Zealand, Sweden and Switzerland. This latest study is the first to ever investigate how second-hand smoke affects us all. Because 2004 was the last year for which there was comprehensive data across all 192 nations under review, the experts used data from that period to ensure consistency. The experts calculated 'disability adjusted life years' (DALYs), which is the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. They found that second-hand smoke affected 40% of children, 35% of female non-smokers, and 33% of male non-smokers in 2004. The bottom line is that smoke exposure resulted in more than 602,000 deaths, specifically 379,000 from ischaemic heart disease; 165,000 from lower respiratory infections; 36,900 from asthma; and 21,400 from lung cancer. A breakdown shows that women accounted for 47% of deaths caused by second-hand smoke, while children and men accounted for 28% and 26% respectively. The DALYs lost due to second-hand smoke exposure totalled 10.9 million, representing around 0.7% of the total worldwide burden of diseases in DALYs that year, and 61% of these DALYs were in children. The diseases that had the greatest impact were lower respiratory infections in children under 5, representing 54% of the total, followed by ischaemic heart disease in adults (26% of the total), asthma in adults (11%) and asthma in children (6%). While similar numbers of adults succumbing to passive smoking were reported across all levels of income in all countries, low-income and middle-income countries reported higher passive smoking-related deaths in children. More than 43,000 children died from passive smoking in Africa compared to 71 deaths in the high-income countries of Europe, the researchers found. 'Two thirds of these deaths occur in Africa and South Asia,' the authors write in their paper. 'Children's exposure to second-hand smoke most likely happens at home. The combination of infectious diseases and tobacco seems to be a deadly combination for children in these regions and might hamper the efforts to reduce the mortality rate for those aged younger than 5 years as sought by Millennium Development Goal 4.' From a global perspective, second-hand smoke affects children more than any other age group. The biggest problem, said the experts, is when parents smoke at home. It is an environment that children are a part of, one that cannot be avoided. The experts also pointed out that nearly 66% of all deaths triggered by passive smoking in children and adults and 25% of DALYs attributable to exposure to second-hand smoke were a result of ischaemic heart disease in adult non-smokers. Thanks to government and company moves to ban smoking indoors, the number of acute coronary events has dropped significantly. 'Policymakers should bear in mind that enforcing complete smoke-free laws will probably substantially reduce the number of deaths attributable to exposure to second-hand within the first year of its implementation, with accompanying reduction in costs of illness in social and health system,' they write. The experts believe that the World Health Organization's (WHO) Framework Convention on Tobacco Control, which comprises higher tobacco taxes, advertising bans, and plain packaging, among others, should be immediately enforced in jurisdictions without comprehensive smoke-free laws. In their paper, the authors underline: 'Policymakers should also take action in two other areas to protect children and adults. First, although the benefits of smoke-free laws clearly extend to homes, protection of children and women from second-hand smoke in many regions needs to include complementary educational strategies to reduce exposure to second-hand smoke at home. 'Voluntary smoke-free home policies reduce exposure of children and adult non-smokers to second-hand smoke, reduce smoking in adults, and seem to reduce smoking in youths. Second, exposure to second-hand smoke contributes to the death of thousands of children younger than 5 years in low-income countries. 'Prompt attention is needed to dispel the myth that developing countries can wait to deal with tobacco-related diseases until they have dealt with infectious diseases. Together, tobacco smoke and infections lead to substantial, avoidable mortality and loss of active life-years of children. 'There can be no question that the 1.2 billion smokers in the world are exposing billions of non-smokers to second-hand smoke, a disease-causing indoor-air pollutant. Few sources of indoor-air pollution can be completely eliminated. However, smoking indoors can be eliminated - with substantial benefits, as shown by this new set of estimates.'
Switzerland, Finland, New Zealand, Sweden