Addicted

By Rina Jimenez-David

“Smoking is an abnormal action for a human being,” says former Thai Sen. Prakit Vathesatogkit. “When you see smoke and feel its choking effect, it’s an instinct not just for people but even for animals to run away from it and seek fresh air.” But people who light up cigarettes or cigars voluntarily and even avidly inhale smoke into their throats and lungs before exhaling it. And once someone starts smoking, says Dr. Prakit, in less than a year, he or she will become addicted.

Dr. Prakit, a pulmonary disease specialist before he became an active antismoking researcher and campaigner, was in the country to help in the campaign to get Congress to enact the “sin tax” bill that seeks to rationalize the taxes imposed on cigarettes and liquor. The new tax regimes will invariably result in higher prices for cigarettes and alcohol, but these are justified by public health considerations. Specifically, proponents hope that more expensive cigarettes will discourage teenagers from starting the habit, and make it more difficult, because expensive, for other youth and adults to continue smoking.

Currently, says the Health Justice Network, 17.3 million adults, 45.6 percent or nearly half of them low-income males, admit to smoking. The economic costs of tobacco use, including expenses for health care and productivity loss, are placed at between P218 billion and P461 billion. This doesn’t even count the “opportunity costs” of smoking—for instance, the amount of money spent on a parent’s cigarettes which would otherwise have gone to food and other basic necessities for the rest of the family. Indeed, the 2003 Family Income and Expenditures Survey found that the poorest Filipinos spent more on tobacco each month than they did on housing, clothing and education, with poor households’ spending on tobacco 10 times the per capita spending on education, and 13.5 times per capita spending on health.

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Getting smokers to cut back on, if not entirely quit, the habit, and preventing young people from picking up the habit make a lot of economic and health sense.

A study by the World Health Organization estimates that some 309,000 Filipinos die annually due to “noncommunicable diseases (NCD),” many of them linked to smoking. What makes the number even more alarming is that these NCD deaths occur among men and women below the age of 60. In his testimony before the House committee on ways and means Dr. Antonio Dans, a professor at the University of the Philippines College of Medicine, cited studies showing that healthy smokers have higher chances of contracting NCDs as compared to healthy nonsmokers.

To treat lung cancer (the leading cancer type here) alone, Dr. Dans says health care costs are already at P1.97 billion, while loss of productivity, resulting from sick leaves taken by those seeking treatment or confinement, cost P0.04 billion. The loss of revenue caused by premature death is a “staggering” P4.94 billion, bringing the total of treatment, productivity cost and deferred income to P6.95 billion.

Moreover, adds Dr. Dans, “with the costs of chronic lung disease, coronary disease, and strokes factored in, the total amount spent on these NCDs caused or worsened by smoking amounts to a whopping P188.8 billion per year.”

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Dr. Prakit warns that increasing taxes and stepping up health promotion activities do not guarantee that smoking will be curbed entirely.

He cites the experience of Thailand, where taxes imposed on cigarettes have been raised 10 times since 1994. The number of smokers in Thailand has decreased by 0.7 million in the last 20 years, factoring in the number of new smokers, but he is proud of the fact that the number of smokers who quit smoking was pegged at 6.3 million in 2009. “You can say that we were able to save 6.3 million lives,” he declares.

Asked if he and other antismoking proponents likewise faced opposition and vilification from tobacco companies, Dr. Prakit replies with a vehement “You bet!” “They are very wily and persistent opponents,” he says of cigarette manufacturers and marketers, cautioning campaigners to keep ever on their toes and alert to the various schemes these companies cook up to sustain their business.

During his stay in the country, Dr. Prakit has been meeting with legislators to personally share with them knowledge and experience gleaned in his decades of work advocating for tobacco control. Among those he wants to meet, he says, is Sen. Ferdinand Marcos Jr., an outspoken and fervid opponent of the “sin tax,” and who claims to speak on behalf of tobacco farmers. “Blown out of proportion” is the Thai expert’s assessment of the impact of higher taxes on the welfare of tobacco farmers.

But he has also taken the time to meet with the media, saying that he believes “the media play an important role in influencing not just lawmakers but the public itself to think more rationally about the harm that tobacco does.” Besides, he adds, “politicians anywhere are afraid of the media.”

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In case anyone accuses Dr. Prakit of speaking from ignorance, the former senator admits to having tried smoking in his days as a medical student.

“But I never spent for cigarettes, I just cadged them from friends and classmates,” he recalls, and admits that after some years, “I was forced to stop smoking when my friends refused to give me any more free cigarettes.”

Many years later, as a professor at the college of medicine, he would take on a more addictive cause. “In 1986, my dean called me and asked me to get involved in tobacco control,” he recalls, “and, you know, from then on I was addicted. You could really get addicted … to this line of work!”

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