July 31, 2013
What plant is responsible for the most deaths in the world?
When Dr. Merlin Wilcox first asked our class this question, I was stumped. How could a plant be responsible for more deaths than car accidents or a deadly virus? I’d heard of poisons like belladonna before, but they seemed relics from an ancient time – it seemed highly unlikely that people were being poisoned at that high a rate in this modern day and age.
And yet, when the answer was revealed to be tobacco, it suddenly made sense.
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Tobacco is estimated to cause 5.4 million deaths each year, Dr. Kremlin Wickramasinghe later informed us. That is more than all the deaths caused by malaria (.8- 1 million), HIV/AIDS (less than 2 million), and TB (roughly 1 million) combined. Furthermore, these facts don’t take into account the burdens diseases such as cardiovascular disease and lung cancer place upon those who live with them – including lost productivity and quality of life.
But, in spite of all this, tobacco isn’t going to get the same publicity or funding as any of these other diseases. Part of the issue is that tobacco causes what are known as noncommunicable diseases (NCDs). These are diseases that cannot be easily transmitted from person-to-person, such as stroke and diabetes. I was surprised to learn that, despite the publicity that contagious diseases get, NCDs accounted for 63% of all deaths in 2008. The difference lies in the perceptions underlying NCDs.
For many years, NCDs were seen as a problem of the developed, wealthy nations. Poorer countries fought off malaria and tuberculosis, while the wealthier ones dealt with obesity and heart failure. It’s easy to understand why philanthropists might have chosen to help the countries they saw most in need of aid – those without the funding to treat preventable diseases – as the wealthier countries had the money to take care of themselves.
The issue with this belief is that it’s no longer true. NCDs are now becoming problematic in lower income countries as well. In fact, nearly 80% of deaths from NCDs in 2008 were in low- to middle-income countries. Tobacco is no exception to this trend – it is estimated that over 80% of tobacco-related deaths will be in developing countries by 2013.
So, it’s not just a problem for wealthy nations. But that’s not the only reason it is difficult to garner support for dealing with NCDs like tobacco-related diseases. Another major problem is that vaccines and other medicines are not the answer – the answer is changing people’s behavior, a much more daunting task.
Lifestyle choices, such as the choice to smoke tobacco or to drink alcohol, are the predominant factors that contribute to one’s development of NCDs. While proper education in the dangers of excessive drinking and smoking cigarettes is important, it is unfortunately not fully successful.
After all, we’ve known that smoking kills since the 1950s, when British doctor Richard Doll conducted research on the negative effects of smoking cigarettes. I personally saw my fair share of terrifying anti-smoking commercials as a child – one with a woman smoking through a hole in her throat still remains with me today. Cigarette cartons themselves also proclaim warnings that their products may cause death. And yet, smoking is still a problem over half a century later, despite all of the warnings.
Even at USC, smoking is prevalent. Freshman year was spent trying to hold my breath on the walk from Birnkrant to EVK every day, lest I breathe in the potentially toxic smoke being puffed out all around me. Debates about making the campus smoke-free have been heated, with many arguing that it’s a personal choice – some even claimed that it was a First Amendment right, and subject to special protections.
Add the US tobacco lobby (which contributed over $4 million during the last application cycle, according to opensecrets.org) on top of all those who already enjoy smoking and don’t want to be told where they can and cannot do so, and you’re faced with an intimidating foe.
But we cannot be discouraged. The dangers of secondhand smoke (estimated to cause 46,000 deaths from heart disease and 3,400 deaths from lung cancer in nonsmokers, according to the American Cancer Society) are more than enough to fight for the banning of smoking in public areas, and it is possible to discourage people from smoking as well.
One major success story occurred in England, where smoking inside public buildings such as one’s office was made illegal. According to the BBC, five years after the ban, workers in bars had significantly better lung function due to the lessened exposure to cigarette smoke. Children’s exposure to secondhand smoke had declined by just under 70%, and, relatedly, there were 15% fewer cases of children with asthma. In addition, there was also a 2.4%.drop in the number of adults having heart attacks.
It’s unclear whether or not the ban has been effective in decreasing the numbers of smokers, however. While the number of smokers in Northern England declined by 8% over six years, it has remained constant overall in the country. Smoking in public areas has decreased, but the restrictions will not discourage everyone from smoking. Ideas such as plain packaging for cigarettes, to make them less attractive to consumers, have also been rejected as of late.
The WHO suggests four “low-cost” tips to reduce burden of tobacco on the public health: raising taxes on cigarettes, protecting people from second-hand effects, warning people about the dangers of smoking, and enforcing bans on advertisements for tobacco products.
There is not going to be one “right” answer to eliminating smoking (and, by doing so, tobacco-related diseases) in every country. Much as with malaria medicine and other communicable disease treatments, one has to consider the political and cultural background of each country in order to make an effective policy aimed at stopping the tobacco epidemic. Furthermore, health officials can’t do it alone – it will take collaborative efforts between health professionals and other officials and sectors in order for a change to come about.
Tobacco is no longer an issue of the rich. And, if we don’t act urgently, it will become an even greater danger to the poor.
Natasha Sosa is a junior majoring in Neuroscience from San Jose, CA.
When I was in elementary school I had my eyes set on becoming an astronaut, but then the NASA program was disassembled and my dreams were crushed. Fortunately, I’ve always had a passion for medicine and a desire to provide aid and care to others. This being so, you can probably guess my major when applying to colleges: Biology. However, during my senior year of high school I took a liking to my AP Microeconomics class and decided to declare a double major in econ, purely out of interest. Little did I suspect the pre-med classes I was taking to ever overlap with my econ classes. Studying tropical medicine in Oxford, and being taught a new perspective on global health has really incorporated the two disciplines for me.
Dr. Aneil Jaswal spoke to our class on July 23rd in regards to the key players in health and development. (Maybe a fact you didn’t know: The Bill and Melinda Gates Foundation comprises nearly a quarter of international funding towards global health and disease prevention.) Dr. Jaswal reported that a lot of money is being pumped into fighting tropical diseases by major international agencies and countries, including the WHO, UNICEF, WFP, World Bank, The Bill and Melinda Gates Foundation, the USA, and the UK, but not all of it is being used justly. Corrupt third-world governments absorb much of the international funding ear-marked for fighting the tropical diseases of their citizens causing it to “magically disappear”. While some money given to the third-world governments is abused by individuals, some governments are just using the money incorrectly. Many countries believe they should be investing funds into bettering the economy with the intention of becoming a richer country and focusing on health after. Dr. Jaswal pointed out that countries in Sub-Saharan Africa use international funds to promote farming or finding oil, which is an approach that is perpetuating poverty and poor health. Dr. Jaswal references China, and the nearly quadrupling of its GDP it’s done in the last couple decades; he displayed statistics that showed that the revolution in Chinese healthcare is what facilitated its rapid growth.
This is where my economics background kicked in.
This will sound nerdy, but please don’t judge! I have a favorite theory of economics, it’s is called the Convergence Theory. The Convergence Theory explains how the economies of poorer countries grow faster than wealthy economies, eventually leading to a convergence of per capita income between all countries. This happens for two main reasons: diminishing returns to capital for rich countries, and the fact that wealthy countries develop the new technologies and make the important discoveries, the poorer countries just have to adopt them. There are few limitations to this phenomenon, one of them being the health of the general population. If the health of the population is too poor the workforce will not be powerful enough to facilitate the economic development. So was the case in China; as soon as the populace became healthy, the economy began booming and there were huge rises in per capita income.
Here is a quick memo to many third-world countries: be patient and focus on the eradicating the tropical diseases that plague your citizens. If you properly use international funding for disease vaccinations, treatments, and prevention methods, your workforce will strengthen and in turn your economies will grow exponentially.
Dr. Jaswal puts half the responsibility on the donors; they have a lot of the power and capability to ensure the money is spent correctly and for the benefit of the people. Raising the money is the hard part, ensuring that it is being used for the greater good seems like the logical second step.
Pradeep Nadeswaran is a sophomore majoring in Biological Sciences and Economics from Orange County, California. After graduating, he would like to pursue a career in interventional cardiology and medical administration.
When I envisioned my first few days studying at Oxford, I imagined frequenting several places: a cookie counter in the covered market, a souvenir shop filled with English goodies, our lecture hall where we would discuss the ongoing problems in global health and tropical diseases, and many other sights and sounds unique to my new home. Little did I know that it would be just my luck to develop an ulcer on my left eye within days of arriving in the United Kingdom due to a faulty, irritated contact lens. Although my eye situation was a little unfortunate, I soon came to realize that for traveling outside of the United States, I happened to be in a country with one of the best healthcare systems in the world.
With an irritated eye and a few directions from our USC international health insurance, I headed to John Radcliffe Hospital, the main teaching hospital and research center associated with Oxford University. A huge medical complex with modern glass buildings greeted me, and as fate would have it, an entire section is devoted to optometry and ophthalmology, the Oxford Eye Hospital. As I entered the emergency clinic I gave my name, birthdate, and local address, but nothing more. No insurance card, phone number, physician contact, or co-payment was necessary and without any fuss, I was added to the list of emergency patients being seen by the clinic.
In 1948, the UK instituted a comprehensive national healthcare plan that came to be known as the National Health Service, a publicly funded healthcare system that provides comprehensive health services free of charge to citizens at the point of entry. To my surprise, these services were also provided to me, and American tourist, free of charge! In less than two hours, without any payment or appointment, I was seen by a qualified physician, diagnosed with an eye ulcer, and on my way to a local pharmacy to pick up an assortment of antibiotic drops and ointments for my irritated eye. In fact, if my appointment wasn’t after regular hours and my medications were in stock, they also would provide me with my prescriptions free of charge at the hospital during my appointment.
Over the course of our trip I made the trek out to the hospital for 3 more checkups, and each time the routine was the same: check in at the desk with my appointment card, visit an emergency ophthalmologist, receive a new prescription or set of directions, and leave the hospital without spending a dime. In fact, the costliest part of my visit was the taxicab!
With the sky-high insurance rates that dominate American healthcare, the UK provides a fascinating model of comparison. Although there has been extensive and controversial debate on the Affordable Care Act and the nationalization of our current healthcare system experiencing the British system firsthand was definitely an eye opening experience. It didn’t matter where I was from or if I was able to afford insurance, I was a patient with an emergency medical situation. As I spend the rest of my journey here studying the diseases, healthcare systems, and challenges of the tropics, I can now say with confidence that I have a more global perspective on how healthcare systems worldwide can work to achieve their goals and provide the services needed by their citizens.
Megan Bernstein is a Senior from Fremont. CA studying Biological Sciences and News Media.