Title : TOBACCO INDUSTRY INTERFERENCE INDEX
Year of publication : 2018
Author : Mary Assunta Kolandai (WHO FCTC)
subject : TOBACCO
Introduction 1
Summary Findings 3
Tobacco Industry Interference
Philippines: Action to protect the Bureaucracy 14
Challenges Remain 16
Conclusions and Recommendations 17
References 18
Title : THE TOBACCO ATLAS
Year of publication : 2018
Author : American cancer society
Subject : Tobacco
By now, we know that tobacco kills more than half of those who regularly use it and has a two trillion dollar (purchasing power parity (ppp)) economic cost to the society each year’ Fortunately” the global community is making progress towards improving tobacco control. The efforts of government, civil society and the international community, including through the WHO framework convention on tobacco control (FCTC) are having life –saving effects in many countries’ Recently, overall global tobacco consumption has even decreased slightly. However, we continue to contend with the reality that many countries with young populations are experiencing growing prevalence as the tobacco industry’s tactic continually undermine public health efforts.
This sixth edition of the tobacco atlas and its companion website – tobacco atlas.org –bring readers and users an exciting and comprehensive guide to key tobacco control issues. it weaves together two related narratives ; the bleak reality of the damage that tobacco causes even before it sprouts from the ground, and an optimistic examination of the evidence – based tools that were using to address this reality , which could be further enhanced through more effective implementation.
CHAPTER 1 – Growing page 14
CHAPTER 2 – Manufacturing page 16
CHAPTER 3 – Marketing page 18
CHAPTER 4 – prevalence page 20
CHAPTER 5 – Secondhand page 22
CHAPTER 6 – Health Effects page 24
CHAPTER 7 – Comorbidities page 26
CHAPTER 8 – Deaths page 28
CHAPTER 9 – Societal Harms page 30
CHAPTER 10 – Global Strategy -page 34
CHAPTER 11 – Quitting – page 36
CHAPTER 12 – Taxes – page 38
CHAPTER 13 – Smoke Free -page 40
CHAPTER 14 – Media campaigns – page 42
CHAPTER 15 – partnership – page 44
CHAPTER 16 – Regulating Novel Products – page 46
CHAPTER 17 – Industry Strategies -page 48
CHAPTER 18 – Countering the Industry – page 50
CHAPTER 19 – Optimism – page 52
Title : TAXATION
Year of publication : 2014
Author : World Health Organization
Subject : Tobacco
Tobacco usage is high in countries of the South – East Asian Region. The adult prevalence of Tobacco use is around 35% in most Member States. The prevalence of Tobacco use among the youth population is around 10%, with the exception of Bangladesh.
Total tax share can contribute to higher retail price and decrease demand for, tobacco products. The total share of all taxes in cigarette retail price varies from country to country. Bangladesh, Sri Lanka and Thailand are the only countries in the Region where the tax share exceeds 70% of the retail price. In other countries the share is between 40%and 50% excepting Nepal and Timor – Leste at around 35%. There are different tobacco taxation policies and systems in Member States. These have implications for the price of, and the demand for, cigarettes and other tobacco products and provide examples that other countries can learn from.
Title: WHO Technical manual on Tobacco tax administration
Year of Publication: 2010
Author: World Health Organization
Subject: Tobacco tax levels and structure, Tax administration, The political economy of tobacco taxation….
Summary: “Sugar, rum, and tobacco, are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation. …… In the mean time the people might be relieved from some of the most burdensome taxes; from those which are imposed either upon the necessaries of life, or upon the materials of manufacture.
The labouring poor would thus be enabled to live better, to work cheaper, and to send their goods cheaper to market. The cheapness of their goods would increase the demand for them, and consequently for the labour of those who produced them.
This increase in the demand for labour, would both increase the numbers and improve the circumstances of the labouring poor. Their consumption would increase, and together with it the revenue arising from all those articles of their consumption upon which the taxes might be allowed to remain.”
Title: Regional Health Forum
Year of Publication: 2013
Author: WHO South-East Asia Region
Subject: Blood pressure-take control
Summary: Globally, cardiovascular disease accounts for nearly one third of the total global deaths . Hypertension is responsible for at least 45% of deaths due to heart disease, and 51% of deaths due to stroke. Currently, 80% of deaths due to cardiovascular disease occur in low- and middle-income countries, where the burden of hypertension has increased over the past decade due to population growth, ageing and increase in behavioural risk factors. If appropriate action is not taken, deaths due to cardiovascular disease are projected to rise further. The cost of inaction may be very high. In low- and middle-income countries, many people do not seek treatment for early stage hypertension because it is unaffordable. Households then spend a substantial share of their income on hospitalization and care of complications of hypertension, and may be driven to poverty. The annual loss of approximately US$ 500 billion due to major noncommunicable diseases amounts to approximately 4% of gross domestic product for low- and middle-income countries. Cardiovascular disease accounts for nearly half this cost. On the other hand, there are significant health and economic gains attached to early detection, adequate treatment and good control of hypertension. These approaches can significantly reduce the need for costly interventions such as cardiac bypass surgery and dialysis. The estimated cost of scaling up highly cost-effective interventions that address major noncommunicable diseases in all low- and middle-income countries is less than US$ 1 per head in low-income countries, less than US$ 1.50 per head in lower–middle-income countries and US$ 2.50 in upper–middle-income countries. Although such cost-effective interventions are available, there are major gaps in implementation, particularly in resource-constrained settings. Public health policy must address hypertension because it is a major cause of disease burden. A combination of affordable, sustainable and effective interventions targeted at the whole population through multisectoral actions and partnerships is needed to address the implementation gap. Salt reduction initiatives can also make a major contribution to the prevention and control of high blood pressure by shifting the blood pressure distribution of the whole population to a healthy level. Health systems need to be strengthened to deliver cost-effective integrated programmes, particularly at the primary care level, and use hypertension and diabetes as entry points. The prevention and control of hypertension requires political will on the part of governments and policy-makers. The World Health Organization is coordinating the development of a global action plan for the prevention and control of noncommunicable diseases for the period 2013–2020 and a global monitoring framework. Together, they will provide a road map to operationalize the commitments of the United Nations Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases.
Title: Curbing the Epidemic
Year of Publication: 1999
Author: –
Subject: governments and the economics of tobacco control.
Summary: Curbing the Epidemic, a World Bank report, examines the economic questions that policymakers must adders when contemplating tobacco control. The report assesses the expected consequences of tobacco control for health, for economies and for the individual. It demonstrates that the economic fears that have deterred policymakers from taking actions are largely unfounded. Policies that reduce demand for tobacco, such as decisions to increase tobacco taxes, would not cause long-term job losses in most countries. Nor would higher tobacco taxes reduce taxes revenues; rather, revenues would climb in the medium term. Such policies could bring unprecedented health benefits without harming economies.
Conclusions:
• If developing countries adopt measures to reduce the demand for tobacco, they can prevent millions of premature deaths and such disability, especially among the poor, who are more likely to smoke than the rich in most countries.
• A comprehensive tobacco control policy is not likely to harm economies. Research shows that such policies do not erode tobacco taxes revenues, nor do they cause permanent job losses.
• Demand-side tobacco control measures are effective in reducing consumption. Key measures include: raising cigarette taxes; implementing a complete ban on advertising and promotion of tobacco products; restricting smoking in public and work places; educating consumers about the health risks of smoking; and increasing access to cessation interventions such as nicotine replacement therapy (NRT) to help those who want to quit.
• Of those measures, the most effective is to increase the price of cigarettes. Children, adolescents and people on low incomes are most responsive to increase in price, so the impact of the measure in greatest among these groups.
• In contrast to these successful demand-reducing measures, efforts to reduce the supply of tobacco through measures such as banning tobacco, restricting sale to minors, trade restrictions or crop substitution, are likely to be effective.
• Poor tobacco farmers need not to be hurt by tobacco controls. Successful control policies will lead to a slow decline in tobacco use. Therefore, any loss of tobacco-farming jobs will be over decades or more, not overnight. Governments have a responsibility to assist the poorest farmers in the gradual transition to alternative livelihoods.
Today, about 1.1 billion people smoke worldwide. By 2025, the number is expected to rise to more than 1.6 billion. With current smoking patterns, about 500 million people alive today will eventually be killed by tobacco use. More than half of these are now children and teenagers…
Title: Tobacco: A Global Threat
Year of Publication: 2003
Author: John Crofton and David Simpson
Subject: Tobacco
Summary: Nicotine addiction, through cigarette smoking and other tobacco use that it perpetuates, is the major cause of preventable deaths in our world. It is exceptional in that the income the cigarette companies and their shareholders receive is directly related to the number of people who became addicted will die of the many cancers and other diseases caused by tobacco. Moreover, parents’ smoking can damage both their unborn babies and their children.
As a paediatrician i am particularly concerned with the worldwide targeting of cigarette promotion towards children and young women, the future mothers. Nicotine addiction is probably as difficult to overcome as addiction to cocaine. The younger a child becomes addicted the greater the damage done to the health and the greater the difficulty and expense of curing the addiction.
Those who live in richer countries have more effective legal systems and community organizations which can resist the wealth of the tobacco companies intent on spreading nicotine addiction. This is not so in the “resource poor” countries where most of the world’s population live.
Title: Impact of tobacco vs. alternative crop cultivation on the socio-economic status of farmers
Year of Publication: 2011
Authors: Prof. H.M.S. Priyanath, S.M. Ranasinghe Bandara, M.A.D. Nissanka Ariyasena
Subject: Impact of tobacco vs. alternative crop cultivation on the socio-economic status of farmers, the impact on the environment and the difficulties regarding the subject is studied through this book.
Summary: The enticements offered by the tobacco industry had been the major factor alluring farers for tobacco cultivation. Provisions of seeds, agro-chemicals, extension services and purchasing of the produce have been part of the package that has been offered to the farmers by the industry. As tobacco was more profitable than the other crops in the initial stages, more farmers took to it.
Mainly the highlands have been used for tobacco cultivation. While these lands have been the ones used for temporary crops cultivation, the crown-land too has been used in growing tobacco.
Two distinct phases in relation to income from tobacco cultivation can be identified. In the initial stages, as the inputs were inexpensive and high price was paid for the produce, the farmers were able to make good profit. However, as the soil fertility began to wear off with repeated cycles necessitating greater inputs, and as the price of labour increased simultaneously, the profits of the farmers plummeted. In addition, the farmers said that they had to expend a lot of physical and mental energy during the period of tobacco cultivation. When the income from tobacco started dropping and physical and mental exhaustion associated with tobacco farming became unbearable, the farmers gradually moved away from tobacco to alternative crops.
Here are some of the environmental concerns expressed by the farmers:
“because of tobacco (cultivation) fertile soil was washed off to the Randenigala reservoir”-a farmer from Walapane
“because of tobacco even a hare could not live” -a farmer from Walapane
“the reason for today’s water problem is tobacco cultivation.” -a farmer from Walapane
“the bees that were there for years left the area because of tobacco” -a farmer from Buttala
The health status of the farmer households fared much better during periods when they cultivated alternative crops as compared with periods of tobacco cultivation. It was also observed that tobacco cultivation has many direct adverse effects on the family members. The heavy labour burden resulted in less attention being paid by the farmers to family health and wellbeing. High usage of chemicals and stacking tobacco leaves within homes gave rise to offensive odour and dust, which in turn caused many health problems among the family members.
Shifting to alternative crops from tobacco has lead to “mental peace” among the farmers and their family members. This in turn has contributed to better social relationships within the family as well as with relatives and with social and religious organizations in the village.
Considering these facts, one can safely infer that alternative crops vis-a`-vis tobacco have, within the parameters studied, positively contributed to the social sand economical improvement of the farmers’ families.
Title: The Tobacco Atlas
Year of Publication: 2012
Author: Michael Eriksen , Judith Mackay, Hana Ross
Subject: The harm caused by tobacco, global smoking prevalence, e-cigarettes and other emerging nicotine delivery systems, illicit trade, black market and public health strategies to reduce tobacco usage.
Summary: “The battle is far from being over. Unless the prevalence of smoking is reduced substantially, the number of smokers will increase in the world in the next several decades, mostly due to population expansion in low- and middle-income countries. Measures to tackle the epidemic remain seriously under-funded.”
Margaret Chan, Director-General, WHO, 2012
www.TobaccoAtlas.org
Title: Strategies to Address Alcohol Problems
Year of Publication: 2005
Author: Diyanath Samarasinghe
Subject: Strategy for global, national and local community needs regarding alcohol problems.
Summary: There is scope, given the global village, for a singal individual to impact on structures of enormous size and power. A network of people, a group or an organisation can indeed achieve much. To succeed, they need to be imaginative and able to learn through doing. Learning is fostered when there is a model for understanding, for putting things together, and for generating ideas to put to test. Much effort is wastedfor lack of a broad grasp.
Clarity increases through continued discussion and debate. Collecting information on things that have been tried, and the results of such trials, improves understsnding on what needs now to be done. All strategy is tentative and must evolve as information flows in. And here lies a catch. In the specialised world that different individuals occupy today, the thinkers and visionaries, the gatherers of information, the researcheres and planneres all occupy worlds far from those of the motivators and the doers. This hinders development. Relevant strategy must evolve in the hands of those who are working. This does not happen enough.
People working with individuals and families affected by the alcohol must also become strategists. They must be encouraged not only to recognise the different options for helping but also to examine critically what communities generate as solutions. Only when can they influence decisions at the broader level.
Action at the grassroots is more vibrant in the more disadvantaded parts of the world. New ways of looking at problems, and solutions, emerge from experiments at the gressroots. These have a hard time making it to the real strategy world. Many of those who specialise in strstegy concentrate on national alcohol policies. But the date they use in decisions at thet level are of a different quality from those that come directly from people. We must all work hard to get the wisdom of the grassroots to add to thet which resides wit experts. This isn’t easy as gressroots wisdom is mostly generated in the economically underprivilaged world.
Title: Unrecorded Alcohol
Year of Publication: 2009
Author: FORUT
Subject: Unrecorded Alcohol and its harmful impacts
Summary: Illicit alcohol is a large and particularly damaging component of unrecorded alcohol consumption. Unrecorded alcohol use constitutes in many poorer countries a large, and in some instances the largest, share of all alcohol consumption. The well-recognized harm from illicit alcohol use is readily and widely attributed to toxic constituents and impurities but not to that resulting from its contribution to total alcohol consumption of the population. This tendency prevails even in settings where unrecorded consumption exceeds that of legal brews. Policies effective in wealthier countries are often less so in poorer countries with large proportions of alcohol consumed being of the ‘unrecorded’ category. Some measures may even have untoward consequences. Interested parties can also use the presence of a sizable market in unrecorded alcohol as an argument to block the adoption of effective policies – by highlighting or exaggerating possible increases in illicit alcohol use that can result from the adoption of such policies. Enhanced criminality, corruption and other negative social consequences that result from large-scale illicit markets are ignored in national and international forums. So also is the possible collusion of the legal alcohol trade in the illicit business.
Title: Alcohol no ordinary commodity
Year of Publication: 2003
Author: Thomas Babor
Subject: Alcohol
Summary: From a public health perspective, alcohol is no ordinary consumer product. On a global level, it is a major contributor to disease, disability and premature mortality. It also has an adverse impact on many aspect of social life. This book describes recent advances in alcohol research that have direct relevance to the development of effective alcohol policies at the local, national and international levels. It covers the search for policies that protect that health, prevent disability, and address the social problems associated with the misuse of beverage alcohol. This book is, at its core, a scientific treaties on what alcohol policy is, why it is needed, which interventions are effectively, how policy is made, and how scientific evidence can inform the policy-making process.
The book opens with an introduction to the alcohol policy agenda. The second section then presents a snapshot of drinking patterns and alcohol related problems throughout the world, providing a global panorama of the challenges faced. The third section critically reviews the evidence for six strategies that have often been used as a basis for alcohol policy: taxation and pricing, regulating the physical availability of alcohol, modifying the drinking context, drinking-driving countermeasures, regulating alcohol promotions, education and persuasion programs, and treatment and early intervention services. Section four provides an international analysis of the policy making process. The book includes with a consumer’s guide to effective alcohol policy, synthesizing what is known about how communities and nation states can effectively manage this extraordinary commodity.
Alcohol has multiple functions in any society. Alcoholic beverages have important cultural and symbolic meanings. They are commodities that are bought and sold in the marketplace. And alcohol is a drug with toxic effects and other intrinsic dangers such as intoxication and dependence. This chapter examines these different functions, paying special attention to the contrast between alcohol’s role as a commodity and as a drug. An understanding of this contrast is essential to the book’s central purpose.
In recent years, public discussion of alcohol policies has too often ignored or downplayed the need to understand both the nature of the agent and its harmful properties, with an implicit acceptance of the idea that alcohol is only an ordinary commodity like any other marketable product. The validity of this assumption is questioned by evidence showing that alcohol intoxication, alcohol dependence. And the toxic effects of alcohol on various organ systems are key mechanisms linking alcohol consumption to a wide range of adverse consequences.
Title: Alcohol and Illicit Drugs
Year of Publication: 1993
Author: Dr.Hans Olav Fekjaer
Subject: Myths and Realities
Summary: Intoxicants have symbolic and ritualistic significance and they are widely used to provide excuses for social ineptitude, poor performance and bad behavior.
Dr.Hans Olav Fekjaer, strongly challenges the conventional wisdom regarding alcohol and illicit drugs. He promotes the view-supported by research evidence-that there are obvious non-pharmacological explanations of the apparently “magic” influence of intoxicants and that the pharmacological effects on mood and behavior are non-specific and for the most part emotionally neutral or unpleasant.
The book also describes how the subjective influence of alcohol and other drugs, and behavior they allegedly induce, can be changed by undermining widely held beliefs about their effects.
It substantiates the emerging view that the “magic” or “pleasurable” experiences commonly ascribed to alcohol and other drugs have little to do with their chemical action.
Title: Oh, go on-HAVE ONE MORE
Year of Publication: 2009
Author: Dr.Diyanath Samarasinghe
Subject: Three easy on Alcohol Matters
Summary: Alcohol and us, Alcohol and pleasure, Alcohol and poverty.
Conclusion: Poverty is not just low income. Nor are poor people a uniform and honogi8nenoues mass, whose development needs are all the same. But some common characteristics that apply to poor living conditions can be recognised, such as the lack of boundaries leading to others including to personal life, aspirations been limited and all extra income been diverted uncontrollably into readymade unproductive channel- specially alcohol use. There are forces top addresses within and outside [poor communities that contribute to enshrining that people do not escape from poverty.
The impact of alcohol on human development is not only on economic matters but also on general wellbeing- including healthy social relating. Alcohol affects both aspects. I6t is a sign9onfiocant contributor to maintaining and worsening economic difficulties and it likely plays a role in generating poverty too. It keeps poor people collectively poor. Alcohol consumption is driven strongly by ritual and symbolic pressure and not only by the desire for it chemical effects. Huge alcohol expenses impact not only on the families of heavy consumers but also on the communities as a whole. Custom associated with alcohol use ensure that those who consume little or no alcohol have to subsidize those who consume more.
There is a mage synergy between alcohol use and poverty in damaging people’s wellbeing, including their physical health. The combined influence of these two factors often has disastrous impact. A particular example is the permission that intoxicated individuals are given to interfere in the affairs of others. This social practice causes heightened harm in poorer settings/ where the associated overcrowding allows intrusion in to each other’s personal lives. The combine effect on the powerless is particularly nasty.
Actions to reduce poverty pay relatively little attention to modifying people’s spending habits and the factors that govern such habits. These include both local and remote influences – the impact of which can be modified by successful collective action. Lack of personal control over expenditure is particularly evident in relation to special events and celebrations. Alcohol provides a good “entry point” to engage communities in a process of positive change or development, which includes taking control over their established patterns of expenditures. People find it quite feasible to reduce their collective alcohol expenditure, when guided to address collectively the determinants of use.
Responses to poverty, alcohol problem and their combined effects on human development would do well to consider the following recommendations:
• Poverty reduction strategic plan should spell out clearly their underline assumptions and premises and be comprehensive in their approach. There should be greater attention to the great variety and diversity of people and communities classified as “poor”.
• Comprehensive strategy should include attention to common factors that impede progress of poor families and communities, and ways of overcoming these. Alcohol is an example of such factors, while the tendency for people in a crowded community to obstruct progress of others is another.
• Poverty reduction interventions must include ways of improving management of limited resources. Unaffordable expenditure on substances such as alcohol, or on special events and celebrations, are examples of things that can readily be changed.
• Strategic plans should provide space for local initiatives and actively seek lessons that can apply across settings.
• Proposed poverty reduction interventions should spell out clearly the process that they propose to generate, within families, communities and society at large, through which their expected results are to be reached.
• There are many local or community level initiatives that deserve to be a poverty of broad poverty reduction initiatives. Examples are available of success using interventions base3d on specific theoretical premises- which allow dissemination across a wide variety of settings.
Title: Alcohol and Poverty
Year of Publication: 2003
Author: Berguot Baklien and Dr.Diyanath Samarasinghe
Subject: Alcohol and Poverty relationship in Sri Lanka
Summary: What is the role of alcohol in different social settings in Sri Lanka? To what extent does alcohol contribute to creating perpetuating or worsening poverty, and to what extent is alcohol a hindrance to development?
Summary
This report is on a study of alcohol and Poverty commissioned by the development agency FORUT (Norway). The study ran from june 2002 to june 2003. it covered several settings specified by forut, as the agency commissioning the study. These settings included urban overcrowed communities(commonly referred to as ‘slums’), dry zone and wet zone reral communities, an estate sector community and a setting of persons initially displayed. To provide better coverage, a predominantly Roman Catholic ’fishing’ community was added to the list originally provided.
Methodology
The methodology was principally an in-depth qualitative inquiry through trained and regularly supervised field assistants. The in-depth component required the field assistant to be in the given community for a period of at least ten days. There were seven locations so studied. This was supplemented by a brief inquiry in three other settings to obtain greater coverage. An ‘informal’ entry was used to study eight other urban settings within the capital Colombo.
In addition a short questionnaire exploring quantitatively some variable connected to alcohol use was administered at the end of the qualitative study.
Principle findings
Poverty
‘Poverty’ could refer to many things including a limitation in richness of people’s lives, poor income or lack of basic needs. All of those unsurprisingly went together in the most of the settings that we studied. Lives were limited in the range of things to be involved in or to do, in variety of interested, in aspirations to aim for and in comforts and range of opportunities to enjoy leisure. We found that people with poor income generally, but not always, had poorer or more limited lives. But poverty of lives was not always a function of poor income.
Poverty seemed strongly to imply uncertainty and a lack of control over the future. Many had such regular and routine lives, with so little variation, that they could forecast today the routine they would have to follow on any given day in the future, even ten years hence. But such persons too still felt uncertain about the future. They were still at the mercy of such things as drought and other natural disasters. Any possible variation from a routine and unchanging life could occur only due to a calamity!
Among the economically deprived there was a great deal of intra-group differences. The poor of many levels, but some common features that were evident below are listed below.
Porosity
Many of the most poor in the city are crowded together. Much of the character of their lives stems from unable to ‘wall themselves off’ for example as a family, from what happens in their community. Most of the poor in the village and the not-so-poor in the city have a slightly better defined space, a boundary. But porosity is found in rural settings too, particularly among those living in the line houses, and in the fishing community.
Because of not having a boundary beyond which the rest of the world or community cannot intrude ( or ‘porosity’ of the living space ), the poor in the city’s overcrowded tenements find it difficult to improve economically. Especially so if others around them do not particularly want them to. This phenomenon has major implications for those living such circumstances and for those working for development in such settings.
Porosity has other important consequences too. The lack of private space makes it difficult to resolve conflicts in private. ‘Loss of face’ has to be avoided and, strangely theris probably more fighting and aggression where people cannot have a boundary between themselves and the rest of the world. Or the fighting is more visible.
Envy and jealousy
A feling of ‘envy’ for anybody who rises above the rest was strongly evident. Whether this tendency, to want keep all others no better than oneself, is a feature outside this kind of community has to be studied. But it certainly is a strong element in these communities. Many of our informants have referred to this as ‘jealousy’. This tendency is most evident in relation to money and materials possessions, and was common to both rural and urban settings.
More subtle improvements are envied too. A couple that is happy together will be envied. There may even be attempt to impede their wellbeing. A man who does not consume alcohol daily with the crowd can be targeted in the same way.
Visible consumption
People spend money on things that give them social credit. We found that there are massive expenditure on alcohol for ‘celebrations’ in poor families. It is almost as if they want to be envied their expenditure. At the same time as they complain of others wanting to keep them down because of envy or ‘jealousy’ there is a desire to do exactly the things that others make other envy them. Showoff is a kind of must. The need to be envied, or to get social credit, is probably an important factor that keeps people poor. Families getting into debt, and having to pay interest of over ten percent per month for life, was reported common following even a single celebration such as that for a daughter reaching menarche.
Lack of control
Poor people seemed to have more direct pressure applied on them than the rich, regarding how they should live. Others in the community could directly demand conformity. This applies to how they choose to conduct a ‘private’ event. Parents in a poor community, who did not wish have a party when their daughter reached menarche, could be asked to explain why. Some informants said that they could be forced to change their decision.
Criminality
Criminals acts and violence appeared rather close to the surface to the poorest communities. Whether similar degrees of violence and criminality in richer communities are somehow hidden requires separate investigation. But the overall impression was that violent and aggressive behavior was always lurking somewhere close to the surface. And it was as if this tendency strongly influenced life in the poorest communities. ‘Everybody’ recognized, for example, that the trade in illicit drugs and illicit alcohol should not be seriously challenged. The undertone of possible organization criminal elements was more evident in the urban settings.
‘Impossibility’ of overcoming poverty
A repeated theme was that people could never emerge from poverty as long as they lived in their overcrowded urban setting, irrespective of the income they were able to earn. One factor underlying this is the ‘porosity’ of living arrangements that we referred to earlier. There is no room for gradual growth or development. Any progress is visible, and others are not keen to see just one family prosper. The sense was that others would not allow people to develop, and that the shared lives allow them to obstruct those who want to develop. There may be other barriers too, common to both rural and urban settings. One of these is that people have not only to overcome their own personal and private poverty. They have to overcome the culture of poverty that is a part of their surrounding and their everyday life. It appears that acceptance of current circumstances is more adaptive than trying to overcome them.
Alcohol and other substance use.
Significant heroin use was almost entirely an urban phenomenon. Cannabis smoking was common in several rural settings. Alcohol was nearly everywhere. Alcohol and heroin are needed as an essential daily commodity by a significant minority of the poor in urban communities. Alcohol, most commonly illicit, is similarly needed daily by a significant minority of the rural. Tobacco is too, but it is somehow less noticed or commented upon. Alcohol and heroin get much more attention than tobacco does.
An apparent discrepancy was found between the qualitative and quantitative study results. In the quantitative study 63% reported that they never consumed alcohol. Only 17% consumed more often than once a week. But the qualitative study yielded the impression that nearly every male wanted to have alcohol at weddings and celebrations and they would all protest openly about not being able to enjoy the event if there was no alcohol. But in the anonymous quantitative study just 32% said that the act of drinking was a pleasant experience while only 14% said that the experience of’ being drunk’ was pleasant.
The data were analyzed separately and could not be clarified with the respondents. There are several possible explanations for this seeming contradiction. One of these is that, during social events, a minority of very vociferous individuals who want to promote alcohol are able to create an impression that becomes somehow the view of the whole group, most whom remain silent.
Perception of ‘alcohol user’ and abstainer.
Title: Prevention and cessation of tobacco use
Year of Publication: 2003
Author: World Health Organization
Subject: Tobacco (a manual for clinic and community based interventions)
Summary: This manual is intended for people in reducing problems caused by tobacco. The damage caused by tobacco is so serious that everybody should really be interested in doing something about it. But this manual is for thos who want to do a little more than the “average citizen”.
Although tobacco is a deadly serious issue, the flavour of activities that are needed to prevent this spread does not have to be heavy and serious. Tobacco use is spread by making it look appealing, attractive, casual and fun. The preventive effort cannot allow itself to appear serious, heavy, boring and uninspiring. But for efforts to be sustained some amount of underlying seriousness is necessary.
We try to avoid the usual formats that make any activity look initially heavy or daunting. The approach used is therefore to give priority to the kinds of things that we need to say to people rather than to the means of organizing action groups, monitoring their activities, record keeping, and evaluating impact and so on. But we have integrated these ideas too, into the day to day actions that are proposed.
The manual is intended primarily for people who work in a health facility serving a “local” population. A doctor or nurse or someone else in the health facility can use the guidelines to create changes in the communities served by them. But people outside the medical or health profession too can use these guidelines effectively. The interventions can be implemented by any concern individual, and do not require special medical expertise.
The manual can be used for self instruction or for training. The activities suggested are for implementation at the level of local communities, not at national level. So the emphasis is on action relevant to a community or a clinic.
Chapteres1-5 covers general theoretical issues, chapter 6 preventive measures, and chapter 8 cession of tobacco use. Theoretical issues dealt within chapteres1-5 are restricted to basic information and background underlying recommendation for action. This overview of theory is not intended to be a comprehensive review of the existing studies.
There is a great deal of progress in the world, in understanding how the spread of the tobacco habit can be curtailed. Some of the opinions that are currently held are presented in chapters 1-5.
It is helpful to keep in touch with new development in the world even if we worked in a very remote location, or with just one small community.
The content in these 5 chapters will be mostly redundant to those who are familier with the basic issues in smoking prevention and cessecion. But the guidelines are meant to be used even by those who are not familiar with the subject, as a tool for training and monitoring activities. Someone who is already convinced of the need for action and familier with the basic issues can skip the rest of the introductory section, and move directly to the sections on prevention or cesssation.
Just reading through the manual should provide ideas for a person interested in taking practical measures to curtail and harm caused by tobacco use. But for maximum usefulness they should be used as a guide for action in stages, where an intervention suggested is carried out and then the next step taken up.
ALCOHOL OBSTACLE TO DEVELOPMENT
Title: Alcohol obstacle to development
Year of publication: 2020
Author: Maik Dünnbier
Subject: How alcohol adversely affects 14 out of 17 Sustainable Development Goals and a total of 54 targets?
Summary: The 2030 agenda contains 17 sustainable development goals with 169 targets. This comprehensive agenda is a plan of action for humanity to tackle the world’s biggest problems coherently and systematically. The 17 SDGs cover all three aspects of sustainable human development: the social, environmental and economic dimension.
Alcohol is major obstacle to sustainable human development, adversely affecting all three dimensions of development and reaching into all aspects of society. it is jeopardizing human capital, undermining economic, productivity, destroying the social fabric and burdening health systems.
Alcohol kills 03 million people worldwide every year. Every 10 seconds human being dies because of alcohol. This represents 503% of all deaths and more than 5% of the global disease burden. Morality resulting from alcohol use is higher than that caused by disease such as tuberculosis, HIV/AIDS and diabetes.
Worldwide, alcohol is responsible for 7.2% of all premature morality. Alcohol harms young people disproportionately. Among people between the ages of 15 and 49, alcohol is in fact the number one risk factor for death and disability, accounting for 10% of all deaths in this age group.
Clearly alcohol is one of the biggest threads to population health worldwide.
Through its multiple health, social and economic harms alcohol is a massive obstacle to sustainable human development.
“Alcohol adversely affects 14 out of 17 SDGs and a total of 54 targets”.
Evidence shows that, alcohol is a cross cutting risk factor in many areas of the 2030 agenda, such as,