European Men's Health Forum Smoking and men's health in Europe

Edward Riley reports on what is still the leading cause of preventable death in Europe fifty years after the dangers were first identified.

Tobacco is the leading cause of preventable death in the world and by 2030 it will account for about 10 million deaths per year . The ‘Tobacco Epidemic’ is known to cause at least 25 diseases, including lung cancer, bronchitis, emphysema, cardiovascular diseases and stroke. Smoking also increases the risk of sexual impotence by around 50% for men in their 30s and 40s, weakening men’s chances of starting a family but, perhaps more importantly, preventing them from maintaining a sexually active lifestyle. More men than women smoke in Europe and male health matters are of increasing concern amongst medical experts since. Chief amongst these are illnesses caused by smoking and passive smoking.

In the European Union alone, 40% of men smoke, an unacceptably high ratio. Cigarettes are highly addictive, though tragically, active smokers are not the only ones to die from smoking. While everyone should have the right to breathe clean, unpolluted air, breathing in other people’s tobacco smoke (passive smoking) exposes non-smokers to many of the same carcinogens and toxic agents as the smoker. Passive smoke has been classified as ‘carcinogenic to humans’ by the International Agency for Research on Cancer (IARC) . Whilst traditionally cases of deaths from passive smoking are believed to have begun with female spouses of smokers – smoking was a predominantly male habit - today the workplace is the originating cause for increasing numbers of tobacco related deaths and disease in men and women due to passive smoke.

Male smokers and non-smokers working in Europe are exposed to passive smoke for up to 75% of their working time, and this can be fatal to their health . Of the 500,000 men and women that die from tobacco related diseases, well over half of these are men. While men are more likely to suffer the effects of tobacco smoke and occupational carcinogens more frequently than women, many are educated to believe that withstanding pain and not going to the doctor is proof of manhood. Nonetheless, the effects of workplace smoking need to be confronted, in particular in relation to the inhalation of secondhand smoke by non-smokers, through continued education of the risks involved, and through the preparation of legislation to protect workers, in order to remove the risks and reduce the large numbers of educated, skilled young men needlessly killed each year. Similarly, employers should take the initiative in developing schemes to help smokers among their workforce to quit.

Recent EU figures show that while about a third of all deaths in men are due to cancer; around a third of these are due to lung and associated bronchial cancers. Smoking and exposure to tobacco smoke has been related to cancer of the bladder, pancreas, kidney and stomach , however it is the prime factor in lung cancer. Lung cancer is a rising cause of death amongst men across Europe and is more often than not linked to lifestyle; its prevalence is found to be a particular problem in men, as they are statistically more inclined to the types of risk-taking behaviour, despite a good knowledge both of the associated health warnings and the risks inherent in continuing the behaviour .
Tobacco is also responsible for cardiovascular diseases and stroke. Cardiovascular disease is the leading cause of death in Europe, accounting for over 4 million deaths each year and 22% of these deaths in men living in Europe are due to smoking . Smoking causes blood pressure to increase, it decreases exercise tolerance and increases the likelihood of blood clots. Additionally, “smoking increases LDL (bad) cholesterol and decreases HDL (good) cholesterol ”. Additionally, cardiovascular diseases from passive smoking are estimated to occur 10 times more frequently in absolute terms than lung cancer.

With around 30% of 15-18 year olds in Europe classifying themselves as smokers, the trend of smoking will remain high as current smokers continue to smoke and as these younger smokers grow older and begin to suffer disease as a result of their smoking. It is vital that the public be made more aware of the dangers of smoking and that legislation to control tobacco prevalence and to protect smokers and non-smokers remains at the forefront of national and international governance. Particularly now, as the European Union expands (from 15 to 29 members in 2004), the challenge is to ensure that effective legislative and health educational programmes are in place to fight the smoking epidemic.

The biggest challenge is in educating young people, in order that they not only do not smoke, but also do not accept the use of tobacco by others: a recent European Conference on the Media, Tobacco and Youth Prevention focussed on this, attempting to bring together policy makers, tobacco control advocates and media representatives (for example, MTV Europe) in order to develop effective strategies to get the dangers and risks of smoking across to young people.

It is in this way that an organization like the ENSP has a pivotal role. ENSP is the largest tobacco control network in Europe, drawing together a wide range of health institutions, governmental agencies and non-governmental organisations. The aim of ENSP is to develop a common strategy for tobacco control in Europe and to coordinate organisations and smoking prevention activities, in order to create greater coherence and efficiency and to promote comprehensive tobacco control policies at both national and European level. This is done through encouraging and supporting the creation and operation of national coalitions, alliances and networks in Member State of the European Union, EFTA and Accession countries and to facilitate the flow of information and understanding between them and between national, European and intergovernmental organisations.

One of the main tasks of the European Network for Smoking Prevention (ENSP) is the dissemination of information and this is done through ENSP’s interactive website (www.ensp.org) through weekly European News Bulletins that summarise the latest tobacco related news and through information releases to members to inform them of important issues and to provide tools for specific action points that could be carried out at a national level to influence EU policy (e.g. the EU Convention and the Tobacco Advertising Directive) and to provide information on global issues such as World No Tobacco Day.

Through an extensive mailing list, ENSP collaborates with national alliances and organisations for smoking prevention in the European region, which includes countries of Central and Eastern Europe and globally, and this global approach to tobacco is particularly important in the light of the first ever treaty on public health, the Framework Convention on Tobacco Control (FCTC) . Initiated by the World Health Organization, the FCTC took four years of tough negotiation between representatives from 153 member states (representing 95% of the world’s population) until it was finally adopted by unanimous vote by the World Health Assembly in May 2003. The Treaty establishes a set of rules and regulations on issues such as taxation, education and cessation, smuggling, tobacco advertising, large health warnings, banning misleading descriptors such as ‘light’ and ‘mild’, protection from passive smoke and a whole host of other concerns. The Treaty needs to be signed, ratified and most importantly, implemented, for the world to have any a chance of reducing the horrifying growth of tobacco mortality.

The second main task of ENSP is the stimulation and coordination of European Commission funded Framework Projects, under the Public Health Programme from 2003 and from the Europe Against Cancer Programme 1997-2002, which were set up in support of EU public health objectives and Article 152 of the Treaty of Amsterdam, which states that: ‘A high level of human health protection shall be insured in the definition of all Community policy and activities’.

The Network co-ordinates between the European Commission and the co-ordinators of each project from the moment at which a call for a proposal is launched, to the time when the completed project is submitted to the Commission, through the management of funds, and until reports need to be presented and published. This ensures that the financial administration of the projects fall within the EU standards, thus saving time and it avoids overlapping.

Many different aspects of tobacco control research and activities have been included in the ENSP Framework Project Applications over the years and these include: The European Network of Smoke Free Hospitals, the European Network of Quitlines, the Tobacco Control Resource Centre, Globalink, Pharmacists Against Smoking, GP Empowerment, European Nurses Against Tobacco and the development of tobacco control training programmes for European dentists (Summaries of the final reports of ENSP Framework projects are available at: www.ensp.org/projects.cfm).

Reports published by ENSP have also included a status report into smoke free workplaces and an examination on women and smoking, also an issue of concern, since the number of women smokers and women dying of tobacco related diseases is rising to follow the male pattern, this has prompted the prediction: “If women smoke like men, they will die like men” . Labour Market figures show that more men than women are in employment in the European Union.

In August 2003, ENSP launched recommendations on smoke-free workplaces, which highlights the benefits that tobacco control measures in the workplace can have on optimising organisational and employee performance (see www.ensp.org/files/rapport_complet_A5.pdf).

Male smoking prevalence and deaths and disease related to tobacco, are important concerns that merit immediate attention. Male smokers and their families must be aware of the dangers of smoking and of the importance of quitting or not starting to smoke. This is also an issue that must be addressed by policy makers nationally and at European level. It is vital that initiatives be developed, momentum followed and precautionary measures taken in order to avoid the horrifying death toll caused by a dangerous and unnecessary habit.

For further information, please contact: s.kazan@ensp.org or eriley@ensp.org.

Edward Riley is Information Officer for the European Network for Smoking Prevention (ENSP), an international non-profit making organisation, created in 1997 under Belgium law. Its mission is to develop a strategy for co-ordinated action among organisations active in tobacco control in Europe and to promote comprehensive tobacco control policies at both the national and European level.

Email: eriley@ensp.org