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England goes smokefree from July 1, when Bangladesh?

It will be against the law to smoke in virtually all enclosed public places and workplaces from today, July 1, 2007 in all over England. This includes places like cafes, bars, pubs, clubs, shopping centres, railway stations, garages, work vehicles, taxis, factories and staff rooms. Anyone who breaks the "smokefree" law could face a fine or end up in court. Virtually all enclosed public places and workplaces in England will become smokefree from this time. It was expected that a "smokefree" England will ensure a healthier environment, so everyone can socialise, relax, travel, shop and work free from secondhand smoke.

The government in England is not taking away people's choice to smoke, but recognises that exposing others to secondhand smoke, especially within enclosed environments, is seriously harmful to health. There is no doubt breathing second-hand tobacco smoke (SHS) is dreadfully dangerous to health. It causes cancer, as well as many serious respiratory and cardiovascular diseases in children and adults, often leading to death. There is no safe level of human exposure to second-hand tobacco smoke.

Secondhand smoke is simply other people's tobacco smoke. Wherever people smoke, there is secondhand smoke in the air. Breathing in secondhand smoke is sometimes called passive smoking. Secondhand smoke hangs around for ages and most of it is invisible and odourless. Smoking in a car is even worse because all of the smoke is concentrated into a small space.

Interestingly people cannot see or smell 85 per cent of secondhand smoke. So no matter how much one try to avoid it, it is pointless. When breathed in, secondhand smoke increases one's risk of getting lung cancer by 24 per cent and heart disease by 25 per cent. Secondhand smoke is a dangerous cocktail of over 4,000 chemicals, including 69 cancer-causing chemicals, such as arsenic, benzene and formaldehyde.

The World Health Organisation (WHO) estimates that around 700 million children, or almost half of the world's children, breathe air polluted by tobacco smoke, particularly at home. Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2020. Half the people that smoke today -- that is about 650 million people -- will eventually be killed by tobacco.

Second-hand tobacco smoke (SHS) has officially been classified a carcinogenic -- cancer causing -- in humans. It also causes severe acute and chronic heart disease. Other adult conditions linked to SHS are bronchitis, pneumonia, asthma, and in children: lower respiratory infections, asthma, middle ear infection, sudden infant death syndrome and low birthweight for babies of women exposed to SHS during pregnancy.

The Global Youth Tobacco survey developed by WHO and the US Centers for Disease Control and Prevention, interviewed students between 13 and 15 years old in 132 countries between 1999 and 2005. The results of the survey show that 43.9 per cent of the students are exposed to second-hand tobacco smoke at home, while 55.8 per cent are exposed to smoke in public places. Support for smoking bans in public places is global, with 76.1 per cent of the students surveyed in favour.

The costs of second-hand smoke are not limited to the burden of diseases. Exposure also imposes economic costs on individuals, businesses and society as a whole. These include primarily direct and indirect medical costs, but also productivity losses. In addition, workplaces where smoking is permitted incur higher renovation and cleaning costs, and increased risk of fire, and may experience higher insurance premiums.

There is considerable evidence from countries that have already introduced smokefree laws that the impact on business can be positive. New York's Smokefree Air Act came into effect in March 2003. After the first year, a report found that business tax receipts in restaurants and bars were up by 8.7 per cent. Ireland (2004), Norway (2004), Scotland (2006), New Zealand (2004), various Canadian territories and Australian states are examples of places which have introduced comprehensive smokefree legislation. California has had state-wide smokefree public places since 1998. Today, over sixteen US states have smokefree legislation that required completely smokefree restaurants and bars.

Comprehensive smokefree legislation has proved to be effective in protecting people from the health risks of secondhand smoke. For example, research published in The Journal of the American Medical Association found rapid and significant improvement in respiratory health of bartenders after the implementation smokefree workplace legislation in California.

A recent survey revealed that in around 70 per cent of smokers in England say they want to stop smoking, and the new smokefree law could provide extra motivation to do so. Smokefree England will help to improve the health of the whole community. The new law will protect all people in virtually all enclosed public places, workplaces, public vehicles and work vehicles, from the harmful effects of secondhand smoke.

If someone do not comply with the new smokefree law in England, will be committing a criminal offence. The fixed penalty notices and maximum fine for each offence are: Smoking in smokefree premises or work vehicles, a fixed penalty notice of £50 (reduced to £30 if paid in 15 days) imposed on the person smoking. Alternatively a maximum fine of £200 if prosecuted and convicted by a court.

Recent survey carried out in England also reveals widespread support for the legislation. Findings include: 93 per cent of the overall population are aware that smokefree legislation is coming, however 45 per cent do not know that it comes into force on 1st July 2007. However, 71 per cent of regular pub-goers support the legislation, as well as 76 per cent of the overall population. It is interesting to note that more than one in ten (15%) businesses in England do not realise that their smoking room will have to be closed by 1st July 2007 and more than half (53%) do not realise that work vehicles will also be covered. New research from the Department of Health shows that although three quarters (75%) of businesses are aware of the forthcoming legislation but many are unsure of the detail.

The government in England has already launched a massive campaign to prepare businesses for July 1, including advertising in TV, radio, newspapers, buses, bill-boards and a mail-out of guidance to more than a million businesses. A dedicated website has also been set up to help businesses and the public to prepare. Not only smoke cigarettes, biri or the hookah, chew tobacco in paan or gutkha are also came under focus at this stage. Smoking rates are much higher in South Asian communities. There are also many health risks, in particular chewing paan makes five times more likely to get oral cancer.

According to WHO about half of Bangladeshi men and one-fifth of women use tobacco in either smoking or smokeless form. Bangladesh, being a member of WHO, made an anti-smoking law named "Smoking and Tobacco Usage (Control) Act" in March 2005, which prohibits publication of advertisements of tobacco products in newspapers, electronic media, books, magazines and cinemas.

The law also bans smoking in public places and transport means with a provision of penalty. Though very slowly, however the situation has been improving because of these measures. In Bangladesh, the awareness level about the harmful effects of tobacco is awfully low. Traditionally, Bangladeshi men smoke cigarettes, biri and hukka, and chew tobacco leaf with betel quid (pan). However, women usually do not smoke but chew tobacco with pan.

WHO revealed that there are estimated 20 million tobacco users in Bangladesh, 5 million of them are women. These estimates include smokeless tobacco also. A considerable amount of tobacco is produced in Bangladesh. Bangladesh was the world's 18th leading tobacco producer in 1994, and continues to be the 4th largest producer of cigarettes in the region. Tobacco-related illnesses such as cancer, cardiovascular and respiratory diseases are already major problems in Bangladesh as in most countries of this region.

Most of the victims in which heart attacks that occur below the age of 40 are heavy smokers. Tobacco poses a major challenge not only to health, but also to economic development.

Tobacco and poverty are inextricably linked. Many studies have shown that in the poorest households in some low-income countries, like Bangladesh as much as 10 per cent of total household expenditure is on tobacco. This means that these families have less money to spend on basic items such as food, education and health care. In addition to its direct health effects, tobacco leads to malnutrition, increased health care costs and premature death. It also contributes to a higher illiteracy rate, since money that could have been used for education is spent on tobacco instead. Unfortunately tobacco's role in exacerbating poverty has been largely ignored by researchers in both fields.

It was reported that London business will boom once the smoking ban comes into force. Jennettee Arnold, Chair of London Health Commission said: "The ban is good for everyone as more people will go out and enjoy London." Restaurants and pubs will sell nicotene patches and gum after the smoking ban comes into force.

To help smokers kick the habit, manufacturers will target areas where people are most likely to suffer cravings. Government watchdog, the Medicines and Healthcare Regulatory Agency plans to allow the more general sale of patches and gum. An estimated four million people are expected to try to quit smoking after the ban.

Tobacco is the fourth most common risk factor for disease worldwide. The economic costs of tobacco use are equally devastating. In addition to the high public health costs of treating tobacco-caused diseases, tobacco kills people at the height of their productivity, depriving families of breadwinners and nations of a healthy workforce. Tobacco users are also less productive while they are alive due to increased sickness.

At present all over England there is an enormous campaign and red alert that it goes smokefree from July 1. Bangladesh has also enacted a tobacco control law in 2005, which is more rhetoric than reality. However, for a greater interest of the nation, future generation and thriving economy Bangladesh needs drastic measures to diminish smoking and it should implement its own tobacco control law. England goes smokefree from July 1, when will we see a smokefree Bangladesh?

Published in The Daily Star, Dhaka, Bangladesh, July 01, 2007

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