Anti-smoking measures give reason to celebrate

World Day for Safety and Health at Work is celebrated annually on April 28 to promote the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

It is easy to spot where tobacco comes into play on this day, as it affects countries that grow tobacco and those where tobacco is smoked - making tobacco a universal problem for safety and health at work.

Hong Kong has reason to celebrate on April 28. Hong Kong has progressively tightened laws on smoking in public places, so the new norm is a safe, non-smoky work environment. These laws have been warmly welcomed and supported by the public, both smokers and nonsmokers. E-cigarettes also harm nonusers so, in the interests of public health, the Hong Kong government banned these and other new products such as heat-not-burn. From April 30, it will no longer be legal to vape in the workplace, including restaurants and bars, which are the workplaces for front-line restaurant staff. Again, parents, teachers and medical and health groups supported the ban.

Why are these bans so important? Environmental pollution of exhaled tobacco smoke from cigarettes and other tobacco products leads to nonsmokers inhaling secondhand smoke. The dangers of secondhand smoke have been documented for decades, and include lung cancer, which can be fatal, as well as heart disease, respiratory disease and more. The vast majority of employees are nonsmoking - on average, only 18 percent of adults in the world smoke, and only 10 percent in Hong Kong. So smoking is the behavior of a small minority, even more so if children are included in the equation. The rights of the majority to a clean, safe working environment outweighs any so-called rights of smokers.

Other hazards in the workplace are those of the danger of fires from carelessly discarded cigarette butts. Smoking is also dangerous for drivers or those operating machinery, as accidents occur when they are distracted by lighting, smoking and discarding their cigarettes.

Employers also suffer economically from lost labor productivity due to smokers' time off for smoke breaks, higher absence rates, loss of skilled workers by premature death, and increased early retirement due to ill health.

The good news is that there is now comprehensive smoke-free legislation in place in one-third of the countries in the world, and moderate protection in another third. Twenty-one percent of the world population is now covered by smoke-free laws, compared with only 3 percent in 2007. While this figure is increasing, there are still millions in the world who live and work in unsafe smoky work environments.

In China, the World Health Organization has estimated that a comprehensive national ban on smoking in offices alone is estimated to reduce the prevalence of smoking among Chinese men by 13 million and avert 6 million premature deaths over a 50-year period. In 2018, more than 60 companies in China representing more than 410,000 employees signed a pledge with WHO and China's Center for Disease Control and Prevention to provide 100 percent smoke-free workplaces for all their employees. It is a popular move, even among smokers. Over half of smokers polled supported a complete ban on smoking in indoor workplaces. Hong Kong does not grow tobacco, but the Chinese mainland is one of the major growers in the world.

Tobacco farming exposes farmers during their work to tobacco leaves and pesticides, and other work issues are child labor in the tobacco fields, and the shackles of poverty, while Big Tobacco reaps handsomely from the poor. Tobacco farming is labor-intensive, with serious negative environmental, health and social impacts. Four serious health risks are prominent in tobacco-growing communities: green tobacco sickness, which is a form of nicotine poisoning affecting adult and child farmers; exposure to agrochemicals; respiratory diseases; and food insecurity due to the displacement of food crops.

Tobacco is not a very lucrative cash crop, particularly for small-holder farmers, who are often impoverished by growing tobacco. Malawi is a good example of a country heavily dependent on tobacco growing and exports. But tobacco has not enriched Malawi itself - it is down at 127th in terms of national net worth. Another example is China, which uses more land to grow tobacco than any other country. This land could instead be used to grow crops to feed China's own people, thereby reducing the nation's dependence on food imports - an increasingly precarious situation amid growing geopolitics.

The good news is that the World Health Organization Framework Convention on Tobacco Control specifically addresses these issues, under two articles. Article 18 addresses protection of the environment and the health of people in relation to the environment in respect of tobacco cultivation and manufacture. Article 17 addresses the provision of support for economically viable alternative activities. There are now 182 parties already committed to this UN convention.

Developing sustainable alternatives to tobacco farming should form the core of government policy for tobacco control. Viable agricultural alternatives exist, with support from WHO and the Food and Agriculture Organization of the United Nations. Alternative farming has been tried in many countries as diverse as China, Bangladesh, Tanzania and Brazil. In Yuxi, Yunnan province, the heart of tobacco growing in China, farmers' income increased by up to 110 percent over a four-year period after they switched to nontobacco crops. The important message, that farmers do better by growing other crops, should not be lost on any government.

Women and young girls are working for a pittance in some factories in Indonesia hand-making kreteks, and rolling bidis in unhealthy conditions in India and Bangladesh.

Big Tobacco has been promoting its corporate social responsibility programs involving gender equality in the workplace. The reality is that the industry's only "sustainable future" will have to be to trap more girls and young women to use its products, and to keep using young women to promote its products.

Governments should abandon the "prosperity narrative" of tobacco and recognize that tobacco means unsafe working environments, and results not in health and wealth, but poverty, to individuals, employers and tobacco users.
Safety and health at work means a tobacco-free world.