Why it is absurd to compare health consequences of Air pollution with Cigarette smoking

We have been constantly witnessing the comparison of consequences of Cigarette smoking with seasonal air pollution in New Delhi. Needless to say, both are equally important public health issues. Such comparisons are based on a formula proposed by Berkeley Earth study that draws an equivalence between the hazards of air pollution and smoking. In the words of one of the co-author of the study “ When you bring scientific terms to something so well known as a cigarette number, it helps to raise awareness and bring discussion. It hits people in the way they can understand.” However, the author’s metaphor is being misinterpreted and belittling something as serious as tobacco control. Following are the reasons why we should immediately stop drawing comparison between the two –

  1. This comparison wrongly trivializes the catastrophic consequences of smoking, which is one of the leading causes of preventable death in the World. At current rate of use, 1 billion people will die due to tobacco use in this century.
  2. Unlike air pollution, cigarette smoke has the world’s most addictive substance called nicotine that makes “toxic fumes” inseparable part of life of a smoker.
  3. Air Pollution is a serious issue on some days of the year in some parts of the country. However, smokers (active and passive) inhale toxic fumes several times every day in every part of the country. A smoker can chose to leave a polluted city but quitting smoking is nearly impossible.
  4. This argument weakens the resolve of the government, civil society and public health activists in controlling tobacco menace. It also indirectly legitimizes the tobacco industry. This is of special significance in countries, such as India, where predominant form of consumption is in the form of chewing tobacco.
  5. The dose or concentration of the suspended particulate matter in the air per day and per lifetime is nearly 200 times lesser than that from the cigarettes.
  6. Such misguided comparisons promote a philosophy that one might as well smoke because it’s no worse than breathing a polluted air. This may justify continuation as well as initiation of the smoking habit.
  7. Berkley Earth study derived its conclusion by considering PM 2.5 (tiny particulate matter suspended in air) levels alone as the harmful constituent. The common ingredients of air pollution are mainly carbon monoxide, carbon dioxide, nitrogen oxide, volatile organic compounds and suspended particulate matter. Cigarette smoke, in addition to all the above, is made of nearly 7,000 toxic chemicals and at least 69 of them are highly carcinogenic.
  8. Some of the most important sources of air pollution are vehicular emission, household emission and industrial emission. These emissions, though harmful, are useful for our day to day living. However, cigarette has no good use whatsoever and leads to premature death among every third user. While humans are ironically beneficiaries of the industry that lead to air pollution, smokers are the innocent victims of the cigarette industry. One can not imagine a world without vehicle, aeroplane and Industry. However, world will be a better place if tobacco was eradicated.
  9. There are safe levels of air pollution below which the harmful effects are minimal. There is no safe level of smoking currently known. In fact, few puffs of cigarette may also lead to mutation and genotoxicity.
  10. Most of the research with air pollution has to do with the immediate and possibly reversible health effects mainly on lung. Whereas, there’s been half a century of high quality research with regards to health effect of smoking.

Therefore, the risks from air pollution are serious but they are not comparable to smoking. It is akin to saying, road traffic accidents are million times more fatal than aeroplane crashes.

Published by Chaturvedi Pankaj

Deputy Director, Center for Cancer Epidemiology, Tata Memorial Center, Mumbai. Professor, Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai

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