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South Asia news, business and economy from India and Pakistan 

As if a crippling medical manpower crunch - with just one doctor currently available for every 10,000 Indians - wasn't bad enough, India is also poised to hold a whopping 60% of the world's heart disease patients by 2010, according to a recent study by the British journal The Lancet.

The groundbreaking study, conducted by a team of researchers led by Dr Denis Xavier of St John's National Academy of Health Sciences in Bangalore, studied 21,000 heart attack patients admitted to 89 hospitals in 50 cities across the country. It found that while the cardiac risk factors in India - excessive tobacco consumption, high lipid levels in the blood due to fat-rich diets and hypertension - weren't dissimilar to those in other nations, what disadvantaged Indians further was the time it took for them to access medical help. . . .

India is also home to 12% of the world's smokers and will witness 930,000 deaths in 2010, according to a study published in the New England Journal of Medicine. The study estimates that India has about 120 million smokers who will contribute to deaths mainly from tuberculosis, heart disease and cancer.

Oncologist Dr Swati Chopra stresses that smoking exacerbates the risk of heart attack as elevated nicotine levels spike the body's bad cholesterol or LDL making the blood stickier and the arteries harder. "This enhances the blood's chances to clot more readily. Sticky blood flowing through hardened arteries can lead to the formation of a clot and block an artery. A blocked artery in the brain," informs the expert, "can trigger a brain stroke which may lead to paralysis or even death."

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American Legacy Foundation® Announces New Youth Tobacco Prevention Grantees 

The American Legacy Foundation, a national public health foundation dedicated to tobacco use prevention and cessation, has awarded more than $1.2 million in grants to 11 organizations as a part of a new grants initiative: the truth®or Consequences Youth Tobacco Prevention Grants Program. This new program, supported by the U.S. Centers for Disease Control and Prevention (CDC), will support community-based tobacco-use-prevention efforts in 18 states across the country.

The truth® or Consequences grants will engage rural and smaller communities in tobacco use prevention efforts, and supplement the truth® youth smoking prevention media campaign in underserved areas, by developing local tobacco use prevention projects relevant to 12- to 17-year-old youth. These youth-led initiatives are designed to be shared at a national level in order to create the greatest possible impact on the issue of tobacco and smoking. The program also gives each grantee the flexibility to choose and customize different tobacco use prevention strategies and methods, so long as young people remain the decision makers and the project is focused on making a lasting community change.

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HANSEN: Do insurance companies want people to quit smoking or not? 

If someone decides to attempt the very difficult task of quitting, it seems to me that their insurance provider would be all over this remedy in an attempt to lessen their burden as smokers take to their beds with related illnesses. It would also have a ripple effect for those suffering the effects of second-hand smoke.

So, do they want people to quit or not?

The cost is about $500-$600 for the full regime . . .

Society vilifies smokers but then smacks them down when they finally decide to quit.

They are faced with an uphill battle on two fronts: A very difficult addiction has to be overcome, but they first have to come up with the money to undertake the battle. It seems those dollar signs turn up around every corner while we try to stay healthy in this country.

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• Edinburgh, East and Fife | Smokers in poorer areas targeted 

The campaign has the backing of the Scottish Government.

ASH Scotland will launch an evaluation of pilot projects in Glasgow at an event attended by Public Health Minister Shona Robison.

The group's research shows that 41% of adults who live in deprived areas smoke, compared to 13% in the least deprived areas.

In the NHS Greater Glasgow and Clyde health board area, where smoking is the highest in Scotland, 34% of all deaths in the 35-59 age group are attributed to smoking.

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• SUNLEY: Favoured tax treatment will boost sales of bidis 

Recent news that the government is planning to reduce tobacco cultivation by half over 10 years is an important development. However, because this proposal would lead to an increase in tax on cigarettes but not on bidis, it would have limited health benefit. Taking into account the health risks of each, bidis are under-taxed.

India’s market for smoked tobacco is dominated by bidis, around 10 bidis are consumed for each cigarette. Far more Indians die from smoking bidis than from cigarettes. Increasing tobacco prices through higher taxes is the most effective method of reducing tobacco use, but continuing to maintain low taxes on bidis will not substantially reduce tobacco consumption or improve the public’s health.

Despite the harm caused by bidis, taxes on bidis are currently just one-twelfth the tax levied on non-filter micro cigarettes, low-priced cigarettes most likely to be purchased by the poor, and are just 2% of the tax on more expensive standard filter cigarettes. As a result, bidis represent less than 6% of India’s total tobacco excise revenues despite making up the vast majority of tobacco smoked.

This favoured tax treatment increases the use of bidis. . . .

Excise taxes should be hiked for all tobacco products. Ultimately there should be a single tax rate for all cigarettes that is set higher than the current rate for standard filter cigarettes. Over several years, the tax on bidis should be raised to the uniform rate for all cigarettes. . . .

However, if the poor bidi smoker reduces his consumption of tobacco, wouldn’t he and his family be better off? The government surely has better ways of helping the poor than providing cheap tobacco products.

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EDITORIAL:Medicaid calculus 

We support increasing Mississippi's cigarette tax as a matter of principle for better public and personal health. The current 18 cents per pack tax is among the nation's lowest, yet our state spends $260 million treating smoking-induced sickness among Medicaid patients.

There's a disconnect in those figures and in the governor's and Lt. Gov. Phil Bryant's unflinching opposition to increasing the tax by $1 per pack.

There's nothing good about smoking. . . .

The cigarette tax alone won't pay the full tab for the rest of the budget year and expected increases in 2009, but morally and as public policy should be part of the calculus.

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Correlates of Smoking Before, During, and After Pregnancy (PDF) 

Results: Although socio-demographic characteristics including education, income, race/ethnicity, and marital status were associated with smoking at all time points, contextual factors including alcohol consumption, breast-feeding, and living with other smokers were also strongly associated with smoking, quitting, and relapsing.

Conclusions: Results of this study may facilitate the creation of more targeted interventions focusing on women at highest risk for smoking during this critical period.

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Killer heart diseases continue to prey on Lothians' poorest  

HEART disease death rates are falling throughout Scotland's most deprived areas – except in the Lothians.

A total of 211 people died in the poorest parts of the Lothians from coronary heart problems between 2004 and 2006, one more than in 2003 to 2005. The death rate also rose slightly to 112.8 per 100,000 people, although this was still below the Scottish average. . . .

"Our argument has always been that as death rates are higher in deprived areas, resources and initiatives need to be targeted there. Heart disease is a problem in deprived areas for a combination of factors – people are more likely to smoke, are less physically active, less likely to have a healthy diet and less likely to get the health services they need." . . .

Dr Alison McCallum, director of public health at NHS Lothian, said: "While we are not complacent, it is encouraging to see that the work we're doing in encouraging healthy lifestyles appears to be paying off in terms of reductions of deaths from heart disease of people with deprived backgrounds. We have made providing practical help, referrals to other services and support to people in so-called hard-to-reach communities a major part of our work.

"This includes help to access services, practical support to help people stop smoking and become more active, all delivered in partnership with primary care, our local authority partners and community health projects."

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• Tobacco firm assigns K400m for Malawi schools 

An international tobacco firm, Philip Morris, has set aside K400 million (US$3 million) for the construction of 100 school blocks across the country in the next five years, starting this year, to help improve Malawi's education standards.

The US based tobacco company, which also buys Malawi's leaf, has already channeled K7 million to Total Land Care, a local NGO which would be executing the project in conjunction with district assemblies and education official among others.

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Alcohol, smokes tipped to rise 

THE Rudd Government could reap up to $3.6 billion from adding a new cigarette tax to its $2 billion alcopop tariff.

And a 300 per cent rise in beer and wine taxes is being proposed by the Government's preventive health taskforce.

A 2.5c tax on every cigarette has been proposed by Kevin Rudd's preventive health expert, Rob Moodie.

It would add about 63c to the price of a packet of cigarettes, raising an estimated $1.6 billion over four years.

While low-income families could be hit hard by higher cigarette costs, experts say the measure would help poorer smokers by making them quit.

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• The Short End of the Longer Life  

THROUGHOUT the 20th century, it was an American birthright that each generation would live longer than the last. Year after year, almost without exception, the anticipated life span of the average American rose inexorably, to 78 years in 2005 from 61 years in 1933, when comprehensive data first became available. Skip to next paragraph

But new research shows that those reassuring nationwide gains mask a darker and more complex reality. A pair of reports out this month affirm that the rising tide of American health is not lifting all boats, and that there are widening gaps in life expectancy based on the interwoven variables of income, race, sex, education and geography.

The new research adds weight to the political construct popularized by former Senator John Edwards of North Carolina, that there are two Americas (if not more), measured not only by wealth but also by health, and that the poles are growing farther apart. . . .

The first of the two reports, released two weeks ago by the Congressional Budget Office, declared that the life expectancy gap is growing between rich and poor and between those with the highest and lowest educational attainment, even as it is narrowing between men and women and between blacks and whites.

Pointing to the effects of smoking, obesity and chronic disease, the budget analysts wrote that “in recent decades, socioeconomic status has become an even more important indicator of life expectancy, whether measured at birth or at age 65.”

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LETTER: Cancer’s costly too  

I applaud our Legislature for raising the cigarette tax again. I was a former smoker who realized how much time and money I wasted smoking. Reading David Tuerck's column made me laugh ("Cigarette tax burns the poor," April 16).

He states that by raising the cigarette tax by a dollar, poor people may have to give up food. If cigarettes are more important to you than eating or staying warm, you should check your priorities.

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• Women's life expectancy drops in some US counties 

Women's life expectancy declined significantly in 180 U.S. counties, mostly in the deep South and Appalachia, between 1983 and 1999, according to a study being released Tuesday.

Researchers blamed the decrease in women's life expectancy on high blood pressure as well as chronic diseases related to smoking and obesity, such as lung cancer and diabetes.

The decline, averaging 1.3 years in the 180 counties. Men's life expectancy declined by 1.3 years in only 11 counties. . . .

The study, based on data from the National Center for Health Statistics and the U.S. Census Bureau, was designed to analyze disparities in life expectancy between different counties with different social conditions and health programs.

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Dalit beaten by upper caste villagers for smoking 

Halki Bai, a Dalit woman from Madhya Pradesh’s Biharipura village, does not have any idea where her husband and son have gone. The only thing she remembers is an attack on their house allegedly by the village Thakurs.

She said her husband was mercilessly beaten up and asked to leave the village with a warning not to show his face again.

“The Thakurs do not behave properly with us. It is not just this incident, they do not allow us to fetch water and we are forced to carry our shoes on our heads while passing in front of their houses,” Halki Bai said.

The immediate provocation for the Thakurs' action was apparently a Dalit smoking without taking permission during a funeral procession.

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EDITORIAL:Unfunded mandates 

Further, the Barbour administration and its supporters in the state Senate won't even allow debate on increased cigarette taxes, which could be directed toward permanent support of Medicaid, whose patient load is heavy with people who are smokers and have smoking induced illnesses.

The House, to its credit, has not backed down from seeking a $1 increase in the cigarette tax - from a paltry 18 cents per pack to $1.18. . . .

The situation as it stands is a classic case of ideology defeating reason.

Start with a proposed tax assessment on occupied private-sector hospital beds, as many in both chambers support and as tentatively agreed to by the Mississippi Hospital Association. Don't stop with that; go for the cigarette tax increase.

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