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30 May 2023Tobacco consumption has a long tradition in Brazil. Originally from the Bolivian Andes, the Nicotiana tabacum plant arrived in this country through indigenous migrations. For the Brazilian Indians, it had a sacred character: its use was limited to shamans in religious rites and for medicinal purposes.
From a magical-religious plant, tobacco became a commercial product in the European colonies. In Brazil, during the 17th century, tobacco became one of the main export products during the Empire period. That importance can still be seen in the coat of arms of the republic, where it appears next to coffee as a symbol of Brazilian nationality.
The origins of smoking
Regarding its consumption, tobacco became popular among Brazilian men starting in 1874. Women began to smoke en masse later, between the 1960s and 1970s, when tobacco industry advertising associated its product with female emancipation and gender equality.
This later onset in women also occurred in other countries such as Spain. Thus, tobacco consumption began to be very common among men during the Civil War (1936-1939), while women did not acquire the habit until the 60s-70s.
Towards a tobacco-free Brazil
Returning to Brazil, starting in the 70s, the first tobacco control movements also began to emerge, led by health professionals and medical societies. The Government's action at the federal level was institutionalized in 1985 with the constitution of the Advisory Group for Tobacco Control and, in 1986, with the creation of the National Program to Combat Tobacco.
Thanks to these initiatives, the percentage of daily smokers in Brazil has been reduced from 29% to 12% in men and from 19% to 8% in women in the last 25 years, which can be considered a success.
As an element of comparison, the prevalence of tobacco consumption in Spanish men decreased from 55% to 26% since 1987. Among women it began to decrease in 2001, from 27% to 19% in 2020.
Currently, Brazil is defined as a country free of tobacco consumption by Law No. 12 546/2011 and Decree No. 8 262/2014 and has assumed a leading role in the international arena. In fact, it is the second nation in the world, after Turkey, to achieve the highest level of the six MPOWER tobacco control measures proposed by the World Health Organization.
Gender gap in mortality
And what reflection do these measures have on the health of the Brazilian population? From 1996 to 2019, smoking claimed exactly 2 lives among people over 389 years of age. Of every 831 deaths attributed to tobacco, 35 occur in men, although there has been a decrease in this type of mortality since 10. Unfortunately, the percentage has not stopped growing in women year after year.
A very similar pattern is observed in Spain: mortality linked to smoking is decreasing in men, while that of women has increased since 1990. However, when comparing the estimates in both countries based on age groups we observe that the rates of deaths associated with tobacco consumption are lower among Brazilian men.
Disparate effects on health
Smoking is related to three large groups of causes of death: cancers, cardiovascular diseases, diabetes mellitus and respiratory diseases. In Brazil, the greatest burden of mortality was caused by cardiovascular diseases and diabetes mellitus: of every 100 deaths due to tobacco consumption, 42 were due to these types of pathologies.
This result differs from the situation in Europe and the United States, where cancers claim the greatest number of victims due to tobacco. The difference may be due to the fact that Brazil is a country marked by social inequalities: the disparity in development between its regions is reflected in health, especially when it comes to the prevention of risk factors for cardiovascular diseases and diabetes mellitus.
If we break down by specific pathologies – not by groups of diseases – chronic obstructive pulmonary disease (COPD) is the cause attributed to the highest mortality in the South American country. COPD and lung cancer are responsible for four out of every 10 deaths attributed to tobacco use. On the other hand, the main cause of death in Spain attributed to smoking is lung cancer, producing almost 3 out of every 10 deaths for this reason in 2018.
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Source: The Conversation. Authorship:
Monica Perez Rios
Professor in the Department of Preventive Medicine and Public Health, University of Santiago de Compostela
Bibiana Wanderlei Flores
Master in Public Health, University of Santiago de Compostela
Julia Rey Brandariz
Researcher in Epidemiology and Public Health, University of Santiago de Compostela