Breaking a habit

For over a week now our office has been hoping for the speedy recovery of a colleague, who suffered a stroke after a few weeks of complaining of vertigo. Until yesterday she was in a coma at the ICU.

She always told me she had no health problems – no hypertension, no high blood sugar, no high cholesterol or blocked arteries.

So she happily indulged in her only vice: smoking. It was not an occasional thing; she was a chain smoker. I often told her I could smell the nicotine coming out of her skin, the way dogs seem to smell it when someone has just eaten dog meat.

I suggested she smoke the way my paternal relatives used to do in the North: using cigars hand-rolled from locally grown tobacco, no filter, with the lit end in their mouth. As my relatives aged they seemed to shrivel and resemble gnarled tree trunks, but what sturdy trees: they had impressive life spans. I attributed their longevity to saluyot and the hand-rolled, filter-free cigarettes.

See, I am not 100 percent anti-smoking. There must be something in nicotine that keeps you slim and keeps out Alzheimer’s (the argument of some smokers). Sure, coughing is a good way to kill appetite. Really, as long as the smokers are in Ilocos and I’m in Manila, I don’t mind.

I don’t know if nicotine-induced emphysema landed our colleague in the ICU, but I know I don’t like spending a fortune on antibiotics to get rid of a nasty cough caused by second-hand smoke.

This happened to me a few times, mostly after attending social gatherings that I’ve since learned to avoid. Two hours of jokes, gossip and karaoke in a smoke-filled, badly ventilated room is simply not worth a month of sneezing and coughing and expensive antibiotic treatment.

There are an estimated 17.3 million smokers in the Philippines. Their world will get smaller starting today – if the Metro Manila Development Authority (MMDA) and Manila city government make good on their commitment to finally implement an eight-year-old law and local ordinances meant to curb smoking.

* * *

It’s an ambitious campaign, with sidewalks to be included, but it’s not impossible to accomplish. Just keep apprehending smokers at random and penalizing them, and it’s possible for the public to get the message that this time, City Hall and the MMDA mean business.

Establishments such as hotels, shopping malls and restaurants should help make the campaign a success by setting aside smoking rooms – properly enclosed and clearly marked – for those who can’t or won’t give up their nicotine habit.

The MMDA and local governments must insist on rooms, not just smoking areas. Business establishments have gone around the laws and ordinances by setting aside smoking and non-smoking areas right in the same room or section, with no physical barriers between the two areas or special air vents to suck out the smoke, so the segregation is nothing but a big joke.

To avoid embarrassing clueless guests or clients, large signs must be posted to warn that smokers could be apprehended and penalized if they light up in prohibited areas. The signs should also direct them to a place where they can smoke in peace.

If local governments want better compliance, establishments that refuse to cooperate must also be penalized. This is what aviation authorities do in countries such as the United States: airlines that tolerate passengers’ smoking on flights face fines and other penalties. The authorities have cigarette smoke detectors and planes are inspected upon landing for possible violations.

I did try puffing on a cigarette when I was a teenager – teens enjoy a license for experimentation and stupidity – but the appeal of smoking has always been lost on me. I associate it only with illness and stink. A smoker’s breath stinks; the skin and hair stink.

It’s bad manners to fart and burp loudly in public; why is it not as bad to make others inhale your poison? In fact it’s worse, because unlike passive smoking, inadvertently inhaling someone else’s fart, though gross, will not cost me a trip to the doctor and up to a month of expensive treatment to get rid of wheezing and coughing.

In that traveling macabre exhibit of real dead bodies and body parts (simply titled “Bodies”), I saw several lungs in various stages of health and deterioration. The last were those of a person who died of lung cancer; the lungs were almost black and about a sixth the size of healthy ones.

Photos of those diseased lungs are unlikely to persuade smokers to go cold turkey pronto. They’re not deterred by warnings on cigarette packs either.

Smokers in our office joke that our colleague suffered a stroke because she decided to stop smoking.

Low-income Pinoy males, when down to their last few pesos, will reportedly spend some of the cash on cigarettes. I don’t know if this is based on sound science, but it has been invoked by those who argue that rationalizing excise taxes on cigarettes, which is expected to increase cigarette prices, is anti-poor and a bad idea.

But exposing them to tobacco-related health risks is even more anti-poor. Even hypertension requires maintenance drugs that are beyond the reach of the impoverished. Tuberculosis remains a big public health problem in this country, with the poor among the worst victims. TB is treated with expensive drug cocktails and treatment can take months.

From 2003 to 2008, the government collected between P23 billion to P27 billion annually from the tobacco industry. On the other hand, Philippine health care costs from tobacco-related illnesses, which account for five of the top 10 killer diseases in this country, averaged P148.5 billion a year, according to a 2006 study by the World Health Organization.

Pharmaceutical giant Novartis is providing free TB treatment to the very poor. The company will be piloting a more sustainable public health assistance project in the Philippines, with drugs to be sold at subsidized prices. Clarification: the company has not yet approached the Bill and Melinda Gates Foundation and the Asian Development Bank to participate in a micro health care initiative in Bulacan and Palawan.

Any assistance to the poor is a laudable effort, but aid is never enough. Warnings on cigarette packs and advertising bans are also not enough to break smoking habits.

Perhaps tossing effective enforcement of anti-smoking laws into the mix will do the trick.