Abstract

PIP: Tobacco plays a key role in both disease and the economy in Brazil. In 1981 about 135 billion cigarettes were smoked, and cigarette-related diseases far outnumber infections as the leading cause of death. Brazil is the 4th largest world producer and the 2nd largest exporter of tobacco. 2.1% of the total population -- 2.5 million people -- are maintained by tobacco-related activities. Cigarette sales taxes provide 11.6% of the country's total taxes. Involved in a deep economic crisis, Brazil depends on this revenue and has not introduced any measures to control or counteract the high pressure marketing of cigarette manufacturers. Ischemic heart disease is the leading cause of death in Brazil, taking 90,000 lives in 1979. Based on World Health Organization estimates, at least 25% of these deaths could be ascribed to smoking. Cancer is the 2nd largest cause of death. In 1979, 10% of 60,000 cancer deaths were from lung cancer. Based on estimate that 30% of cancer deaths are provoked by smoking, more than 20,000 of those deaths were caused by tobacco. In Brazil, lung cancer is the 2nd highest cause of death from cancer in men and 3rd among women. Smoking in Brazil is definitely associated with low birth weight, the single most important predictive factor of perinatal and infant mortality. Rural workers giving up subsistence crops to grow tobacco may also affect their children's health. Also in such low-income populations, expenditures for cigarettes leave less money for essential goods. As a result of the high tax rate and the enormous number of cigarettes sold, 11.6% of all the country's revenue comes from the tobacco industry. The Brazilian Association of Tobacco Industries has been trying to link cigarette sales to Brazilian social development but does not mention the cost of disease, disability, and early death provoked by smoking. In Brazil tobacco companies have a huge market free of constraints, and the country lacks consistent smoking control policies. Recently some Brazilian medical associations have urged the government to take stronger measures, but physicians remain reluctant to speak out. Specific legislation regulating cigarette sales and advertisements is needed. The 1st task is convincing politicians and other policymakers that aiding and abetting the cigarette companies is, in the long run, bad for the economy. Medical institutions are in a key position to pressure the government and the tobacco industry.