The full extend of damage caused by smoking is still unknown. Every day more diseases are being discovered to be caused by smoking. The effects of passive smoking are as bad as that of active smoking. While 25 per cent of people are affected due to direct smoking, 75 per cent of the people get affected by inhaling the smoke released by the active smokers.

In Bangladesh, over all 50 per cent male and 3 per cent female population are cigarette smoker. In addition to that 16 per cent male and 31 per cent female population use oral smokeless tobacco. Men age 35-49 years have highest smoking prevalence at 70 per cent and smoking prevalence is highest among the poorest. Smoking prevalence declines proportionally as income increases. 83 per cent of smokers in lower socioeconomic class smoke bidi than more expensive cigarette. We don’t have the data on how many people are suffering, how many people are dying early directly or indirectly from diseases related to smoking. We don't know smoke related health problems adding to our constrained health budget. But there is no doubt millions of people are suffering, a considerable portion of health budget is wasted every year from diseases caused by smoking. More over there is no quality control over the cigarette, bidi and other tobacco products. As the number of smokers are decreasing in the developed world, the tobacco companies are targeting poor people of the developing countries like Bangladesh.

British American Tobacco (BAT) is a ubiquitous presence through its glossy media advertising, cigarette display cases, and storefront sign. In 1998, BAT spent 3.4 million US dollar on brand promotion and development. The situation is alarming. We need to stand together to save our nation from smoke related damages.

Dr Ann McNeill of University college London describes the situation as a tobacco epidemic and warns the full extent of the damage has not been realised. Tobacco cause more deaths world wide than the HIV, TB, maternal mortality, road traffic accidents, homicidal and suicidal deaths combined.

A new initiative to slash smoking
European smokers are due to be bombarded with graphic images designed to scare the smoke out of them in the New Year. Forty-two gruesome photographs are due to appear on cigarette packages in an effort to remind smokers of the dangers of the habit, which is also causing harm to passive smokers. These pictures range from the graphic to the humorous and highlight the negative effects of smoking, from cancer to impotence. The photographs including rotten lungs (lung cancer), a young man in a mortuary (early death), a throat tumour (slow and painful death), patient with open chest in operation theatre (heart surgery for block artery), woman carrying empty buggy (impotence) etc.

Significance and usefulness of the photographs
The idea of photographs was first tried out in Canada followed by Brazil. A year later after their introduction, a study by the Canadian Cancer Society found they could motive for more than a third of smokers trying to give up. The study also found 43 per cent of smokers were more concerned about the aftermath of smoking due to warning and one or more occasions, almost a quarter of smokers tempted to have a cigarette decided not to because of warning.

Ireland will be the first country to use the new images. This country was the first to ban the advertising of tobacco back in the late 1970s and it was also the first country to outlaw smoking all indoor places of work and also in all public places. Malta has also banned smoking in work places. Sweden will follow next year.

David Byrne, The EU Commissioner for Health and Consumer protection said 'People need to be shocked out of their complacency about tobacco. I make no apology for some of pictures we are using. The true face of smoking is disease, death and horror, not the glamour and sophistication the pushers in the tobacco industry try to portray.'

Developing country like Bangladesh, where the budget is always in constrain, people are less aware about their health problems, many people are under poverty level, cannot afford to bear another burden which is unnecessary. Government has to take step by step initiatives like banning advertise of smoking in newspaper, magazine, radio, TV, internet, stopping cigarette firms to sponsor sports, cultural or other events, increasing tax on tobacco products, not selling tobacco products under 18, banning smoking in work places, increasing social awareness against this dirty and deadly habit.

Dr Md Habibe Millat, MBBS(Dhaka), FRCS(Edin), is a Senior Specialist Registrar of Department of Cardiothoracic Surgery of St. James's Hospital, Dublin, Ireland