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Quitting smoking is as important as wearing a mask

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World ‘No Tobacco Day’ falls tomorrow on the theme ‘Commit to Quit’

by Randima Attygalle

Chemicals found in nail polish, rat poison, battery acid, car exhaust fumes, paints, rubber cement and gasoline are just a handful of what you will find in a single cigarette. A lighted cigarette create more than 7,000 chemicals and nearly 70 of them are known to cause cancer; and many are toxic. While many of these chemicals found in consumer products carry warning package labels (eg. rat poison), there is no such warning about toxins in tobacco smoke, points out the American Lung Association.

While cigarette smoking is the most common form of tobacco use worldwide, all forms of tobacco including water pipe tobacco, smokeless tobacco products, cigars, pipe tobacco, bidis and kreteks (used in Indonesia) are all harmful. ‘The tobacco epidemic’, according to the WHO, is one of the biggest public health threats the world has ever faced, killing more than eight million people a year around the world. More than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to tobacco smoke. ‘Over 80% of the 1.3 billion tobacco users worldwide live in low and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco,’ notes the WHO.

Cigarette smoke reduces the amount of oxygen carried to tissues and even in case of COVID patients, oxygen saturation (percentage of oxygenated hemoglobin returning to the right side of the heart) levels are low. Consultant Respiratory Physician and Senior Lecturer from the Department of Anatomy, Faculty of Medicine, University of Colombo, Dr. Yamuna Rajapakse points out that several studies have now confirmed that oxygen saturation is less in patients who smoke compared to non-smokers. “Smokers function in a low oxygen saturation environment, hence they are at greater risk than non-smokers during COVID lung involvement.”

Smoking causes thrombosis or blood clot formation. This could lead to stroke, heart disease and peripheral vascular disease. COVID too causes thrombotic effects and smoking may increase this risk she explains. Tobacco smoking is a significant risk factor for both viral and bacterial infections of the respiratory system. Smokers are five times as likely to develop influenza and twice as likely to have pneumonia. This, as many reputed medical journals including the British Medical Journal (BMJ) confirms, is an important factor worsening the impact of COVID-19. ‘There is evidence from case series that smoking is associated with more severe disease, a greater risk of intensive care need and excess mortality in people with COVID-19 admitted to hospital,’ notes the BMJ.

Smokers have more phlegm in their system and experience bouts of what is commonly known as the ‘smoker’s cough’. “Tobacco smoke burns the protective mechanism we have in our lungs which acts as a buffer against dust, viral and bacterial particles entering the respiratory system,” says the physician. She adds that smokers are more likely to develop pneumonia and this risk is aggravated in COVID patients who smoke.” Dr. Rajapakse also remarks that while the majority of COVID patients are asymptomatic, smokers show more COVID symptoms as research findings from China and UK also confirm.

New tobacco trends such as shisha smoking (smoking tobacco through a water bowl via a hose or tube) has also become an added problem notes Dr. Rajapakse who also warns that sharing of cigarettes and shisha tubes could increase the transmission of COVID and other respiratory infections.

Lung cancer which is the leading cause of cancer death the world over with smoking long established as a major cause, is now being diagnosed in a younger adult population. “Today we see advanced lung cancers in those in their 30s and 40s. Although genetic predominance is also present in lung cancer, a sizable percentage is attributed to second-hand or passive smoking (involuntary inhalation of other people’s smoke). Victims include women exposed to a smoking spouse.” Pregnancy is the worst time one could be around smoke, says the physician who warns that babies born to mothers exposed to passive smoking have lower lung reserves. Low birth weight is also common among such babies. Third-hand smoke where residual nicotine and other chemicals are left on indoor surfaces, clothing etc. is also bad for people who are exposed to them.

Entailing symptoms similar to asthma with wheezing and coughing, Chronic Obstructive Pulmonary Disease (COPD) is another serious smoke-induced condition. A non-reversible condition, COPD does not respond very well to inhalers, explains Dr. Rajapakse. Smokers with a specific enzyme deficiency can end up with COPD prematurely, she warns. Besides noncommunicable diseases such as high blood pressure, heart disease and stroke, smokers are also at a higher risk of having intermittent claudication and vascular ulcers leading to amputation of limbs, she says.

Despite tobacco smoking being established as a real risk factor for COVID-19, seriously compromising immunity and structural functioning of the respiratory system, there is very little discourse on it, observes the Consultant Psychiatrist from the National Hospital of Sri Lanka and the Director, Centre for Combating Tobacco, Dr. Mahesh Rajasuriya.

“Not smoking is as important as wearing a mask, yet the tobacco industry has been careful in downplaying this,” says the Psychiatrist who adds that apart from developing very serious complications, tobacco smoking also directly violate COVID control measures. “Smokers are compelled to remove their masks to smoke and even if they are smoking outdoors, there is a tendency for them to interact with a few more people in a small enclosure inhaling and exhaling each other’s breath more sharply. Here the risk of contracting COVID is enormous. Secondly our health care system is already exhausted with COVID patients and if a smoker suffers a heart attack, a stroke or gets pneumonia to which they are more susceptible, it will add to the burden.”

While hardly anyone “pledges to smoke to the grave”, most smokers wish to quit at sometime but several factors prevent them from doing so, says Dr. Rajasuriya. “These can be broadly classified into demand and supply factors. While the former makes smokers want to smoke again, the latter keep the environment conducive to smoking such as making cigarettes cheaper and more accessible.” Although the price of a cigarette should be more than what it is now in the Sri Lankan market compared to other consumer goods, it has on the contrary become more affordable, driving those from lower socioeconomic levels and youngsters who are still dependent to become addicted, says Dr Rajasuriya. “The tax increases on cigarettes too has been fraudulent with less money going to government coffers and larger proportions to the tobacco industry.”

The non-availability of a local license system as in the case of many countries including several in the region such India and the Maldives, makes cigarettes freely available, he points out. The absence of a law banning single stick sales adds fuel to fire during the pandemic he says. “Added to the physical touch when selling single sticks, the smoker does not see the pictorial health warnings on cigarette packs.”

A large majority of smokers quit without any psychological help says the psychiatrist who observes that the tobacco industry has created a myth that quitting is an uphill task and only those with extraordinary willpower can do so. “It is imperative to see through this myth first if you want to quit smoking,” he reflects. Certain stereotypes ingrained in the brain such as the need for physical pharmaceutical support for quitting often discourages a smoker wanting to quit the habit. “Another myth which needs to be debunked is that cigarettes need to be replaced with another chemical to help one to quit.”

The benefits of quitting tobacco are almost immediate, confirms the WHO. ‘After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within two to 12 weeks, your circulation improves and lung function increases. Within one to nine months coughing and shortness of breath decreases. Within five to 15 years, your stroke risk is reduced to that of a non-smoker. Within 10 years, your lung cancer death rate is about half that of a smoker. Within 15 years, your risk of heart disease is that of a non-smoker.

While some can navigate the transitional phase after quitting, many experience ‘withdrawal symptoms’ such as irritation, anxiety for which medication may be required. Getting rid of not merely cigarettes but all smoking associated paraphernalia including lighters and ashtrays is vital when preparing to quit says Dr. Rajasuriya. The comprehensive course designed by the Centre for Combating Tobacco, Help Quit sponsored by the WHO country office helps those who aspire to quit smoking and other support personnel including doctors, nurses, psychotherapists, counselors etc. to assist others to quit.

“The image about smoking is negative today, although the tobacco industry is trying hard to project otherwise. In this exercise, social media is now heavily used to induce the smoking habit and also to target a locally untapped market of young girls and women. Hence it is important for the public to see the true picture and not be deceived by the tobacco industry’s marketing strategy,” concludes Dr. Rajasuriya.



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Fractious West facing a more solidified Eastern opposition

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An Iranian attack on a neighbouring Gulf state. Image courtesy BBC.

Going forward, it is hoped that a reported ceasefire agreement between the US and Iran would provide a basis for a degree of stability in the Middle East and pave the way for substantive peace talks between the powers concerned. The world is compelled to fall back on hope because there is never knowing when President Donald Trump would change his mind and plans on matters of the first importance. So erratic has he been.

Yet, confusion abounds on who has agreed to what. The US President is on record that a number of conditions put forward by him to Iran to deescalate tensions have been accepted by the latter, whereas Iran is yet to state unambiguously that this is so. For instance, the US side claims that Iran has come clear on the point that it would not work towards acquiring a nuclear weapons capability, but there is no official confirmation by Iran that this is so. The same goes for the rest of the conditions.

Accordingly, the peace process between the US and Iran, if such a thing solidly exists, could be said to be mired in uncertainty. Nevertheless, the wider publics of the world are bound to welcome the prospects of some sort of ceasing of hostilities because it would have the effect of improving their economic and material well being which is today under a cloud.

However, questions of the first magnitude would continue to bedevil international politics and provide the breeding ground for continued tensions between East and West. Iran-US hostilities helped highlight some of these divisive issues and a deescalation of these tensions would not inevitably translate into even a temporary resolution of these questions. The world community would have no choice but to take them up and work towards comprehending them better and managing them more effectively.

For example, there are thorny questions arising from the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). Essentially, this treaty bans the processing and use of nuclear weapons by states but some of the foremost powers are not signatories to it.

Moreover, the NPT does not provide for the destroying of nuclear arsenals by those signatory states which are already in possession of these WMDs. Consequently, there would be a glaring power imbalance between the latter nuclear-armed states and others which possess only conventional weapons.

Such a situation has grave implications for Iran’s security, for instance. The latter could argue, in view of the NPT restrictions, that the US poses a security threat to it but that it is debarred by the Treaty from developing a nuclear arms capability of its own to enable it to match the nuclear capability of the US. Moreover, its regional rival Israel is believed to possess a nuclear weapons capability.

Accordingly, a case could be made that the NPT is inherently unfair. The US would need to help resolve this vexatious matter going forward. But if it remains, US-Iran tensions would not prove easy to resolve. The same goes for Iran-Israeli tensions. Consequently, the Middle East would remain the proverbial ‘powder keg’.

Besides the above issues, the world has ample evidence that it could no longer speak in terms of a united NATO or West. Apparently, there could be no guarantee that US-NATO relations would remain untroubled in future, even if the current Iran-US standoff is peacefully resolved. US-NATO ties almost reached breaking point in the current crisis when the US President called on its NATO partners, particularly Britain, to help keep open the Hormuz Straits for easy navigation by commercial vessels, militarily, on seeing that such help was not forthcoming. Such questions are bound to remain sore points in intra-Western ties.

In other words, it would be imperative for the US’ NATO partners to help pull the US’ ‘chestnuts out of the fire’ going ahead. The question is, would NATO be willing to thus toe the US line even at the cost of its best interests.

For the West, these fractious issues are coming to the fore at a most unpropitious moment. The reality that could faze the West at present is the strong opposition shown to its efforts to bolster its power and influence by China and Russia. Right through the present crisis, the latter have stood by Iran, materially and morally. For instance, the most recent Security Council resolution spearheaded by the US which was strongly critical of Iran, was vetoed by China and Russia.

Accordingly, we have in the latter developments some marked polarities in international politics that could stand in the way of the West advancing its interests unchallenged. They point to progressively intensifying East-West tensions in international relations in the absence of consensuality.

It is only to be expected that given the substance of international politics that the West would be opposed by the East, read China and Russia, in any of the former’s efforts to advance its self interests unilaterally in ways that could be seen as illegitimate, but what is sorely needed at present is consensuality among the foremost powers if the world is to be ‘a less dangerous place to live in.’ Minus a focus on the latter, it would be a ‘no-win’ situation for all concerned.

It would be central to world stability for International Law to be upheld by all states and international actors. Military intervention by major powers in the internal affairs of other countries remains a principal cause of international mayhem. Both East and West are obliged to abide scrupulously with this principle.

From the latter viewpoint, not only did the West err in recent times, but the East did so as well. Iran, for instance, acted in gross violation of International Law when it attacked neighbouring Gulf states which are seen as US allies. Neither Iran nor the US-Israel combine have helped in advancing international law and order by thus taking the law into their own hands.

Unfortunately, the UN has been a passive spectator to these disruptive developments. It needs to play a more robust role in promoting world peace and in furthering consensual understanding among the principal powers in particular. The need is also urgent to advance UN reform and render the UN a vital instrument in furthering world peace. The East and West need to think alike and quickly on this urgent undertaking.

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Science-driven health policies key to tackling emerging challenges — UNFPA

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Dr. Dayanath Ranatunga

Marking World Health Day on April 7, health experts have called for a stronger commitment to science-based decision-making to address increasingly complex and evolving health challenges in Sri Lanka and beyond.

Dr. Dayanath Ranatunga, Assistant Representative of the United Nations Population Fund, stressed that health is no longer confined to hospitals or traditional medical systems, but is shaped by a broad spectrum of social, environmental, and technological factors.

“This year’s theme, ‘Together for Health. Stand with Science,’ reminds us that science is not only for laboratories or policymakers. It is a way of thinking and a tool that shapes everyday decisions,” he said.

Dr. Ranatunga noted that modern health challenges are increasingly interconnected, ranging from infectious diseases such as COVID-19 to climate-related risks, demographic shifts, and emerging forms of online violence.

He warned that maternal and newborn health continues to demand urgent attention despite progress. Globally, an estimated 260,000 women died from pregnancy and childbirth-related causes in 2023 alone—many of them preventable through timely, science-based interventions.

“In countries like Sri Lanka, where fertility rates are declining and survival rates improving, every pregnancy carries greater significance—not just for families, but for the future of communities and economies,” he said.

The UNFPA official also highlighted the growing threat of Technology Facilitated Gender-Based Violence (TFGBV), including cyber harassment and online abuse, noting that these forms of violence can have deep psychological consequences despite lacking visible physical harm.

He emphasised the need for multidisciplinary, science-informed approaches that integrate mental health, digital safety, and survivor-centered care.

Turning to demographic trends, Dr. Ranatunga pointed out that increasing life expectancy is bringing new challenges, particularly the rise of non-communicable diseases such as diabetes, cardiovascular illnesses, and cancers.

In Sri Lanka, nearly 13.9% of mothers develop diabetes during pregnancy, a trend attributed to obesity and unhealthy lifestyles, underscoring the urgent need for preventive healthcare strategies.

“Are we investing enough in prevention?” he asked, noting that early intervention and healthier lifestyles could significantly reduce long-term healthcare costs, especially in a country with a free public healthcare system.

He underscored the importance of data-driven policymaking, stating that scientific research and analytics enable governments to identify gaps, anticipate future needs, and allocate resources more effectively.

The UNFPA, he said, is already leveraging tools such as Geographic Information Systems (GIS) to improve access to maternal healthcare, including mapping travel times for pregnant women to reach health facilities.

Digital innovation is also transforming healthcare delivery, from telemedicine to real-time data systems, improving efficiency and ensuring continuity of care even during emergencies.

In Sri Lanka, partnerships between the government and development agencies are helping to modernise training institutions, including facilities in Batticaloa, equipping healthcare workers with both clinical and digital skills.

However, Dr. Ranatunga cautioned that technology alone is not a solution.

“It must be guided by evidence and grounded in equity,” he said, pointing out that women’s health remains significantly underfunded, with only about 7% of global healthcare research focusing on conditions specific to women.

He also drew attention to the growing health impacts of climate change, including extreme weather, food insecurity, and displacement, describing it as an emerging public health crisis.

“Health does not begin in hospitals. It is shaped by the environments we live in, the choices we make, and the systems we build,” he said.

Calling for renewed commitment, Dr. Ranatunga urged stakeholders to invest in prevention, embrace innovation, and ensure that science remains central to policy and practice.

“Science is not just about knowledge—it is about ensuring that everyone has the opportunity to live healthy, dignified lives, and that no one is left behind,” he added.

 

By Ifham Nizam

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Sharing the festive joy with ‘Awurudu Kaale’

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The visually impaired who make up Bright Light Band in Awurudu attire

Melantha Perera is well known as a very versatile musician.

He was involved with the band Mirage, as their keyboardist/vocalist, and was also seen in action with other outfits, as well, before embarking on a trip to Australia, as a solo artiste.

I now hear that he has plans to operate as a trio.

However, what has got many talking about Melantha, these days, is his awesome work with the visually impaired Bright Light Band.

They have worked out a special song for the Sinhala and Tamil New Year, aptly titled ‘Awurudu Kaale.

Says Melantha: “This song has been created to celebrate the spirit of the Sinhala and Tamil New Year and to share the joy of the Awurudu season with all Sri Lankans”.

Yes, of course, Melantha composed the song, with the lyrics written collaboratively by Melantha, Badra, and the parents of the talented performers, whose creative input brought the song to life during moments of inspiration.

Melantha Perera: Awesome work with Bright Light Band

This meaningful collaboration reflects the strong community behind the Bright Light Band.

According to Melantha, accompaning the song is a vibrant video production that also features the involvement of the parents, highlighting unity, joy, and togetherness.

Beyond showcasing their musical talents, the visually impaired members of Bright Light Band deliver a powerful message, through this project, that their abilities extend beyond singing, as they also express themselves through movement and dance.

Melantha expressed his satisfaction with the outcome of the project and looks forward to sharing it with audiences across the country during this festive season.

He went on to say that Bright Light Band extends its sincere gratitude to Bcert Australia for their generous Mian sponsorship, the CEO of the company, Samath Fernando, for his continuous support in making such initiatives possible, and Rukshan Perera for his personal support and encouragement in bringing this project to completion.

The band also acknowledges Udara Fernando for his invaluable contribution, generously providing studio space and accommodating extended recording sessions to suit the children’s availability.

Appreciation is warmly extended to the parents, whose unwavering commitment from ensuring attendance at rehearsals to supporting the video production has been instrumental in the success of this project.

Through ‘Awurudu Kaale’, Bright Light Band hopes to spread festive cheer and inspire audiences, proving that passion and talent know no boundaries.

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