Gláucia Maria Moraes de Oliveira et al. Miguel Mendes Oscar Pereira Dutra Aloysio Achutt … Mario Fernandes Vanda Azevedo Maria Beatriz Sena e Costa Santos Ferreira Armando Serra Coelho Miryan Bandeira dos Prazeres Cassandra Soares Mário Alberto Brito Lima Évora Mário Gomes Mariotto João Araujo Morais
Introduction
Depending on the epidemiological perspective of the observer and the extent of his concept of causality, tobacco consumption can be considered the second cause in the world of death attributed to classic cardiovascular risk factors, preceded only by hypertension, and the first cause of premature death and disabilities. When understood as an immediate cause without contextualization in the complex that determines and maintains population behavior, smoking was responsible in the world for about 8.10 (7.79-8.41) million deaths and 213.39 (201.16-226.66) million healthy life years lost (disability-adjusted life-years, DALYs). Although the number of daily smokers (individuals aged 15 years and older who smoke daily) has decreased, the total number of smokers continues to increase, imposing a major global challenge for healthcare systems.
Physicians, who generally deal directly and individually with the patient, tend to consider health/illness limited to the patient’s organic commitment and personal history and are less appreciative of the “causes of the causes” and the psychosocial determinants of the phenomena and behaviors, inseparable from the ecological context and interests. Environmental pollution (which has also a contribution from smoking and is progressively increasing) is currently considered to be the most important cause of morbidity and mortality in the world’s population, extending the spectrum beyond the traditionally valued risk factors. This perspective is very important for an understanding of the resistance to smoking control and planning of strategies that are more effective to approach this issue.
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