2019: Recommendations for Reducing Tobacco Consumption in Portuguese-Speaking Countries - Positioning of the Federation of Portuguese Language Cardiology Societies

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.1 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,2 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. In all Portuguese-speaking countries (PSCs), smoking is more frequent among men; the difference in rates between men and women vary among the countries and are greater in the African countries. Table 1 describes the standardized prevalence by sex in 2015 and the annualized difference for men and women from 1990 to 2015 according to the sociodemographic index (SDI).3 The rates of daily smokers vary from 19.0%, 16.8%, and 7.2%, in African countries, Portugal, and Brazil, respectively.4 Table 1 Standardized prevalences by sex in 2015, and annualized difference by sex from 1990 to 2015 according to the sociodemographic index