Sanda: People are keen on smoke-free events
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FIFA has long supported the World Health Organisation (WHO) in its campaign for smoke-free sporting events. Indeed the mother of them all, the FIFA World Cup™, has involved tobacco-free stadiums including and since 2002.

And this trend is set to continue. Indeed on Thursday 7 March, FIFA, along with the Local Organising Committee (LOC) and WHO, announced that this year’s FIFA Confederations Cup and the 2014 FIFA World Cup Brazil will be smoke-free competitions. FIFA.com caught up with Dr Luminita Sanda from WHO to discuss the aim of the campaign and the serious dangers caused by tobacco.

FIFA.com: What exactly does a ‘smoke-free stadium’ mean?
Dr. Sanda:
WHO recommends that all mega-events, weather sport, social or cultural, be tobacco-free. This means that, primarily, stadia which host an event provide all participants – athletes, players, staff, visitors, public, etc. – a venue with a healthy environment free of tobacco smoke in all indoor and outdoor areas. It also means that nobody attending the event, whether directly or through any media , is exposed to any form of tobacco advertising, promotion and sponsorship, and it has absolutely no links with the tobacco industry in any form. Finally, it means that it does not allow sales of tobacco products or related tobacco products within the event site.

Is it possible to forbid people to smoke in public open-air areas?
It is possible to create smoke-free events, and people are very willing to comply. Recent events organised as tobacco-free, such as summer/winter Olympic Games in Beijing, Vancouver, London, or the football World Cup in South Africa, demonstrate that it is possible and achievable. Research shows that concentrations of second-hand tobacco smoke in many outdoor areas are often as high or higher than in some indoor areas, and thus there is genuine interest in protecting people from the dangers of tobacco smoke in outdoor areas. More and more, national and sub-national jurisdictions expand the scope of their completely smoke-free indoor laws with smoke-free outdoors, such as open dining areas, beaches, parks, children’s playgrounds, outdoor grounds of health and educational facilities, including university campuses, sports facilities, stadia, open auditoria, and the list may continue.

Can you give numbers on the damages caused by smoking in the world?
The tobacco epidemic is one of the biggest public health threats the world has ever faced. It kills nearly six million people a year, of whom more than five million are users and ex-users and more than 600,000 are non-smokers exposed to second-hand smoke. Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease and death has just begun. Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to one billion deaths in the 21st century. Approximately one person dies every six seconds due to tobacco and this accounts for one in ten adult deaths. Up to half of current users will eventually die of a tobacco-related disease. Nearly 80 per cent of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

What type of medical problems does smoking cause?
Tobacco kills and maims. Because of all the toxins contained in tobacco products, tobacco smoking can damage any part of ‎the body. It causes more than 50 very serious ‎diseases, many among them are world’s top killers, such as the coronary heart disease. People frequently associate tobacco smoking with lung cancer, yet 11 other cancers are caused by tobacco (e.g. of the mouth, throat, blood, kidneys, stomach, etc.). Among young people, the short-term health consequences include respiratory effects, addiction to nicotine, and the associated risk of other drug use. Smoking reduce young people’s lung growth rate and so their physical fitness is hurt, even among those trained in competitive running. Because smoking-related diseases do develop over the course of a lifetime, it gives the appearance of only effecting elderly people. However, people in their 20s and 30s have died from strokes caused by smoking. By narrowing the blood vessels (arteries), smoking also causes a range of problems from pain to tissue loss or gangrene. The lung’s function is decreased, due to chronic obstruction of the airway, infections and other respiratory diseases. Smoking also has many adverse reproductive effects – infertility, impotence for example – also early childhood effects like sudden death.

What type of population is particularly in danger with smoking: youth, elderly, pregnant women?
Tobacco is dangerous to everybody: it kills in any form it is consumed. Exposure to tobacco smoke also kills. However, the tobacco industry is especially interested in targeting through their tobacco advertising, promotion and sponsorship, youth and women in order to replace smokers that die or quit. Billions of dollars are spent for depicting tobacco as a desirable consumer product. Tobacco is falsely associated with youth, energy and glamour instead of cancer, heart disease and other illnesses. It is therefore very important to avoid any form of advertising, promotion or sponsorship, especially in mega-events that are watched and followed by millions all over the world, such as the World Cup. In addition, tobacco use is a major contributor to inequalities in health both within and across populations. Tobacco use is linked to poverty, disparity and social disadvantage, being concentrated in populations with low incomes and lower educational attainment, limited economic and social development opportunities (e.g. poor or living at marginal economic situations, immigrant populations, mental health patients and prisoners, homeless, and so many other groups where smoking prevalence is likely to be high but are less likely to receive cessation assistance). For this reason, any social responsible entity, like FIFA, cannot allow themselves to be involved in promoting such health and social harms, and hence the need of a tobacco-free World Cup.

Are there any studies that prove passive smoking is also dangerous to health? Do you have statistics about this?
Second-hand smoke is the smoke that fills restaurants, offices or other enclosed and open spaces when people burn tobacco products such as cigarettes, bidis and water pipes. Tobacco smoke contains more than 7,000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer. Smoking puts more than just the smoker at risk. Study results consistently indicate that second-hand smoke (SHS) exposure increases the risk of coronary heart disease by 25–30 per cent in non-smokers, and that there are increased risks even at the lowest levels of exposure – they also show up to a 47 per cent decrease in the rate of heart attacks in smokers and non-smokers after smoking bans are implemented. A WHO research report (found about 600,000 premature deaths per year worldwide due to exposure to second-hand tobacco-smoke. Almost half of children regularly breathe air polluted by tobacco smoke. I would like to add an important fact based on clear evidence that there is no safe level of exposure to SHS, as it cannot be controlled by ventilation, air cleaning or spatial separation of smokers from non-smokers. An increasing number of countries that recognised the dangers of exposure to SHS tobacco smoke have adopted comprehensive bans on smoking in all indoor and some outdoor public places and ‎workplaces.

Do you believe that, beyond the health matter, a smoke-free stadium campaign can also help in terms of a more general awareness raising?
Players, spectators, staff, volunteers, media and other visitors are more likely to enjoy a sporting event that protects their health from any threats, tobacco included, thus a tobacco-free stadium campaign is an excellent opportunity for increasing the popularity of any of the stadium’s hosted sporting events. Nowadays broad media coverage often results in the involvement of millions of ‘live’ spectators and fans. Therefore, beyond the commitment to provide healthy environments free of tobacco, mega-sporting events have the potential to influence social norms, by promoting health and facilitating positive lifestyle changes (like giving up smoking). The commitment to a lasting health legacy – longer, healthier lives through a cultural shift towards healthy lifestyles – is a robust message that can only increase the prestige of any sporting arena.

Does WHO provide any practical guidance on how to make sure the stadium is truly tobacco-free?
The organisations committed to a make the stadium tobacco-free should know that all measures described previously take into account the provisions of the WHO Framework Convention on Tobacco Control, an international treaty with 176 Parties as of February 2013, and also lessons learned from previous mega-events. A sample policy and other practical information for policy review and evaluation are included in the WHO’s ‘Guide to Tobacco-free Mega-events’, which provides event organisers with detailed contents of the measures to be applied, duties of compliance and enforcement means, as well other tools and elements important to ensure venues are truly tobacco-free (e.g. signage templates, check-lists, etc.). Guidance on promoting the tobacco-free event, which includes developing and implementing a communication plan, are included.