The high smoking prevalence of more than 40 % among men living on the West Bank of the occupied territories is a major challenge for the Palestinian health authorities although the prevalence is lower in the Gaza Strip and among women.

The Palestinian population living in the Occupied Territories has suffered from abnormal circumstances for generations and is constantly exposed to human rights abuses and attacks by the Israeli army and Zionist settlers and exposed by living on the training ground of the Israeli military and arms industry. More stressors like economic hardship, unemployment and lack of future prospects might increase tobacco addiction and make it easy for the aggressive marketing from the tobacco industry to derail the efforts of the Palestinian health authorities’ policy against smoking.

Fig. 1. Life expectancy and expected life time without and with chronic disease at age 15. Men, West Bank, 2010.

To pinpoint the seriousness of the health problem this study quantified the impact of smoking on life expectancy and the average lifetime without and with chronic disease among West Bank male never smokers, ex-smokers, and smokers.

Life tables by smoking category were constructed based on a life table for the West Bank male population and Danish estimates of relative risks for death for smokers and ex-smokers versus never smokers. Self-reported prevalence of smoking and chronic disease were from the Palestinian Family Survey 2010 (14,769 men in the West Bank). Expected lifetime without and with chronic disease was calculated by Sullivan’s method.

The main results from the study are shown on the figure. A 15-year-old Palestinian man in the West Bank who will never start smoking could expect to live 59.5 more years, 41.1 (95% CI: 40.3-41.9) of which would be without chronic disease and 18.4 years (CI: 17.6-19.2) with disease. For lifelong heavy smokers (more than 20 cigarettes per day) the figures were 52.6 life years, 38.5 years (CI: 37.3-39.7) without and 14.1 years (CI: 12.9-15.2) with chronic disease. Lifetime for 15-years-old moderate smokers (20 cigarettes or less per day) was on average 55.6 years of which 41.2 years (CI: 40.1-42.3) without disease and 14.4 years (CI: 13.3-15.4) with disease. Ex-smokers could expect 57.9 years of remaining lifetime, 37.7 years (CI: 35.9-39.4) to be spend without disease and 20.2 years (CI: 18.4-22.0) with disease.

It appears that heavy and moderate male smokers lose on average almost 7 and 4 years of life, respectively compared with their never smoking counterparts. In addition, the loss of years without chronic disease is substantial among heavy smokers and in particular among ex-smokers, probably because they stopped smoking due to chronic diseases.

Smoking is the most important preventable lifestyle-related risk factor among Palestinian men in the West Bank. The results must be of great concern for the Palestinian health authorities. The health gain from successful interventions against smoking is substantial. First, prevention policy should be aimed at protecting children and women from starting smoking.

Henrik Brønnum-Hansen
University of Copenhagen, Denmark

Publication

The effect of smoking on the healthy life expectancy of Palestinian men in the West Bank: a cross-sectional study.
Brønnum-Hansen H, Jonassen M, Shaheen A, Duraidi M, Qalalwa K, Jeune B
Lancet. 2018 Feb 21

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