HKU Bulletin May 2005 (Vol. 6 No. 3)

7 The Economic Fall-out of Smoking T he alarming financial cost of smoking has been revealed by a HKU-led team of academics in a shocking new study. The fruit of five years of research shows that smoking is responsible for $5.3 billion a year in health-related costs. And this, they say, is a conservative estimate dwarfing the government’s own guess that smoking costs approximately $900 million a year. The team took into account the effects of passive smoking and all the costs linked to smoking-related diseases, including strokes, heart disease and major cancers. It also considered the loss of income resulting from a patient’s shortened working life. According to the study, the overall estimate of the costs of direct health care for diseases caused by active and passive smoking is $2.6 billion for acute and chronic health care; $0.9 billion for long term care (mainly in nursing homes); and $1.8 billion for productivity losses each year. This is Hong Kong’s f i rst comprehensive study of the economic fall-out of cigarettes on the health service. The team included research project leader, Associate Professor Sarah McGhee, Head and Chai r Professor of the Department of Community Medicine Professor Lam Tai Hing, Chair Professor Anthony Hedley and health economist, Helen Lapsley from the University of Queensland, Australia. They estimate that almost 7,000 people die annually from active and passive smoking. Of these almost 4,000 are premature deaths before the age of 75. Professor Lam said he believed the results would provide a good footing from which to challenge the tobacco industry and would further reinforce the government’s campaign to ban smoking in Hong Kong restaurants and bars. The controversial reforms are aimed at reducing harm to the 85.6 per cent of the population that do not smoke. Dr McGhee said: “Unt i l now we have not had a comprehensive, rel iable, up-to-date estimate of the cost of diseases caused by tobacco, including passive smoking. “Having this information at our fingertips should remove any shred of doubt that we need to move ahead with more effective smoke-free laws as soon as possible.” The team also stressed that $50 million annually would go a long way towards supporting services that help people kick the habit. The figure represents just one per cent of the total cost of smoking to Hong Kong. They also called for $15 million to be set aside by government officials for tobacco research. The study follows on from earlier research released in January this year that indicated that living with a smoker and inhaling second-hand smoke increases stroke deaths by 50 per cent. That research was conducted by academics in the same Department working alongside the University of Oxford and the government’s Health Department. The report, published in the British Medical Journal , showed for the first time that the damage caused by passive smoking to arteries in the brain is an important preventable cause of death from stroke. McGhee, lead author of that report said that the evidence for a direct cause and effect relationship between passive smoking and fatal illnesses was very strong and the risks increased with the number of smokers living with a non-smoker. “The findings show that anyone with regular exposure to second-hand smoke is at a much increased risk of serious and life-threatening diseases.” She added that one in five of all deaths from a stroke in non- smokers are attributable to damage from second-hand smoke. “Assuming conservatively that 50 per cent of the population aged over 35 is exposed to second-hand smoke, the best estimate is that 1,324 death per year in non-smokers from heart, vascular and lung diseases, and cancers are strongly associated with passive smoking at home or work,” she said. A Magnetic Combination E arth scientist Jason Ali and historian Peter Cunich have been puzzling over the unusual orientation of 18th century English churches for the past four years. Now they have an answer and it comes from another unlikely pairing. Edmund Halley, the brilliant scientist immortalised by the comet that bears his name, and architect Nicholas Hawksmoor, the ‘Devil’s Architect’ best known for his foreboding baroque churches, likely collaborated to achieve exact east-west alignment for several places of worship in London. To achieve that goal they would have had to use modern science – the first time it was applied in architecture. The results have been published in journals far removed from Dr Ali and Dr Cunich’s fields of expertise – the Journal of the Society of Architectural Historians and the Royal Astronomical Society’s Astronomy and Geophysics . Nature has also reported on their findings and the University’s Department of Architecture hosted a talk by the pair, who met by chance when Dr Ali missed a bus and Dr Cunich offered him a ride to the University. “We could never have got this far with this project individually because it requires the skills of both an historian and a scientist,” Dr Cunich said. “The findings tell us a lot about the architecture and history of the time, as well as providing unique insights into Great-and-the-Good who 300 years ago were beginning to assume power in England.” The churches were being built when the Church of England and the state were trying to establish England as the centre of Christianity, with London being the ‘New’ Jerusalem. The east- west orientation idea in building design was part of grander scheme to get back to a primitive, ‘purer’ form of the religion. Hawksmoor and Halley both played important roles in the church building programme. Hawksmoor was keen to achieve exact orientation for his churches, whi le Hal ley (a bui lding commissioner) was an expert in geomagnetism and could get true N-S-E-W by using corrected compass bearings. Dr Ali and Dr Cunich suggest the two joined forces, Halley using his knowledge to help Hawksmoor achieve precise alignments on two East End churches. “These measurements could not have been guessed at and they would have been very difficult to achieve without the kind of expertise that Halley had,” Dr Ali said. “The Chinese also used compasses, but structures we’ve measured in various Chinese cities, as well as Hong Kong’s walled villages, indicate that their measurements were never exact or systematic.” Apart from shedding light on church orientation, the research is the first to report on the Hawksmoor-Halley relationship and gives a new angle on Halley’s religious beliefs. His biographers have concluded that he was irreligious, but Dr Cunich said he might have been in sympathy with the idea of London being turned into the ‘New’ Jerusalem. “We don’t know what his religion was, but we can say that he did have a deep interest in these buildings,” Dr Cunich said. “A reasonable argument you can make from the evidence is that perhaps he was supporting this new interpretation of what it meant to be a Christian.” The findings complement earlier work by the pair on medieval churches which appear to have been orientated using the rising/setting sun on auspicious days in the Christian calendar. Next up, Dr Ali and Dr Cunich are aiming to produce a social history of the church building period, followed by investigations of the Khmer temples in Indochina, and cities, temples and burial complexes in China. 6 RESEARCH