The director of the Pan American Health Organisation , Dr Carissa Etienne, has warned about what she described as the tobacco epidemic in the Americas, including the Caribbean, saying that though the devastating health effects of tobacco use are well known, tobacco’s negative repercussions extend well beyond the obvious health outcomes. “Tobacco consumption creates a significant economic burden on societies because of both the high costs of health care and the associated lost productivity,” said the Dominican-born Etienne, writing in the Pan American Journal of Public Health.