Another year closer to a tobacco-free world: World No Tobacco Day
By Kawaldip Sehmi, IAPO CEO
What confuses most physicians and health professionals in developing a patient-centric health practice is a patient who wants to ‘exercise’ his/her informed choice to keep on smoking despite being counseled and warned on the danger of continued tobacco use: especially if h/she has a condition brought about by tobacco use in the first place!
On World No Tobacco day celebrated every year on 30 May 2017, the world will come together to celebrate, reflect and learn from the successes of the past. The day is intended to draw attention to the widespread prevalence of tobacco use, highlight the health risks associated with tobacco use, which according to WHO currently lead to nearly 6 million deaths each year worldwide, including 600,000 of which are the result of non-smokers being exposed to second-hand smoke, and lastly encourage governments to adopt effective policies to reduce smoking and other tobacco use.
The campaign to establish a tobacco-free world really began 50 years ago when scientists first found an association between tobacco use and lung cancers. It required a lot of hard advocacy and innovative partners to get where we are now. The unanimously adopted resolution on the WHO Framework Convention on Tobacco Control by the 56th World Health Assembly on 21 May 2003 was seen as a culmination of one of the most successful social change campaigns in recent years and a triumph in international public health regulations and advocacy.
Effects of Smoking
Tobacco use is the largest preventable cause of death and disease. It causes many types of cancer, as well as heart disease, stroke, lung disease, and other health problems. Denial of health services to patients who are smokers is now a heated topic in health policy circles. More and more, the idea that doctors have the right to withhold non-emergency treatment from patients who do not stop smoking is taking off. Evidence shows that smoking can affect many treatments and slow the healing process, in a resource constrained health system priority to then given to non-smoking patients to improve efficacy and impact.
The health professionals most concerned about smokers are anaesthetists. They fear for the smoker’s recovery and also malpractice litigation because smokers often need a higher dose of anaesthesia than non-smokers and are at risk of developing complications. Smokers have decreased blood oxygenation, leading to decreased oxygen delivery to their tissues; consequently, they are more likely to need oxygen therapy. The Royal College of Anaesthetists produced a joint briefing in partnership with Action on Smoking and Health advising patients to quit before surgery for better health outcomes.
This year we can celebrate the introduction of plain packaging which limits misleading labelling and increases the effectiveness of health warnings. Australia, Great Britain, Northern Ireland, and France have all passed laws to implement plain packaging.
It will be a great day for our health systems when they no longer have to transfer vital funds from essential health services and medicines to treat an all-together preventable and avoidable tobacco use related health burden. Patients have a significant role to play. Quit tobacco use!
The WHO Framework Convention on Tobacco Control (FCTC) is the first internationally binding public health law that 180 Member States have now ratified; it covers more than 90% of the world’s population. WHO FCTC marks the success of advocates like the FCTC Alliance for making it one of the most successful and rapidly ratified treaties in the United Nation’s history.
The history of the WHO FCTC campaign is now used to train health policy advocates. It is a campaign that used all the policy instruments available: a whole-of-government and a whole-of-society approach to progressively advance tobacco control. From simple research and policy briefings, through to the World Health Assembly resolutions, the history of the world’s first public health treaty is populated by a fascinating landscape full of characters and moments of set-backs and triumphs.
The campaign, notable because it is a ‘David versus Goliath battle’ pitched lay creative public health advocates against giant tobacco companies. The ramshackle groups of patients suffering from terminal non-communicable diseases took on the organized and professional tobacco lobbyists and lawyers who worked in concert with corrupt politicians to undermine and taint a whole cross-section of global health policy machinery; they had prided themselves for never having lost a case.
What won the day with the WHO member states was the persistent patient-voice that kept going, even when it was physically impossible to speak through the tracheostomy speaker valves. The courage of those disfigured mouth cancer patients, the barely breathing COPD patients on nebulised oxygen masks, and the dying lung cancer patients who came out of palliative care to speak out on their pain and suffering at big public hearings globally.
A character that has stood out in public health circles in regards to advocacy on the dangers of smoking is the late Sir Richard Doll. His longitudinal study of smoking amongst British doctors, a cohort of 30,000 general practitioners, gave the global tobacco advocacy and health promotion movements gems like:
- Smoking kills!
- Half of long-terms smokers will die prematurely, many in their most productive middle-age
- Smokers die 10 years earlier than non-smokers
- Smokers are more likely to develop heart disease
- One year after stopping, the risk of a heart attack falls to about half that of a smoker. Within 15 years the risk falls to a level similar to that of a person who has never smoked.
The most powerful message for smokers that the smoking cessation counsellors and health promotion advisers used from Doll’s data was: If you quit before the age of 30 you can avoid almost all of the risk of lung cancer attributable to smoking.
With Sir Doll having given us the tools, the battle then was between the tobacco owned-media and the media sympathetic with public health to win the hearts and minds of public policy elites. We learnt that you must get your artists (the creatives) and the media to come up with campaigns that resonate with decision-makers. From this developed the Social Marketing Approach (not to be confused with social media marketing)
The World Bank has evaluated five of the most successful tobacco control policies and showed that what worked best was :
- M-Monitoring tobacco use and prevention policy impact
- P-Protect people from tobacco smoke
- O-Offer support to users to quit
- W-Warn about tobacco use dangers
- E-Enforce bans on tobacco advertising and promotions
- R-Raise tobacco taxes