WHO Public Hearings on the Framework Convention on Tobacco Control October 2000 Geneva, Switzerland Written Testimony

Transcription

1 WHO Public Hearings on the Framework Convention on Tobacco Control October 2000 Geneva, Switzerland Written Testimony Name of your organization: Heartfile, The National Heart Foundation of Pakistan Activity of your organization: Heartfile was founded in partnership with the Canadian International Development Agency (CIDA) in 1998 and is rapidly becoming the driving force behind a nation-wide public health initiative to control and prevent the rising epidemic of heart disease and stroke in Pakistan. Prioritising on creating public awareness about heart disease and its risk factors and how to prevent and control them through various campaigns, Heartfile also works in the areas of heart health advocacy, physician education, research and issues related to tobacco control in Pakistan. The Heartfile project profiles for optimal heart health programming for health professionals and the public are given below, with some programs already in place and some in the pipeline. PROFESSIONAL Overview PUBLIC Genera l Public Women Children Continuing health education for physicians Heart health in medical curriculum *Newspaper campaigns **Radio spots **TV spots *Pamphlets ***Heart health education for the illiterate *Heartfile Eat *Special publications as part of the newspaper campaign ***Recipe book ***Pamphlets ***School Health Intervention *Newsletters with clinical guidelines for doctors ***Practice Guidelines ***Heart Healthy kit. ***Teaching Sessions ***Specialized curriculum * Projects already implemented ** Projects already funded this year *** Projects for which feasibility is now being launched or is at the stage of proposal drafting Heartfile s strategy for information dissemination and campaigning for heart health strives to involve all segments of the population. This extends from the

2 English newspaper health education campaign and the English language public service pamphlets for the upper classes, to the Urdu newspaper campaign and Urdu language public information pamphlets for the middle class and the mass media audio-visual campaigns of TV and radio spots for the uneducated. Projects already implemented Heartfile-The News Public Awareness Campaign against Heart Disease: A project in partnership with the Jang Group of Publications, publishing weekly articles in the largest national English daily. Heartfile-Jang Public Awareness Campaign A project in partnership with Jang Group of Publications, publishing weekly articles in the largest national Urdu daily. Heartfile Public Information Pamphlets A set of six pamphlets (in both English and Urdu) on sale at pharmacy counters all over the country. Heartfile Public Information Posters Public awareness posters in English and Urdu in doctors clinics all over the country. Heartfile Eat Healthy Promotional Campaign: Endorsing and promoting heart health-eating habits a heart healthy section has been incorporated into the menu of the Karachi Marriott and Kitchen Cuisine, a leading confectionary enterprise sells heart healthy items. Heartfile Newsletter: A quarterly newsletter distributed to over 2000 doctors all over the country and abroad with current information on recent developments in CVDs in developing countries and simplified algorithms on guidelines for the treatment of cardiovascular diseases. Heartfile Anti-Tobacco Activities Anti-passive smoking posters to schools, anti-tobacco newspaper articles, INGCAT World No Tobacco Day children's competition of essays, posters etc. All the projects are ongoing and we are in the phase of evaluating the projects to optimise their efficiency in the future. The Heartfile pamphlets are also a fundgenerating activity for Heartfile. Projects in the process of development Mass Media Campaigns For Heart Health Promotion through Television and Radio Please visit our website for further information. Physician Guidelines for the prevention of Heart Disease Who is funding your organization/institution? The main funding is provided by the Canadian International Development Agency, Pakistan. Heartfile projects covered by this are: the Newspaper Campaigns, the Public Awareness Pamphlets, the Eat Healthy Advocacy Campaign and the approved Mass Media Campaign which is in the process of development. Caring International, a diplomatic charitable organisation, provided

3 the funds for the printing of School Health Posters and ICI Pakistan Pharmaceutical Business Limited provides the printing courtesy for the Heartfile Newsletter and the Public Awareness Poster on high blood pressure. Your interest in the Framework Convention The second half of the twentieth century has witnessed the emergence of a cardiovascular diseases (CVDs) epidemic as the major public health challenge of our times. As documented in the 1997 World Health Report, cardiovascular diseases account for more than 30% of all deaths worldwide today, or close to 15 million each year with about 9 million of these being in developing countries. According to the World Health Report 1999, there are 1.15 billion smokers in the world, of which 82% live in low or middle-income countries. Located in the developing world, South Asia has been termed the most deprived region in the world. The South Asian ethnic group has been documented to have the highest prevalence of coronary heart disease compared to any other ethnic group in the world. Pakistan s economy and health resources translate into tough health priorities, where clearly, communicable, nutritional, and maternal and child health issues are priorities. With a GNP of US$ 67,993 million, a per capita income of $460 and total health expenditure 0.7% of the GNP, the public sector is far from widening its health sector outreach even for preventive programs. This spells out a need for appropriate non-governmental organizations in the cardiovascular sector for implementing heart health programs. This precisely is the mission of Heartfile, The National Heart Foundation of Pakistan: initiating preventive programs, which can control the CVD epidemic through cost-effective and customized strategies. The silent epidemic of tobacco addiction is one of the biggest problems that we in the field of heart disease prevention have to face. Heartfile is committed to preventing heart disease in Pakistan and prioritises on public awareness programmes in the form of factual, thought-provoking articles on all topics relating to the prevention of heart disease, which obviously very much includes anti-tobacco campaigning. A Convention which is binding upon the government of Pakistan would be a godsend for our work and would improve the general cooperation between the public and the private sector in the arena of tobacco control. Choose a/several topic/s you would like to make a statement on: 1. Heartfile, being a Pakistan-based organization, has first-hand experience of and a vested interest in improving the health of the developing world with regards to tobacco consumption. The draft of the Convention needs to stress with even greater emphasis the problems posed in the developing world.

4 2. We strongly support the Working Group s comment that an addition should be made to the preamble on a programme for smoking cessation. This topic has been covered to some extent under the section of Obligations in Subsection C on Treatment of Tobacco Dependence. As a public health organisation, we feel that this point is sufficiently important to merit mention in the preamble as it is a vital means of tobacco control by reaching those already addicted. 3. In our struggle against tobacco-addiction, where legislation and antitobacco advertising are the most visible elements, the role that public awareness can play in bringing about behavioural change must not be overlooked. Behaviour changes at an early age lead to healthy habits in later life. The Global Youth Tobacco Survey by the WHO has recently determined that 20% of school children are already regular smokers. The survey also found that nearly 25% of child smokers started the habit before the age of ten. Obligation H 1 (b) alludes briefly to the fact that children are a key target group, however it fails to make any reference whatsoever to the fact that the area of greatest potential in educating children is via school health projects. It is, without a doubt, the most fertile soil in which to plant the seeds of a tobacco-free lifestyle and it must receive special emphasis and due consideration. Ideally there should be a separate binding Protocol on School Health. 4. With regards to Obligation H 3 (c), where there is mention of integrating tobacco control into reproductive health care systems: Firstly, when we refer to outreach mechanisms for supporting public health messages, it should be made binding that the Parties should utilize existing and evolving networks. In this context, evolving networks in the developing countries such as development programs/poverty alleviation programmes/community support networks if utilized would optimise the efficiency of the endeavour. Secondly, this method of information dissemination should not be restricted to data on treatment of tobacco dependence, but it is equally essential that this conduit be used for information on the harmful effects of tobacco, the facts and figures and preventive measures. 5. With regards to the advertising campaigns mentioned in the same subsection as the previous point, it is Heartfile s opinion that the antitobacco advertising campaign will have to be culturally customised to combat the carefully researched tobacco industry advertisements. Advertising needs to be varied from the now ineffective stereotyped slogans to include truth based, factual messages with examples from real life. The same attention to detail and planning will be needed in designing the warnings on the cigarette packaging as the target audience has become immune to the monotony of the message content.

5 Related to the topic/s chosen, give examples of what the particular situation in your country/project/field of activity is: Prioritising on information dissemination, Heartfile is staging a three-tiered strategy to create awareness regarding heart disease and its risk factors. This strategy targets the adults primarily in print media campaigns. With the launching of the mass media campaigns, the outreach will extend to involve children. We are now proposing to launch a school health project in major cities of the country, with international donor support and technical collaboration. Conclude why the topic/s should be/needs to be addressed/regulated on international level The tobacco-problems of the developing world listed above need to be addressed at an international level due to two reasons; one is that the problems being experienced now (with regards to creating public awareness about the hazards of tobacco consumption, the legislative acts that need to be enforced and the regulations that need to be imposed upon the industry, among other things) have all been experienced already by the countries of the developed world and they can conceivably be of assistance in solving these problems. It is much less time (and money) consuming to work on the common problems of developing world countries at one time rather than address each country s situation individually. By that time, tobacco will have claimed a lot more lives. The second reason is that if the problems are not tackled at an international level as has been previously pointed out by others and is here reiterated by Heartfile, the tobacco problem is merely displaced form one country to another rather than tackled head on all fronts. By tightening up on legislation in the developed world, it has become apparent that the tobacco industry has simply moved to greener pastures and uneducated, vulnerable markets who are not health aware. By addressing this problem at the international level, the solution should not prove as difficult to get hold of. Please state if you want to make an oral statement at the conference Yes Presenter: Dr Sania Nishtar MRCP President Heartfile, The National Heart Foundation of Pakistan 1-Park Road, Chak Shahzad Islamabad, Pakistan. Tele: Fax: info@heartfile.org Website: