Prevent Chronic Diseases Through Tobacco Control

Transcription

1 10 Prevent Chronic Diseases Through Tobacco Control Situation It has been scientifically proven that tobacco smoking increases the risk of many diseases such as cancer (including lung cancer), myocardial infarction, stroke, and chronic obstructive pulmonary disease and that abstinence from tobacco can decrease these risks and lead to health improvement. The World Health Organization (WHO) states that tobacco smoking is the single largest preventable cause of disease. 1 Tobacco smoking is classified in the category of mental and behavioral disorders due to psychoactive substance use according to the ICD-10, 2 because it is difficult for most smokers to stop smoking by themselves and many require support in overcoming the addiction. Tobacco smoking is now recognized as an addiction in Japan and, since 2006, medical service fees for smoking cessation treatment have been classed as nicotine addiction management fees. 3 The integrated results of three large-scale cohort studies in Japan show that, among 1,084,000 deaths in 2005, the number of men, women and the total population who died of any disease related to smoking is estimated to be 112,000, 19,000, and 131,000, respectively. 4 Furthermore, it has been scientifically verified that secondhand smoke increases the risk of various diseases and disorders, as well as death from serious diseases. One effective method of reducing the health risks is banning indoor smoking to prevent exposure to secondhand smoke. The WHO recommends that every indoor workplace and all public spaces be made smoke free. A non-smoking environment in indoor areas is also useful for smokers who want to stop smoking. It has been reported that a policy of smoke-free air in every workplace could reduce the absolute prevalence of smoking. 5 The 2013 National Health and Nutrition Survey reported that the overall prevalence of smoking among Japanese adults is 19.3 percent. The rate of smoking by men is 32.2 percent and the rate for women is 8.2 percent. Rates for both men and women have tended to decrease. However, in particular, the prevalence of smoking by men in their 30s through 50s is between 39 and 44 percent and the rate for women in their 20s through 40s is between 12 to 13 percent. These smoking rates are high. 6 For passive smoking, the rate in all locations, excluding schools and game halls, is decreasing; however, the passive smoking rate in restaurants, leisure and amusement facilities, and workplaces exceeds 30 percent and remains high. 6 A survey on the prevention of passive smoking and a smoking ban for indoor workplaces conducted on 8,000 indoor workers in Japan in 2014 showed that 66 percent of non-smokers desired a total smoking ban and even 25 percent of smokers also desired the ban. Eighty-one percent of indoor workers expect preventive measures against passive smoking, including measures for the separation of smoking rooms so that smoke does not leak. Sixty-two percent of indoor workers would support a legallymandated total smoking ban. Only 14 percent say that the passage of such laws would have a negative impact on their business. Sixty-three percent of indoor workers agreed with the establishment of a passive smoking prevention ordinance by According to one survey, the economic loss per year due to tobacco smoking is estimated at JPY1.62 trillion in terms of excess medical costs for smokers, JPY0.14 trillion in excess medical costs for passive smokers, JPY0.48 trillion in excess nursing care costs, JPY3.93 trillion in losses related to the labor force, and JPY0.19 trillion due to fires or extra cleaning of facilities/ interior areas. This adds up to a total annual loss of JPY6.36 trillion. 7 Current Policy In May 2003, the government of Japan Lengthening Healthy Lifespans to Boost Economic Growth 51

2 implemented Article 25 of the Health Promotion Act to eliminate second-hand smoking in public spaces. The law does not stipulate any penalties, specifying only good faith efforts, but it has gradually promoted a voluntary non-smoking movement. Further, with Japan s June 2004 ratification of the WHO Framework Convention on Tobacco Control, which came into force internationally in 2005, efforts to adhere to the treaty including the introduction of the Taspo system to prevent purchases of tobacco by minors have been implemented in Japan. National health insurance coverage for the treatment of nicotine addiction through smoking cessation programs has been provided since The coverage requirements are set based upon the daily number of cigarettes smoked multiplied by the number of years of smoking. Because coverage includes only persons for whom this formula totals more than 200, however, most young smokers are excluded. In October 2010, tobacco tax rates were raised, leading to a reduction in tobacco consumption. The demand for taxation revisions made by the Ministry of Health, Labour and Welfare indicates that the increase in the tobacco tax rate is included from the perspective of public health. In the Basic Plan to Promote Cancer Control approved by the Cabinet in June 2012, the first numerical targets adopted were aimed at reducing the national smoking rate to 12 percent by Further, in stage two of the health promotion goals for Healthy Japan 21, the following targets were set in relation to preventing passive smoking by reducing the opportunities for passive smoking in: 10 Government buildings, from 16.9 percent in 2008 to 0 percent by 2022 Medical institutions, from 13.3 percent in 2008 to 0 percent by 2022 The workplace, from 64 percent in 2011 to 0 percent by 2020 In restaurants, from 50.1 percent in 2010 to 15 percent by 2022 If there are opportunities where students can receive education on the negative effects of smoking before they become adults, in particular, as a theme of health education at schools, students will have a chance to acquire health literacy. Such education may contribute to preventing smoking at a young age and reducing smoking rates when these students become adults. With regard to education on the negative effects of smoking provided in school, the Japanese Society of School Health has prepared Materials for Teaching the Prevention of Smoking, Drinking, and Drug Abuse. The materials are expected to be used for teaching the prevention of smoking. The Japan Medical Association proposed political measures under its School Health Committee Report 11 compiled in March 2014 on the health education themes for each school year and clinical department by subject, and the targets of the education would include students, school teachers and staff members, and parents. The report includes a proposal to provide health education on the Negative Effects of Smoking from internal medicine departments and pediatrics departments as a theme for students in the second year of junior high school and higher. The plan is considered effective for the prevention of smoking at a young age as a means of providing health education as a part of school education. The proposal will be linked with school curriculum guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology. In June 2014, the Act for Partial Amendment of the Industrial Safety and Health Act was passed and it included promotion of preventive measures for passive smoking in the workplace by stating that the employer shall strive to 52 Lengthening Healthy Lifespans to Boost Economic Growth

3 take appropriate measures based on the actual conditions of the employer and the work area in order to prevent the passive smoking of workers. Consider an increase in the tobacco tax, which is expected to lead to reducing tobacco consumption and thereby improving overall health. Recommendations In order to protect the public s health and prevent various diseases, seek additional preventive measures against passive smoking, while respecting people s opinions. Implement health education on the negative effects of tobacco for students in school health classes. References 1. World Health Organization report on the global tobacco epidemic, World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). 3. Ministry of Health, Labour and Welfare, the latest information on tobacco at 4. Katanoda K, et al. Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies, J Epidemiol. 188: , Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behavior: Systematic review, BMJ 325: , Ministry of Health, Labour and Welfare National Health and Nutrition Survey. ka/ pdf 7. Institute for Health Economics and Policy. Study of anti-smoking measures: Estimate of costs resulting from smoking, July Japan-wide survey of 8,000 indoor workers on the prevention of passive smoking and a smoking ban in the workplace, conducted by Johnson & Johnson K.K. Consumer Company, released on May 26, co.jp/group/press/2014/0526/pdf/ pdf 9. Ministry of Health, Labour and Welfare. Outline of Major Taxation Amendment in file/04-houdouhappyou seisakutoukatsukan-sanjikanshitsu_shakaihoshoutantou/ pdf 10. Reference material for the promotion of Healthy Japan 21 (stage two) by the Regional Public Health Promotion Nutrition Subcommittee, Health Sciences Council, July Ideal Health Education Considered by Doctors in Each Clinical Department (Materials in the back of the book, pp3-5) Lengthening Healthy Lifespans to Boost Economic Growth 53

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