TREATING TOBACCO DEPENDENCE A GLOBAL NEED AND A GLOBAL INITIATIVE

Transcription

1 TREATING TOBACCO DEPENDENCE A GLOBAL NEED AND A GLOBAL INITIATIVE The Problem Cigarette smoking is recognized as the greatest preventable cause of death and disability in the world, causing more deaths each year than malaria, tuberculosis, suicide, homicide, and HIV/AIDS combined. 1 The tobacco pandemic and the associated adverse health consequences will only increase as we go further into the 21 st Century if nothing is done to stem the tide. We have the means to do this through the Framework Convention on Tobacco Control (FCTC), the world s first global health treaty, which has been ratified by over 170 countries. 2 The FCTC provides the impetus for effective tobacco control through policy change and a mandate for treatment of tobacco dependence. The treaty provisions focused on providing tobacco dependence treatment are contained in Article 14 of the FCTC which obligates countries to provide treatment for tobacco users, while many other policy issues are covered by other articles in the Treaty. We must now work to overcome the barriers to the wide implementation of the health policy and treatment provisions contained in this Treaty. The main barriers to broader implementation of the FCTC Article 14 provisions are: The lack of recognition that treatment can be effective. Few healthcare professionals are trained to assess and treat tobacco use. Little advocacy for health policy change is being advanced which would lead to increased and improved tobacco dependence treatment. The opposition by the tobacco industry to these efforts. Healthcare Professionals can be Part of the Solution Healthcare professionals are among the most educated members of any community and are most often viewed as the most credible source of health information in those communities. As a result, healthcare professionals not only provide care for innumerable patients with a wide range

2 of medical conditions, but they can also represent a major and largely untapped force for health policy change. Healthcare professionals are most comfortable when treating patients, but because most have not had training in health policy advocacy, they decline to participate in advocating for health policy change that could ultimately benefit their own patients and the broader population. The FCTC Provides the Tools The FCTC framers recognized that there is a need for a wide dissemination of treatment services for tobacco dependence in addition to public health policies to reduce tobacco availability, exposure, and use initiation. Because of their training background, professional standing and motivation to serve patient s needs, there is no group in a better position than health care professionals to carry out the mandates to provide treatment for tobacco dependence and to advocate for effective health policy change regarding tobacco control. Tobacco Industry Opposition The world has never faced such a growing pandemic as tobacco use presents, since most public health problems are solvable when healthcare and public health professionals ally together to provide effective prevention and treatment. Unfortunately, tobacco use is widely promoted by the multinational cigarette manufacturers, which sets it apart from any other health pandemic to face the human race. As stated by the WHO in a 2000 report, The evidence presented here suggests that tobacco is a case unto itself, and that reversing its burden on global health will be not only about understanding addiction and curing disease, but, just as importantly, about overcoming a determined and powerful industry. 3 Global Bridges can be the Vehicle In 2010, with an unrestricted education grant from Pfizer Medical Education Group, financial and in-kind support from the American Cancer Society, and in-kind support from Mayo Clinic and the University of Arizona, we undertook the challenge of developing a network of healthcare

3 professionals to begin to more effectively address the tobacco pandemic. The founding partner institutions were the American Cancer Society, Mayo Clinic, and the University of Arizona. At the outset, this new initiative entitled: Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment developed a clear and compelling mission statement: To create and mobilize a global network of healthcare professionals and organizations dedicated to advancing effective tobacco dependence treatment and advocating for effective tobacco control policy. Our objectives are to build connections and create opportunities to share treatment and advocacy expertise among network members within and across regions, provide state-of-the-art evidencebased training in treatment and advocacy to network members, and to facilitate the implementation of Article 14 of the FCTC in every nation. We believe that tobacco dependence treatment and tobacco control policy go hand in hand. Simply stated, effective treatment cannot be provided in the absence of good tobacco control policy; and conversely, good tobacco control policy can be enhanced with good treatment. We focused our initial attention on regional programs in Latin America, the Middle East, and Africa. We have robust programs in the Middle East and Africa under the leadership of Global Bridges Regional Directors Dr. Feras Hawari of the King Hussein Cancer Center and Dr. Lekan Ayo-Yusuf of the University of Pretoria, respectively. Because of the unique nature of the trans global collaboration, the focus of this report will be on our efforts in Latin America and our new efforts in the European region, particularly among Spanish-speaking populations. Global Bridges in Latin America and Connecting to Europe In the Latin American region, our Regional Director for Global Bridges is Dr. Gustavo Zabert, a pulmonologist from Argentina, who holds leadership positions in the Latin American Thoracic Society and the Latin American Coalition for Tobacco Dependence Treatment. He works in collaboration with Beatriz Champagne, PhD, Executive Director of the Interamerican Heart Foundation (IAHF). Dr. Zabert and the IAHF are working to improve the availability of

4 effective tobacco dependence treatment throughout the region. To date, they have trained over 800 healthcare professionals from 19 countries across Latin America. The Latin American team has collaborated closely with Dr. Carlos Jimenez-Ruiz of Madrid, Spain. Dr. Jimenez-Ruiz has assisted the Latin American team in a variety of trainings in Latin America and has brought expertise from that continent to Spain to share with our European colleagues. Last year, Dr. Jimenez-Ruiz hosted a symposium in Madrid where over 300 healthcare professionals from Spain learned state-of-the-art tobacco dependence treatment and how to advocate for tobacco policy change. Assessing the European Landscape for Global Bridges In the European region, we have partnered with Andy McEwen, PhD, and Emma Croghan, MPH, both of whom work at the National Centre for Smoking Cessation Training (NCSCT) in London, UK, under the leadership of Robert West, PhD. The NCSCT was established to support the delivery of interventions provided by local stop smoking services, support the National Health Service and local authorities to deliver effective evidence-based tobacco control programs, and deliver training and assessment of programs to Tobacco Treatment Specialists and other healthcare professionals. In 2012, NCSCT conducted a scoping exercise for Global Bridges to assess the treatment and training needs of the 53 countries which comprise the WHO European region. Based on these findings, we are working in close collaboration with Dr. McEwen and Ms. Croghan in addition to other partners in the European region. In June 2012, we convened a meeting in Birmingham, UK, with tobacco treatment experts from seven countries from the region to discuss how best to introduce Global Bridges to Europe. We decided that our primary focus in the European region should be in countries which have high smoking prevalence and few services. We will use the models that have been developed in Madrid by Dr. Jimenez-Ruiz and in the Czech Republic by Dr. Eva Kralikova to begin training of healthcare professionals in Eastern Europe as well as helping physicians and other healthcare

5 professionals to stop smoking. For many countries, helping physicians and other healthcare professionals to stop smoking is the initial step. We recognize that the high prevalence of smoking in some of these countries and a strong presence of the tobacco industry will be an impediment to developing and implementing effective treatment programs and advocating for tobacco policy changes. Nevertheless, experiences among tobacco control experts in similar regions indicate that with science-based training and policy change these impediments can be overcome and health improved throughout the region. Global Reach for Capacity Building The tobacco pandemic is a global problem, and requires reaching healthcare professionals worldwide in order to motivate them to engage in this effort and to build the necessary treatment and health policy advocacy capacity. This requires training tools that have the potential for a global reach. While this report focuses on Global Bridges work in Spanish-speaking countries, we have a robust and growing website which is multilingual and accessible to healthcare professionals around the world. We also have collaborated with the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, to develop a distance learning program. In the second quarter of 2013, we will introduce a basic distance module for treating tobacco dependence, initially in Spanish and Arabic. We plan to have other languages and additional training modules in more advanced tobacco dependence treatment and in health policy advocacy available as we continue to develop that capability. Electronic media will be central to our communication capabilities and will expand the reach of Global Bridges network to members from across the globe. We will continue to collaborate with other treatment-focused organizations such as treatobacco.net, ATTUD, and Tobacco Control Nurses International. Joining Global Bridges is at no cost, and we welcome new members to join through the website and to actively participate on the website or on our list serve. Doing so

6 can make a significant contribution to reducing the global burden of death and disease imposed by tobacco use and its vector, the multinational tobacco industry. References 1. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009; Implementing smoke-free environments. 2009; Accessed January 21, World Health Organization. WHO Framework Convention on Tobacco Control. 2003; Accessed January 10, World Heath Organization. Tobacco Company Strategies to Undermine Tobacco Control Activities at the World Health Organization: The Report of the Committee of Experts on Tobacco Industry Documents. July 2000; Accessed March 15, 2013.