4ème congrès de l'Union Méditerranéenne de Pathologie Thoracique
Alexandrie 2004
Textes des conférences

Why do we need an educational programme in tobacco control ?

The world is afflicted with an important but preventable epidemic that is tobacco. As tobacco consumption is now decreasing in most industrialised countries, the multinational tobacco campagnies are concentrating their massive resources towards developing countries already assailed with infectious diseases and malnutrition. It is established that death caused by smoking will soon wipe out gains made in preventing death from malnutrition and communicable diseases in the developing world. Tobacco epidemic is a global threat in term of health with 4.2 million deaths in the year 2000 and 10 million deaths forseen in 2025-30 , but also in term of economics with material and human losses , but also in term of environment with increase in green house effect, soil erosion , deforestation and trash. According to the World Bank, the global annual economic costs are up to 200 billion US dollars in 2000. It is expected to rise 500 billion US dollars in 2010 if the situation remains as it is now

Who needs education ?

For all the above reasons, an educational programme in tobacco control (EPTC) is essential to increase awareness and support for sustained progress in tobacco control. The objective of any EPTC is of course curbing the tobacco epidemic on a local as well as on a global scale, by dramatically reducing both tobacco consumption and disease incidence. To be successful, such programme must be carried out at local and global level. It must involve the general population, decision makers, opinion leaders, non governemental organizations ,with a focus on media, educators including at the front line health professionals. School children and students have tobe tought not to initiate smoking and smokers should be educated to quit.

What to educate and by whom?

It is a shared responsibility for governements, NGOs, opinion leaders, civil societies and educators to take and implement the following measures recommended by the World Health Organization (WHO) :

• A ban on all tobacco promotion , including sponsorship
• Prominent health warnings on tobacco packs
• A ban on tobacco sales to children
• Smoke free public places
• Increasing exice taxes
• Public information and education programmes
• Phasing out tobacco growing
• Tight controls on smugling
• Using criminal and civil law against tobacco companies
• Support for an expanded access to effective means of quitting
• Regular monitoring and evaluation of progress

What to educate depends on the target population. Large information and education will aim at the general public through the media. Instead of skeching out what to educate because it depends on the target population, we will concentrate on specific programmes, on the one hand EPTC for school children and students in an interactive way, in an overall holistic approach to health, on the other hand for health professionals. For school children and students it is important to :

So, training and educating the educators is a pre-requisite to fulfil these tasks. In turn, those who need education could educate if well informed, trained, and motivated. Once again, health professionals should be at the front line, first as learners and then after as educators. Physicians particularly, should integrate prevention and tobacco control in their day-to-day activities towards :

Physicians should set a good example (« the first great gift we can bestow on others is a good example »), give brief and repeated advice, counselling at every visit, promote and reinforce antitobacco legislation , and set up stop smoking interventions.

Setting up stop smoking interventions is the most benefitial action as it could save from dying 160 million additional smokers before 2050. The 5 A’s are the key points :

Enhancing motivation for patients unwilling to quit is based on the 5 R’s :

Health science schools should include course work on tobacco and health as well as on training in tobacco cessation programmes.We are proud to have been a pioner in this field by introducing since 1983, a course work on tobacco and health at the medical school of Casablanca, a fact that has contributed to some extent to a decreasing trend in smoking among medical students as well as in teachers of the same school.

At international level, cooperation in sharing information and methods about all aspects of tobacco control in a partenership way is a must. The Framework Convention on Tobacco Control initiated by WHO, is a good tool for supporting effective tobacco control policies worldwide.

Conclusion

The chance of success of any EPTC depends not only on the involvement of health professionals, but also on the contribution and mobilisation of governemental authorities, opinion leaders, NGOs and the media, with the objective of increasing public awareness about the negative effects of smoking in terms of health, economics, and environment , opposed to the benefits of absention or quitting. As public opinion gradually recognises such evidence, more and more people will seek support for quitting. The challenge is to get ready to answer the demand. Hopefully it will be a time for a smoke free way of life worldwide.

création: février 2007