Leading transformational change: inner and outer skills
Smoking cessation
1. NIMRA ZAMAN
PHARM-D (2015) MPH PART –II ( 2017-19)
FACULTY OF COMMUNITY MEDICIEN AND PUBLIC HEALTH
SCIENCES LUMHS, JAMSHORO
WORLD NO TOBACCO DAY
31ST. MAY 2019
2. • Tobacco consumption (smoke and smokeless) is
major public issue globally.
• Tobacco is the single largest preventable cause of
death.
• Tobacco is the only legally available consumer
product that kills people when it is used entirely as
intended.
• By 2030 more than 80% of the world's tobacco-
related
deaths will be in low and middle income countries.
• 55% of Pakistani households have at least one
smoker.
3. • Pakistan is one of 15 countries worldwide with
a heavy burden of tobacco-related ill health.
5000 Pakistanis are admitted to hospital every
day because of tobacco-related illnesses.
• Worldwide, tobacco use causes more than 7
million deaths per year. If the pattern of
smoking all over the globe doesn’t change, more
than 8 million people a year will die from
diseases related to tobacco use by 2030.
• Tobacco kills 274 Pakistanis everyday!
(Pakistan Health Education Survey, 1999)
4. Other Departments Are Preventing Us Enacting Any
Measures To Stop Smoking In Public Places. How Can
We Convince Them To Collaborate On This Critical
Health Issue?
Aim is to achieve DE - normalization of tobacco in the entire
community
5. Smoking cessation at public places cuts across
many sectors and requires their full participation
to be effective. Ministries, institutions of learning
and research, non-governmental organizations
and the civil society are the leading partners and
advocates for a comprehensive strategy in the
fight against the epidemic of smoking .
Agricultural sector and labor associated with it
Health sector
Workplace
Education sector
Media
FBR and ministry of finance
Political will
1. Commitment to the vision of total
human development.
2. Commitment to empowering the
poor and vulnerable with knowledge
and opportunity.
3. Pursuit of evidence and truth.
4. Commitment to fairness and equity
in the provision of adequate health
and social measures.
5. Trustworthiness and public
accountability
6. Agriculture
• It is not the only sector in Pakistan that resists major tobacco control initiatives.
• Pakistan is a tobacco growing country
• There are 75,000 tobacco growers producing tobacco all over Pakistan.
• Though tobacco is grown on around 0.25% of total irrigated land of Pakistan, the crop plays an important role in Pakistan’s
economy by generating income and employment in the tobacco farming, manufacturing, distribution and retailing.
The LABOUR SECTOR points out the prospect of millions of labour involved loosing their job due to major
tobacco control actions
A work force of 350,000 is directly and indirectly employed in the tobacco industry, which generate annual income of around
Rs.300 billion and a source of livelihood for 1.2 million people.
• Pakistan tobacco board instead of working for promoting tobacco growth and
its export would work for crop substitution.
• Shifting to nutritious, economies viable and environmentally sound
alternative crop would promise a bright future for Pakistan. Tobacco is not
good for any countries economy; in fact it makes poor country even poorer.
Income support should be provided to tobacco farmer until the process of
diversification is complete and sustainable.
Loans would be provided to them for starting some alternative earning opportunities
7. Taxation ( increasing the price of tobacco products)
• Price has likely been the single most effective policy intervention by those seeking to reduce tobacco-
caused death and disease.
• It is estimated that for every 10% increase in the price of tobacco products, consumption can
decline by 4 to 8%.
• The drop in consumption is more pronounced among young people and a large pop due to the
decline in their purchasing power.
• Recent survey shows that cigarette price in Pakistan are the cheapest in the region.in as survey c0nducted
When asked about the cost of 20 manufactured cigarettes, the response varied from PKR 48
to 210 (NON-COMMUNICABLE DISEASES RISK FACTORS SURVEY – PAKISTAN )
Tobacco taxes would be increased
• Special “Health Tax” on cigarette pack would be introduced.
• Money generated would be used for mass media campaign against the tobacco
• Revenue generation from tobacco should be linked to the health cost incurred
because of tobacco consumption. Any revenue generated is offset if it leads to
mounting health costs because of increased tobacco consumption..
8.
9.
10. • Tobacco smoke pollution (TSP) causes number of diseases
• Evidence-based advocacy needs to be carried out to attract funds and
commitment for tobacco cessation counseling and pharmacotherapy
• activities require substantial funding and resources, from the provision of
comprehensive smoking cessations services to action on illicit tobacco and
sustained public health social marketing campaigns.
PUBLIC HEALTH/ HEALTH SECTOR
Anti Tobacco advertisements must be shown on electronic and print media.
Educate the public on the dangers of tobacco use on various health days e.g. No Tobacco Day,
Stroke Day, Diabetes Day, Heart Day, Kidney Day, Hypertension Day and TB day. On these days
all electronic media are looking for “news” related to these public health issues.
Anti tobacco laws must be publicized through electronic and print media.
School curriculum should include tobacco as a subject and the Ministry of Education must be
involved in this process.
Religious scholars must be involved to propagate anti tobacco message at religious gatherings.
• All professional medical/nursing organizations must be engaged in anti tobacco
• There is a clear case that, in light of the substantial burden on society of smoking,
these activities should be funded by the tobacco industry. A special tax on tobacco be
imposed which will have the merit of securing funds for a comprehensive and
sustained health promotion program FOR anti-tobacco activities.
• Patients, who suffered from tobacco related illnesses can claim heath care cost recovery from
tobacco companies.
11. • HCPs are crucial in the success of tobacco cessation programes. They are the key players in providing counseling and drug
treatment to smokers and create among them the motivation to succeed in their quit attempt
• A consolidated body of resources to develop and disseminate knowledge concerning smoking cessation, and develop special
expertise concerning these issues, should be found in at least every health services region.
Medical school curriculum should include tobacco control and smoking cessation.
Special workshops must be arranged for GP’s pharmacists and other hcps for building their smoking cessations skills.
Health care providers in BHUs and THQs should be provided with simple tools enabling them to assist patients with smoking
cessation.
Pharmaceutical companies should be asked to provide quit smoking medicines at affordable price.
• integrating tobacco use screening into the clinics and health facilities
The most important health message a HCP can give to
patients is to quit smoking.
Even simple advice from health-care providers is known to increase
significantly abstinence among tobacco users than no advice at all.
12. • These organizations recognize that workplace health and
wellbeing is not just a ‘nice to have’, but that it makes
great business sense with organizations that promote
workers health
• For businesses, even if they have workplace tobacco-free
policies, helping employees to quit smoking can improve
the bottom line through:
Avoiding lost productivity and absences due to
sickness
Avoiding lost productivity due to people taking
smoking breaks
WORKPLACE
13. Among All stakeholders the most important intervention considered as education.
They diversified the way it should be delivered and emphasized that people in rural areas and
minority groups are illiterate and other approaches than the common one must be utilized
School/ UNIVERSITIES/ COLLEGES program are often one of the first approaches mentioned in
efforts to denormalize tobacco.
(a) have explicit tobacco control policies for educational institutions
(b) have appropriate teacher training regarding smoking cessation, its’ harms and impacts
(c) involve parents and families
(d) support cessation for teachers, staff and students
EDUCATION SECTOR
14. S
W O T
!
WHAT IS A ‘”SWOT?”
A SWOT analysis is a group activity commonly used to identify the Strengths, Weaknesses, Opportunities,
and Threats relative to your unit or organization.
A SWOT analysis helps us to focus on specific areas and determine how you can leverage strengths, address
weaknesses, maximize opportunities, and minimize threats.
What are your strengths ?
What do you do better than others?
What unique capabilities and
resources u possessed?
What do others perceived as your
strengths ?
What are your weaknesses?
What are your weaknesses?
What do others do better
than you ?
What can u improve given
the current situation?
What do others perceive as
your weakness?
What trends or
conditions may
positively affect you ?
What opportunities
are available to you ?
W trends or conditions may
negatively impact you ?
W are your competitors doing
that may impact you ?
What impacts does your
weaknesses have on the threats’
to you ?
Editor's Notes
To increase public awareness on the consequences of tobacco
use
There is strong scientific evidence that tobacco is injurious to health. Tobacco is known
to contain more than 4,000 chemical substances, out of which more than 50 are
carcinogens. Smoking is responsible for 90% of all lung cancer, 75% of chronic
bronchitis and emphysema and 25 % of ischaemic heart disease cases. It is harmful both
to the smoker and the non-smoker who is exposed to sidestream smoke. In Mauritius, it is
estimated that around 1000 deaths yearly are directly attributable to the use of tobacco.
The economic burden of tobacco use on families cannot be overlooked as money needed
for food, health, clothing, housing and other basic necessities of life is often spent on
tobacco products.
Information remains a key element in confronting the epidemic of tobacco use. It
encourages smokers to quit smoking and non-smokers not to take it up. It helps young
people to dissipate perceptions such as smoking makes them fashionable, manly and
attractive. It also helps people to understand the subtle strategies used by the tobacco
industry to influence their behaviour and project a positive public image. Information is
a powerful advocacy tool that serves to influence policies for stronger anti-tobacco
regulations.
. The key elements for tobacco control recommended by World Health Assembly, for comprehensive tobacco control programmes include measures from various sectors, such as,
health, finance & treasury, customs & excise, trade & commerce, consumer affairs, agriculture, external affairs & international trade, law & justice, labour, transport & public service, education, environment, defense, culture & sports, and religion (WHO Fact Sheet No. 159. Governments for a tobacco- Free World. May 1998).
. Tobacco farming is very profitable for the multinational companies, small farmer fall into a debt trap perpetuated by tobacco companies. WHO Framework Convention on Tobacco Control (FCTC) calls governments for financial and technical assistance to tobacco growers.
Regular increase in taxes and the price of tobacco products are considered to be one of
the most effective strategies in tobacco control.
Detailed studies have shown that in many countries price increases cause many smokers to quit and others to reduce their smoking Studies confirm the inverse relationship between taxation and consumption: when tobacco becomes more expensive, consumption goes down and vice versa.
reduce exposure to environmental tobacco smoke.
There is also ample evidence that there is no safe level of exposure to tobacco smoke.
Smoking PROHIBITION in indoor public places such as health and educational institutions, public
libraries, sport complexes, offices, public transport, pharmacies, lifts, museums, post offices, police stations and other places of work intended for use by the public.
However,
non-compliance is common in certain places and the Global Youth Tobacco Survey of
2003 indicates high exposure to tobacco smoke among school adolescents aged 13 to 15
years, both at home and in public places.
The promotion of smoke–free places not only protects nonsmokers
from environmental tobacco smoke but also denormalises smoking in public
places and makes it socially unacceptable.
In so doing, smoke-free environments provide
the additional benefits of encouraging smokers either to quit or reduce smoking.
Regulating smoking in public places is also a recognition of the right of individuals to
live in an environment free from tobacco smoke.
Should be considered as epidemic and be prioritized
Workplace quit programmes deliver a measurable return
on investment and can result in net cost savings within
four years.6
• Investments in quit programmes in the
workplace can generate immediate cost
benefits. A US study found by investing $0.18 to
$0.79 per member per month, an employer can
generate a cumulative savings of $1.70 to $2.20 per
member per month after five years.7
•.,.8
• Productivity gains from reducing the number of
unsanctioned smoking breaks and absenteeism
are substantial. Research by the UK Centre for
Tobacco Control Studies found that smokers are 33%
more likely to miss work than non-smokers and were
absent for an average of 2.7 extra days per year.9
• Businesses benefit from reputation-building, by
adding integrity and credibility to their brand, and
improving their capacity to attract and retain people.
`
The only way schools can reach all of the
above goals (especially with limited budgets) is a comprehensive
approach in which preventing initiation is a high public priority
and significant progress has been made on denormalising
tobacco use in the broader community. Supporting this, a recent
European study47 found that disciplining students for a smoking
infraction was only associated with lower prevalence when
teachers and parents were non-smokers and supportive of the
programme.
a required or allowed amount, especially an amount of money legally payable in damages.
"the court must determine the quantum of compensation due"
