The critical importance of healthcare  worker leadership in the tobacco          control movement                The Urugu...
Outlines Why and how HCP should involve on  tobacco control and treatment? A real world story: Uruguayan’s medical docto...
Why and How?               3
The tobacco epidemic     The leading preventable cause of death and diseases worldwide. The list of conditions      cause...
The tobacco epidemic A social problem. A environmental problem. An economic and development  problem.BUT MAINLY….      ...
…IS A HUGE GLOBAL  HEALTH PROBLEMWho should take care     about it ?                       6
Of course … Government and legislators . Society at large. But one group of professionals has a  special role to play: ...
We have the knowledge Implementing a comprehensive, continuous, sustainable and adequately  funded tobacco control strate...
PREAMBLE OF THE WHO FCTC   HIGHLIGHT HCP ROLE  “…Emphasizing the special contribution ofnongovernmental organizations and ...
Professional Societies Are CredibleThey Are Trusted and Valued, Because They: Are seen as trustworthy, objective and poli...
HOW TO GET IT DONE:            Advocacy To support, plead, defend a cause To express your views to:   Create a shift in ...
Health Professional´s Roles Role model Clinician Educator Scientist Leader Opinion-builder Watch out for tobacco in...
Barriers to health professional involvement in               tobacco control  1. Lack of knowledge and skills about     to...
Health Professional Societies           Do/Could/Should:                                Raise awareness of                ...
What We Really Need to Do Now Is:Plan and Act ! Make a clear, basic, action plan with relevant  stakeholders, including: ...
Level of InterventionIndividual level         Clinical Practice, research, trainer Local Level         SFE and provide tre...
A real world story:   Uruguayan medical doctorsengagement in tobacco control and          treatment .                     ...
The pioneers Dr Saralegui Padrón (60-70s). Prof. Dr. Helmut Kasdorf (80-90s) Prof. Dr. Milton Portos and Dr. Beatriz  G...
The influence of the International tobacco               control community• 1998: IAHF- Heart & Stroke Foundation Trainthe...
Was the tobacco epidemic a problem                    for Uruguay?        Uruguay : one of the highest tobacco consumptio...
Uruguay – MD engagement                Timeline              • Creation of a Tobacco Control Commission from the Medical U...
Article related to TobaccoControl at the NationalMedical Bulletin                             22
SMU Newspaper –May 2002                          23
2003                          Creation of the Uruguayan Smoke Free Network                          (RULTA): consolidate C...
National Journalist Contest - 2003                                     25
2004 -SMU challenged FNR Are you going to help smokers to quit? Jan 2, 2004: Smoking cessation program  for patients fro...
EL PAIS: Treaty against deadSep, 2003 El País                                   27
SMU looks for a quick approval of anti-           tobacco treaty                             A mistake…that               ...
2004-2005Congress approved FCTC RatificationSept 9- Uruguay ratified2000   2001   2002     2003   2004   2005    2006   20...
2005                                   • Dr. T. Vazquez took office as President                                   • MOH A...
Getting the ‘impossible’ just needs               more time…• Small business criticized theregulation: ‘It is unfair. Bett...
2005 -2006   A champion at the                      Uruguay became first Smoke Free Country in   Congress:                ...
The tobacco epidemic research           center •   Developing high quality research • Capacity building • Disseminating in...
2007              • Advocating for a Comprehensive TC law development at the              Congress.              • The imp...
BREATHES URUGUAY• Dr. Chan (WHO) visited and requestedtaking the interactive exhibition to COP 3 (South Africa)           ...
Respira is still a valuable educational resource from Uruguayan’s                       Government perspective            ...
Proactively and reactively SMU advocated at the Parliament for a       Comprehensive National Tobacco Control Law/ Nov 200...
2008       • March: A comprehensive national tobacco control law passed.       • CS wrote President Vázquez asking for hos...
WHO MPOWER- Feb 2008:Uruguay as a tobacco control leader                                      39
2009       • SMU elected as host of 2011 WMA General Assembly, asked for Tobacco       Control as topic for the Scientific...
Feb 2010:PMI vs URUGUAY     PMI : URUGUAY VIOLATES     INVESTMENT BILATERAL AGREEMENT     SWITZERLAND-URUGUAY   ICSID- Int...
A WELL PLANNED STRATEGY    • A new Government, open to dialogue.    • A recent painful international litigation with    Ar...
Civil Society Intelligence gathering…                          Civil Society                           denounced          ...
Minister of Health publicly announced the set                    back                         July 25, 2010   July 23 , 20...
SMU and Civil Society rejected set backin tobacco control policy              July 25-26 2010                             ...
MUJICA and VÁZQUEZ FACED BY TOBACCO           CONTROL POLICY                                      46
2010   • October- South American Congress of Cardiology: “ For a Smoke Free South   America”, in Montevideo. Congress with...
2011              • SMU convened creation of the National NCD Alliance.              • WMA General Assembly Scientific Ses...
Did it have any impact?                          49
Tobacco consumption prevalence     35%                                                                          Medical Do...
2011 MD tobacco consumption survey Attempts to quit last year: 61% Received help to quit: 33% Intention to quit: •   Na...
2011 MD tobacco consumption survey• SMOKING CESSATION TRAINING: 46,6%• ALWAYS OFFER PATIENTS ADVICE TO QUIT: 82%• INITIATE...
SFE impact on AMI admissions in               Uruguay                                                                     ...
Trade and Economic Impact Annual Tobacco Sales*                TOBACCO FISCAL REVENUES*                               350 ...
Uruguay´s Tobacco Control Policies:          A regional model.  SFE legislations: Most of S.A. and   C.A. countries passe...
Conclusions   Health professionals have a prominent role to play in tobacco control.   Have the trust of the population,...
THANKS !biancoeduardo1@gmail.com                           57
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The Critical Importance of Health Care Worker Leadership in the Tobacco Control Movement in Uruguay -- Eduardo Bianco, M.D.

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Presentation by Eduardo Bianco, M.D., Framework Convention Alliance, Uruguay, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

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The Critical Importance of Health Care Worker Leadership in the Tobacco Control Movement in Uruguay -- Eduardo Bianco, M.D.

  1. 1. The critical importance of healthcare worker leadership in the tobacco control movement The Uruguayan Case Dr Eduardo Bianco, MD. Centro de Investigación para la Epidemia del Tabaco- CIET The Tobacco Epidemic Research Centre Uruguay 1
  2. 2. Outlines Why and how HCP should involve on tobacco control and treatment? A real world story: Uruguayan’s medical doctor engagement on tobacco control and treatment. Did it work? 2
  3. 3. Why and How? 3
  4. 4. The tobacco epidemic The leading preventable cause of death and diseases worldwide. The list of conditions caused by tobacco consumption has grown. 1 Those who consume tobacco are not the only ones exposed to its negative effects. There is conclusive evidence linking passive smoking to an increased risk of many adult and children diseases . 2 Tobacco dependence itself is a chronic relapsing disease and frequently requires proper treatment 3 But… tobacco consumption continues to increase worldwide, expanding to less- developed countries The tobacco industry, the vector of the epidemic, has a huge potential market in developing countries:, weaker tobacco control measures and find a great number of possible new customers. 1.The Health Consequences of Smoking: A Report of the Surgeon General, 2004 2. DRAFT Health Effects Assessment for ETS. SRP Review. 2005 3. International Statistical Classification of Diseases and Related Health Problems, 10th revision,WHO, 2003. 4
  5. 5. The tobacco epidemic A social problem. A environmental problem. An economic and development problem.BUT MAINLY…. 5
  6. 6. …IS A HUGE GLOBAL HEALTH PROBLEMWho should take care about it ? 6
  7. 7. Of course … Government and legislators . Society at large. But one group of professionals has a special role to play: HEALTH CARE WORKERS 7
  8. 8. We have the knowledge Implementing a comprehensive, continuous, sustainable and adequately funded tobacco control strategy. Tobacco control efforts should be focused on several fronts: • preventing people from taking up tobacco consumption; • promoting cessation; • protecting non-smokers from the exposure to tobacco smoke; and • regulating tobacco products and preventing Tobacco Industry Interference. We have the tool: ACCELERATING FCTC IMPLEMENTATION. 8
  9. 9. PREAMBLE OF THE WHO FCTC HIGHLIGHT HCP ROLE “…Emphasizing the special contribution ofnongovernmental organizations and othermembers of civil society not affiliated with thetobacco industry, including health professionalbodies, women’s, youth, environmental andbodiesconsumer groups, and academic and health-careinstitutions, to tobacco control efforts nationallyand internationally and the vital importance oftheir participation in national and internationaltobacco control efforts…” 9
  10. 10. Professional Societies Are CredibleThey Are Trusted and Valued, Because They: Are seen as trustworthy, objective and politically neutral Are known and respected by policy makers Draw information and experience from scientific evidence Policy makers are interested to hear from them Are legitimate to speak on behalf of those they purport to represent or those affected by the issue 10
  11. 11. HOW TO GET IT DONE: Advocacy To support, plead, defend a cause To express your views to: Create a shift in the environment Mobilize resources Change public opinion, or Influence someone’s perception or understanding of an issue 11
  12. 12. Health Professional´s Roles Role model Clinician Educator Scientist Leader Opinion-builder Watch out for tobacco industry activities 12
  13. 13. Barriers to health professional involvement in tobacco control 1. Lack of knowledge and skills about tobacco and tobacco control. 2. Lack of organizational leadership. 3. Tobacco consumption among health professionals. 13
  14. 14. Health Professional Societies Do/Could/Should: Raise awareness of importance of TC/SC among HCPs Bridge research and policy Promote, develop and disseminate evidenceEmpower their Advocate for members policy change Develop and implement clinical guidelines Communicate clear messages Deliver training Be a platform to share evidence, information, concerns, good practices 14
  15. 15. What We Really Need to Do Now Is:Plan and Act ! Make a clear, basic, action plan with relevant stakeholders, including: People directly affected by the problem (smokers & their families) Decision makers Groups interested in solving the problem (tobacco control coalitions, other professional societies, etc) Identify few clear key messages to push forward Be aware of the policy making processes. To have influence, you need to: Know them Respect them Use them 15
  16. 16. Level of InterventionIndividual level Clinical Practice, research, trainer Local Level SFE and provide treatment at local health facilitiesNational Level Engaging National Medical Association, Scientific AssociationsRegional Level Engaging Regional Medical/Scientific Networks 16
  17. 17. A real world story: Uruguayan medical doctorsengagement in tobacco control and treatment . 17
  18. 18. The pioneers Dr Saralegui Padrón (60-70s). Prof. Dr. Helmut Kasdorf (80-90s) Prof. Dr. Milton Portos and Dr. Beatriz Goja created first Smoking Cessation Clinic at the Public School of Medicine in 1989. 1997, first Smoking Cessation Program at the pre-paid Health Care System (At the Spanish Association in Montevideo). 18
  19. 19. The influence of the International tobacco control community• 1998: IAHF- Heart & Stroke Foundation Trainthe Trainers workshop in Ottawa, Canada.•1999: European Congress Tobacco and Health,Las Palmas, GC, Spain.• 2000: 11th WCTOH in Chicago, US. WHO-FCTC negotiating process began. 19
  20. 20. Was the tobacco epidemic a problem for Uruguay?  Uruguay : one of the highest tobacco consumption prevalence in L.A. 1  5.000 people died yearly due to tobacco related diseases. 2  The highest lung cancer mortality in men in L.A. 3  The highest COPD prevalence in L.A. 4  Argentina and Uruguay with the highest ETS indoor air contamination levels. 5  Ineffective tobacco control dispositions.  No accurate data on the tobacco consumption prevalence.  Well organized tobacco industry lobby.1. Organización Panamericana de la Salud (OPS). El tabaquismo en América Latina, Estados Unidos y Canadá (Período 1990-1999).OPS, Junio 2000.2. Comisión Honoraria para la Salud Cardiovascular. Datos de Mortalidad por Tabaquismo en Uruguay, 2000-2002. Área de Epidemiología y Programación.• Mackay, J ; Jemal, A; Lee, N; Parkin, D. The Cancer Atlas (2006). American Cancer Society.• Dres. Adriana Muiño, María Victoria López Varela, Ana María Menezes. Prevalencia de la enfermedad pulmonar obstructiva crónica y sus principales factores de riesgo: proyecto PLATINO en Montevideo. Rev Med Uruguay 2005; 21: 37-48. http://wwwscielo.edu.uy/pdf/rmu/v21n1/v21n1a06.pdff5. Navas-Cien,A. JAMA. 2004;291:2741-2745 20
  21. 21. Uruguay – MD engagement Timeline • Creation of a Tobacco Control Commission from the Medical Union Association. • Engaging in WHO-FCTC: SMU sent submission. • Built a National Tobacco Control Alliance: Civil Society, MOH, PAHO WNTD celebrations: Sports and Tobacco Started to ‘dream’: Uruguay first smoke free country in LA Participating in Regional FCTC related events.2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011• First National TC Forum• Medical Survey on Tobaccoconsumption:27%• MD educational process.• Identify journalists.• Identify a champion at theMOH. 21
  22. 22. Article related to TobaccoControl at the NationalMedical Bulletin 22
  23. 23. SMU Newspaper –May 2002 23
  24. 24. 2003 Creation of the Uruguayan Smoke Free Network (RULTA): consolidate CS movement. FCTC gets to the Parliament for discussion.2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 • The battle for FCTC ratification. • A tobacco control lobbyist at the Parliament. • Mobilizing medical doctor at the Parliament and Political Parties. Dr. Tabaré Vázquez. • Using the power of the media 24
  25. 25. National Journalist Contest - 2003 25
  26. 26. 2004 -SMU challenged FNR Are you going to help smokers to quit? Jan 2, 2004: Smoking cessation program for patients from FNR. Feb: Media awareness campaign. March: they doubted… April: SC program opened to the general public . Sept: 9 weekly SC groups (word of mouth spreading). July: sent letter to the Parliament asking for FCTC ratification. 26
  27. 27. EL PAIS: Treaty against deadSep, 2003 El País 27
  28. 28. SMU looks for a quick approval of anti- tobacco treaty A mistake…that helped a lot! Jun 9, 2004 28
  29. 29. 2004-2005Congress approved FCTC RatificationSept 9- Uruguay ratified2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 FNR: Training and offering medication for free. More than 100 SC programmes around the country. In 2010, almost 20.000 treated 29
  30. 30. 2005 • Dr. T. Vazquez took office as President • MOH Advisory Commission advice Minister of Health on FCTC Implementation and request Dr Vazquez as speaker on WNTD 2005.2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 • Jan: Creation of the MOH TC • President Vazquez Launched first Decrees to advisory Commission implement FCTC at national level. • Other advisors suggest not applying the smoking ban to all of locations and facilities. 30
  31. 31. Getting the ‘impossible’ just needs more time…• Small business criticized theregulation: ‘It is unfair. Better yougo directly to a total ban’•Shopping mall surveys: less than4% of customers against a totalsmoking ban.•A Parliamentarian TobaccoControl Workshop in B. Aires(August 18, 2005).• First, international speakersparticipated in a Workshop at theCongress and, then visit Vazquezat the Presidency (August 17).• Sept 5, Pte Vazquez launched anew decree on SFE. 31
  32. 32. 2005 -2006 A champion at the Uruguay became first Smoke Free Country in Congress: Americas Region Dr. Miguel Asqueta2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011• At same time Dr Bacheletwas President of Chile…it is Creation of The Tobacco Epidemicnot yet a Smoke Free Country Research Centre – CIET Uruguay 32
  33. 33. The tobacco epidemic research center • Developing high quality research • Capacity building • Disseminating information. • Advocacy • Multidisciplinary : physicians, lawyers, psychologist, economists, journalists, dentists, sociologists, academics, stakeholders, etc. 33
  34. 34. 2007 • Advocating for a Comprehensive TC law development at the Congress. • The importance of the a MD to champion at the Congress • New evaluation of Tobacco consumption in MD: 17% • 2nd MD and Tobacco Workshop2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 • CIET/SMU and others launched RESPIRA Uruguay (Breathes Uruguay)-.Youth Exhibition. 34
  35. 35. BREATHES URUGUAY• Dr. Chan (WHO) visited and requestedtaking the interactive exhibition to COP 3 (South Africa) 35
  36. 36. Respira is still a valuable educational resource from Uruguayan’s Government perspective Governmental Educational Webpage. Feb 9, 2012 Recently a Scotish delegation visit Respira to reproduce the exhibition there 36
  37. 37. Proactively and reactively SMU advocated at the Parliament for a Comprehensive National Tobacco Control Law/ Nov 2007 1. The Tobacco Industry representative MainTobacco lobbyst 2. Advertising Associations 3. National Medical AssociationSMU 37
  38. 38. 2008 • March: A comprehensive national tobacco control law passed. • CS wrote President Vázquez asking for hosting COP 4 (as a protective measure) • Respira Uruguay in COP 3 in South Africa2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 38
  39. 39. WHO MPOWER- Feb 2008:Uruguay as a tobacco control leader 39
  40. 40. 2009 • SMU elected as host of 2011 WMA General Assembly, asked for Tobacco Control as topic for the Scientific Session. • Tobacco Control Commission asked to organize the event and request to the Executive Committee to develop actions to set MD tobacco consumption below 10%. • Creation of the Uruguayan Society of Tabaccology2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 • Development of the National Guidelines for Smoking Cessation and Treatment. • Uruguayan Cardiology Society and its commitment to tobacco control influenced South American Cardiology Society to set Tobacco Control as priority topic in 2010 Regional Congress. • Creation of Alerta Tabaco (Tobacco Alert network). 40
  41. 41. Feb 2010:PMI vs URUGUAY PMI : URUGUAY VIOLATES INVESTMENT BILATERAL AGREEMENT SWITZERLAND-URUGUAY ICSID- International Centre for Settlement of Investments Disputes. 1. The prohibition of using different presentations of a brand. 2. Health warnings that cover 80% of the packaging. 3. Images do not fit reality.**PMI has quit this claim 41
  42. 42. A WELL PLANNED STRATEGY • A new Government, open to dialogue. • A recent painful international litigation with Argentina . • They offered a “reasonable” solution . INGRAVESCENT• New Government felt alone. 42
  43. 43. Civil Society Intelligence gathering… Civil Society denounced Government was negotiating with PM and there would be a set back July 7, 2010 43
  44. 44. Minister of Health publicly announced the set back July 25, 2010 July 23 , 2010 44
  45. 45. SMU and Civil Society rejected set backin tobacco control policy July 25-26 2010 45
  46. 46. MUJICA and VÁZQUEZ FACED BY TOBACCO CONTROL POLICY 46
  47. 47. 2010 • October- South American Congress of Cardiology: “ For a Smoke Free South America”, in Montevideo. Congress with a Plenary on Tobacco Control and Treatment. • November- COP 4 in Punta del Este, Uruguay. SMU as representative of WMA.2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 • Anecdote: President of the Uruguayan Cardiology Society , the evaluation of the smoking ban impact on the AMI admissions , and the 2010 Cardiology Congress in Venezuela. 47
  48. 48. 2011 • SMU convened creation of the National NCD Alliance. • WMA General Assembly Scientific Sesion: Tobacco Control. • MD tobacco consumptiom prevalence survey2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 48
  49. 49. Did it have any impact? 49
  50. 50. Tobacco consumption prevalence 35% Medical Doctors 27% 1 30% Adults 25% 20% 17% 1 Youth 15% 10% 2 5% 9.8% 0% 1998 2001 2006 2009 1. Encuestas Junta Nacional de Drogas 1. SMU, Sindicato Médico del Uruguay2. ENPTA 2008-CIET y GATS 2009 2. CIET; SMU; FEMI, Federation of Medical Doctors of Inland Cities 50
  51. 51. 2011 MD tobacco consumption survey Attempts to quit last year: 61% Received help to quit: 33% Intention to quit: • National Tobacco Control Policy support: 78,8% strongly agree, 18,3% agree 51
  52. 52. 2011 MD tobacco consumption survey• SMOKING CESSATION TRAINING: 46,6%• ALWAYS OFFER PATIENTS ADVICE TO QUIT: 82%• INITIATE TREATMENT • SENT PATIENTS TO SPECIALIZED SMOKING CESSATION PROGRAMMES 52
  53. 53. SFE impact on AMI admissions in Uruguay 22%Hospital admissions for acute myocardial infarction before and after implementation of a comprehensivesmoke-free policy in Uruguay. E. Sebrie´, E.Sandoya, A. Hyland, E. Bianco, S. A Glantz, K M Cummings,Tobacco Control (addmited, to be published in short). 53
  54. 54. Trade and Economic Impact Annual Tobacco Sales* TOBACCO FISCAL REVENUES* 350 300 250 200 150 100 50 0 2004 2005 2006 2007 2008 2009 2010 2011* Data from Fiscal Authority US$ million dollar 54
  55. 55. Uruguay´s Tobacco Control Policies: A regional model.  SFE legislations: Most of S.A. and C.A. countries passed SFE laws. 6 are already implementing that.  Regional Cooperation.  “Pilot Case”: First evaluations showed that FCTC implementation works… even in a Latin American country. 55
  56. 56. Conclusions Health professionals have a prominent role to play in tobacco control. Have the trust of the population, the media and opinion leaders, and our voices are heard across a vast range of social, economic and political arenas. At the individual level, we can educate our patients on the harms of tobacco use and exposure to second-hand smoke and help tobacco users overcome their addiction. At the community level, we can be initiators or supporters of some of the main tobacco control policy measures, for example, promoting smoke-free workplaces and extending the availability of tobacco cessation resources. At the society level, we can add our voice and experience to national and global tobacco control efforts . Health professional organizations can show leadership and become a role model for other professional organizations and society by embracing the tenants of the Health Professional Code of Practice on Tobacco Control. 56
  57. 57. THANKS !biancoeduardo1@gmail.com 57

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