Tobacco Free Initiative

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Let us imagine that the sum of all human experience in the 20th Century is fully grasped by a single human being who has also been gifted with tact, wisdom and intelligence, in addition to great insight in health and medical sciences. If we were to ask this seasoned sage to define the worst health problem of all, what answer do we think he would give?

Needless to say, we have to provide our sage with some terms of reference in order to help him come up with right answer. Thus, the problem he chooses should be possible to describe as follows:

• Something has spread far and wide, and remains extremely complex, full of paradoxes and

very difficult to wrestle with. -

• Something that affects all people, regardless of their social status, intellectual affiliations and ethnic origins.

• Something that affects all age groups, bringing its harmful effects to unborn children, infants, youths, adults and elderly of both sexes.

• Something that penetrates into all societies, primitive and sophisticated, rural and urban, open and closed.

• Something that has a considerable bearing on different aspects of social life: health, economy, politics, morals, religious, environment, etc.

• Something with harmful effects that are both complex and cumulative, so as to destroy health completely.

Would any one doubt that our sage would have only one answer to give, stating unhesitatingly that the health problem in question is SMOKING.

If we combine this with the prevailing attitudes in the medical sector to the tobacco problem, we can imagine that there will come a time when the media will include in the column devoted to most amazing fact an item on these lines:

A large number of doctors and other health professionals were still in the habit of smoking tobacco in the last decade of the 20th Century. Indeed, some of them used to smoke in front of their patients.

Many people would certainly be incredulous

CONTRADICTIONS GALORE

Although people in the 21st century may not believe that a significant percentage of our present-day doctors smoked, the smoking problem is certainly over-full with contradictions:

• Knowledge: A loud outcry is heard in every community stressing the undoubted fact that smoking is a killer and it has reached pandemic proportions. Television and all media organize interviews, panel discussions, etc. explaining the harmful effects of smoking and passive smoking ... Shortly afterwards, fine commercials are shown on television promoting tobacco.

• Laws and Regulations: Government authorities enact laws to ban or severely restrict tobacco advertising ... The same authorities, however, turn a blind eye to the numerous ways in which the tobacco industry try to circumvent this ban and promote its harmful product.

• Political and Social Orientation: Medical colleges include in their curricula the long list of health hazards caused by tobacco consumption, while nursing schools often ignore the subject

… At the same time, agriculture colleges and institutes study the best methods to increase the tobacco harvest wherever it is planted.

• Child and Adolescent Care: Childhood diseases continue to kill more than 2 million children every year because they have not been vaccinated, despite the fact that suitable vaccines are available and cost only a few dollars per child.... In contrast, the tobacco industry spends more than 4 thousand million dollars a year on advertising.

• Community Health: The World Health Organization and UNICEF estimate the additional costs needed to better combat childhood diseases and reduce malnutrition and child mortality by half at 4 thousand million dollars a year. The provision of safe drinking water and sanitation as well as proper family care and family planning services to all requires additional resources estimated at 25 thousand million dollars a year... In contrast, Europe alone spends double this amount (i.e. 50 thousand million dollars) every year on tobacco consumption.

Nevertheless, the greatest paradox of all is the fact that medical doctors and health professionals continue to smoke. In this, they are just like the chief of traffic control who drives in the wrong direction in a street which he himself has designated as a one-way street. After all, those professionals are in fact the group best aware of the harmful effects of tobacco smoking. They remain in closest contact with its victims and are the first to receive the latest information on the findings of scientific research in tobacco addiction. Indeed, their knowledge of the tobacco problem is both first-hand and profound. Who can better appreciate the agony caused by lung cancer, or the debility and failures associated with cardiovascular diseases, than doctors, nurses and other health professionals? Hence, they are always counselling patients and their relatives to quit smoking, and telling young people never to smoke.

Recent studies have shown that the prevalence of tobacco smoking among health professionals in the Eastern Mediterranean Region continues to be at a high level, compared with the US and European countries. Nevertheless, the overwhelming majority of health professionals, including many of those who smoke, view smoking with a genuine dislike. Their attitude, however, remains negative. They shy away from taking the logical positive step that translates knowledge into practice so as to play a leading role in the efforts that aim to free our world from the tobacco pandemic.

A recent study conducted in an Arab country has revealed that more than half the doctors working in health centres smoke. It is ironic that the percentage is higher among those holding the highest positions in these centres. Studies have also shown that smoking prevalence among doctors reaches 64% in Kuwait, 60% in Bahrain, 56% in Sudan, 54% in Tunisia, 29% in the Islamic Republic of Iran and 35% in Iraq.

This paradoxical phenomenon includes employees in ministries of health, faculties of medicine, nursing schools and health sciences intitutes. Indeed, some of these institutions include in their budget an item for the purchase of ashtrays, whereas they should allocate funds for activities which aim to help smokers quit the habit.

Perhaps the first step in remedying this situation is for ministries of health, medical and nursing schools, private and general hospitals and clinics as well as pharmacies to bring their practices in line with their knowledge and enforce a total ban on smoking in their premises. (There are adequate examples from different parts of the world on how this has been achieved).

In many cases this does not require more than a deligeant enforcement of laws and regulations already in place. In Bahrain, for example, a ministerial regulation has banned smoking in all hospitals and health centres, while in Qatar smokers are no longer welcome as employees in the Ministry of Health. In both Cyprus and the Islamic Republic of Iran, there are laws restricting smoking in hospitals and all public places.

A recent study in an Arab country has shown that the prevalence of smoking among final-year students in the Faculty of Medicine is double the percentage among first-year students. This is further evidence of the dichotomy between knowledge and behaviour. The World Health Organization, particularly its Eastern Mediterranean Regional Office, gives high priority to promoting healthy life styles, but the health educational institutions are not doing enough to bring behaviour in line with knowledge.

Hence, medical students may be able to pass examinations with distinction and are well-qualified after graduation to prescribe appropriate treatment, but their leading role in setting a social example receives very little attention. This sad situation also Setting a good example applies to health sciences institutes and nursing schools. Hence, a thorough revision of the curricula, teaching methods, conditions of admission and requirements for graduation is urgently needed in order to introduce the necessary amendments that enable graduates to set an ethical and practical example for the rest of society. In practical terms, this means that smoking and all other forms of tobacco consumption should be, for health professionals, emphasized as being contrary to the ethics of their professions.

When we combine this with a total ban in all establishments that provide health care we can make a reality of the Slogan of this year’s World No-Tobacco Day, which is: "Health Services:

Our Window to a Tobacco-Free World".

Bearing all this in mind, I cannot resist the thought that new language should be added to the Hippocratic Oath in the following terms: "I shall never smoke or consume tobacco; and shall never allow smoking in front of patients. I shall do my best to combat all forms of tobacco consumption, wherever I work".