More work needed to help smokers quit, reports WHO

Many more tobacco users want to quit, but less than a third of them have access to smoking cessation help, reports a new study. The seventh WHO report on tobacco use worldwide points out that while 1.1 billion adults currently smoke, many countries still lack effective quitting programs.

Tobacco kills more than 7 million people each year. Thanks to WHO and partners, tobacco control measures, such as graphic warnings on cigarette packs, advertising bans and smoke-free laws, protect two-thirds of the world’s population. WHO/S. Volkov
Tobacco kills more than 7 million people each year. Thanks to WHO and partners, tobacco control measures, such as graphic warnings on cigarette packs, advertising bans and smoke-free laws, protect two-thirds of the world’s population. WHO/S. Volkov

Smoking cessation saves lives, enhances health, and saves money. Smoking is a risk factor for several non-communicable epidemics today, namely, heart disease, stroke, chronic lung disease and cancer. Quitting tobacco can extend life expectancy by up to 10 years, while improving productivity and the quality of life by reducing the risk of these chronic and debilitating diseases. It also makes excellent economic sense, saving $422 billion on healthcare-related spending, and more than $1,000 billion additionally due to loss of productivity and smoking-related deaths. 40% of this cost affects low- and middle-income countries (LMICs).

Current global policies aim at a 30% reduction in tobacco use. The benchmark is the WHO Framework Convention on Tobacco Control (WHO FCTC) describing tried and tested measures to reduce tobacco demand, tobacco-related disease and deaths. The MPOWER report of 2017 focused on a six-step strategy that meshes with the WHO FCTC, namely:

  • Monitor tobacco use and prevention
  • Protect people from tobacco smoke
  • Offer help to quit tobacco
  • Warn about the dangers of tobacco
  • Enforce bans on tobacco advertising
  • Raise taxes on tobacco

Turkey and Brazil are now the first and second countries to completely and fully execute all the six MPOWER measures.

There are multiple cessation interventions, including behavioral therapies, which are inexpensive but effective; pharmacological therapy; and health education materials. It is important to understand that tobacco cessation programs are comparable to breast cancer screening in terms of the benefits they confer as against their costs. This calls for higher political and financial commitment to tobacco cessation efforts, such as including them in national universal health coverage policies; building viable and sustainable funding sources for quitting programs; partnering with other private organizations to achieve the goal; stressing interventions at population level first to maximize coverage; providing diverse sources of information about the risks of smoking; and proper monitoring of all programs.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, comments: “Quitting tobacco is one of the best things any person can do for their own health. The MPOWER package gives governments the practical tools to help people kick the habit, adding years to their life and life to their years.”

The focus is on integrating tobacco cessation interventions into existing healthcare programs at all levels, to reduce the costs of expansion while covering many more potential users. Other aspects include countering misinformation about alleged “cessation aids” like e-cigarettes by the tobacco industry, which could interfere with efforts to quit smoking.

The current report looks at how quitting programs are functioning in member countries. Each of these steps has been executed at the highest level in one or more new countries in the period between the current report and its immediate predecessor, including 17 (out of 34) low-income countries. However, 59 countries failed to implement even one at the best-practice level, of which 49 were LMICs.

Comprehensive programs to help tobacco users quit it are available in 23 of the 171 participating countries. In absolute terms, this means about 2.4 billion people can now take advantage of smoking cessation programs to quit, compared to only 0.4 billion in 2007. These include toll-free lines nationally, mobile phone-mediated “mCessation” facilities, counseling by primary health care providers and free nicotine substitutes. This also means this is the second-largest coverage achieved by an MPOWER step, due primarily to its adoption by India and Brazil.

Today, smoking has been banned, or graphic warnings published on tobacco product packaging, as well as other measures to limit tobacco use, in several countries covering 5 billion of the world’s people, four times higher than just 10 years ago. However, more remains to be done.

On the bright side, at least one of the MPOWER steps was added at the highest level in 36 countries, covering 5 billion people or 65% of the world’s population, up from only 15% in 2007. Of these, the graphic warnings on tobacco packaging has been applied to cover almost 4 billion people, or more than half the world’s people.

10 new countries introduced tobacco taxes amounting to 75% or more of retail prices, covering 14% of the user population vs 8% previously. Though coverage is low, the impact is high.

10 new countries put in place broad bans covering tobacco advertising, promotion and sponsorship (TAPS), taking the number to 48, while 103 had partial TAPS bans. Meanwhile, 62 countries banned public smoking, covering 1.6 billion people, while another 70 have partial bans.

This is the third step in the MPOWER program, but, the report points out, the most poorly implemented. Four countries adopted best-practice tobacco quitting programs, but six dropped lower from highest-level criteria. However, the report also showed that there is a great felt need for these services. The report points out, “Cessation support can more than double the chance of successfully quitting.”

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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