Smoking as a Risk Factor for Chronic Airways Disease

Abstract

7.1: There is overwhelming evidence that tobacco smoking is the predominant causative factor in COPD (sections 1-3) though other factors (reviewed elsewhere), play some part. Their interaction with smoking needs further elucidation.

7.2: Smoking by parents clearly predisposes to ARI in infants (1.3) and so indirectly may predispose to adult COPD. The effects of passive smoking on older children and adults is less well defined and needs further research. But the established contribution of passive smoking in the causation of lung cancer in nonsmokers is having an important influence on public opinion in many countries. This encourages the spread of smoke-free public places and transport and so tends to make nonsmoking the norm for social behavior.

7.3: Though the marked decrease of tobacco consumption in some industrialized countries indicates that the smoking pandemic can be successfully fought, the marketing activities of the multinational tobacco companies in developing countries are resulting in frighteningly rapid escalation with grim portents for the future. WHO and international NGOs must therefore combine to stimulate such countries to effective action (section 5). WHO must work through governments, international NGOs to stimulate national NGOs and professionals to intensive campaigning for comprehensive national action.

7.4: To be successful a national campaign must be continuous and comprehensive ("The Remedial Cocktail", 4.3). A national coordinating committee is desirable. Components of the campaign should include regular increases in tax (particularly effective on teenagers and the less well educated); extensive and continuous health education and cooperation with the media; health warnings on cigarette packets and tobacco promotional material (where still permitted); gradual reduction of tar content, etc, in cigarettes; ban on sales of new tobacco products; ban on all forms of advertising and promotion; steady extension of smoke-free environments in public places, workplaces, and transport; legal ban on sales to children; and lessening availability through a ban on vending machines and the licensing of outlets. These measures have to be adapted to the particular country and their effectiveness refined by ongoing operational research.

7.5: WHO and international NGOs (including IUATLD) can facilitate implementation of the above by coordinated and complementary action. This includes cooperating in WHO Regional Action Plans (5.3), as in Europe, with WHO influencing governments, international NGOs influencing national professionals and national NGOs. Appropriate literature (4.5.2), some of which is already available, must be provided, as well as help with Regional or national working groups and seminars (see details in Section 5 above).

7.6: IUATLD (section 6) is including the problem in all its global and regional conferences and has produced recent literature for its 5,000 members in 113 countries. It is also stimulating professional interest through its current global survey of medical students' habits, knowledge, and attitudes in 40 countries, and is contemplating extending this as a global survey of nurses.

7.7: Professionals and international bodies must recognize that the major enemy of the public health in this field is the multinational tobacco industry, with its immense resources, its unscrupulous promotion and its capacity to influence politicians and others. Professionals must evolve new campaigning skills to counter this evil. Much of the international support in developing such skills must come from the international NGOs.