Doctors and Tobacco: Medicine's Big Challenge
Executive summary - the main recommendations for action
Chapter 1 Introduction
Tobacco is the single largest cause of preventable illness and
death. National Medical Associations (NMAs) and their members have
a crucial part to play in tobacco control. Doctors and Tobacco:
Medicine's Big Challenge is an action manual for both NMAs and for
individual doctors. Although commissioned by the TCRC especially
for doctors in Europe, the guide will also be relevant to doctors
elsewhere, as well as to other health professionals and advocates.
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Chapter 2 The risks from tobacco
World-wide, tobacco kills 4 million people every year. By 2020,
the annual toll will rise to 10 million. In 1995, tobacco caused
1.2 million deaths in the European region alone; by 2020, the toll
will reach 2 million. Smoking is a major cause of cancers, cardiovascular
disease, lung disease, and reproductive health problems. Passive
smoking causes lung cancer, chronic respiratory disease, heart disease
and stroke in adults, as well as asthma, lower respiratory tract
illnesses, reduced lung growth and function, and middle-ear infections
in children. Smokeless tobacco causes head and neck cancer. At any
age, giving up tobacco improves health and increases life expectancy.
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Chapter 3 Women and young people
In many European countries, smoking among women and young people
is on the increase. Both groups are important new markets for the
tobacco industry and are targeted through advertising and promotion.
Most smokers begin smoking as children. NMAs should work with organisation
and media relevant to young people and women, and consider both
groups when planning tobacco control activities, and ensure that
women are represented on any tobacco advisory group.
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Chapter 4 Tobacco and inequalities
Patterns of tobacco use often vary between population groups. Groups
that are especially vulnerable include lower socio-economic groups
and certain ethnic minorities, including immigrant populations.
NMAs should include such groups in formulating tobacco control activities
and communication strategies.
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Chapter 5 The potential of doctors
Doctors have enormous potential in reducing illness and death from
tobacco. They have high credibility when speaking on matters of
health, the responsibility and opportunity to advise patients, and
access to decision-makers. Doctors recognise the need for collaboration
and partnership with other health professionals and groups when
tackling tobacco.
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Chapter 6 Smoking cessation
Many smokers want to stop smoking, but find it difficult to succeed.
Brief advice from a doctor increases the chance that a smoker will
succeed in stopping. Doctors should ask whether patients smoke,
advise of the dangers, offer assistance and support, and arrange
follow up. A protocol for a brief intervention is outlined. Nicotine
replacement therapy roughly doubles the chance of quitting and should
be offered where appropriate. Other health professionals also have
an important role to play. NMAs should educate doctors regarding
the importance of cessation and their responsibility to assist patients.
Representatives from groups of other health workers should be included.
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Chapter 7 Tobacco control: action for doctors at the local level
Local NMA groups and individual doctors can act to combat tobacco
by working with local communities, media, politicians and decision-makers.
Doctors in professional advisory roles - occupational, environmental
and public health, local government, labour unions and the media
- have additional opportunities for action, as do those involved
in research and research funding bodies. NMAs can provide support
for local and individual actions in tobacco control.
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Chapter 8 Education and training
Much can be achieved without training. However, training can raise
awareness and build commitment. Training in smoking cessation may
build doctors' confidence, but has not been shown to significantly
improve outcomes. Medical schools must take an integrated approach
to educate students about tobacco - an action checklist is provided.
Continuing medical education and professional development also provide
opportunities to learn about tobacco control. NMA representatives
should be trained in media skills and in countering tobacco company
arguments and tactics.
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Chapter 9 Increasing doctors' awareness: action for medical associations
NMAs have a duty to raise awareness of tobacco among
their members. An action guide is provided. NMAs should
recognise that tobacco control is an important part
of their work, and establish a tobacco group with
commitment at the highest level. Doctors' own smoking
habits influence their attitudes towards tobacco and
the advice they give to patients. NMAs should carry
out regular surveys of tobacco use among their members
and disseminate the results. NMAs can educate their
members about tobacco through courses, meetings, NMA
publications and the medical press. Doctors who smoke
should be offered support to stop. Members should
be encouraged to advise patients on smoking cessation.
NMAs should ban smoking in their buildings and meetings
and review their investment portfolios.
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Chapter 10 Tobacco control: action for medical associations
NMAs have an important role in campaigning for tobacco control.
The NMA tobacco group should formulate a national action programme.
Collaboration with other health and professional bodies is essential.
NMAs should establish relationships with the media and politicians.
NMAs should campaign for smoke-free health facilities and for effective
tobacco education in medical schools. NMAs may wish to campaign
for or prepare a baseline report on the national tobacco problem
and monitor the situation regularly. Evaluation of the success of
tobacco control measures is essential.
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Chapter 11 Tobacco control policy
NMAs should campaign for comprehensive tobacco control legislation
that is monitored and enforced. Key elements include: bans on tobacco
promotion; increased prices through taxation; public education;
health warnings; smoke-free public places; bans on sales to children;
product regulation; and support for smoking cessation.
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Chapter 12 Doctors and tobacco litigation
Tobacco is a dangerous product that is largely unregulated. Health
care providers and smokers have taken legal action against tobacco
companies to recover costs and damages inflicted by tobacco. Doctors
have a role in litigation as expert witnesses and as personal physicians.
NMAs can foster litigation and explain its importance. Legal action
has also been taken against employers by employees exposed to smoke
in the workplace. In future, patients who feel they have been inadequately
advised or helped to give up smoking may take legal action against
their doctors.
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