Conversation with Dr. Prakit Vathesatogkit in Conjunction with 2016 Asia Pacific Lung Cancer Conference (APLCC)
Conversation with Dr. Prakit Vathesatogkit in Conjunction with2016 Asia Pacific Lung Cancer Conference (APLCC)
Tobacco control must be a priority for health professionals
What does WHO FCTC Say on the Role of Health Professionals in Tobacco Control?
The WHO FCTC Protocol approach is a dynamic model of global standard-setting. The term “framework convention” is used to describe a variety of legal agreements that establish broad commitments and a general system of governance for a particular issue. With the WHO FCTC in place, national public-health policies, tailored around national needs, can be advanced without the risk of being undone by transnational phenomena (e.g. smuggling as well as cross-border advertising, promotion, and sponsorship).
The Preamble of the WHO FCTC Specifically Mentions the Role of Health Professionals in Tobacco Control. Article 12 on “Education, communication, training, and public awareness” and Article 14 on “Demand reduction measures concerning tobacco dependence and cessation” are also of particular interest for health professionals.
PREAMBLE OF THE WHO FCTC
“...Emphasizing the special contribution of nongovernmental organizations and other members of civil society not affiliated with the tobacco industry, including health professional bodies, women’s, youth, environmental and consumer groups, and academic and health-care institutions, to tobacco control efforts nationally and internationally and the vital importance of their participation in national and international tobacco control efforts...”
Prevention is Key
“As lung cancer treatment outcomes are difficult and five-year survival is historically low, preventing lung cancer is a top public health priority. Up to 90 percent of lung cancer cases stem from tobacco use. Therefore, effective implementation of evidence-based and comprehensive tobacco control policies will make a huge difference in slashing new cases of lung cancer as well as preventing a large number of other diseases, disabilities, and premature deaths attributed to tobacco use,” said Dr. Prakit Vathesatogkit, Executive Secretary of Action on Smoking and Health Foundation of Thailand.
“More than 100,000 deaths occur each year because of lung cancer in the Association of Southeast Asian Nations (ASEAN). Additionally, new cases of lung cancer and overall mortality rates are rising each year in ASEAN. That is why tobacco control attains a never-before urgency,” Dr. Vathesatogkit added. “Out of the 50,710 tobacco-related deaths occurring in Thailand every year, 11,740 or 23 percent were because of lung cancer. In the ASEAN region, it is estimated that out of the total 467,194 smoking-related deaths every year, 107,454 were due to lung cancer. Tobacco-related lung cancer deaths will keep growing in catastrophic proportions due to the 121 million smokers in the ASEAN region if we fail to act now. Also, it is important to underline that tobacco-related lung cancer rates might shoot up because of the combined effect of the tobacco industry’s aggressive marketing, weak political will on tobacco control, and other key factors. Therefore while making progress in the treatment of lung cancer is very welcome, more contribution from healthcare workers in tobacco control is direly needed.”
Dr. Vathesatogkit Walks the Talk
Dr. Vathesatogkit is an example of how health professionals can contribute to tobacco control. In his 40 years as a lung disease specialist, he spent the first 10 years in clinical management of lung diseases, of which smoking was the major and most common cause. He was left aghast not only with how late diagnosis of lung cancer cases were typically being diagnosed, but with the abysmally low cure rates for lung cancer cases. Also, available treatments were available to only a few of his patients. He joined the nascent tobacco control movement 30 years ago and learned by doing. He has contributed to tobacco control-related policy and engaged with the legislative processes in Thailand. His leadership in strengthening the Global Tobacco Treaty (formally called the WHO Framework Convention on Tobacco Control or WHO FCTC) is well known.
Health Care Workers Can Bolster Tobacco Control
According to Dr. Vathesatogkit, health professionals, including lung cancer experts, have a prominent role to play in tobacco control. They have the trust of the population, the media, and opinion leaders, and their voices are heard across a vast range of social, economic, and political arenas.
|ASEAN and WHO FCTC Ratification Status|
|Country||Date of WHO FCTC ratification|
|Brunei Darussalam||3 June 2004|
|Cambodia||15 November 2005|
|Indonesia||Not ratified yet|
|Lao PDR||6 September 2006|
|Malaysia||16 September 2005|
|Myanmar||21 April 2004|
|Philippines||6 June 2005|
|Singapore||14 May 2004|
|Thailand||8 November 2004|
|Vietnam||17 December 2004|
“At the individual level, they can educate the population on the harms of tobacco use and exposure to second-hand smoke. They can also help tobacco users overcome their addiction. At the community level, health professionals can be initiators or supporters of some of the policy measures described above, by engaging, for example, in efforts to promote smoke-free workplaces and extending the availability of tobacco cessation resources. At the society level, health professionals can add their voice and their weight to national and global tobacco control efforts like tax increase campaigns, and become involved at the national level in promoting the WHO FCTC. In addition, 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,” Dr. Vathesatogkit said.
Physicians, nurses, dentists, pharmacists, and all health professionals in everyday health care settings need to address tobacco dependence as part of their standard of care practice.
The Treating Tobacco Use and Dependence - Clinical Practice Guidelines, issued by the U.S. Department of Health and Human Services recommends the 5As approach:
Status of Tobacco Control Law in ASEAN Nations
Brunei Darussalam: Tobacco Order 2005 and Tobacco Regulations 2007
Cambodia: National Tobacco Control Law already drafted
Indonesia: Under National Health Law Nr. 36/2009 regarding Health [Chapter VI: Health Efforts; part 17: Security Addictive Substance article 114, article 115 paragraph (1), article 115 paragraph (2), article 116]
Lao PDR: Law on Tobacco Control, 2009
Malaysia: Control of Tobacco Products Regulation 2004 and Control of Tobacco Product (Amendment) Regulations 2008; 2009; 2010 and 2011 under the Food Act 1983, National Tobacco Control Law already drafted
Myanmar: The Control of Smoking and Consumption of Tobacco Product Law (The State Peace and Development Council Law No. 5/2006)
Philippines: Tobacco Regulation Act 2003 (Republic Act 9211)
Singapore: Tobacco (Control of Advertisements and Sale) Act, the Prohibition on Smoking in Certain Places Act, Smoking (Control of Advertisements and Sale of Tobacco) (Labelling) (Amendment) Regulations 2006, Circular No.12/2008 New Marking Requirement on Cigarette Sticks
Thailand: Tobacco Products Control Act B.E. 2535 (1992) and Non-Smokers’ Health Protection Act B.E. 2535 (1992)
Vietnam: Decision No.1315/QD-TTg of the Prime Minister adopted the implementation plan Framework Convention on Tobacco Control for Vietnam and Directive No.12/CT-TTg of Prime Minister on strengthening tobacco control activities
- Ask about tobacco use.
- Advise all users to quit.
- Assess willingness to make a quit attempt.
- Assist the patient to quit.
- Arrange follow-up contact.
ASEAN and Tobacco Control
ASEAN is a geo-political and economic organization of 10 countries located in Southeast Asia: Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam.
Dr. Vathesatogkit said, “In 2002, through the 6th Health Ministers Meeting, ASEAN governments committed to a vision and a ‘Regional Action Plan on Healthy ASEAN Lifestyles.’ Identifying tobacco control as one of the priority policy areas, the Action Plan calls upon member nations to implement a Programme of Work on promoting healthy ASEAN lifestyles. For tobacco control, this includes developing and implementing a national action plan, consistent with the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) on issues such as smuggling, taxation, product advertising, distribution, sales, and agricultural production.”
There are other actions that have been taken by governments in this region, too. In ASEAN (see box), apart from Indonesia, every other country has signed and ratified the Global Tobacco Treaty (WHO FCTC). Recognizing tobacco as the major and common risk factor for a range of life-threatening diseases including lung cancer, Health Ministers from 11 countries in the Southeast Asia region signed the Dili Declaration in September 2015, pledging to accelerate hard-hitting measures to reduce tobacco use.
Dr. Vathesatogkit said, “At the very least, all health care personnel must provide brief advice for smoking cessation to every patient who has a smoking history, in every consultation visit. Worldwide, doctors are among the most influential figures in leading the tobacco control movement. I urge all doctors to join and support the tobacco control movement, not just by a supportive gesture but by action, in whatever capacity they feel comfortable.”
For more information on IASLC Asia Pacific Lung Cancer Conference, please visit:
Website: www.aplcc2016.com | Twitter: @APLCC2016 | Facebook.com/APLCC2016
About the IASLC
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer. Founded in 1974, the association's membership includes more than 5,000 lung cancer specialists in over 100 countries. Visit www.iaslc.org for more information.
(This article was written jointly by Shobha Shukla and Bobby Ramakant of CNS (Citizen News Service) and edited by IASLC. CNS is a media partner of APLCC 2016. Follow CNS on www.citizen-news.org Twitter: @CNS_Health, Facebook.com/CNS.page and YouTube.com/c/CitizenNewsOrgCNS)