Yasmin Williams - HEALTH-WISEWHO reports that over 90 per cent of countries have signed expressing support and it is expected that by the end of 2004, the required number of countries would have 'ratified' the treaty or contract, indicating that they will implement it and it will then become international law. This global treaty has been reportedly described by the chairman of the Intergovern-mental Negotiating Body for the framework as a "basket of best options for nations seeking to curb the tobacco epidemic".
Jamaica has been involved in the development of the framework and in the recent past, there was at least one big local stakeholder's workshop at which much information was shared. Congratulations to all those hardworking persons involved in these activities.
Despite all this, I have a sense that at 'the operational level', my colleagues and I have not been as active as we should be. Visibly, at the national level, the government's health promotion programmes/projects have focused on reproductive and sexual health. More recently, there has been a noticeable focus on healthy diet and adequate physical activity. However, I am not hearing or seeing media messages re tobacco smoking and as far as I am aware, there are no structured local programmes for smokers who wish to quit.
The U.S. Public Health Service has issued evidence-based clinical practice guidelines aimed at practising clinicians. Studies have shown that 25 per cent of US adults smoke, 70 per cent would like to stop,but only about half of them are advised to stop, and only between two and 15 per cent are given any substantial support to do so. I do not have comparative data for Jamaica, but I suspect that our data would not be too different.
Dr. Michael Fiore, chair of the guideline panel, and director of the Centre for Tobacco Research and Intervention at the University of Wisconsin (US) is reported to have said that: "Anyone who uses tobacco and is committed to quitting needs to know that tobacco dependence is a chronic disease that, like hypertension or diabetes, frequently requires treatment over time to get it controlled. In my view, a doctor isn't providing an appropriate standard of care for his or her patient if he or she does not ask two key questions - 'Do you smoke?' and 'Do you want to quit?' and then work with the individual to make it happen."
ASK, ADVISE, ASSESS, ARRANGE
Screening for tobacco use is highlighted as the single most important step in addressing tobacco use and the '4 As' ask, advise, assess, and arrange are designed to be used with the smoker who wants to quit. The '5 Rs' relevance, risks, rewards, roadblocks and repetition are designed to motivate tobacco users who are unwilling to quit.
Former smokers may relapse, sometimes years after they quit and therefore there must also be an intervention to target them. Effective interventions for treating tobacco use and dependence will prevent more illnesses, save more lives and improve health more than any other clinical intervention. (Fiore MC et al. Treating Tobacco Use and Dependence. Quick Reference for Clinicians. USPHS 2000). The tools which we have been given are easy to use and, therefore, we must initiate or expand their use.
Dr. Yasmin Williams is a family doctor and public health specialist; email: yourhealth@gleanerjm.com.
