TROPICAL DOCTOR VOLUME 22 NUMBER 1 JANUARY 1992
EDITORIAL
Tobacco: a major challenge for the developing world 1962 is a landmark in the history of the anti-smoking movement. One of us (AA) , who was a medical student at the time, vividly remembers Sir Robert (later Lord) Platt's visit to the medical school in Khartoum as external examiner. The students were privileged to be given first hand information from the President on the recently published Royal College of Physicians Report on Smoking and Health'. The document startled the world by incriminating smoking as an important factor in causing lung cancer and other diseases. Since then further harmful effects of tobacco have been documented, particularly in relation to coronary heart disease, peripheral vascular disorders and gastroenterological complaints in addition to a number of other cancers and obstructive lung disease (chronic bronchitis). The damaging effect of tobacco on women and the newborn has also been shown. These findings led to much concern in the industrialized world where diseases caused by smoking were a major cause of morbidity and mortality. In the face of this, various campaigns emerged alerting the public to the damaging effects of tobacco. Between 1975 and 1985 cigarette consumption fell by 25OJo in the UK and by 9OJo in the USA. In Western Australia between 1984 and 1990 the prevalence of smokers fell from 35OJo to 26OJo in men and from 29OJo to 20OJo in women.
The tobacco companies facing such a powerful anti-smoking climate in the West shifted their attention to the developing World. Marlboro placards appeared in many countries. Smoking was shown to be glamorous, adventurous and sexually attractive, a message clearly targeted at youth. For the educated, the affluent and the policy makers cigarettes were portrayed as symbols of sophistication and prestige and lead to high smoking rates among the business and professional classes. A survey in Khartoum showed that 64OJo of doctors and University lecturers and 34OJo of medical students were smokers-, In Nairobi 35OJo of older primary school children and 58OJo of non-medical staff at the teaching hospital smoked. In Shanghai 40OJo of male medical and 69OJo of army personnel smoked", a picture repeated in many less developed countries. Non-industrial countries are already overwhelmed by problems of malnutrition and endemic infectious diseases together with very inadequate health services. They cannot hope to match the resources of the multinational tobacco companies. Knowledge of tobacco hazards is lacking or absent and there are very few statistical data on diseases caused by smoking. Doctors find that these diseases are increasing in frequency. Coronary heart disease is already a major cause of death among the professional, administrative and business classes in Nairobi (Wangai P, personal communication) and Khartoum. Unless prompt action is taken it is likely that coronary heart disease
2
Tropical Doctor, January 1992
and lungcancer will soon become leading causes of-deathIa developing countries. Forty years ago postmortem surveys showed that lung cancer was very rare in Nigeria, Uganda and Kenya, but today tMy are' increasingly common causes of death. In some countries tobacco is an important cash crop, but in many it is grown at the expense of food production. Trees have to be sacrificed for tobacco curing, leading to deforestation and desertification. Most local tobacco companies are subsidiaries of the multinationals who take back most of their profits to the industrialized nations, thus aggravating their debt problems. Drain on the economy is aggravated by high levels of smuggling in exchange for such vital commodities as grain and live stock. Children and young men selling smuggled cigarettes are a common sight in many large towns when they should be at school or learning useful trades. Since the sale of high tar tobacco will soon not be permitted in Europe, much of it is being exported to developing countries. The European Community spends over £900 million on subsidizing the production of tobacco of which about a half is exported to Eastern Europe or the Third World. A brighter side of the picture is shown by the development of various tobacco control activities. Tobacco Control Groups are being formed in many developing countries. Unfortunately they lack funds to conduct effective campaigns. Many lack simple office equipment such as a typewriter and have no finance to conduct the surveys which WHO recommends. Organizations such as the International Union Against Cancer and WHO have sponsored a number of workshops", As a result in some places the climate of opinion is beginning to
change and cigarette advertising has been banned in several countries. In Sudan the giant Marlboro cowboy placards have come down. Health warnings have been introduced in a growing number of countries, although most of the warnings are too weak to affect consumption significantly. Illiteracy is still widespread, a fact which underlines the need for health education by cinema and by radio, media widely used by the tobacco companies. The tobacco epidemic is now spreading rapidly through developing countries, stimulated by the promotion of unscrupulous multinational companies. It is estimated that by the early years of the next century ten million deaths a year will be caused by tobacco and that most of them will be in developing countries. WHO believes that smoking is the largest preventable cause of death worldwide. A powerful coordinated effort by the governments of both rich and poor countries is mandatory if this tragedy is to be avoided. MOHAMED AL ARABI
Khartoum KEITH BALL
London
REFERENCES
Smoking and Health. Report of the Royal College of Physicians 1962. London: Pitman Medical Publishers, 1962 2 Al Arabi MA. The third world struggle against tobacco. Sudan Experience. Proceedings of the 7th World Conference on Tobacco and Health, Perth, WA 1990:372-3 3 Weng XZ. Smoking - a serious health problem in China. China Med J 1988;101:371-2 4 Nostbakken D. UICC smoking control activities in Africa. Proceedings of the 7th World Conference on Tobacco and Health, Perth, WA 1990:169-78
The Nuffield Institute for Health Services Studies: Courses The following three postgraduate courses will commence on 7th October 1992.
Master of Arts in Health Management, Planning and Policy This full-time 12 month course aims to provide participants with an opportunity for analysing the major policy, planning and management issues facing the provision of health and health-related services within developing countries. Postgraduate Diploma in Hospital Management in Primary Health Care The object of this full-time 9-month course is to offer academically based training, with a strong emphasis on the practical application of this, for candidates currently pursuing careers in hospital management in developing countries. Postgraduate Diploma in Health Planning and Administration This full-time 9 month course provides training in the management of health and related services in the developing world. It is designed for senior health planners/administrators with substantial experience in the health sector in developing countries. Short courses include: Quantitative Techniques for Health Planning; Primary Health Care Policy; Health Economics for Developing Countries; and The Role of Non Governmental Organisations in Health Services Further information from: The Admissions Officer (TD), The Nuffield Institute for Health Services Studies, International Division, The University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK.
EDITORIAL
Tobacco: a major challenge for the developing world 1962 is a landmark in the history of the anti-smoking movement. One of us (AA) , who was a medical student at the time, vividly remembers Sir Robert (later Lord) Platt's visit to the medical school in Khartoum as external examiner. The students were privileged to be given first hand information from the President on the recently published Royal College of Physicians Report on Smoking and Health'. The document startled the world by incriminating smoking as an important factor in causing lung cancer and other diseases. Since then further harmful effects of tobacco have been documented, particularly in relation to coronary heart disease, peripheral vascular disorders and gastroenterological complaints in addition to a number of other cancers and obstructive lung disease (chronic bronchitis). The damaging effect of tobacco on women and the newborn has also been shown. These findings led to much concern in the industrialized world where diseases caused by smoking were a major cause of morbidity and mortality. In the face of this, various campaigns emerged alerting the public to the damaging effects of tobacco. Between 1975 and 1985 cigarette consumption fell by 25OJo in the UK and by 9OJo in the USA. In Western Australia between 1984 and 1990 the prevalence of smokers fell from 35OJo to 26OJo in men and from 29OJo to 20OJo in women.
The tobacco companies facing such a powerful anti-smoking climate in the West shifted their attention to the developing World. Marlboro placards appeared in many countries. Smoking was shown to be glamorous, adventurous and sexually attractive, a message clearly targeted at youth. For the educated, the affluent and the policy makers cigarettes were portrayed as symbols of sophistication and prestige and lead to high smoking rates among the business and professional classes. A survey in Khartoum showed that 64OJo of doctors and University lecturers and 34OJo of medical students were smokers-, In Nairobi 35OJo of older primary school children and 58OJo of non-medical staff at the teaching hospital smoked. In Shanghai 40OJo of male medical and 69OJo of army personnel smoked", a picture repeated in many less developed countries. Non-industrial countries are already overwhelmed by problems of malnutrition and endemic infectious diseases together with very inadequate health services. They cannot hope to match the resources of the multinational tobacco companies. Knowledge of tobacco hazards is lacking or absent and there are very few statistical data on diseases caused by smoking. Doctors find that these diseases are increasing in frequency. Coronary heart disease is already a major cause of death among the professional, administrative and business classes in Nairobi (Wangai P, personal communication) and Khartoum. Unless prompt action is taken it is likely that coronary heart disease
2
Tropical Doctor, January 1992
and lungcancer will soon become leading causes of-deathIa developing countries. Forty years ago postmortem surveys showed that lung cancer was very rare in Nigeria, Uganda and Kenya, but today tMy are' increasingly common causes of death. In some countries tobacco is an important cash crop, but in many it is grown at the expense of food production. Trees have to be sacrificed for tobacco curing, leading to deforestation and desertification. Most local tobacco companies are subsidiaries of the multinationals who take back most of their profits to the industrialized nations, thus aggravating their debt problems. Drain on the economy is aggravated by high levels of smuggling in exchange for such vital commodities as grain and live stock. Children and young men selling smuggled cigarettes are a common sight in many large towns when they should be at school or learning useful trades. Since the sale of high tar tobacco will soon not be permitted in Europe, much of it is being exported to developing countries. The European Community spends over £900 million on subsidizing the production of tobacco of which about a half is exported to Eastern Europe or the Third World. A brighter side of the picture is shown by the development of various tobacco control activities. Tobacco Control Groups are being formed in many developing countries. Unfortunately they lack funds to conduct effective campaigns. Many lack simple office equipment such as a typewriter and have no finance to conduct the surveys which WHO recommends. Organizations such as the International Union Against Cancer and WHO have sponsored a number of workshops", As a result in some places the climate of opinion is beginning to
change and cigarette advertising has been banned in several countries. In Sudan the giant Marlboro cowboy placards have come down. Health warnings have been introduced in a growing number of countries, although most of the warnings are too weak to affect consumption significantly. Illiteracy is still widespread, a fact which underlines the need for health education by cinema and by radio, media widely used by the tobacco companies. The tobacco epidemic is now spreading rapidly through developing countries, stimulated by the promotion of unscrupulous multinational companies. It is estimated that by the early years of the next century ten million deaths a year will be caused by tobacco and that most of them will be in developing countries. WHO believes that smoking is the largest preventable cause of death worldwide. A powerful coordinated effort by the governments of both rich and poor countries is mandatory if this tragedy is to be avoided. MOHAMED AL ARABI
Khartoum KEITH BALL
London
REFERENCES
Smoking and Health. Report of the Royal College of Physicians 1962. London: Pitman Medical Publishers, 1962 2 Al Arabi MA. The third world struggle against tobacco. Sudan Experience. Proceedings of the 7th World Conference on Tobacco and Health, Perth, WA 1990:372-3 3 Weng XZ. Smoking - a serious health problem in China. China Med J 1988;101:371-2 4 Nostbakken D. UICC smoking control activities in Africa. Proceedings of the 7th World Conference on Tobacco and Health, Perth, WA 1990:169-78
The Nuffield Institute for Health Services Studies: Courses The following three postgraduate courses will commence on 7th October 1992.
Master of Arts in Health Management, Planning and Policy This full-time 12 month course aims to provide participants with an opportunity for analysing the major policy, planning and management issues facing the provision of health and health-related services within developing countries. Postgraduate Diploma in Hospital Management in Primary Health Care The object of this full-time 9-month course is to offer academically based training, with a strong emphasis on the practical application of this, for candidates currently pursuing careers in hospital management in developing countries. Postgraduate Diploma in Health Planning and Administration This full-time 9 month course provides training in the management of health and related services in the developing world. It is designed for senior health planners/administrators with substantial experience in the health sector in developing countries. Short courses include: Quantitative Techniques for Health Planning; Primary Health Care Policy; Health Economics for Developing Countries; and The Role of Non Governmental Organisations in Health Services Further information from: The Admissions Officer (TD), The Nuffield Institute for Health Services Studies, International Division, The University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK.
