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Asian Tribune is published by World Institute For Asian Studies|Powered by WIAS Vol. 12 No. 2681

Cessation Support (Article 14) Is Not Costly Or Complicated – And It Is Effective!

By Pieris Manjari

There is strong international support to strengthen and accelerate full implementation of Article 14 of the WHO Framework Convention on Tobacco Control (FCTC), as evidenced by the World Conference on Tobacco or Health Declaration in 2015 that “By 2018, at least 50% of FCTC Parties will have developed and published an official national tobacco dependence treatment strategy, in accordance with Article 14 Guideline recommendations”, says Martin Raw, Director, International Centre for Tobacco Cessation, London.

Most of the substantive FCTC Articles, especially 6, 8, 11, 12, 13 and 14, promote tobacco cessation (as opposed to discouraging young people from starting) in one way or another. It is important to note that only effective cessation will have a sufficient effect on mortality in the 9 years left to reach the UN/ WHO goal of a 25 percent reduction in premature mortality from NCDs by 2025.

According to Martin Raw, the 2014 WHO Global Progress Report on FCTC implementation suggests good progress in FCTC implementation, but notes that some treaty articles are being implemented more quickly than others. The report adds that only half of Parties said they were implementing Article 14 by 2014.

Evidence from MR’s group’s survey (at Nottingham University, UK) suggests perceived cost to be one concern about tobacco cessation support, another may be lack of clarity about the role of such support, including about its effectiveness and cost effectiveness.

Helping tobacco users stop is a cost effective healthcare intervention, which saves lives and improves population health. Every day that smokers over 35 years old continue to smoke they lose about 3–6 hours of life, thus for the estimated 500 million current adult smokers, 62 million days of life are lost every day. Some of these tobacco users will stop unaided, others will stop only after repeated attempts over time, and many more will die before they can stop, principally because tobacco use is so addictive.

The unaided population tobacco cessation rate after 1 year is very low, only about 3–5 percent, meaning that the majority of smokers who try to stop without help fail. Adding comprehensive cessation support can be up to about four times more effective, at about 20 percent after a year, but even brief advice has a worthwhile effect.

One key reason why the majority of ex-smokers stopped without help is because the majority do not have access to help. According to WHO, just 15 percent of the world’s population have access to appropriate cessation support. Arguably, cessation support should be provided alongside measures that prompt cessation attempts, like those in Articles 6, 8, 11, 12 and 13. Given a genuine need for cessation support, the fact that globally most tobacco users don’t have access to it, and that providing it implies at least some basic infrastructure, can anything be done quickly to improve the situation, something that low and middle income countries can afford.

Martin Raw says that he thinks countries could consider the following relatively low-cost measures to build core infrastructure:

1. Conduct a national situation analysis, as recommended in the FCTC Article 14 guidelines;

2. Develop a national cessation strategy;

3. Mandate recording tobacco use in all medical notes;

4. Offer mobile phone text messaging systems;

5. Integrate brief advice to all tobacco users into the healthcare system.

As resources become available countries can consider adding the following:

6. Develop and disseminate national cessation guidelines;

7. Make affordable medicines available;

8. Establish mass communication and education programmes that encourage cessation and encourage tobacco users to use cessation support;

9. Offer specialist tobacco cessation support. The availability of new, low-cost interventions and methods to help countries select affordable treatments (will remove significant barriers to the development of tobacco cessation support and make Article 14 implementation both feasible and a significant contributor to global health.

Martin Raw, is the Director of International Centre for Tobacco Cessation, London, UK; Visiting Scholar, New York University Medical School, New York, USA and Thomas Glynn, Consulting Professor, Stanford University Prevention research Center, School of Medicine, Palo Alto, California, USA
This article draws extensively on a comment published in the Lancet in January: Raw M, Mackay J, Reddy S. Time to take tobacco dependence treatment seriously. Lancet, 30 January 2016.

Source of information: - COP7 Bulletin

- Asian Tribune -

Martin Raw -  Director, International Centre for Tobacco Cessation, London.
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