Problem

In order to reverse the tobacco epidemic, concerted efforts will be needed from a wide range of sectors, with national health systems well-placed to take the leading role for implementing measures to prevent and treat tobacco dependence.

However, in many countries capacity for tobacco control is weak. Health systems are not set up to integrate tobacco prevention and treatment into routine patient care. Medical professional training includes, at best, only a bare minimum of time devoted to treatment of tobacco dependence, and many health professionals do not see tobacco control as part of their job. In some countries, a large number of health professionals are users of tobacco themselves.

Solution

Health professionals, including doctors, dentists, pharmacists, nurses, midwives and others, are highly respected and are trusted sources of information and advice in matters related to health. Many health professionals are influential community leaders and are considered role models for others. In their professional lives, they are in contact with a high percentage of the population and can be instrumental in helping people change their behaviour, particularly in quitting tobacco use.

It has been recognized that medical professionals possess the greatest potential of any group in society to promote a reduction in tobacco use and, thus, a reduction in tobacco-related mortality and morbidity. Outside of the health arena, medical professionals who have spoken out publically and lobbied for comprehensive tobacco control policies, including smoke-free public places, have undoubtedly saved millions of lives and helped to change the social norms around tobacco.

In 2004, during a meeting convened by WHO, health professional associations adopted a code of practice on tobacco control that lists 14 tangible ways in which these associations can engage in tobacco control. For example, the associations and their members should act as a role model for their patients, ensure that workplaces and public facilities are smoke- and tobacco-free, and support the political process of tobacco control, including support for the WHO Framework Convention on Tobacco Control (WHO FCTC).

WHO code of practice on tobacco control for health professional organizations:

• be a role model,
• advise on cessation,
• make your own premises and events smoke-free,
• influence health and educational insititution to include tobacco control in curricula,
• prohibit the sale and promotion of tobacco on premises,
• support smoke-free places.

Code of practice on tobacco control for health professional organizations

Preamble: In order to contribute actively to the reduction of tobacco consumption and include tobacco control in the public health agenda at national, regional and global levels, it is hereby agreed that health professional organizations will:

• Encourage and support their members to be role models by not using tobacco and by promoting a tobacco-free culture.
• Assess and address the tobacco consumption patterns and tobacco-control attitudes of their members through surveys and the introduction of appropriate policies.
• Make their own organizations’ premises and events tobacco-free and encourage their members to do the same.
• Include tobacco control in the agenda of all relevant health-related congresses and conferences.
• Advise their members to routinely ask patients and clients about tobacco consumption and exposure to tobacco smoke –using evidence-based approaches and best practices–, give advice on how to quit smoking and ensure appropriate follow-up of their cessation goals.
• Influence health institutions and educational centres to include tobacco control in their health professionals' curricula, through continued education and other training programmes.
• Actively participate in World No Tobacco Day every 31 May.
• Refrain from accepting any kind of tobacco industry support – financial or otherwise –, and from investing in the tobacco industry, and encourage their members to do the same.
• Ensure that their organization has a stated policy on any commercial or other kind of relationship with partners who interact with or have interests in the tobacco industry through a declaration of interest.
• Prohibit the sale or promotion of tobacco products on their premises, and encourage their members to do the same.
• Actively support governments in the process leading to signature, ratification and implementation of the WHO Framework Convention on Tobacco Control.
• Dedicate financial and/or other resources to tobacco control – including dedicating resources to the implementation of this code of practice.
• Participate in the tobacco-control activities of health professional networks.
• Support campaigns for tobacco-free public places.

Adopted and signed by the participants of the WHO Informal Meeting on Health Professionals and Tobacco Control; 28-30 January 2004; Geneva, Switzerland.

WHO recommended strategies for strengthening health systems

A more systematic approach to engaging health professionals in tobacco control is also needed, starting with training. It is also necessary to build countries' capacity to strengthen primary health-care systems to make brief tobacco interventions available through primary health-care services. The following summarizes WHO recommended strategies for strengthening health systems:

• identify models to integrate brief tobacco interventions into the existing primary health-care programme,
• support health professionals to quit tobacco use,
• develop training materials on strengthening primary health-care systems for treating tobacco dependence and facilitate training workshops at country level.

Studies show that even brief advice from health professionals can increase tobacco abstinence rates up to 30%. Interventions for smoking cessation led by nurses have shown to increase the chance of successfully quitting smoking by up to 50%. There also needs to be a systematic approach for incorporating brief tobacco interventions (the "5 A's" and "5 R's") into primary health-care services.

Experience and examples

England is an example of a country that offers comprehensive tobacco dependence treatment to all. For a more in-depth description, see the WHO report on the global tobacco epidemic, 2009.