For "non fumeurs" the unmistakable "odeur" of stale tobacco smoke wafted through the ventilating shafts into the large meeting hall in the Palais de Congress in Paris.
Those sitting inside the room, including officials of the World Health Organization and the World Medical Association and a large group of physicians attending the International Congress on Anti-Cancer Treatment, in addition to being exposed to second-hand smoke, were serious about stopping the smoking epidemic in Europe as well as around the globe.
May 31 is World No Tobacco Dayan event spearheaded by WHOs Tobacco Free Initiative, a global effort to reduce smoking prevalence and tobacco consumption. The initiative has partnered with such organizations as UNICEF, the World Bank, the U.S. Centers for Disease Control and Prevention, and the U.S. Environmental Protection Agency.
WHOs Tobacco Free Initiative coordinator, Douglas Bettcher, M.D., Ph.D., promises use of "the crafty symbols of the tobacco industry" to speak out against tobacco, including posters, television commercials, and other anti-smoking materials.
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Smoking has gone downa little. According to the Mutuelle Nationale des Hospitaliers et des Personnel de Sante (MNH), which insures health care workers and hospitals in France, about 38% of the population, including doctors, were smokers in 1992. Since then, the number of physicians who smoke has decreased slightly, and according to MNH the decrease within the general population is very small as well.
European countries are now working on standardizing their laws regarding tobacco and their prices of tobacco goods to discourage cross border purchases and smuggling.
Because of its higher taxes on tobacco products, for example, an estimated 25% of the total number of cigarettes smoked in the United Kingdom are smuggled in from the main continent, said Kenneth Clarke, the deputy chairman of the British American Tobacco Company.
"Smuggling is a serious problem," said Bettcher, "but there does seem to be a will on the global level to address it." He said that at a recent meeting the prime ministers of India and Singapore indicated their concern about tobacco ads and products coming in from neighboring countries.
"With globalization the tobacco industry has been quite ingenious as far as gaining demand for a deadly product," he added. "Internet trade and advertising is totally unregulated. Still, its not hopeless."
Unifying Efforts
Several efforts throughout Europe have targeted tobacco control:
Since l992, a French law has required restaurants and other public places to provide areas for nonsmokers. This works in large restaurants, although in Paris a request for a nonsmoking seat in a small restaurant may simply involve moving the ashtray off the table.
Under a European Commission action plan, member states have been encouraged to ban tobacco ads on television, harmonize anti-tobacco legislation, and prohibit oral tobacco products. They also have been asked to label tobacco packages with health risks and rotate the health warnings that may include warnings about the dangers of smoking during pregnancy, the effect of adult smoking on children, and the risks for development of heart disease and cancer, said Annie Sasco, M.D., of the Centre International de Recherche sur le Cancer in Lyon. The action plan also calls for cigarette packs to include ingredient lists and for terms like "light" and "ultra light" to be banned.
A European Smoke-Free Hospital Network has been set up that so far includes Belgium, France, Italy, Luxembourg, Spain, Sweden, and the United Kingdom. Coordinated by the French, this involves training health care workers in how to approach smokers in the hospital about quitting; removing ashtrays from hospitals; not allowing tobacco sales in hospitals; and, if smoking areas are considered necessary, locating them away from clinical and reception areas.
Plans are in the works to limit smoke exposure in the workplace and to set up other networks, including a network of youths without tobacco, a network of cities without tobacco, and a network of general practitioners.
The World Medical Association also has a campaign to get European general practitioners, who treat most patients, to help their smokers quit.
Looking East
In the Eastern block countries, matters are far worse according to more than one estimate. Delon Human, secretary general of the World Medical Association, said that physicians need to get more involved in getting their patients to quit, not to mention quitting themselves.
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General practitioners in Europe can help, but in one survey only 38% of patients said their doctors even asked if they smoked, Human said. To help people quit, physicians must understand the phases people go through in quittingfirst they contemplate it, then they think about it seriously, then they prepare to quit, and then they need a plan of action and of maintenance, he said.
Human suggested physicians stamp each patients chart with a reminder to ask the patient about smoking. Helping patients plan how to quit should only take a few minutes. He suggested simple strategies such as advising them to quit, identifying those that are willing to quit, and then helping by giving them information and following up.
"I think in a country like France, where general practitioners play such an important role in the care of a patient, that it can be a cheap and effective way to save millions of lives," Human said.
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