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Europe: WHO Takes On Tobacco

Prague, 3 February 1999 (RFE/RL) -- World Health Organization (WHO) Director-General Gro Harlem Brundtland has unveiled a major project to help smokers in Europe, Russia and the Central Asian Republics break the habit (stop smoking).

Brundtland announced the initiative during a weekend address at the World Economic Forum in Davos, Switzerland. She told the gathering of world business and political leaders that investing in health is "sound economics."

To illustrate the point, Dr. Brundtland noted that by 2020, the burden of disease attributable to tobacco is expected to outweigh that caused by any single other disease -- most notably in Europe.

At present, only AIDS (Acquired Immuno-Deficiency Syndrome) -- for which there is n-o known cure -- is a potentially bigger threat.

Dr. Derek Yack, Program Manager of WHO's Tobacco Free Initiative, says a reduction in tobacco use is the single most important public policy action countries can undertake for health and economic gain.

He says, "Maybe a third to a half of these [tobacco] deaths are being caused by old age and two-thirds, and in some cases a half, being caused in middle age. And [of] those people dying in middle age, many are losing 20 years of life expectancy. Now, add to that the impact on mobility and suffering -- on having somebody unable to walk without wheezing, the productivity losses, the impact on non-smokers, the impact on children -- and you realize you are dealing with a massive health problem and one that has been hidden from the view of the public for far too long. So, I think you'd find it very difficult to name a public health program in magnitude and in potential to make a difference anywhere equivalent to tobacco."

Yack told RFE/RL that interventions for tobacco control are among the most cost-effective measures currently available in public health and yet he says they are n-o-t being applied. And the reason they are n-o-t being applied, according to Yack, is that there are few people, as he put it, with sufficient courage to push ahead in the face of the tobacco industry and associated pressures.

But the pharmaceutical industry, much like big tobacco, is also accused of being driven by the quest for profits. And Yack's project is unique in that it calls for WHO to join forces with three major pharmaceutical companies.

Glaxo Wellcome, Novartis Consumer Health, and Pharmacia & Upjohn all manufacture treatment products for tobacco dependence, ranging from nicotine gum to inhalers. They also were behind the creation of a patch worn on the skin designed to halt cravings for nicotine, the addictive element in cigarettes.

David Graham is the Director of Product Development for Tobacco Dependence at Pharmacia & Upjohn in Helsingbord, Sweden. He told RFE/RL how companies like his plan to make a difference with this joint initiative.

"This initiative will certainly be setting measurable targets as we go through the first step in its development. One key component of the project is called measurement data and outcomes. And in particular what we will be looking to establish is a gold standard of measurement of attitudes and intentions for smokers to quit, as well as measuring actual quit attempts, use of treatments and overall success rates. All of these are much finer tuned measurements before we look at the end base of change in smoke prevalence and it is hoped that we can record real change in smokers' attitudes, which ultimately leads to a change in behavior."

Graham stressed that tobacco-dependence products are currently available in 60 countries, including those of the program's target area. However, he did note that access was n-o-t as prevalent in Central Asia due to regulatory controls. But he said the situation there was under review. Graham estimates the cost of such items at just more than two U.S. dollars a day, for example, for nicotine gum. Products such as the patch, he said, run a bit higher, but n-o-t so much so as to be prohibitive.

Graham also pointed out that in Europe, 60 to 70 percent of smokers were unhappy about their habit when surveyed. With that in mind, Graham said the initiative could serve as a model for defeating tobacco-related death and disease and increasing quit rates.

"There is a grave need in Eastern Europe for practical models. And Poland represents an excellent example. It is an EU accession country with very good advanced tobacco control legislation. And success in Poland is likely to provide practical examples of implementations that could be carried out in other parts of that area."

Graham told our correspondent the WHO tobacco control initiative coincides with World No Tobacco Day set for May 31. The theme of this year's effort is for smokers to "leave the pack behind." And that is what the WHO European Parternship project on tobacco dependence hopes all smokers will do this year, particularly those in Europe, Russia and Central Asia.