Public Health Panorama 2020 Vol. 6, Issue 2. (dohányzás téma)

Articles in this issue

Advancing tobacco control with human rights
Progress in the fight against the tobacco epidemic has been too slow in the WHO European Region. The human rights-based approach provides a novel instrument to advance tobacco control and thereby increase the pace and sustainability of tobacco control policies. This paper discusses how tobacco production, marketing and use are associated with human rights violations and how human rights arguments and instruments can be used to advance tobacco control. Human rights – such as those to life and health as well as the rights to safe working conditions, protection from hazardous child labour and the best interest of the child – place obligations on governments and, above all, they give them the right to protect the population from the tobacco industry. They help increase support from other government departments and the public, can be invoked in court cases to defend tobacco control measures and have an independent monitoring system, unlike the WHO Framework Convention on Tobacco Control. This paper describes advances that have already been made in the European Region and globally.

Women and tobacco in the WHO European Region: a time for gender transformative action
A broad range of social, environmental and psychological factors is associated with tobacco use. Among these, gender has been recognized as one of the most influential drivers. The tobacco industry has long understood the role that gender plays in initiating and maintaining tobacco use, and has taken great advantage of this in the marketing of its products. The public health community, on the other hand, has widely neglected gender-focused approaches to the global tobacco epidemic. In the WHO European Region, tobacco use in women and girls has been of great concern for the past few decades. Although overall the prevalence of tobacco use is decreasing in the Region, it is dropping at a much slower rate in women compared to men, and in some countries the rates of smoking in women are on the rise. In this context, gendered approaches and analyses are needed to revert increasing trends and reduce the deadly impact of tobacco on European women.

Supporting policy implementation: introducing a tobacco free campus policy in Irish adult community mental health day services
The prevalence of tobacco use among people with mental health difficulties (MHD) can be up to one and half times that observed in the general population and contributes to the 10-to-20-year lower life expectancy observed in this population. Permissive attitudes among mental health professionals towards smoking among people with MHD may impair smoking cessation initiatives and contribute to a culture of smoking within mental health services. The commitment of senior level leadership and the adoption of a systematic approach that engaged staff and addressed concerns, facilitated policy implementation. Harnessing the support of key relationships provided resources and advice in building capacity and resolving pragmatic issues. Ongoing sustainability is being achieved through the devolvement of responsibility to local services, an integration of TFC-related standards into the organizational quality assurance process and the incorporation of any required actions into local service plans. Furthermore, the implementation of the TFC policy has triggered a broader health and well-being dialogue within the organization and has led to a variety of new health-promoting initiatives for both service users and staff..

Supporting policy implementation: introducing a tobacco free campus policy in Irish adult community mental health day services
Tobacco use is one of the leading preventable causes of illness and premature death globally, accounting for 8 million deaths a year. In England, approximately 5.9 million people still smoke. England has strong national tobacco control, with many of the requirements of the WHO Framework Convention on Tobacco Control in place, including the MPOWER measures. However, tobacco remains a burden both to health and on the economy in England, and is also a driver of inequality. Addressing this burden effectively requires localized implementation to reinforce national action. Barnsley is a former coal mining and now market town in England that has experienced high rates of tobacco use and the related health problems. In response, Barnsley has taken innovative cross-sectoral action. Since 2012 the adult smoking prevalence in the town has fallen by 7%, compared to a 4.9% decrease nationally. The smoking prevalence in routine and manual occupations in Barnsley fell by 6.3% from 2016 to 2017. This paper shares the lessons learned from Barnsley and describes the whole system approach that has targeted inequalities and achieved a greater reduction in local tobacco use than nationally. The paper focuses on three local interventions: the social norms campaign Make Smoking Invisible, and supporting smokers to quit through both maternity care and hospital services..

Make Smoking Invisible: tailoring a global health priority to an industrial town in England
When used as intended, tobacco is the only legal product that kills at least one in two. Aimed at protecting populations from the devastating effects of tobacco, WHO introduced the Framework Convention on Tobacco Control in 2003, subsequently publishing its evidence-based model, MPOWER, in 2008. This case study reviews the efforts made in Greater Manchester (GM), a city-region in England with a devolved health and care system, to deliver a whole-system approach to tobacco control, utilizing the MPOWER model. The Greater Manchester Health and Social Care Partnership (GMHSC Partnership) aims to end an inter-generational cycle of smoking by reducing rates by one third in less than four years and ultimately make smoking history in the region by 2027. The overall aim of GMHSC Partnership is to rapidly and greatly improve the health and well-being of the 2.8 million people of GM. Under a unique Taking Charge devolution deal GMHSC Partnership brings together the leadership, decision-making and long-term planning needed to achieve this goal.