Tobacco control at the community level

 In terms of global threats, tobacco is one of the biggest dangers in the world today. In 2010, more than five million people died from the effects of smoking or chewing tobacco. This is not just a disease of the rich. According to the World Health Organization (WHO), 80 per cent of these deaths were in low- and middle-income countries. Tobacco remains the only legally available consumer product that will kill at least a third of all users.

As a doctor I have had to tell many patients that they have lung cancer and also counsel families who have lost loved ones as a result of tobacco-related illness. One of the main reasons I moved from clinical medicine to public health was that I was distressed that so many of these deaths could have been prevented.

Low cost, high impact

The cost effectiveness of tobacco control is clear. Since tobacco kills at least one in three of its users, if you cause three people to stop smoking through health education and support, you will have saved at least one life! To make a comparison: an immunisation programme may require 150 immunisations to prevent one death. It is clear that spending on tobacco control is a good investment.

The interventions that have been shown to be most effective include: increasing the price of tobacco through taxation, regulating the advertising of cigarettes, mass social marketing designed to change behaviour and banning smoking in public spaces.

Some Footsteps readers may be able to lobby governments for taxation changes and laws banning tobacco but we can all be involved in reducing tobacco use at a community level.

Northern India: Reducing tobacco consumption at a local level

Joining together to lobby and influence

Whilst it is difficult as individuals or small organisations to lobby governments, the Community Health Global Network (CHGN) Uttarakhand Cluster of North India has brought together 37 community health programmes to advocate on tobacco. We began by undertaking an awareness campaign and we are now developing a comprehensive tobacco control and cessation initiative. By linking together, the group produced an awareness DVD, involved the health minister and had a high-profile launch. Together we had a stronger voice against tobacco.

The cluster also mobilised international support to reduce tobacco use. The Cluster Tobacco Control Initiative (CTCI) was developed in consultation with tobacco control experts in Australia and has three main parts: a school tobacco action campaign, a community awareness/social marketing campaign and a cessation services programme.

Using community health workers or volunteers

Smoking rates tend to be higher amongst the poorer and less educated people in rural areas. Many of our community health programmes have health and outreach workers to target such groups. These workers are often more effective at getting messages to rural and marginalised communities than mass advertising using television or billboards. Where there is both low knowledge and high rates of smoking (such as in Uttara-khand, India), studies have shown that many will stop smoking immediately as soon as they understand the dangers of tobacco.

In the CTCI each member organisation selects one or two master trainers. These forty trainers are then responsible for delivering training to over 3000 health workers and volunteers as Tobacco Control Advocates. This provides one advocate for each village in our area of northern India and allow wide coverage all the way to the grassroots.

Ideas for local anti-tobacco campaigns

• General awareness-raising through developing relevant local anti-tobacco posters, organising com-munity festivals or creating DVDs to raise awareness about the dangers of tobacco.
• Training health workers about tobacco cessation. There are excellent materials available that teach on the dangers of smoking. Simple advice and support from respected health practitioners has been shown to be effective.
• Focusing on schools work as children are particularly vulnerable to starting smoking. Since tobacco is highly addictive it is easier to ‘stop people starting’ than to help them stop once they have already started. You could run a competition at school for the best anti-tobacco advertisement or help children themselves to spread anti-tobacco messages and discourage tobacco use in their communities.

Smoking facts 

Passive smoking or second hand smoke is when people are exposed to the harmful effects of smoking by sharing space with a smoker or another source of smoke, such as an indoor cooking fire. These passive smokers have a higher risk than other non-smokers of developing cancer and COPD. 

Smoking in pregnancy is harmful to the baby, as well as the mother. It has been linked to miscarriages and other complications. Often, it leads to low birth weight which gives the child a higher risk of diabetes and heart disease later in life.

Quit-to-win community events

At a community festival CHGN Uttarakhand Cluster offered US$25 to three volunteers if they stopped smoking and remained so for six months. That would be equal to one life saved as long as they continue as non-smokers. Such ‘Quit-to-win’ programmes can be effective and those who quit can in turn become ‘quit champions’ in their communities and in turn lead more people to stop smoking. Following the event, at least four other people followed their lead and stopped smoking.