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Tobacco use continues to fall, but still ‘long way to go’

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The number of tobacco users continues to decrease globally, going from 1.32 billion in 2015 to 1.30 billion last year, the World Health Organization (WHO) said onTuesday.  

And according to the fourth WHO global tobacco trends report, that number is expected to continue to drop to 1.27 billion by 2025.   

Sixty countries are now on track to achieving the voluntary global target of a 30% per cent reduction by 2025, an increase from two years ago, when only 32 countries were on course.

Encouraging news 

For WHO Director-General Tedros Ghebreyesus, the numbers are very encouraging, but more work must be done. 

“We still have a long way to go, and tobacco companies will continue to use every trick in the book to defend the gigantic profits they make from peddling their deadly wares”, Tedros said.  

According to WHO, recent evidence shows that the tobacco industry used the COVID-19 pandemic to build influence with Governments in 80 States. 

The report urges Member States to accelerate implementation of the measures outlined in the WHO Framework Convention on Tobacco Control (WHO FCTC).  

Ruediger Krech, Director of WHO Department of Health Promotion, attributed some of the progress to measures aligned with the WHO FCTC, while maintaining that success is “fragile.” 

“It is clear that tobacco control is effective, and we have a moral obligation to our people to move aggressively in order to achieve the Sustainable Development Goals (SDG) link”, he said.  

Good investment 

A newly released WHO Global Investment Case for Tobacco Cessation, also makes the case for investing in cessation interventions. 

According to the report, contributing US$ 1.68 per capita each year to national toll-free quit lines, SMS-based support, and other interventions could help 152 million tobacco users successfully quit by 2030.  

The report and the investment case were released right after the ninth session of the Conference of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products.Protocol to Eliminate Illicit Trade in Tobacco Products

Key findings 

Last year, 22.3% per cent of the global population used tobacco, 36.7 per cent of all men and 7.8 per cent of the world’s women. 

Approximately 38 million children between the ages of 13 and 15 currently use tobacco, 13 million girls and 25 million boys.  While it is illegal for minors to purchase it, the goal is to achieve zero child tobacco users. 

On average, upper middle-income countries are making the slowest progress, but with data quality low or insufficient  in 29 countries, more monitoring is needed to assess a trend. 

Regions 

Of all WHO regions, the steepest decline is in the Americas, where the average user rate dropped from 21 per cent in 2010 to 16 per cent last year. 

In Africa, the rate fell from 15 per cent to 10 per cent and the continent continues to have the lowest numbers.  

In Europe, 18% per cent of women still use tobacco, substantially more than in any other WHO region, while all others are on track to reduce women’s usage rates by at least 30% per cent by 2025. 

Although South-East Asia has the highest rates, with around 432 million users or 29 per cent of its population, it is also the region in which the numbers are declining fastest. 

Finally, the Western Pacific is projected to become the region with the highest use among men, with indications showing that more than 45% per cent will still be using tobacco in 2025. 

According to WHO, this product kills more than 8 eight million people each year, over 7 seven million of whom die as a direct result of smoking tobacco while around 1.2 million others from second-hand smoke. 

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In fight against male cancer, caring for mental health is a growing priority

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By Anthony King

At a hotel in the Scottish city of Aberdeen about 20 years ago, urologist James N’Dow and other doctors met a group of men who had suffered prostate cancer to ask for feedback on their care before and after surgery. The clinicians were stunned by the critical, albeit constructive, responses.

‘Frankly, they felt abandoned,’ said Professor N’Dow, who works at the University of Aberdeen. ‘When we discharged them after surgery, we thought their general practitioners were looking after them and their GPs thought we were.’

Minding the mind

Dealing with the emotional and mental toll of prostate cancer has grown in importance along with detecting and curing the disease itself. Prostate cancer is the second-leading cancer among men in Europe and is sometimes mistakenly viewed as a disease only of old age. It caused an estimated 335 500 cases, or 12.5% of cancers, in the EU in 2020.

Prof N’Dow heads an Innovative Medicines Initiative project – PIONEER – on prostate cancer that seeks to improve diagnosis and treatment. A parallel EU-funded initiative called FAITH is developing an electronic application for cancer survivors that could help spot if the “black dog” of depression is stalking them.

‘Depression is a big thing in post-cancer survivors,’ said Gary McManus, who leads FAITH and works at the Walton Institute for Information and Communication Systems Science in Waterford, Ireland.

Four in 10 men who have been treated for prostate cancer say they are anxious or depressed to some degree, with troubles worsening the more advanced the cancer, according to a 2020 study by Europa Uomo, a European advocacy movement for sufferers of the disease. Prostate cancer can increase the risk of suicide.

Stopping the spread

When prostate cancer is caught early enough, a man can be cured. If it spreads beyond the prostate, the cost of treatment is high and delivers minimal benefit. Usually, the disease will spread – metastasize – to the bones and lymph nodes.

‘It is not curable at that stage,’ said Prof N’Dow. ‘We are still picking up too many men with metastatic disease – and this is a failure of the system.’

Without treatment, the average period of survival from prostate cancer that has spread beyond the gland is about 21 months. With some newer therapies, some metastatic prostate cancer patients can survive five years or more.

Even when the cancer is aggressive, if it is restricted to the prostate gland a patient can be cured by surgery or radiation therapy – or a combination. Almost 95% of these patients are still alive up to 15 years after their diagnosis. Treatment can, however, affect a man’s urinary or erectile function.

Prof N’Dow hails recent EU recommendations to screen prostate cancer in men up to the age of 70 using a blood test and magnetic resonance imaging (MRI) scans based on an individual’s risk. Certain men over 50 and those of African descent or with a family history of prostate cancer are at heightened risk from this cancer and should be targeted for early detection.

Tracking the blues

Amid the efforts to improve detection and cures, FAITH’s planned app highlights the heightened focus on the psychological well-being of cancer patients.

Although it is being tested on people who have overcome lung and breast cancer, the app could be made to work for survivors of the disease in other parts of the body including the prostate.

In its study two years ago on anxiety or depression among men who have been treated for prostate cancer, Europa Uomo said 0.5% felt either one to an “extreme” degree and almost 4% to a “severe” extent. Nearly 11% and 28% fell into “moderate” and “slight” categories, respectively.   

A tracker of sorts, the app is being developed by European technologists and cancer doctors working together. The tests are taking place at three hospitals in Ireland, Spain and Portugal.

At home, a wearable watch records movement and sleep patterns that get fed into a phone app. Patients must occasionally answer questions from the app, for example about dietary choices, while a voice module checks for any changes in a person’s speech that may indicate depression.

In all, 27 measurements are being tracked in a bid to uncover which ones could flag a downward trajectory in a patient’s mental health. Performance will be compared against clinical questionnaires that doctors already use to monitor patients.

‘Once the patient is signed out of the hospital, they’re often on their own,’ said McManus. ‘If the hospital gives this app to a patient, doctors can remotely monitor how the patient is getting on.’

The phone app will not send sensitive patient data to the Internet. Instead, an algorithm is updated on the phone and fed back to the development team, which helps improve the app’s performance.

‘We’ll build our algorithm and try to pick out these downstream trajectories,’ said McManus. ‘Then we are basically training the app.’ Eventually, if the app picks up worrying signals, ‘an alarm is raised in the hospital and the patient is contacted,’ he said.

Empowering patients

The mental-health aspect of cancer diagnosis and care needs to be improved across Europe, according to Prof N’Dow, who said that this is a central goal of the European Association of Urology, where he is adjunct secretary general responsible for education.

‘The impact psychologically of the diagnosis or consequences of treatment is huge,’ he said. ‘This is something we understood in PIONEER.’

The project has sought to ensure that treatment comparisons take into account the impact on patient quality of life such as sexual, bowel or urinary function. Also crucial has been to identify those outcomes that matter most to patients.

That is why PIONEER has included patients themselves in discussions aimed at determining key unanswered research questions about prostate cancer.

‘Patients understand what they need,’ Prof N’Dow said. ‘Our job is to improve the lives of the most vulnerable and get them back to the life they knew before it was rudely interrupted by disease. The psychological well-being of the patient and their families should be recognized as central to that.’

Research in this article was funded via the EU. This material was originally published in Horizon, the EU Research and Innovation Magazine.   

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Central Asian Countries Show Commitment to a Cross-regional Approach to Pandemic Prevention

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Government officials representing health, environment, and agriculture sectors from all of Central Asian countries participated in a regional ministerial meeting Protecting Livestock and Preventing Pandemics that took place in Almaty today. The participants reaffirmed commitment to cooperating on One Health–a cross-sectoral approach that aims to help the region prevent future pandemics. The participants signed a communiqué giving a formal start to the development of the Central Asia One Health Framework for Action and a call for joint resource mobilization in support of the initiative.

Managing global health risks requires full cooperation between the livestock, environmental and public health sectors, at the national, regional, and global levels. One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment are closely linked and inter-dependent.

“The case for collaboration on One Health in Central Asia could not be clearer,” said Tatiana Proskuryakova, World Bank Regional Director for Central Asia. “The region shares many common challenges but also strengths and opportunities that can help the region realize One Health. What we are witnessing now is Central Asia setting an example for other regions and countries on how to work together for future generations’ health and wellbeing”.

The event in Almaty builds on the discussions held during a meeting in Tashkent in July 2022 when participants agreed on the need to prepare the Central Asia One Health Framework for Action that could provide a blueprint for the countries in the region to move forward with concrete actions, as well as would include a roadmap for investments at national and regional levels.

More specifically, the Regional One Health Framework for Action aims to contribute to addressing three high-level goals shared among Central Asian countries: pandemic prevention and preparedness, resilience of food systems, and improving regional trade and the competitiveness of agriculture. In addition, the Framework for Action will identify focus areas and mechanisms for regional collaboration, and include a One Health dashboard to monitor progress, while facilitating policy responses to emerging issues.

“Investing in One Health is an investment in humanity’s future. The proposed investment framework helps governments and development partners to avoid the cycle of panic-and-neglect and direct financial resources. This integrated, risk-based approach requires compliance with international health standards and promotes country ownership, while recognizing its global public goods nature. The vast majority of investments in One Health will also result in significant co-benefits, including improving food safety, preserving biodiversity and reducing GHG emissions” said Martien van Nieuwkoop, the World Bank’s Global Director for Agriculture and Food. “The World Bank is collaborating with several countries in Central Asia on this approach, and we are encouraged by the region’s resolve to work together to invest in One-Health as an important building block for pandemic prevention, preparedness and response”.

The development of the Framework for Action will support regional dialogue between networks of decision makers and technical staff, including epidemiologists, veterinarians, and environmental specialists from the three operational sectors. This will be especially useful in cases of transborder disease outbreaks, as it would enable sharing of information, quick integration of new knowledge, and regional action.

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Countries Need to Fundamentally Change Health Systems to Better Prepare for Future Shocks

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As the experience from COVID-19 has shown, countries need to take transformative action to build stronger, more resilient health systems, says a new World Bank report. Boosting health system resilience now reaps large dividends when emergencies occur. To do so, governments need to improve their health sector governance, cross-sectoral partnerships based on a One Health approach that prioritizes health service delivery, and pandemic prevention, preparedness, and response (PPR).

According to the new report, Change Cannot Wait: Building Resilient Health Systems in The Shadow of COVID-19, resilient health systems are integrated systems that are aware of threats and risk drivers; agile to respond to evolving needs; absorptive to contain shocks; adaptive to minimize disruptions; and able to leverage lessons learned to transform after a crisis. These systems also integrate essential public health functions to help prevent, manage, and mitigate impacts of other challenges, such as climate change, ageing populations, and fragility and conflict.

Investing in resilient health systems requires long-term commitment and action by governments,” said Mamta Murthi, Vice President for Human Development, World Bank. “With shrinking health budgets following the COVID-19 crisis response, countries need to set priorities for their health spending, including on areas such as public health, disease prevention, and primary health care to protect human capital and ensure health services for all, especially the poorest and most vulnerable.”

The report identifies several actions governments can take to make their health system more resilient:

  • Investing in robust public health institutions and agile, evidence-based decision making for health crises
  • Improving awareness and early warning functions
  • Expanding community health workforce and building multi-disciplinary competencies for PPR
  • Prioritizing and tracking investments in PPR
  • Strengthening risk communication and community engagement
  • Investing in primary health care with integrated public health functions
  • Enhancing quality legal and regulatory frameworks

Pandemic prevention, preparedness, and response is integral to strong health systems. A country that is not prepared cannot be resilient,” said Juan Pablo Uribe, World Bank Global Director for Health, Nutrition & Population and the Global Financing Facility. “Investments in health system resilience need to go hand-in-hand with the broader health agenda, including advancing toward Universal Health Coverage (UHC), to enable equity.”

This report proposes a three-tiered framework to help countries prioritize spending options based on their impact on resilience. The framework proposes risk reduction, prevention and community preparedness as most important tier one activities, followed by tier two with a focus on detection, containment and mitigation activities. Tier three which is the most expensive part includes advanced case management and surge response.

The World Bank has long been committed to helping low- and middle-income countries build stronger, more resilient health systems and provide quality, affordable health services to everyone. Our $34 billion global health portfolio includes over 240 projects that help countries take a comprehensive approach to improving health outcomes, especially for poor and vulnerable people, by strengthening primary care and key public health functions.

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