Tobacco Use Worldwide

Currently, approximately one third of the global population over the age of 15 - about 1.1 billion people - smoke cigarettes. Tobacco use continues to be the leading preventable cause of death worldwide, killing at least five million people each year. Trends from illness and death related to tobacco use indicate that by 2030, tobacco use will contribute to the deaths of more than 10 million people worldwide each year, 70 percent of whom live in the developing world. Though various strategies are in place, including bans on smoking in public areas, restrictions on advertisements for tobacco products, and increased taxes on cigarettes, the number of people who use tobacco has not significantly decreased. A recently released report from the World Health Organization (WHO) details cigarette and smokeless tobacco consumption and seeks to find an approach that may lessen the use of these products.

The WHO report indicates that though 22 of the world’s most populous 100 cities are now “smoke-free,” this only accounts for 5.4 percent of the world’s population. In 2008, the WHO established a set of guidelines aimed at helping nations to reduce smoking, which include:

1. Monitoring tobacco use and the policies to prevent it,
2. Protecting people from tobacco smoke,
3. Offering people help to quit using tobacco,
4. Warning people about the dangers of tobacco,
5. Enforcing bans on tobacco advertising, promotion, and sponsorship, and
6. Raising taxes on tobacco.

However, reports indicate that less than 10 percent of the world’s population is covered by any one of these measures. Additionally, only two percent of individuals live in nations that have comprehensive and widely-accepted smoke-free laws, and 94 percent are not protected by any laws against smoking.

Laws banning smoking - including the use of cigarettes, cigars, and hookahs - in public places will come into force in 2010 in many areas of the world. According the Syrian Society for Countering Cancer, 60 percent of adult men and 23 percent of women in Syria smoke, and 98 percent of Syrians are affected by second-hand smoke exposure. Other nations face similarly high rates of tobacco use and smoking-related illness and death. The high incidence of tobacco-related deaths in the Philippines (90,000 per year), Malaysia (10,000 per year), and Vietnam (40,000 per year) has caused concern in these regions, but fully effective smoking bans are not yet in place. Reports indicate that the majority of smokers in some Southeast Asian countries are men, and that as many as 75 percent of men smoke, compared to fewer than 20 percent of women who do. In Cambodia, for example, roughly half of the older women do use tobacco, but favor smokeless chewing tobacco, which many women begin during pregnancy to help lessen prenatal nausea.

Over the past four years, smoking rates have decreased in developed nations including the United States, Japan, and Western Europe as anti-smoking laws gain momentum. However, the World Lung Foundation (WLF) indicates that “More than 80 percent of those with premature deaths [from smoking] would occur in low- and middle-income countries.” Since 1960, according to the WLF, “the global production of tobacco has increased 300 percent in low- and middle-resource countries while dropping more than 50 percent in high-resource countries.” In China and India, over half a billion men consume tobacco, and other nations are facing similar problems of mass consumption of tobacco use. Tobacco is a contributing cause to heart attacks, strokes, diabetes, cancers and asthma worldwide, regardless of how it is consumed (smoked, chewed, etc.). According to Ala Alwan, the WHO non-communicable diseases expert, more than 80 percent of the WHO’s projected cancer deaths are likely to occur in the poorest regions of Africa. To increase awareness and provide education about the dangers of smoking, the WHO is planning to establish a regional hub there in 2010.

It remains to be seen how much impact the efforts of the WHO and other organizations will have with regard to decreasing the number of individuals who use tobacco. Through newly established laws, increased taxation, and outreach and education about the dangers of cigarettes and smokeless tobacco products, it may be possible to urge individuals to quit smoking or not to start at all.

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Appropriate Technologies

The primary goal of the iCons in Medicine program is to create a community of healthcare professionals, enabled by appropriate technology to build bridges and forge connections across geographic, social, cultural, and ideological boundaries to make high-quality medical knowledge available wherever medicine is practiced. Appropriate technology is not necessarily items that are high-tech or low-tech, and may not be commercial off-the-shelf items. Rather, appropriate technologies are those that best combine suitability to the task at hand with compatibility with the technological, cultural, and economic framework of the region where they are deployed. Groups of researchers, universities, and not-for-profit and for-profit companies have all begun making strides to create healthcare tools that can be utilized in areas that may lack trained medical staff, resources, and/or reliable Internet connectivity, as well as other regions worldwide.

Health IT advancements and web-based tools offer an opportunity for physicians and healthcare workers to use technology in ways that previously were not available. Mobile applications for iPhones are gaining popularity among healthcare providers in the developed world. The BBC reports that, per Manhattan Research, 64 percent of U.S. doctors currently own a smartphone, and this figure is expected to rise to 81 percent by 2012. Most popular smartphone-based apps are available for the iPhone, among these tools are those that allow for collaboration between healthcare providers working in country, and remote consulting physicians. Among these are the iStetho Adapter and iStethoscope Pro app, developed by RidRx, which allow for audio information to be captured via a stethoscope modified for use with the adapter to be translated into sound spectrograms.

For some physicians in the United States and other areas of the developed world, high-tech solutions provide an opportunity to provide the best quality of care. Dr. Dinesh Patel, iCons in Medicine Member and Chief of Arthroscopic Surgery at Massachusetts General Hospital, finds that in his practice, new imaging and lens technologies have had the greatest impact. Technologies, which are “constantly evolving as high-tech experts bring new ideas,” bring cost reductions and improved health outcomes, as well as reducing complications and insurance costs, according to Dr. Patel. President of the American Telemedicine Center Corp., Dr. Gildred Colon Vega, also utilizes computer-based solutions in her practice at the San Juan Health Centre. Dr. Colon has found that an electronic medical record technology known as Web (based) Disease Management Electronic Medical Record (WebDMEMR) has been especially useful for storing clinical trial information.

Areas of the developing world are also making use of many of these high-tech solutions, including smartphones, and computer-based and mobile applications. The lack of trained staff have led physicians at one eye hospital in India to employ the use of mobile technology to improve its reach in rural and semi-urban areas. By training individuals in rural areas to take retinal images that are then sent to doctors’ iPhones at the hospital in Bangalore, providers are better able to ensure that infants are treated quickly if Retinaopathy of Prematurity (ROP – a potentially blinding condition) is detected.

Life-saving solutions are also being created specifically for use in the developing world, both by researchers in more developed regions and healthcare providers working in-country. These appropriate technologies are often designed with an eye towards sustainability, and make use of the skills of local craftsmen with readily available materials. Diagnostic technology is one area that holds great promise for creating technologies that are both highly effective and inexpensive, and that will provide a global benefit. Additionally, prosthetic and wheelchair fabrication techniques, such as those developed by the Center for International Rehabilitation (CIR) provide low-cost alternatives to standard prosthetic and orthotic devices that can be used in areas where resources or highly-trained personnel may not be available.

These technologies, initially conceived for use in medically underserved and post-conflict areas, also have the potential to impact healthcare in the developed world. The World Health Organization (WHO) reports that chronic disease is now the major cause of death and disability worldwide. With issues like cardiovascular disease, diabetes, and obesity, as well as pandemic outbreaks of H1N1 and HIV/AIDS, the development and utilization of globally appropriate solutions is surely practical. Hector Casanova, CP and Yeongchi Wu, MD, both iCons in Medicine Members, have noted the importance of exploring these technologies as possible alternative treatment options to help lower healthcare costs while maintaining a high quality of care. To this end, many technologies that have been conceived for use in the developing world are now being applied in the United States as well in a process known as “reverse innovation.” Companies like General Electric have created technologies in emerging markets and then bringing them to more developed regions.

Through “reverse innovations” and the application of appropriate technologies conceived in the developed world for the developing world or for global application, healthcare worldwide can be improved. By utilizing appropriate technologies that best combine the task at hand with the technological, cultural, and economic framework of the region where they are deployed, connections can be forged to make high-quality medical knowledge available around the globe.

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