Friday, May 31, 2013

Poverty and Tobacco: A Time for Grand Visions

Tracking the health news over the past few months, there's been one very intriguing trend that has stood out to us here at CNiC:  Grand Visions.
Two examples of this that have huge implications for health are the push for eliminating extreme global poverty by 2030 and very serious discussions about moving toward an endgame for tobacco - pushing tobacco use nationally and globally toward, or very near, zero.  

For each, the stage seems set for success.

In a moving speech on Poverty, Health, and Human Future to the World Health Assembly this month, World Bank President, Jim Yong Kim, made the compelling case that visions for a poverty-free world are possible by 2030. Speaking, he said:
 A generation must rise that will drive poverty from the earth. We can be that generation. A generation must rise that will end the scourge of inequality that divides and destabilizes societies. We can be that generation. A generation must rise that will bring effective health services to every person in every community in every country in the world. We will be that generation, and you—members of this Assembly—will lead the way.
Yes, I’m optimistic. I’m optimistic because I know what global health has already achieved—what you have achieved.
Such a goal does take optimism, yet the numbers seem to point toward will and hard work as the deciding factors rather than hope and luck.  Even the often staid Economist wrote that there's an "astonishing chance to take a billion people out of poverty by 2030." 

Astonishing, as well, would be the elimination of tobacco from the national and global landscape, and a supplemental issue of the British Medical Journal: Tobacco Control is dedicated to a serious discussion of real moves in that direction.  In the opening editorial, Elizabeth Smith writes:
The need for an endgame comes from the recognition that we do not have to accept the industrial marketing of tobacco, and that current policies—successful as they have often been—will likely not make the tobacco problem disappear. Those policies were never intended to eliminate the tobacco industry; the best case scenario they offer involves endless skirmishes with the industry's ongoing attempts to expand its markets and thwart regulation. Discussion of an endgame can inspire new visions of the possible.
Even though great strides have been made against tobacco over the last number of decades, it remains a scourge on public health and is used and sold at rates that should be unthinkable.  It's encouraging to see that the time has finally come to consider tobacco's endgame - a process that is likely to be long and difficult, but one that should remain a goal as we all move forward.  

A world free of extreme poverty and tobacco is hard for most of us to imagine today, but the seeds are there and starting to grow.  The positive impact such achievements would have on national and global rates of disease and mortality would be truly astounding.

Let the endgames begin.

Wednesday, May 29, 2013

New Report Makes Case for Physical Activity and Physical Education in Schools

In a time when school budgets are stressed and school performance is judged more and more on standardized test scores, it's understandable that certain aspects of the school day that can seem less-critical get cut back or cut out altogether.  Student physical activity and physical education has been one of those things slowly reduced over the years to make time and resources available for more classroom instruction.

While this can certainly seem to make sense given the academic mission of schools, a new report out from the Institute of Medicine (IOM) argues forcefully that such cuts in active time for students is a short-sighted fix that can ultimately hurt students and schools, since active kids are more productive, healthier, and perform better academically (see video below).

With half of students not meeting recommended levels of daily physical activity, reintegrating activity and physical education back into the school environment could have large payoffs not only in terms of short-term health and academic success but also in students' later adult lives, helping them be more productive and active members of their communities.

So important is regular activity, that the IOM recommends that it be recognized by the federal government, states, and school systems as a "core subject" because it is foundational to learning. And the new report provides a number of recommendations for integrating or improving the physical activity and physical education in schools.

Though there is no such thing as a magic bullet for good health, physical activity is as close to one as we'll ever get.  It lowers the risk of many important diseases, keeps weight in check, keeps people agile as they age, and provides a good boost to mental mood.  Laying the foundation for a life filled with enjoyable exercise and activity can't start too early, and the school setting is one of the best places to do this.

Tuesday, May 28, 2013

New Phase of CDC's No-Holds-Barred Anti-Smoking Campaign: "Talk with your doctor for help"

As we wrote about earlier this spring, the new "TIPS from a former smoker" campaign from the US Centers for Disease Control and Prevention is gaining a lot of attention for its no-holds-barred effort to shock non-smokers into staying smoke-free and smokers into to quitting smoking - hopefully for good.

One primary thrust of the campaign is to get smokers to hook up with local, state, and federal resources (like 1-800-QUIT-NOW and for tools to help them quit.  While many smokers are able to quit cold turkey, there's very good evidence that smokers who get some kind of external help have a greater chance of eventually succeeding in dropping smoking once and for all.

As was recently highlighted in a nice piece in the Journal of the American Medical Association (JAMA), the second phase of the TIPS campaign is just rolling out and builds on this approach by encouraging smokers to talk to their doctors about getting help quitting.  While most physicians today do a good job asking patients about their smoking history, there is still a lot of room for improvement - both in asking about a patient's smoking history and in effectively helping them quit.  Prompting patients to actively talk with physicians for help quitting can only further cement smoking as a key part of the patient-doctor relationship, kicking up the rate of successfully quitting along the way.

"Shared decision-making" is a key ideal of medical care moving forward - patient and doctor working together to make decisions that are best for the patient across a number of issues.  Talking together about the best way to quit smoking could be a great way to open that conversation or keep it going.

Saturday, May 11, 2013

Siteman Cancer Center's "Cancer Doesn't Take a Holliday" Colon Cancer Awareness Campaign Gaining Steam

In a recent post about our newest addition to the 8IGHT WAYS® series (8IGHT WAYS to Prevent Colon Cancer), we also highlighted the latest cancer awareness campaign coming out of the Siteman Cancer Center featuring St. Louis Cardinals player Matt Holliday and his mom, who was recently diagnosed with, and treated, for colon cancer.  The "Cancer Doesn't Take a Holliday" campaign has the high energy duo getting the word out about the importance of screening for colon cancer, and the campaign is getting some good notoriety, with one high-profile feature by Jenifer Langosch recently published on Major League Baseball's website,

Screening for colon cancer is the single best way for people to protect themselves from colon cancer, which is the third most common cancer in the United States as well as the third most common cancer killer.  And screening helps on both of these counts, lowering the number of new cases and extending survival in those who develop the disease.  

Unlike some other screening tests, tests for colon cancer can help find cancer early when it's most treatable but it can also find pre-cancer growths, called polyps, that can be removed before they have a chance to turn into cancer.

Most people should start screening at age 50.  Some people at high risk should start earlier.  There are a number of effective tests - each has pluses and minuses (see table).  Talking with a doctor can help you decide which one is best for you.   It's your health.  Take Control.

Tuesday, May 7, 2013

Australian tobacco labeling draws fire

Australia is leading the world having implemented aggressive laws limiting tobacco advertising and packaging of cigarettes. These are reportedly some of the toughest restrictions to date. Publicly accessible images show the impact of the limited marketing. The Australian Department of Health and Aging web site shows package labels.

Among the key elements of tobacco control are the increase in quit attempts and increase in use of evidence-based treatment to aid cessation and improve the effectiveness of treatment. A rigorous simulation analysis for the US shows that a combined effort across all three strategies could lead to the reduction in adult smoking that has previously been set as a national goal. (Levy DT, et al Am J Public Health 2010).

Among the effective strategies to increase quit attempts is the use of graphic labeling on cigarette packets and the media coverage of such initiatives. Analysis of data from Australia shows an increase in calls to the quit line for smokers following release of major media efforts and the implementation of package labeling restrictions.

Media efforts and restrictive tobacco labeling drive smokers towards quitting.

The graph below from Miller and colleagues shows calls to the Australian quit line before and after introduction of graphic cigarette package warnings. Repeated surveys in Australia show the substantial increase in calls to the quit line following major media events depicting the adverse consequences of smoking and announcing the implementation of package labeling restrictions. To try to counteract this, a number of cigar exporting countries, such as Cuba and the Dominican Republic, are now challenging the package labeling in Australia since it runs counter to their interests and marketing of cigars. It is reported in the New York Times that Australia represents a tiny fraction of the income for Cuba from cigars (which are only a fraction of their export income). Yet the legal challenge at the World Trade Organization is made against a public health strategy that is known to be highly effective.

The cost of cigarettes and tobacco consumption are amazingly well documented. Many reports from the US Surgeon General have summarized the impact of smoking on cancer, heart disease, chronic obstructive lung disease, and many other conditions. In addition to the impact on individual health, exposure to other people's smoke, or secondhand smoke, raises risk of many conditions and has substantial societal cost. Smoking increases workdays lost in the active workforce, and increasing disability days reported in the population, as well as lower quality of life.

Isn't it time we work to finally eliminate the number one cause of preventable more to morbidity and mortality?