eISSN: 2450-5722
ISSN: 2450-5927
Journal of Health Inequalities
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vol. 5
Special paper

Challenges for the tobacco endgame

Mark Parascandola

J Health Inequal 2019; 5 (1): 36-37
Online publish date: 2019/07/31
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The subtitle of this session is “Preparing for the Tobacco Endgame”. Is the tobacco endgame truly within our grasp? Much progress has been made since the early reports documenting cancer and other health effects from cigarettes in the 1950s and early 1960s. Today, there is an overwhelming volume of evidence about the adverse health effects of cigarette smoking. Smoking is linked to over 40 specific diseases and health conditions and effects almost every organ and system of the body. Decades of experience and evidence demonstrate that comprehensive tobacco control programs can reduce tobacco use and related disease and save lives. A framework for global tobacco control, along with a global community to support it, is provided by the World Health Organisation (WHO) Framework Convention for Tobacco Control (FCTC), and the MPOWER (monitor, protect, offer, warn, enforce, raise) provides an established set of evidence-based tobacco control measures and tools for countries to implement.
However, as the speakers in this session have highlighted, the environment in which tobacco control policies and interventions are implemented is dynamic and changing. This situation creates new and ongoing challenges. I will highlight a few major challenges here:
1. The Implementation Gap: According to the latest WHO Report on the Global Tobacco Epidemic, less than half the world’s population is covered by the basic recommended MPOWER strategies. For some measures, the level of protection is especially low. For example, only 10% of the world’s population resides in a country or economic region where tobacco tax policy meets the WHO guidelines. And only 20% reside where they are protected by comprehensive smoke-free workplace policies. So, despite the fact that we know what works and that there is an international legal framework to support action, these measures fall far short of full implementation.
Recently, “implementation science” has become a popular buzzword in health research. This is the study of methods to promote the systematic uptake of evidence-based interventions into routine medical practice. It has been widely reported that new interventions take, on average, 17 years to be incorporated into routine general practice in health care, and about half of the interventions found to be effective in research studies never make it into practice at all. Historically, this research-to-practice gap has not been the concern of researchers. But...

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