Public Health Nursing in Switzerland - Research Paper Example

Public Health Nursing: Tobacco Consumption in Switzerland Description of Switzerland Location The country of Switzerland, a federal republic, is officially known as the Swiss Confederation. It is located in the Western Europe. The population of this country is about 7.7 million and the area is 41,285 km². The federal republic consists of 26 states which are known as cantons. The capital city of the country, also known as the seat of federal authorities is Bern. The most important economic centres are Geneva, Zurich and Basel. Switzerland is one of the richest countries in the world as far as per capita income is concerned. Nominal percapita gross domestic product averages to $67,384 (Switzerland.com, 2009). The republic is surrounded by Germany to the north, Italy to the South, France to the West and Liechtenstein and Austria to the East. The country is a host to many international organizations like World Trade Organization and Red Cross society. The country has four national languages, namely, French, German, Romansh and Italian (Switzerland.com, 2009). Vital Statistics As on July, 2008, the population of Switzerland is 7,581,520. 15.8% of the population is in the age group 0-14 years, 68.2% between 15- 64 years and 16% of the population is above 65 years. The median age of the Swiss population is 40.7 years, that of males being 39.6 years and of females being 41.7 years. The population growth rate is 0.329%. The birth rate is 9.62 births/1,000 population and the death rate is 8.54 deaths/1,000 population. At birth, the male: female ratio is 1.05 male(s)/female. The infant mortality rate is 4.23 deaths/1,000 live births. The life expectancy at birth is 80.74 years (Indexmundi, 2009). Conditions that contribute to health issue (tobacco consumption) The health issue I have chosen to discuss in this article is 'tobacco consumption in Switzerland.' The country of Switzerland is a land of muesli, health spas and mountain air, but haunted by smokers. Infact, it remains one of the last European havens for smokers. This is because of the powerful hotel and restaurant lobby in the country. There are about 20,000 such establishments in the country (The Age, April 9, 2008). While it has been estimated that about 1000 people die of smoking each year in the country due to smoking, it is stunning to know that 20% of these are victims of passive smoking (The Age, April 9, 2008). Despite thorough education and knowledge about the hazards of smoking, only 6 out of the 26 cantons have done away with total ban against smoking (The Age, April 9, 2008). This is because of many conflicting political, commercial and industry issues. While the director of hotels and restaurants federation called GastroSuisse says "we defend the freedom for our members to make up their own minds on their policy about smoking" and puts a full stop to complete ban of smoking in his estableshments (The Age, April 9, 2008), Toni Bortoluzzi, a Swiss people's Party right wing member is against banning of a legal product. According to this politician, "the state interferes in private affairs when it defines the rules of tobacco consumption in a privately-owned restaurant or a bar" (The Age, April 9, 2008). According to the Federal Public Health Department, weaker national legislation is one of the causes for cutting across strict laws in cantons. Though Switzerland has signed anti-smoking convention pact with the World Health Organization, it has not been able to rule out smoking area completely. Another reason for the increased smoking rates in Switzerland is the low excise tax for tobacco. Infact, the tax is the lowest in the whole of Western Europe. Also, the various laws which govern the sales and marketing of tobacco are weak and have minimal effect on the tobacco industry (Lee and Glantz, 2001). It has been propagated that many researchers who support the fact that smoking does not cause much health hazards as advertised, actually work secretly for tobacco-industry firms and are paid enormously for making such wrong research-related statements (Lee and Glantz, 2001). Health issue Definition of the health issue: Tobacco consumption One of the major health issues in Switzerland is consumption of tobacco. The main form of consumption of tobacco is cigarette smoking. Other forms of tobacco usage are cigars, snuff and pipes which are less common (Bernstein, 2006) and comprise of less than 10% of tobacco products. According to the Federal Office of Health reports of 2003, one third of the population between the ages 15 and 65 are smokers. The World Health Organization (2002; qtd. in Swissworld, 2006) has reported that "the Swiss smoked between 6 and 8 cigarettes a day." Considering other European country rates, this is very high. Infact, only the Spanish and Dutch smoke more than 6 to 8 cigarettes (Swissworld, 2008). Also, every year, more than 10,000 people die in this country due to the health effects of tobacco (Swissworld, 2008). Thus tobacco consumption is a major health issue in Switzerland Incidence and prevalence Though the current smoking rates are high, the fact is that there is actually a downfall in the smoking rates as years go by. In 1996, it was estimated that the per capita consumption among 16-year old Swiss was 1600 and this fell to 1036 in 2005. Also, according to a survey in 2007, while in 2002 23% of 15-year olds smoked a cigarette minimum once a week, in 2007, this number fell to 15% (Swissworld, 2006). The percentage of smokers of 33% in 2001 has dropped to 30% in 2006 (Swissinfo, 2006). The fall in the smoking rates is most probably because of increased health awareness and steep rise in cigarettes. Experts opine that this fall is not sufficient and more and more preventive strategies need to be implemented to protect the population from the hazards of tobacco. Also, since more and more women, children and adolescents are resorting to smoking (Lee and Glantz, 2001); preventive measures which target this population must be introduced for effective reduction of smoking. Morbidity and mortality Smoking is associated with many health-related problems and hence is a major health-related issue. It is a leading cause of illness and death all over the world and also in Switzerland. In Switzerland alone, it has been estimated that about 10,000 people die every year due to the health hazards of smoking (Swissworld.com, 2008). A smoker is at risk of developing cancers of the throat, mouth, lungs, bladder and esophagus and also heart attack. Research has shown that smoking increases the risk of lung, throat and mouth cancers by 14 times, cancer of the esophagus by 4 times, chances of death through heart attack by two times and chances of bladder cancer by 2 times (Bernstein, 2006). Other health-related problems occurring due to cigarette smoking are emphysema, chronic bronchitis, peptic ulcer disease, pneumonia, cancer of the lip, cancers of the larynx and pharynx, malignancies of the abdomino-pelvic organs like pancreas, bladder and kidneys and also cancer of the cervix. Cigarette smoking can also increase the risk of burns (Bernstein, 2006). Implications of tobacco consumption for the health of the country’s population As discussed before, consumption of tobacco, especially in the form of smoking is a leading cause of death and causative factor for many other conditions. Other forms of tobacco also lead to various health ailments. Research has shown that both active and passive smoking can produce health related hazards. According to the 2006 Statistics (AT-Switzerland, 2007), 27% of population of Swiss between 14- 65 years of age are exposed to passive smoking and 20% of deaths due to smoking are related to passive smoking like in workplace. Highest rates of passive smoking exposure is seen in cafes, restaurants and bars, followed by work place and then homes of relatives, friends and acquaintances. The quality and lifespan of smokers depends on the severity and number of smoking related illness and other associated comorbid conditions. Consumption of alcohol and other illicit drugs, sedentary lifestyle and stresses life can increase the mortality and mobility related to smoking (Bernstein, 2006). Implications of tobacco consumption for global health More than 1.1 billion people who fall in the above 15 years age-group smoke cigarettes and there are about 4 million deaths every year globally due to tobacco consumption. It has been estimated, in the next decade, the death toll will rise to 100 millions a year (Pohrehn and Squier, 2000). This number will actually exceed the total deaths caused by AIDS, automobile accidents, tuberculosis, maternal mortality, homicide and suicide, all these combined. Such are the implications of tobacco consumption globally. The main problem arises because of exports of tobacco from developed countries to developing and underdeveloping countries. Thus tobacco consumption is a global health problem Efforts and Strategies being applied to concern Current resources at all three levels of prevention that are being applied by public or private agencies in the country There are 3 levels of prevention: primary, secondary and tertiary. Primary prevention includes "efforts to control the underlying cause or condition that results in disability," secondary prevention is "preventing an existing illness or injury from progressing to long-term disability" and tertiary prevention is "rehabilitation and special educational services to mitigate disability and improve functional and participatory or social outcomes once disability has occurred" (DCPP, 2006). Prevention of tobacco-related disabilities at all the 3 levels of prevention are discussed below. Primary prevention strategies There are many anti-smoking campaigns which have gained ground in Switzerland. The first comprehensive program for prevention of tobacco consumption was a 5 -year program between 1996 and 1999 (Lee and Glantz, 2001). This campaign was issued by the Swiss Federal Office of Public Health. However, this program failed because of lack of sufficient resources and also lack of specific intervention focus. There was also no cooperation between tobacco prevention partners and program coordinators and managers. Also, the campaign ignored the most important influencer of tobacco consumption, the tobacco industry. Thereafter, the United States and the World Health Organization too took active involvement in the tobacco industry and the next five year plan, 2001- 2005 targeted the tobacco industry (Lee and Glantz, 2001). The main tobacco industries in Switzerland are Philip Morris and British American Tobacco (Lee and Glantz, 2001). In the year 2005, the Swiss Federal Railways banned smoking in trains in Switzerland. Since 2006, even cantons started banning smoking, especially in public places (Swiss world, 2009). In 2006, the Federal Health Office set a target of reducing the number of smokers in the country from 30% to 20 % over a span of ten years. In order to affect this target, the health authorities have prevented the tobacco companies from advertisement in the public, especially on television. Many restaurants and hotels too have banned smoking.. The Swiss government has signed an antismoking pact with the World Health Organisation in 2008 (The Age, April 9, 2008). However, the complete norms and conditions that need to be followed are yet to be established and the laws have not yet been implemented full fledged manner. The employment law in Switzerland at the federal level protects employees from passive smoking by directing employers to provide non-smokers with smoking-free zones (Ch.Ch, 2008). The law also outlaws smoking in enclose workspaces and public spaces which is shared by several people. Though small bars and restaurants, who cannot afford a smoke-free zone, can continue to allow smoking, this must be done only after their staff has explicitly agreed to work in smoking establishments (Ch.Ch, 2008). As per the mandatory rule of Federal government, all tobacco product packets started to display strict warnings against tobacco consumption like "Smoking kills”, “Smoking when pregnant harms your baby", etc (Ch.Ch, 2008). Since 2008, these warning notices are being accompanied by “Stop Smoking Hotline” numbers like 0848 000 181. In addition to these, harmful substances also are being listed in the packet. The government of Switzerland has been actively introducing policies to combat smoking since the year 2001. Though the movements against tobacco are gaining momentum, consumption of tobacco continues to be highest in Europe (Ch.Ch, 2008). Secondary preventive strategies The Swiss Cancer League, Swiss Association for Smoking Prevention and the Swiss Heart Foundation, in conjunction with Tobacco Control Fund have launched National Stop Smoking Program, the goals of which are "to motivate and enable health care professionals in stop-smoking counseling." The attention of the smokers is drawn by various analogies like "to motivate and enable health care professionals in stop-smoking counselling." The program is planned provisionally to continue till 2012. Details of other projects are given in Table-1. Name of project Since Activities Main target groups Tobacco free 2001 Smoking Cessation Intervention Training for physicians GP's Tobacco - intervention in dental practices 2002 Smoking cessation lessons in under graduated education and in further education for dentists, dental hygienists, prophylaxis assistants The whole team of dental practices Smoking Cessation in Pharmacies 2004 Smoking cessation lessons in under graduated education and in further education for pharmacists and pharmacy assistants The whole team of in pharmacies Hospital Quit Support 2005 Implementation of hospital-based smoking cessation services Major Suisse hospitals Brief intervention in cardiovascular and diabetes practices 2007 Smoking Cessation Intervention Training for cardiologists Cardiologists Brief intervention by non-medical staff for cardiovascular patients and diabetes patients 2007 Smoking Cessation Intervention Training for advisors for diabetes patients advisors for diabetes patients Quit and Win Contest 1994 National contest organised early around the World No Tobacco Day Smokers who want to quit, aged 25 - 45 Table-1. Smoking Cessation Programs in Switzerland (AT- Switzerland, 2009). Tertiary preventive strategies The WHO (2003; cited in IRC, 2009) orders that: "Healthcare providers should not miss any opportunity to advocate and advise treatment strategies to people wishing to quit. The role of policy-makers, professionals and researchers will also be imperative in putting smoking cessation on the agenda.” According to the International Union Against Cancer (IRC, 2009), "health-care professionals have a duty to provide counseling and treat tobacco dependence as they would any other disease or addiction." The New Zealand National Advisory Committee on Health and Disability (2002; cited in IRC, 2009) states that “there is good evidence that even brief advice from health professionals has a significant effect on smoking cessation rates.” Every primary care physician must identify all tobacco users at every visit. The identification must follow a systematic process. After identification, the physician must strongly urge the individual to quit. During the process, smokers willing to quit must be identified and helped with a quit plan. Pharmacotherapies and supplementary materials must be provided. A follow-up contact schedule must be elaborated (Sharma and Lertzman, 2009). Physicians and other health professionals must educate the smokers who come to them about benefits of smoking cessation and also the process of cessation. Details of withdrawal syndrome must be explained to them. Various cessation methods like nicotine replacement therapy, antidepressant medications, group therapy, behavioral training and hypnosis must be mentioned to them. Current resources efforts at all three levels of prevention that are being applied by the international community The World Health Organization Framework Convention on Tobacco Control or FCTC is a treaty ratified and signed by 145 countries all over the world. According to the treaty, "all governments must incorporate the diagnosis and treatment of tobacco dependence and counseling services on cessation of tobacco use in national health and educational programmes." The FCTC states that "given the diversity of countries’ economic situations, regulatory regimes and health care systems, the effort to treat tobacco dependence requires a multi-faceted approach. Therefore, a tobacco control program should not only encourage tobacco users to quit but also provide assistance in doing so." The services which have been recommended to be introduced are health education in the form of tobacco product packaging, counseling services like intensive behavioral support by appropriate specialists, and maternal and child health clinics. The FCTC also recommends to "level the regulatory playing field” between tobacco and pharmaceutical products, "provide protection from secondhand smoke" and "present cessation-oriented messages on all cigarette packages." The WHO promotes cessation of smoking through 3 strategies: the public health approach, the health systems approach and the surveillance, research and information approach (WHO, 2009). Evaluation of the strategies and efforts to prevent smoking Despite aggressive measures by various governments, private agencies and health organisations, smoking and the ill effects of smoking continue to be a problem. Research has shown that only about one third of smokers attempt to quit smoking every year and of these hardly 3% have long-term success. According to the WHO (2003; cited in IRC, 2009), "public health sector in many countries is not investing in smoking-cessation services, and in most countries only limited steps have been taken to provide treatment, train health-care providers, and release financial resources and smoking cessation is very often not seen as a public health priority, or included in governments' tobacco control strategies." The governments of all the countries need to implement some supportive environment to facilitate cessation of smoking like advertising bans, higher tobacco taxes and smoke-free public places. The strategies must aim to raise awareness and also to decrease access to the products of tobacco. Current research pertaining to the health issue Key areas in which research is going on for cessation of smoking is evaluation of various policies and interventions for tobacco control, influences of environments on smoking and also smoking-related behaviors, relationship between use of tobacco and health inequalities, impact of passive smoking on health and modes of controlling passive smoke, regulation and behavior or tobacco and tobacco-related products industry and finally investigation of formation and implementation of various tobacco control policies (Signal et al 2001) . References American Thoracic Society/European Respiratory Society Task Force or ATS. (2004). 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Retrieved on June 6, 2009 from http://www.swissinfo.ch/eng/science_technology/detail/Public_s_view_of_tobacco_goes_up_in_smoke.html?siteSect=511&sid=6752696&cKey=1148804115000 Switzerland. com. (2009). Switzerland. Retrieved on June 6, 2009 from http://www.switzerland.com/en.cfm/home The Age. (April 9, 2008). Switzerland remains smoking haven. Retrieved on June 28, 2009 from http://news.theage.com.au/world/switzerland-remains-smoking-haven-20080409-24wg.html WHO (2009). Policy recommendations for smoking cessation and treatment of tobacco dependence. Retrieved on June 28, 2009 from http://www.who.int/tobacco/resources/publications/tobacco_dependence/en/index.html Read More