World No Tobacco Day 2018

The focus of this year’s World No Tobacco Day on May 31st is the impact of tobacco on cardiovascular health. In 1967 the Surgeon General’s report definitively linked smoking to lung cancer and presented evidence that it causes cardiovascular problems. Despite all the evidence and outcry from health professionals, it was not until the 1990s when many countries around the world banned smoking in public places. There have been several policies including those deterring tobacco companies from advertising to younger age groups and forcing them to add warning labels on tobacco products. Despite all these efforts, tobacco still kills 7 million people each year and tobacco use (and secondhand smoke) is responsible for nearly 12% of all deaths globally due to cardiovascular diseases (CVDs).

Tobacco1

Tobacco smoke contains more than 7000 chemicals and is divided into a) a particulate phase which contains nicotine and total aerosol residue or tar and b) gas phase which contains carbon monoxide and other gases. The image below depicts how chemicals in tobacco cause CVDs.

Tobacco2

While the effects of tobacco on heart health are well known, knowledge among the public that tobacco is one of the leading causes of CVD is very low. The figure below from WHO’s brochure shows the percentage of adults who do not believe or do not know that smoking causes stroke and heart attacks.

Tobacco3

The goals of World No Tobacco Day 2018 are to:

  • Emphasize the links between use of tobacco products and CVDs
  • Increase awareness among the broader public about the impact of tobacco and exposure to secondhand smoke on heart health
  • Provide opportunities to make commitments to promote heart health
  • Encourage countries to strengthen implementation of MPOWER

WHO and the US Centers for Disease Control and Prevention launched the Global Hearts initiative in September 2016. The initiative aims to support governments in bolstering prevention and control of CVD. Global Hearts comprises of three technical packages: a) MPOWER for tobacco control b) SHAKE for salt reduction and c) HEARTS to strengthen management of CVD in primary health care settings.

Hopefully, on this World No Tobacco Day, the governments will commit to protect their citizens from tobacco use. The truth of the matter remains: prevention and control are not sole responsibilities of governments. Health care professionals, public health agencies/staff, national/state/local governments, educational institutions, business leaders/businesses, community based organizations and community leaders all have a role in making everyday a “No Tobacco Day”.

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Beat Diabetes: WHO call to action

It’s World Health Day today and the WHO has issued a call to action to “Beat Diabetes”.

World Health Day 2016 poster: Halt the rise in diabetes

Source: World health day

Diabetes is  a set of diseases that result in excessive amounts of sugar in the blood a.k.a high blood glucose. Type 2 diabetes is among the most common types of diabetes and it occurs when the body stops using insulin properly ultimately leading to “insulin resistance”. The other common types are

  1. Type 1 diabetes
  • occurs due to lack of insulin production
  • poorly understood form of diabetes

2. Gestational diabetes

  • occurs during pregnancy
  • risk factor for pregnancy related complications
  • increased risk of Type 2 diabetes for both the mothers and their children.

Diabetes is a metabolic disorder and its long term complications include heart disease, strokes, diabetic retinopathies, kidney failure  and poor blood flow to the limbs that could result in amputations. It is also among the leading cause of death. In 2012 nearly 1.5 million deaths were directly attributed to diabetes. Early diagnosis, management of blood glucose levels through diet, physical activity and medication when necessary and routine screenings are not only cost-effective but are effective interventions to prevent diabetes-related complications from occurring or worsening.

A new study published in The Lancet this month has raised the alarm by showing that there has been quadrupling of the number of people with diabetes since 1980. The pooled analysis of 751 population-based studies involving nearly 4.4 million participants from 146 countries shows increasing burden of diabetes, more so in low and middle income countries than in high-income countries. This number is startling and is  a wake up call to public health and health care professionals.

World Health Day 2016 banner

Image Source: World health day

 

Diabetes is a treatable disease and efforts to prevent/treat it, will help achieve MDG 3 target of preventing premature mortality from noncommunicable diseases by one-third by 2030. We should be working together to raise awareness about diabetes with a particular focus on low and middle income countries, scale up prevention strategies that are specific, effective and affordable.

For this campaign, WHO has created a quiz-take it to test your knowledge!

Together we can Beat Diabetes!

Note: This was cross-posted to my blog

PRI’s The World: Mysterious Kidney Disease Now Found in South Asia

I found this story particularly interesting, since I did a one-year fellowship with CDC-NIOSH on pesticide poisoning surveillance. The story examines a high incidence of kidney disease in Sri Lanka and discusses how farmers, medical professionals and government authorities have been dealing with it. The full story can be viewed here; a summary of the story, and a video, can be found below.


A form of chronic kidney disease (CKD), similar to one that has been killing sugarcane field workers in Central America, has now been observed in South Asia. The World‘s Rhitu Chatterjee reports from Sri Lanka, where thousands of rice farmers and their families are affected. Her story is part of a series, Mystery in the Fields, produced in collaboration with The Center for Public Integrity.

The afflicted show no signs of high blood pressure or diabetes – the most common causes of CKD elsewhere in the world – and yet their kidneys are failing. There is no known cure. Authorities are trying to find a cause, but their preliminary findings have not reached the people whose lives are threatened.

A new study by the World Health Organization and the Sri Lankan Ministry of Health suggests that Sri Lanka’s CKD sufferers may have been poisoned by chronic, low-level exposure to the heavy metals cadmium and arsenic. Researchers think the toxins may be coming from farm chemicals, such as pesticides and fertilizers. But while the study points to a possible cause, the study’s results have not been widely publicized.

Chatterjee speaks with rice farmers, doctors, government officials, and a representative from Sri Lanka’s farm chemicals industry. Her report examines the results of the WHO study, the secrecy that surrounds it, and the frustration of Sri Lankans who see little being done to prevent more people from falling ill.

The full report can be found here: http://bit.ly/Q9Gv1g

And we wonder at the growing obesity epidemic…

Global health advocates are becoming increasingly vocal about the growing international obesity epidemic, and all of the complications that come with it (e.g. cancer, diabetes, etc.). I have been traveling all across the state during the last few weeks for my day job (I coordinate a surveillance program at the  state health department), so I have been spending a lot of time in airports. Here is a shot of a drink vending machine at one of them.

Yep, that’s right: rows and rows of sodas and sugar-sweetened beverages, and no water. Next to this machine is a snack machine (naturally full of candy and salty snacks) and next to that was a coffee machine. There was no place in this tiny airport to buy a bottle of water.

And that, ladies and gentlemen, is why over a third (35.7%) of Americans are obese.

Cancer: the Next Challenge for Global Health

Guest blogger: Dr. Isobel Hoskins

We think of cancer as a disease of affluent countries. That may have been true in the 1970s, but since then, cancer levels in developing countries have risen alarmingly. This massive rise in cancer is one reason why a UN summit in June is addressing chronic diseases, including cancer, with the aim of kickstarting the fight against these illnesses.

Some figures: 5.5 million of the nearly 8 million deaths from cancer in 2008 happened in the developing world. Back in 1970 only 15% of cancers were found in the developing world. However, by 2008, according to the World Cancer Report, more than half of cases were in developing countries. These numbers hide a burden of misery – cancers in developing countries are often detected at a late stage – too late for many treatments. These patients often don’t even have access to pain medications.

What drove this increase? The WHO Director General, in a recent address to the IAEA, cited ageing, urbanization and the globalisation of unhealthy lifestyles. Population growth has also driven the numbers up. Isn’t it ironic that improved life expectancy leads to increased cancer burdens?

Many papers can be found indicating the enormous problem that cancer is for developing countries. Given the expense of treatment is there anything that can be done to reduce the cancer burden? Fortunately there is – I read a paper in the Lancet that gives a ray of hope…

Farmer et al. say that we shouldn’t accept that cancers in developing countries will remain untreated. Instead, we should make cancer prevention and treatment broadly available as rapidly as possible. We should consider the example of HIV and TB a decade ago: critics asserted that HIV and TB treatments were too complex and long term for weak health systems. These arguments proved unfounded. Farmer et al. point out examples of successful treatment and prevention of cancer in low resource settings that we can build on.

The approach should concentrate on curable and preventable cancers. Farmer et al. have come up with a list. These cancers can be prevented by reducing risk factors such as tobacco use or infection, or they can be cured by early detection and surgery methods or specific low cost systemic drugs. It includes some very common cancers: lung cancer, breast cancer, cervical cancer and liver cancer.

Many problems posed by cancer care, including cost of drugs and lack of infrastructure and specialists, was a big obstacle for HIV, too. The solutions could be similar: Farmer et al. suggest reducing drug cost by drug purchasing and production negotiations, as well as the use of primary and secondary caregivers to deliver services. The paper cites an example of cancer care in Malawi that uses such workers with remote support from specialists.

And if there is no suitable treatment, pain control is low cost, and the paper asserts that all should have access to that as a human right.

Farmer and co-authors have formed the Global Taskforce on Expanded Access to Cancer Care and Control in Developing Countries to address cancer care worldwide. I for one hope this taskforce prospers!

Dr Isobel Hoskins is Co-Editor of the bibliographic database Global Health which covers public health research worldwide. Global Health is produced by CABI, an international not-for-profit information provider. She’s usually found blogging on the Global Health Knowledge Base and on Twitter here: @CABI_Health.