Agrees Professor (Dr) Rama Kant, the World Health Organization (WHO) Director-General’s Awardee for tobacco control (2005) and National President-elect of Association of Surgeons of India: “The problem of indoor tobacco smoke pollution is more pronounced in the case of children living in hutments and slums. They are more exposed to secondhand tobacco smoke which contains over 4000 chemicals, many of which are not only carcinogenic, but also reduce the child’s immunity. These children are already very likely to be malnourished, deprived of proper ventilation and sunlight. On top of this, right from the time they are inside the mother’s womb, they are at a very high risk of being exposed to the hazards of secondhand tobacco smoke, even when they have not seen the light of life, as smoking is more common in poor people.”
There is an already established link between smoking and poverty. “So according to me one important and worthwhile intervention is that facilities for tobacco cessation should be made available to people who are ready to quit. People are, by and large, more aware about the health risks of tobacco consumption and smoking, thanks to efforts made by NGOs and government and other agencies. But they do not know where to go to quit tobacco successfully. I can say this with confidence that facilities for tobacco cessation are very meagre in our country, and this is a sad part. Unless we have facilities that can help people quit, and unless they are available constantly, many of the efforst to control tobacco will go waste. The WHO had started around 20 such clinics, but gradually they are closing down due to paucity of funds and government efforts are not of that level which can manage these clinics” said Prof (Dr) Rama Kant.
Prof (Dr) Enarson is in agreement: “Difficulty with tobacco smoke is persuading people not to smoke or to stop smoking and persuading people to change their behaviour is not so easy. One of the things we focussed on was trying to catch people’s attention based upon some of the personal experiences that they had. With biomass smoke we have tried to catch people’s attention by identifying champions in the community who have suffered some adverse effects themselves and they can champion the issue with their neighbours. We did this for biomass smoke, but the same is true for tobacco smoke. In most societies the most challenging problem people face is to have a child who is hospitalized for a serious illness.”
“So we focussed on requesting the families to bring in their children for serious pneumonia and trying to talk to them about tobacco smoking and biomass smoke exposure. And in this way trying to persuade them that this is an important issue, educate them and encourage them to be champions of health in their own communities. If someone from outside the community comes in and begins to preach to people that is not a very successful way to change their behaviour” added Prof (Dr) Enarson.
Suggests Prof (Dr) Rama Kant: “So I want to emphasize two things - people need to be aware that smoking should be controlled and never done inside homes, and secondly cessation facilities will go a long way in preventing children from suffering from pneumonia and its complications (including deaths). We have a jumbo system of public healthcare consisting of a large number of doctors, paramedics and other staff. But their services are not being utilised to the fullest, especially in the rural areas. So, cessation facilities can be integrated with the existing healthcare system, and piggy back on the existing health services.”
Clearly pneumonia is the most important killer of small children in the world. “Unfortunately we haven’t paid that much attention to pneumonia as we have for other lung diseases, and I feel that this should be a priority. Even among people living with HIV (PLHIV) pneumonia is probably more common than tuberculosi,s although tuberculosis co-infection is very important in PLHIV. We need to find a way to highlight the issue of pneumonia," said Prof (Dr) Enarson.
Shobha Shukla and Bobby Ramakant – CNS