This statement in Julie's contribution ("This is a key problem from a public health perspective, not only because the physician is an important model for patients, colleagues and medical students, but also because physicians’ personal use of tobacco impairs interactions with patients about smoking"), resonates with my experience when as a younger resident doctor, I 'caught' my consultant vascular surgeon smoking cigarette. We spent hours preaching to our patients and saying to them, 'you will lose your limbs or undergo arterial replacement surgery if you continue smoking' on the other hand, 'stop smoking and keep your limbs', but behold the chief preacher was a secret smoker!. The same can be said about obese health workers managing obese patients and so on. The patients must be wondering, why is she / he asking me to lose weight, if that (losing weight) is such a good idea, why not practice it?
With smoking, the public must be wondering, if smoking is so harmful why do all governments, democratically elected or dictators, communist, socialist or capitalist why do they persist on licensing tobacco growers, cigarette producers and taxing them? If smoking is that bad why should governments persist in raising revenue from the harm caused to their citizens? Even when all governments profess that they wish and want the best for their citizens!!
That cigarette is addictive makes it difficult for the addicts to stop permanently, even when they know of and understand the message and the reason not to smoke. However if the substance (tobacco) is not available, if its production is banned and therefore no cigarettes or other forms of tobacco to be smoked, assuming governments are prepared to find alternative health-friendly sources of revenue, the harm from tobacco will disappear. This merry go round debate about public health consequences of smoking will cease. This view will not be appealing to the current beneficiaries of the status quo including not least the tobacco industry and Tax-Collecting Governments, but any other intervention is akin to applying bandaid to this perenial global problem.
Prof Joseph Ana
Lead Senior Fellow/ medicalconsultant.
Center for Clinical Governance Research &
Patient Safety (ACCGR&PS) @ HRI GLOBAL
P: +234 (0) 8063600642
E: info@hri-global.org
8 Amaku Street, State Housing, Calabar,Nigeria.
www.hri-global.org
HIFA profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria, established by HRI Global (former HRIWA). He is a member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health, he led the introduction of the Homegrown Quality Tool, the 12-Pillar Clinical Governance Programme, in Nigeria (2004-2008). For sustainability, he established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria. His main interest is in whole health sector and system strengthening in Lower, Low and Middle Income Countries (LLMICs). He has written six books on the 12-Pillar Clinical Governance programme, suitable for LLMICs, including the TOOLS for Implementation. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Nigeria Medical Association’s Award of Excellence on three consecutive occasions for the innovation. He served as Chairman, Quality & Performance, of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He is member, National Tertiary Health Institutions Standards Committee of the Federal Ministry of Health. He is the pioneer Secretary General/Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers. (http://www.hifa.org/support/members/joseph-0 http://www.hifa.org/people/steering-group). Email: info AT hri-global.org and jneana AT yahoo.co.uk
