Tobacco control and the professionals
The professionals therefore have moral, ethical or social responsibility of explaining the ill effects or dangerous effects of tobacco and how one can get benefit by shunning it, writes N Islam
Every year on May 31 World No-Tobacco Day is observed with a theme for the Day for some specific purposes. The theme is meant to be educative and informative for health education and motivation of the people.
Some of the themes during the recent years are: Tobacco & Poverty: A vicious Circle (2004); Tobacco free fashion, tobacco free films (2003); Tobacco free sports (2002) and Second Hand Smoke Kills (2001). This year the theme is — Tobacco Control and the Professionals. This obviously does not indicate relationship between Tobacco and the professionals. Rather it indicates the professional responsibility for Tobacco control.
The role of tobacco is now established beyond doubt with scientific evidences and research publications over 5000 all over the world. In short, Tobacco is a Poison and it kills. Nobody has ever been able to find out one single benefit of tobacco despite billions of dollars spent by the giant tobacco companies for the promotion of tobacco manufacturing and its uses.
The social scientists could not sit idle over this question and came forward to tackle the problem. The publication of Richard Doll & Hill way back in 1950 was the first effective scientific proof against tobacco. This was followed by the reaction of the Royal College of Physicians. All attempts were made by the tobacco companies to level these findings as statistical jargon failed. Researches all over the world poured in and the scientific findings confirmed and reconfirmed these at various centers.
The World Health Organization (WHO) was sensitive. A department was set up for tobacco control which subsequently was transformed into the department of tobacco & addictive substances of which Tobacco was considered as the leader. Several facts have emerged and there is no contradiction from any corner on this specific issue.
Some facts about tobacco are: i. tobacco kills every year 04 million people all over the world. ii. while the tobacco consumption is reducing at 1.1% in the developed countries, this is increasing at 2.1% in the developing countries. If the tobacco control measures are not effectively executed by the year 2020, one crore people will die from this dangerous habit. What is more two-thirds of these victims will be contributed by the developing countries.
Dr Halfdon Mahler, the former director-general of the WHO was indeed a mighty proponent of Tobacco Control. His successor Dr Gro Harlem Brundtland proved even mightier. Her prominent projects viz. Tobacco-Free Initiative (TFI) and Framework Convention on Tobacco Control (FCTC) are the two praiseworthy and bold steps, which added strength to the anti-tobacco policy of the WHO and gave it the brilliant outcome of the unanimous resolutions at the 56th WHA. This Convention was held in 2003 where 192 countries participated. Dr Khandaker Mosharraf Hossain, minister for health & family welfare, Government of Bangladesh had the unique opportunity of presiding over the function where his performance was brilliant and applauded by many except perhaps the tobacco industrialists which is not expected.
After the adoption of the resolution in the convention there came the question of ratification. Bangladesh was the first signatory in this ratification. With the signing of Peru as the 40th country the convention resolution becomes binding for all the 192 participating countries.
The government of Bangladesh has set a brilliant example through the introduction of the TOBACCO CONTROL ACT-2005, which provides prohibition of smoking in public places, conference halls, public transports and even in the open space to protect the health of the consumers and the passive smokers.
In this context our health minister was conscious of his responsibility and convinced of this unique opportunity. He had at his hand the support of the prime minister, a motivated person against tobacco. It is she who declared her Secretariat Tobacco-free on 24 September 1992. With the Prime Minister having such a background, the Health Minister did not face much difficulty in processing the Bill for Tobacco Control Act. The cabinet headed by the PM adopted the bill, which was introduced in the parliament on March 13, 2005.
The bill titled ‘Smoking and tobacco usage (control) ACT-2005’ prohibits publication of advertisements of tobacco-products in newspapers, books and magazines, in radio and television broadcasts and in cinema. The category of public places includes educational institutions, government, semi-government and autonomous offices, libraries, lifts, hospitals, clinics, court buildings, airports, sea and river port buildings, railway stations, bus terminals, ferries, cinema halls, covered exhibition centers, theatres, children’s parks and other places designated by gazette notification.
According to new law, putting up billboards and printing leaflets and handbills or any other documents, including films and videotapes, containing advertisements of tobacco are banned. The law dictates that no company will be allowed to distribute tobacco free of cost, arrange any competition and make any offer of scholarship or donation to publicize tobacco products. A punishment of three months imprisonment or a fine of Tk. 1000 or both is enforceable for its violation.
Piloting the bill, Dr Mosharraf Hossain said it is aimed at discouraging smoking and sales of cigarettes and tobacco products in the country. The new law also bans smoking in public places and transports with a provision for penalty. Anyone who violates the provision will be fined with Tk.50/-. The Act came into existence from 26 March 2005 with clear definition. This will be followed by the regulations. The Act shall be strengthened by these regulations and the weaknesses removed.
The law also prohibits donation of any tobacco products, sponsoring in any ceremony or sports tournament and sponsoring scholarship to individuals by tobacco producers.
Violation of this clause of the law may be liable to three months’ imprisonment or a fine of Tk. 1000/-. Thus the action taken by the government is excellent. It is now the responsibility of all of us. The family members, the health personnel, social scientists, school teachers, religious leaders, electronic and print media, political leaders, in the family, the NGOs, in the mosques and temples and everywhere everybody has the responsibility.
This year’s World No-Tobacco Day’s theme is ‘Tobacco Control and the Professionals’. Here the health professional has great responsibility in the implementation, which is more difficult than adoption of the Tobacco Control Act. I will now elaborate on the theme of the day.
Health Professionals in Bangladesh context
This is a very wide term and includes everybody engaged in healthcare system in whatever capacity they may be. This, therefore, embarrasses everybody from the senior consultants or professors to an assistant of the lower grade, nurses and technicians.
The first step in my opinion is freedom from Tobacco of all persons enumerated here. If nobody in the hospitals, health complexes or clinics smokes and the campuses remain tobacco-free the patients and visiting persons will not dare smoking so long they are in the hospitals. If a patient is suffering from one the tobacco related diseases he may be explained the reasons behind that inflicted tobacco is the greatest single cause of his disease and there is no alternative than to give up the habit of smoking. It is likely that this will have influence on his decision to give up if he is a smoker.
All health professionals here have great responsibility in motivating the sufferers. Not only in a group but one by one which is likely to help a summation effect. If anybody in the campus smokes that will be great deterrent for the implementation of the programme. If nobody smokes and everybody speaks against tobacco then the sick person in his weak moment is most likely to submit to suggestion of the professionals and shall be tempted to give up smoking. This conversion may not be limited to a single person. In fact, through this process a mighty group can be built up who would ventilate reasons behind giving up smoking. Hospitals, therefore, are mighty grounds for carrying out propaganda regarding anti-tobacco activities and building up mighty force against tobacco. Obviously the activities of the professionals must go far beyond and every profession has its responsibility everywhere. The Consultants occupy a significant position during consultation hours. He should serve as a role model for anti-tobacco activities and must explain the fact and the reasons behind suffering from his present disease as an example if it is applicable.
I have often said that a physician with a cigarette in left hand has no right to prescribe with a right hand advising his patients not to smoke. This becomes contradictory as he is being a smoker and smoking before a patient is encouraging the patient not to smoke. It should, therefore be a moral obligation for all the physicians to give up smoking and set example before the public which will definitely influence and motivate them for giving up smoking.
All health centres tobacco-free: Ministry’s directives
I understand the Ministry of Health has issued circulars that all health centres should be tobacco free and nobody (employees and visitors) should be allowed to smoke in the campuses. It is the responsibility of all health care personnel working there to strictly observe this and see that nobody smokes. Even more, doctors may respectfully refuse to treat a patient who expresses inability to give up smoking despite advice from the doctors. Any patient suffering from tobacco related diseases has no right to smoke and must be forcefully asked to give up smoking for a cure or he should be warned against the future consequences of smoking and effectiveness of therapy if smoking continues.
Every year on May 31 WNTD is observed with a view to creating public awareness for tobacco control and as mentioned above an appropriate theme is selected for the purpose. This year’s theme is Tobacco Control and the Professionals. The professionals include senior consultants and professors to lower level health workers and paramedics engaged in the profession of health care.
In a country like Bangladesh professionals occupy a respectable position. People come to them for healthcare with clear confidence and respect at times of distress. Their advice is taken as gospel uttered with sincerity and medical ethics for the welfare of the suffering humanity. The professionals therefore have moral, ethical or social responsibility of explaining the ill effects or dangerous effects of tobacco and how one can get benefit by shunning tobacco.
Parents at home, teachers in the schools and colleges, religious leaders in the mosques and prayer places, professionals in their clinics or treatment centres, social workers, everybody everywhere can play vital role in guiding the public educating them and encouraging them to give up smoking. It is, therefore recommended that all health care centres, all hospitals, must be tobacco free, all professional members must set example by giving up smoking. They, in fact, constitute the mightiest group where the sick vulnerable come to them for relief and medical advice with full confidence and faith in them with an attitude to accept their advice and follow their instructions.
Of all the weapons we have in possession against tobacco, the professionals, therefore, occupy a unique position. The theme this year is intended to exploit this situation and utilize everybody’s might by setting example themselves and instructing and inspiring the smokers to follow them and shun tobacco, which offers immense benefit and freedom from health hazards of tobacco use. The opportunities and responsibilities are of the professionals to whichever category they belong. It is therefore for all of us to exploit this situation for exposing tobacco and eliminating tobacco hazards and tobacco from the society.
The writer is a national professor, founder-VC, USTC & founder-President, ADHUNIK
Living down under
As stated by some sources, migration of Bangladeshis to Australia began in the 1970s, mostly due to the War of Independence, and by the early 1980s it was assumed that there were 200 migrants in Australia from Bangladesh, of which almost all were professionals. Then, in the mid-1980s they were joined by some students pursuing tertiary studies and by 1991 the number grew to around 2,000... writes Ahmed Imran
Exactly 9013 km away from our Buriganga, the capital of the lonely island continent in down under, Canberra, was not much known to many even 20 years back and a large number of people invariably mistook Sydney or Melbourne as the Capital of Australia. Canberra, apparently the new capital city was established in 1927 and has grown from a large sheep yard to a modern culturally diverse city, surrounded by the typical Australian bush land. As of today, this is undoubtedly one of the most well planned capitals of the world.
People had a perception about this Kangaroo land as a bit laid back, famous for dairy and wineries; a place where many convicts were put in solitary confinement. But Australia’s tremendous progress in the last 40 years made it one of the most developed nations in the world. With its booming knowledge based economy, the country is expected to grow further in all aspects of civilization, although its history is quite new and short as opposed to the long cultural history and heritage of Bangladesh.
Today’s Canberra is a perfect example of a modern multicultural society; the reflection of which is quite evident in many spheres and through the annual multicultural festival (in such a wide spectrum). Through a weeklong program every year all the diversified cultures tend to mingle into a single tune of humanity and equity. The demography of Canberra also shows an interesting blend of different ethnic and religious beliefs, making it a newer concept in the global village. The Australian Bureau of Statistics (ABS) 2001 census showed that over one-fifth of Canberra’s population was born overseas and 14% of its people speak a language other than English. According to the Australian Department of Immigration, Australia has a non-discriminatory immigration policy, which implies that anyone from any country can apply to migrate, regardless of their ethnic origin and race. Relevant to mention that multicultural diversity is a feature of life for all Australians and it gives distinct social, cultural and business advantages. The multicultural policy of the government addresses this issue very seriously and as such it recognizes, respects and celebrates the cultural diversity existing here.
History says, migration mainly started after World War II largely from European countries, then gradually spread to other parts of the world. During that time, Australian government also offered incentives to migrants to promote recovery and development of the national economy, as it was acutely suffering from shortage of manpower and low birth rate.
However, in those days, migration was not a popular idea in many Asian countries and Bangladesh was no exception. Over the years, this view has changed for various reasons and today, it’s a normal social phenomenon among a lot of families in Bangladesh too. Understandably, in this era of globalisation and modern communication in which geographical location one resides is not important anymore; in fact people tend to have a sort of global identity now and this migration process has contributed a lot in changing the perceptions of a modern society.
Once it was unthinkable to hear a Bengali voice in a bus or a public place but these days it’s not a novelty anymore and with little effort one can always find Bengali speaking people in Canberra. Seeing a lot of Bangladeshis in this low populated city one might think, though mistakenly, that we are probably one of the highest numbers migrating to Australia but the actual figure shows Bangladesh is far away from the top 10 countries (37th in rank and forming .22% of total overseas people by birth categories) although there are few Asian countries in the list (as shown in bar chart from the latest data found from DIMIA).
Nevertheless, we did not perform low in other statistics. Overall, we stood 4th in the list of the top ten largest increase in birthplaces between 1996 to 2001, which is from 5063 to 9077 (about 79.3% increase) all over Australia. It will be interesting to wait and see this figure in the coming census to be held in Aug 2006.
This upward trend occurred due to various reasons. Obviously, one is the sudden shift and downfall of the migration trend to other parts of the world especially the US and as a result, over the last few years, Australia has become a popular destination from the migration perspective. Its world rating as the most livable city (Melbourne) also strengthened people’s decision to pick Australia as their first choice and despite its recent political stand, Australia is still perceived to be a relatively safe, peace loving multi cultural society focussed on nature and environment where one gets plenty of air to breathe under the vast blue sky. The only problem appears to be its geographical position which is a bit detached from the world thus making communication and transportation a bit difficult. But gradually that is also becoming easier with the advent of modern technology and introduction of new flights and jets. The day is not far when there will be direct flights to many Asian countries.
Apart from those who come deliberately to migrate, students and others who come with temporary employment rarely go back after the completion of their assigned tasks and this is largely due to the changing circumstances and lack of opportunity at home. On the other hand, the government here also targets to retain the skilled and educated manpower by providing a comparatively easy and fast migrating process. Australia’s migration program is now specifically designed for migrants with skills or outstanding abilities who are likely to contribute to the country’s economy.
But, according to some, all this may not be verry good news for countries like Bangladesh. A comparative study of ‘Employed and Unemployed Bangladeshi Professionals in Sydney’ revealed that the mother country suffers a great loss both economically and socially due to the chain migration where the ratios of remittances are low. Understandably, any scientist or any skilled professionals are the country’s pathway towards development and such losses are likely to create a vacuum in the professional arena.
Yet, like many other third world countries, Bangladesh government actively encourages emigration of its citizens on the basis of the fact that repatriation of foreign earning played a significant role in the economic development of the nation in the past, especially from middle-eastern countries. However, without going into that debate, this writer has made an effort to draw a picture of the migration trend of Bangladeshis, focussing particularly on Canberra. For the easy understating of general readers only the salient aspects of our interests are shown without going into minor details and analysis. Please bear in mind that, the writer was able to show the data till 2001 only (as this was the latest available official census conducted by ABS). Also note that children of Bangladeshis born in Australia are not included in this list. Nevertheless, the reason for showing relatively old data can be justified as follows:
n To get a general overview or historical perspective of the initial settlement of Bangladeshis
n To understand the general trend of Bangladeshis migrating to Australia
n To provide a basis for further study
n Overview of the migration of Bangladeshis to Australia
Now, the total number of Bangladeshis by birth is assumed to be about 14,000 (approx) and a majority of them are living in Sydney (NSW) with a smaller significant population in Melbourne (VIC), Canberra (ACT) and other regional capitals.
The writer is a retired army officer. He is grateful to Dr Mohammad Shaidullah and Dr Abul Majumder of Australian Bureau of Statistics for their kind help in providing the primary census data 2001 and valuable comments.
Now let’s pick up the pieces
The French referendum result should raise rueful smiles, writes Peter Preston
Ten points adrift on the exit polls and 50 fathoms deep politically! The great French referendum debacle is much more than wriggling humiliation in the Maastricht manner. It writes the obituary of a presidency which doesn’t deserve to survive. Jacques Chirac’s performance, from start to finish, has been inert and empty. Who could trust a single word he uttered? Where was leadership in the black hole between Le Pen and the far left?
Yet sometimes, even in the extremities of despair, you have to smile and tell yourself that serious événements can’t always be taken too seriously. In truth, this treaty, under attack from left, right and bemused centre, was never going to get round the two-year obstacle course of electoral approval from Amsterdam to Prague unscathed. It’s a dud, a dodo, an impossible dream (as well as a bombastic morass of verbiage). So turn again, and think again.
We’re told that failure to ratify - certain after such a defeat, with Dutch knives waiting - must mean years of drifting decay. We’re told that the project either retains momentum or wallows in the mire, that European union itself could end in a whimper of disillusion. (Do you recall how the Soviet Union simply disintegrated?) Ho-hum! It’s time for that serious smile.
What really goes down the pan with Giscard’s discard? The difficulty has always been that this desert of text conceals only an arid agenda for change. Take away a European foreign minister, a full-time president of the European Council, scrapping of various minor vetoes and, after 2014, a smaller commission, and what have you got? Not a fat lot: a charter of rights that may or may not make a difference, some added powers for national parliaments they may or may not choose to exercise, better security planning that will probably happen in any case.
Of course it would have been better to sign up and move on. Of course rejection presages turmoil. But the blow is emotional and symbolic, rather practical or fatal.
Europe’s single foreign supremo was never going to supplant his British, French or German masters when the chips were down on vital issues like Iraq or relations with Bombardier George W Bush. He’d only be managing the small change of consensus and cooperation. No match for Condoleezza Rice - just as, come to think of it, Ms Rice is no match for Colin Powell, because the second Bush administration has already lost clout and direction.
Does it make sense to have a more permanent president or chairman of the council based in Brussels, rather than swap Europe’s titular leadership every six months? Yes: but the sense is administrative, not ideological (and hardly crucial, except as a job opportunity for retired prime ministers). Are many of the scrapped vetoes important? No, even our own, dear Tory party wouldn’t claim that.
The big point about the impasse, then, is that there isn’t a big point. The trouble lies in faith and vision and explanation, not in the horrors of lurking sub-clauses. It’s a project deficiency. And we can’t, any longer, do the faith thing without going back to basics.
The European Community, and then its successor union, rose from the ashes of a continent laid waste by repeated war. It sought to close the fault lines for ever, to merge national interests into a single interest of peaceful and prosperous intent. Inevitably, its definition of ‘Europe’ left out the lost lands of the east. This was western Europe, not eastern Europe: this was Bonn and Paris getting their acts together.
But dismantle the Berlin Wall, reunite Germany, bring Poland and Hungary (let alone Romania, Croatia, Ukraine and Turkey) into the ambit of this ‘ever-closer union’, and everything changes. The new EU is a tremendous spreader of democratic practice and market reform, but its initial flame has faded. It is something different now, not more of the same.
Here’s where anyone following the French debate has found perplexity. It has often seemed as though, two years too late, France was deciding whether to let Poland inside the club. Here’s where old ideas, like the wonder of a common currency, have struggled to cope with a multiplicity of new and very different economies. Here’s where one size (for Bulgaria and Belgium, say) can’t remotely fit all far into the future. Here’s why Warsaw’s idea of a competitive society simply does not match the German approach next door. Here’s why job mobility has become such a brutal, racist vexation in the Netherlands.
The incoherence is fundamental, the tendency - wondrously illustrated by Chirac’s flailings - to impose sinister constructions on the most blameless and boring of paragraphs has been irresistible. This is our new bespoke Europe. The motivations for joining and participating are cut 25 different ways; so is what Tony Blair likes to call the ‘heart’ of the project.
None of this, if you can still smile, is fatal. All of it can and should be part of building a European future where history never ends. But we can’t do that by mystic diktat. ‘Old’ Europe, by chance, is clapped out for the moment, with a German chancellor building his own knacker’s yard and a French president who builds only contempt and distrust. Reassessment couldn’t look more inopportune as Luxembourg hands the package of problems over to Britain and any focus shrinks into domestic politicking about Blair’s survival and need to call a referendum of his own on a doomed, redundant treaty. Of course not.
But to hell with all of that! You can’t run a continent on empty indefinitely. You have to pause, refuel and travel on. You have to smile over what has been achieved and what more can be made of a unique engine of hope. It ain’t broke, but now it needs all our fixing.
This article first appeared in The Guardian
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