translated from Spanish: Dr. Amarales for smoking: “Chile has an outstanding debt because there has not been a policy of cessation”

This week saw the commemoration of World No Tobacco Day and, in response to this, Lidia Amarales, doctor and coordinator of Public Health at the School of Medicine of the University of Magallanes (UMAG), again raised her voice around the problem of smoking in Chile, something on which she has been working incessantly since the exercise of her profession with the aim of contributing to the effective reduction of levels of prevalence in our country.
Thus, to highlight the importance of advancing on this issue, the former undersecretary of Public Health, presented in a webinar organized by the Citizen’s Table Tobacco or Health, which, in collaboration with different entities, wanted to put on the table the discussion about how to advance in public policies of smoking cessation, where the State adopts a more prominent and permanent role , making known, in parallel, different experiences of smoking cessation programs in Chile.
In this way and in her role as director of the organization RespiraLibre, Dr. Amarales, through the presentation of a pilot program of the Ministry of Health and the Pan American Health Organization (PAHO), executed by that foundation, in 6 communes of the country – including Puerto Natales – made see the need for the State to be able to safeguard the right to health , promoting the abandonment of tobacco and the treatment of dependence as a permanent policy in the primary care of our country.

In a more in-depth interview, the renowned health care provider shared her perspective and her reflections on the management of this health problem at the national level.
The presentation was entitled “Quitting smoking, an outstanding debt”…
As a country we have an outstanding debt, without a doubt. In order to control the smoking pandemic, the WHO is making a public health treaty called the Framework Convention, where Chile has made laws that have been regulating consumption with different measures: tobacco-free space, warnings, elimination of advertising, etc. But there is an outstanding debt that is Article 14 of the Framework Convention, where countries have to implement a policy of cessation or treatment of smoking throughout their primary network and Chile has not done so, therefore, it is an outstanding debt.
And not only for that reason, in addition, in the health objectives for the decade 2010-2020, the strategy was to implement the Cessation program in primary health centers, and that is the reason, that, although we have significantly decreased the prevalence of smoking in Chile, we have not managed to reduce health expenditures, because the critical mass of the smoking population has not had any possibility of being able to have a smoking treatment , this being a triple addiction because only between 3 and 5% of smokers manage to quit smoking. The rest have to have a comprehensive treatment.
50% of our smoking population wants to quit smoking, but they cannot do so because of this triple addiction. Chile therefore has an outstanding debt, because it has not adopted a policy of cessation, as it should have done under the Framework Convention, because of health objectives, but, above all, because of people who want to stop smoking and cannot do so because they have no possibility of treatment.
In relation to what has been developed with RespiraLibre and its experience, how do you evaluate this work and the benefits it has for public health?
From the Health Roundtable in which civil society, universities, scientific societies, among others, participate, we have encouraged the Ministry of Health to make a policy of Cessation in primary care, which is a commitment.
Thus, it makes a pilot program, which is implemented by Respira Libre and we carried it out in three communes of Santiago: Peñalolén, Lo Prado and Macul, which was carried out in 2018. The program consists of leaving installed capacity, doing cessation clinics in these health centers and the pilot included 400 patients. The result was very successful, we achieved a 57% dropout rate in this population that was treated in the third month that the program ended formally.
We not only train cessation professionals, but also follow up on patients, but we have not managed to get the Ministry of Health to implement this policy in the rest of the country and that is why it remains an outstanding debt.
Nevertheless, Respira Libre makes an agreement with the Pan American Health Organization (PAHO) to repetir this program, but now in an online format, given the pandemic situation we live in. We do the same model, that is, we train the professionals of the health center, we do accompaniment in the pilot programs remotely. We already left and the communes chosen were Natales, from the Magallanes Region; Doñihue, from the O’Higgins region; and Independencia, from the Metropolitan region. At the moment, in these communes, they are attracting smoking patients who wish to quit smoking.
In Natales we are going to start with 15 patients, but with the idea of, as the installed capacity remains, they will be able to have a permanent offer, and in time, any natalino who wants to give up smoking, will be able to have treatment in their family health center.
What are the economic benefits for both the patient and the State to reduce tobacco consumption in the population?
There are many cost studies regarding what smoking means to the state. On the one hand, Chile’s health costs are around 2.5 billion pesos a year due to tobacco, either due to illness, premature death, etc. We must bear in mind that more than 16 thousand people die every year in Chile because of tobacco, that is, similar to the number of deaths due to Covid, 45 people die daily products of tobacco consumption.
And those numbers have a cost to people, a cost per disease, because it’s a risk factor for all chronic diseases, like cardiovascular diseases, cancers, diabetes, etc. In other words, there is practically no organism that is not affected by tobacco.
A smoker spends between 800 thousand to one million 200 thousand pesos annually just for the purchase of cigars. If we add to that that a person being a smoker has more morbidity (greater disease), generates greater expense for the purchase of medicines or professional care. This means that there is an impoverishment of people because of being smokers, even more so if you can compare high socioeconomic levels versus low socio-economic levels, the latter have higher prevalence, more severity in smoking, smoke twice as much as high socioeconomic levels, spend about 25% of their income on tobacco , therefore, it is a factor of impoverishment of people. So the state spends more, people spend more, that is to say nobody wins here, only the tobacco companies.
As Respira Libre, we conducted a cost-effectiveness study of implementing a smoking cessation program in primary care health centers and demonstrated, scientifically, that a treatment is effective. That is, what the state spends on implementing treatment is far below what it spends on treating people who are smokers. That is why it is important to implement and extend this experience that took place in the three communes of Santiago and that we are now doing in three other communes.
Are there any studies that indicate that tobacco use has increased as a result of the pandemic? What are the figures in Chile for smokers?
There is no study to show that tobacco use has increased as a result of the pandemic. What I can say at the moment, and what is important, is that people give up smoking at this time of pandemic, because being a smoker increases the incidence of people getting sick and people getting sick from Covid-19 increasing the severity and mortality. Clearly, it is a risk factor plus being a smoker to be able to get sick, aggravated or die from Covid-19. That is why the WHO is calling for smoking to stop smoking, especially in times of pandemic.
I mean, that regardless, that people are with a level of stress, this is not combated with the cigarette, that is part of dependence. You have to combat stress with other types of treatments, such as alternative activities such as sports, going out to ride a bike, walking dogs, going for a walk, dancing or drinking a lot of fluids, which releases endorphine that produces a feeling of pleasure.
A smoker eliminates tobacco smoke in conjunction with viruses, it can reach up to two meters, therefore it is a contagion factor for people who are around a smoker who may be infected and is eliminating viruses driven by tobacco smoke.

Original source in Spanish

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