Regional case studies of strategies to achieve clean indoor air policies

1. Regional case studies of strategies to achieve clean indoor air policies Florin Dumitru Mihaltan, Aer Pur, Romania

2. Smoke free environments • Smoke free hospitals • Smoke free workplaces • Smoke free social places

3. Air pollution • Indoor air pollution • Outdoor air pollution

5. Arguments of the industry • The tobacco industry has developed its own campaign: • to defend the “rights” of smokers and • to cast doubt on the scientific link between passive tobacco use and death and disease. • “smokers rights” campaign

6. Arguments of the industry • The tobacco industry will do whatever it can to avoid being regulated:not “intrusive rules and regulations”“if people will only cooperate with each other.” • “The Harm is Uncertain” • “It’s a Ventilation Problem” • “Separate Tobacco use Sections Will Solve the Problem” • “There Are More Serious Problems” • “Small Group of Fanatics”

8. What does the tobacco industry fear Clean air activity : • “the most dangerous development to the viability of the tobacco industry that has yet occurred“ • “fewer opportunities to enjoy our products, they will use them less frequently and the result will be an adverse impact on our bottom line.” - Philip Morris, 1994

9. Argumentsof the governmental and nongovernmental organization 1They promote health and save lives. 2 They make breathing easier. 3 They save business money. 4 They save society money. • They help our children grow up tobacco-free. • Smoke-Free Americas Workshop

10. Medical ArgumentsSecondhand Smoke -Adults • In smoky, unventilated rooms, the level of carbon monoxide can be two to three times the level found at highly polluted city intersections. • The exposure to other carcinogenetic substance

11. Some of the areas that need to be targeted for smoke-free policies include: • ·worksites • ·schools and day care centers • ·health care settings   • ·public transportation • ·restaurants • ·government buildings • ·retail stores • ·sports arenas • ·theaters • ·any place frequented by young children.

12. Smoke free environments • Increase productivity by encouraging smokers to quit. • Nonsmokers get sick less often. • Cut down on cleaning and other maintenance costs. • Increase workplace safety. • Offer an attractive working environment for most people. • Smoke-Free Americas Workshop

13. 22.3% 12.7% Percentage of decline in tobacco use attributable to smoke free workplaces (does not include impact of other smoke-free environments) Australia United States

14. Attitudes of the governmental and nongovernmental organization • Direct advocacy • Media advocacy.

15. Direct advocacy • the efforts you undertake to directly persuade government leaders or other decision makers to adopt policy changes. • a single small victory can serve as a model • targeting one environment, such as a hospital or government building, can be just asimportant as advocating for broader policies

16. Media advocacy • includes techniques and tactics that gain access to the mass media in ways that educate the public about the dangers of secondhand smoke and frame the issues so as to create an environment where broad support for smoke-free policies exists.

17. Activities to promote smoke-free policies • activities that promote community wide smoke-free policies • activities aimed at specific targets

18. Community wide Activities ·Try to convince public authorities with regulatory powers to ban tobacco use • Ask property owners and store managers to voluntarily ban tobacco use on their premises. ·Talk with editors of your local newspaper to write editorials in support of both mandatory and voluntary tobacco use bans.

19. Community wide Activities Arrange meetings or presentations with policymakers • -to write editorials in support of both mandatory and voluntary tobacco use bans. -to inform them about the risks associated • about secondhand smoke and about their responsibility to ban tobacco use in all public places.

20. Community wide Activities • Use policy examples from other communities orcountries to convince or shame leaders into adopting similar policies. • Use that victory to build support for a different type of policy.

21. Activities aimed at specific targets ·Call a radio talk show host to suggest that a visiting expert would be available to discuss issues relating to secondhand smoke and smoke-free environments. ·Use “creative epidemiology” to present old statistics in a new and interesting way. (compare the number of deaths caused by secondhand smoke to some other cause of death, such as car crashes or homicides).

22. Activities aimed at specific targets • To write about the “right” to breathe clean air and the real issues surrounding exposure to secondhand smoke • Press conference featuring local medical officials to call for smoke-free public transportation in your community • To highlight the dangers of secondhand smoke and the lack of tobacco use-control policies in your community.

23. Activities aimed at specific targets • promote public events, such as contests or demonstrations that support smoke-free policies. • alert the media to efforts to implement smoke-free policies. • contact local media and explain the importance of the legislation to your community and your nation. • suggest local experts on tobacco and health who can discuss the legislation with reporters or in radio and television interviews

24. In Romania in 1995 29193 persons died by diseases caused by smoking. (Richard Peto et all. WHO)

25. Smokefree worksites • ·Have workshops to provide information to worksite managers, employees, and union officials • ·Provide employers with signs to post and leaflets secondhand smoke • ·Assist employers in surveying individual workplaces • ·Work with labor unions to develop methods for implementing worksite policies • ·Adapt information detailing the job-related costs of secondhand smoke

26. Smokefree workplaces in Romania • First places- McDonalds and some private owners of factories • A certain presure of European Union • First law protecting the pasive smoker -2003 • Many problems of implementing the law • Who is in charge to make the control ? • Very criticised by the cigarette producers • Where is the right of the manager or of the privat propriety ?

27. Smokefree Hospitals • ·Persuade health care providers and managers to ban tobacco use in all health care facilities and to educate their patients, • ·Promote voluntary tobacco use bans in health care facilities through resolutions and campaigns initiated by medical and dental societies and other professional associations.   • ·speak with every patient about the harmful nature of direct and involuntary tobacco use.  

28. Smokefree Hospitals • Display posters and distribute pamphlets in health care clinics • Publishing the financial benefits to hospitals that go smoke-free; • Sample media advocacy activities: • ·Initiate media coverage of any of the above direct advocacy initiatives by suggesting that your local newspaper write a feature story about health care providers that go smoke-free.   • ·Issue public awards to smoke-free health facilities.

29. Smoke free hospitals actions in Romania (1989-2001) • An ancient law unsustained by the government and medical staff • An unchanged prevalence of smokers at the medical staff • Bad habits coming from school and teaching staff • Absence of quit smoking department in hospitals

30. Smoke free hospitals actions in Romania (1989-2001) • Absence of regular minimal advice • Absence of education course for certain generation of doctors • Absence of a good collaboration between NGO and Minister of Health • Absence on the march of the quit smoking products

32. The prevalence of smoking by profession(Mihaltan et all.2002)

33. Prevalence of smoking to the students(Lupu-1995) I. Lupu et I. Zanc, 1994/1995

34. Prevalence of smoking to pharmacists(Fl.Mihaltan1997) Mm1997

35. Prevalence of smoking to surgeons(Fl.Mihaltan-1999) Fl. Mihaltan, M Costea et coll, 1999 45,8% Ocasionnels 15.9% Permanents

37. Age of quitting smoking by doctors (Didilescu-1999) Enquête de C. Didilescu et Ioana Munteanu, 1999

38. In 2003 we are more optimistic • A new law for protecting the passive smokers/2003 • Courses with medical students in university centers • Romania is in a project of the EU (Smokefree hospitals) • New interests from the part of the pharmaceutical producers • Courses for preparing doctors in quit smoking methods • First broadcastings for doctors and students speaking about secondhand smoking

39. Prevalence of smoking to GP and Pneumologists-2002(Fl.Mihaltan) GP Pneumologist

40. The prevalence of smoking to the medical staff in a pneumology departament(Mihaltan et all.2002)

41. Schools, Preschools, and Day Care Centers • ·Provide schools with curricula on the dangers of direct and involuntary tobacco use and the need for smoke-free environments. • ·Promote adoption of civics projects centered on student initiatives, • ·Provide school boards and administrators with model smoke-free policies for schools • Use local media to raise the general issue of the harmful effects of secondhand smoke on children.

42. Restaurants and Retailers • ·Find out if there are any associations that represent restaurants or other businesses in your community. Provide these organizations with information about secondhand smoke and ask that they accept voluntary smoke-free standards among all their members. • ·Offer to hold your organization’s meeting in a local smoke-free restaurant as a way of rewarding their healthy policy. • ·Conduct a survey of restaurant patrons to ask whether they feel comfortable asking their fellow patrons not to smoke

43. Other Smoke free social places in Romania • Some campaign in schools ( not very good coordination) • Many aspects neglected • High prevalence of smoking to teachers and children • In the restaurants their own politics • In reality smokefree areas only in airports

44. Benefits of smokefree placesSmoke free environments normalize nonsmoking. Youth stop seeing smoking as a normal part of growing upSmokers receive encouragement to quit or to smoke less.

45. Clean Indoor pollution-Romania • Many aspects neglected even in the medical books • Absence of the courses in the curriculum of the Medical Universities • Creating new partnerships, finding new partners • Electrolux-Romanian Society of Pneumology-Aer Pur (articles, broadcasting,symposia)