What is the status of tobacco control in Argentina?
Gustavo Zabert, MD, is the regional director for Latin America at Global Bridges. A trainer, educator and pulmonologist, Zabert is also the director at Carrera de Especialista en Neumología Escuela de Medicina and an associate professor at the Universidad Nacional del Comahue.[MH2]
What is your professional background?
Early in the 1980s I was trained in internal medicine and soon after I got the board in intensive care and pulmonology so my practice was mostly focused in the latter two specialties.
You have been very active and passionate about tobacco control/tobacco dependence treatment. What led to your involvement?
During my university and post-graduate training, smoking was a “normal” behavior among students, fellows, attending staff and board physicians in Argentina. In my fellowship´s training hospital, we all used to smoke during clinical rounds, meetings and even when talking with patients’ relatives. Although I perceived it as a contrasting scenario, I agreed not only because it was the standard behavior but also because I used to smoke as well.
In those days scientific papers were hard to get in the Patagonia but I was lucky to get a landmark paper from Doll and Peto (J Natl Cancer Inst. 1981 Jun; 66(6):1191-308) that revealed as much as 30% of current U.S. cancer deaths that were due to tobacco. At the same time, I was moved by my older son who was still using a pacifier during the night so my wife Laura and I demanded he get rid of it. Just before his 4th birthday, Ignacio made a deal with me — “no pacifier for him and no cigarettes for dad.” We both had no choice so he slept without the pacifier and I quit smoking cold turkey.
I soon understood that I had not only thrown out a major health risk but also resolved a huge discrepancy between smoking behavior and my practice as well. My perspective and attitude dramatically changed, and I turned to an active supporter of tobacco control and smoking cessation counseling.
During the 1980’s and early 1990’s, tobacco control activities were somewhat frustrating in Argentina since interventions were not reimbursed, drugs were not available, and most colleagues were skeptics. Argentina endured setbacks in tobacco control actions e.g. industry interference in VIII Tobacco or Health World Congress, President Menem vetoed the Neri´s tobacco control law. The very few non-governmental organizations (NGOs) and physicians devoted to tobacco control were seen as “knights in the fight against a pretended monster” but fortunately the paradigm changed in following decade.
What do health care providers currently do in your country – and what do you think they could do?
Today, there are many NGOs and scientific societies that support tobacco control actions and FCTC ratification since our country is the single one in Latin America that has not approved it yet. Some of the organizations include: UATA, AsAT, AAMR, ALIAR and FIC. They are all very active and work in collaboration with government officers to implement rules and laws in connection with FCTC in all dimensions of tobacco control, but I think that we should still wait a couple of years for FCTC ratification in Argentina.
In terms of treatment, Argentina launched National Guidelines in 2005 and they were updated in 2011 but dissemination and implementation is limited. Although many physicians are aware of them, not many other health care providers (HCPs) are, and reimbursement and coverage for counseling and drugs are incomplete in public and private sectors.
There are many opportunities for training in tobacco dependence treatment and most of them are suitable to international standards but the number of HCPs trained is too scarce to have an impact on the whole population yet. Global Bridges is filling this gap, along with NGOs, universities and scientific societies with an “attend one, teach one and run one” strategy.
Describe some of the biggest challenges you face in your work.
I perceive that the most challenging matter is to address tobacco as any other health issue in the government’s agenda. Although it is mostly recognized that smoking is an addiction and that the health consequences are huge, the resources are scarce. Therefore, I think that many of the barriers to tackle tobacco are ambiguous, sometimes ideological and certainly influenced by economic arguments.
Please tell us about some of the things you are working on now.
The Latin America Global Bridges team has been very active in training HCPs in the last three years. I am very proud of the team´s effort and accomplishments but I feel that we have opened Pandora´s box. We receive a large number of requests for training so we are urged to satisfy the needs. Our approach is to share our resources with partners in order to potentiate training and networking.
What else would you like to accomplish in your work with tobacco control?
GB training outcomes are promising in terms of knowledge, practices and confidence but we are looking for patient outcomes after training. The final endpoint should be to decrease the smoking prevalence but this is a long range goal influenced by many other dynamics. In intermediate terms, to improve brief interventions among smokers attending health care facilities would be a measurable goal.
Is there anything else that you want people to know?
Latin America is a large and unique region, with developing countries bound by cultural, historical and language connections. Although smoking is a highly prevalent behavior, huge advances have been achieved in the last decade. Uruguay´s experience is a model to follow and a source of inspiration not only for Latin America but also for the world.
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