News page

Cigarettes Held Cause of Death Of Non-Smoker Sweden's Insurance Court of Ap- peal, in a first decision of its kind, has awarded compensation to the family of a non-smoking woman after ruling that smoking by her colleagues at their place of work had been "the probable cause" of her death. For almost two decades, Gun Palm, a non-smoker, shared a poor- ly ventilated office in Stockholm with colleagues, several of whom smoked regularly. Although her parents were smokers. they had given up cigarettes. So did her husband, but even during the times when he smoked it was never in their bedroom, or in the family car. In general, he avoided smoking in her presence. Although a life-long non-smoker, she developed lung cancer of a type that almost exclusively occurs among smokers, in 1980 at age 53. "By that time, a sma ll-cell anaplas- tic carcinoma. located in her left lung, was diagnosed," according to a report by Dr Lars M. Ramstrom, director of Sweden's National Smoking and Health Association. "After treatment with cytosta- tics, the tumour disappeared from the x-ray picture," he goes on to say, "but in December 1981, the tumour reappeared and metastases were found in the brain and pleu- ra." She died in February 1982-a victim of what is now called "pas- sive smoking." Photo W HO/T. Farkas Reducing the social acceptability of smoking. A year before her death, the victim had filed for compensation under Sweden's Occupational In- jury Insurance Act. In July 1982, five months after her death, the local social insurance office denied the claim. 30 A I Living Memorial' To lndira Gandhi India opened a new, five-year programme of immunization last year on an auspicious date- 19 November, the birthday of the country's late Prime Minister lndira Gandhi. The programme, which aims at protecting against six childhood diseases, was desig- nated as a "living memorial" to her by her son, Prime Minister Rajiv Gandhi . "When we think of the future, our thoughts naturally focus on the needs of chi ldren, " he said at the inaugural ceremony in New Delhi in acknow ledgement of his mother's abiding interest in India's youth. India plans to spend US $270 million in a nation-w ide drive against polio, diphtheria, pertussis (whooping cough) and tetanus as we ll as measles and tuberculosis over the next decade, according to the first issue of Action for Children, the publication of a UN ICEF cit izens' group. More than 350,000 health workers are expected to take part in immuniz- ation of a total of 82 million children and expectant mothers. This is part of the world-wide Expanded Programme of Immuniz- ation, launched by WHO in 1974, that is intended to protect against the six diseases by 1990. The global programme was given added impetus in 1985 by UNICEF through its sponsorship of a declaration ca lled "Universal Child Immunization, 1990. " • •••••• ••••••• ••• ••• ••• •••••• •••••• ••••• • ••••••••••• ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••• ••• ••• ••• ••• ••• ••• • •••••••••••••••••••• ••• ••• ••••••• ••• ••• ••• •••••• ••••••• ••• ••• ••• • •••••• ••• ••• ••••••• ••• ••• ••• ••••••• • •••••••••••••••••••••••••• ••• ••• ••••••• ••• ••• ••• •••••• • •••••••••••••••••••••••••• ••• ••• ••• ••• ••• ••• ••• ••• • ••••••••••••••• ••• ••• ••••••• ••••••••••• ••••••• ••• • •••••••••••••••••••• ••• ••• ••••••• ••••••••••• ••••••• ••• • ••••••••••••••••••• ••• ••• ••••••• •••••••••• •••••• ••• • ••••••••••••••••• Her family appealed, and in 1983 a regional insurance court reversed the decision, ruling that her cancer was an occupational injury in the sense of the .Act. and therefore subject to compensation . This followed testimony from four professors of occupational health stating that- in the absence of "stronger" evidence to the con- trary- passive smoking is "suffi- cient to induce biological effects in terms of impaired lung function, " Dr Ramstrom says in explaining the decision. Now it became the turn of the National Socia l Insurance Board to appeal , taking the case to Swe- den's court of last resort, the Insur- ance Court of Appeal. In November 1985 that court up-held the regional court. saying expert advice from the National Institute of Environ- mental Medicine had supported evidence submitted earlier. Ruling that "this case of lung cancer can be classified as an oc- cupational injury due to passive smoking in the work-place," the high court ordered payment of the equiva lent of US $1 ,000 for funeral expenses plus an annuity for each chi ld up to age 19 amounting to 20 per cent of their mother's yearly salary. Assessing the implications of the case, Dr Ramstrom says that the de- cision wil l "support and accelerate future development towards reduc- ing the social acceptabi lity of smok- ing, and effectively contribute to strengthening the measures to cre- ate smoking-free environments." • What Makes UNICEF Run? Why, UNIPAC " Faster, cheaper, better" are the standards to which UNICEF's Procure- ment and Assembly Centre (UNIPAC) in Denmark holds. lt sends out medical supplies hours after disas- ters; it buys in bulk, therefore at low prices; and it makes certain that drugs and vaccines meet re- quirements of quality. Best of all , it is at the service not only of UNICE F, but also of all UN agencies, and as well of govern- ments and private humanitarian agencies . Indeed, it has been said that it would be difficult to run UNICEF and a multitude of develop- ment programmes w ithout UN IPAC. Some 5,000 items are on stock at its warehouse in the free-port sec- tion of Copenhagen . When disaster strikes, blankets and tents already packed are ready to go, as are WHO Emergency Health kits. Some 90 per cent of stocks, however, are for long-term pro- grammes : water and sanitation supplies, which in 1983 provided clean water for some 13 million people; pharmaceuticals; hospital equipment; teaching materials, as for instance the growth monitoring charts, given thus far to 2.5 million mothers; vehicles- the UNICEF jeep particularly; spare parts; building materials and so forth. In 1985 alone, UNIPAC shipped out drugs and vaccines purchased at a bargain US $40 million but worth Photo W HO/E. Mandelmann Storing some 5,000 items for the survival of children. much more at regular market prices. Without bulk purchasing through public bids, these quan- tities would have cost. at 1980 prices, an estimated US $68 mil- lion . The stock today of essentia l drugs is valued at US $10 million. Some sample items : $5,95 for 1 ,000 choloroquine tablets, 150 mg in strength, against malaria; $0 04 for a litre packet of oral rehydration sa lts against diarrhoea! disease; and $0.07 for a 5 g, tube of tetra- cycline eye ointment against tra- choma. Some 90 per cent of drugs and vaccines purchased were from Western European manufacturers, 5 per cent from Eastern European. There are plans to invite more Third World manufacturers to bid in 1987. And there are plans too, to set up a US $23 million revolving fund to facilitate purchasing by the least developed countries. UNIPAC was set up, seemingly as an afterthought. in 1953- thirteen years after UNICEF's creation . In 1962, it out-grew space availab le at the United Nations and moved to Denmark. That year, it handled goods worth US $3 million . Last year. some two decades late r, the figure reached US $185 million. Over the years UNIPAC's storage space for supplies and equ ipment that are vita l to child survival has increased from just a basement in New York to 23,000 sq. meters in Copenhagen - the size of three footba ll fields put together. • The I Macabre Processions' Are Ending In many a vi llage along the Volta River Basin just a decade ago, a majority of adults suffered from onchocerciasis, a parasitic disease that slowly blinds. Because the blackfly, which transmits the dis- WoRLD HEALTH, May 1986 ease, breeds in fast-flowing wa- ters, onchocerciasis is also called river blindness. lt was then the lot of children, probably already infected by the parasite but not as yet sightless, to lead adults about on a stick. A child taking a string of men through a vi llage in that way was common- place. Now thanks to a programme against onchocerciasis launched in 1974 in seven West African coun- tries - Benin, Burkina Faso, Cote d' lvoire, Ghana, Mali, Niger, and Togo-such macabre processions are becoming just an awful mem- ory of the past. As a resu lt of weekly larviciding of breeding places of the blackfly along some 18,000 kilometers of rivers, the disease's transmission has been stopped in 90 per cent of the 764,000 square ki lometers of the original ly infested areas. Put another way, no new cases are being reported now in an area the size of France and the United Kingdom combined. Even better, WHO says, some three million chi l- dren born over the past decade will never become bli nd. Buoyed by these successes, health workers are now taking the campaign westward- to Guinea, Guinea-Bissau, Senegal, and Sierra Leone- as wel l as extending it to western Mali, and southern Benin, Ghana, and Togo. By adding 556,000 square ki lo- meters to the area of operations, they expect to protect an estimated eight mil lion more people and, just as importantly, cut off routes for re- introduction of the diseases from the west and the south by migrat- ory blackflies capable of flying long distances. Photo WHO Becoming soon an awful mem- ory of times past. The new phase is planned to run for five years, through 1991, at an estimated cost of US $133 mi llion. The fight against onchocerciasis has already cost US $162 mi llion, contributed by 19 countries and institutions'-not a large sum or, as the World Bank says, "less than $1 per protected person a year." • 1 Belg ium, Canada. Federal Republic of Ger- many, Finland. France, Italy, Japan, Kuwai t. Netherlands, Norway, Saudi Arabia, Switzer- land, United Kingdom, United States. OPEC Fund, African Development Bank, UNDP. World Bank and WHO. WoRLD HEALTH , May 1986 News briefs e As UNICEF Turned 40. As part of its anniversary observed 14 April, it was time to pay tribute to the "Goodwill Ambassadors, who lent their talents to UNICEF. " Tarzie Vittachi, the agency's Deputy Director for external affairs, saluted a distinguished roster as follows: "Danny Kaye, the dancing, singing minstrel, and the first Children's Ambassador; Pe/e, who spread the word with his sparkling feet on soccer fields; and Peter Ustinov, Liv Ullman and Tetsuko Kuroyanagi, who moved the hearts and minds of thousands. " And Abba, the Bee Gees, George Harrison. 0/ivia Newton-John, Yoko Ono, Diana Ross, Donna Summers ; Earth Wind and Fire, the Young Menudo, other rock groups ; and David Frost, who organized the music for the UNICEF concert; "And Michae/ Burke and lbrahim Amin, who told the sad story of Ethiopia so poignantly that the world 's understanding was roused to an unprecedented state of generositv " e 'Designer Drugs.' The annual report of the International Narcotics Control Board in Vienna has warned against what are called "designer drugs" - a reference to a new group of drugs now finding its way to the world's big cities. Because the drugs are made by altering the chemical structure of existing ones, they are now unregulated In a related development. the UN General Assembly set 17-26 June 7987 for a world conference on drug abuse in Vienna. Proposed by the UN Secretary-General, Javier Perez de Cuellar, it is yet another recognition of the growing need to crack down on drug trafficking and the illicit production of narcotics and psychotropic substances (chemically produced stimulants such as amphetamines, barbiturates, and hallucinogens). • Gramm-Rudman. The deficit-reducing act passed by the US. Con- gress in December 1985 is referred to simply as Gramm-Rudman. Under it, automatic cuts in the US. budget each year are mandated beginning from fiscal year 1987 and ending in 7991 when, theoretically, the deficit will be eliminated This will affect spending on development programmes. Asked about the implications of the act on the UN system, Patricio Ruedas, UN Under-Secretary-General for Administration and Management gave this reply in an interview last January: " I read in the newspapers every day that there 's great confusion and disarray as to what effect Gramm-Rudman can have on the operations of the US. government .. . so I can only say that the same confusion exists here ... but the implications .. . can be really enormous ... Let 's say, a $7 0 cut this year can be a $30 cut next year, and then a $80 cut two years from now. So the progressive effect ... can be little short of disastrous." The act is named for Senators Phi/ Gramm (Texas), and Warren Rudman (New Hampshire), but Senator Ernest Hollings (South Carolina) is also a sponsor. e Salubritas on Sale. This quarterly newsletter published by the American Public Health Association and the World Federation of Public Health Associations is still alive, according to Heidi Sawyer, associate editor. it used to be distributed free of charge to some 72,000 readers, but now is available for $70 a year, or for $8 for a minimum of eight subscriptions. For details. write : Salubritas. APHA. 1015-15th Street, NW. Washington, D.C 20005 USA. e The Legacy of Vul Brynner. "Now that I'm gone, I tell you: don't smoke, whatever you do. " So said the star of stage and screen, Yu/ Brynner, when asked what he would say on the subject of smoking if given the chance to do so after his death. The hero of "The King and / " and " The Magnificent Seven, " who died from lung cancer in October 7985 at age 65, often spoke of a desire to leave a health education programme as his legacv @ c "' § en _j .9 0 .<::: Now his words are being put to use by the American Cancer Society in a public service announcement that starkly warns of the dangers to health from cigarettes. ===="- In the next issue Not all the diseases that plague humanity can be blamed on microbes and vi ru ses. Among the most distressing of "man-made diseases" are the addictions - to tobacco, to alcohol and to drugs. What these diseases have in common is that they are preventable. World Health in June looks at these three menaces to the world's well-being. Authors of the Month Professor Brian ABEL-SMITH is Pro- fessor of Social Administration at the London School of Economics and Political Science, U.K. Mr Pape Marcel SENE is a journalist working with the Secretariat of the Presidential Office for Senegambia, in Dakar. Dr Marten LAGERGREN works at the Swedish Secretariat for Future Studies in Stockholm. Dr Lee M . HOWARD is with the Office of External Relations Coordi- nation, WHO Regional Office for the Americas/Pan American Sanitary Bureau , Washington , D.C. , USA. Dr Kai Hong PHUA is Senior Tutor in the Department of Social Medicine and Public Health , National Univer- sity of Singapore, where he teaches health economics and administration . Mr John WICKETT is a Consultant with WHO's Smallpox Eradication Programme in Geneva. Dr Ok Ryun MooN is Associate Professor of Health Administration, School of Public Health, Seoul Na- tional University , Seoul , Republic of Korea. Dr John S. AKI is a Senior Econom- ist working at the Population , Health and Nutrition Department of the World Bank , Washington , D .C., USA. Ms Helene PouR is information, Education and Communication Officer on labour and population matters at the International Labour office in Geneva. Mr Alejandro LLANO DELA TORRE is Information Officer at the Depart- ment of Social Communication in the Ministry of Health and Welfare of Mexico. Dr A viva RoN is Director of the Planning and Information Division , Kupat Holim Health Insurance Insti- tution in Tel Aviv, Israel. WORLD HEALTH For readers everywhere 1986 Subscription Rates One year Two years Three years US$ Sw. fr. 12.50 25.- 22.50 45.- 30.- 60.~ ORDER FORM Please enter my subscription to "World Health" as fo llows: One year D Two years D Three years D I enclose cheque/international postal order in the amount of: ____ _ Name: --------~-­ Street: -----'------'--'--- City: _________ _ Count~: _________ _ World Health, WHO, Avenue Appia, 1211 Geneva 27, Switzerland World Health is also distributed through the network of international bookstores and sub- scription agencies. For payment in national cur- rencies. please contact your usual bookseller.