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'' Pre-Emptive Ban'' Sought Against Smokeless Tobacco By World Experts A group of experts meeting under the aegis of WHO has cal led for a "pre-emptive ban" on smokeless tobacco wher- ever this product has not been introduced to "prevent a new public health epidemic from a new form of tobacco use". As the basis for its recom- mendation, the experts stated that smokeless tobacco is "now being promoted cynical ly and aggress ively around the world despite its known harm- ful health consequences". Thus, governments "shou ld as a matter of urgency, pre- emptively ban the manufac- ture, importation and sale of smokeless tobacco products before they are introduced into the market." Dr Gregory N. Conno lly, Di- rector of Dental Health, Depart- ment of Public Health, Boston, who chaired the week-long meeting said, " lt is vita l that we do not repeat the mistakes which have led to the massive health problems caused by cigarette smoking ." The experts were from Aus- tralia, Hong Kong, India, Ireland, Pakistan, Sweden, the United Kingdom and the U.SA. The use of forms of smoke- less tobacco- that is, tobacco not smoked but chewed, dip- ped, or just left in the mouth, even overnight between gum and cheek- has already been prohibited in Hong Kong, Ire- land, Israel and New Zea land. Although promoted as an al- ternative to cigarettes, smoke- less tobacco is described by WHO PHOTO!Tibor Farkas Free samples : A need to pro- hibit them. 30 "AIDS: A Worldwide Effort Will Stop lt" Above: The theme of a worldwide health education and public information pro- gramme launched recently by WHO to increase awareness of how AIDS is spread, and, just as importantly, how it is not. At right.· The symbol. Through them. the aim is not only to "communicate the severity of the AIDS threat," as Dr Jonathan Mann, Director of WHO's programme on AIDS, explained during an unveil ing ceremony, but also to make it plain that "only a global strategy can control it. " There is good reason for mounting such a concerted attack against AIDS, the dreaded acquired immuno-defi- ciency syndrome. According to figu res received by the end of Aug ust. 144 countries reported cases and, in the six years since the disease was first identified in 1981, the total number of victims reached some 57,000. That f igure, whi le high, is stil l estimated to be less than a half of all actual cases worldwide. The need for a globa l assault was endorsed by the leaders of the world's seven major industrialised countries - Canada, the Federal Republic of Germany, France, Italy, Japan, the United Kingdom and the United States. At their meeting last June in Venice, according to Dr Halfdan Mahler. WHO's Director-Genera l, they sing led out WHO as the "best forum for drawing together international efforts on a world wide leve l to combat AIDS." In exp laining the symbol, its U.S. designer, Milton Glaser, said he sought an image with the "power to persist in the memory." The result of this work- two red hearts that converg e on a blue fright mask. • ...... ....... ... ... ... ...... ...... ..... . .......... . ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••• ••• ••• ••• ••• ••• ••• • •••••••••••••••••••• ••• ••• ••••••• ••• ••• ••• ••••• ••••••• ••• ••• ••• • •••••• ••• ••• ••••••• ••• ••• ••• ••••• • • •••••••••••••••••••••••••• ... ... ....... ... ... ... .... . . ......................... . ••• ••• ••• ••• ••• ••• • • ••• • ••••••••••••••• ... ... ....... ........... ..... . ... . ................... . ... ... ....... ........... ..... . ... . .................. . ... ... ....... .......... ..... ... . ................ . WHO as a "new threat to society" - particula rly to young males who are. thus far, the major targets in promotiona l and advertising campaigns. Studies have shown "bey- ond any reasonable doubt." ac- cording to a WHO working paper, "that its use has led to leukoplakia, white patches on gums, which in turn may de- velop into cancer. and to gums that recede from the crowns of teeth thereby leaving roots ex- posed. Its addiction is "similar to that produced by cigarette smoking and by other addictive drugs such as morphine or cocaine". In another major recommen- dation, the experts urged coun- tries where smokeless tobacco is already in use to subject the product to legislation that is as strong as that for cigarettes. The primary aim. however. should be ending its use. Among measures ca lled for are the prohibition of sa les to adolescents, as we ll as a ban on promotion in the mass media. Among promotional techniques are offers Gf free samples of tee-shirts, and of " introductory" pouches pack- aged in look-alike tea-bags. Also recommended are a series of regularly rotated health warnings on smokeless tobacco products and adver- tisements . In Western nations. smoke- less tobacco is sold as : • Moist snuff, tobacco finely cut and marketed loose. or in pouches, which is avai lab le in different flavours. This form is preferred in the United States and in Sweden. • Chewing tobacco, wh ich is coarsely cut tobacco. • Dry snuff, tobacco in a dry and finely powdered form, which is sniffed or taken by mouth. In the United States alone, a form of smokeless tobacco is used by an estimated 12 mi llion people, three mill ion of whom are under age 21. In India and Pakistan, it is estimated that least 100 mill ion people use smokeless tobacco, often combined in the bete l quid w ith lime and flavouring agents. • Enforcement Alone Is Not Enough to Fight Drug Abuse Measures aimed against traf- ficking and at law enforcement are essentia l in the fight to curb drug . abuse around the world. but by themselves are not enough. Because drug abuse is a health problem too, health measures are needed also. Drug abuse is both a symp- tom and a cause of psycho- social deterioration, accord ing to Dr Norman Sa rtoriu s, Direc- tor of WHO's Division of Mental Health. " it strikes at youth, a most vulnerable section of the popu- lation, " who need help, not punishment. he said in ad- dressing the recently con- cluded UN Internationa l Confer- ence on Drug Abuse and Illicit Trafficking in Vienna. The development of "de- signer drugs," made in laboratories by tampering with legally permitted compounds, has also added to the "catas- trophic health consequences of drug abuse." These synthetic formulations have an addictive impact as much as a thousand times more than natural, plant- based substances. And AIDS, "infesting and kill- ing not on ly those injecting drugs but also spreading from them into a far wider popu la- tion," has raised the threat to health to new heights. The UN Message: Say Yes to Life; No to Drugs. Prevention, treatment and rehabilitation are preferable to measures that might alienate already confused young drug users. In large part. a country's anti-drug programme shou ld be based on prevention. "No country can claim it is dealing with the fearful threat of drug abuse unless the health sector is intimately involved in demand-reduction." he said. To reduce the demand, there is the need for countries to pro- mote healthy behaviour, to W oRLD HEALTH , October 1987 make health and wel l-being possible and enduring, and drug abuse less likely. Above all, there is need for an international all iance aga inst death, disease, socia l deterioration and misery which drug abuse is bringing to the world ." In al l countries narcotic and psychotropic drugs are be- ing misused and abused. The number of cocai ne abusers stands at 4.8 million, of opium abusers at 1.7 million, and of heroin abusers at 750,000, ac- cording to figures reported to the United Nations. • A Step Forward In Protecting The Ozone Layer By 1990, world production of chlorofluorocarbons wi ll be frozen at 1986 levels. Over the two fo llowing yea rs, production wi ll be reduced by 20 pe r cent, and from two to four years later cut by a possible 30 per cent. That is the gist of a draft proposal that is likely to form the basis of a "meaningful in- ternational ag reement to pro- tect the ozone layer " from the sun's destructive ultra-vio let radiation, according to Dr Mos- tafa K. Tolba, Executive Di rec- tor of the UN Envi ronment Pro- gramme. Evidence over the past de- cade shows that use of CFCs, fo r instance, in aerosol cans, refrigerators and cleansing agents, thins the ozone and as a consequence raises the planet's temperature, as well as accelerating the so-called "green-house" effect that cou ld alter the earth's cli mate. One health effect of ozone depletion is an increase in skin cancer. "There was no dissent at all about the fact that we are fac- ing a rea l problem of the deple- tion of the ozone," the top UNEP offic ial sa id during a 31-nation conference held in Geneva in May, " but because of economic factors, industry needs to have time to adjust to change." About a month later, in a related development, U.S. and Soviet scientists agreed to ex- pand a pact between the two nations on research in the at- mosphere, in particular the ex- change of information. If their studies show that a "hole" in the ozone layer over Antart ica is widening, UNEP is committed to ca ll ing an emergency conference later this year. • WoRLD HEALTH, October 1987 News brief • Awards: Candidates are being sought for the second A!bert Dubois Quinquennial Prize for Tropical Pathology. The prize, of a half million Belgian francs, is named for a scientist regarded as a founder in tropical medicine, and who began his life's work at age 24 in the Congo combating sleeping sickness and leprosy. Candidates are asked to submit a summary, in Dutch, English or French, at least ten pages long, of studies carried out and published within the past five years. Deadline is 37 December 1987, with the award to be made in 1988. (For more details. write Academie Royale de Medecine de Belgique. Palais des Academies. 1 rue Oucale. 1000 Bruxelles). - Next month, Or Fe del M undo, a pioneer in the development of family planning programmes in the Philippines, will receive the triennial IAMANEH-Bourguiba Award in recognition of her life- time's devotion to maternal and child health. it will be presented on 7 November during the 3rd International Congress of Maternal and Neonata! Health to be held in Lahore, Pakistan. Given by the International Association for Maternal and Neonatal Health, Geneva, and the Tunisian Association for the Health of the Mother and the Newborn, the award is named, in part, after Tunisia's President Habib Bourguiba. UNFPA. UNICEF and WHO are on the selection committee. - For "sustained contribution made to the cause of refugees in their country, and throughout the world over the years," the people of Canada have been awarded the Nansen Medal by UN High Commissioner for Refugees, Jean-Pierre Hocke. The award is named for Norwegian scholar and explorer, Fridtjof Nansen, who was the first commissioner, under the League of Nations, for refugees. • Calendar : Of more than usual noteworthiness, the Interna- tional Conference of Ergonomics, Occupational Safety and Health, and the Environment, to be held a year from now- from 24 to 28 October 7988- in Beijing, China. The Chinese Society of Metals, and the Darling Downs Institute of Advanced Education, Australia, are joint sponsors of the conference aimed at making workp!aces safer and healthier. The event, they say, will be " the biggest of its kind yet staged in China." (For details. write ICEOSHE Administrator. P 0 Box 44. Darling Heights. Toowoomba. Queensland 4350, Australia). • Still Playing, but Only When Safe: Hollywood has responded, at least in part, to a call by the US. Department of Health and Human Services for AIDS education programmes that stress abstinence and "sa fe sex." The first AIDS-influence films, which reached movie houses last summer, show that while heroes still play, they play it safe. In the latest James Bond film, "The Living Daylights," Secret Agent 007 practices monogamy. While in previous adventures he has been required to go to bed thrice with three different women, he frolics now thrice with the same woman. And in a police thriller, "Dragnet," the hero, albeit reluctantly, passes up a liaison with a blond on discovering that his stock of condoms has run out. "We have to conform to what's going on in the world. We have to be responsible, " the New York Times quotes the producers as saying. • Turning to Nutritious Fast Foods. The message of a current advertising drive by McDonald's Restaurant is that the worldwide hamburger chain is cutting back on fat and salt, thus in effect striving for more nutritious content in the "fast food" it serves. i t has lowered the sodium content of pork sausages and pickles. it is frying fish and chicken in pure vegetable shortening, instead of animal fat. thereby helping to lower cholesterol levels. In the next issue WHO has long been in the forefront of efforts to find and develop new and better methods for fertility regulation. Some of the exciting developments in the field of research into human reproduction are discussed in the November issue of World Health. Authors of the Month Dr Jorge OsUNA is Area Direc- tor of Health Systems Infra- structure at WHO's Regional Of- fice fo r the Americas, PAHO. Mr Mark L. SCHNEIDER is a Technical Officer in the Analysis and Strategic Planning unit at WHO's Regional Office for the Americas, PAHO. Dr Jose R. FERREIRA is Program Coordinator, Health Manpower Development, at WHO's Regional Office fo r the Americas, PAHO . Dr George A. 0. ALLEYNE is Area Director, Health Programs Development, at WHO's Regional Office for the Americas, PAHO. Mr Horst 0TIERSTETIER is a Sanitary Engineer in the En- vironmental Health Program at PAHO, and Mr Alberto F'LORES is Director of the Pan American Center for Sanitary Engineering and Envi ronmental Sciences in Lima , Peru. Dr Eisa M. MORENO is Program Coordinator of the Maternal and Child Health Program; Dr Nes- tor Suarez OJEDA and Dr Ciro de QuADROS are both Medical Officers in the same program. Dr Claude de V ILLE DE GO YET is a Medical Officer in PAHO's Emergency Preparedness and Disaster Relief program. Dr Carlyle GUERRA DE MACEDO is Director, Pan American Health Organization, and Re- gional Director fo r the Americas of the World Health Organi- zation. WORLD HEALTH For readers everywhere 1987 Subscription Rates US$ Sw. fr . 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