Smoking is recognized as a public health problem by the World Health Organization (WHO), because 50% of smokers will eventually develop a tobacco-related disease (Doll et al BMJ 1994). These diseases, including cancer and cardiovascular diseases account for 15% of all annual deaths. But before they cause death, tobacco use accounts for approximately 10% of total health spending. In 2003, the prevalence of smokers in the population over 15 years in Florianopolis was 21.4% above the national average of 18.8% (MS / SVS 2004) and smoking experimentation among 12-15 years old also was high in Florianopolis: 30% (Vigescola, 2004).
Since 2006 the Department of Health of Florianopolis considered tobacco control a priority and outlined the goal of reducing smoking prevalence by 1% a year. Since then, systematic policies were implemented to control this epidemic, adapting the recommendations of the Framework Convention on Tobacco Control (FCTC) for application in Florianopolis:
(1) Protect people from tobacco smoke through legislation (Art.8);
(2) Offer help to those who want to quit (Art.14);
(3) Warn about the dangers of smoking (Art.11, 12);
(4) Ban advertising, promotion and sponsorship (Art.10, 13);
(5) Increase taxation of tobacco products and curbing the illicit market (Art.15).
The FCTC in Art.14 recognizes the need for the provision of treatment to smokers, since smoking, and risk factor for many diseases, is also a chemical dependency (CD) to nicotine - ICD F17 (ICD-10 WHO 1997). However, a gap in academic health professionals makes a need to train them, to meet the expectations of users on the treatment of CD. Thus, regular trainings are offered annually to offer intensive treatment to smokers through cognitive-behavioral approach (CBA) and pharmacological support, and treatment access at least on 70% of Primary Care Centers. The portal of the City of Florianopolis has information on how the treatment works on 35 health centers. (http://portal.pmf.sc.gov.br/entidades/saude).
However, treatment of nicotine dependence is only one of six evidence-based strategies for tobacco control, according to the WHO policy package (MPOWER). The other guide managers and legislators to implement other policies to reduce consumption of this drug by the population. The FCTC calls for effective measures of protection such as the creation of environments smoke free in all areas of collective use, as this measure helps to change the social norm of acceptance of this drug among young people and decreases consumption among current smokers. However, the tobacco industries invest billions of dollars to impose their economic interests and prevent the loss of sales of cigarettes, which are the side effect of reducing consumption desired by public health managers. This conflict of interest between the goal of the tobacco industry who want to increase sales, and health, who wants to reduce consumption of cigarettes, greatly hinders the implementation of economic measures and laws to control the tobacco epidemic in countries, states and municipalities. Florianopolis was no different, but after the training of professionals in the health surveillance measures on education and enforcement of smoke-free environments, we approved a Municipal Law which prohibits smoking in enclosed, was no different, but after the training of professionals in the health surveillance measures on education and enforcement of smoke-free environments, we approved a Municipal Law which prohibits smoking in enclosed, semi-open areas of collective use.
To obtain the support of the people in law enforcement, it must be warned and reminded that smoking is through reliable information in spoken and written media and other printed materials. The Health Department of Florianopolis, in training health professionals, informs about the pandemic of tobacco and ways to interfere not only with the "host" of the disease - smoking, but also with the "vector "- the tobacco industry. (Lessons available on the portal: http://portalpmf.sc.gov.br/entidades/saude). Social mobilization was also critical of the initiative through "Floripa without tobacco" (http://www.floripasemcigarro.com.br/) and participating Alliance for Tobacco Control - ACT (http://www.actbr.org. br).
Thus, with measures of tobacco control at the federal level added to municipal actions, the prevalence of smokers in Florianopolis reduced to 17.6% (VIGITEL, 2008), equating the Capital to the percentage of smokers in Brazil, which according to the PNAD / IBGE is 17.2% (IBGE, 2009).
The goal is to maintain this sustainable decline with the adoption of all measures recommended by the WHO FCTC and decreasing the damage and suffering caused by smoking on the health of citizens in Florianopolis.
by Senen D. Hauf
