APPROACH AND METHODOLOGY
Healthcare providers ideally serve as non-tobacco using role models, as first-line treatment providers for their tobacco dependent patients, and as highly credible advocates for policy change designed to promote tobacco dependence treatment and tobacco control policy more broadly through increased taxes and smoke-free workplaces.
Currently, there is a great need and opportunity for a well-coordinated, global, science-based initiative to help healthcare providers coalesce around the issue of treating tobacco dependence and policy change. The most significant recent effort has been the Global Healthcare Alliance for Treating Tobacco Dependence (GHA), a non-branded initiative supported by Pfizer, Inc. which convened healthcare providers from multiple regions at an annual meeting for training and sharing of expertise. Since the initial GHA meeting in 2007, it has gained momentum and attracted a great deal of interest, growing to over 300 active participants worldwide. However, participants and the leaders of GHA felt the organization would benefit from independence from pharmaceutical management. In July 2010, Pfizer Medical Education Group awarded an unrestricted educational grant to Mayo Clinic to carry on this work, but their contribution is just the start of what this important global initiative will need to ultimately be successful.
Future work will be aligned with the WHO's Global Treaty, the Framework Convention on Tobacco Control (FCTC), which provides a clear and compelling roadmap for comprehensive actions (e.g. provision of treatment for tobacco dependence, increased tobacco taxes, smoke-free work places, and elimination of tobacco advertising and promotion, among many other provisions) which need to be taken in order to avert the impending epidemic of tobacco-caused deaths. The FCTC is in force in 169 countries, covering more than 85 percent of the world's population. In particular, Article 14 of the FCTC requires treatment guidelines to be implemented in party nations and a specific set of guidelines are expected to be adopted in November 2010 at the Conference of the Parties in Uruguay.
IMPLEMENTATION, TIMELINE, DELIVERABLES
The Mayo Clinic School for Continuous Professional Development and the Nicotine Dependence Center commit to accomplish the following, commencing with grant funding approval in July 2010:
Start up (July 2010 to December 31, 2010):
-Establish initial staff and infrastructure
-Confirm mission, objectives, and metrics for initiative
-Select and protect name and logo for initiative
-Complete initial needs assessment among stakeholders in each region
-Complete initial website development
-Identify candidates for regional leaders
-Develop communications plan
-Begin development of structure and requirements for small grants research program
-Participate in 4th Conference of the Parties to FCTC (treatment focus)
Year One (January 1, 2011- December 31, 2011)
-Complete development of and activate communications plan
-Continue website development and expand language capabilities
-Assemble external advisory board and conduct quarterly teleconference meetings
-Assemble fundraising committee to develop & begin implementing three-year fundraising plan
-Implement healthcare provider internet-based survey to evaluate state of international activities on tobacco dependence treatment
-Conduct initial meeting of regional leaders
-Launch small grants research program, make initial awards, assuming two grants per region
-Contribute to Article 14 guidelines implementation at the regional level
-Conduct evaluation of year one activities (healthcare provider survey) & make adjustments where needed
-Work closely with Fundraising Committee in fundraising initiatives; develop expansion plan
-Outreach to like-minded organizations, initiatives, and individuals
-Establish web-based distance learning modules
-Conduct one regional meeting in each region
-Conduct the annual meeting of Regional Leaders
-Conduct one face-to-face meeting of the External Advisory Board plus three teleconference meetings
-Contribute to Article 14 implementation at regional levels as appropriate
-Conduct second round of small grants research program, assuming two grants per region
-Conduct evaluation of year two and make adjustments as needed
-Work closely with Fundraising Committee to secure long-term funding
-Expand outreach and involvement with like-minded organizations, initiatives, and individuals
-Conduct web-based distance learning trainings
-Expand web capabilities to further region specific policies and practices
-Continue communications activities
-Conduct third round of small grants research program
-Conduct one regional meeting in each region
-Conduct the annual meeting of Regional Leaders
-Conduct one face-to-face meeting of External Advisory Board plus teleconference meetings
-Continue to contribute to Article 14 implementation
Tobacco use will kill one billion people in the 21st century unless strong, decisive, and immediate action is taken on a global scale. The dramatic effect of tobacco on health began to be understood in the 1950s and is now well documented. As the public health response was initially stronger in developed countries, the brunt of the epidemic has moved to the developing world. By 2030, 70 percent of tobacco-related deaths are expected to occur in developing countries (Tobacco Atlas, 2nd Ed).
The greatest immediate reduction in premature death, illness, and attendant economic losses due to tobacco will be achieved through application of effective treatment and policies to reduce the current prevalence of tobacco use (Peto & Lopez, 2001). Tobacco dependence treatment is very cost-effective; even a small amount of time invested in patient counseling leads to a measurable improvement in outcomes (Cochrane Database, 2004). The impact is increased with more intensive treatment. In most countries current tobacco users indicate an interest in quitting, but lack the support to do so. Healthcare providers need the training to assist their patients in quitting. Healthcare providers can also be forceful advocates for policy changes that have been shown to reduce tobacco use, such as increased taxes and smoke-free workplaces; however, as with treatment, they may not realize the impact they could have, and they generally lack training in advocacy skills.
In comparison with other leading causes of death such as AIDS, tuberculosis, and malaria, tobacco control is seriously underfunded (WHO Report on the Global Tobacco Epidemic, 2009). The most significant recent effort to address this issue on a global basis is the Bloomberg Initiative (BI), established by the Bloomberg and Gates Foundations, which designates million over six years (2007-2013) to reversing the tobacco epidemic worldwide. The BI focuses on evidence-based policy interventions in countries with a high tobacco burden to maximize the population impact of its efforts. The new Mayo initiative, which provides a healthcare provider-focused approach for both treatment and policy change, is a logical complement to the BI.
Mayo Clinic is the ideal host for this new initiative because of its demonstrated institutional commitment to global health education as well as its specific expertise in tobacco dependence treatment. Mayo Clinic School of Continuous Professional Development has been training physicians, nurses, and other allied health professionals from throughout the world for over 100 years. Since its inception in 1988 under the leadership of Dr. Richard Hurt, the Mayo Clinic Nicotine Dependence Center staff has treated over 48,000 patients with tobacco dependence and also has created active medical education and research programs which operate in the U.S. and abroad. Dr. Hurt leads the new initiative, along with a team of expert collaborators with extensive international experience and complementary skill sets. Hosting this new project at Mayo affords the opportunity to leverage a broad range of world-class expertise.
SEEKING: Financial Resources, Best Practice Information, Media/Marketing Opportunities
Primarily, the project team seeks additional funding to expand the work beyond the initial period, and to the country level as required. The initial grant from Pfizer will build the foundation of the new project and begin to connect partners in each of WHO's six regions. However, the expected adoption of specific treatment guidelines at the end of 2010 (following a successful Conference of the Parties) will create an immediate requirement for action in specific countries, and an accelerated demand for training in cessation services across the globe. The existing resource will not be sufficient to meet that demand.
Partnerships or in-kind
OFFERING: Implementing Partners, Best Practice Information
1. Our project, when successful, will improve global health in a unique, measureable, and cost-effective way, while building healthcare provider capacity around the world. We particularly welcome involvement from healthcare providers or organizations in developing countries which share our commitment to reducing tobacco use but have previously lacked the expertise to effectively treat tobacco users or advocate for tobacco policy change.
2. Our collaborators are world-leading experts on the treatment of tobacco dependence. Their expertise could be applied to the study of other addictions.