100% Smoke-Free Campus IFMSA Asia-Pacific Regional Advocacy Campaign [Guidelines]

Introduction - Advocacy, Education and Policy in IFMSA Asia-Pacific

In an era when health is not only determined by biological mechanisms but also by social, economic, political and environmental determinants, in an era when health challenges transcend borders and require collective global action from across disciplines, locations and levels, we, medical students of Asia-Pacific, believe that future doctors should be equipped not only in working for the cure of organic diseases, but also in addressing the social and political forces shaping the health of our populations through the triad of advocacy, education and policy engagement. We find this era as an opportunity to realize the vision of Rudolf Virchow, the Father of Social Medicine: "Medical education does not exists to provide students with a way of making a living, but also to ensure the health of the community." Hence, the IFMSA Asia-Pacific envisions to launch a new generation of medical students and future doctors who will actively participate and take leadership in health issue advocacy, policy engagement and global health education in order to create changes leading to a healthier Asia-Pacific region. The work entails achieving the following missions: To engage and equip medical students with knowledge, attitudes, skills and tools in advocacy, policy works and global health education. To define key areas and propose key strategies for advocacy, policy engagement and global health education works for NMOs in Asia-Pacific. To create a regional culture and provide a regional framework for advocacy, policy and education in addressing regional health issues in the Asia-Pacific region. In this fiscal year (2012/13), 3 passionate medical students have been appointed to serve in our region as the Development Assistant for Advocacy, Education and Policy: 1. Ms Shela Putri Sundawa - CIMSA Indonesia 2. Ms Briar Mannering - New Zealand Medical Students' Association (NZMSA) 3. Ms Jade Lim - Australian Medical Students' Association (AMSA-Australia) They can be contacted on da.aep.ifmsa.ap@gmail.com.

Background:
Tobacco use continues to be the leading global cause of preventable death. It kills nearly 6 million people and causes hundreds of billions of dollars of economic loss worldwide each year. Most of these deaths occur in low- and middle-income countries, and this disparity is expected to widen further over the next several decades. If current trends continue, by 2030 tobacco will kill more than 8 million people worldwide each year with 80% of these premature deaths among people living in low- and middle-income countries. Over the course of the 21st century, tobacco use could kill a billion people or more unless urgent action is taken.[1] Tobacco not only kills the smokers, but also kills the innocent people. Research shows that large number of people continue to be exposed to second-hand smoke at home and in the workplace. The 2010 United States Surgeon General's report contains new scientific data that confirm the health harms caused by tobacco smoke, and detail the biological and behavioural mechanism of how mainstream and second-hand smoke damage human body. The WHO Framework Convention on Tobacco Control (FCTC) states in Article 8: scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability, and parties (countries) shall adopt and implement measures providing for protection from exposure to tobacco smoke in indoor workplaces, public transports, indoor public places and other public places.[2] There is no safe level of exposure to second-hand smoke.[3]

The number of deaths from exposure to second-hand smoke in the Asia-Pacific region ranks second highest in the world, according to the Tobacco Atlas Report.[4] This report also reveals that global deaths from exposure to second-hand smoke are highest in women and children. There are many diseases related to second-hand smoke. For adults, these include coronary artery disease, lung cancer, pre-term deliveries and strokes, whilst for children it can cause middle-ear disease, impaired lung functions, Sudden Infant Death Syndrome (SIDS), low birth weight and others. Study results published by the United States Institute of Medicine consistently indicate that second-hand smoke exposure increases the risk of coronary heart disease by 25 - 30% in non-smokers, and that there are increased risk even at the lowest level of exposure.[5]

The only effective way to protect people from the devastating exposure to second-hand smoke is through the creation of a completely 100% smoke-free environment. It also helps smokers to reduce cigarette consumption, and helps smokers quit. Separate smoking rooms and ventilation systems do not prevent second-hand smoke exposure.[6] Although the adoption of 100% smoke-free laws have achieved progress during the last few years in Asia-Pacific, universities have proven to be sectors particularly resistant to such measures. In most cases, standards established by the international scientific community to reduce consumption in high level educational settings are still below expectations.[2] The standards from the FCTC advocate that the only way to protect people from the harm caused by the exposure to second-hand smoke is the implementation of a smoke-free environment in all indoor public venues and workplaces.[2] The International Federation of Medical Students' Associations (IFMSA), adopted a policy statement on tobacco control, in 61st August Meeting 2011 General Assembly at Mumbai India. [7] This strongly reflects the commitment of IFMSA, its member organizations and all its medical students in fighting the tobacco epidemic. The Regional Coordinator for Asia-Pacific 2012/13 and his regional team members, in

the 1st Online Meeting, decided to launch the "100% Smoke-Free Campus" IFMSA Asia-Pacific Regional Advocacy Campaign. This proposed guidelines was drafted by the Development Assistants for Advocacy, Education and Policy from November 2012 to January 2013. This guidelines will be presented during the regional session in March Meeting 2013 IFMSA General Assembly at Baltimore, USA, to be adopted and officially implemented then on. It is established based on international tobacco control recommendations, and are aimed at supporting the implementation of 100% smoke-free environments in Asia-Pacific universities. Unlike the Europe and America regions, advocacy is still a relatively new concept to many NMOs in our region, especially the Asia. The Pacific (AMSA Australia and NZMSA) however, are doing better and actively engage in many advocacy campaigns locally and globally. We want to build the advocacy capacities of our NMOs, hence we thought it will be a great to start learning and doing at the school-level.

Objectives:
The objectives of this campaign are: To support the WHO Framework Convention for Tobacco Control, as students' organization. To create a smoke-free environment, by students for students. To provide a platform for knowledge-sharing, capacity building on advocacy among NMOs in AsiaPacific region.

How can we implement a 100% smoke-free university?

The key to succesful implementation of a smoke-free university is the commitment of all sectors. Students, faculty, authorities and support staff need to be actively involved in achieving a smoke-free university. The implementation itself is not instantaneous, but rather a continuous and gradual process that seeks to transform the culture of the university. Below is the four-stage plan modified from the Towards a Smokefree University Guidelines by ALIAR Argentina. [8] Stage 1- Understand the Condition Actions: 1. Check for previous regulations: Confirm the existence or absence of resolutions regarding smokefree environments. If there is an existing regulation, modify it to meet health protection standards. 2. Identify key stakeholders: Stakeholders in universities include student organizations, labor unions, faculty associations, university authorities and many more. Once the key stakeholders have been identified, they should be engaged to collaborate in an inter-sectoral effort. 3. Detemine the baseline: Pool information about tobacco use, degrees of knowledge regarding harm from second hand smoke exposure, evaluation of smoking habits in indoor areas, as well as the level of support for the implementation.

Stage 2 - Prepare the Campaign Actions: 1. Gather people: It is important to create a group of people that is representative of the university community. We can then form allies to strengthen the future implementation of a smoke-free university. Furthermore, the allies should include all university sectors; faculty, students, counselors, administrative staff, etc. We can start to create a committee from these allies. The committee will be responsible for the general coordination of making the university 100% smokefree, and it will liaise with the rest of the community. 2. Educate the university community: Raising awareness is an important step; if people know about the harm caused by exposure to secondhand smoke, it will increase their willingness to support our initiative. There are different ways to increase awareness among the university population, such as organizing talks or workshops, making print or online materials, bulletin boards, internal publications, social networks, and through mailing lists. 3. Elaborate a proposal: We will need to pass a proposal to the university about our initiative. It should incude the basic argument, steps that must be followed, the benefit of the implemetation, and examples of the successful implementation. It should also include the ban of tobacco sale, advertising and promotion inside university premises. 4. Request the implementation of 100% smoke-free environments: Submit the proposal to the university authorities. Stage 3 - Implement 100% smokefree environment Actions: 1. Issue a resolution to implement a 100% smoke-free environment: Should be done in all indoor university places, with no exception. 2. Enable a channel for queries: Designate a person to answer queries. 3. Inform the community: Communicate the date in which the resolution will enter into force. Everyone in the university should be aware of the implementation of smoke-free university. 4. Develop and distribute informative material: The material should contain the benefits of a 100% smokefree environment, information about the new resolution, as well as promote tobacco cessation. Data gathered during stage 1 can also be used to disseminate information on the degree of public support for the initiative. We reccommend launching the implementation process with a public event or a small flyer-and-poster campaign, in anticipation of the coming changes. Stage 4 - Monitor and Evaluate Results Actions: 1. Evaluate the projects success: Evaluate the impact of the implementation and compare the results with data gathered in Stage 1. 2. Analyze the outcomes: The outcomes of the evaluation will be useful to determine whether the initiation has been a success or not. The result of it can also help us to determine what needs to improve in the future.

Definitions:
Several alternative terms are commonly used to describe the type of smoke inhaled by non-smokers. These include "second-hand smoke", "environmental tobacco smoke", and "other people's smoke" and "passive smoking". In this draft paper, we use "second-hand tobacco smoke". Second-Hand Tobacco Smoke: the smoke emitted from the burning end of a cigarette or from the tobacco products usually in combination with the smoke exhaled by the smokers. Smoke Free Air: the air that is 100% smoke free, includes but is not limited to, air in which tobacco smoke cannot be seen, smelled, sensed or measured. Smoking: This term should be defined to include being in possession or control of a lit tobacco product regardless of whether the smoke is being actively inhaled or exhaled.

Completely smoke-free environments with no exceptions are the only proven way to protect people from second-hand smoke.

Reference: [1] WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. World Health Organization. Geneva, Switzerland. [2] WHO Framework Convention on Tobacco Control. World Health Organization. Geneva, Switzerland 2003. [3] WHO International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking. IARC Monographs on the Evaluation of Carcinogenic Risk to Humans. Lyon: WHO IARC, 2004. [4] Tobacco Atlas 4th edition. Available at tobaccoatlas.org [5] U.S. Institute of Medicine. Secondhand smoke exposure and cardiovascular effects: Making sense of the evidence. Washington, DC: Institute of Medicine. [6] American Society of Heating Refrigerating and Air Conditioning Engineers (ASHRAE). Environmental tobacco smoke: Position document. Atlanta: ASHRAE, 2005. [7] IFMSA Policy Statement on Tobacco Control, August 2012. International Federation of Medical Students' Associations. [8] . Argentina Smokefree Alliance. Towards a smoke free university: guideline for the implementation of 100% smokefree environments in institution of higher education. Argentina: Interamerican Heart Foundation Argentina.