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June 14, 2016

European Respiratory Society Presidential Conference

As the chair of the NCD Alliance, and as the leader of two public health organizations, prevention is foremost on my mind. The impacts of non-communicable diseases in the world are grave. Sixty-eight percent—roughly two out of every three deaths—are from NCDs. Diabetes. Cancer. Heart disease. And, of course, lung disease.

The human and economic tolls are enormous. We simply cannot allow NCDs to go on claiming lives at this rate. The health cost is unacceptably high because, as you know, most non-communicable diseases are entirely preventable.

As this group well knows, two of the biggest risks for respiratory disease are smoking and air pollution.

On the tobacco front, we have done much to increase awareness about the harms of tobacco use, but there is still much work to do.

The tobacco industry invests billions of dollars to push new products in new markets, with the pretense that products like e-cigarettes will reduce harm. We know, however, that their real aim is to sell more tobacco products, to create more addiction, and to develop new generations of tobacco users. In addition, secondhand smoke causes 600,000 deaths a year, and children are especially vulnerable to asthma and other respiratory problems from exposure to tobacco smoke.

The industry is indifferent to the disease and death it knowingly causes.

It is even less concerned about how it is destroying families and lives in low- and middle-income countries where tobacco policies are weaker. Complicating this threat, low- and middle-income countries face greater prevalence of health challenges such as HIV or tuberculosis.

Obviously, we must reduce the use of all tobacco products. As doctors, you play an important role in prevention by encouraging and supporting your patients in quitting.

That’s a critical part of the solution. But there’s more. The European Respiratory Society should join with other medical organizations and civil society to demand the legislative, policy and economic changes that can end tobacco use along with monumental pain, suffering and loss that comes with it.

Specifically, it is time that the medical community joins with the public health community and urges governments to adopt best practice policies such as those articulated by the WHO Framework Convention for Tobacco Control. This includes raising tobacco taxes and targeting the revenue for public education about tobacco harms and improving health systems; strengthening smoke-free legislation; and advocating for graphic warning labels on all tobacco products. These interventions are proven to work to reduce smoking and prevent premature deaths. We must tell our governments that the time has come to accomplish the achievable goal of ending smoking as we know it.

We must also address the terrible impact of air pollution on human health.

Globally, air quality is getting worse.  Air pollution is on the rise, and deaths caused by air pollution have increased from 4.8 million annually in 1990 to nearly 7 million in 2015. Developing nations with rapid industrial and urban expansion bear the heaviest burden of air pollution’s effects.

The Global Burden of Disease project has shown recently through their research that air pollution-related deaths in Latin America, Sub-Saharan Africa, and Southeast Asia have worsened more dramatically than other regions during the last decade. And we receive weekly bad news about the effects of smog and urban air pollution, along with lax regulation and poor oversight among government agencies worldwide responsible for air quality. Even as we make gains in reduced emissions and improved regulations, we also face monumental setbacks in improving air quality.

Despite the challenges, the imperative is clear: more efforts must be made to reverse the current trends, to reduce human exposure to air pollution, and to save lives.

I ask the ERS to join us in urging legislators and policymakers to address the sources of air pollution and to reduce emissions from personal and commercial sources. We must persuade lawmakers to hold manufacturers and businesses accountable on air quality issues, and to expand clean air public transportation and active commuting options such as walking and bicycling over personal commuting with automobiles and motorbikes. We must ask our governing bodies for the reduction of fertilizers and other harmful air pollutants in the agriculture industry.

Taking action as a professional body is not only appropriate, it is more urgent than in the past, given the world’s ever-increasing population, and the health-complicating factors of expanding urbanization and climate change. With WHO’s 2030 Global Goals we have a new, stronger bargaining chip with our governments: the Sustainable Development Goals include NCD targets that governments have agreed on. We can push our lawmakers and representatives to be accountable at a higher level than in the past. We can make a greater impact if we join efforts and demand improvements together.

Erasmus, the Dutch humanist, made the observation over 400 years ago that, “prevention is better than cure.” While cures and the people who deliver them are vitally important, I think we can all agree that greater success with prevention would make all our lives better.

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