Unlike Australia today where the prevalence of smoking is about 15%, Vietnam remains a country where smoking is widespread. About 60% of the men smoke and about 5% of women. The burden of diseases related to smoking is therefore extremely high. On visiting a Hanoi hospital respiratory ward last week, most of the 100s of inpatients were patients with acute exacerbations of COPD (Chronic Obstructive Pulmonary Disease), and visiting the cancer hospital also showed that most of the cancers were also smoking related. There are efforts to reduce uptake of smoking however there is little supporting funding.
My role in the short week of visiting these sites was to teach the staff about smoking cessation. The medical and allied health staff were very keen and eager to learn about our approaches. However there was a great deal more to address. Cigarettes are very very cheap and readily available. The tobacco industry is local and tobacco is grown in Vietnam, with probable conflicts of interest for the government. The math has been done however that shows the enormous loss in health costs versus the gain in income.
There are particular goals that might make a difference relatively quickly. Increasing the cost of tobacco and hypothecating the income to smoking related tobacco control and treatment services is known to have a significant effect on prevalence. Improving the awareness of health workers of the huge financial and health burden that smoking has on the well-being of the population would commence a trickle-down effect to the community. This along with a multifaceted intensive and prolonged anti-smoking media campaign would be very cost beneficial.
There are things, however, we may learn from the prevalence of smoking in Vietnam. Most intriguingly it would be helpful to understand why so few women and girls smoke. It is highly inappropriate for Vietnamese women to smoke. A study of the cultural and environmental influences may show results that might be translated to other nation’s groups in order to reduce the prevalence of smoking elsewhere, and not just in women and girls.
Renee Bittoun is Adjunct Associate Professor, Clinical School, Smoking Research Unit, Faculty of Medicine, Brain and Mind Centre, Sydney Medical School, University of Sydney.