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It’s a paradox. Smoking and lung cancer are the
perfect example of the power of epidemiologic evidence to bring
about important social change, and the perfect example of the
inadequacy of data to bring about important social change,
according to Matthew Myers, President of the Campaign for
Tobacco Free Kids. Speaking to The Epidemiology Monitor following
his keynote address to a special meeting of the Young Epidemiology
Scholars (YES) program in Washington in early June, Myers noted
that “The effort to reduce tobacco use and the death and disease
caused by it is often seen as one of the great public health
victories, but while the progress that has been made is
impressive, the battle is far from over. There are extraordinarily
important lessons that apply to all public health issues.”
Disease Burden
In a talk entitled “Putting the Power of Science to
Work—It Takes Leadership As Shown by Both The Failure and the
Success in US and Global Tobacco Control”, Myers laid out the
challenge facing scientists and others committed to tobacco
control.
There were 100 million deaths from tobacco in the
20th century and an estimated 1 billion people will die
from tobacco in the 21st century if current trends
continue. According to Myers, tobacco is the leading preventable
cause of death killing more than 400,000 annually which is a
larger number than those dying from AIDS, alcohol, car accidents,
murders, suicides, and fires combined. Nearly 90% of lung
cancer cases, one third of the total cancer deaths, and twenty
percent of the deaths from heart disease are tobacco related.
Tobacco results in 96.7 billion in annual health care costs.
Hurdles To Policy
Action
In his presentation, Myers sought to explain some
of the reasons behind the slower than warranted progress in
tobacco control. He noted that the tobacco industry was the first
to recognize the power of politics and of political action and the
importance of framing the debate. Thus, the industry developed
political friends in high places, according to Myers, used the
media to frame the issue as one of an individual’s right to choose
or tobacco as a legal product or tobacco control as government
intrusion, and it created scientific create doubt about the
science.
He reiterated that in epidemiology and public
health it is rarely enough to produce science and assume that
change will happen. Change requires leaders, leadership,
dedication, and sustained commitment, said Myers.
Three Hurdles
Like other public health issues, tobacco is a
health issue, but its solution is a political AND social issue
according to Myers. “All policy change faces three hurdles,” said
Myers, including 1) “uninformed policy makers and the public, 2)
inertia, and 3) active opposition—often from powerful forces that
creates a lack of political will.”
To address these hurdles, Myers claimed a solid
scientific base is a prerequisite. Stated most simply, “we must
have the facts and serve as the information resource,” according
to Myers.
More About Hurdles
Myers elaborated on overcoming the hurdles by
saying that facts must be followed by achieving a public
recognition of the problem. This he argued for in the form of
media campaigns to keep the issue visible and framed as a serious
problem with a sense of urgency if not public outrage.
Next he highlighted the importance of gaining
support from organizations and individuals to join in the fight
because “when priorities collide, political leaders do what they
believe the people who are active care about.” He urged
non-governmental groups to relate to government by helping where
appropriate but pushing where necessary. He made a distinction
between coalition building and advocacy stating that direct
advocacy for public policies that make a difference is crucial and
that advocates need to know who counts to make change take place.
He cautioned that change does not occur overnight ---“it is a
marathon not a sprint.”
Formula for
Success
He told the audience “it is our responsibility to
address all three hurdles.” His formula for success in bringing
about change is: Science + Communications + Advocacy + Coalition
Building = Policy Action, Environmental and Behavior Change.
Individual leaders are required to make these elements happen, he
said, and the roles of the engaged persons can vary depending on
the circumstances, but all of the elements must be addressed.
Staying Objective
When asked about potential loss of objectivity for
scientists engaged in the process of making change, Myers said
engaging in the process of social change does not require a loss
of objectivity. In fact, he said, “we expect nothing less from
scientists” and being engaged is the best guarantee that the
evidence produced by epidemiologists or other scientists is not
ignored or misused. When scientists fail to engage, Myers said
they fail to assure the proper use and impact of the evidence.
Furthermore, it is important for scientists to be engaged with
those interested in addressing public health and social problems
because non-scientists can identify gaps in data which must be
filled for the scientific work to be of real benefit
Constructing The
Story
As part of his formula for success, Myers told the
audience that scientists and public health professionals must be
able to tell a compelling story and tell it simply. “We need
individual leaders to be engaged, to reach out to the public, to
make the case,” he told the Epi Monitor. “It does not happen
naturally.” Using tobacco as an example, he said it is a story
that can be and must be told in just four sentences or concepts:
1. We must act. We face a genuine tragedy if we
don’t act, act now, and act decisively.
2. Tobacco caused deaths are preventable. We
already know how to reduce tobacco use. And we can afford it.
3. The action we propose translated into lives
saved, costs saved, and longer healthier living. This is about
real people.
4. This is the time to act.
Champions
Myers anchored his talk in expanding on these four
concepts concluding that people make a difference and that behind
every public health victory is a champion or a group of champions
providing the essential leadership element. Unless individuals and
scientists feel strongly enough about the need to translate
evidence into action or policy, then it won’t happen, said Myers.
Even when the science is right, he added, well
meaning decision makers have lots of problems to address. Which
one gets tackled depends on which one has people behind it
demanding change.
Perseverance
He reiterated that meaningful change takes time and
perseverance. “What is radical and impossible today becomes
tomorrow’s norm,” he said, “and success is rarely a straight line.
But with the right effort, the arc of progress leans the right
way. There is nothing more fulfilling,” he stated at the end of
his presentation.
Audience Reaction
Kevin Xu,
one of the young participants in the YES event in Washington, told
the Epi Monitor that Myers’ presentation was remarkable and very
different from other keynote speeches. Why? Because Myers’ talk
was very down to earth and candid about the challenges facing
those who would translate evidence into action, he said. He added,
there is a “schism” between policymakers in the outside world and
researchers in the ivory tower with the latter not really aware of
what it takes to get people to listen or to take action. Myers’
talk was “very constructive”, he said.
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