Washington, D.C., 2 October, 2015 (PAHO/WHO) -- A growing number of countries in the Americas have in the past two years instituted legal restrictions on tobacco advertising, sponsorship and sale, according to a progress report presented at meetings here this week of high-level health officials from throughout the region.
The summary of tobacco control efforts since 2013 was one of a series of progress reports presented at the 54th Directing Council of the Pan American Health Organization (PAHO), the regional office for the Americas of the World Health Organization (WHO).
The reports brought into perspective the status of efforts to improve oral health, road safety and prevent the incidences of dengue across the region and of chronic kidney disease in Central America.
The number of countries that are parties to the WHO Framework Convention on Tobacco Control (FCTC) increased to 30 in the region with the ratification of El Salvador in October 2014. In the last two years, progress has been slow. A new round of the Global Youth Tobacco Survey was carried out in seven countries and is in preparation in four more.
While no nations in the Americas have passed new legislation since 2013 to promote smoke-free environments, a number of countries have made progress in controlling tobacco use through economic means, the health officials were told.
Chile, Venezuela, Honduras, Dominica and Grenada have raised taxes on tobacco products. Legal mandates for graphic health warnings on tobacco products have been instituted by Jamaica, Suriname and Trinidad and Tobago. And Uruguay has joined Brazil, Colombia, Panama and Suriname in approving a total ban on tobacco advertising, promotion and sponsorship.
The report recommends further efforts to control tobacco use by the countries of the Americas, with the goal of reducing tobacco use by 30% by 2025.
There are six parties to the new Protocol to Eliminate Illicit Trade in Tobacco Products, two of which (Nicaragua and Uruguay) belong to the Region.
The nations of the Americas have achieved marked progress in reducing tooth decay since 2006, when PAHO passed the 10-year Regional Plan on Oral Health for the Americas, health officials were told.
The increased integration of oral health treatment into primary health care and the advancement of fluoridation programs have reduced the prevalence of dental cavities by between 35% and 85% in the Americas since 2006, according to the report presented to the health officials. In 34 member states, 12-year olds had an average of fewer than three cavities.
The report calls for extending successful fluoridation programs, working to change the persistent attitude that oral health is not as critical as overall health care, and improving government responses to the increase in oral cancer associated with the human papillomavirus (HPV).
Since 2011, the countries of the Americas have progressed significantly in making their roads safer, but there is still more to be done, the health officials were told this week.
Of the 35 PAHO member countries, 27, or more than half, have a well-funded agency responsible for promoting road safety in all its regards, the report found.
The number of countries mandating seatbelt use has risen from 20 to 32.Those mandating helmet use for motorcycle passengers have risen to 30, up from 12 in the same period. And the number of countries that prohibit drivers with a blood alcohol level of greater than 0.05% from operating a motor vehicle has risen from 10 to 15.
Despite the gains, the report found an urgent need for better data collection by many countries of the region on traffic-related injuries, for more progress in establishing consistent safety measures for road sharing with pedestrians and bike riders, and for increasing funding and authority of government efforts to ensure compliance with road safety laws and measures.
Dengue prevention and control
Dengue, a debilitating viral disease of the tropics transmitted by mosquitoes, remains a pressing public health challenge in the Americas despite progress made to stop and mitigate the impact of epidemics, according to a report on the control and prevention of the disease presented to health ministers this week.
The report notes that dengue incidence in the region has increased 30 times in the last fifty years, with more than 14.2 million cases registered between 2000 and 2014. Indeed, 2013 had the highest burden of disease ever registered, with the largest epidemic in the history of the Americas, with a total of 2.3 million cases, 37,898 severe cases and 1,318 deaths.
But while the incidence of the disease is troublingly high, the number of severe cases of dengue has dropped in the last five years, since health systems adopted new clinical guidelines for its care and a network of state-of-the-art laboratories to diagnose the disease was established throughout the region. The report says about 3,300 deaths from the disease were prevented between 2011 and 2014.
More advances are needed, according to the report. Medical care for the region's rural and most marginalized communities will need to improve. Work must continue on the development of a dengue vaccine and other promising technologies to control the disease. And since illiteracy, poor sanitation and access to clean drinking water and poverty in general are related to the high incidence and transmission of the disease, an integrated societal response across government and the private sector will be needed to foment public policies to beat the disease.
Chronic kidney disease in agricultural communities in Central America
Public health systems in the past two years have made some initial progress in quantifying and understanding a puzzling two-decade long surge in chronic kidney disease (CKD) in Central America, but much more remains to be done, according to a report presented to the health ministers this week.
The deadly outbreak, centered in farming communities, is not linked to the most frequent causes of chronic kidney disease - diabetes and hypertension. And while its specific cause is still unknown, scientists with PAHO and public health systems across the region believe it to be related to occupational hazards, perhaps including pesticide use.
Central American countries have taken steps to limit pesticide use. In El Salvador, lawmakers have prohibited the use of 53 highly toxic active ingredients in pesticides that had been widely used. Guatemala has approved new regulations on occupational health and safety and is working to modify its regulations on domestic pesticides. And throughout Central America, public health systems have improved primary care for those ill with CKD. Access to kidney transplants and coverage for such treatment has improved across the board.
But to make real progress against the disease, more action is needed. The report calls for regional cooperation on research into the disease and data collection on its effects. Because the cost of CKD treatment is very high, the report calls for study into negotiating better prices for drugs and treatments.
The health ministers also heard a report on incorporating health technology into national health systems and a review of work done by PAHOs specialized centers, one focused on the study of Foot and Mouth Disease and one, the Latin American and Caribbean Center on Health Sciences Information, that channels scientific and technical cooperation to member countries.