This chapter describes Project QTI, a pioneering attempt to find out what we need to know to successfully carry out tobacco cessation in clinical and community settings. Formative research carried out in India and Indonesia is described. Both countries have high prevalence rates of tobacco use across all social classes, popular indigenous as well as imported tobacco products, few cessation activities, and no established tobacco curriculum in medical schools. A biopolitical model is presented for encouraging systematic assessment of tobacco dependency at the sites of the body, environment, and state. The tobacco control field recognizes the value of transdisciplinary research. The chapter describes Project QTI's ongoing attempts to build a community of tobacco cessation practice that spans both efforts to encourage individuals to quit tobacco use and communities to establish smoke free households and worksites.
This study documented the tobacco use among male diabetes patients in a clinic-based population of urban India, patient reports of physician cessation messages and patients' perception of tobacco use as a risk factor for diabetes complications. All the 444 male diabetes patients who attended three public sector hospitals in Thiruvananthapuram district, Kerala, were surveyed to ascertain their tobacco use as well as the frequency and content of quit messages received from health staff. A significant proportion (59%) of diabetes patients were tobacco users prior to diagnosis and more than half of them continued to use tobacco, many daily, even after diagnosis. Of the 100 current smokers, 75% were asked about their tobacco use at the time of diagnosis; of those, 52% were advised to quit. However, a lack of patient awareness existed regarding the linkages of smoking and diabetes complications. Notably, 52% of patients did not associate smoking with diabetes complications. Given the magnitude of tobacco use among diabetics, there is clearly a need for more proactive cessation efforts. The times of illness diagnosis, illness flare-ups and emerging illness complications are teachable moments when patients are primed to change their behavior and more motivated to quit tobacco.
Despite South Asia’s promising social inclusion processes, staggering social and health inequalities leave indigenous populations largely excluded. Marginalization in the South Asian polity, unequal power relations, and poor policy responses deter Adivasi populations’ rights and opportunities for health gains and dignity. The ongoing COVID-19 pandemic is likely to result in a disproportionate share of infections and deaths among the Adivasis, given poor social conditions and exclusions. Poor health of indigenous people, inequalities between indigenous and non-indigenous groups, and failures in enforcing constitutional and legal provisions to reclaim indigenous land and cultural identity herald deeper structural and political fractures. This article unravels health inequalities between the Adivasis and non-Adivasi populations in their social context based on a critical review of secondary sources. We call for intersectoral policies and integrated health care services to address systemic inequalities, discrimination, power asymmetries, and consequent poor health outcomes. The current COVID-19 pandemic should be viewed as a window to pursue real change.
Despite having a captivating history of outstanding health achievements during the second half of the 20th century, China, Sri Lanka, and the Indian state of Kerala face several health challenges, particularly in the context of a shift in financing health care from a predominantly public-sector to a market-oriented provision. Over the 1990s, these "good health at low cost" (GHLC) regions faced widening health inequities and adverse health outcomes in relation to social, economic, and geographical marginalization, compared to another GHLC country, Costa Rica, and to Cuba, which have a similar history of health and economic profile. While the historical process of health development in China, Sri Lanka, and Kerala is closely entangled with the interrelated policies on health and allied social sectors with an abiding public-sector support, the retreat of the state and resultant increase in private-sector medical care and out-of-pocket spending resulted in widening inequities and medical impoverishment. Investigating the public health challenges and associated medical care-induced impoverishment, this article argues that the fundamental root causes of health challenges in these regions are often neglected in policy and in practice and that policymakers, planners, and researchers should make it a priority to address health inequities.
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