Any idea how many people were killed in the last century by war? We're talking about World War I, World War II, Korea, Vietnam – keep counting.How many people died in the atomic bomb blasts in Japan alone? How many people were killed in German, Russian, Korean, Chinese and Cambodian "death camps"? Add together every war, every oppression, every government action, every political death – how many people were killed in the 20th century?
The staggering, heartbreaking total is reasonably estimated at around 200 million – the equivalent of two of every 3 people currently living in the United States, and approximately 3 percent of the entire current global population.1 It is a monumental figure – a figure that evokes awe and reverence; revulsion and introspection.
Now ponder this question: How many people will die in the 21st century from tobacco? Could it possibly be a number anywhere close to the number that died in last century's wars? It seems an outlandish proposition, but the astounding reality is tobacco is predicted to kill as many as 1 billion people globally in the 21st century2 – more than double, triple or even quadruple the number of people who died from every war, every genocide, every atomic bomb dropped in the 20th century.
In the U.S., tobacco is the single leading cause of preventable death. If that isn't a public health concern, what is? What else could possibly qualify as a public health concern if this did not? The next question is, as a health care provider, what are you doing about it? What are you doing to help patients quit?
We Need to Join the Fight
Chiropractors can – and we should – make a difference. We learned recently through the Gallup / Palmer poll that half of American adults have been to a chiropractor. We see and interact with too many patients not to make this leading "silent killer" a central concern in our interactions.
Helping to fight Big Tobacco – and more importantly, helping patients fight their addictions and reclaim their health – is a "natural" fit for chiropractors. The World Federation of Chiropractic (WFC) notes chiropractors should join this fight against tobacco for multiple reasons:
- Tobacco use (and secondhand smoke) are leading causes of death and disability.
- Chiropractors often advocate for "drug free" health – fighting tobacco is consistent with this principle.
- Smoking is associated with low back pain.
- Chiropractors have a duty to assist in this cause as primary care practitioners.
- This fight, albeit not directly in our professional interest, but in the interest of patients' health, will build trust and goodwill.
The WFC has endorsed the World Health Organization's (WHO) Tobacco Free Initiative, and has proposed the Chiropractors Against Tobacco (CAT) initiative.3 Through this latter initiative, patient brochures, postures, and other literature and resources are available to chiropractors and their patients from a chiropractic source. This information is all readily available on the WFC website.
Take Advantage of Your Unique Ability to Influence
Many patients already know tobacco is a leading killer. Many may have even tried to quit. They may be aware that tobacco increases the risk of cancer in every organ system.4 Knowing these facts has not yet been enough to help them change. So, why could your influence help?
First, tobacco is associated with low back pain. A patient may be particularly susceptible to prompts to quit when they are feeling the immediate effects of low back pain (rather than the chance of cancer at some point in the future). Now, while they are trying to overcome this pain with your help, and are receiving advice on home care, nutrition and exercise, and hopefully complying, is an excellent time to introduce the key advice to quit. This could be as simple as providing patients with the phone number to your state's "quitline."
What a great piece of home care for LBP: "Call the state tobacco 'quitline.'" Indeed, while low back pain may have brought the patient into your office, your advice to help them quit tobacco may be what helps save their life.
Second, research has shown people who talk to their doctors about quitting are far more likely to succeed than those who do not.4 Take the position of leadership with your patients and advocate for their health against this significant source of morbidity and mortality. The U.S. surgeon general has a terrific report for consumers that can really help open eyes and minds.4
As a chiropractor, I personally work with a few groups to advocate for the public's health. One of those groups is my county board of health, where I serve as chair. We successfully advocated for a law that banned smoking on all county-owned and county-leased property. It's one of the accomplishments I am most proud of in my life. Over time, I expect laws such as this one to help increase quit attempts, reduce the visibility of tobacco, reduce secondhand smoking-related deaths, and hopefully reduce morbidity and mortality in current smokers.
Another group I work with is the American Public Health Association (www.apha.org), specifically the Chiropractic Health Care section of this group. The Chiropractic Health Care section has recently refined its message to make clear how chiropractors can advocate for public health through a variety of methods and populations. I invite you to consider membership in this section and participate in the powerful combination of public health and chiropractic, which have so much to offer one another.
Tobacco is the ultimate silent killer, but we can help fight this killer through advocacy to our patients, in the community and at large. Resources such as the American Public Health Association, the World Federation of Chiropractic, the World Health Organization, and other specific anti-tobacco groups such as ASH – Action on Smoking and Health (www.ash.org), Truth (www.thetruth.com) and many others are available to help you join the fight.
It's a natural battle for DCs to join. Please give it your consideration.
- "Necrometrics: Estimated Totals for Entire 20th Century." Necrometrics.com
- Frieden TR, Blakeman DE. The dirty dozen: 12 myths that undermine tobacco control. Am J Public Health, 2005 Sept;95(9):1500-1505.
- "WFC's Anti-Tobacco Campaign - Chiropractors Against Tobacco (CAT) - and the Role of You and Your Association." World Federation of Chiropractic endorsement, 2003.
- "Let's Make the Next Generation Tobacco Free: Your Guide to the 50th Anniversary Surgeon General's Report on Smoking and Health." U.S. Department of Health and Human Services, 2014.
Click here for previous articles by Rand Baird, DC, MPH, FICA, FICC.
Dr. Jonathon Egan is a graduate of New York Chiropractic College and current chief of staff of the NYCC Campus Health Center. Formerly a clinician at the VA facility in Rochester, N.Y., he now chairs the Seneca County Board of Health.