Sunday, January 08, 2006

Smoke-free cities: what can we learn?

On November 28th and 29th, 2005, I have participated at an "Expert workshop" on Smoke-Free satisfying request of the CIFAL Lyon. As I informed some of you in a previous message, the purpose of this participation was mainly to present the AIDS Competence approach to that group, and to see if there is any added-value to develop a similar process for achieving the ultimate goal of "Smoke-Free Cities".
Here are my comments/lessons from these two days:

1. First of all, it is now clear for me that the goal of having "smoke-free cities" is limited; it mainly focuses on the development and implementation of tobacco-control policies and rules. Most of the participants were in the controlling mode and aimed at enforcing legislation at city level. We all know that putting a ban on smoking in all public buildings and settings etc... will only reduce tobacco prevalence by 20%.

2. Second, the main target of the group was not so much people, but Mayors and other local authority decision-makers. They needed to develop advocacy or communication strategies to convince or attires City Halls to establish tobacco-control regulations.

3. Third, most of the participants were still convinced they know exactly and extensively what to do to have smoke-free cities. They didn't see as an issue the fact that applying a smoking ban in e.g. restaurants is probably not as simple as it appears; it is not so much to make tenants to sign at the bottom of a document and putting posters. How bar tenants are dealing with reluctant people? How do they explain this rule to the "hard-to-change" consumers so that they don't lose too many clients?

4. Smoke-free cities are different of tobacco-free cities. The group stated that they wanted to focus on Smoke-free cities at first. Decreasing tobacco prevalence further will need other strategies and approaches, more related with behavior changes, for which they didn't have a clue.
While they realized that an ACP-Like process may be useful for tackling smoking attitudes, they didn't have any knowledge of successful aproaches or interventions which could apply.

I think the goal of such Smoke-Free Cities group is worth to implement, but limited. In spite of these limitation, there would be some interest to develop a learning and exchange process for increasing efficiency of some "control" measures. However, an ACP-like process would be much more interesting and efficient if the group would have considered a tobacco-free cities goal!
At the end, the group designed a classical approach to organize a workshop where local authorities will be trained (taught) to implement control strategies in their respective cities.

I am, more than ever, convinced that tobacco issues is one of interest for learning and exchanges process. But, such process cannot be initiated by an expert group: local authorities who are willing to reduce tobacco prevalence in their city are probably the right people to talk to. They will be much more interested in action-oriented and result-oriented strategies. If the Constellation is approached by such partner, than it will be possible to propose an appropriate process.

The real success for a Smoke-Free city would be to influence behavior of the citizens, through a collective approach led by a Mayor or other local authorities; non to inforce rules which may only marginalize smokers and make them "hard to reach". Next step would be to develop a Tobacco Competence concept!

Thank you.

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