MUSC medical student takes on cause of World No Tobacco Day, observed May 31

By Rahoul Ahuja

Over the past few years, I’ve had the opportunity to volunteer along with healthcare professionals in developing countries, work with global health experts at the World Health Organization (WHO) and Centers for Disease Control (CDC), and also conduct research in Argentina. Through these experiences, I’ve not only cultivated a passion for global health, but have also found that international traveling is very humbling, and really broadens your perspective.

In 2010, I traveled to Costa Rica to work with doctors to provide healthcare in rural communities with high disease burdens. As an aspiring physician, I was surprised to see that contrary to popular belief, infectious diseases were not the leading causes of death in the developing world. Rather, chronic, non-communicable diseases (NCDs) like heart disease and cancer imposed the highest burden of morbidity and mortality.

As weeks passed, I found myself captivated by not just the causes of NCDs—tobacco use, unhealthy diet, physical inactivity—but also the causes of those causes: the social and structural determinants of health. Indeed, the conditions that people live and work in are the primary drivers of disease worldwide. These experiences inspired me to learn more about the social, legal, and ethical issues surrounding global health and led to me interning at the World Health Organization’s headquarters in Geneva, Switzerland in 2011.

Working in the WHO’s Department of Non-communicable Diseases and Mental Health has been the most humbling and enriching experience of my life so far. Among my fellow interns were physicians from India, Egypt, as well as graduate students from every continent worldwide. As the only American in my department, I came to see how working with people of different backgrounds is critical to tackling global health problems. But while working at the WHO, one particular health issue caught my eye: the global burden of tobacco use. While I knew tobacco use was certainly harmful, I didn’t know it was the number one preventable cause of death worldwide—responsible for six million of the 56 million deaths that occur every year globally (and nearly 500,000 in the US every year). Since tobacco use kills up to half its long-term users, it imposes not just debilitating health burdens, but also enormous economic costs on countries worldwide.

While at the WHO, I also learned how the implementation of strong tobacco control policies—just simply passing, and enforcing them--has far-reaching potential to avert preventable deaths. In China for instance, where 49% of all males smoke, a 50% tobacco tax increase would avert 20 million deaths by 2050. The CDC’s recent anti-smoking ads helped 100,000 people quit smoking, averting nearly 50,000 premature deaths. These are issues that don’t necessarily require massive amounts of funding to solve—they are political issues, which require strong support from the public and policymakers. To make sustainable global health progress (and address NCDs), it is key to reduce the population prevalence of tobacco use.

After my experiences at the WHO, I also had the opportunity to conduct research at the CDC’s Global Tobacco Control Branch in 2012, as well as research in Buenos Aires, Argentina, where I examined how indirect tobacco advertising in entertainment media may affect youth smoking rates in developing countries. I’ve also had the great pleasure of working with researchers like Dr. Jim Thrasher at USC, as well as Dr. Michael Cummings here at MUSC, a global leader in tobacco control who is helping incorporate smoking cessation services into the MUSC Hospital system.

In South Carolina, a third of all cancer deaths are linked to tobacco, and since tobacco use kills nearly one-half of its long-term users, this work will go a long way towards averting premature deaths. All the work we do--from members of the healthcare team to global health researchers—can make a real difference in people’s lives. Ensuring that critical issues like tobacco use are not neglected—whether in the UN’s global agenda or in the healthcare clinic—is critical to improving the well-being of those in our communities and populations globally.

I’ve learned some important lessons from my experiences abroad, as well as here in the classroom at MUSC. There are some things that are going to happen, no matter what you do. But then there are things that are on the fence that could go either way. Success is not guaranteed, but if you really make a focused effort, you can succeed. These on-the-fence issues are priorities, or “winnable battles.” Tobacco control is a winnable battle; hundreds of countries have already made tremendous progress in implementing the WHO’s recommendations on tobacco control.
Still, one billion people are expected to die this century from tobacco use unless urgent action is taken, and there is plenty of work to be done. These numbers resonate with me not just as an aspiring global health advocate, but also as a medical student, where seeing the real human toll of tobacco use in the clinics humanizes the statistics and gives me a greater sense of urgency.

I hope to use my medical training here at MUSC to develop my skill-set as an aspiring physician-scientist, in order to lay the groundwork for internationally collaborative efforts to tackle these issues. There will be numerous challenges along the road, no doubt. But if we work hard together and make a concerted effort, we will reach the right solutions.

Rahoul Ahuja is a second-year medical student at MUSC. See MUSC PR News Center article.

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