CHINH SACH
NANG CAO HIEU QUA CHINH SACH PHONG, CHONG TAC H A I THUOC LA
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NGUYEN ANH FHlTONG*
Trong dieu kien ly tu'dng, cac quoc gia nen cam ta't ca cac hoat dong san xuat, mua ban, su' dung thuoc la, bdi hdn nu'a so khach hang tieu thu san pham thuoc la da, dang va co the se tuT vong vi suT dung chung.
Mac du biet ro nhu'ng tac hai tuT viec suT dung thuoc la gay ra cho su'c khoe ca nhan va cong dong, van de kho giai quyet la co rat nhfeu ngu'di dan, va ca nguon ngan sach cua nhieu quoc gia, dang phu thudc, hoac hu'dng ldi tuT nganh cong nghiep thuoc la. Them nu'a, mot trong nhu'ng van de khd khan la giai quyet mcl quan he giu'a quyen tu' do ca nhan vdi anh hu'dng co hai trong vi§c sii'dung thuoc la cho cong ddng va ganh nang kinh te xa hoi. Bai viet nay neu sd lu'dc ve tac hai cua viec sii dung thudc la tran lan va khung kho chien lu'dc chung ve Iciem soat thudc la;
tu' dd, khuyen nghj mot so giai phap chinh sach phdng, chdng thudc la phu hdp vdi nu'dc ta.
1. M$t s6 tdc h^i cua vi^c sd* dung thu6c id trdn lan
Nguy hffi cho s^ khoe cd nhdn Khodng 5,8 nghin ty (5.800.000.000.000) dieu thudc la cdc loai da dugc sir dung trdn thd gidi tiong nam 2014. Hipn nay, 10 nudc tieu thy thudc la ldn nhit ldn lugt tii tidn xudng Id Trung Qudc, Nga, My, Indonesia, Nh^t Ban, Dire, An Dp, Thd NhT Ky, Hdn Qudc va Vi$t Nam'.
Su dyng thu6c Id Id nguydn nhan pho bidn hdng dau dan den nhieu can b§nh gay tli vong tidn thi gidi, nhung cd the ean thifp phdng trdnh duge. Vi dy, hiit thuoc la ldm tang nguy ea mdc bpnh tiiieu mdu cyc bp ccr tim them hern 2,5 lan, benh ung thu phoi khodng hem 20 lin. Nam 2008, ed khoang 1,4 tripu ngudi chit vi ung tiiu phdi, 80%
tiong sd do gay ra bdi ttiude Id. Tinh trung binh, mSi ndm hi$n cd khodng gan 6 tri^
7^p chf Nghiin dhiL$p phip.
Midad Erilsen, Judith f^ackay, Neil Schluger, Farhad t^ml, Jeffrey Drope (2015), The tobacxs atias, American Cancer Sodety.
34
P H A P _ / S 6 24 (304) T12ffi015CHINH SACH ngudi tii vong vi thude Id. Ndu khdng ed
nhiing bidn phap ean thiep hidu qud, vdo khoang nam 2030, con sd nay cd thd tang ldn 8 tiieu ngudi/ mdt naml U"dc tmh khodng 01 ty ngudi se tu vong tiong thd ky 21 do cdc cm bdnh lien quan ddn thudc Id ndu dua tren md hinh hidn tgi, so vdi khodng 100 trieu ngudi chdt vi thudc la tiong thd ky 201
Bdn cgnh dd, thdi gian su dyng thudc Id cang lau thi rui ro bdnh tdt nhu ung thu phdi, bdnh vd tim mach edng cao, tudi thg tiimg binh cdng thip. Vi dy d My, tudi tiig trung binh cua ngudi da hiit thudc Id rdi bd thudc d tudi 35 keo ddi ban tir 6 ddn 9 nam so vdi nhiing ngudi vdn tidp tyc hiit thuoc.
Ngay cd vdi nhiing ngudi chi bd thude la d tudi 65 vdn kdo dai tudi thp ban tii 1 ddn 3 nam so vdi ngudi tidp tyc hiit thudc". Thdi gian hiit thudc cang ddi thi do riii ro mdc benh ung thu phdi cdng eao, ndu thdi gian su dung thude tang gip 3 lin, rui ro tang 100 Idn^
Cho ddn nay, Tnmg Qudc vdn la nudc san xuat vd tidu thy thudc la ldn nhdt tien the gidi, vdi viing nguyen lieu ehidm khoang 37,1%, vd sdn lugng san xuat ehidm khoang 40,5%. Cd ban 300 trieu ngudi Trung Qudc sir dyng thudc la, chiem khoang 1/3 tdng sd ngudi sur dyng tiiudc la tren thd gidi, vd tidu thy khodng 1/3 sdn lugng toan edu. Mdi ngdy, ban 3.000 ngudi dan d qude gia nay tir vong cd nguydn nhdn tii sir dyng thudc la.
Con sd nay se tang, tii khoang 0,8 trieu ngudi
moi ndm vdo nam 1990, ldn ddn khodng 2 trieu ngudi mdi nam vdo nam 2025^.
Ngay cd qudc gia kha thdnh cdng trong ehinh sdch kidm soat thude la nhu Austialia, thudc la vdn Id nguyen nhan chinh ddn den cdi chdt eua khoang 15.500 ngudi hang nam, Khoang 1/4 nam gidi va 1/5 nu gidi d dd tudi trudng thdnh tidn tdng dan sd vdn dang hiit thuoc la, va khoang mdt nira trong sd hg dugc cho la cd thd se chdt, ndu khdng dimg vide sii dyng thudc la'.
0 nhiem moi tru&ng song vd nguy hg.i cho cong dong
Vide tidng cdy thudc Id Id mgt tiong nhiing nguyen nhan tryc tiep va gian tiep dnh hudng d nhidm mdi trudng va bidn ddi khi hau, dgc bidt d eac qudc gia dang phat tridn, nhu hidn tugng ddt dai can cdi, ngudn nude d nhiem, chdy rumg, dnh hudng ddn cdc loai sinh vdt quanh viing nguydn lieu v.v.. Hut thudc la eiing Id mdt tiong nhung nguydn nhan hang ddu gay m eae vy hda hoan ddn ddn chdt ngudi d My^. Ngoai ra, rac thai tii hut thude la ciing la v&i dd gay d nhidm n&ig nd.
Bdo vd mdi trudng va siic khde cua ngudi dan (Didu 18) Id mgt tiong nhimg ndi dung trgng tdm cua Cdng ude khung vd kiem sodt thudc Id (WHO Framework Convention on Tobacco Control - FCTC). Mac du vdy, ty lp ede nude tham gia cdng udc thyc hien diing cam kdt ndy cdn thap, phdn tich sd lidu trung binh tii cac nude tham gia FCTC cho thay ty Id thyc hipn ehi dat dudi 40%^.
2 Worid Health Org (2008), MPOWER: A policy package to reverse ttie tobacco epidemic.
3 Xem chd thfch 1: Michael Eriksen et at (2015).
4 Peto R, Darby S, Deo H, Silcocks P, Whitiey E (2000), Smoking, smoking cessation, and lung cancer in the UK sines 1950:
combination of national stattsUcs with two case-control studies, British Medical Journal, no. 321, pp. 323-329.
5 AlbergAJ, Samet JM (2003), Epidemiology of iung cancer. Chest 123.
6 Guo H,SaZ (2015), Socioeconomic difkrentials in smoking duration among adult male smokers in China: Result from the 2006 China Health and Nutrition Survey, PLoS ONE voi 10, no. 1.
7 Scollo, MM & Winstanley, MH (2012), Tobaax) In Australia: Facts and issues, 4th edn, Melbourne: Cancer Council WctiJria.
8 Xem chd ttii'ch 1: Michael Eriksen etaL (2015).
9 WHO (2014), 2014 global progress report on implementation of the WHO Framework Convention on Tobacco Control, Li- brary Cataloguing-in-F^biication Data.
S6 24(304)T12/2015\
NOHl£N c i h i l nm - U P PHAPI J 3
CHINH SACH
Ben cgnh dd, bao ddm khdng hiit thudc la tgi ncri cdng cdng, nai ldm vide chinh Id mgt cdch dd bdo vd mdi trudng sdng, mdi trudng ldm vide trong Idnh. Bdi vi, thudc la khdng ehi nguy hai cho siic khde cd nhdn ngudi su dung, md cdn dnh hudng tdi siie khde edng ddng, nhiing ngudi phai hiit thudc la mgt each thy ddng trong mdt mdi trudng sdng bi d nhidm bdi khdi thudc Id gay ra.
Ngudi hut thudc Id thy ddng (secondhand smoke, hoac passive smoking, hoac environ- mental tobacco smoke) ciing chiu tae hai nghidm tigng ve sire khde, vi dy nhu tang nguy CO mac bdnh tim mgch idn han 25%, bdnh ung thu phdi ldn han 30%. Mdi nam, tidn thd gidi vdn cd khoang 600 nghin ngudi tir vong la do SHS. Rieng d Trung Quoc, udc tinh cd khodng hon 540 trieu ngudi bi de dga bdi hut thudc Id thy ddng'".
Q Viet Nam, ty Id hiit thudc Id d nam gidi trong do tudi trudng thanh da gidm tii 56,1 % nam 2001, xudng 47,4% ndm 2010. Ty le sir dyng thudc Id d thanh thidu nien tii 13 den 15 tudi gidm tir 3,3% nam 2007, xudng 2,5%
nam 2014. Cd 87% ngudi trudng ihdnh nhdn thiic rang hiit thudc id thy ddng cung ddn ddn cdc bdnh gidng nhu ngudi hut thudc ehu ddng". Tuy nhidn, didu khdng dang ty hdo la nude ta nam trong nhdm 10 nudc tidu thy thudc la ldn nhdt hien nay, va con sd ngudi bi dnh hudng bdi SHS cd thd rit cao, nhung chua cd nhieu sd lieu nghidn ciiu cy the, tin
cay vd cap nhdt, ddc bidt Id vd he qud tac^' ddng ddi vdi phu nii vd tre em'^. Trong khi dd, theo nhidu nghidn eiiu qudc td thi hiit thudc Id thy ddng cdn cd hai cho tre em boi nhiing tac ddng gidn tidp ddn gan, suy giam he mien dieh, gdy ung thu, ngodi cdc benh lidn quan den phdi''*.
Thiet h^i kinh te vd gdnh nqng y ti cong
Mac du khdng cd thdng kd ddy du cac thidt hgi, chi phi kinh te lien quan ddn viec sir dung thuoc Id tidn toan cau, nhung con s6 udc tinh ldn tdi khodng 12,7 nghin ty do la My trong khodng 20 nam tdi. Vi dy, tnrdc khi tang thud tidu thu thude Id ndm 2012, Chinh phu Philippines dy tinh cdc thiet hai Uen quan den thudc la, it nhdt khoang 177 ty pd-sd (Php - khodng 4 ty dd la My) hang nam, trong khi ngudn thu tir nganh cdng nghidp thude la ehi la 32,9 ty Php (khoang 747,3 trieu do la My)'". Phdn tich chi phi - lgi ich cho thay, d Viet Nam, ddng gop hi nganh edng nghidp thudc Id cho ngdn sach nha nudc vdo khodng 0,75% GDP, thap hem rdt nhidu so vdi cdc chi phi phdi bd ra de di^
tri cdc bdnh lidn quan ddn thudc la, ciing nhu chi phi ddnh mua thude la mdi nam (khoai^
22 nghin ty ddng), vdi tdng sd tien la hon 45,14 nghrn ty ddng (khodng 1,8% GDP)".
Chi tinh ridng gdnh ndng y td, ty Id nay a Tnmg Qudc udc tinh khoang 0,7% GDP.
Trong khi do, d cdc nude phdt tridn, khoang
10 Kinglun Ngdi (2010), The devetopment and limitations of China's tobacco control policy: A reluctant tobacco amtiol move- ment
11 10 nSm thut hien Cdng udc khung ve ki&n soit thudc la tai Viet Nam, http://www.baomoi.com/10-nam-thuc-hien-0)ng- uoc-khung-ve-kiem-soat-ttwoc-la-tai-Viet-Nam/(^16873126.epL
12 Hot so nghien cud d Vi^Nam cho ring, Viit Nam duhg thu'15 tidn UiegkS ve sdiUdng ngUcff hut thuoc li, vaoj khoang 33 tiKu ngudi hut thudc li ttiu dgng. Xfem tiiem: Gia tang ginh nang benh tat do thudc la, link: http://laodangttiudo.VT^^
tang-ganh-nang-benh-t3t-do-thuoc-la-19874.htinl, tivy cap ngay 10/12/2015.
13 Eman Ai-Sayed & Khadiga Ibrahim (2014), Second-hand tobacco smdce and diikiren, toxicokigy and indusOiai healtii, vaL 30, no 7, pp. 635-644.
14 Wcfor Bcpu & Abraham Bromi (2015), The economic impact of smoking and of redudng smcddng preval&KS: Review of evidence. Tobacco Use Insights, no. 8, pp. 1-35.
15 Pham Hoing Anh 8iLe Thi Thu, Ganh nang binh lat va chi f^i y te cua cic b&^ 11^ quan d&i thudc la, HealttiBrHgi Canada tai Viet Nam.
Q C I NGHICH CUU .
0 0 I L A P p | | A P ^ S 6 24(304)T12«015
CHINH SACH 15% tiong tdng ngdn saeh y te ddnh eho cac
van dd lidn quan ddn thudc Id. 6 My, ty Id nay dao dpng tii 6% ddn 18% tiiy bang. 6 Anh, tdng chi phi tryc tidp udc tinh tiong khoang 2,7 ddn 5,2 ty bdng Anh, tuang duang 5% tdng ngdn sdch ehi cho y td hdng nam. Neu tinh ea ehi phi tryc tidp vd gian tidp, rieng d My, tdng chi hang ndm cho dich vu y td lidn quan ddn tiiude Id, cpng vdi tiiilt hgi udc tinh tu suy gidm nang suit lao dgng do thudc la gay ra trung bmh vdo khoang 289 ty do la My mdi nam, tir ndm 2009 ddn nam 2012'^. Con sd nay dugc du bdo ngdy cdng tdng len vi sd ca mac benh do thudc la vd ehi phi y t^ ngdy cang tang.
Rd rang, vide thu thud tir sdn xudt, sir dung thudc Id Id rat khd bu ddp cho cac chi phi de khae phyc hau qud ciia nd. Sir dyng thudc la cdn Id nguyen nhan ldm suy gidm chdt lugng ngudn nhdn lyc. Dang chii y la, ganh nang vd y td, ehi phi xa hpi dang ed xu hudng djch ehuyen nhanh ehdng sang cdc nudc kem phdt tridn hem trong khoang 2 thdp ky tdi. Khodng 70% tii vong lidn quan ddn thudc Id Id d cdc nudc dang phat trien.
Khoang 80% nhiing ngudi hut thude la trdn the gidi sdng d nhiing nudc thu nhap trung binh, thidu nhung kidm sodt chat che vd hiit thudc Id''. Ddy Id nhiing thdch thiic khdng nhd eho muc tidu phdt trien bdn viing cua cac qude gia ndy.
Gdnh nang xa hpi
Thudc Id khdng ehi cd hai cho siic khde, nd cdn lien quan ddn eac vdn dd phdt tridn bdn vung, ehinh sdch an sinh xa hgi eiia cdc qudc gia. Day Id vdn dd khdng chi cac qude gia dang phat tridn, ma cd cac qudc gia phdt tridn eiing phdi ddi mat, bdi nhung gdnh
ndng xa hdi, dae bidt ddi vdi nhdm ngudi ydu thd va tid em. Nhin ehung, hdnh vi sii dyng thude Id cd lien quan ddn tuih tigng kinh td vd dia vi xa hdi. Cac nhdm ddn sd ydu thd trong xa hdi nhu ngudi ngheo thudng hut thudc Id nhidu ban, khd tir bd thude Id hon, va thudng gdp phin ldm lan trdn vide sir dyng thudc la (smoking prevalence).
Ty Id su dyng thude Id lidn quan ddn dia vi xd hgi thdp the hidn qua ede tidu chi nhu mirc do thu nhdp, miie dp gido due vd vide ldm. Theo sd hdu nghidn ciru tgi Trung Qudc, sau khi da didu ehinh ve dac didm dia ly, lich sir hiit thudc vd tinh trang sure khde, thi nhung ngudi dd tung hut thudc cd tinh tigng nghd nghidp lao ddng chdn tay, gidn dan, dia vi xd hdi thap, thi cd thdi gian hiit thudc Idu hon so vdi nhiing ngudi cd vide ldm tiong khu vyc hdnh chinh, hay cdc chuydn gia, hoac ngudi cd dia vi xd hdi cao. Nhiing ngudi cd thu nhdp thdp nhdt vd ngudi khdng di hgc thi ty Id thdi gian hiit thudc keo ddi cao hon, lin lugt Id 11% vd 14% so vdi ngudi cd thu nhdp cao nhdt hoac cd trinh do gido dye dai hgc trd ldn'®. Sy chdnh lech ndy cho thdy muc dp lo nggi ngdy cdng gia tdng ve su bdt bmh ddng tiong chdm sdc siic khde y te. Vi the, cdn cd ehinh sdch tap trung can thidp vao nhdm ngudi nay.
Cdc nudc phdt trien, nhu nudc Phap, ciing ton tgi vdn dd bat binh ddng xa hdi lidn quan ddn hut thude la. Kdt ludn nit ra tir mpt nghidn eiiu'^ vdi cac bien sd: trinh dp hpc vin, gidi tinh vd thd he (lua tudi), thu thdp tir ndm 2010 (mau khao sat gdm 27.653 ngudi), chia lam 3 nhdm tiidi (1941-1955, 1956- 1970 va 1971-1985) cho thiy: nhdm cd hgc vdn cao thi ty lp hiit thudc gidm dan, nhdm
16 Xem chli thich 1: Michael Eriksen et at (2015).
17 Xem chu thich 7: Scollo S Winstanley (2012).
18 Xem chu ttiidi 6: Guo H,SaZ (2015).
19 Bricard, D, Jusot, F, Beck, F, Khiat, M, & Legleye, S (2015), The evolution of social inequalities in smoking over a 11^ cycle:
An analysis according to gender and generation, Eeonomie & Statistique.
—. , NGHICN CUUI O T S5 24(304)T12/2015^LAp P H A p l " '
CHINH SACH
ed hpc vin thip tiii ty Id nay tdng. Ty 1? nii gidi hut thudc Id eung cd xu hudng tang ldn qua tdng thd he. Bit binh ddng xa hdi cao tiong sir dyng thude la thd hidn rd rang vdi do tudi thip han, d cd 3 nhdm tudi vd frong cd nam vd nu gidi. Ddi vdi nhdm tudi gid han thi bit binh ding cd gidm din, trong khi do, ddi vdi nhdm tudi thdp ban thi bat binh ding vdn duy tri d miic cao vd thdm ehi cd xu hudng gia tang sau tudi 25 ddi vdi nft.
Dya trdn nghidn cim ndy, ngy y chmh sdch hipu qud hon Id can can thidp vao timg nhdm xa hpi, vdi cdc do tudi khde nhau, vd tap trung vdo cdc nhdm bat ddu hiit thude ma cd trinh do hpc vdn thap ban.
Trong khi dd, khoang 1,1 tii?u fre em ngheo d nudc Anh dang sdng tiong gia dinh cd it nhat bd hodc me hiit thudc Id, vd dy bdo se ed thdm khodng 400.000 tre em niia cd the rai vao eanh ngheo vi ganh nang tdi chinh ddi vdi cac gja dhih cd thu nhap thip, khi ma bd me nghien thudc Id cd xu hudng cdt giam, hogc ddnh ddi cdc nhu cdu chi tidu cdn thidt cho gja dmh de mua thude la (fiind their addiction).
Nam 1999, Chinh phiiAnh da thdng bao mye tidu khdng cdn tre em ngheo vdo nam 2020.
Mac du vdy, myc tidu ndy cd the se khdng dgt dugc, ma mdt tiong nhiing nguyen nhan ehinh la do nhung ngudi nghipn thude Id^''.
Didu dang lo nggi ban Id nhung tre em ndy cd nguy co eao vd hut thudc Id thu ddng vd khd ndng hiit thuoc Id sdm, hi dd tidp tyc gia tdng dp lyc len cac chinh sdch an sinh xa hpi.
Tuong ty, eac nghidn ciiu d My, An Dd cung cho thiy hut thudc la la mdt thdi quen tdn kem, xa xi, gdp phdn lam bin cung hdng tiieu ngudi. Nhung ngudi ndy chip nhdn tieu it tidn cho cdc dich vu ca bdn thidt ydu, cdt
gidm ehi phi an udng, giao due, gidi tri de danh tidn sir dyng thudc Id. Ngugc lgi, nk dat dugc ty lp hgc vdn eao ban thi cd thd lam giam ty lp hut thudc tiong tdng dan s6^'.
Nhiing tid em dugc ddn trudng, va nhiing hgc sinh cd thanh tich hpc tap tdt han, thi thudng cd ty Id hut thudc Id it hon. Doi voi nhung ngudi di lam thi cdng ehiic van phdng, lao d§ng trinh dp eao ed ty Id su dyng thude Id thap ban so vdi ngudi lam cdng vi^
ddi hdi tiinh dd ehuyen mdn thip, khdng cin ky nang cao, ngudi ldm lao ddng chdn tay^.
Nhiing nghien ciiu d Anh vd Australia ciing chi ra rdng, su khde bidt d cdc nhom trong xd hdi ciing dnh hudng den ty le ca nhdn hut thudc Id, vd cai nghidn thuoc la thdnh cdng. Trong nhdm ngudi cd dia vi v^
hgc thiie eao thi sd ngudi bdt diu hiit thudc, bode tdi sir dung thu6e Id Id thip hon so voi nhirng nhdm ngudi ydu thd. Day la nguySn nhdn chinh ddn ddn vide ngdy cang gia tang chenh lech ty lp ngudi hut thude la giua hai nhdm, ban la nguyen nhan ddn tu sy thanh edng trong tir bd tiiudc Id d mdi nhdm". Mac dii bidt ring thudc la Id nguydn nhdn gay ra nhidu vdn dd bdnh tdt, nhiing cd nhdn vdi dia vi xa hdi thdp, trinh do hpc vdn thdp thudi^
dd ddng hon trong vide chdp nhdn sir dung hoac quay lgi su dyng thudc la.
Bdn cgnh dd, chinh sdch kidm sodt thieu mgnh me, khdng nhdt qudn doi vdi nganh edng nghidp thudc la ciing gdp phan tao them nhiing ganh ndng kinh td, xa hdi vd lau dai.
Vi dy, Trung Qude dang phdi ddi mgt vcd tinh hudng luong nan: la qudc gia ngdnh cdng nghipp thudc la ldn nhdt tidn thd gicri;
vd cd nhieu ngudi hiit thudc la, cung nhu tii vong vi thude la cao nhdt tien the gicri.
20 NewsRx Health (2015), Smoking; parental smoking puts nearly half a million UK children into poverty, NewsRx Healtii 21 Marsh A & McKay S (1994), Poor smokers. Policy Sbidles Institiite, London, p. 78.
22 Tyas S & Pederson L (1999), Psychosocial Actors related to adolescent smoking: a critical review of tiie literature, TotacO) Control, voL 7, no. 4, pp. 409-420.
23 Hill DJ, White VM and Scollo MM (1998), Smohng behaviours of Australian adults in 1995: trends and concerns. Medial Journal of Australia, vol. 168, no. 5, pp. 209-13.
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l NOHlfiN CUU .I L A P P H A P / S d 24(3041712/2015 4
CHINH SACH Ngdnh cdng nghipp thude la ed tdc dpng trdi
ngugc, mgt mat dnh hudng tidu cyc den siie khde ngudi ddn, mgt khac, dnh hudng da chidu ddn "siic Idide cua ndn kinh td". Bdi vi, ngdnh cdng nghidp thu6c Id Trung Qudc mang lai ngudn thu ddng kd cho ngan sdch, cd dnh hudng mgnh den eac vin d^ tang trudng kinh td, sir dyng ngudn nhan lyc, ciu true kinh te ndng nghipp, tidu chuin s6ng vd sy dn dinh xa hdi^^ Mau thudn lgi ich giua hogch dinh ehinh sdch y td, an sinh xa h§i va phat tiidn kinh td la mgt tinh hudng ludng nan eho Chinh phu Trung Qudc.
Nhu vdy, trong khi ngdnh cdng nghidp thudc la mudn thue day vide bdn cae sdn phdm, thi thi trudng eae nudc dang phdt tridn Id mye tieu khai thdc quan trgng. Trong dd, nhdm ngudi ydu thd lai Id nhdm khdch hang ldn nhat. Nhiing sdn pham ndy se dem den rit nhidu van dd khd khdn eho hp. Hon niia, thude la khdng chi gdy nghipn, bdnh tdt vd eai chet, nd cdn mang den nhiing tdn thucmg lan rpng cho xa hgi, cho cOng ddng, thdt chgt vdng luin quin ddi ngheo. Day ehinh la van dd gdnh ndng cho ngdnh y td cdng cdng, gdy thidt hgi cho ngan saeh nhd nudc, thdch thirc cdc chinh sach an sinh xd hdi, ehinh sach gidm ngheo, lam suy ydu nguon lyc qudc gia ddnh cho tang trudng vd phdt tridn.
2. Khung kho chinh sach chung \k phdng, chong thuoc la
Chidn luffc chung
Mgt khung khd chinh sdch todn didn ve kidm sodt thudc Id can bao quat dugc cdc npi dung chinh sau: kidm soat, gidm eau vd lupng cdu vd thude la; kiem sodt, gidm cung vd lugng cung vd thudc la. Ddng thdi, ean thue h i ^ cdc bien phdp ho tig kbdc, nhu hgn chd cdc tdc hai true tiep vd gidn tiep tir vipe sit dyng thude la cho bdn thdn ngudi dimg vd
edng ddng; bdo vd mdi trudng trong Idnh, khdng khdi thuoc; hd tig cai nghipn vd giai quydt gidm nhp cdc ganh nang kinh te, xa hgi tii vipe sii dyng thuoc Id qua tumg giai do?m, nhdm tidn tdi mye tidu xdy dyng xd hdi khdng cd thudc la (tobacco-free societies).
Cdc n0i dung tidn eung dugc thd hipn khd diy du tiong cdc di^u khodn ciia FCTC vd cdc hudng dan, earn kdt thuc thi cua chinh phii cdc nudc thdnh vien, dd Id: Thyc tiii cdc gidi phdp phd hgp dd bdo vd ehinh sdch kidm soat thu6c Id tgi mdi qudc gia (theo Dieu 5.3); Bdo vp ngudi ddn khdi cdc dnh hudng, tdc hai tii khdi thudc (Didu 8); Quy dinh ve cdc quy cdch mlu ma sdn phim thu6c la (Didu 9 vd Didu 10); Quy dinh chat che vd bao bi, nhan hipu thudc Id (Didu 11); Giao dye, tmydn tiidng, ddo tgo, ndng cao nhgn thdc vd tdc hgi thude la (Dieu 12); Nghidm edm cdc hogt dpng qudng cdo, khuyen mai, tdi trg (Didu 13); Gidm nhu cdu vd sy phy thupc vdo thude, hd trg "eai nghipn", diing su dyng thuoc Id (theo Didu 14); Ngodi ra, cdc bidn phdp kidm sodt ngudn cimg thudc la, ehdng budn lau thudc Id, tang thud va gid ban, cdc rdng bu0e phap ly vd bdo vd mdi trudng cung dugc khuyen nghi (cac phdn IV, V, VI, v n , VIII - FCTC).
Thdm nua, Td ehiie Y td thd gidi (WHO) eiing de xuat chidn luge kidm soat thude la:
MP0WER2^ bao gdm 6 tiidnh td: Monitor - Gidm sat vipc sii dyng thude la va ede chinh sach phdng, chdng tae hgi thudc Id (THTL);
Protect - Bdo vd mpi ngudi trdnh khdi khdi thudc Id; Offer - Hd tig cai nghipn thuoc la;
Warn - Canh bdo ve tae hai cua thudc Id;
Enforce - Nghidm cdm qudng cdo thudc Id, khuydn mai vd tai tig; Raise - Tang thud thudc la.
Nhu vdy, cd thd thay vd nguyen tdc, cin
24 Wang (2006), Tobacco control in China: The dilemma between economic development and health improvement, Salud publica Mex, vol. 48, no. 1, pp.140-147.
25 Xem chd thieh sd2: WHO (2008).
S 6 2 4 ( 3 0 4 ) T 1 2 / 2 0 1 5 V L A P P H A p l " "
CHINH SACH
thyehien vide kidm soat dd giam cd cung va cdu vd thudc la, ddng thdi vdi cac chinh sach ho tig va kbdc phyc hdu qud cua vide sir dyng thudc Id trdn lan tir trude. Dya tren chidn luge ehung nay, moi qudc gia cd thd xay dyng, phat tridn them cdc phuang an chinh sdch vdi timg myc tidu vd bidn phdp can tiiidp ey thd, phii hgp vdi eac dac didm ridng cua mdi nudc. Trdn thyc td, ty Id cac nudc tham gia FCTC tidp can dp dyng mdt chien luge, kd hogch vd chinh sach todn didn, kidm sodt da chidu (theo Dieu 5.1 - FCTC) da tang tii 49% ndm 2010 ddn 59% nam 2012 va 68%nam2014^^
Cung vdi do, cd mdt sd nguydn tae, hogc bien phdp dat duge sy iing hp cao, can luu y la:
- Cdc ehien dich truyen thdng, gido dye ndng cao nhdn thiie vd THTL gdp phdn tich cyc lam giam sd ngudi hiit thudc la va sd ngudi mudn hiit thudc. Co sd cua nd la, ndu nhu eac each thiic qudng cao tinh vi cua cac cdng ty thudc la cd thd lam tang sd ngudi tidu thy thudc la (khodng 6-7%), thi vide qudng cao, tuydn truydn vd THTL vd phdng, chdng but thudc Id ciing cd thd thay ddi thai do, hdnh vi ciia ngudi hiit thudc la va ed nhirng ngudi bi tdc dpng ed hgi tii khoi thudc Id^^.
- Lgi ich ciia ngdnh cong ftghidp thudc Id (the tobacco industry's interests) cd mdu thudn ea ban va kh6 dung hda vdi lpi ich tir cac chinh saeh siic khde cdng cpng (public
health policy interests). Ngdnh cdng nghiej)^
thudc la sdn xudt vd ban eae sdn phdm mang ddn cdi chdt cho khoang mdt niia khdch hang, vi the, eae cdng ty nay cdn minh bach cdc khia cgnh lgi ich, lam ro eae mat tich circ va tidu cue vd thyc hidn tidch nhidm xa hpi d6i vdi eong ddng, cung cdp day du thong tin va gdnh chiu cac chi phi kidm dinh sdn phim v.v.^l Khdng ndn tgo ra nhiing chinh sach co lpi, hodc gian tiep khuyen khich phat triln cdng nghiep thudc la vi se dan tdi xung dot vdi muc tidu chinh sdch kidm soat thudc la".
- Nhidu nghidn ciru ddu cho rang, tang thud va do do, tang gid thudc la ndn la m^t giai phap uu tidn trong chinh saeh, chiln luge kidm soat thudc W°. WHO khang dinh, danh thud thudc Id cao Id bidn phap hieu qai nhit nhim giam eae tae hgi tir thudc la".
Nhieu ngudi hiit thudc la se gidm lugng tieu thy hdng ngdy khi gid thudc la tang cao, thay vi chuyen sang cac loai thudc la nang hem, hodc thyc hidn cdc hdnh vi bu vdo sy thilu hut lupng tidu thy, nhu hit khdi thudc vao sau ban, thd khdi thudc ra nhanh, ngdn hon.
Quan tipng ban, gid thudc la qua cao co the la mgt dgng luc dd nhidu ngudi bd ban viec hut thudc Id, ciing nhu nhidu ngudi cSn nhac se khdng bat dau hiit thude la, nhat la ddi voi nhdm ngudi ydu thd, ngudi cd thu nhap thap.
Ddi vdi nhiing ngudi khdng hiit thudc la thi vide tdng gid thudc la la didu kidn dam bao mdi trudng trong lanh cho siic khoe tot
26 Xem chu thidi 9: WHO (2014).
27 Kenneth Warner (2001), Tobacco contml policy: From action to evidence and back again, American Journal of Preventive Medicine, vol 20, no 25, pp. 2-5.
28 World Health Organization (2013), WHO framework Convention on Tobacco control; Guidelines For implementation.
29 Vidu, viec tuyen dudng Vinataba btn cdc phudng tien truyin thong eo thi gdy ra tac dung ngUdc. Xem: Vinataba dudc vinh danh tai Le tuyen dUdng eac cong trinh, san pham, dich vu tiiu bie'u va dien hinh tien ften giai doan 2011-2015, bvy 49 ngay 05/12/2015, hap://www.wnataba.com.vn/default.aspx?page=news8ido=detail&categoryjd=508ad=549&menu_id=4 30 Zhang B, Schwartz R (2015), What effect does tobacco taxation have on contraband? Debunking the taxation - c o n t r a M
tobacco mytii, Ontario Tobacco Research Unit, Special Report, Toronto.
j>i World Healtii Organization (2010), WHO technical manual on tobacco tax administiation. Geneva, Switzerland: World HeM Organization.
I I NGHIEN cull .
' I LAP P H A P ^ S 6 24 (304) T12/2015
CHINH SACH ban^l Nhu vdy, tang thud thudc Id chinh Id
giai phap cd tdc dgng kdp tiong gidm ea eung vd cdu vd thude la.
- Vide tang thud dgt kdt qud tdt nhit khi ddng hdnh vdi ddy mgnh chdng budn lau thudc la.
Mpt s6 kinh nghidm thttc tiin Dya trdn khung khd chung va tidp can chinh sdch kiem sodt thudc la toan didn, nhidu qudc gia dd thu dugc nhirng kdt qud tich eye. Kinh nghidm thyc tidn eho thdy, gidm dugc vipc sii dyng thudc la tidn lan cd ty Id thugn vd xdy ra ddng thdi vdi cdc hogt ddng kidm sodt chat che vipc sir dyng thudc Id. Vi dy d Austialia, vide giam ty Id nam gidi hiit thude trong nhiing ndm 1980, xdy ra ddng thdi vdi cdc tdi tig truydn thdng kdu ggi bd thudc la vd chidn dieh kiem soat thudc Id, qudn ly chat ehe vide qudng cao thudc Id tidn cdc phucmg tidn thdng tin dai chung; duy tri hen tyc cdc khuydn nghi vd THTL. Ngugc lgi, ty Id hiit thudc Id it thay ddi tiong nhiing ndm 1990 d Australia lien quan den sy tidm ldng vd cdc chinh saeh, phap lugt, quy dinh lidn quan den quan ly quang cao va hgn chl hut thudc, cirng vdi vipc gidm ngan sach danh eho eae dgt tuydn truyen, giao due cd lien quan ddn THTL".
6 My, chuang trinh kidm soat thudc Id todn didn cua bang California da ed nhiing thdnh edng, qua each tidp can da chidu: (1) uu tien kiem sodt vide hiit thudc la thu ddng, kiem soat chat che cdng nghidp thude la, hgn ehd tidp can cdc sdn phdm thudc la vd eung cip ede dich vy cai nghidn (providing cessa-
tion services); (2) hudng ddn vide dd xudt xdy dyng, hogc thay ddi thdi do xd hdi ddi vdi vin dd gid ed, hiit thudc la thy dpng, thay ddi nhiing quan nidm xa hgi vd dnh hudng, tdc hgi eila thudc la; (3) Chinh saeh khdng didn hinh, khuydn khich cac gidi phdp sdng tgo, chu dpng tu dia phuong tiong vide kidm soat thudc la^".
Vide can thidp vdo giam hiit thudc Id noi ldm vide cd lgi ieh kinh td vd xa hdi rdng ldn, dat ty Id lgi ich - chi phi ldn tdi 8,75, tao ra tidt kidm chi phi tiong 12 thdng ciia ngudi lao ddng tir 150 ddn 540 dd la My/ngudi, ddng thdi gidm lugng thudc Id dugc tidu thy, vd tryc tidp hay gian tiep giam chi phi y td.
Lpi ieh trong ddi ban la ngan chgn sir dung thudc la tran lan, ddn tdi mdt mdi trudng lam vide lanh mgnh, dat hidu suit lao ddng eao bcm^^ O My, nhung nai cd viing cdm hiit thude thi mirc do ngudi bi hiit thudc Id thy dpng thap hem 90% so vdi nhiing noi khdng quy dinh^^. Bdn cgnh dd, cdc chuong trinh phd bien trong trudng hgc vd THTL cd thd giiip lam gidm su lan trdn su dyng thudc la tiong ngan han khoang tii 30% ddn 70%, vdi miic chi phi tu 16.400 ddn 580.000 dd la tuy thugc quy md, miic dp ean thiep''.
O Canada, theo mgt nghien ciiu mdi day, Co quan qudn ly nhd Waterloo tidn hdnh dp dyng chinh sdch khdng hiit thudc d cdc nha chung cu, nhd d xd hdi. Id cam kdt bdt budc ddi vdi nhiing ngudi mdi den d. Qua phan tieh sd lieu thu thap ve ty Id ngudi hiit thude la trudc khi dp dung chinh sdch (nam 2010) va eae nam sau dd (2012, 2013) eho thiy,
32 Xem chu thieh 27: Kenneth Warner (2001).
33 Xem chii ttiidi 7: Scollo & Winstanley (2012).
34 Young-Hoon (2012), A longitudinal study on the impact of income change and poverty on smoking cessation. Canadian Journal of Public Healtti, vol. 103, no. 3, pp.189-194.
35 Xem chu thich 14: ViOor Ekpu & Abraham Brown (2015).
36 Leslie Zellers (2013), Tobacco control legal consortium, global tobacco contivl: What the U.S. can learn from other coun- tri^.
37 Xem chu thich 14: Victor Ekpu & Mraham Brown (2015).
—. , HGHlfeN Cinil I So 24 (304) 712/2015^ U j p pHAPl '
CHINH SACH
chinh sdch ndy da gdp phin ldm giam sd ngudi hut thudc Id tiong nha cua hp, ed tdc dung lam tang sd ngudi tir bd thude Id'^
Trong khi dd, miie dp nhdn thiie, cung nhu cdc phdn iing khi bidt rd tdc hgi cua thudc la Id khae nhau. Vl dy, tiong sd 46,6 tridu ngudi hiit thude d My, cd 70% mudn bd thude Id va 40% tiiii bd thude mdi nam'".
Cdn d Trung Qudc, ty lp bd thudc thdnh cdng chi ehidm 11%, vd 82% khdng nghT ring hp se bd hiit tiiudc Id"".
Didu gdy nggc nhidn Id d mdt sd nudc, cdc thdy thude, thudng dugc xem ed vai tid rit quan trgng trong vide gidm sir dyng thudc Id vd tuydn truydn nhMi thiic vd cdc tdc hgi tir thudc la, lgi hay sir dung thudc la noi ldm vi$c vd trudc mat benh nhdn. Viec ydu edu hodc tu vin cho bdnh nhan bd thudc la la khdng phd bidn doi vdi cac thdy thudc, ddc bidt vdi nhung ngudi y bdc sT cung dang hiit thuoc. Ty Id trung bmh cac thdy thuoc hiit thudc la cao nhit d Trung/Tay Au (37%), chau Phi (29%), Trung va Nam My (25%) va chdu A (17,5%). Cdc chuang trinh van ddng khdng hiit thudc la trong cdc thdy thudc la it thiy d nhidu qudc gia, va ty Id bd thudc Id ciing thip"'. Do vdy, cdn chu tigng thyc hidn nghidm cdc quy djnh cam hiit thudc la ddi vdi nhdm ddi tugng lidn quan tryc tidp ddn vide thuc thi cae bidn phdp phdng, chdng THTL.
Mdt vin dd nira dang luu y ve tac dpng tidu eye, ngugc chidu tir cdc chidn dich truydn thdng, qudng cdo nham chdng hut
thudc la, do ehinh cdc edng ty thudc Id thtrc*
hipn. Cdc chidn dich van ddng phdng, chdng thudc la tiong gidi tie, do cac edng ty thudc la thyc hidn tgi My vd cdc nudc chau My la tinh, kidu nhu: Hay suy nghT ky, dimg hiit tiiudc; Quydt dinh dung, dimg lgi ngay, Giiip thanh nidn ndi khdng; Giiip thanh nidn quydt dinh, V.V. cd tdc dyng ngugc, gidn tidp ddn ddn tang so ngudi hut thude vd ldm ydu di cdc van ddng khdng hut thude khdc"^. Ben cgnh dd la nhiing lo ngai vd ede chuang trinh trdch nhiem xa hdi cua cdc cdng ty thuoc la vi nd chira dung mdu thuan giiia vide vira tao ra, vira nd lyc gidm nhp tac hai tir chinh san phim eiia hg. Trong khi neu khdng kidm soat tdt tiii cac hogt ddng xa hgi lai gidn tidp c6 vii cho hdnh vi sii dung tiiudc Id.
3. Giai phap chinh sach yh phdng, chong thu6c la d Vi^t Nam
Can Cli vao khung khd chinh sdch, chidn luge chung vd kidm sodt thude la dupc khuydn nghi, ed thd ndi he thdng ehinh sach, phdp ludt vd kidm sodt thude la d Vi^t Nam Id tucmg ddi ddy du. N^u Luat Phdng, chdng THTL nam 2012, ciing nhu cdc giai phap chinh sdch cu thd dugc thue thi nghiem tuc, quyet liet thi da cd the gidm ddng kd sd nguoi sii dyng thude la. Tuy nhidn, tren thyc te, vide thyc thi cdn chua ddng bd, vdn "danh trdng bd dui", khdng thudng xuydn, nhieu thdi didm tidm ling, ldn xudng theo phong tiao. Hipu qud thyc td chua dat nhu mong mudn, ky vgng vi thidu nhung dpng lire, quydt tam chinh tri va phuang an thuc thi
38 Kennedy, R, Ellens-dark, S, Nagge, L, Douglas, O, Madill, C S Kaufman, P (2015), A smoke-free community housing policy:
Changes In reported smoking behaviour • findings from Wateiioo region, Canada, Journal of Community Healtti, vol. 40, no. 6, pp. 1207-1215
39 Shane Davis (2013), The role of tobacco contiol policies In redudng tobacco use disparities, strengthening psydiology's role in reducing tobacco healtti disparities.
40 Xem diu tiikh 6: Guo H,SaZ (2015).
41 Abu Abdullah, Frances Stillman, Li Yang, Hongye Luo, Zhiyong Zhang & Jonathan Samet (2014), Tobacco use andsmoldng cessation practices among physicians in developing countries: A literature review (1987-2010) Int J. Environ. Res. PuOfc Healtti, no. 11, pp. 429-455.
42 Sebrie, Emesb} M & Glantz, Stanton A (2007), Tobacco industry "Youth Smoking Prevention"pmgrams to undermine mean- ingful tobacco control in Latin America, American Journal of Public Health.
/.Q IHGHItHCini ;
' ^ ^ I L A P P H A P - / S 6 24 (304) T12/2015
CHINH SACH chinh sdch sao eho hieu qud. Vi thd, mgt gidi
phdp tidp can todn dipn, da chidu va quydt tam chinh tii d cdp eao nhit la cdn thidt dd ndng eao hidu qud cdng tdc phdng, ehdng THTL d nudc ta. Dudi day chiing tdi khuydn nghi each tidp egn tdng qudt vd mdt sd gidi phdp cy thd:
Thuc dhy xay dtfng chinh sdch dira tren thuc ch^g
Ben cgnh nhung quy dinh cdn ndng vd
"tuyen ngdn", mgt nguyen nhdn quan tigng Id chung ta thidu nhung s6 lipu cd dp tin egy cao, nhiing bdo cdo phdn tich dinh lugng day dil, thuydt phyc dd lam ca sd cho cdc gidi phdp ehinh saeh dua tien thyc chiing (evidence-based policies) dung din va kip thdi, tgo didu kidn de ddng tridn khai thyc hidn. Day Id mdt tiong nhiing khdu ydu, ddn den cdc gidi phdp thudng chung chung, khdng ed myc tidu bipn phap can thi^p trpng tdm thieh hgp, ddn ddn tdc dpng kem hi?u qua tiong vide tuyen truydn vd thyc thi vide phdng, ehdng THTL.
Cung vdi nhiing nghidn cihi dinh tinh hogc md td dan thudn, cdc phdn tich chinh sdch dya trdn thyc chimg, chi ro mdi quan hp nguydn nhdn - kdt qud eua vin dd sir dyng thudc Id trdn lan, cd kidm dinh, kidm tia ddnh gia ket qua ede bipn phdp ean thipp, se Id ydu td thuydt phyc chiing minh tinh diing ddn hay sai lam cua cae giai phap chinh sdch trong didu kidn cy thd timg dia phuang vd tidn binb didn qudc gia. Vi dy nhu cdc nghidn ciiu vd mdi lidn he tucmg quan giua ty Id su dyng thudc la vd nhdm xa hgi, cdc md hinh, dgc didm bdnh ly, nguydn nhdn, sd lupng cdc loai bdnh ed lidn quan ddn thude Id, phu hgp vdi didu kidn thd trang ngudi Viet Nam; nghidn ciru vd gidi, vd dan tge, vung dia ly, nhdm bi
tdc ddng bdi hiit thudc Id thy ddng, tdc hai cua thudc la ddi vdi phy nir vd tre em,v.v..
cdn cd sd lieu phdn tieh dinh lugng ehi tidt, tin cdy dd thuydt phyc dugc edng chiing vd ngudi hogch dinh, thyc thi chinh sdch. Tir do cung hinh tiianh dugc he thdng ca sd du lieu qudc gia vd phdng, chdng THTL. Vi thd, cdc phdn tich chinh saeh vd hoaeh dinh chinh sdch dua tidn thyc ehung ndi chung, va phdng, chdng THTL ndi rieng cdn dugc cd vii, thiic day mgnh hem nua. Tat nhidn, dd ldm duge didu nay, ngoai dgi ngu chuydn gia, van dd tdi chinh tdi trg nghidn ciiu Id rit can thidt, nbimg edn gap nhieu khd khan tiong phgm vi ngdn saeh hgn hep.
Tiep can da chieu, da nganh Vipe tham khao thdng tin nghien eiiu tir ede nudc tidn thd gidi, nhu ede ket qua phan tich sd lipu dua ra d trdn, cling Id mdt ca sd quan trgng dd iing dung vao didu kidn nudc ta. Tidp can xdy dyng chinh saeh toan didn, huy ddng nd lye ehung eua todn xd hdi Id rit ean thidt, tiong dd, Chinh phu va he thdng hdnh chinh nha nudc can nghidm tiic trien khai, tgo sy lan tda ra toan xa hgi. Ben cgnh cdc gidi phdp chinh sach true tidp, vdn de cua nudc dang phat tridn nhu Viet Nam edn bi chi phdi bdi nhiing chinh saeh phat tridn kinh td, chinh sach an sinh xa hdi ndi chung. Ngay cd cdc nudc phdt tridn, mac du ty Id ngudi hiit thudc cd gidm, nhung bdt binh dang tiong ty Id ngudi hut thudc van khdng giam, thdm chi tang ldn d mdt sd nudc, do tang ty Id ndy tiong nhdm ngudi ydu thd, bdn Id xd hdi^l Mgt trong nhiing gidi phdp cho vin dd ndy, nhu da phan tich, chinh Id tdng thud thudc Id vdi miic cao, giup gidm lugng thudc Id duge tidu thy, gidi quyet tinh trgng bit binh ddng trong ty Id ngudi hiit thudc la giiia cac nhdm xa hgi"".
43 Reid, Hammond, Boudreau, f=dng & Siahpush (2010), Sodoeconomie disparities in quit intentions, quit attempts, and smok- ing abstinence among smokers in four western countries: Rndings from the International tobacxx) aintroi. Four country survey. Nicotine Tob. Res.
44 JhaPA Peto R (2014), Global effects of smoking, of quitting, and of taxing tnbaco}. New England Journal of Medidne.
S6 24(304)T12/2015\ NGHItN CUV I LAPPHAPl
143
CHINH SACH
Cung lidn quan ddn van dd nay, can tham khdo thdm md hinh 4 giai dogn lay lan, phdt tridn cua "dich bdnh" thude Id, tiong nghien cuu d cac nudc phdt tridn"^. Trong dd, giai doan 2 la liie md ty Id ngudi su dyng thude Id d nam gidi tang ldn tidn 50%, tinh trang hiit thudc trong gidi nir cung tang nhanh.
Nhieu nudc chdu My la tinh, vimg Bac Phi, Ddng Nam A va Trung Qudc hien nay ciing cd nhiing dgc didm phu hgp giai doan ndy.
Tuy nhien, ddi vdi nhiing nudc dang phdt tridn vd d khu vyc chdu A, vdi khac biet ve van hda, nhu Trung Qudc thi ty Id hut thudc trong gidi nu khdng tang manh nhu cdc nudc phdt tridn. Didu ndy ciing tuong ty ddi vdi Viet Nam, nhung do didu kidn hdi nhdp qudc td sdu rpng, quan nidm vd hut thudc vd cdc rdng budc van hda, xa hdi ddi vdi gidi nu cd nhidu thay ddi, ndn chinh sach kiem sodt thudc la can thieh ung dd hgn chd sy biing nd ty Id ndy. Giai doan 3 ciia md hinb la Iiic ma ty Id hiit thudc d cd hai gidi lan rdng vd dgt miic cao nhat rdi gidm ddn. Liic ndy, cdc chuang trinh tuydn truydn gido dye ed tdc dyng rdng khap, thu duge hidu qud, nhgn thiic vd THTL dugc ndng cao. Tuy nhidn, sd ca tli vong va eac bdnh lidn quan den thudc la vdn tidp tue gia tang do dp tre tac dpng tu vipc sii dyng thudc Id giai dogn trudc, doi vdi the he trude dd. Ap lyc chi phi y td, gdnh ndng xa hdi vdn tidp tue Id mdi de dpa ddi vdi ngdn sdch vd chinh sdch cdng. Mac dii chua cd nghidn cuu chmh xdc, tinh trgng su dung thuoc la d Viet Nam cd thd d giai doan 2; vd nhd nhiing ehinh sdch lidn tuc tiidi gian qua, cung nhu cdc dac didm ridng eiia nudc di sau, chiing ta ed the can thidp dd din chuyen tidp sang giai doan 3 tuong img trong md hinh. Vi thd, vdn de cdn tap trung giai quyet ehinh la ndng cao hieu qud cdc chuong tiinh tuyen truydn phdng chdng THTL, ddng
thdi vdi chudn hi ngudn lyc gidi quydt h^l qud vd dich benh va van ngn xa hpi tir s&
dyng thudc la trdn lan tiong sudt thdi gian qua. Thdm niia, cdn long ghep bidn phap kidm soat thude la trong ede chinh saeh moi cd dp dyng cae tidu ehi do ludng chu^
ngheo da chidu, giai doan 2016 - 2020, trong do nhdn manh ddn cdc dich vy xa hdi co han nhu tidp can vd y td, gido dye, nhd d, nuoc sach vd vd smh, tiep cgn thdng tin. Day la vdn dd nan giai vd cap thidt, khi md trong tuang lai gdn, Viet Nam phdi ddi mat voi hang loat vdn de phat tridn khac, nhu 6 nhidm mdi trudng, dan sd gid hda, bdt hinh dang xd hdi gia tang.
Bdn canh dd, rat khd dd dat dugc muc tidu phdt tridn ben vung khi phdi ddi mat \k keo ddi tinh tiang duy tri, phat tridn nganh edng nghidp thudc la, rdi phdi gidi quydt hau qua xa hdi ngdnh ndy mang lai. Day Id van dd can cdn nhac ddnh ddi giua lpi ieh trudc mdt vd Igi ich lau ddi, ndu le thudc vdo "ndn kinh td thudc Id" nhu kinh nghidm tiiam khao d Trung Qudc. Hon nua, d Trung Qudc, van dd tham nhiing trong ngdnh cdng nghiep thudc Id ciing gay khd khdn cho vide kidm sodt thudc la, md Chinh phu nudc nay da phdi nghiem cdm dimg ngan sach cdng mua eac loai thude Id vd rugu cao cap"*. Vi vay, chiing ta cdn cd nhung bidn phdp minh bach vd manh me han niia trong thyc hien quy hogch ngdnh cdng nghidp thudc la vd hudng chuyen ddi sdn xudt kinh doanh.
Mpt so hdnh dpng cu thi khde Ngodi nhung khd khan trong dp dung Ludt Phdng chdng THTL, chung ta cin mot quydt tdm ehinh tri dd thuc hidn cae gidi phap sdn cd sao cho hidu qud hem, tmdc bet Id trong cae CO quan hanh chinh nhd nudc d trung uong vd dia phuang, dd gay hidu iing lan tda den gia dinh, edng ddng va xa hdi. Cdn dua cdc quy
''^ r o ^ ' ^ CMf^aiv W & Piha T (1994), A descriptive model of tiie dgarette epidemic in developed countries, Tobaao Control, no. 3, pp. 242-247.
"^ ^"ph^S"iST^' ^ ^'^'^' ™ ^ ' ^ «'^°i™'s totocco indusby and anti-amoking campaign, China Center t^om-
> P H A P ^ S o 24 (304) T12/2015
CHINH SACH dinh khdng hiit tiiude la tgi nai lam vipc vdo
cdc quy tac dgo diic vd iing xii chung eho bg mdy hdnh chinh va ede td chiie, dan vi sy nghipp, eiing nhu tiong quy chd npi bd ciia ca quan (Bidu 6 Ludt Phdng, chdng THTL); cd xir phat nghiem minh, ldm rd tidch nhidm ngudi diing ddu ndu dd xdy ra vi phgm, bdo dam quyen dugc sdng, lam vide tiong mdi trudng khdng cd khdi thudc Id (khodn 1, Didu 7 Ludt Ludt Phdng, chdng THTL).
Chung ta khdng ndn thda hipp vdi nhiing bien lugn vd sd thieh, tiidi quen hay quydn ridng tu cua ca nhdn trong khi hiit thudc la gay ra nhung anh hudng tidu eye, thidt hgi nghidm trpng cho sue khde cdng ddng. Vi dy nhu nghidn ciiu d My, liy y kidn vd ban ehd thudc la tinh diu bac ha trudc hai ludng quan didm ung hg va phdn ddi, kdt qud Id cd 71%"' img hd cho vide cdm. Nhu vdy, edn phdi bdo dam quydn lgi cho sd ddng tnrdc tdc hai ciia thudc Id vd hiit thude Id thy ddng, trdnh nguy ca suy gidm ngudn nhdn lyc. Nhung quy dinh ndy eiing cd the tridn khai tdi cdc doanh nghiep, c ^ khu nhd chung cu, cae td dan phd khdng hut thude Id, la tidu ehi xet chudn gia dinh van hda, khu ddn cu vdn hda, md rdng cdc dia didm edng cpng khdng dugc sir dyng thude la.
Mdt vdn dd rdt quan trpng Id gido dye ndng eao y thiic phdng, chdng THTL ddi vdi tre em. Trong khi vide tuydn tmydn phd bidn thdng tin tren mgt sd phucmg tidn truydn thdng cd thd cd hipu qua hgn ehd, cdn kdt hgp cmi thidp hudng vdo ydu td xd hdi vd tdm ly"^
(psychological factors). Cd thd tham khdo kinb nghiem dp dyng bidn phdp "tidm phdng
thai dp""' (attitude inoculation) cho tie em tiong cdc trudng hgc nham tao ra sy "mien nhidm ddi vdi nhiing thay ddi" (unmunization against change) bdt lgi do ydu td ngoai cdnh tdc ddng. Nhidu nghien eiiu chi ra cdch tidp can khd dan gidn. Id hay dat hgc sinh vdo ede tinh hudng cd thd hi ban be ldi keo vdo vide hut thudc/ hodc ngan cdn vide bd thudc, dd nhung hpe sinh ndy thyc hanh nhung phan img phdng vd thich hgp. Kinh nghidm ndy se tid nen cd ich, giup tre cd thdi do hdnh xir dung ddn khi gap phdi nhung tinh hudng trong thyc td, trdnh nhung va vdp, cudn vdo vipc sit dyng thude Id. Bidn phdp nay da cd tdc dyng tich cue tiong vipe giam ty Id ngudi sii dyng thude la trong trudng hpe, Id tidn dd tdt dd han che sir dung thude Id d cdc bdc hpc cao ban. Trong mdi trudng cam kdt khdng thude la d eac trudng dgi hpc, sd sinh vien hiit thudc cung it hon vd sd chdp hdnh mdi trudng khdng hiit thudc ciing ehidm da sd^".
Them nua, bd me ciing ddng vai trd quan tigng ddi vdi vide gidm hiit thude la eua eon cdi. Trong dd, ddng chu y la viec kidm sodt chat che cua bd me ddi vdi eon cdi cd tdc dgng, anh hudng ldn hem, nhit Id ddi vdi nam gidi, so vdi nhiing ho tig don thuin vd cdm xue (khuydn nhu, ddng vidn) tii bd mp, bat kd ddi vdi cdu true gia dinh khde nhau^'.
Vi vdy, kdt hgp cac bidn phdp tuydn truydn, giao dye ndng eao nhdn thiic vd phdng, ehdng THTL giua gia dinh vd nhd trudng van la ydu td then chdt, dnh hudng Idu ddi ddn thd he hipn tgi vd tuong lai khdng thudc Id •
47 J^drew Cheyne, Lon Dorfrnan, Ridiard Daynard, Pamela Mejia & Mark Gottiieb (2014), A dangerous loophole vs Freedom of choice, Mi J Public Healtii.
48 Gilbert Botvin, Steven Sdiinke, Mario Oriandi (1995), School-based health promotion: Substance abuse and sexual behavior.
Applied & Preventive Psychology, Cambridge University Press, na. 4, pp. 167-184.
49 McGuire, W. J. (1961), Rea'stance to persuasion conferred by active and passive prior refutation of tiie same and alternative counterarguments. Journal of Abnormal 8L Social Psychology, vol. 63, no. 2, pp. 326-332.
50 Amanda Fallin, Maria Roditis, & Stanton Glantz (2015), Association of campus tobacco policies with secondhand smoke ex- posure, intention ta smoke on campus, and attitudes about outiJoor smoking restridlons. Am J Public Health, no.105, pp. 1098-1100.
51 Choquet, M, Hassler, C, Morin, D, Failssard, B, S 0?3U, N (2008), Perceived parenting styles and b3bacco, alcohd and cannabis use among ftendi adc^escents: Gender and family stirueture diffierentials. Alcohol and Aieoholism: International Journal of the Medical Coundl on Ala^oUsm, vol. 43, no. 1, pp. 73-80.
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