Post on 06-Oct-2020
Lebanon’s Tobacco Control Policy:
Opportunities and Gaps May 11, 2013
The 46th Middle East Medical Assembly
American University of Beirut
Towards a comprehensive tobacco control policy: Building capacity for effective
smoking cessation programs at national level
Rima Nakkash, DrPH
Assistant Professor Coordinator- AUB Tobacco control research group
Health Promotion and Community Health Department Faculty of Health Sciences
American University of Beirut
Review progress on implementation of tobacco
control policy at the national level.
Identify further steps necessary to move forward
towards a comprehensive tobacco control policy
framework.
OBJECTIVES
Evidence
Parliament
Media
Civil society
Ministries
Tobacco Industry
Industry allies
•Health Promotion and Community
Health
•Health Management and Policy
•Engineering
•Pathology and Laboratory
Medicine
•Nursing
•Issam Fares Institute for Public
Policy and International Affairs
•Epidemiology and Biostatistics
•Chemistry
•Economics
AUB Tobacco Control
Research group
“Tobacco smoking is a commercially driven behaviour, and policies that prevent smoking have been under development for decades”
Lancet Editorial 2013
FROM THE RIGHT TO HEALTH TO THE RIGHT TO TOBACCO CONTROL?
..the right to life and the right to a safe clean environment.
…Tobacco use is unlike other threats to global health.
Infectious diseases do not employ multinational public
relations firms. There are no front groups to promote
the spread of cholera. Mosquitoes have no lobbyists.
—Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny,PhD, Fazel
Randera, MD1
The tobacco industry as disease vector
*The tobacco industry plays a key role in the tobacco epidemic.
*Industry voluntary or self-regulatory measures have not been proven to be effective.
*Release of internal tobacco industry documents (TIDs).
A barrier to moving foreword …..
“Nicotine is addictive. We are, then, in the business of selling
nicotine…”
(Addison Yeaman from Brown & Williamson, 17 July 1963)
Tobacco company CEOs declare, under oath, that nicotine is
not addictive (1994) –in court.
Tobacco Industry Interference in Tobacco Control Policy making
WHO Framework Convention on
Tobacco Control
Until now, over 172 countries have ratified the WHO FCTC
Over 86.44% of the world population
The Framework Convention on Tobacco
Control is the first treaty negotiated
under the auspices of the World Health
Organization
All the articles in the convention are based
on scientific evidence.
*Youth smoking prevention initiatives
*Youth access measures (age restrictions and retail compliance laws)
*School programs (alone)
*Partial marketing restrictions
*Accommodation programmes for co-existence of smokers and non smokers
*Reduction of tar yield as measured by smoking machines.
ASH Policy recommendations
Price measures- Taxation measures
Non-price measures
Advertising bans
Warning labels on tobacco products
Ban smoking in public places
Protecting from tobacco industry interference, providing cessation programs, educational campaigns, control smuggling…..
LEBANON
2005
Policy under discussion
…poorly informed by evidence
….and not in line with the FCTC
LEBANON
2009
Smoking/nonsmoking sections
Loopholes-restricted places were ban is active
Long and gradual implementation delays
Partial bans of advertising (sampling under 18,point of sale,
relationship marketing and direct. Up to three-5 year
proposed delays
HW’s textual and 30%
No penalty or fine system
Sustained advocacy
Smoke free
policies Health Warnings
Tobacco
industry
influence
Waterpipe health effects, prevention , intervention , and policy implications
Disseminate policy relevant and timely research
to support needed policy changes
Economics of
Tobacco
Taxation
Main Elements of Law No. 174
voted upon on August 17, 2011
• Total bans of smoking in indoor
public places without exemptions
and without permission for smoking
and non-smoking areas.(September
2011-2012
• Total comprehensive advertising
bans, both direct and indirect
(including promotion, branding,
etc.)(March 2012)
• Larger health warnings on (at least
40% textual, then pictorial) based on
issuance of a decree (October 2013)
• Fines on individual and
establishment
Direct and indirect advertising
POST LAW 174
Winston
February 2013
Marlboro
June 2013
Pre law 174
Tobacco Industry interference
Post Law 174
While the Syndicate of Owners of
Restaurants, Cafés, Night-Clubs &Pastries
in Lebanon is in favor of the move from a
health perspective, the current law is
incomplete as it sets the stage for poor
implementation, corruption and a non-
negligible negative effect on the country’s
tourism and hospitality sectors. As a
result, the syndicate saw a room for
improvement in the current tobacco
control legislation, so as to ensure its
feasible implementation and efficacy.
http://www.beirutnightlife.com
/news/smoke-ban-lebanon-
blessing-curse/
Percentage of venues –
according to to US EPA
Air Quality Index PM 2.5 venues concentration
3.70%7.40%
3.70%
14.80% 14.80%
59.30%
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7good
modera
te
unhealthy f
or
sensitiv
e
people
unhealthy
very
unhealthy
hazard
ous
Air Quality
Perc
en
tag
e
Pre law 174
Indoor polloution(2008)
Post law 174
Indoor pollution (2013 )
White list White list
* Civil society commitment(TCCW)
* Sustained advocacy for enforcement
* Changing social norms
* Decree’s issued
https://www.facebook.com/Law174
*
*
*As in the market now….
BRAND
Brand
https://www.youtube.com/watch?v=DJaM1SD-
z8M&feature=g-crec-u
*
2013
Price measures- Taxation measures
Non-price measures
Advertising bans
•Warning labels on tobacco products
Ban smoking in public places
Protecting from tobacco industry interference, providing cessation programs, educational campaigns, control smuggling…..
Towards a comprehensive tobacco
control policy
*Lack of accountability and proper
governance structures
*Wavering political will for enforcement
*Poor coordination among ministries
*Perceived competing priorities, political,
and security issues.
*Disrespect for law enforcement
*Pervasive pro social norms
*Devious tobacco industry interference
*Develop and support national
tobacco cessation guidelines
*Evaluate and monitor enforcement