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