Turkey wins plaudits for tobacco control

Abstract

Ahead of World No Tobacco Day on May 31, Sharmila Devi reports from Istanbul on Turkey's progress with tobacco control, which has been gaining international recognition.“Smoking like a Turk” was a common expression in several European languages during the past century but now Turkey is receiving international plaudits for its efforts to stamp out the country's traditional and deeply rooted consumption of tobacco.One in three Turks, or about 31% of the population, smoked in 2008, when Turkey became the third country to introduce a widespread smoking ban after Ireland and the UK, Nazmi Bilir, a professor of public health at Ankara's Hacettepe University, told The Lancet. “Smoking has been a traditional, male behaviour in Turkey so it's not been easy”, Bilir said. “But my feeling is that Turkey will become truly smoke-free.”Hopes are high that the next Turkish survey of smoking consumption, to be released in the autumn, will show that up to 2 million Turks have quit since 2008, bringing the rate down to around 25%, he said. For comparison, around 20% of people smoke in the UK and in the USA.“If someone told me 5 or 10 years ago that Turkey would be a smoke-free country, I'd have thought they were making a joke”, said Toker Erguder, manager of WHO's Tobacco Control/Bloomberg Initiative to Reduce Tobacco Use programme in Turkey.Turkey ranked fourth, after the UK, Ireland, and Norway, in the European Tobacco Control Scale published by the Association of European Cancer Leagues last year. “I believe Turkey will one day be a tobacco-free country. I can't say in how many months from now that will happen but we're going in a good direction”, said Erguder.Turkey was one of several countries to be given a Bloomberg Award for Global Tobacco Control earlier this year. The Turkish National Coalition on Tobacco or Health (SSUK)—a coalition of more than 40 Turkish organisations that focus on tobacco—was recognised for its advocacy to ensure that the country's laws were strong and comprehensive and for its monitoring of these laws.The Bloomberg awards are given to low-income and middle-income countries where 80% of tobacco-related deaths occur and the other countries to receive awards this year were Colombia, Egypt, Philippines, and Uruguay. The Bloomberg charitable foundation is also committing US$220 million over the next 4 years to fight tobacco use globally.Turkey's recent success is all the more remarkable given the historical importance of tobacco production to the economy and the one-time world-wide popularity of Turkish or “oriental” tobacco.Tobacco has been produced in Anatolia for 400 years and been a substantial revenue item for more than a century. “Control of the cultivation of and market in tobacco has always meant control of the country. Thus tobacco has been a symbol reflecting recent political history”, said a WHO report co-authored by Bilir.Tobacco was banned by Sultan Osman the Young for a short period during the 17th century, notes the report, but the crop was too important a source of revenue to the Ottoman empire.While Turkey's Government, led by Prime Minister Recep Tayyip Erdogan since 2003, has been criticised by human rights groups as authoritarian, political stability is cited by antitobacco campaigners as an important component of reduced tobacco use. “We've had the same prime minister and health minister for the last 9 years so political stability and having the same key people in government and parliament has worked in our favour”, said Bilir.Turkish tobacco control measures include a ban on smoking in all indoor areas, raising cigarette prices, a full advertising ban, antismoking media campaigns, warnings on tobacco packaging, and increased access to cessation products and treatments.“4 years have passed since the [antismoking law] came into effect and it has yielded positive results during this time”, Elif Dagli, chairwoman of the SSUK, said earlier this year. “The smoking rate has decreased by 15% and the number of people being admitted to hospitals for treatment for smoking-related diseases has decreased by roughly 20% in Turkey.”Campaigners would like to see a further tightening of the law to hide the display of tobacco in shops as well as increased inspections of public spaces. In the business and tourist hub of Istanbul, for example, breaches of the smoking ban are more common, particularly in establishments serving alcohol, said Bilir.He would also like to see greater scrutiny of the tobacco industry. Although he said Turkish tobacco production had fallen from 4·0% of global production to 1·7% in the past 20 years, the industry still commanded power and close ties with the government. Ahead of World No Tobacco Day on May 31, Sharmila Devi reports from Istanbul on Turkey's progress with tobacco control, which has been gaining international recognition. “Smoking like a Turk” was a common expression in several European languages during the past century but now Turkey is receiving international plaudits for its efforts to stamp out the country's traditional and deeply rooted consumption of tobacco. One in three Turks, or about 31% of the population, smoked in 2008, when Turkey became the third country to introduce a widespread smoking ban after Ireland and the UK, Nazmi Bilir, a professor of public health at Ankara's Hacettepe University, told The Lancet. “Smoking has been a traditional, male behaviour in Turkey so it's not been easy”, Bilir said. “But my feeling is that Turkey will become truly smoke-free.” Hopes are high that the next Turkish survey of smoking consumption, to be released in the autumn, will show that up to 2 million Turks have quit since 2008, bringing the rate down to around 25%, he said. For comparison, around 20% of people smoke in the UK and in the USA. “If someone told me 5 or 10 years ago that Turkey would be a smoke-free country, I'd have thought they were making a joke”, said Toker Erguder, manager of WHO's Tobacco Control/Bloomberg Initiative to Reduce Tobacco Use programme in Turkey. Turkey ranked fourth, after the UK, Ireland, and Norway, in the European Tobacco Control Scale published by the Association of European Cancer Leagues last year. “I believe Turkey will one day be a tobacco-free country. I can't say in how many months from now that will happen but we're going in a good direction”, said Erguder. Turkey was one of several countries to be given a Bloomberg Award for Global Tobacco Control earlier this year. The Turkish National Coalition on Tobacco or Health (SSUK)—a coalition of more than 40 Turkish organisations that focus on tobacco—was recognised for its advocacy to ensure that the country's laws were strong and comprehensive and for its monitoring of these laws. The Bloomberg awards are given to low-income and middle-income countries where 80% of tobacco-related deaths occur and the other countries to receive awards this year were Colombia, Egypt, Philippines, and Uruguay. The Bloomberg charitable foundation is also committing US$220 million over the next 4 years to fight tobacco use globally. Turkey's recent success is all the more remarkable given the historical importance of tobacco production to the economy and the one-time world-wide popularity of Turkish or “oriental” tobacco. Tobacco has been produced in Anatolia for 400 years and been a substantial revenue item for more than a century. “Control of the cultivation of and market in tobacco has always meant control of the country. Thus tobacco has been a symbol reflecting recent political history”, said a WHO report co-authored by Bilir. Tobacco was banned by Sultan Osman the Young for a short period during the 17th century, notes the report, but the crop was too important a source of revenue to the Ottoman empire. While Turkey's Government, led by Prime Minister Recep Tayyip Erdogan since 2003, has been criticised by human rights groups as authoritarian, political stability is cited by antitobacco campaigners as an important component of reduced tobacco use. “We've had the same prime minister and health minister for the last 9 years so political stability and having the same key people in government and parliament has worked in our favour”, said Bilir. Turkish tobacco control measures include a ban on smoking in all indoor areas, raising cigarette prices, a full advertising ban, antismoking media campaigns, warnings on tobacco packaging, and increased access to cessation products and treatments. “4 years have passed since the [antismoking law] came into effect and it has yielded positive results during this time”, Elif Dagli, chairwoman of the SSUK, said earlier this year. “The smoking rate has decreased by 15% and the number of people being admitted to hospitals for treatment for smoking-related diseases has decreased by roughly 20% in Turkey.” Campaigners would like to see a further tightening of the law to hide the display of tobacco in shops as well as increased inspections of public spaces. In the business and tourist hub of Istanbul, for example, breaches of the smoking ban are more common, particularly in establishments serving alcohol, said Bilir. He would also like to see greater scrutiny of the tobacco industry. Although he said Turkish tobacco production had fallen from 4·0% of global production to 1·7% in the past 20 years, the industry still commanded power and close ties with the government. Tobacco industry versus tobacco controlMay 31 is World No Tobacco Day. This year's theme is tobacco industry interference, chosen, in WHO's words, “to expose and counter the tobacco industry's brazen and increasingly aggressive attempts to undermine the WHO Framework Convention on Tobacco Control (WHO FCTC)”. Full-Text PDF