Development & Aid, Headlines, Health, Middle East & North Africa

HEALTH: Chained to Smoking

Cam McGrath

CAIRO, Mar 2 2010 (IPS) - Arab governments have stepped up efforts to curtail tobacco use, but initiatives have met stiff resistance from the region’s smokers.

“This is a challenging region taking into consideration the social acceptance of tobacco use, the diversity in cultural concepts, and new trends such as women’s liberalisation – all of which are contributing to an increase in tobacco use,” says Dr. Fatimah El-Awa, regional advisor at the Tobacco Free Initiative, a World Health Organisation (WHO) programme.

Indeed it would be hard to imagine the Arab world without its chain-smoking taxi drivers, smoke-filled coffee shops or the gurgling of the ubiquitous waterpipe. Tobacco consumption in the Middle East is among the world’s highest.

“I’ll never give up my Cleopatras,” says Egyptian carpenter Mohamed Helmy, referring to the local brand of cigarettes he smokes. A pack retails for 2.50 Egyptian pounds (45 cents), making them among the cheapest cigarettes in the world.

Health experts cite a strong correlation between poverty and tobacco use. A WHO survey of the region conducted in 2001 revealed a lower prevalence of smokers in the wealthier Gulf Arab states, while rates in the poorer Levant countries and Yemen were considerably higher.

The survey found that over half the male population of Syria smokes, while Yemeni men are the biggest smokers in the region, with 77 percent smoking. Recent national surveys show lower rates in some Arab countries, but El-Awa cautions that this is not necessarily evidence that tobacco has declined.

“Unfortunately, there is no centralised tool used throughout the region to measure adult tobacco use, so WHO depends largely on numbers supplied by health ministries,” she told IPS. “There are many different factors that contribute to the varying results…including sample size and sample area – urban versus rural.”

Arab governments began implementing tobacco controls in the 1970s, though most states had no legislation until the last decade. Early measures included label warnings and restrictions on tobacco advertising. Health officials concede that the efforts have done little to bring smoking rates down.

More recently, Arab states have joined the WHO’s Framework Convention on Tobacco Control (FCTC), a treaty that sets stringent guidelines on tobacco control and surveillance among its 168 signatory states. While the convention has helped push regulatory control, the legislation developed has not been as forceful as WHO officials had hoped, especially in regard to public smoking bans and the package warning size.

But there has been progress, El-Awa stresses. Egypt and Jordan have added pictorial health warnings to cigarette packages in line with FCTC guidelines. Several countries in the region have banned tobacco advertising and passed legislation prohibiting the sale of tobacco products to minors.

In January the United Arab Emirates began phasing in a national public smoking ban. The anti-smoking legislation follows similar bans in Egypt, Jordan, Bahrain, Qatar and Saudi Arabia’s holy cities of Medina and Mecca.

Enforcement of these bans has proven difficult.

“Such laws are not easily enforced,” says Dr. Fouad M. Fouad, project coordinator at the Syrian Centre for Tobacco Studies (SCTS) in Damascus, where a public smoking ban issued last November is about to go into effect. A 1996 decree that banned smoking in Syrian government institutions, hospitals and airports is “often flouted.”

“Restaurants and bar owners have expressed fear of the ban, and some say they will resist it as most of their profits come from shisha (waterpipe) smoking,” says Fouad. “Many others are skeptical of the ability of the government to enforce this law, where people light up in offices, universities, taxis and even hospitals, and where smoking has long been a social imperative and a rite of passage for young men.”

Fouad argues that cheap tobacco prices are undermining efforts to control smoking in the region.

“It’s not easy to convince people when smoking is very common even among teachers and physicians, and where packs can cost as little as 50 cents,” he says.

Another concern is the growing prevalence of tobacco use among women and youth, who perceive smoking as an outward expression of independence. Advances in women’s movements among conservative Arab societies have been accompanied by more women taking up tobacco use, particularly shisha.

“Women and youth are the two big groups that entered the ‘market’ of smoking in the last decade, and mostly use waterpipes to smoke flavored tobacco,” says Fouad. “The attractiveness and the social attitude of waterpipe smoking may be a setback to efforts.”

Progress will require firm political resolve. But the involvement of high- ranking politicians with the tobacco industry has cast doubt on how far governments are willing to go. State-owned Arab tobacco firms, such as Egypt’s Eastern Tobacco, churn out millions of cheap cigarettes a year and consistently turn profit.

“The government produces cigarettes while the Ministry of Health tells us we shouldn’t smoke them,” says Helmy. “It’s hypocrisy.”