Thursday, August 26, 2010

A Smoking Ban in Lebanon: Reality, dream or just another example of a deeper problem?

By Ashley S. Westerman


Light up. Burn. Inhale. Exhale.


This is what almost half of the people of the country of Lebanon do on a daily basis. Whether it’s cigarettes or water pipe, smoking is becoming a big health problem for the only 4 million citizens of this tiny jewel on the Mediterranean Sea.


Recently, discussion of banning smoking indoors in all public places has arisen again in parliament but the Lebanese government has developed a bad habit of flicking off progressive policy like ash in the wind.


Research Assistant at the American University of Beirut’s Department of health Behavior and Education, Dr. Rima Nakkash, estimates that 28%-35% of women in Lebanon smoke while 45%- 60% of men light up too.


According to recent research report by the AUB Tobacco Control Research Group (TCRG), headed up by Nakkash, cigarette smoking costs the nation about $327 million a year and Lebanon has one of the highest smoking rates per capital worldwide.


“Definitely in total, more than 50% of the Lebanese population smokes – that would be fair to say,” says Nakkash.It’s a compound problem, she says, noting that youth in the country start smoking cigarettes as young as 11-12 years old. She says that even though 80% of the people who smoke in Lebanon know it’s bad for them, they do it any way and one-third of women continue to smoke even during pregnancy.


“With such an environment, you are actually supporting the smoking and creating a social norm that it is acceptable behavior to smoke,” says Nakkash. “It’s in your face – it’s everywhere. It’s a very hard environment for people to even think about quitting.”


Nakkash is also a big supporter of the regulation of the water pipe, also known as narghile or shisha. Her studies have found 60% of 13-15 year olds have tried the narghile at least once. According to Nakkash, popular myth says smoking a water pipe is safer than smoking a cigarette because the smoke passes through water before being inhaled. However, research prepared by the TCRG has concluded the narghile to be just as addictive and full of high levels of toxic compounds as regular cigarettes. This information led to an official warning statement released by the World Health Organization on the deadly effects of smoking narghile.


“They want to a ban, narghile needs to be counted in the ban – it is counter intuitive to ban cigarettes inside [public places] and not narghile,” says Nakkash.


But what ban?


A smoking ban in Lebanon is almost non-existent, even though 3,500 -4,000 Lebanese die each year from smoke-related disease, especially lung cancer. Nakkash says that Lebanon has the weakest tobacco control policy in the Arab region, if not one of the weakest in the world.

According to the National Tobacco Control Program (NTCP), a ministerial decision or decree was passed in 1995 related to the dangers of second-hand smoke, “prohibiting smoking in places such as hospitals, infirmaries, pharmacies, theaters, public transport services, health clubs and all schools, universities and elevators.” However, the decree had no mechanisms for implementation or punishments for failure to do so. In addition, according to NTCP’s website, there are there “are no legal requirements for the testing of tobacco products by health officials, nor on reporting of cigarette constituents by tobacco manufacturers, as well as no specified limits for nicotine or tar content.”


The proposed law currently up for discussion will serve as an update to the ’95 decree, with the main objective to strengthen it by focusing on banning tobacco advertisement, including large picture warnings on packs of cigarettes and completely banning smoking in public places.


Nakkash says that Lebanon is like the United States in the ‘80s and that it may take the country 20 or 30 years to catch up with more progressive places. The United States banned tobacco advertisements on the television and radio in 1971 with the Public Health Cigarette Smoking Act and most recently in June of this year, restricted tobacco companies from sponsoring sports, music and cultural events. In addition, since the Federal Cigarette labeling and Advertising Act was passed in 1985 all cigarette packages in the US must display a large, prominent warning from the Surgeon General.


She also says that Lebanon is in a great position to learn from other countries, such as what works and doesn’t work when it comes to tobacco control and even though the proposed law is currently stuck in sub-committee investigation but Nakkash is hopeful that this time the it won’t get buried beneath other legislation like it has been several times in the past.


“We want a law, but not just any law, it’s all about the details,” says Nakkash. “Awareness on its own is not enough; the law must really convince people to not take up smoking. I think we will get there eventually, it just takes time to change social norm.”


Dr. Nakkash’s research, along with the AUB (a smoke-free institution), serves as one part of the Trifecta pushing for stronger tobacco control in Lebanon. The other two facets of the full frontal assault on the country’s unchecked tobacco use are the Tobacco Free Initiative (TFI) and the Ministry of Health’s Tobacco Control Program (NTCP).


Joe Souaid is the Executive Director of the Tobacco Free Initiative, an organization established in 2000 with the objective to fight tobacco consumption in youths in order to help.


“We are here to prevent, protect and help,” says Souaid. “We want them to say that they don’t need to smoke; we are not here to tell them they cannot smoke.”


There is no other non-governmental association in all of Lebanon that specializes in the fight against tobacco among children and teenagers, says Souaid. Headquartered in Jbeil, TFI does a lot of work in schools and community centers all over the country holding yearly assemblies and workshops. Souaid says that they will work with anyone, “from CEO’s to poor people, in the Palestinian refugee camps and in the banks.” In 2008, the organization was given an award by the World Health Organization for outstanding work in the Tobacco Control Area.


However, Souaid says the country needs a national law for any of their work to be effective.


“There is no problem with our mission; we are looking to have a lot of results but if we don’t have a very good law...in the country, we will never touch our objectives.”


Souaid says he is sure the law will help all levels of society in Lebanon, “the poor man, the rich man, everyone” but the politicians must work on it. He also claims that TFI has no opposition from any of the school or communities they work with and that they organize smoke-free nights at clubs, bars and restaurants all the time.


For now they are strictly a Lebanese organization but hope to go international some day and for Souaid, a father, protecting the next generation is top priority and TFI will never stop until there is no more smoking indoors.


“You have the right to smoke anywhere you want, but you have to respect non-smokers too; you must protect them,” says Souaid. “I have two daughters, I have to protect them, I need to help them.”


Even though Director of the Ministry of Public Health’s Tobacco Control Program, Dr. Georges Saade, echoes some of the same concerns as Dr. Nakkash and Joe Souaid, he thinks that better implementation of eventual law – not awareness – is what will help youth stay away from smoking the most. Saade has completed many research projects and published annual reports on youth usage prevalence and the affects of second-hand smoke.


He says that raising awareness does not affect usage prevalence, especially since smoking is socially accepted in Lebanon.


“We need a strong policy in schools and institutions that really work,” says Saade. “When you go and teach the students not to smoke or that smoking is hazardous for your health and the same student sees that teacher smoke during break time, the student will not buy you; they will not believe you.”


However, Saade and the TCP do understand the importance of educating the younger generation.


“We should work on our future generation. When we do this, I think implementation will be very effective. Once they understand it’s for their own safety – that second-hand smoke kills – they will tell their fellow citizens not to smoke.”


Saade was actually one of the recent driving forces behind moving Lebanon from a smoking- friendly society to a non-smoking friendly society when he wrote a tobacco control proposal to the Bloomberg Initiative.


According to TobaccoControlGrants.org, the Bloomberg Initiative – established in 2006 – is a $125 million program that offers grants to developing countries in order to implement the Framework Convention on Tobacco Control (FCTC). The Initiative includes five institutions: the Center for Disease Control, the World Health Organization, the Johns Hopkins Bloomberg School of Public Health, the Campaign for Tobacco Free Kids and the World Lung Foundation.


The initiative was extended to $250 million in 2008, the same year that Saade wrote the proposal to obtain a grant to rejuvenate the tobacco control unit within Lebanon.


Saade says the choice to support tobacco control is easy, “We have to remove the things that are harmful to our culture. If we have marijuana, we must remove it. It we have drugs that are hurting our culture, we must remove it.”


One of the biggest hurdles the NTCP faces is big-time lobbyists such as Philip Morris, the largest tobacco agent in Lebanon. Saade also says that there is little to no control over progressive policies like a smoking ban because there is no control in the government and politicians only see it through a short-term lens. In addition, says Saade, everyone is so connected in Lebanese politics that the government is like the Italian mafia.


“Our politicians are there because of families...because we are a mafia-run country. They don’t care about their people, only their connections.”


Saade says there is also much opposition from restaurant and other business owners that allow smoking in their establishments as well as the myth that a ban will hurt Lebanon’s tobacco farmers. Sadde says this is just not true.


The fear of tobacco being smuggled in from outside the country is another concern that opposes tobacco control but Saade says that this is still a stupid reason not to increase taxes. He says it would be very simple to sit down with surrounding countries, especially those with better tobacco control policies, and make an agreement to both raise taxes. Saade says that it will be much more difficult for people to purchase cigarettes when the price is finally raised to higher than $1 per pack.


Despite all of the forces against the program, Dr. Saade says he is optimistic about the policy change but implementation will be the hardest part.


“Implementing the law is a gray area. It is not easy to control the Lebanese; Lebanese do not like law and don’t like to implement law in Lebanon.”


But will it really be that difficult to enforce a non-smoking indoors policy once it’s made into an actual national law?


Andrew Toriz has been the owner of Captain’s Cabin in the Hamra area for over 13 years. A popular college hang-out, the hole-in-the-wall bar has been open since 1964 and has always allowed smoking inside. However, Toriz – a smoker himself – says that if there is a law, he will enforce it.


“I’ll have a reason to tell the people not to smoke because there is a rule now. Like before, everybody could drink but they made the law that under 18 you cannot drink so I do not let them drink in here unless they are over 18. Because it’s the law and when they pass this law for non-smoking, I will tell them no smoking.”


Toriz also says that the law will give him a reason to stop smoking too.


“I don’t smoke at home but when I come here I smoke. But sometimes it gets very smoky in here and with a law I will have a reason to also not smoke.”


He says that he doesn’t know if he is one of the few owners who want the government to pass a law but if they do, he will willingly abide.


“I hope they pass it.”


The willingness to uphold the law is not the issue, says owner of Hamra Street Café Mohamed Sourth.


“They should establish a lot of other laws we need [in Lebanon] other than not smoking inside.”


Hamra Street Café’ has only been open for five months and is one of the many coffee shops in the area that sell shisha. Sourth says that only 5% of his business depends on shisha but there are some places that depending on it for 50%-90%. He says an indoor ban will definitely hurt them since shisha is like a habit in Lebanon.


However, Sourth would like to see many other things get regulated first.


“When they can deal with the traffic, the pollution, the electricity – then okay; they should establish these before they think about regulating smoking inside or outside.”


Sourth says that he wishes these things would be regulated so the Lebanese people will appreciate the banning of smoke in doors.

“There is a big problem with the whole system; there are no regulations here,” says Sourth. “It is not a problem with Lebanese mentality; it is a problem with the entire system.”

3 comments:

  1. Smoking is surely a big health problem there is no doubt about that, i don't think that imposing bans is the only solution, there are many alternatives of smoking and they just need to promote them.

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  2. There are advantages and disadvantages of everything, non smoking people will appreciate this ban and smokers will get annoyed, in a way these bans are beneficial for us.

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  3. Tobacco can cause some serious health issues, one thing i don't understand is that why this thing is sold legally when everyone knows it is dangerous for us.

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