Lebanon s Tobacco Control Policy: Opportunities and Gaps
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1 Lebanon s Tobacco Control Policy: Opportunities and Gaps May 11, 2013 The 46 th Middle East Medical Assembly American University of Beirut 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 Towards a comprehensive tobacco control policy: Building capacity for effective smoking cessation programs at national level
2 OBJECTIVES 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.
3 AUB Tobacco Control Research group Tobacco Industry Ministries Industry allies Civil society Evidence Parliament Media 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
4 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.
5 The tobacco industry as disease vector 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
6 *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).
7 A barrier to moving foreword.. Tobacco Industry Interference in Tobacco Control Policy making 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.
8 WHO Framework Convention on Tobacco Control 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. Until now, over 172 countries have ratified the WHO FCTC Over 86.44% of the world population
9 *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
10 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..
11 LEBANON 2005
12 LEBANON 2009 Policy under discussion poorly informed by evidence.and not in line with the FCTC
13 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
14 Sustained advocacy
15
16 Disseminate policy relevant and timely research to support needed policy changes Smoke free policies Health Warnings Tobacco industry influence Economics of Tobacco Waterpipe health effects, prevention, intervention, and policy implications Taxation
17 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 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
18 Direct and indirect advertising
19
20 POST LAW 174 Marlboro June 2013 Winston February 2013
21 Pre law 174 Tobacco Industry interference
22 Post Law /news/smoke-ban-lebanonblessing-curse/ 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 nonnegligible 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.
23
24 good moderate unhealthy for sensitive people unhealthy very unhealthy hazardous Percentage Pre law 174 Indoor polloution(2008) Air Quality Index PM 2.5 venues concentration % 7.40% 3.70% 14.80% 14.80% 59.30% Air Quality Percentage of venues according to to US EPA
25 Post law 174 Indoor pollution (2013 ) White list White list
26 * Civil society commitment(tccw) * Sustained advocacy for enforcement * Changing social norms * Decree s issued
27 *
28 *As in the market now. BRAND * Brand
29
30
31
32
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34 2013 *
35
36
37 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..
38 Towards a comprehensive tobacco control policy
39 *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
40 *Develop and support national tobacco cessation guidelines *Evaluate and monitor enforcement
Background 3/27/2013. Tobacco control policymaking and policy enforcement in the Eastern Mediterranean Region. The case of Lebanon
control policymaking and policy enforcement in the Eastern Mediterranean Region The case of Lebanon Rima Nakkash, DrPH Assistant Professor Health Promotion and Community Health Department Faculty of Health
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