Background 3/27/2013. Tobacco control policymaking and policy enforcement in the Eastern Mediterranean Region. The case of Lebanon

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1 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 Sciences American University of Beirut February 26, 2013 Governance of in the 21 st Century: Strengthening National and International Policy for Global Health and Development Background Arab region of the Middle East- involving 22 member states Diverse group of countries at different level of economic and political development. Minimal response at the public health and policy levels Lack of national surveillance of tobacco use Poor planning and prioritization of tobacco control public health and policy initiatives. FCTC ratification and slow adoption of legislation. Fluctuating enforcement Age-standardized estimated prevalence of current cigarette smoking among men and women (15+ years) for selected Arab countries, 2009 (WHO 2009) 4 1

2 Current cigarette vs. waterpipe smoking among yr olds in several Arab countries according to GYTS or surveys of comparable methods 0Truth%20ARABIC.pdf (Mzayek et al. 2012; Al-Mulla et al. 2008, Jasim et al. 2009) The waterpipe tobacco industry JTI acquisition of Nakhla in 2012 Unregulated industry Consumer driven hospitality sector International epidemic Waterpipe tobacco control and the FCTC LEBANON In 2009 the policy under discussion was poorly informed by evidence and not in line with the FCTC Non existent tobacco control policy Policy under discussion 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 fine system 2

3 Three year intensive campaign focused on use of evidenc Disseminate policy relevant and timely research to support needed policy changes Industry allies Industry Public Civil society AUB TCRG Parliament Media Health Promotion and Community Health Health Management and Policy Engineering Pathology and Laboratory Medicine Nursing School Issam Fares Institute for Public Policy and International Affairs Epidemiology and Biostatistics Chemistry Economics Smoke free policies Health Warnings industry influence Economics of AUB Control Research group Waterpipe health effects, prevention, intervention, and policy implications Taxation Law No. 174 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 Prelaw 174 Direct and indirect advertising 3

4 POST LAW 174 Marlboro June 2013 Winston February 2013 Pre law 174 Industry interference Post Law ws/smoke-ban-lebanon-blessingcurse/ 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. 4

5 Breakthroughs Civil society commitment(tccw) Sustained advocacy Changing social norms Setbacks Lack of accountability and proper governance structures Wavering political will for enforcement Perceived competing priorities, political, and security issues. Disrespect for law enforcement Pervasive pro social norms Devious tobacco industry interference 5