Todays Zamen – 4th May 2008
” Mackay proposes conducting public opinion surveys, organizing media campaigns and getting celebrities to lead the charge. Glantz suggests the use of media by nonprofit groups against smoking: “They can press the government to advertise.”
“Smoking is a necessity of existence to the Turk; one could almost fancy it a part of his religion; and naturally, therefore, the shops of tobacconists and of vendors of chibouques and amber mouthpieces abound everywhere. … Nothing is more delicious or favorable to poetic reverie, than to inhale, in gentle puffs, while seated upon cushions of a divan…”
These words of praise and admiration were dispatched from İstanbul by Theophile Gautier and published in The New York Times on Aug. 1, 1875. Over 125 years have gone by since this article appeared in the well-respected US paper, yet here we are, as Turks, still addicted to smoking. In defiance of scientific research and health warnings, one in every seven people in Turkey today continues to smoke, not including second-hand smokers. The only difference is that we do not praise it as “an art or a religion,” as Gautier described, but have begun to admit that it is “an addictive passion” we simply can’t do without.
In the last decade or so, however, antismoking campaigns have been very strong and successful in Turkey, resulting in legislation aimed at curbing smoking, especially among teenagers. To some extent, this legislation has exceeded some of the stringent legal regulations adopted by the European Union and the United States, according to Dr. Toker Ergüder, the World Health Organization’s (WHO) Tobacco Control Program officer in Turkey. With new amendments to the legal code regulating “the prevention of the hazards of tobacco and tobacco-related products,” Ergüder argues, Turkey will be the first country in its region to take such measures. The changes, slated to go into effect on May 19, aim to reduce second-hand smoke exposure by expanding Turkey’s smoking ban to include public spaces such as cafeterias, bars and restaurants and even open spaces surrounding schools and educational institutions.
Pushing legislators to enact laws is one thing, but putting these laws into practice is an entirely different matter in Turkey, experts say. The problem is not unique to Turkey, though. Speaking to Sunday’s Zaman, Judith Mackay, the director of the World Lung Foundation’s Global Tobacco Control Program, says: “Implementation is always a bit difficult, especially in remote areas. The police are often lukewarm about taking on this job, as they think it is more important to catch criminals. Some governments have a squad of dedicated tobacco control health officers — we have 60 in Hong Kong for a city of 7 million — whose job it is to check on the observance of smoke-free areas.”
Antismoking campaign watchdogs in Turkey point to the previous bans in public places such as airports, train stations and passenger buses. In the initial stages, the ban proved to be difficult to enforce in many places, and public quarrels were a common occurrence among smokers and non-smokers’ “non-smoking” areas. Over time, however, the public seemed to accept the new conditions. For example, you no longer risk having a passenger sitting next to you in the bus blowing smoke rings in your face. Of course, you might still smell smoke coming from the bus driver, who thinks he is an exception to the rule and smokes out of the driver-side window. Strangely enough, most passengers seems agree with that and you don’t hear many concerns or criticisms.
What we are seeing in Turkey is a direct impact of a worldwide campaign against tobacco that has been active for many years. Mackay sounds very optimistic. She says, “If you compare 2008 with 1968 — or even 1988 — there have been many, many developments.” She praises Turkey for being one of the earlier countries to ratify the WHO Convention on Tobacco Control in 2004. The convention has been signed by 168 countries and ratified by 154. Ergüder is more enthusiastic now that the new changes to the law are to be implemented by the middle of May, and he hopes 500,000 smokers will give up smoking within a year.
Another well-known scholar in the global antismoking campaign is Stanton A. Glantz, who is a professor of medicine and the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. Sharing his expertise with Sunday’s Zaman, Glantz says he thinks of the antismoking movement as “clearly an idea whose time has come,” adding, “Many governments are taking steps to protect their people from the toxic chemicals in second-hand smoke.” His worry, however, comes from a tobacco industry that will do anything to prevent antismoking laws from being enacted. He says: “Of course, the tobacco companies understand how dangerous this is for them, because it confirms the falling social acceptability of smoking, helps people quit and prevents the initiation of young people, which costs them money. As a result, the industry does everything it can to prevent these laws. If it can’t stop them altogether, it works to put in place weak, useless laws (like smoking sections or ventilation). Failing that, it encourages people to ignore the law and prevents the government from properly enforcing it.”
Mackay agrees with Professor Glantz about the threat the tobacco industry poses for the antismoking movement. She says: “In terms of legislation, smoke-free areas are now on an unstoppable roll, with country after country introducing legislation. This is usually fiercely opposed by the tobacco industry, but it is happening and the results are looking good.” She goes on to say: “Since the tobacco industry documents have been put into the public domain, we have a much better understanding of how the companies have been operating within countries.” She stresses that the litigation factor has brought popularity to the antismoking campaign worldwide. “The tobacco industry has been taken to court in dozens of countries for the harm it has done to individuals and governments,” she adds.
Although the trend is gaining support worldwide and leading more people to give up smoking, tobacco industry projections in terms of profit still look good for the foreseeable future. “The tobacco industry has nothing to fear,” says MacKay, adding, “Global predictions for the epidemic are that the current 1.2-1.3 billion smokers will increase to 1.64 billion by 2030, principally due to population expansion in developing countries.” She argues, “Even if the prevalence falls, the absolute number of smokers will increase (even in countries like the US), and I am sure this will be true for Turkey.” She is right. In Turkey, children smoking are at epidemic levels. Ergüder says, “The last survey done in 2003 showed every one child in 10 smokes in Turkey.” “What is more concerning is the fact that 30 percent of these children start smoking before they hit the age of 10,” he adds.
Ergüder urges the government to raise taxes on tobacco products to discourage people from smoking. He says, “The price in Turkey is very low when compared to prices in other countries.” “We also need to put more visible warnings on cigarette packages,” he notes. Mackay draws attention to another growing problem: “It is now quite rare to see tobacco ads on TV, in print media or on billboards. However, the industry has turned to more subtle forms of promotion, such as logos on clothing and other goods.”
The question of what more can be done to prevent the hazards of smoking calls for further analysis. Mackay proposes conducting public opinion surveys, organizing media campaigns and getting celebrities to lead the charge. Glantz suggests the use of media by nonprofit groups against smoking: “They can press the government to advertise.” The challenge here, of course, comes from the abundance of financial resources commanded by the tobacco industry. Mackay admits, “Yes, they do have huge amounts of money compared with tobacco control, but more funding is slowly coming on board, as governments, health organizations and philanthropists are realizing that chronic diseases cause the majority of deaths in the world, even in developing countries.” Glantz doesn’t see the need for huge finances to succeed. He argues: “You don’t need to meet the industry dollar-for-dollar. Coming within a factor of four seems more than adequate. It is easier to sell the truth than to sell a lie.”