BEIRUT: Less three years after Lebanon banned smoking in public places, activists are alarmed and disappointed at the apparent rollback of the country’s tobacco-control legislation.
Since the controversial Law 174 came to force in September 2012, the Interior Ministry has come under intense pressure from the hospitality and tourism establishments to reverse the decision. Interior Minister Nouhad Machnouk and Tourism Minister Michel Pharaon have recently expressed sympathy for those wanting to relax the law, delighting the Syndicate of Owners of Restaurants and others in Lebanon’s wounded hospitality industry.
Anti-tobacco advocates, however, have seen the move as a disappointment. “Now, the implementation of the law has been derailed,” said Abdallah Jabbour, executive director of Lebanon’s Tobacco Free Initiative.
Speaking to The Daily Star, advocates and academics who helped pass Law 174 explained why smoking rates remain stubbornly high, and how tobacco consumption prevalence is shaped not only by individual choices, but also by social and environmental norms.
The Lebanese contextAccording to statistics from World Health Organization and the Health Ministry, smoking takes 3,500 Lebanese lives each year. Of these, 350-500 are victims of secondhand smoke. “Lebanon has one of the highest smoking rates in the world, especially among young people and women,” said Jad Chaaban, assistant professor of economics at AUB.
A 2010 study he authored found that the rate of smoking among Lebanese men was near 40 percent, while for women the rate was close to 30 percent. Lawmakers point to this high dependence on tobacco as evidence of the need for the law.
While media outlets have repeatedly referred the law’s ban on smoking in public places, lesser mentioned components include limitations on advertising, promotional activities and event sponsorship.
The law also required larger text warnings of health hazards on cigarette packages.
According to Law 174, violators are punished with fines and, in some cases, imprisonment. But advocates from the Tobacco Free Initiative said the judiciary has neglected to follow up on those cited.
“Several venues have accumulated over 20, 30 or 40 fines, and the law stipulates a jail sentence after the second offense,” Jabbour said. He added that there has been a steady drop in the issuance of fines. Moreover, he said, establishments with deep pockets, such as nargileh cafes, are able to continually pay fines with ease.
Several ministries are responsible for enforcing the law, including the Health Ministry, the Economy Ministry and the Tourism Ministry, as well as the Internal Security Forces.
Yet enforcement of the ban on smoking in public venues has slipped since the law’s implementation. As a consequence, establishments are increasingly returning to their smoke-filled past.
Creating an enabling environmentThis lack of compliance on the part of some establishments in Lebanon discourages smokers from kicking the habit, anti-tobacco advocates say.
Rima Nakkash, assistant professor of public health at the American University of Beirut and coordinator of the college’s Tobacco Control Research Group, explained that Law 174 doesn’t just protect non-smokers from second-hand smoke. It also “supports smokers in quitting because it provides an enabling environment,” she said, adding that this helps reduce cravings in those with the intention to stop smoking.
Taxation to curb smoking
As research worldwide has confirmed, taxation is a crucial component in driving down smoking rates. Higher prices cause smokers to think twice before purchasing cigarettes, and the adjoining taxes generate revenue for the government. However, Lebanon’s cigarette prices remain low.
Previously, The Daily Star reported on a 2012 AUB Tobacco Control Initiative study. It found that, through appropriate taxation of tobacco products, the government could add around $170 million to its revenues, while curbing the smoking rate.
“We’ve been trying to increase taxes on tobacco products for the past six years, but it keeps getting blocked by MPs who have political and financial gains to make from the tobacco industry and farmers,” Jabbour said.
Critics of high tobacco taxation have cited fears of increased smuggling should cigarette prices climb too high, but the same study demonstrated that, even if smuggling rose 200 percent, government revenues would still increase by 52 percent.
Resistance and rebuttalsAdditional resistance has ensued beyond the issue of taxation. As the law was being drafted in 2011 the restaurant owners’ syndicate and the then Tourism Minister Fadi Abboud predicted it would threaten the hospitality industry. Some projected that the law would gut some industries of $50 million and result in high numbers of job layoffs. Further, Abboud feared that a ban on nargileh smoking would threaten local tradition.
Jabbour countered this claim, explaining that the heritage of Lebanese cuisine far predates the nargileh trend that proliferated in the early 2000s.
“It is just unfathomable to me that Lebanese cuisine is associated with cancer,” he said.
As for the loss in restaurant industry revenues, Chaaban’s research published in 2013 tracked sales at cafes, restaurants and pubs, using numbers submitted by establishments to the Finance Ministry. Results showed a 3 percent revenue climb for the three months following Law 174’s implementation, when enforcement was at its highest.
Lebanon a prime target for tobacco companiesRecent years have seen a shift in tobacco company strategy. Public health experts have the tobacco trade targeting low- and middle-income countries, such as Lebanon. Jabbour explained that, as the industry has reached market saturation in high-income countries, they have turned to weaker economies to turn a profit.
Big tobacco firms have shifted focus away from areas where policies are strongly enforced as in countries where restrictions exist, “there are governments that set standards on how multinational companies should or should not market products,” Nakkash said.
She added that in countries like Lebanon, tobacco firms “can take advantage of the fact that we don’t have policies set in place, and that people don’t understand what conflict of interest is.”
The influence tobacco representatives have over public health policymaking is problematic because profits take precedence over concern for public health, Nakkash added.
Tobacco is big business in LebanonPublic health scholars point to the close relationship between the Finance Ministry and the Regie Libanaise des Tabacs et Tombacs, Lebanon’s state-controlled monopoly that oversees the country’s tobacco trade. Gains and losses of the Regie are tightly bound to public treasury funds.
“There is little separation between those in power and those who control big business, such as the tobacco trade. Many members of Parliament are close to tobacco traders,” Chaaban told The Daily Star.
According to a study he co-authored in 2010, net revenue from the tobacco industry hovered near $270 million in 2008, a figure that incorporates international tobacco companies’ expenditures in Lebanese advertising.
Chaaban explained that tobacco companies specifically target the high numbers of youth in low- and middle-income countries as “you can sell them more and get them addicted to a product earlier in life.”
The high cost of tobacco use on health and the public
Although the tobacco industry reaps large gains in Lebanon, their wins come at a great cost for the Lebanese government.
A study published in 2014 by Chaaban’s colleague, AUB economics professor Nisreen Salti, cited the total social costs of tobacco use at $326.7 million, as of 2008. These losses are related to high mortality and medical expenditures, in addition to productivity losses.
In an earlier study, Chaaban found that “the highest cancer incidence rates in Lebanese male adults are those pertaining to smoking-related cancers.”
He also found that spending on tobacco products is most burdensome for the poorest segments of the Lebanese population.
Next stepsAlthough the recent easing of Law 174 may be a setback on the road to a healthier Lebanon, advocates say the fight isn’t over. The Tobacco Free Initiative’s Jabbour said he intends to “shame and blame every minister who does not implement the law,” as well as other obstinate stakeholders.
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