Experience of Turkey in introducing total ban on smoking

in (enclosed) public spaces

Prof. Nazmi Bilir MDHacettepe University Faculty of Medicine

Department of Public Healthnbilir@hacettepe.edu.tr

We win!Dear all,Let me share with you our celebration on the smoking ban accepted today, on theMay 17th 2012, by the National Assembly of Bulgaria. The Parliament accepted thetotal smoking ban on public places including working places, stadiums, open air kindergarten, schools and school hostels, summer theaters and cinemas. Ourbattle was a hard one because the strong resistance on the behalf of the Tobacco Industry supporters, incl. restaurants, bars, café etc. owners. After “stormy”public debates and various activities performed by the NGO’s Coalition SmokelessBulgaria the dream of many generations outstanding Bulgarian people came true.About 600 health inspectors are in due to control the observing the low. Now wecan celebrate! Please join us!

Kind regards

Prof. Liliana Tsoneva-Pentcheva, PhDChair, Association Women Against Tobacco-Bulgaria1000 Sofia 22a Dondukov Blvd.BulgariaTel: +359 2 898 8030 Fax: +359 2 9819009

CONGRATULATIONS BULGARIA

History of Tobacco in Turkey

• Turkey is a tobacco producing country– Major economic activity – Providing 4% of world production 1.7%

• State-owned tobacco monopoly: TEKEL – No advertisement, no interest of market expansion

• Smoking is common – Particularly among men

• No restriction (until 1996)– “smoke everywhere”

History of TC Activities in Turkey – phase 1/3

Before 1980’s

(before foreign tobacco companies’ attack)

1980’s to 1996 (Law No. 4207) and 2008

1984-1986-1991-1995-2002 – 2008

2008 – Future challenges

(hospitality industry --- tobacco industry)

• 1601 – entrance of tobacco into Turkey

– British sailors

• 17. c. İbrahim ef. (chief medical officer) –

some efforts – unsuccessful

• 17. c: complete ban Murat 4th.“concern; fire”

• 1874 – tobacco cultivation started in Turkey

Before “Republic of Turkey”

First phase – Before 1980’s

• 1924 establishment of “TEKEL” (state monopoly)First Anti-Tobacco Law initiative• 13.12.1926: proposal by Dr. Fuat (MP):

– Smoking and drinking of children is forbidden– Tobacco products shall not be sold to minors– Those who violate this prohibition shall be fined from

5 to 50 TL. (repeated violation; jail for 2 months)

not accepted by the Parliament

Some relevant publications

• Besim Ömer Akalın (founder of MCH services, dean of med. school)

Mükeyyifat ve Müskirattan Tütün, 1888 (Tobacco as pleasurable substance)

• Osman Şerafettin Çelik

Tütünün Kalp Üzerine Tesiri, 1936 (Tobacco, effects on heart)

• Peyami Safa

Sigara, Gözlerimiz ve Ruhumuz, 1938 (Smoking, our eyes and our spirit)

• Fahrettin Kerim Gökay – physician, Mayor of İstanbul

Gençlik ve Tütün İptilası, 1942 (Youth and tobacco dependence)

• Sadi Irmak – Prof of medicine, Minister of Health

Okullarda Sigara Yasağı, 1942 (Smoking ban at schools)

• Mazhar Osman Uzman – founder of modern psychiatry

Tütün; Bilhassa Marazi Tesirleri, 1942 (Tobacco, harmful effects)

History of TC Activities in Turkey – phase 2 / 3

Before 1980’s

(before foreign tobacco companies’ attack)

1980’s to 1996 (Law No. 4207) and 2008

1984-1986-1991-1995-2002 – 2008

2008 – Future challenges

(hospitality industry --- tobacco industry)

Changing economic system

• Early 1980’s

• “Liberal” economic system

• Privatization of TEKEL

• Reduction of tobacco production

• Tobacco importation started ---- increased

• Selling TEKEL to foreign tobacco industry

• Development of tobacco control law

New Laws

• 1984: importation of “foreign” cigarettes– by TEKEL

• 1986: importation by “private” companies– Abolishing of TEKEL’s right of importation

• 1991: establishment of cigarette producing factories by multinational industry – Joint establishment by national companies

Advertisements started

Tobacco use increased

Cigarette sales, Turkey, 1925-2011

102% increase betwen 1980 – 2000

Hospital admissions due to lung cancer, 1964–2004

Lung Cancer Cases, Hospital Admissions, Turkey, 1964-2004

1222 1614 20184363

687811324

1844221729

52865

0

10000

20000

30000

40000

50000

60000

1964 1969 1974 1979 1984 1989 1994 1999 2004

Number

Hospital admissions due to coronary heart disease, 1964–2004

6628 1286526207

77022

198113

0

50000

100000

150000

200000

250000

1964 1974 1984 1994 2004

Number

Hospital admissions due to chronic obstructive pulmonary disease, 1964–200420519

42774 50305

97569

211545

0

50000

100000

150000

200000

250000

1964 1974 1984 1994 2004

Number

Multinational tobacco companies

decreased “domestic” production and

increased “imported” tobacco

Tobacco Production in Turkey

production decreased ---- importation increased

Years 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Number of tobacco farmers (x1000) 622 568 583 478 405 318 282 252 215 207

Production area (x1000 ha) 278 270 237 199 199 184 193 185 146 145

Production (x1000 ton) 202 244 204 150 160 112 134 135 98 80

Tobacco import

(x1000 ton)

42(1988 0.6) 49 62 50 56 55 57 67 66 63

Phillip Morris

41%

British American Tobacco

33%

Japan Tobacco

18%

Imperial Tobacco

4%

European Tobacco

3%

Korean Tobacco

1%

Market shares of Tobacco Companies, Turkey

TEKEL was owned by BAT in 2008

No “Turkish” cigarettes on the market.

All cigarettes belong to “multinationals”