As World No Tobacco Day is marked today, experts say more still needs to be done in the Middle East to discourage people from smoking.
In the region as a whole, laws and their enforcement often lag behind best practice.
“A number of countries in the Middle East have made quite significant progress but there’s still a long way to go,” said Prof Kamran Siddiqi, professor in public health at the University of York in the UK, who researches non-communicable diseases in low and middle-income countries.
“The regulations need to become more comprehensive in line with international recommendations. At the same time there should be a strong focus on implementing these regulations.”
The UAE is ahead of the majority of its neighbours when it comes to keeping smoking rates down.
According to the most recent edition of The Tobacco Atlas, released last year, the equivalent of 438 cigarettes are smoked in the UAE per person each year, with a lower figure recorded only in Yemen, where the number is 214.
In some parts of the Middle East, numbers are several times as large, with the biggest figures recorded in Libya (1,764 cigarettes), Kuwait (1,849 cigarettes) and, highest of all, Lebanon (1,955 cigarettes).
Too many choices
The region faces particular challenges because, as well as cigarettes, other forms of smoking are also popular.
Prof Siddiqi said that the particular ways in which tobacco was consumed in the region, notably with shisha pipes, raised additional issues.
“Shisha is a major concern, particularly being popular among young people,” he said.
The smoking of dokha with a medwakh pipe is another issue, especially as research has indicated that tar and nicotine levels are much higher than with cigarettes.
Medwakh, shisha, cigarettes and other tobacco products increase the risk of conditions including lung cancer, coronary artery disease, chronic obstructive pulmonary disease and emphysema.
WHO recommendations
Bans on smoking in hospitality venues, offices and government facilities are recommended in the World Health Organisation’s Framework Convention on Tobacco Control.
Other measures that the WHO advises include banning tobacco advertising, promotion and sponsorship, requiring at least half the front and back of the packet to be covered by health warnings, and making taxes account for a minimum of 75 per cent of the price of top-selling brands.
In 2017 the UAE brought in a 100 per cent tax on tobacco and tobacco products, meaning that 50 per cent of the total retail price is accounted for by tax.
“It’s essential [to be] making comprehensive smoke-free laws, increasing tobacco taxes, offering smoking cessation, making sure the packaging of cigarettes is standardised … and banning all forms of tobacco advertising, sponsorship and marketing,” Prof Siddiqi said.
While less hazardous, e-cigarettes are also associated with health risks and a study released last year found that nearly a quarter of university students had vaped in the past month.
Since the WHO launched its FCTC, in 2003, the demand-reduction measures it advises have been associated with lower smoking prevalence, and tobacco related morbidity and mortality, according to the organisation.
“We are sending out a strong message that the convention has proven its effectiveness and is as important today as it was 20 years ago,” said Dr Adriana Blanco Marquizo, head of the WHO FCTC Secretariat.
“However, we must also remember the convention is only as strong as its implementation at the country level.”
Grow food, not tobacco
The WHO recently recommended that tobacco farmers ditch their crops to grow sustainable food instead, a move the organisation said would help to feed millions of people and cut the amount of smokers at risk from lung cancer.
A new WHO report called Grow Food released last week suggested that the move could help more than 300 million people facing acute food insecurity, and prevent some of the eight million deaths caused by cigarettes annually.
According to the report, around 3.5 million hectares of land is converted for tobacco cultivation each year, with the industry also contributing to 200,000 hectares of deforestation each year.
Intensive use of pesticides and fertilisers required to yield a successful harvest is also contributing to soil degradation making it harder to grow other crops in the future.
“Tobacco is not only a massive threat to food insecurity, but health overall, including the health of tobacco farmers,” said Dr Ruediger Krech, Director of Health Promotion at the WHO.
“Farmers are exposed to chemical pesticides, tobacco smoke and as much nicotine as found in 50 cigarettes – leading to illnesses like chronic lung conditions and nicotine poisoning.”
Historically, tobacco farming has been dominated by nations across Asia and South America, but data from the WHO report showed tobacco companies are turning to Africa to open new farms.
Since 2005, Africa has seen a 20 per cent increase in tobacco farming, reducing the amount of land available to cultivate vital food crops.
The Tobacco Free Farms Initiative, in partnership with the WHO, Food and Agriculture Organisation and the World Food Programme, supports more than 5,000 farmers in Kenya and Zambia to grow sustainable food crops as alternatives to tobacco.
Meanwhile, the FCTC outlines policy options to promote economic alternatives for tobacco farmers and individual traders to protect the environment and improve public health.
Lung cancer, of which smoking is a key cause, is the leading cause of cancer deaths worldwide and kills as many people in the US as colon, breast and prostate cancer combined.
However, thanks to earlier diagnosis and wider access to chemotherapy, targeted therapy and immunotherapy, mortality rates are on the decline.
In the US, the Lung Cancer Research Foundation said that the incidence rate of lung cancer has decreased by 2.6 per cent a year in men, and 1.1 per cent a year in women since 2006.
