Smoking prevalence Smoking prevalence is high in Turkey

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Smoking prevalence • Smoking prevalence is high in Turkey – GATS 32% (2008, daily,

Smoking prevalence • Smoking prevalence is high in Turkey – GATS 32% (2008, daily, 15+ yrs; M: 48%, F: 15%) – Health professionals, 2007 (daily smokers, CDC, WHO) • • Physcian: GP: 31%; Specialist 22% Nurse-midwife 30% Pharmacist-dentist: 26% Health technician: 34% – GYTS: 15 -17 yrs, 2003 • ever smoker: M: 31. 7 F: 19. 7 • daily smoker: M: 9. 4 F: 3. 5

Second-hand exposure is high, 2003 • GYTS: – 81. 6% – at home –

Second-hand exposure is high, 2003 • GYTS: – 81. 6% – at home – 85. 9% – at public places • Urinary cotinine – students – 76% of children have high levels • CO in breath: coffee-house, – Non-smoker outside: 3. 5 ppm – Non-smoker inside: 8. 9 ppm – Smoker inside: 23. 5 ppm

Rationale of Tobacco Control in Turkey • Tobacco kills – 110 000 in Turkey

Rationale of Tobacco Control in Turkey • Tobacco kills – 110 000 in Turkey – 300 / day • Environmental pollution – indoor air quality, – outdoor – cigarette butts – millions of. . . 50 tons/day • Fires – 52% of fires in Ankara, 48% in İstanbul • Economic loss – 50 million USD / day (only for purchasing) • Hacettepe University budget: 50 million USD – 25. 5 billion USD / year • 4 times of Mo. H budget (6. 5 billion USD)

Tobacco Control Strategies Prevention of initiation Target: children Prevention of harms to others Help

Tobacco Control Strategies Prevention of initiation Target: children Prevention of harms to others Help for quitting Target: smokers Target: general population

1990’s; Steps to reach the Tobacco Control Law • 1992 – First Tobacco and

1990’s; Steps to reach the Tobacco Control Law • 1992 – First Tobacco and Health Symposium – MP’s, journalists, representatives of Ministries, … • 1995 – Establishment of SSUK (11 institutions) • Researches: Tobacco use among “role model” groups – MP’s, physicians, teachers, artists, journalists … • Lobbying: (Law; in the agenda of Parliament) – Visits: (explaining the health, economic, . . . impacts of tobacco) – President – Political parties’ groups – MP’s – Participation in meetings of Commissions (Health, Justice)

First Anti-Tobacco Law, No. 4207; 1996 • Law on Prevention of Harms of Tobacco

First Anti-Tobacco Law, No. 4207; 1996 • Law on Prevention of Harms of Tobacco Products, – Ban smoking at public transport, – Ban smoking in “some” public places, – Ban smoking – health and educational institutions, – Ban “all kinds of” advertisements and promotion, – Health warning on the packages – Prohibition of selling to minors – 18 yrs. – TV airtime, 90 min/month – “harms of smoking” • 1997 ve 1999 Smoking and Health Congress

First Tobacco or Health Congress, 7 -8 Nov. 1997

First Tobacco or Health Congress, 7 -8 Nov. 1997

 • 2002: – TAPDK (Tobacco Regulatory Authority) -- established • 2004 FCTC –

• 2002: – TAPDK (Tobacco Regulatory Authority) -- established • 2004 FCTC – Signed, April 2004 – Ratified, Nov. 2004 • 2004 -2007 National TC Program&Action Plan – Participation of govt. &non govt. organizations (>100) • 2006 TC Unit at Mo. H established • 2007 Natl. TC. Program and Action Plan – Declared as Prime Ministerial Decree, 2008 -2012

National Tobacco Control Program November 2007 Three sections: A: measures to reduce demands for

National Tobacco Control Program November 2007 Three sections: A: measures to reduce demands for tobacco products B: measures to reduce supply of tobacco prodducts C: monitoring, evaluation and reporting TC program

National TC Action Plan, 2008 -2012 • Defines the strategies and activities • Defines

National TC Action Plan, 2008 -2012 • Defines the strategies and activities • Defines responsible agencies • Gives duty to Governmental and NGO’s • Defines timescale • Indicates progress indicators • Possible threats and obstacles

Objectives A. 5. Reklâm, Promosyon ve Sponsorluk Tütün mamulleri ile ilgili her türlü reklam,

Objectives A. 5. Reklâm, Promosyon ve Sponsorluk Tütün mamulleri ile ilgili her türlü reklam, promosyon ve sponsorluk faaliyetlerinin önlenmesi. Expected outcomes 1. 2007 yılına kadar, sigara ve diğer tütün mamullerin in marka ve firma reklamına aracı olacak her türlü reklam, sponsorluk ve promosyon ihlallerini sıfıra indirmek. Firma bazında sponsorluk konusunda düzenleme yapılması 2. 2007 yılına kadar idari ve adli yaptırımları etkili, adil ve caydırıcı hale getirmek. Strategies 1. Yurt içi ve yurt dışı kaynaklı reklâm ihlallerini izleyecek ve gerekli ihbarları daha yaygın ve hızlı yapacak mekanizmaların oluşturulması. Responsible institutions 1. Sanayi ve Ticaret Bakanlığı – Reklam Kurulu 2. Tütün 1. Sağlık mamullerinin sınır Bakanlığı ötesi açık veya gizli reklam, promosyon ve sponsorlukların önlenmesi için gerekli yasal düzenlenmenin yapılması. Görülmeyecek şekilde şatışa sunulur Satılan sigara miktarına göre teşvik verilmeyecek Activities Collaborating Date institutions completed 1 -Sanayi ve Ticaret Bakanlığı (Reklam Kurulu) 2 -RTÜK 3 - Anadolu Ajansı 1 -Sağlık Bakanlığı 2 -TAPDK 3 -Dış Ticaret Müsteşarlığı 4 -İçişleri Bakanlığı 2009 Possible obstacles Halkın biliçlendiril me-si RTÜKTAPDK idari para cezası mevzuat değişikliği Yargı süresinin kısaltılması için yasa değişikliği Firma sponsorlukl arı konusunda yasal düzenleme yapılması Tütün kontrolu çerçeve sözleşmesi maddesinin mevzuat karşılığının olmaması Tütün reklam, promosyon ve sponsorluğ un Progress criteria İhlal sayılarında değişiklik (önce artma sonra azalma) Yasal düzenlemele r-in yapılması ve hayata geçirilmesi Monitoring measures Günümüze kadar hangi kaynaklardan hangi veriler alınmıştır ve alınma yöntemleri nelerdir Uluslararası örnekler ve teknikler Sınır ötesi yasal düzenlemel er konusunda veri yetersizliği vardır

Minister of Health Undersecretary Deputy Undersecretary Public Health Institution Directorate of Control of Tobacco

Minister of Health Undersecretary Deputy Undersecretary Public Health Institution Directorate of Control of Tobacco and Substance Abuse Tobacco Control Division

TAPDK Circular 6 Jan 2005

TAPDK Circular 6 Jan 2005

14 pictures, May 2010

14 pictures, May 2010

History of TC Activities in Turkey – phase 3 / 3 Before 1980’s (beforeign

History of TC Activities in Turkey – phase 3 / 3 Before 1980’s (beforeign tobacco companies’attack) 1980’s to 26 Nov. 1996 (Law No. 4207) and 2008 1984 -1986 -1991 -1995 -2002 – 2008 – Future challenges (hospitality industry --- tobacco industry) “private” premises

Third phase, 2008 and. . • Amendment of 1996 Law (4207), 3 Jan. 2008

Third phase, 2008 and. . • Amendment of 1996 Law (4207), 3 Jan. 2008 – Smoke-free places “expanded” • Included hospitality sector • “all” closed places – Implementation of the penalties “clearly stated” • Referring “Misdemeanors Act”, No. 5326 • Easy to implement the fines • “imprisonement” for selling cigarettes to minors (6 -12 mo. ) – Public places – 19 May, 2008 – Hospitality industry – 19 July, 2009

Support for Smoking Ban in Closed Places Hasuder Report, Ankara, May 2008 No idea

Support for Smoking Ban in Closed Places Hasuder Report, Ankara, May 2008 No idea Against Supports Smoker Non-smoker

Support for Law No. 4207 among people interviewed in May 2010 (%)

Support for Law No. 4207 among people interviewed in May 2010 (%)

Main steps in the development of tobacco control activities, 1993– 2008

Main steps in the development of tobacco control activities, 1993– 2008

Essential elements of success in implementing Law Community participation and support Support from nongovernmental

Essential elements of success in implementing Law Community participation and support Support from nongovernmental organizations and private agencies Information for and support from the hospitality sector Work with academics Support from other governmental institutions Support from the media Relations with international organizations

Turkey is successful in tobacco control • Legal support • Political commitment – Prime

Turkey is successful in tobacco control • Legal support • Political commitment – Prime Minister; “supportive” – Mo. H and bureaucrats “unchanged” • Strong civil society – National Coalition • Provincial tobacco control board – Inspections

National Legislation • Law, 4207 in 1996 • 2002 Establishment of TAPDK • 2004

National Legislation • Law, 4207 in 1996 • 2002 Establishment of TAPDK • 2004 Ratification of WHO-FCTC • 2005 Misdemanors Act • 2006 Prime Ministerial Decree – National TC Program and Action Plan • Amendment of the Law 4207 in 2008

Conclusions • All closed places smoke-free – Public transport – Closed places, incl. hospitality

Conclusions • All closed places smoke-free – Public transport – Closed places, incl. hospitality workplaces • • Cigarette sell decreased Acute conditions provoked by smoke reduced People liked “clean” air Turkey: 4 th. rank in Europe

Turkey wins plaudits for tobacco control The Lancet, May 2012 • One in three

Turkey wins plaudits for tobacco control The Lancet, May 2012 • One in three Turks, or about 31% of the population, smoked in 2008, when Turkey became third country to introduce a widespread smoking ban after Ireland the UK, Nazmi Bilir, a professor of public health at Ankara’s Hacettepe University, told The Lancet. • “Smoking has been a traditional, male behaviour in Turkey so it’s not been easy”, Bilir said. “But my feeling is that Turkey will become truly smoke-free. ”

What is next ? ? • Smoking is increasing among youth !!! • Violations

What is next ? ? • Smoking is increasing among youth !!! • Violations – Inspections should be enforced • Issues not covered by Law – “smokeless” products – narghile … – Private premises • Private cars – presence of child • Private homes – presence of child

Global Youth Tobacco Survey, Turkey (2003 & 2009) 2003 Prevalence 2009 Boys (%) Girls

Global Youth Tobacco Survey, Turkey (2003 & 2009) 2003 Prevalence 2009 Boys (%) Girls (%) Total (%) Tried smoking 31, 7 19, 7 26, 3 32, 5 25, 4 29, 6 Started smoking before age 10 34, 9 23, 7 30, 7 31, 6 31, 7 30, 5 Current smokers 9, 4 3, 5 6, 9 10, 2 5, 3 8, 4 Think about starting within a year time 8, 2 5, 3 7, 0 10, 6 9, 8 10, 2