Fortunately, Turkey has become a model for those trying to fight against this avoidable but significant factor in death worldwide, according to Dr. Toker Ergüder from the World Health Organization (WHO). When traveling in the francophone parts of Europe, you may hear the saying “fumer comme un Turc” (to smoke like a Turk) much like the English phrase “to smoke like a chimney” to describe someone who smokes too much.
However, within the last few years, Turkey has started an exemplary fight against smoking that is believed to be gradually reducing the number of smokers in the country.
In an interview with Sunday's Zaman, Ergüder said there has been an immense transformation in Turkey concerning the state's approach towards tobacco products and their deadly effects on users. “With this huge change in the way Turkey undertakes its collective campaign to reduce tobacco usage in the country, it has become an example not only for developing countries but also for developed ones, too,” he said, commending the state's policies.
The Turkish state has tightened up its anti-smoking policies in recent years. With the previous ban, which came into force on May 19 of last year, smoking has been prohibited in the closed areas of all institutions, public and private, and in the education, health care and trade sectors as well as social and cultural centers and all mass transportation vehicles, including cabs. With an amendment made to Law No. 4207 on the Prevention of the Harmful Effects of Tobacco Products, smoking will not be permitted in the closed areas of cafes, bars, restaurants and the like, starting today. The operators of such businesses will be responsible for monitoring their clients' compliance with the law and reporting any violations by phoning the nearest police station or by calling the Health Ministry's Communication Center (SABİM) directly at 184. Any violation on the part of operators and clients will be penalized by fines of TL 560 to 5,600 and TL 69, respectively.
Ergüder has been the national tobacco control program officer at the WHO's country office in Ankara for the last two years, but his experience actively fighting against smoking goes even further back to his first days in a lab coat. While pursuing his doctoral studies in public health in Elazığ in eastern Turkey some 15 years ago, he became involved in the fight against tobacco use thanks to his professor at the time, Erol Sezer, who is one of the major figures in this field in Turkey. After having worked for 10 years in the Ministry of Health in the Turkish capital, first as an officer carrying out the World Bank's health care projects, then as the director of the Substance Addiction Department and lastly as the director of the Tobacco Department, he headed to his current position with the WHO.
‘We try to prevent people from an early death’
Smoking-related diseases cause about 5 million deaths each year around the world, almost 100,000 of which are in Turkey. Reiterating these figures, Ergüder said these are preventable tragedies to which neither national governments nor the WHO can remain indifferent. “Doctors do not have the final say over how long people will live, and we are well aware of that, but what we are solely trying to do here is to protect them from an early death and render their lifetime as comfortable as possible,” he stressed, adding, however, “It is such a difficult job to change people's behavior in either getting them to avoid taking their first cigarette out of a pack or convincing them to quit.”
A patient for whom lung cancer is diagnosed may only survive for up to nine more months. “It is not like other cancers because it is so insidious. We cannot track its development within the body, and unfortunately doctors can do nothing after the diagnosis,” he said.
Ergüder drew attention to the economic cost of smoking. “People lose $15 to 20 billion out of their pockets to buy cigarettes each year. Additionally, the state has an annual expenditure of $3.4 to 4.5 billion to pay for health care for those who get sick because of smoking. These figures are far from being easy to imagine. Let me tell you something to explain the magnitude of that much financial resource for Turkey. The total budgets of the ministries of health and national education here in this country are about $20 billion. Fortunately, these numbers have left no room for further discussion on the scope of the problem and the Turkish state has started an extensive campaign against smoking for the sake of everyone,” he said.
‘Turkish political backing unparalleled in the world’
WHO tobacco control officer Ergüder spoke in particularly glowing terms of the political support behind the anti-smoking campaign in Turkey. He talked about the change in the state's approach in that regard. “A couple of years ago while we were having talks about the strategy to be adopted in our campaign, people attending were smoking during those meetings. Now Turkey has a prime minister who considers the fight against smoking equally important as the fight against terrorism. The law that is going to be implemented from July 19 on was passed in Parliament with a consensus between all the groups represented,” he said.
He further noted that as Turkey has courageously taken steps in its battle against smoking, the international community and other countries have also started to express their admiration of the country's resolute stance in that regard. “When I attended the first few international meetings as a representative from Turkey, people stared at us as if we were never going to be able to implement any laws even if they were enacted, considering the fact that not only are 30 percent of our country's population smokers but Turkey is also a major tobacco producer. Happily, time has proven them wrong, and Turkey has now become a model for all those trying to carry out such an extensive campaign,” Ergüder said.
Talking about the difficulty of their fight, Ergüder pointed out that it is in fact a campaign against the tobacco industry. “Ostensibly, we are solely trying to convince people to quit smoking but the most difficult part of our job is the hindrances the tobacco industry puts in place to maintain its business. For instance, we were informed lately that some people are meeting with café owners and offering to buy air conditioners for their places should they oppose the new ban.” Turkey, alongside its huge domestic market, also has a considerable tobacco export market. Although the volume of Turkey's tobacco exports has been decreasing for the last two years, the country made $428.5 million worth of tobacco sales to foreign countries in 2008. Drawing attention to this fact, Ergüder said Turkey is the only country in the world to undertake such an extensive anti-smoking campaign under these circumstances, namely being an important tobacco producer and having demand for what is produced.
‘New smoking ban one of the greatest moves in Turkey's health care history’
Ergüder believes that with the new ban starting today, many people will first reduce the number of cigarettes they smoke and ultimately quit smoking. “The image of smoking in society will deteriorate after July 19, and it will be less attractive to start smoking. As smokers abide by the law and do not smoke in cafes, bars and restaurants, they will certainly smoke less than they used to, and I believe some of them will also quit after sometime. This is literally one of the biggest moves Turkey has made in its health care history,” he highlighted.
Assessing the scope of Turkey's current anti-smoking policies, Ergüder said, however, there are still steps to be taken. “For example, smoking cessation help is not at the desired level. We need special centers for this purpose as they have in many developed countries. Turkey also has a long way to go in organizing activities to raise awareness either through audiovisual or written media or by establishing direct contact with the public. The last thing I want to say in that regard is the fact that the price of a pack of cigarettes is too low in Turkey. Prices should be increased without delay. According to recent research, a 10 percent price increase leads to an 8 percent reduction in consumption. This cannot be ignored,” Ergüder said, adding that the relatively high support for anti-smoking policies in Turkey gives policy makers plenty of room to maneuver and courage to move ahead with tighter controls. Recent research conducted by the WHO showed that more than 90 percent of the Turkish population backs the new ban.
As Turkey exhibits strong determination and courage at the level of both state and society to eventually create smoke-free air countrywide, another proverb, “etre fort comme un Turc” (to be strong like a Turk) will prevail in Europe, describing Turks' non-smoking habits.
The Turkish state has tightened up
The Turkish state has tightened up its anti-smoking policies in recent years. With the previous ban, which came into force on May 19 of last year, smoking has been prohibited in the closed areas of all institutions, public and private, and in the education, health care and trade sectors as well as social and cultural centers and all mass transportation vehicles, including cabs. With an amendment made to Law No. 4207 on the Prevention of the Harmful Effects of Tobacco Products, smoking will not be permitted in the closed areas of cafes, bars, restaurants and the like, starting today. The operators of such businesses will be responsible for monitoring their clients' compliance with the law and reporting any violations by phoning the nearest police station or by calling the Health Ministry's Communication Center (SABİM) directly at 184. Any violation on the part of operators and clients will be penalized by fines of TL 560 to 5,600 and TL 69, respectively.
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