Profit, addiction and the national drive towards better health. Hala Sakr investigates the dynamics inherent in the passing of Egypt's latest tobacco control law this week Click to view caption The campaign against smoking scored this week when the new tobacco law made it through the People's Assembly. The law incorporates the new amendments, proposed by Hamdy El-Sayed, chairman of the People's Assembly Health Committee and head of the Medical Syndicate. These include a ban on the sale of tobacco to minors below 18 and they prohibit all forms of tobacco advertising. In 1981, President Sadat signed law 52 limiting tobacco advertising to cigarette packets which had to display what the cigarettes were composed of and carry health warning labels. Later, in the 1990s, Sherif Omar, professor of oncology and former chairman of the People's Assembly Health Committee, tried to amend the law but failed. "The problem with smoking is that it is perceived both by individuals and decision-makers as a non-pressing issue that can always be postponed simply because its adverse effects do not materialise immediately," he explained to Al-Ahram Weekly. "In addition we should never forget that tobacco companies are not an easy enemy." The situation is exacerbated by Egyptian state ownership of the Eastern Tobacco Company, established in 1920 and nationalised in 1956. The company monopolises local production and is the largest cigarette producer in the Middle East. A report released by Parliament as the law was debated pointed out that only last year tobacco revenues contributed LE3.1 billion to the general state budget. The major markets for multinational tobacco companies, according to the World Health Organisation (WHO), are developing countries. And, according to Mohamed Awad Tageddin, minister of health and population, Egyptians consume 60 billion cigarettes per year, spending three billion pounds annually of the national income. Official statistics further show that Egyptian smokers increase by six to eight per cent every year as compared with minus one per cent in the West. A 1998 survey by the minister of health showed that 40 per cent of Egyptian males and two per cent of females smoked. The percentage rose among certain professions -- 45 per cent of teachers smoked and 44 per cent of physicians. Anti-smoking efforts in Egypt gained great momentum when Mrs Suzanne Mubarak opened a conference in April last year, launching a national campaign for the control of smoking and drug abuse. "A total advertising ban in all forms of the media including sponsorship has always been crucial. At all times, the latter has posed a backdoor for tobacco companies to get around ad bans and sneak in," commented Omar. Sami Ahmed, head of the Smoking Control Programme affiliated to the Ministry of Health and Population, considers the ban on cigarette sales to under-18s as the strongest measure in the new law. "Egypt has half a million smokers up to 15 years of age and a hundred thousand under the age of ten. The outcome is always for the better if you can get to the kids before they actually pick up the habit. After all prevention is always better than control," he told the Weekly. According to recent data released by the WHO, one-third of young smokers start before the age of ten, and the vast majority of adult smokers start before the age of 18. Hamdy had wanted a detailed health warning to cover 30 per cent of the cigarette packet. But for some this was too much. "It was finally agreed that the current warning of 'Tobacco seriously damages health' should be complemented by a 'and leads to death' phrase," said Talaat Abdel- Qawi, deputy chairman of the People's Assembly Health Committee. "I think that the new law is a brilliant step. It includes important measures for tobacco control," said Fatemah El- Awwa, regional adviser for WHO's Tobacco Free Initiative (TFI). "I do wish, though, that the health warning on the cigarette packet would take our illiteracy rates into consideration. It should be complemented in the future by a picture that alerts people." Hussein Hammouda, director of the Arab League's Department of Health and Environment, pointed out that the new law is in line with the Consultative Unified Arab Law for Tobacco Control recommended by the Council of the Arab ministers of health in 2001. The request for increased tobacco taxation, however, was rejected -- again -- by the Plan and Budget Committee and the representative of the Minister of Finance despite its positive aspects. During the final discussion of the draft law within the People's Assembly, Ahmed Ezz, chairman of the Committee, argued that further taxation would put an extra burden on individuals and families. "Bread winners who smoke will not stop buying cigarettes even at higher prices and will cut into their families' budgets," he said. In the Parliament's Plan and Budget Committee report, however, there was no mention of a burden. The report stated that since 1986 raising cigarette prices has not proved effective in reducing the sales of the state-owned Eastern Tobacco Company. On the contrary, the company's sales have continuously increased. The original suggestion was to raise the current prices by 10 per cent. "My own belief was to go for an increase of five per cent to be directed to the new children's cancer hospital," Abdel-Qawi told the Weekly. "Such an increase would be important in discouraging youngsters from smoking and decreasing tobacco sales in general." Omar pointed out that Egypt provides the cheapest cigarettes in the world. Prices have barely changed since 1992 despite inflation. "Pricing is very important in cutting down on consumption and providing for health care expenditure. In 1992, a simple increase of 10 piastres per packet brought in 200 million pounds per year which were used for the health insurance of schoolchildren. The 10 piastres, however, were not enough to affect the number of smokers." Back in 1989 Omar took part as the principle investigator in a WHO sponsored study of economic loss due to tobacco use in Egypt. A shocking loss of one billion pounds per year was calculated. "This was 13 years ago. If inflation and all other related economic factors are considered, we can imagine what the present figure is like," he said. Some might argue that it was up to the medical establishment to set an example for the rest of the population. In Egypt, though, doctors are often to be seen smoking. Tageddin said: "Smoking is prohibited on any premises affiliated to his ministry whether medical or not and this is particularly applied to physicians." El Sayed said that the Medical Syndicate would take punitive measures against physicians smoking in their working hours. Essam El-Erian, assistant to the secretary- general of the Medical Syndicate, said, however, that so far smoking among doctors had not been brought up at the meetings of the syndicate's board nor at its general assembly. "Moreover, nothing of the sort is mentioned in the syndicate's code of conduct". Abdel-Qawi of the Parliament's Health Committee said: "I believe that this new law is an achievement: a step along the way. The next step should be to struggle for an increase in taxation on imported cigarettes. "No one can claim that this would be a burden on the average Egyptian smoking local brands. Those who consume imported brands can definitely afford to pay more and revenues should then go to health care." "But increasing public awareness of the dangers of smoking remains crucial. This is society's responsibility -- that of the media especially." Omar added: "This should be done consistently and not merely for the sake of ceremony. Our society must be clear cut about its norms: we must be healthy, fit, active, productive and non-smoking."
