The Third International Conference on Waterpipe Smoking Research. Beirut, Lebanon. November, 2017
Contributed by: Alexandra Ataya
(Based on a project titled “Supporting tobacco control research and dissemination” implemented by the American University of Beirut with the collaboration of various NGOs and funded by International Development Research Centre. For more detailed information please visit the AUB-Tobacco Control Research Group website.)
BACKGROUND AND CONTEXT:
As reported in the 2010 paper, The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption, produced as part of the American University of Beruit Tobacco Control Research Group, “Lebanon has high smoking rates for both cigarettes and waterpipes, especially among the youth aged 13-15. According to the most recent figures (Sibai and Hwalla, 2010; Saade, 2005), approximately 42.9% of male adults and 27.5% of female adults are cigarette smokers. The prevalence rates are 14.8% and 6.7% for male and female youth respectively. Waterpipe smoking prevalence in youth was even more staggering than that of cigarettes, with 64.5% of males and 54.6% of females smoking on a regular basis. Lebanese women have the highest female smoking rate in the region. An alarming 78.9% of children in Lebanon are exposed to smoke at home, and 74.9% are exposed to it outside the home. In 2007 approximately 2,701 deaths were due to smoking-related diseases, leading to an indirect cost of $64.6 million. … Experts estimate that in Lebanon 150,000 children and 350,000 adults alive today will die prematurely because of smoking or second-hand smoke unless tobacco control measures are improved.”
Lebanon ratified the Framework Convention on Tobacco Control (FCTC) in 2005, but the implementation was past due, as Lebanon still had one of the weakest tobacco control policies in the Middle East region in 2010. In January 2010 the Lebanese Parliamentary Committee of Administration and Justice started discussing the tobacco control law that was dormant since 2003-2004. In February 2010, in collaboration with two civic non-governmental organizations, Tobacco Free Initiative-Lebanon and INDYACT, the American University of Beirut-Tobacco Control Research Group (AUB-TCRG) conducted a press conference in which they issued a position statement titled: “Advocating for a strong tobacco control law in Lebanon”. The objective of the conference was to announce through the media to the public and policymakers that the law under discussion was currently not in line with FCTC and with best research evidence. The position statement covered all aspects of the law that needed amendment and provided the scientific evidence to back it up.
GOALS OF THE CAMPAIGN:
The Mission of the AUB-TCRG is to promote public health by producing and disseminating evidence-based tobacco control research.
The specific objectives were:
At the national level:
- Generate evidence-based data in multiple fields related to tobacco control and contribute to the knowledge base
- Disseminate research findings in a user-friendly way to the public
- Transfer evidence of best practices in tobacco control legislation to policy and decision makers
- Build the capacity of civil society to implement and evaluate interventions to promote tobacco control
- Advocate for the implementation of strong tobacco control policies in Lebanon
At the regional level:
- Share research findings and successes in tobacco control across countries
- Facilitate networking and communication among tobacco control researchers and civil society in the region
- Support research collaborations
TARGETS AND AGENTS OF CHANGE:
The advocacy group engaged several agents of change in working to promote the adoption of a tobacco control policy. Members of the Lebanese Parliament were seen as the most immediate targets of change for the adoption of the policy. Following the press conference, AUB-TCRG members, with the assistance of two local NGOs, met with over 35 Lebanese Parliamentarians from different political parties to advocate and seek support for a strong, comprehensive tobacco control policy. Later, a reception designed to bring together policy makers was attended by 22 members of Parliament, who all expressed their support for the implementation of a strong tobacco control law in Lebanon. In addition, local media, NGOs and civil society were mobilized to advocate for a stronger law.
STRATEGIES AND TACTICS OF LEGISLATIVE ADVOCACY:
Advocates pushed for a law that is in line with the FCTC articles, which highlighted three points:
- Total ban of smoking in indoor public places (with no exemptions)
- Comprehensive advertising bans, including sponsorship
- Large pictorial health warnings
AUB-TCRG coordinated with partners to develop a petition which called for a strong evidence-based tobacco control law. The petition was circulated to organizations and individuals through email and advertised through Facebook pages. To date, the petition has been signed by over 50 organizations, 15 syndicates and public institutions, and 30 private companies, as well as Heads of Parliamentary blocs and a number of individual Parliamentarians. The petition was covered in major local newsletters and websites.
The three main targets of advocacy by the AUB-TCRG were policy makers, media, and non-governmental organizations (local and international).
Research evidence was produced by the AUB- Tobacco control research group, and dissemination efforts included policy briefs, fact sheets, newsletters, posters, social media, and the development of a group website. Advocacy efforts entailed press conferences, position statements, lectures and seminars, meeting up and lobbying with parliamentarians, petitioning, intensive media advocacy (including articles in local newspapers, magazines, press releases, interviews on TV shows, radio spots, etc.), and having a team run in the annual Beirut Marathon under the theme “Run for Tobacco Free Lebanon.” AUB-TCRG also collaborated with NGOs from the civil society for direct advocacy action and mobilized, supported, and provided knowledge to the civil society.
RESOURCES AND ASSETS USED:
Resources used included the results of research projects conducted by the American University of Beirut faculty.
ALLIES AND OPPOSITION:
The major advocates of a tobacco control policy included: AUB-TCRG, the Lebanese Ministry of Health and the Ministry of Social Affairs, NGOs/Civil Society such as INDYACT and TFI, the Lebanese Coalition on Tobacco Control, other academic institutions, social networks such as Facebook groups, and 20 NGOs who were part of the Lebanese National Tobacco Control Coalition (LNTCC). The main benefit of working and cooperating with NGOs is that they have a direct connection to the public and can reach the different areas of Lebanon. All these advocates were supportive of the AUB-TCRG efforts and played an important role in communicating the message in different parts of the country.
The groups opposing the adoption of the policy included: the multinational tobacco industry and Regie, the National Monopoly in Lebanon (such a policy could be damaging to their tobacco sales in a country where the demand is high), the hospitality sector, some farmers syndicates, and advertising agencies that rely on tobacco company funds.
The groups that had a variety of opinions included policy-makers, the media, and the hospitality sector. Some parliamentarians argued that most countries implemented such laws gradually and they were afraid that a strict law would result in the loss of business for waterpipe cafés as well as the loss of subsidy for tobacco farmers. They were also implicitly worried about losing popularity among their constituency if they were supportive of tobacco control policy.
To contend with the opposition, AUB-TCRG used research findings from previous surveys about positions on FCTC articles which revealed that the Lebanese overall were supportive of tobacco control policy. The point that a large number of Lebanese people are in fact non-smokers was emphasized as well. Mostly, the arguments that were brought up by opposing parliamentarians were similar to those perpetuated by the tobacco industry in various countries in the world. All arguments against a tobacco control policy were countered with multiple materials containing research findings and local statistics to clarify the gravity of the tobacco problem in Lebanon and the desire of the people to improve the situation.
RESULTS AND EVALUATION OF SUCCESS:
One way that AUB-TCRG conducted evaluation was through media monitoring – collecting and analyzing tobacco related news on a daily basis, which provided immediate evidence of the effects of the initiative.
On the media level, there was a positive shift towards supporting the tobacco control movement. The daily monitoring of local newspapers revealed a high coverage of tobacco related news/articles (this is a change from previous years, although this has not yet been quantified systematically). Additionally, many articles were supportive of tobacco control policies and criticized the tobacco industry, its misleading health messages, and its manipulation of the Lebanese government officials since the FCTC was ratified in 2005.
These changing opinions in the media were reflected in January 2011 when one of the top five TV stations in Lebanon (LBC) shifted its position from conservative and resistant to airing news about tobacco control policies, to banning all kind of tobacco advertising on its screen.
One of the main roles of AUB-TCRG was capacity building of NGOs, by providing them with all the needed support in their advocacy activities (providing them with tobacco control related materials and references, research findings, some logistics, and advice). AUB-TCRG is often the first reference contacted by NGOs and the public when it comes to certain tobacco related issues and activities due to the quality of the research they conduct and their efforts at disseminating the results of this research. As public awareness of the tobacco control policies increased, the group received numerous requests to go on TV shows and do interviews with the media.
The increased awareness of tobacco control policies in Lebanon also motivated some organizations to announce themselves as a smoke-free closed area, such as some restaurants (listed on the website of the National Tobacco Control Program), a few municipalities (Municipality of Zouk Mikayel, Sarafund and Saida, and Beirut as of February 2011), two ministries (Ministry of Social affairs and the Ministry of Public Health), and three educational universities (Hagazian University, Al-Jinan University, and the Lebanese American University).
The increased media attention to the issue of tobacco control:
- Made the public more aware of the ill effects of not only smoking but also exposure to second hand smoke
- Informed the public of the unethical tactics of the tobacco industry
- Increased the public’s knowledge of the advocacy efforts and activities conducted by different civil society groups
- Kept the public updated on the progress of the tobacco control policy draft during the parliamentarians’ committees’ discussions.
As part of the global and regional trend of adopting a smoke-free policy in restaurants, cafes, pubs and clubs, some of the Lebanese hospitality businesses decided to introduce in their establishments smoke free areas or days or even go totally smoke free. This was intensified during the last few months, obviously as a result of the actions of the tobacco control advocates whose activities were advertised in the media.
The AUB Tobacco Control Research Group’s (AUB-TCRG) joint efforts with civil society succeeded in pushing the Lebanese Parliament to adopt the first comprehensive Tobacco Control Policy in Lebanon’s history on August 17, 2011.
- Chaaban, J, Naamani, N, & Salti, N. (2010). The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption. Paper produced as part of the AUB Tobacco Control Research Group and sponsored by the Issam Fares Institute for Public Policy and International Affairs at AUB.
- AUB-Tobacco Control Research Group