Salem Radio Network News Wednesday, October 4, 2023

Health

The Media Line: Lebanon Has the Highest Smoking Rate in the Middle East

Lebanon Has the Highest Smoking Rate in the Middle East

On World No-Tobacco Day, we explore Lebanon’s deep-rooted tobacco crisis—high smoking rates, failed regulations, economic impact, and hurdles in law enforcement due to industry interests

By Andrea López-Tomàs/The Media Line

[Beirut] As the world marks another World No-Tobacco Day, it’s time to focus our attention on a country often overlooked in global health discourse yet enveloped in a heavy cloud of tobacco smoke—Lebanon. The small nation nestled on the eastern coast of the Mediterranean Sea holds a dubious distinction—it boasts the highest rate of tobacco consumption in the Middle East. Here, the fragrant aroma of mezze often intermingles with the thick smoke from cigarettes and waterpipes, painting a stark image of a health crisis that has taken root amid the vibrant culture and enduring traditions.

Smoking in Lebanon—from the bustling streets of Beirut, where locals and tourists alike puff leisurely on their cigarettes and hookahs, to the more remote corners where tobacco farming supports entire communities—is not just an individual choice but a complex sociocultural phenomenon.

Lebanon’s efforts to reduce tobacco consumption are necessarily intertwined with and impacted by the country’s complex and often challenging economic, political, and cultural realities. This World No-Tobacco Day, we pull back the shroud of smoke that surrounds Lebanon and bring to light the urgent need for action. Because every conversation brings us a step closer to a smoke-free Lebanon.

The smoke here comes in many fragrances. Walk around Beirut and the scents of different flavored tobaccos waft out of a shisha café. Hop into a shared taxi, and you might be left with the smell of traditional tobacco in your hair. In any bar, people stop their conversations to vape for a while before continuing to share their stories. Smoking is simply part of Lebanese life.

Lebanon has the highest rate of smoking in the Middle East, according to the Tobacco Atlas, which analyzes smoking figures around the world. In 2022, the Lebanese smoked 1,955 cigarettes per person, the Atlas said. This is compared with 1,849 in Kuwait and 1,764 in Libya. At the other end of the scale, in Saudi Arabia, the figure was 485, in the United Arab Emirates 438, and in Yemen 214.

According to the World Health Organization, in 2020, 38% of Lebanese adults aged 18 to 69 were current tobacco smokers and 23.2% were daily smokers. (The numbers for tobacco “users” as opposed to “smokers” were even higher: 38.7% were current users and 29.3% were daily users.) Broken down by gender, 47.6% of men and 29% of women were current smokers, while 29.5% of men and 18% of women were daily smokers.

“Unfortunately, in areas like Lebanon and the Middle East, talking about the risks of smoking seems like discussing luxurious ideas, because people are suffering to afford their health care, to bring food to the table,” Dr. Raeda Al Habbal, an internal medicine specialist who is doing her fellowship in pulmonary and critical care, told The Media Line.

“Smoking cessation is not getting a lot of financial funding or time from the health system and healthcare providers, because they are busy taking care of more urgent matters,” she said.

Lebanon is going through one of the world’s worst economic crises since the 1850s, according to the World Bank. The United Nations has estimated that around three-quarters of the population of about 6.7 million live under the poverty line, estimated to be less than $14 per day for an average family.

Already more than a decade ago, alarming data on smoking in Lebanon forced the authorities to adopt a strong tobacco control policy. In August 2011, the Lebanese parliament passed Law 174, which bans smoking in all enclosed public spaces, including government buildings, airports, schools, public transport, malls, restaurants, bars, and nightclubs. The law also mandates health warnings on tobacco product packages and bans all forms of tobacco advertising, promotion, and sponsorship.

But the reality on the ground is very different.

“After a few months of the law being in place, no one was abiding by it, and now everyone seems to have already forgotten it,” Al Habbal said. “People are suffering from a lot of things on so many levels—economically, healthwise, many live an unstable life and face safety issues—so they don’t really take the warning seriously that smoking is dangerous to your health later on.”

Despite this, some activists have tried to enforce the implementation of Lebanon’s smoking laws. Al Habbal told The Media Line that the tobacco control activists, “all volunteers,” faced immense difficulties “going against a lawless state and huge vested interests the government and politicians have in the tobacco industry,” with the tobacco importer, exporter, and manufacturer under the Finance Ministry.

Speaking on condition of anonymity, a source familiar with the matter told The Media Line: “Ministries barely have any employees at work because their salaries are worthless given hyperinflation, and transportation costs have also increased, which means no inspectors will bother dealing with Law 174 infractions, and even if they did, the penalties would also be worthless. Courts are also not really functioning, and nobody can be held accountable for anything these days.”

Although the law bans sales of tobacco products to those under 18 years old, this too is poorly enforced, and Al Habbal expressed particular concern about the effects of smoking on the young. According to a WHO survey from 2017, 11.3% of 13- to 15-year-olds in Lebanon were smokers—15.6% of boys that age and 7.2% of girls.

“When people start smoking when they are 15 or 16, usually the damage is worse because the lungs are not fully developed yet and smoking will affect the development of the lungs. This will make things worse if they continue smoking throughout the years,” Al Habbal said.

“Unfortunately, the lack of regulation about which age people are allowed to smoke lets teenagers go and buy cigarettes from the supermarket. There is no punishment for the people who sell those products to underage teenagers.”

An additional problem is that a significant number of Lebanese depend on tobacco farming to earn a living. Tobacco is a vital part of the agricultural economy, creating jobs in its production and trade for large numbers of people often located in poorer areas of Lebanon.

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