Why should tobacco control be a public health priority in Turkey Responsibilities of the Government

1
Why should tobacco control be a public health
priority in Turkey?Responsibilities of the
Government and the Public

• By
• Ayda A. Yurekli, Ph.D
• World Bank
• Washington, DC

2
Why should tobacco control be a priority in
Turkey? Turkey alone smoked 2 global and 14
regional cigarette consumption in 2001
Source USDA and World Bank calculation, 2001
3
Why should tobacco control be a priority in
Turkey? Cigarette consumption has been
increasing in Turkey
Source Tekel, and USDA database
4
Alarming Smoking Prevalence Rates Smoking is an
acceptable social behavior in Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
5
Why do Governments Intervene?

• To deter children from smoking
• Age for starting smoking gets younger
• Youth underestimates the risks
• To protect non-smokers from others smoke
• Second hand smoke is as deadly as smoking
• Most adults still smoke front of children and
  homes
  
• To provide adults the needed information to make
  an informed choice
  
• Smokers often regret that they started smoking
• Smokers spent high share of income on cigarettes
• To help smokers who wish to quit smoking
• Tobacco is addictive and smokers need help
• Smokers are not aware they need help on quitting
• Cessation help should be available and affordable

6
Why should tobacco control be a priority in
Turkey?In Turkey, most smokers start at age 12,
13, 14Ankara,Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
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Why should tobacco control be a priority in
Turkey? The age of starting smoking was late for
older generation, Ankara-Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
8
Why should tobacco control be a priority in
Turkey? Smokers often regret that they started
smokingAnkara-Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
9
Why should tobacco control be a priority in
Turkey? Tobacco is addictive and difficult to
quit, Ankara-Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
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Why should tobacco control be a priority in
Turkey? Still some smokers are not aware that
they need help to quitAnkara-Turkey, 1996
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
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Smoking is more prevalent among poor in many
countries. This is not the case in Turkey
Higher the Income, Higher the Smoking Prevalence!
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
12
Smoking is less prevalent among educated in many
countries BUT, in TurkeyPrevalence rate is
already high among the educated groups
!!Turkiye okumus cahillerin ve vurdum
duymazlarin ulkesi mi??
Smoking prevalence rate
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
13
Do Turkish smokers mean what they say?Not clear

• 99 of teachers who smoke are against smoking in
  front of students, but 68 do it
  
• 97 of physicians who smoke are against smoking
  in front of patients, but 68 smoke at work
  
• 98 of mothers who smoke are against teachers
  smoking in front of children, but 85 of mothers
  smoke front of their children

Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
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Mothers lack of information or unwillingness to
act on it! Higher Smoking Prevalence among
Mothers, and Grandmothers in Turkey, 1996

• 1 out of 3 mothers currently smoke in almost all
  age groups
  
• 31 of all mothers currently smoke
• Smoking is more common among young mothers

Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
15
Turkish mothers and teachers lack of
information and unwillingness to act on it!
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
16
Turkish smokers lack of information and
unwillingness to act on it! Nobody is aware of
second hand smoke!!Why are we poisoning our
children?
Source Bilir et.al, 1997 Smoking behavior and
attitudes, Ankara-Turkey
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Cigarettes burn our pockets!!High opportunity
cost for families and smokers
Source Onder 2002, Economics of Tobacco in Turkey
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How important is tobacco for the Turkish economy?

• Generates high revenues
• Significant share of GDP
• Brings hard currency through trade
• Do large numbers of farmers and employees depend
  on tobacco for their livelihoods?
  

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Tobacco Tax Revenue is an Important Part of Total
Revenue in Turkey
Source WB and IMF database and WB calculation
20
And cigarette expenditures are significant part
of GDP
Source IMF and WB database and WB calculation
21
Is tobacco an important export product?
Source USDA 2001 and Onder 2002
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Fluctuations in tobacco trade earnings
Source USDA, Onder 2002 and WB calculation
23
Large number of tobacco farmers and industry
employees

• Industry Employees
• 1998 30,404
• 1999 27,708
• 2000 28,123

Thousand
Source Onder 2002, Economics of Tobacco in Turkey
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But industry employment has been decreasing Why?
Efficiency, technology and privatization
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What can Governments do? Measures to reduce
demand work! Turkish Evidence

• Higher cigarette prices via taxes
• Non-price measures
• consumer information, - Using electronic and
  print media to distribute information on tobacco
  and health and distributing research results
  
• cigarette advertising and promotion bans
• warning labels and restrictions on public
  smoking,
  
• Affordable and available nicotine replacement
  (NRT) and other cessation therapies

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Revenue Generating Potential of Tobacco
TaxesEmpirical Arguments

• Depends on several factors.
• Consumption level
• Retail price of cigarettes
• Tobacco tax rates
• Income
• Price and income elasticity of demand
• Control of smuggling activities

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Turkey meets EU requirements for tobacco tax rates
Source EU Tax database, IMF country documents
28
Do higher tax rates mean higher prices?Turkey
has high tax rate but lowest average price/pack
when compared to Europe
29
Low domestic cigarette prices
Source TEKEL, USDA, Onder 2002
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Real Price Matters!Nominal Cigarette prices have
been increasing. What are real prices?
Source TEKEL, USDA, Onder 2002, and WB
Calculation
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Why Low PricesPrice control in Turkey and its
impact on cigarette prices, 1999
Source MOF Turkey, IMF
32
Turkeys tax revenue per smoker is lower than EU
countries tobacco tax revenues per smoker US
Source WHO Country profiles, USDA and WB
calculation
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Higher consumption, higher tax rate, lower
priceRESULT lower tax revenue compared to
Europe
Source USDA, IMF and WB calculation