Tobacco Control in Turkey Story of commitment and leadership March 2012 Tobacco Control in Turkey Story of commitment and leadership By: Nazmi Bilir, Hilal Özcebe, Toker Ergüder and Kristina Mauer-Stender AbstractAbstract 7REDFFRFRQWURODFWLYLWLHVLQ7XUNH\KDYHEHHQKLJKO\HIIHFWLYH7KH¿UVWDQWLWREDFFRODZZDVDGRSWHG7REDFFRFRQWURODFWLYLWLHVLQ7XUNH\KDYHEHHQKLJKO\HIIHFWLYH7KH¿UVWDQWLWREDFFRODZZDVDGRSWHG LQ /DZ1R UDWL¿FDWLRQRIWKH:+2)UDPHZRUN&RQYHQWLRQRQ7REDFFR&RQWUROIROORZHGLQLQ /DZ1R UDWL¿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¿FHYLGHQFH$IWHU/DZ1RZDVHQDFWHGWKHVHSDUOLDPHQWDU\FRPPLVVLRQVDQGSURYLGLQJVFLHQWL¿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eywordsKeywords 602.,1*±SUHYHQWLRQDQGFRQWURO602.,1*±SUHYHQWLRQDQGFRQWURO 72%$&&2±OHJLVODWLRQ72%$&&2±OHJLVODWLRQ +($/7+32/,&<+($/7+32/,&< 352*5$0(9$/8$7,21352*5$0(9$/8$7,21 785.(<785.(< 3KRWRJUDSKVWDNHQE\7XQD6XQGXU:+2&RXQWU\2I¿FH7XUNH\Photographs3KRWRJUDSKVWDNHQE\7XQD6XQGXU:+2&RXQWU\2I¿FH7XUNH\ taken by Tuna Sundur, WHO Country Office, Turkey Printing by: Anıl Advertising Printing House Co. Ltd. $GGUHVVUHTXHVWVDERXWSXEOLFDWLRQVRIWKH:+25HJLRQDO2I¿FHI$GGUHVVUHTXHVWVDERXWSXEOLFDWLRQVRIWKH:+25HJLRQDO2I¿FHIRU(XURSHWRRU(XURSHWR 3XEOLFDWLRQV 3XEOLFDWLRQV :+25HJLRQDO2I¿FHIRU(XURSH :+25HJLRQDO2I¿FHIRU(XURSH 6FKHU¿JVYHM 6FKHU¿JVYHM '.&RSHQKDJHQ'HQPDUN '.&RSHQKDJHQ'HQPDUN $OWHUQDWLYHO\FRPSOHWHDQRQOLQHUHTXHVWIRUPIRUGRFXPHQWDWLRQKHDOWKLQIRUPDWLRQRUIRUSHUPLVVLRQ$OWHUQDWLYHO\FRPSOHWHDQRQOLQHUHTXHVWIRUPIRUGRFXPHQWDWLRQKHDOWKLQIRUPDWLRQRUIRUSHUPLVVLRQ WRTXRWHRUWUDQVODWHRQWKH5HJLRQDO2I¿FHZHEVLWH KWWSZWRTXRWHRUWUDQVODWHRQWKH5HJLRQDO2I¿FHZHEVLWH KWWSZZZHXURZKRLQWSXEUHTXHVW ZZHXURZKRLQWSXEUHTXHVW © World© World Health Health Organization Organization 2012 2012 $OOULJKWVUHVHUYHG7KH5HJLRQDO2I¿FHIRU(XURSHRIWKH:RUOG+HDOWK2UJDQL]DWLRQZHOFRPHVUHTXHVWV$OOULJKWVUHVHUYHG7KH5HJLRQDO2I¿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statusstatus of any of country, any country, territory, territory, city or city area or areaor of itsor ofauthorities, its authorities, or concerning or concerning the delimitation the delimitation of its offrontiers its frontiers RUERXQGDULHV'RWWHGOLQHVRQPDSVUHSUHVHQWDSSUR[LPDWHERUGHUOLQHVIRUZKLFKWKHUHPD\QRW\HWEHRUERXQGDULHV'RWWHGOLQHVRQPDSVUHSUHVHQWDSSUR[LPDWHERUGHUOLQHVIRUZKLFKWKHUHPD\QRW\HWEH full agreement.full agreement. 7KHPHQWLRQRIVSHFL¿FFRPSDQLHVRURIFHUWDLQPDQXIDFWXUHUV¶SURGXFWVGRHVQRWLPSO\WKDWWKH\DUH7KHPHQWLRQRIVSHFL¿FFRPSDQLHVRURIFHUWDLQPDQXIDFWXUHUV¶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ontentsContents 3DJH3DJH 3DJH ACKNOWLEDGEMENTSACKNOWLEDGEMENTS ......................................................................................................... .........................................................................................................4 4 ACKNOWLEDGEMENTS .........................................................................................................4 FOREWORDFOREWORD ............................................................................................................................. .............................................................................................................................5 5 FOREWORD .............................................................................................................................5 PREFACEPREFACE.................................................................................................................................................................................................................................................................7 ...7 PREFACE..................................................................................................................................7 BACKGROUNDBACKGROUND ........................................................................................................................ ........................................................................................................................8 8 BACKGROUND ........................................................................................................................8 ProductionProduction and saleand saleof tobacco of tobacco ....................................................................................... .......................................................................................9 9 Production and sale of tobacco .......................................................................................9 PrevalencePrevalence studies studies ........................................................................................................ ........................................................................................................11 11 Prevalence studies ........................................................................................................ 11 HealthHealth consequences consequences of increased of increased tobacco tobacco use ........................................................... use ...........................................................17 17 Health consequences of increased tobacco use ...........................................................17 EconomicEconomic burden burden of tobacco of tobacco use .................................................................................. use ..................................................................................19 19 Economic burden of tobacco use ..................................................................................19 DevelopmentDevelopment of tobacco of tobacco control control activities activities and andlegislation legislation ............................................... ...............................................21 21 Development of tobacco control activities and legislation ...............................................21 First Firstanti-tobacco anti-tobacco law inlaw 1996 in 1996 and nongovernmentaland nongovernmental organizations organizations ............................. .............................21 21 First anti-tobacco law in 1996 and nongovernmental organizations .............................21 EstablishmentEstablishment of the of Tobacco the Tobacco Regulatory Regulatory Authority, Authority, 2002 2002 ...........................................