Findings from TEPAV’s extensive research report examining the dimensions of supply, demand, health, and public policy dynamics related to tobacco consumption in Turkey were discussed. The speakers also emphasized where further research is required in devising more effective control policies.
Making the opening remarks, TEPAV Executive Director Şenay Akyıldız reminded the audience of the harms of tobacco use on human health and stated that according to the World Health Organization (WHO), approximately 8 million people die each year due to diseases related to tobacco use. Although the effects of tobacco use on health is clearly demonstrated by research, 1.3 billion people in the world continue to consume tobacco products, of which 80% live in low- and middle-income countries. In addition to its impact on health, Akyıldız also underlined that tobacco use has a serious economic burden, which includes both its cost on the health system and the loss of productivity due to tobacco-related diseases and deaths. Moreover, while Turkey was one of the first countries to sign and ratify the WHO Framework Convention on Tobacco Control (WHO FCTC), enacting strict rules and legal regulations, the expected decrease in the tobacco use rate in Turkey did not take place. This situation reveals why it is critical to investigate tobacco control policies in Turkey and to establish a strong understanding of the current situation in Turkey and around the world. As such, the research being conducted by the TEPAV Tobacco Control Policy Research Team is to meet this need, and that the comprehensive report will contribute to Turkey's tobacco control policy goals.
Sharing the findings of the report, TEPAV Sustainability Governance Program Director Sibel Güven noted the importance of contributing to the development of effective tobacco control policies in Turkey. Güven stated that this research was carried out to scrutinize the roles of stakeholders such as producers, users, and the public sector on the axis of supply, demand, and public policies. Emphasizing that the majority of preventable deaths are due to tobacco use, Güven added that the number of tobacco-related premature deaths in 2050 is globally estimated to exceed 127,000 individuals annually. Furthermore, data from 2002 to 2017 reveals that the burden of active and passive tobacco use on Turkey's health system is rather high.
Highlighting that the health aspect of the consumption of tobacco products in Turkey came to the fore in the 1990s, Güven reminded that Turkey was the first country to carry out all of the WHO’s MPOWER policy package measures to its highest levels. WHO’s tobacco policy package is meant to Monitor tobacco consumption, Protect individuals from smoking, Offer services for quitting, Warn of risks, Enforce bans, and Raise taxes (MPOWER). Güven emphasized that tobacco use rates in Turkey are higher in all age groups compared to peer countries, this includes an increase of consumption for adolescents aged 15-17 over the years, the alarming increase of consumption of students aged 13-15, that the daily tobacco use rate for women increases faster than that of men, and that the tobacco use rate increases in tandem with an increase in the level of education. Indicating the asymmetrical and incomplete information on the health effects and economic consequences of tobacco use, Güven stressed the need to develop more focused policies for subgroups witnessing increased consumption levels.
Asena Caner, who leads the TEPAV Tobacco Control Policy Research Team, made a detailed statement classifying MPOWER measures as price-oriented and non-price oriented measures. Citing the current implementation of the policy of reducing tobacco use in Turkey by increasing taxes on tobacco products as a price-oriented measure, Caner pointed out that the tax burden on tobacco products in Turkey is above the world average. The total tax burden on cigarettes in European Union countries is on average 80.3%, however, this rate for Turkey in 2020 for average and above average priced cigarettes were 84.8% and 92.1% for below average priced cigarettes. Additionally, tobacco tax revenues obtained in Turkey in 2018 amounted to 41.8% of total public health expenditures with most health expenditures (roughly 77%) being covered by the public sector. Stating that the effect of taxation on the demand for tobacco products depends on the composition of ad valorem and specific taxes in the total tax burden, as well as important parameters such as income, price, and cross-price elasticity of demand, Caner emphasized that more detailed studies are a must in studying the demand effects of tobacco taxation.
Explaining the details of non-price-oriented measures, Caner emphasized having a holistic approach in designing economic policies taking into account the supply side of the market. For the policies to be effective in demand reduction, the focus should be on supplementing population-wide policies with policies that target certain demographic groups such as women, adolescents, students, teachers, and doctors. Additionally, to improve the implementation processes of tobacco control policies, it is necessary to monitor the entire implementation process by clarifying the institutions responsible for ensuring regulatory compliance as well as following through with the enacted punishments and penalties.