The health and productivity impact of smoking: Is the UAE ready to stub it out?

Smoking is slowly being stubbed out.

That’s at least how it can feel when we take a look at certain countries around the world: The US, Canada, Australia, the UK and others are showing a year-on-year decrease in the prevalence of smoking.

But what about the UAE?

The answer to this question is important for both those who smoke and those who don’t. Because smoking not only affects the health of a population, but also its productivity. And with the dangers of second-hand smoke, even those living a healthy lifestyle can be at risk if a country is not forming laws to protect people.

Smoking: The UAE and the rest of the world

Those of you who remember the ‘Don’t smoke’ advertising campaigns of the 1980s will recall the terrifying statistics around the dangers of smoking. It’s no secret. But even today, it makes for shocking reading. This is the opening sentence from the US Centers for Disease Control and Prevention (CDC) report on smoking last year:

“Tobacco smoking is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year.”

Okay, as we recover from those numbers it’s not difficult to see why so much is being done in the United States and elsewhere. Because that same CDC report shows that American adults who smoke cigarettes declined from 20.9% in 2005 to 16.8% in 2014. There is similar news on the other side of the Atlantic: Ongoing research by Smoking Toolkit Study on cigarette smoking prevalence in England shows 24.2% in 2007 down to 18.5% in 2016.

All these numbers are heading in the right direction, but the finish line is still far away.

So let’s now turn to the UAE.

As we often find, it’s not easy to get exact numbers when it comes to our region. What we do know is that as sales decline in the West, large tobacco manufacturers have made a conscious effort to expand more in the Middle East. The World Health Organisation (WHO) Report on the Global Tobacco Epidemic in 2015 showed 28.1% male adult tobacco use and a far lower 2.4% female adult tobacco use in the UAE. The percentage is particularly high among young people, with 16.5% male youth tobacco use and 8.4% female youth tobacco use. When it comes to younger people, the numbers are heading in the wrong direction.

In the UAE there is a 28.1% male adult tobacco use and a far lower 2.4% female adult tobacco use.

It’s interesting to note that what we’re talking about here is tobacco use, not specifically cigarette smoking. This is likely because of the prevalence of shisha and other tobacco smoking methods.

Shisha is often incorrectly seen as a safer form of smoking, but even after the smoke has passed through water, it still retains high levels of toxic agents which can cause cancers in the lung, bladder, as well as mouth. In addition, shisha has a significant impact on adding to the passive smoking problem – something we’ll look at in a moment.

What is the UAE doing to tackle the smoking problem?

In 2014, the heavily publicised Anti-Tobacco Federal Law came into effect, which contained a series of measures aimed at protecting the younger generation from the perils of smoking. These measures included the banning of smoking in cars in the presence of children under 12 years old, forbidding the sale of both tobacco and shisha products to any person under the age of 18, and restrictions on the sale of shisha and tobacco products within close proximity to schools, kindergartens, universities and mosques. Shisha cafes are now also required to be at least 150 metres from the nearest residential area.

The law also requires all tobacco products to come with a large warning label, while both tobacco and shisha products cannot be displayed in the vicinity of health products, products aimed at children, or food. Finally, in perhaps the clearest indication from the UAE government that it means business in the fight against high smoking rates, all tobacco advertising was banned in 2014, as was the growth and production of tobacco for commercial purposes.

In the UAE, all tobacco advertising was banned in 2014.

This is very positive news. At the start we looked at countries that are showing real declines in smoking. But those declines came only after years of programmes and initiatives. In fact, it’s the same countries that launched laws and regulations a decade or more ago which are now doing well: England introduced a blanket ban on smoking in all enclosed workplaces back in 2007 and we now see the excellent knock-on effect.

So this stuff works. It just takes a while to take hold.

Looking to the future: UAE’s future anti-smoking plans

The Ministry of Health in the UAE announced a follow-up list of mandatory anti-smoking measures in January 2015. This was more about where smoking was permitted rather than how tobacco products could be marketed and sold. Under the latest regulations, smoking is banned throughout all occupied buildings and enclosed spaces including offices, dormitories, lifts, toilets, staircases, balconies, cafeterias and company vehicles. Smoking rooms are no longer allowed, and any designated smoking areas must be outside. Finally, all ashtrays must be removed from public spaces and “no smoking” signs must be displayed.

That’s pretty comprehensive. But it doesn’t end there.

The director of public health for Health Authority Abu Dhabi (HAAD) suggested last year that further price hikes could be on the horizon. These sentiments were echoed at 2015’s No Tobacco Day, when the head of the Tobacco Control Programme at the Ministry of Health and Prevention announced that he would be pushing for plain tobacco packaging that is void of all colour and branding in 2016.

Clearly then, the message from UAE health officials is firm: If you want to smoke, we’re going to make it difficult for you.

What is vital, though, is that these messages start to land with younger people – and that everyone (smokers and non-smokers alike) understands that these bans are important for everyone’s health in public spaces.

Second hand smoke: Why anti-smoking laws matter to everyone

So why exactly is the UAE so intent on making smoking as unattractive as possible to its citizens? Like many countries before, the UAE wishes to protect the health of its citizens – not only those who choose to smoke but those who might be around second-hand smoke as well.

According to the CDC, around 2.5 million American non-smokers have died since 1964 due to health conditions caused by second-hand smoke. The CDC also predicts that, between the years of 2005-2009, second-hand smoke has been the cause of 34,000 heart disease deaths and 7,300 lung cancer deaths each year among non-smokers in the United States.

Second-hand smoke has been the cause of 34,000 heart disease deaths and 7,300 lung cancer deaths each year among non-smokers in the United States.

In the UK, Cancer Research predicts that second-hand smoke is responsible for over 12,000 deaths from lung cancer, heart disease, stroke and chronic obstructive pulmonary disease (COPD), every year. The charity also estimates that passive smoking causes around 165,000 new cases of disease in children each year.

For years, smoker’s rights advocates (yes, such people really exist) have maintained that second-hand smoke is relatively harmless, or that simply imposing no-smoking sections in restaurants is enough to protect non-smokers. But second-hand smoke even in small doses is incredibly toxic. In fact, side stream smoke (the stuff that burns directly from the end of the cigarette and is not inhaled) is around four times more toxic than mainstream smoke (that which is inhaled through the butt of the cigarette). Side stream smoke also contains around three times as much carbon monoxide, 10-30 times more nitrosamines, and between 15-300 times more ammonia.

Starting initiatives; seeing results

So can the government of UAE be hopeful that its recent anti-smoking regulations will have a positive impact on the health of its citizens? Time will tell whether adjustments need to be made to ensure the message is getting through loud and clear. But if we look to the UK again, we see that a number of serious smoking-related diseases are far less common since the smoking ban was introduced. A Cancer Research UK study reported in 2008 that an astounding two billion fewer cigarettes were smoked and 400,000 people quit smoking within just one year of the start of the UK ban.

So how fast can we go in the UAE? Well, let’s not forget that we’re a relatively young country and there may be an element of catching up to do in terms of legislation. However, the UAE now proudly boasts some of the strongest anti-smoking legislation in the world.

While there are some alarming signs, particularly around smoking and young people, there are many positives to take away. At ground level, initiatives such as Dubai Health Authority’s (DHA) smoking cessation clinic shows an increase in quitting rate from 11% in 2012 to 14% in 2013 and 17% in 2014.

The key is to keep those smoker numbers going down. Because the habit affects everyone – in families, in business, in life. And to put it simply, the less smoke in the air the better for us all.

Please visit the Al Futtaim Willis UAE website at www.willis.ae.