What other Arab countries can learn from Saudi Arabia’s fight against tobacco use

DUBAI: Tobacco use remains a serious health concern in countries across the Middle East and North Africa, which have some of the highest proportions of smokers in the world.

Despite this high prevalence of tobacco use in the region, policies introduced by Saudi authorities appear to have resulted in significant reductions in the number of smokers in the country, coupled with an increase in those seeking help to quit the habit.

The public-health consequences of what the World Health Organization calls a “tobacco epidemic” are grave. Tobacco smoke contains more than 2,500 carcinogenic chemicals and, according to WHO data, smoking eventually kills up to 50 percent of those who indulge in the habit.

The Tobacco Atlas, a project that collects data about the problems stemming from this global epidemic and the ways in which they are being tackled, estimates that more than 8.67 million people died from smoking-related diseases in 2019 alone, including 1.3 million who were exposed to secondhand smoke, also known as passive smoking.

In Saudi Arabia alone, it is estimated that smoking kills 70,000 people each year.

Smoking is responsible for between 80 and 90 percent of lung cancer deaths and significantly increases the risk of other cancers, as well as cardiovascular, lung, neurological, eye, digestive and infectious diseases.

The often-hidden economic toll of smoking, which includes the bill for medical care of smokers and those exposed to secondhand smoke, costs many countries billions of dollars each year.

According to the Tobacco Atlas, the worldwide economic damage caused by smoking in 2019 amounted to approximately $2 trillion, which is equivalent to about 1.8 percent of global gross domestic product.

A study published in the academic journal Tobacco Control in 2021 estimates that the total cost of smoking for the six Gulf Cooperation Council countries — Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and UAE — amounted to more than $14.3 billion in 2016 alone. Government health spending accounted for almost 75 percent of the cost.

Among those six nations, the economic cost of smoking was highest for Saudi Arabia, the most populous GCC country, where it amounted to more than $6.3 billion.

The global prevalence of smoking dropped from 22.7 percent in 2007 to 19.6 percent in 2019, the most recent year for which WHO data is available, according to Tobacco Atlas.

The Eastern Mediterranean region has experienced a 15 percent drop in the proportion of the population over the age of 15 who smoke daily since 1990. However, the number of smokers in the region has doubled since 2007 due to the rapid population growth of the Middle East.

A growing number of younger smokers creates more challenges. While the use of electronic cigarettes and heated tobacco products — known as “vaping” — is often marketed to smokers and non-smokers alike as a less-harmful alternative to cigarettes, it carries its own risks, especially for teenagers and young adults.

Dr. Shaikh Abdullah, a pediatric and adolescent specialist at King Abdulaziz Medical City in Riyadh, previously told Arab News in September 2019 that “one might be tempted to turn to e-cigarettes as a way to ease the transition from traditional cigarettes to not smoking at all. But smoking e-cigarettes is not advisable either.”

He warned that young people who vape are at risk of stunted brain development and developing memory issues.

The Saudi Ministry of Health is working to address the challenges created by the rise in popularity of vaping. It has posted messages and images on Twitter and other social media platforms warning of the dangers of e-cigarettes, featuring slogans such as: “Flavor inside, color outside, but its truth is an electronic heart attack.”

Since the early 2000s, Saudi authorities have adopted a range of policies designed to combat tobacco use. In 2003, they launched the nation’s first public anti-smoking campaign.

In 2015, they banned smoking in many public places, including educational and cultural organizations and almost all workplaces. The current goal is to reduce the proportion of the population that smokes daily from 11 percent to five percent by 2030.

Authorities in Riyadh are not resting on their laurels, however, and plan to implement additional initiatives to further reduce the harm caused by tobacco use.

In an interview in June this year with the Saudi TV channel Al-Ekhbariya, Dr. Mansour Al-Qahtani, the secretary general of the Saudi Anti-Tobacco Committee, said that the government intends to ban the sale of tobacco products in supermarkets, after having previously banned their sale in kiosks in 2016.

Thereafter, cigarettes will only be available for purchase in specialist shops selling tobacco products such as shisha and chewing tobacco.

The heavy taxation of tobacco products has proven to be a particularly effective tool for combating smoking and one that the Kingdom has relied on heavily. While the Middle East as a whole trails other regions in imposing heavy taxes on tobacco as a deterrent, a number of GCC countries have bucked this trend.

A 2021 WHO study that compared anti-smoking policies around the world found that in June 2017, Saudi Arabia introduced the highest duty on cigarettes in the GCC area: An excise tax of 100 percent.

Research has shown that the Saudi policies have been successful in reducing smoking. A study published in the Eastern Mediterranean Health Journal found that the 2017 tax increase was followed by a noticeable reduction in the Kingdom’s smoking population and in the number of cigarettes smoked.

A 2022 analysis published by the Annals of Saudi Medicine also revealed that the annual importation of cigarettes dropped by over 27 percent from 2013 to 2019 after the implementation of the tax.

Saudi Arabia and the UAE has also imposed advertising restrictions and bans on smoking in public, and implemented extensive programs to help and support smokers who want to quit, according to the WHO.

The Kingdom was only the second country in the Arab world to establish national stop-smoking programs and clinics, in 2011, after Bahrain, which introduced them in 2004.

As of 2019, there were 542 such clinics operating across Saudi Arabia. According to official statistics, nearly 27 percent of people in the Kingdom who participated in programs designed to help them stop smoking managed to quit, according to a 2020 study published in the Journal of Health Informatics in Developing Countries.

Saudi Arabia also leads the Arab world in the use of media to raise awareness of the harm tobacco use can cause, and on the warnings printed on cigarette packaging.

According to a 2022 study published in the journal Tobacco Control, Saudi Arabia was the first country in the Eastern Mediterranean region to mandate the use of plain, non-visually appealing packaging on tobacco products.

The significant reduction in smoking in Saudi Arabia, following the strict measures introduced to increase the cost of consumption and decrease demand, is unsurprising and follows data-driven policy recommendations.

A 2018 study of public-health policies designed to reduce smoking, published by the Journal of Public Health Management and Practice, found that a tax rate of at least 50 percent is the most effective tool in the long term.

However, the Saudi government is not content to make do with the results of its existing policies. In an interview this year with Yahla Program, Al-Qahtani said: “According to studies, the most successful method for combating smoking is not voluntary or treatment (for those seeking to quit) but laws and (government) policies, and the most important among them is increasing the price. We are still striving to increase the price.”

According to the latest international studies, he added, a 150 percent tax would be more effective. If introduced, this policy would result in the price of a pack of cigarettes increasing to about $10.50 in Saudi Arabia, the highest average price for a pack in the Arab world.

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