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EGYPT: Is the government blowing smoke in anti-tobacco campaign

November 9, 2010 |  6:50 am

Antismokingx Mohammed Mustapha, a waiter in a Cairo cafe, likes to smoke, but he's not fond of the pictures the Egyptian government stamps on each pack of cigarettes: teeth rotted from gum disease, a limp cigarette suggesting impotence or a man with emphysema tethered to an oxygen mask.

With graphic advertising, new bans and taxes on tobacco, the Egyptian government seems serious about curbing the nation's epidemic number of smokers. But, as with many things in this country of 80 million, contradictions undermine appearances. Most Egyptians smoke Cleopatra cigarettes, manufactured by a company controlled by the government.

Egypt leads the Arab world in tobacco consumption. In 2009, the World Health Organization reported that 38% of Egyptian males use tobacco of some sort and that 32% smoke cigarettes. Females admit to much less smoking -- below 1% -- because it is taboo in this patriarchal culture.

Egyptians have enjoyed flavored tobacco for centuries, mostly inhaled from water pipes known as shishas. Reports suggest that today only 6% of men smoke water pipes, a figure hard to trust when most every street and alley in Cairo boasts a lively shisha cafe. However, cigarette smokers have increased twice as fast as population growth over the last three decades, according to the WHO.

The morbidity and mortality associated with tobacco use is shifting from the developed world to developing countries, especially low- and middle-income Arab nations. It is an expensive public healthcare burden few countries can bear, especially Egypt, where about 40% of the population lives on about $2 a day. 

That may be about to change. The Egyptian government has recently enacted tough new measures, such as hefty tax increases, a ban on smoking by minors and restrictions on smoking in schools, youth centers and public buildings. A poll by the Global Adult Tobacco Survey found that nearly half of smokers who saw Egypt's anti-cigarette ads said they wanted to quit.

An attempt to make the coastal city of Alexandria smoke-free was launched in June. Cigarettes and shishas are banned in all public places, including clubs and cafes, a measure no one, not even health officials, thought possible. Individuals caught smoking can be fined up to 100 pounds (about $20), and cafe owners can be charged up to 20,000 pounds per violation.

"Banning is very difficult, but the governor of Alexandria is very supportive" said Dr. Sahar Labib, director of tobacco control for the Health Ministry. "In Cairo, this would be too difficult right now."

Although broad enforcement in this chaotic country seems unlikely, word from Alexandria is that fines are being handed out. Labib said enforcement would first target tourist areas near the sea and the famed library, and then spread inland.

The most popular cigarette brand here is Cleopatra, which can be bought for as little as 80 cents a pack. The brand is produced domestically by Eastern Company SAE, a government-controlled company that enjoys dominance and less competition because of low prices.

Does the Egyptian government want its people to smoke, or do business profits outweigh health concerns? Until it stops selling cigarettes, the government's resolve will be suspect.

"The important thing is that Egypt is taking the first step, with smoke-free zones and various initiatives; the benefits will only be seen downstream in lower healthcare costs," said Ron Hess, associate director of the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, which is helping Egypt with the campaign.

Something is "changing here," said Hussam Rajab, communications advisor for the CCP. "People are going outside to smoke, even in Cairo, where it will be most difficult to change, to avoid harming family and colleagues with secondhand smoke."    

Yet in the cafe, nothing deters Mustapha, the young waiter, from lighting up. Taught to inhale at age 12 by a cousin, he still breathes easily and his teeth are white enough. He shrugs, saying, "Sometimes I think about the pictures, but I never think about quitting."

-- Clare Aigner in Cairo

Photo: An Egyptian anti-smoking ad suggesting smoking causes impotence. Credit: Associated Press