Ready to be Smoke-free? Ensuring a Smooth Transition Towards Non-smoking Public Spaces in Armenia
Author: Liana Simonyan
The adoption of policies banning smoking in public spaces is an essential step in having a healthier society. Armenia is going to ban smoking in public places starting from 2022. Before the implementation the state has two years to ensure an easy transition for all the involved stakeholders. The paper underlines the necessity of utilizing the transition period as an important step to conduct campaigns, review the contested points and make sure that all the stakeholders, including the smokers and restaurant/café/bar owners do not have unaddressed concerns and financial losses. The paper provides certain recommendations so that these later will not be translated into bigger problems in the implementation phase.
According to STEPS National Survey (2016), more than half of men (51.5%) and 1.8% of women in Armenia are smokers. 94.3% of them use factory-produced cigarettes. The middle age of smoking is 18.1. What is more important, 56.4% of the adult population is affected by secondhand smoke at home and 26.6% at the workplace.
The reduction of the number of smoking people in the population is a critical public health challenge. According to the WHO Tobacco Free Initiative, there is rising evidence of the damaging impact of exposure to secondhand tobacco smoke, which creates the necessity of establishing smoke-free environments. A well-known solution to this is banning smoking in public places to protect non-smokers from harming their health by the tobacco smoke and reducing consumption. On 13 February 2020, the Armenian government adopted an anti-smoking bill, which will ban smoking in closed public places, including in all public food establishments, which will come into force in 2022. The paper points out that there is a need to facilitate the transition to a completely smoke-free environment in Armenia, as compared to other states, the smokers constitute a more significant part of the society. The paper firstly outlines the situation in Armenia and describes the existing problem. Further, it suggests potential policy alternatives by examining the international experience, and later provides recommendations, possible implementation, and concluding remarks.
The situation on anti-smoking policies in Armenia
Every year 1300-1500 new cases of malignant neoplasms of bronchi and lungs are diagnosed in Armenia. The total number of patients in 2016 was 1,930 of which 1,624 were men, 306 were women. Thus, the incidence and mortality of lung cancer among men is 5-6 times higher than among women, and as the specialists note this may be due to the high prevalence of smoking among men, noted in STEPS National Survey (2016). Furthermore, according to World Cancer Research Fund, as of the year 2018, Armenia was in the top ten among those countries who have the highest percentage of Lung Cancer Rates in men. From the top ten, Armenia was eighth with 58.5 age standardized rate per 100.000(WCRF 2018).
It should be noted that research on the prevalence of tobacco in Armenia has been conducted since 2004 According to Bazarchyan (2004, 12) as of 2004, in Armenia there were no legislative limitations on tobacco use both in work places and public places. The limitations which existed in private institutions were initiated by the directors and were not regulated or directed at the state level. The result of a household survey which was conducted in two regions of Armenia (Gegharkunik and Armavir) have demonstrated that nearly 60% of the population (including children) is always or often exposed to tobacco smoke.
On 13 February 2020, the Armenian government adopted an anti-smoking bill, which will ban smoking in closed public places, including in all public food establishments. This law will come into force by 2022. A total number of five laws have been discussed in that day, and the changes to the laws were suggested by the Government. 76 MPs votes for it and 16 were against it. The first one was related to the harm that cigarettes and other cigarette alternatives bring to the heath of the people. The second one entails a change on informing the public about the harm that second hand smokers are projected to via awareness programs. The third one entails banning all kind of advertisements entailing cigarettes or cigarette alternatives. The fourth one puts more restrictions on the allowance of selling tobacco, and the fifth one elaborates on the fines in case of breaking the above mentioned four (Parliament.am 11.02.2020).
As the National Assembly approved government sponsored bill, this entails banning smoking in eateries, cafes, and other indoor public places in the country. The fine for indoor smoking will comprise from 50.000 AMD to 200.000 (Hetq.am 13.02.2020), which is commensurate with the minimum wage in Armenia.
Armenia is considered to be a regional outlier as all of its neighboring countries have already banned smoking in public places (EurasiaNet 2019). Although the government has issued a number of policies and adopted specific laws regarding smoking bans, the problem is still prevalent. The new policy on banning smoking in public places will put many clear restrictions on smoking in public areas and on defining certain places where cigarettes can be sold (ArmeniaSputnik 2020) However, there is dissatisfaction among the smoking people and restaurant/café/bar/pub owners.
Firstly, there is a significant concern from the local restaurants/bars/pubs/cafes about the implementation process of the policy. They are not necessarily against it, but they have doubts about who is going to control the whole process, as the owners state that they do not want to be the ones who become policemen and control the behavior of their customers (ArmGov 2019). Some pub owners also said that they are willing to pay more taxes for at least having a place for smokers (CivilNet 2020).
An opinion prevailing among smoking people is that the government leaves them with no alternative (like iqos, or wipes) to the cigarettes, and many have confusion why those are banned as well (ArmLur TV 2020). They claim that the existing policy not only restricts the rights of smoking citizens but vanishes them at all. Moreover, another opinion is that the law bans and does not help the smokers to quit smoking. Non-smokers mainly perceive it as a positive development and consider it better to finally seat and enjoy their time in a place where there is no smoke.
These points mean that there is vagueness in specific aspects of the policy, which should be addressed to ensure a smooth transition towards non-smoking public places. This paper aims to elaborate on the nature of these problems and provide some possible solutions for the transition period by examining the international experience and addressing the unclear points in the existing policy.
There are several country examples, which provide an insight on how to educate the public, milden the differences of opinions, and show that each stakeholder matters. For instance, in Canada, the government adopted a more participatory model of a “smoke-free” policy, as the Health committee organized a fifteen-hour meeting, where five-minute deputations were heard from any individual or group that wanted to express their opinion on the proposed by-laws. This is a way of understanding the opinion of all stakeholders and better adjusting the polices to their needs. There was also a campaign launched, called “Smoke-Free Ottawa,” which involved a partnership of various healthcare entities. The partnership sponsored a number of advertisements, the creation, and development of a website keeping the public informed (Tilson 2017, 5) In the case of New Zealand, the report (Laugesen 2000, 9) states that huge attention was given to public education, which they consider an early and essential component of the policy campaign. They emphasized on positive, with expressions such as “Banning smoking to creating smoke-free environments for work, travel and leisure or lifestyle, etc.”
Another study (Rooke et al. 2013, 16-17) on the experience of England points out that the way how people will feel themselves is dependent on how participants will experience smoking. This is related to “the nature and quality of outdoor space available for smokers,” as some areas can be just liminal spaces, and others may be an extension of the pub setting to outdoors. Furthermore, as it is stated in the report on Estonia, the smoking-related diseases or smoking-related disability have been a major problem for the country. In the Tobacco Control Act adopted by the country, it there were requirements for particular ventilation systems and standards in separate smoking rooms and areas.” Under the Tobacco Control Act the owner, landlord or employer of such premises is obliged to provide a designated separate room or area for smoking wherever necessary and feasible at their own expense: this separate room or area must be directly connected to the outside environment via an independent ventilation system.” The country also took action to train physicians, family doctors, activate counseling centers with a trained stuff, to give abidance and advice to smokers on quitting (Lipand 2007).
Coming to Armenia’s neighbors, Iran has one of the world’s most comprehensive anti-smoking laws. In WHO report on the global tobacco epidemic, 2019, in the Country profile of Iran (Islamic Republic of) it got really impressive scores in Anti-tobacco mass media campaigns, and banning in the majority of public spaces, but the place where the compliance level is not high are Cafés, pubs and bars (WHO 2019). It is important to consider that tobacco use is a deep-rooted habit and is appealing to Islamic values, the law did not succeed in winning the population and the government is facing difficulty in exercising control over this. Thus, the law did not have the level of success that its advocates were hoping for, as many restaurant owners ignore the ban and there is a significant increase of the use of water pipes. And only recently, the anti-tobacco association concentrated its efforts on education campaigns, targeting children as young as six (Foreign Policy, 29.01.2018).
What refers to Armenia’s other neighbor, Georgia, On 1 May 2018 new tobacco control legislation came into force in Georgia. It is important to note that the campaign under the slogan “Get free from tobacco smoke” was launched to support the new tobacco control legislation, and it had a positive impact on shaping understanding about the new law both among the public and the businesses as it had the aim of “promoting compliance before the implementation” (WHO, 01.05.2018).
One of the main objectives of any policy is to take into account the opinion of all the stakeholders. There is dissatisfaction among specific stakeholders after the adoption of the final policy in the case of Armenia, and it may be growing till 2022 when the law comes into force. To avoid this, there is a need to make this transition as smooth as possible. The preliminary ways which can ensure this are as follows:
- Starting a campaign promoting smokers to quit is the first suggestion. To avoid what happened in Iran, it is important to start a campaign in an early phase, as it is not only about the health of those who are affected by the smoke, but it is very important to help those who want to quit. Campaigns should be aimed not only at Yerevan but also the regions. It is also essential to conduct more public surveys in this phase of facilitation and learn more about the prevailing opinions on the law.
- Besides the campaign, it will be effective and beneficial to collaborate with NGOs to have more programs aimed at public education and at promoting quitting smoking and a healthy lifestyle, according to the statistics mentioned earlier, the majority of people are affected by the smoke at their homes, which cannot be regulated by the government. These programs will have a positive influence if they are actively implemented in the transition period by providing information and assistance to children and adults.
- Public private collaboration, by introducing certain benefits (such as not paying some part of taxes till the law comes into force) to those entities where smoking is totally banned inside. The companies will improve their marketing strategies by the saved money and be ready when smoking will be banned absolutely in all closed areas.
- Creation of a committee addressing the main unclear points in the policy, including considering to deal with the concerns of smoking people who feel that they are left with no alternative. Specific changes can help to milden the opinion among smokers that their rights are being violated.
- Finally, considering the option of having a separate place (ծխարան) for smokers in bars/pubs with the condition that owners will pay more taxes, and those pubs/bars which do not have a special place, their customers will smoke in a separate place outside after the policy implementation. This separate place can be directly connected (voluntary) to the outside environment via an independent ventilation system, as it was in the case of Estonia.
The main stakeholders involved:
Smokers, non-smokers, restaurant owners, Municipality, Ministry of Health, food inspection service, NGOs, local businesses, tobacco importing companies.
The suggested facilitation can be implemented by the following phases:
The campaigns will be implemented by the Ministry of Health via a collaboration with various NGOs specializing or interested in the issue.
Secondly, to ensure that the rights of smokers are not being restricted, and this will not cause further problems after the law comes into force, the created committee (in the Government) will suggest changes in the adopted law after the discussions and information on conducted surveys.
What refers to the businesses, the government (specifically the State Revenue Committee) will control the suggested benefits (taxes) or fines to local businesses via public private collaboration to milden their potential financial losses.
All of the suggested steps will safeguard the promotion of compliance before implementation.
The paper concentrated on the main problems which are related to the newly adopted law. It is good that the implementation process will start in 2022, as it gives a country with a very high rate of tobacco consumption, more time to prepare for this transition. As the law is primarily aimed at preserving the health of non-smokers, who unwillingly consume the second hand smoke, it did not entail particular programs aimed at helping the smokers to quit which in its turn raised dissatisfaction among smokers. Another stakeholder not satisfied were the club/bar/restaurant owners, who did not want to lose their clients or control their customers. The paper suggested a number of solutions for the implementation of the facilitated transition period. Most importantly, promoting compliance before implementation, and suggesting certain benefits to the owners (such as not paying some part of taxes till the law comes into force). And activating campaigns helping smokers to quit, which will result in considering the rights of both smokers and non-smokers. As the paper demonstrated, facilitation in these two years is essential, as it will prepare people and the private entities for the final adoption and will ensure that the opinion of all the stakeholders who are affected by the law, are taken into account. If the recommendations are considered, the rights of smokers will not be restricted. The right of non-smokers will not be protected at the expense of smokers. And, finally the cafes/bars/restaurants will have a significantly low level of financial losses.
- (2020). Where and When will smoking be banned in Armenia https://armeniasputnik.am/infographics/20200219/22102433/hayastanum-erb-ev-vortex-kargelen-tsxel.html
- (2019). Smoking will be banned in closed places https://www.youtube.com/watch?v=-bz0d-MPU_c
- ArmLur TV. (2020). What do people think about anti-smoking bill? https://www.youtube.com/watch?v=RgTUX6nD8GU
- Bazarchyan A., Darbinyan Z., Davidyants A. and others. (2004). Contemporary issues in tobacco control policy in Armenia. Yerevan, AUA Fund. Retrieved from https://aua.am/chsr/PDF/2004/TobaccoControlArmenia_Eng.pdf
- CivilNet (2020). Cafes on anti-smoking bill https://www.youtube.com/watch?v=ffIxTnNYOS8
- Foreign Policy (2018). Iran is losing its Jihad on Tobacco. Retrieved from https://foreignpolicy.com/2018/01/29/iran-is-losing-its-jihad-on-tobacco/
- am (2020). Armenian Parliament Approves Indoor Smoking Ban. Retrieved from https://hetq.am/en/article/113288
- Laugesen M. (2000) Smoke-free Policies in New Zealand. WHO/NHM/TFI/05.9
- NA of Armenia. The record of February 11-13, 2020 session. Retrieved from http://parliament.am/register.php?AgendaID=541&day=13&month=02&year=2020&lang=&fbclid=IwAR0DBeDPdhE4NSTnBqMryMgHANBezWbYKsEvKOFssccdagZ98FuZjEe8NgA#13.02.2020
- Lipand A. 2007 Successful Use of Smoke-free Policies in Tobacco Control in Estonia WHO/NHM/TFI/05.7
- (2019). Give me a smoke free Armenia, but not yet https://eurasianet.org/give-me-a-smoke-free-armenia-but-not-yet
- Rooke, C., Amos, A., Highet, G., & Hargreaves, K. (2013). Smoking spaces and practices in pubs, bars and clubs: Young adults and the English smokefree legislation. Health and Place, 19, 108-115.
- STEPS National Survey. (2016) http://www.moh.am/#1/1019
- Tilson M. (2017). Country Reports on Smoke-free Policies in Canada. WHO/NHM/TFI/05.3
- WHO Tobacco Free Initiative https://www.who.int/tobacco/training/success_stories/smokefree_policies/en/
- WCRF 2018. Lung Cancer Statistics. Retrieved from https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics
- WHO report on the global tobacco epidemic. (2019). Country Profile Islamic Republic of Iran. Retrieved from https://www.who.int/tobacco/surveillance/policy/country_profile/irn.pdf?ua=1
- WHO (2018). New law on cigarettes and tobacco coming into effect in Georgia. Retrieved from http://www.euro.who.int/en/countries/georgia/news/news/2018/5/new-law-on-cigarettes-and-tobacco-coming-into-effect-in-georgia