The World Bank


Ankara, February 12, 2002 - Questions have arisen as to the World Bank's policy on tobacco and interventions to reduce the use of tobacco. This statement seeks to clarify the Bank's policy on tobacco.

Tobacco kills 4 million people around the world each year. Tobacco use is growing rapidly, and the burden is shifting increasingly to low and middle-income countries, where the growth has been faster than in high income countries. The situation in Turkey is not different. Turkey has experienced a rapid increase in cigarette consumption in the past decade. Between 1990 and 1997, total cigarette consumption in Turkey increased by 42%, the second fastest increase in cigarette consumption in the world after Indonesia. Currently 51.1% of the Turkish adult population smoke. The high rate of smoking prevalence among Turkish women - 50% of women in urban areas and 25% of rural women- and youth (in some cities 60% of 15-18 year olds are smokers) is also alarming. If a major rise in tobacco-related deaths and disease is to be prevented, much more needs to be done to discourage tobacco use among youth and adults.

To reduce the effects of tobacco use, the World Bank's policy since 1991 has been to work with countries to support their efforts to reduce tobacco use, and not to lend money, invest or guarantee investments or loans for activities that directly or indirectly support tobacco production, processing or marketing of tobacco and tobacco products.

The World Bank explicitly does not endorse youth anti-smoking programs supported by the tobacco industry. Many of these programs urge youth to wait until they are old enough to smoke. Instead of reducing tobacco use among young people, these programs may encourage it. It is hard to see how a company that sells cigarettes can be a credible partner in efforts to reduce smoking. The Bank is firmly opposed to any messages or implications that support smoking at any age. All cigarettes and other tobacco products are harmful to the health of users and others who breathe in second-hand smoke.

International organizations, including the World Bank, have joined efforts to address the tobacco use epidemic, and are collaborating with governments and other national organizations to strengthen and support tobacco control activities in many countries around the world. There is a strong consensus on the extent of the problem and on the most cost-effective measures to reduce tobacco use. The World Bank's views and recommendations are laid out in the 1997 World Bank Health, Nutrition and Population Sector Strategy Paper (HNP Strategy). The strategy recommends the following policies to reduce tobacco use: (1) high prices for tobacco products, (2) complete bans on all advertising and promotion of tobacco products and trademarks, (3) prominent and strong health warnings and well-focused mass media education messages on the health risks of tobacco use, (4) better capacity to monitor tobacco burdens and the impact of interventions and stronger actions to discourage tobacco use, and (5) restrictions on the ability of the tobacco industry to target young smokers. The Strategy specifically mentions Turkey as an example of a country that has completely banned advertising and promotion of tobacco products and trademark promotion. We recognize this achievement of the Government of Turkey, and the firm line that the Ministry of Health has taken in upholding this legislation. There has also been strong support from many groups outside of government who are committed to improving public health.

To strengthen the evidence base for the Bank's support for tobacco control within a sound economic framework, the World Bank undertook an extensive review of existing research and data and commissioned new analysis on the economics of tobacco control in several countries, including Turkey. The results of these analyses are summarized in a report published in 1999, called "Curbing the Epidemic: Governments and the Economics of Tobacco Control". This report has been translated into 13 languages, including Turkish, and widely disseminated and discussed around the world. At the invitation of the Ministry of Health, a Bank team will visit Turkey on April 4 and 5th to discuss the economics of tobacco control and the relevance and applicability of the findings analyzed in "Curbing the Epidemic" with key policy-makers, the media and the public. At a seminar being organized by the Ministry of Health on April 5, in Ankara, the Bank will present global evidence on tobacco consumption and the Bank's policies and recommendation on cost-effective interventions to reduce tobacco use. At the seminar, there will also be a presentation on the results of a study commissioned by the Bank to better understand issues on the economics of tobacco control in Turkey and how the World Bank might do more to support efforts in Turkey by the Government and their nongovernment partners.