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31 May 2015 | Cairo, Egypt – On World No Tobacco Day 2015 ‘Stop illicit trade of tobacco products’

Head of the Egyptian Society for Tuberculosis and Chest Diseases and former Minister for Health, Dr Awad Tag El Din; Head of Cairo Association Against Smoking, Tuberculosis and Lung Diseases, Dr Essam El Moghazy; Head of the Tobacco Department, Ministry of Health and Population, Dr Sahar Labib; distinguished guests, ladies and gentlemen.

Good morning.

First of all, I would like to thank the Ministry of Health for organizing today’s event. World No Tobacco Day is one of the most important annual events in the calendar of the World Health Organization. I think we should make every day World No Tobacco Day! I am making a joke, but I am also very serious. Tobacco-related illnesses represent a global epidemic – an epidemic which WHO has been urging all its 194 Member States to fight with all their might.

We recognize the good work done by the Ministry of Health and Egypt at large as presented by Dr Sahar Labib and Dr Essam El Moghazy. Nevertheless many challenges remain in tobacco control.

Tobacco kills up to half of its users and continues to pose a real threat to public health. Nearly 6 million people die every year as a result of tobacco use, including 600 000, who are killed by the effects of exposure to second-hand smoke. Tobacco use is the main risk factor for a number of noncommunicable diseases, including cardiovascular diseases, lung diseases and cancer. All together these diseases are responsible for 82% of all deaths in Egypt.

Data from the 2012 STEPwise survey indicated the high prevalence of tobacco use in Egypt at all age groups. Nearly half of adult Egyptian men are smokers and recently we have also seen a worrying rise in the use of tobacco by women. Young people are particularly vulnerable with 17% of university students and 14% of students aged 13-15 using tobacco products. And now we see an even additional threat, as the rates of shisha smoking skyrocket across Egypt, with 74% of university student smokers also using shisha. We cannot afford to let this epidemic continue and expand.

The focus of World No Tobacco Day this year is on illicit trade of tobacco products. Illicit tobacco products pose additional challenges in the fight against tobacco. They are typically sold at lower prices, thereby increasing consumption, especially to the young and poor. Moreover illicit products are untaxed and unregulated, with no health warnings, packaging or labeling.

In short, illicit tobacco trade leads to an increase in tobacco consumption rates, especially among the poor and the youth, an increase in the tobacco health burden and loss of government revenues.

A national study conducted in 2013 revealed that illicit cigarette trade is a major problem for Egypt. From 2009 to 2012 the illicit cigarette market doubled from 10 billion to 20 billion illicit cigarettes.

This resulted in loss of governmental revenues from tobacco tax. The revenue loss increased from less than one billion LE in 2010 to nearly 4 billion LE in 2013. This loss reverses the positive measures the government has made recently to increase tobacco taxation. Fortunately, every problem has a solution. WHO’s “Protocol to Eliminate Illicit Trade in Tobacco Products” provides countries with guidance on political, technical and international collaboration, necessary to eliminate the illicit trade in tobacco products. This is the first protocol to the WHO Framework Convention on Tobacco Control.

As Egypt was one of the pioneer countries that signed and ratified the FCTC, WHO is looking forward to Egypt being among the first countries to sign this protocol. Eliminating the illicit trade in tobacco products will lower tobacco consumption, reduce tobacco related morbidity and premature deaths and increase government revenues.

WHO wants to renew attention to this long-running problem. We want to say clearly and loudly; stop illicit trade of tobacco products. And WHO is ready to support you, and to support Egypt, in this fight – now and always.

Egypt has made a lot of achievements in the field of tobacco control in the past decade: raising tobacco taxes, adding health warning on tobacco products packs, banning tobacco products ads. However, the gains that Egypt has made are compromised by this illegal process. I am therefore calling on all concerned stakeholders to work together, to fight the illicit tobacco trade.

Before closing, I want to mention one final thing. At a meeting on tobacco last year His Excellency the Minister for Health and Population stood up and made a bold statement – that all government health facilities would become smoke-free. This is indeed an important step in reducing the harm from tobacco. I implore that we see this policy enforced.

WHO stands ready to support its introduction. We hope that this policy will be further extended to other public institutions, starting with the Ministry of Health and Population!

Together let us set the right example.

3 June 2015 – Welcome address at the Second International Conference on Public Health "Health promotion: integrated life cycle approach"

Kasr Al Ainy Faculty of Medicine, Cairo University

Dean of the Faculty of Medicine Cairo University, Professor Fathy Khodeir; Conference President, Professor Maissa Shawky; Section Chief, Child Survival And Development, UNICEF Egypt, Dr Magdy El Sawady; distinguished professors and colleagues, ladies and gentlemen.

Good morning, and welcome.

Firstly I would like to thank the Faculty of Medicine of Cairo University for organizing this important event. While walking in I was reminded by the Dean that this university is 180 years old. It has a long and strong history in public health. I attended the Public Health conference last year, and we are grateful to know that this conference will now become an annual event.

Health promotion is often not given the attention it deserves and is sometimes thought of as an add on to core health areas, but its importance should never be underestimated.

Globally we are experiencing unprecedented societal transformation as a result of population growth and urbanization together with environmental and other changes. In most countries, the number of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. In Egypt we face an even larger challenge with a fertility rate that has actually increased. In 2013 there were nearly 6.5 million older people in Egypt, almost 8% of the population, and this will only increase.

In the light of these changes, new approaches are required to address the broader determinants of health. Promoting health through the life course is becoming more important than ever before.

An important element of assuring health through the life course is universal health coverage, which not only includes curative, palliative, preventive services, but also health promotion.

The Egyptian Government has recently made clear movements towards making Universal Health Coverage as a priority objective for health sector development and health system strengthening which I find very promising.

Historically, Egypt has been challenged by a low public investment in health, with large out-of-pocket expenditure. This has resulted in a large private sector and in turn has led to three serious market failures in health: poor safety and quality of services; inequity in health service utilization; and a lack of investment in prevention.

However, the commitment of the new Constitution approved in January 2014 to nearly double government spending from 1.5% of gross domestic product to 3% provides a valuable opportunity to improve health systems and work towards achieving universal health coverage.

As the government proceeds with its commitment to increase health expenditure, I strongly recommend that it concentrates its spending on the areas where the market has failed. One of these areas is of importance for you here today – a lack of investment in prevention and health promotion.

Because of our previous lack of focus on prevention Egypt is now faced with overwhelming challenges such as the enormously high use of tobacco products and the alarming growth of shisha consumption. Shisha smoking is taking over restaurants where we are all exposed to second hand smoking. And despite what some say, when looking around it is clear to me that many of these shisha smokers are women. As health promoters it is our responsibility to change behaviours so that Egyptians act in the interest of better health for themselves, their families and the wider community.

Because that is what health promotion is – positively changing behaviors. It is not just about making interesting marketing campaigns, ‘raising awareness’ or increasing knowledge. It needs to go two steps further changing attitudes, and especially changing behaviors.

Health promotion needs to have a strong and scientific foundation; a clear communication and evaluation strategy to ensure that it will have a true and measurable impact.

Unfortunately, too often in the past we have focused on developing health promotion products without assessing their effectiveness. For example, in Egypt we have a one of the best in-depth training program, curriculum for infection control and trainers. Despite this, we still see an estimated 100,000 to 150,000 new hepatitis C infections ever year, the majority of which come from health facilities.

We have to ask the question – is this health promotion program really working? Has it changed knowledge, attitude and more importantly behavior? If not, why not?

Or does the program not meet the right coverage in the fragmented health system of Egypt, and does it need to be expanded well beyond the Ministry of Health and Higher Education health care facilities? Have we covered all the services, such as dental services and pharmacies?

How do we make health promotion effective? The first step is to ensure that health promotion is focused on the needs at hand. Scientific research is required to first understand where knowledge gaps lie and identify areas requiring change.

Next, we need to monitor and assess health promotion activities to confirm that activities are actually having an impact, and are changed when they are not. I really believe that universities can play an important role in the research and monitoring that is required to make health promotion work.

So as you participate today and tomorrow in this workshop I would like you to keep in mind the importance that research and evaluation have in effective health promotion.

There is no doubt that the public health environment is changing, and a life course approach will require even more from you as health promoters. We will need to find innovative ways to make sure that our work is as effective as can be.

Lastly I want to mention something that became even more apparent to me recently. We must carefully consider the communications methods we use to ensure they reach our audiences. The other day I saw my family all staring at their mobile devices at the same time. This is the way things work now, and mobile health is more important than ever. Recently we had a mission to Egypt on H5N1, and they discovered that messages around the prevention of bird flu were transmitted on TV stations that only very few people watch anymore! The mediums in which we communicate need to considered carefully.

With this, I wish for you all a successful workshop and truly hope that you gain some positive outcomes for health promotion in Egypt.