An omission in the Ministry of Health: from 2014 the fight against smoking was effectively stopped, and from 2015 the number of smokers increased, especially the young

This is according to the State Comptroller's report published yesterday (Tuesday). The report also shows that the tobacco companies are using their enormous economic power to thwart legislation that would reduce the attractiveness of smoking. The Minister of Health (currently deputy minister but acting minister) Yaakov Litzman met twice with senior representatives of the tobacco industry and did not report this to the public. 

The World Health Organization defines smoking as the biggest preventable cause of death. Tobacco products mainly include cigarettes, rolling tobacco, hookah tobacco and cigars. According to a report submitted by the Minister of Health to the Knesset regarding the smoking situation in 2016[1] , about 350 of the substances contained in tobacco products are dangerous to humans, and about 70 of the substances are carcinogenic. It was also stated in the report of the Ministry of Health that tobacco contains a dangerous drug that causes a very rapid addiction and severe dependence of the user on the product. The report also stated that the degree of addiction to tobacco is defined as higher than the degree of addiction to other drugs.

According to the report of the Ministry of Health, the life expectancy of smokers is 10 to 13 years lower on average than the life expectancy of non-smokers. Smokers have an increased risk of suffering from various disabilities, atherosclerosis, myocardial infarction and aortic aneurysm. Cigarette smoking causes more than ten types of cancer and more than 90% of chronic obstructive pulmonary diseases, as well as delays ulcer healing and increases the risk of cataract formation. Smoking cigarettes during pregnancy causes complications for the mother and the newborn. Smoking also causes indirect costs to the economy and damage to work productivity due to lost work days and loss of work capacity.

Very few international companies are involved in the tobacco industry. The profits of these companies are enormous - according to the report of the Ministry of Health, in 2013 the net profit of the largest tobacco companies in the world was estimated at approximately 44 billion dollars. In recent years, the companies involved in the tobacco industry have been working aggressively, including through lawsuits, against countries promoting the fight against smoking. In this regard, it should be noted that during the legislative process in the Knesset regarding the transition to uniform cigarette packs (uniform appearance and color and uniform writing of the product name), foreign countries exerted pressure on the decision makers, in order to thwart the legislation[2].

The responsibility for carrying out the activity to prevent smoking is given to several bodies. The Ministry of Health is the regulating body that sets the policy in this area, and the health insurance funds assist in smoking cessation as part of the services they provide to the public. Other partners in the activity in this area are the Ministry of Education, which deals with education and training for smoking prevention, the IDF, medical organizations and associations.

Two main laws regulate the fight against smoking: the Law for the Prevention of Smoking in Public Places and Exposure to Smoking, 1983 (hereinafter - the Law for the Prevention of Smoking); The Law on the Restriction of Advertising and Marketing of Tobacco Products, 1983-2005 (hereinafter - the Law on the Restriction of Advertising and Marketing). By virtue of these laws, various regulations were established. In 2003, the State of Israel ratified the International Tobacco Control Convention drawn up by the World Health Organization in XNUMX (hereinafter - the Convention).

In January 2011, a public committee to prevent the harms of smoking established by the Ministry of Health (hereinafter - the public committee) submitted its recommendations to the government[3]. Based on the recommendations, the government decided in May 2011 on a national plan to reduce smoking and its harm[4] (Also below - the government's decision from May 2011). In the decision, the ministers of health, finance, education and environmental protection were tasked with taking the necessary actions to implement the program, including amendments to laws.

According to the report of the Ministry of Health, in 2016 about 8,000 people died in Israel from an illness caused by smoking, about 800 of them due to exposure to second-hand smoke. The cost of treating diseases related to smoking in 2016 was at least 3.7 billion NIS. At the beginning of the seventies of the twentieth century, there was a decrease in the proportion of smokers, but from 2013 the downward trend was halted^[5]. In 2016, about 22.5% of the population in Israel - smoked (about 1.6 million people).

The government policy regarding the fight against smoking

By the time the audit was completed, only some of the actions set forth in the government decision from May 2011 had been implemented. For example, the Minister of Health did not establish a unit in his office to combat smoking, and the tasks in this area are spread among different employees, including a center, without the head of a responsible entity. This does not allow targeted treatment of the smoking phenomenon. The Ministry of Health has adopted several goals established in the public committee's report, but these goals and the manner of achieving them are not mentioned in the Ministry's annual report or in its work plans. For example, the work plans did not set goals regarding increasing enforcement actions and reducing the number of smokers, according to their gender, sector and age. The tasks set by the ministry regarding smoking for the years 2016 and 2017 were not carried out at all. Only in 2017 did the ministry set a quantitative goal of a 1% decrease in the number of smokers in the Arab sector, as it recognized that there was an increase in the number of smokers in this sector. However, he did not take into account gender (in 2016, about 43% of men and about 10% of women in the Arab sector smoked). The ministry stated that the use of tobacco and smoking products causes severe and even fatal damage and expanded the restrictions on smoking in public places by decree, however, as of March 2014, it stopped promoting the amendment to the Advertising and Marketing Restrictions Law. This should be taken very seriously. The Minister of Finance did not submit recommendations to the government regarding the tax rates on tobacco products. The Minister of Environmental Protection did not submit to the government a plan to reduce the damage caused by cigarette butts that create a waste hazard in public space.

With regard to the treaty, it emerged that Israel is partially acting on it: a relatively low tax is imposed on some tobacco products; There is no ban on smoking in all public places, and there is no supervision of the content of tobacco products; There are no frightening graphic warnings on the packaging; The verbal warnings on the packs are indicated on a smaller area than recommended in the convention; The Ministry of Health does not finance public awareness programs regarding the harms of smoking; It is not prohibited to advertise tobacco products in all media and social networks.

Meetings of the Minister of Health and senior officials of the Ministry of Health with representatives of tobacco companies without reporting to the public

The Minister of Health MK Yaakov Litzman and the senior officials of the Ministry met twice with representatives of tobacco companies, but contrary to the provisions stipulated in the convention, the Minister did not bring this fact to the public's attention. The public must be informed about the meetings of the decision makers with the representatives of the tobacco companies, since public exposure of these meetings has the power to stop the tobacco companies exerting pressure on the decision makers, and to prevent decisions being made that are not in line with the need to protect public health. Also, hiding the meetings with the tobacco companies goes against the vital need for transparency.

The main recommendations

1. The downward trend in the number of smokers in Israel has stopped. The mobilization of the government, and first and foremost of the Ministry of Health, in the fight against smoking is a necessary condition for reducing the phenomenon and its damage. The government ministries, and in particular the ministries of health, finance, education and environmental protection, must be fully engaged in the fight against smoking and its harms. They must promote legislative and regulatory actions, carry out advocacy and increase enforcement actions in this area. The Minister of Health and the CEO of his office must decisively lead the implementation of the policy to reduce the phenomenon of smoking, including the implementation of the government's decision on the subject and the implementation of the provisions of the convention. The Ministry of Health must lead an inter-ministerial staff work, for the formulation of a systemic and operative national plan in which goals, indicators and timetables will be set in order to achieve the overarching goal - a real reduction in the scope of smoking. The high rate of smokers among young people is extremely worrying. The Ministry of Health must take actions to prevent young people from entering the circle of smokers and to help young people who already smoke to quit.
2. The annual national expenditure on treating diseases caused by exposure to smoking is high and is estimated at 3.7 billion NIS. The audit revealed that taxation has an effect on the consumption of tobacco products. The Minister of Finance and his office must re-examine in depth the issue of taxation of all tobacco products, including rolling tobacco.
3. The cash registers must act to locate smokers and invite them to participate in smoking cessation workshops. The Ministry of Health must promote a program for smoking prevention and cessation and examine, in cooperation with the funds, the possibility of training primary care physicians to go through workshops to encourage patients to quit smoking.
4. The IDF should examine ways to prohibit the sale of cigarettes even in closed bases, and especially in the main training base in the Negev. The Chief of Staff must monitor the implementation of his decision and establish indicators to examine its success.
5. The Ministry of Education must act to implement the circulars it published on the prevention of smoking cigarettes and tobacco products in educational institutions. It is also appropriate for the Ministry of Education to develop indicators to test the effectiveness of the fight against smoking.
6. It is appropriate that the heads of the local authorities, the local government center and the Minister of the Interior, who is in charge of the local authorities, adopt the initiative of a "smoke-free city". The Minister of the Interior must encourage the local authorities to fight smoking and incentivize the authorities whose actions are effective.
7. The Ministry of Health must address the enforcement limitations of the ushers regarding smoking in public places and act to prevent smoking in hospitals and non-governmental nursing institutions. If necessary, legislative amendments should be initiated. The Ministry of Health, in cooperation with the local government center, must act in order to promote the increased enforcement of the local authorities in the area of ​​smoking control.

Summary

Every person has the duty to preserve his life and health, as it is written - "And you shall be very careful for your souls" (Deuteronomy 8,000:XNUMX); The Ministry of Health, as the regulator of the health system and responsible for public health, also assumes duties to prevent public illness. Smoking cigarettes and other tobacco products damages all body systems. Every year, studies are published proving that smoking causes an increasing variety of diseases, such as cancer, cardiovascular diseases and respiratory diseases. In Israel, about XNUMX people die each year from diseases caused by smoking. Along with the serious damage caused by smoking, it is also defined as the biggest preventable cause of death. The audit revealed that the ministry's activity on the subject of the fight against smoking is limited and therefore should be done on every possible front. Success in the fight against smoking can lead to a reduction in spending for diseases caused by smoking, which will allow funds to be directed to other purposes, for example to cure diseases that cannot be prevented.

The audit examines the struggle of various parties, led by the Ministry of Health, in the smoking phenomenon. Deficiencies have arisen in various areas, including taxation of tobacco products, legislation on smoking, enforcement of existing laws on smoking, information and education regarding the harms of smoking and intervention in the community to prevent smoking.

It is appropriate that the activity to prevent smoking and reduce its harm be national-systemic and include all the relevant agencies in the country: the Ministry of Finance, the Ministry of Justice, the Ministry of Education, the IDF, the Ministry of the Interior, the local government center, the local authorities, the Ministry of Environmental Protection, the health funds and the hospitals. The Ministry of Health must resolutely lead the execution of the aforementioned activity, and among other things, initiate and promote legislative changes that will make it difficult to distribute tobacco products, initiate informational activities regarding the harms of smoking, and act among the health insurance funds, so that they locate their insureds who smoke and encourage them to participate in detoxification programs and publish as soon as possible on the network's website a program national plan to prevent smoking, which will include measurable implementation goals. Also, the Ministry of Finance, in cooperation with the Ministry of Health, must act to raise taxes on tobacco products and explain to the public the benefit of this step.

The government must identify the reasons for the non-implementation of its decision from May 2011, take, with the cooperation of the factors mentioned above, decisions regarding the solution of the problems that make the implementation of the decision difficult, be involved in the implementation of the national plan and monitor it, including by setting milestones for each of the factors involved. The Ministry of Health must act to correct the deficiencies raised in this report and report to the government on the progress of implementing the national plan. The government's involvement and supervision is also required on the progress of the national plan, identifying the problems and finding solutions to address this important issue.

[1]        The report of the Minister of Health on smoking in Israel 2016, published, submitted to the Knesset in May 2017.

[2]        Name, P. 77.

[3]        The committee was chaired by Prof. Roni Gamzo, Director General of the Ministry of Health at the time. This committee was intended to finish the work of a previous committee chaired by Judge Gilon, appointed by then Minister of Health Shlomo Benizri. The previous committee started operating in 1999, but did not submit a summary report for about ten years.

[4]        Resolution No. 3247 of 29.5.11.

[5]        The report of the Ministry of Health, P. 20.

More of the topic in Hayadan:

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• Hiding the medical damage of smoking by the tobacco companies