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Turkey: the trade–health divide

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Despite Turkey's steady transition from relative poverty and isolation to a modern European nation, it still retains some of its old image. In this country on the join of Europe and Asia, still occasionally emanating more than a whiff of its past mystery, when its Ottoman court ruled over a great empire, all is not always as it seems. Nowhere is this more evident than in the recent history of tobacco, as recorded in several past issues of this journal. Its model tobacco control legislation has repeatedly been the target of attempts to circumvent the total advertising ban it contains. The growth of a strong and active health coalition is more than matched by increasingly subversive measures to establish Formula One motor sport, apparently for the sole purpose of illicit tobacco promotion. It is possibly the unlikely success of health interests, in a country where the international tobacco industry must have least expected serious opposition, that has pushed the tobacco industry's counter offensives deeper underground.

In April, the minister of culture officially opened the newly restored building that housed Turkey's first modern parliament, dating from 1923, a place of great reverence for Turkish people and akin to a national monument to the founder of modern Turkey, Mustafa Kemal Atatürk. Who had paid for the highly costly restoration? Philip Morris, a public company that does not spend its shareholders' money like this without having a clear business objective in mind. The minister had told critics in the health coalition that they were prejudiced, and that this was a simple service to the state; but thanks to the coalition's media advocacy work, public opinion has moved on in Turkey. The minister received a blizzard of protest faxes, and was subjected to stinging criticism in the media for his involvement with a tobacco company whose true motives the press and public seemed to have little difficulty understanding.

It is not hard to see what some of the payback for Philip Morris might be. Shortly before the ceremony at the old parliament, for example, the government's foreign trade office convened a preparatory meeting for the Turkish delegation going to the second Intergovernmental Negotiating Body (INB 2) of the International Framework Convention on Tobacco Control (FCTC). Among those invited were representatives of Philip Morris, Japan Tobacco (incorporating the old RJ Reynolds international business), and Tekel, the Turkish tobacco monopoly. Some of the industry delegates appeared very confident, variously threatening a woman from the health ministry that they would have her removed from the delegation, and telling a senior professor of chest medicine that they could take him to court. Not surprisingly, this inauspicious start was borne out later by Turkey being openly branded by health advocates at INB2 as one of the countries whose delegation's agenda was the preservation of the tobacco industry, not health.

But worse was to come. Turkey has been going through a severe and prolonged economic crisis, an unfortunate development for a country striving to become a successful player in the international marketplace and a full member of the European Union. So the government applied to the international community for help, and after lengthy negotiations with such bodies as the World Bank and the International Monetary Fund (IMF), and involving discussions with both US and British finance ministers, a deal was struck. If the Turkish government would reform 15 key sectors of the economy, it would receive a substantial IMF loan. Ominously, one of the sectors was tobacco. The bank sent its Turkish vice chairman, Mr Kemal Dervis, to be appointed minister of economics as part of the deal. In May, Mr Dervis signed an agreement with the IMF for $3.8 billion for the tobacco sector, part of a massive $17 billion overall injection into Turkey's ailing economy.

One of the conditions of the tobacco loan, as expected, was that Turkey must approve a new tobacco law, whose draft, when revealed, appeared to have been heavily influenced by tobacco companies. It set a capacity threshold whereby companies producing more than two billion pieces in one shift would be given freedom of importation and pricing, a massive advantage that would be denied to smaller manufacturers such as Tekel, soon to be privatised. To the shock of the health community, the bill also prescribed a potentially industry laden committee to control all aspects of tobacco—including health considerations. The government let it be known that all the reforms were stipulated by IMF and the World Bank, in the interests of modernising Turkey's economy along free trade principles. Discreet inquiries at the bank, however, revealed that on tobacco at least, the very opposite was the truth. The most tobacco friendly parts of the draft bill had come from Turkey.

Fast forward to June, and we see Mr Dervis, the World Bank man in Turkey, frantically telling the minister responsible for privatisation to take out the threshold clause, and insert another stipulating that nothing in the new law should override the existing tobacco control act. The bank, which became officially pro-health on tobacco a decade ago, was anxious not to be blamed for undermining a rare example of a model tobacco control policy in the region. Rather than do the bidding of Mr Dervis, the privatisation minister resigned, though his principles did not seem to be offended so much by the health concession as by the removal of the threshold clause so keenly sought by the big multinationals. Conversely, the bank had picked up an unlikely supporter for the threshold change—BAT. Unlikely, that is, until it is realised that, being a newcomer to Turkey's lucrative market and strategically well placed export base, the threshold would have sidelined not just the state company, but BAT as well.

Parliament approved the tobacco bill with Mr Dervis's amendments, and BAT immediately announced its entry into the Turkish market. Its optimism was short lived. Just two weeks later, in early July, President Sezer vetoed the bill. In addition to the freedom the bill would have given the international tobacco industry, it appears that the President was especially concerned about its threat to four million jobs dependent on tobacco growing.

Whatever happens in Turkey during the next year, it seems that tobacco will dominate the country's part in the FCTC negotiations, and that ultimately, Turkish tobacco policy will boil down to a choice: free, unfettered tobacco trade, or the interests of health being given precedence. This choice, faced and mostly won by health advocates in Thailand in the 1990s in their pioneering appeal to international trade authorities, is likely to surface increasingly around the world over the next few years. The tobacco industry, with everything to play for, will continue to exploit the plight of countries with weak economies to try to ensure that free trade, along with their profits, wins out over health.