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In February, Yugoslavia became a federal state called the Republic of Serbia and Montenegro. Through times of war, internal strife and economic hardship, health has taken a back seat. Now Serbia, emerging from international isolation, is on the brink of another catastrophe—an epidemic of tobacco deaths.
In Serbia, every second man smokes, as does every third woman, and every fourth teenager. The past three decades have seen a dramatic increase in smoking among women, and among secondary school and college students. Cardiovascular diseases, cancer, and lung diseases—already the leading causes of death in Serbia—are rocketing.
Although Serbia has a thriving domestic tobacco industry, the transnational companies are not far behind. Alongside local brands, Serbs puff on Lucky Strike, Marlboro, and—for those who can afford it—Davidoff. In spring, Belgrade hosted its International Film Festival. The main sponsor was BAT.
As former Yugoslavia, the country was a key destination and shipment route for smuggled tobacco, and transnational tobacco companies have shown a keen interest in domestic production (see Tobacco Control 2002;11:92–3). Health interests campaigned for measures to curb domestic production, prevent transnational companies from taking control, and ban all tobacco advertising. New tobacco legislation enacted in February provides low interest loans for tobacco growing and manufacturing and a licensing system for tobacco manufacturers. The transnationals seem poised to pounce.
While the legislation may go some way towards combatting smuggling, it pays scant attention to health. The only provisions are to ban tobacco sales to under 18s, and require health warnings—size unspecified—on packs. The future of legislation to regulate tobacco advertising seems uncertain, following the assassination in March of the prime minister, Zoran Djindjic.
But some progress is being made. A National Commission for Prevention of Smoking has been formed, and a campaign launched in partnership with government and NGOs. Support has come from the World Health Organization, the European Agency for Reconstruction, the Canadian International Development Agency, and UNICEF. Philip Morris also offered its help—and was refused.
The first phase of the campaign concentrates on health professionals, in the hope that their lead will influence others. The target may not seem easy: more than one in three doctors (37%), and one in two nurses (52%) smoke. More than four out of 10 (42%) family doctors and one in four (25%) paediatricians smoke. But more than eight out of 10 (85%) have tried to stop, citing in the main health concerns—and just as many say they advise their patients to quit.
Concern about the health effects of smoking is high: 85% of smokers are worried about the effect of secondhand smoke on children, and 75% of smokers worry about their own health. The campaign aims to tackle both these concerns, by targeting the protection of non-smokers and encouraging smokers to quit.
A 1995 law, poorly respected, restricts smoking in public places. Health institutions are drawing up action plans to make their premises smoke-free, and information posters and signs are being distributed. Counselling services and information for smokers encourage and support quitting, and leaflets for non-smokers give advice on how to help.
A public information campaign has also begun, with spots on state and private television, radio jingles, and billboards urging smokers to quit. On national No Smoking Day at the end of January, hoards of smokers exchanged their cigarettes for fruit at a large tent in central Belgrade.
Halting the tidal wave of smoking induced illness that seems set to engulf Serbia in the next few decades seems a tough order. But in a country battered and impoverished by economic flux, conflict, and political instability, tobacco control seems the only prescription.