World Health Organization (WHO)

Framework Convention on Tobacco Control (FCTC)

Shadow Report-Jordan Status

INTRODUCTION

Jordan is located in the heart of the Middle East in the center of the communication
roads between five countries and four continents with a population 6,003,239. Its
capital is Amman City where more than one-third of the population lives. As a
developing country, Jordan has a High rate of smoking prevalence compared to
developed countries. Furthermore, Jordanians view smoking as a social habit;
having coffee and cigarettes with friends and family members is deeply rooted in
the culture. During 2002−2006, 50% of adult men and 11% of adult women
smoked. A recent series of surveys in Jordan estimated smoking rates of 24.9%
among youth, with a 76.3% self-report of SHS exposure , 22.4% among male
physicians , and 28.6% among college students , which rose to 35% in 2008
according to the International Journal of Environmental Research and Public
Health ISSN 1660-4601.(Attachment #----)

Nearly 1 in 5 students smoke shisha; boys 25.4% and girls 12.9%. Tobacco smoke
exposure (ETS) is very high-more than 6 in 10 students live in homes where others
smoke in their presence; almost two-thirds are exposed to smoke in public places;
more than half of students have parents who smoke. An interesting fact to know is
that more than 8 in 10 students think smoking in public places should be banned
and almost three-fourths of smokers want to quit smoking.
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Even though the cigarette market is supplied by nine Jordanian tobacco

manufactures, the use of foreign tobacco is significantly. However, Jordan has a
very small pipe and cigar tobacco market.

PROJECT OBJECTIVES

This project aims to monitor the Jordanian Government's compliance to the FCTC
agreement and examines Jordan's fulfillment of the goals of the treaty with special
focus on "article 13" which addresses the "Tobacco advertising, promotion and
sponsorship".

In 2010, Jordan among the parties that will begin submitting their responses to the
group 2 questionnaire developed by the FCTC Secretariat. The FCA shadow report
will verify and respond to these reports, concentrating on enforcement and
compliance. The global report will focus on “Article 13”, since the 5-year
deadline for implementation of a comprehensive ban coincides with the official
Party reporting deadline. While the global report will include information on other
issues, including “Article 8: protection from exposure to tobacco smoke”: and
“Article 11: Packaging and labeling of tobacco products”, primary observational
data will be gathered only on Article 13 at the country level.

FCTC STATUS IN JORDAN

Jordan is the second country in the Eastern Mediterranean Region and the 29 th in
the world that has adopted the WHO Framework Convention of Tobacco Control.

The Ministry of Health is main party that is responsible for all health matters in the
Kingdom. Historically, tobacco control laws in Jordan evolved from the 1971
Public Health Law. By 1977, after much well-publicized research on the dangerous
effects of smoking on health, MOH issued in regulation no. 64 "Protection of
Public Health from the Health Risks of Tobacco".
Nowadays, several new legislations are evolved to cover all aspects of tobacco
control and to make this mission more comprehensive and broad. (Attachment #--):

WHO conducted a Needs Assessment in coordination with Ministry of Health

(MOH) as part of the FCTC broad framework. This assessment produced
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comprehensive results that can be summarized in the following points (Attachment

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#----):

It was found out that high prevalence of tobacco use in men, still low among
women, some tobacco control measures are in place, but these are relatively weak
as compared to international standards.

A national infrastructure for tobacco control is in place though. The tobacco

control legislations by article are:
Article 6.2: No restriction for imports of tobacco products.

Article 8: Partial ban of smoking in public places, government, health and

educational facilities covered by a complete ban, bars and restaurant by partial ban
GTCR: overall enforcement of the smoke-free legislation is low (4 out of 10).

Article 9: 9 rules for testing and regulation content of products in place.

Article 10: content disclosure requested.

Article 11: warnings of 30% no rotating warning, there is only one general
warning. Currently, the percentage has been raised to 50%.

Article 13: comprehensive advertising ban, including cross-border advertising.

Article 15: measures in place to combat illicit trade.

Article 16: sales prohibited to youth, no age limit given though.

Jordan has carried a couple of actions at the level of policy following the signature
and ratification of the FCTC agreements as follows (Attachment #----)*:

1. Jordan has activated, updating or issuing new laws in favor of FCTC listed
below:
 Issuing the new Public Health Law carrying the number 47/2008.
Chapter two of the new law tackles all aspects of the tobacco and
smoking matters.
 Issuing the law of Adolescent Behavior Control Law.
 Modifying the Law of Driving.
 Modifying the Law of Education.
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 Issuing the religious consents.

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 The MOH chose 4 health warnings and it will appear on the cigarette
boxes and will be rotating periodically taking effect the next 12 month.

2. Other Policy actions are represented by the following:

 Reactivation of National Anti-Smoking Committee.
 Prepare the National Health Youth Strategy.
  Nominates the national focals of anti-smoking in all the Jordanian
directorates of health.
 Forming a national commission to examine the possibility of elevating
the prices of cigarettes pack.
 Forming a national committee to propose actions towards the tobacco and
cigarettes confiscated.
 Issuing of the new standard and specification that proposed 50% of the
area of the cigarettes pack is covered anti-smoking messages that points
out health matters.

Land and Human to advocate Progress (LHAP) was able to support the
implementation of a National Advisory Committee compromised of all concerned
national institutions based on their role in implementing the FCTC agreement and
achieving its objectives:

1. Committee of Health and Environment of the upper house.

2. Committee of Health and Environment of the Lower House.
3. Ministry of Health.
4. Ministry of Finance/Jordan Customs Department.
5. Ministry of Finance/Income and Sales Tax Department.
6. Ministry of Agriculture.
7. Jordanian Institutions for standards and Metrology.
8. Private Sector
9. National Anti-Smoking Society.
10.Jordan News Agency (Petra).
11.Police Department/the Royal Institution for Environmental Conservation.
12. World Health Organization Representative Office in Amman.
13.Jordan University of Science and Technology (JUST).
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*Source: LHAP annual report under American Cancer Society-Cancer Research

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UK-FCA.

Ministry of Health detailed work plan to enforce health law no. 47/2008 can be
viewed in attachment #----- which is prepared by Dr. Malek Habashneh, director of
Health Awareness and Media department at MOH.
On the other hand, Dr. Heba Ayoub, the Director of Protection from Dangers of
Smoking Department at MOH, prepared a detailed presentation for MOH
achievements in the field of smoking combat. (Attachment #-----).

FCTC Definition of Article 13

A ban on tobacco advertising, promotion and sponsorship is effective only if it has

abroad scope. Marketing communication involves an integrated approach to
advertising and promoting purchase and sale of goods, including direct marketing,
public relations, sales promotion, personal selling and online interactive marketing
methods. If only certain forms of direct tobacco advertising are prohibited, the
tobacco industry inevitably shifts its expenditures to other advertising, promotion
and sponsorship strategies, using creative, indirect ways to promote tobacco
products and tobacco use, especially among young people.

The definition of “tobacco advertising and promotion” according to what WHO

FCTC declared in the conference of the parties held at Durban, South Africa dated
17-22 November 2008, is any form of commercial communication,
recommendation or action with the aim, effect or likely effect of promoting a
tobacco product or tobacco use either directly or indirectly. Where FCTC defines
“tobacco sponsorship” as any form of contribution to any event, activity or
individual with the aim, effect or likely effect of promoting a tobacco product or
tobacco use either directly or indirectly.

World Health Organization (WHO) in coordination with Ministry of Health

(MOH) prepared a " Needs Assessment: need report that assessing the situation of
tobacco ban in Jordan. This assessment resulted with a comprehensive matrix that
covers all tobacco articles and different categories of users. We will discuss below
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the results that fall under article 13 (Attachment#----).

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 On the other hand, Jordan doesn't comply with the national laws that
completely ban tobacco smoking indoors restaurants, pubs and bars and in
all other indoor public places.

 Although the national law at Jordan requires fines for violations, it doesn't
dedicate funds for enforcement.
 There is in Jordan a nicotine replacement therapy that can be legally
purchased in a pharmacy without a prescription and is covered by the
national/federal health insurance or the national health services.(refer to
author comment).

 Jordan applies with the national laws that completely ban tobacco smoking
indoors in health care facilities, educational facilities, universities, offices,
public transport. (Refer to author comment).

 The smoking cessation support is available in some of the health clinics or

other primary care facilities and communities.(refer to the author Comment).

 The Jordanian law mandate specific health warnings on packages.

 The percentage of the principal display areas of the cigarette package on its
front and rear that is legally mandated to be covered by health warnings is
30%. This percentage has been raised to 50% of the package.

 Only one health warning is approved by the law. These health warnings
appear on each package and any outside packaging and labeling used in the
retail sale and describes the harmful effects of tobacco use on health, there is
an update from the MOH for this year 2010 indicating that 4 health warning
has been approved and will appear periodically soon.

 Moreover, the Jordanian law mandates font style, size and the color of health
warnings. They are written in Arabic which is the principal language of the
country but they are not rotating.

 The assessment shows that Jordan is already implementing national laws and
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regulations that are completely banning direct advertising of all tobacco

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products in the national TV and radio, but there isn't any law that controls
the direct advertising on the international TV and radio which broadcasted
from abroad including satellite.

 There are national laws and regulations that are completely banning direct
advertising of all tobacco products in the local magazines, newspapers,
billboards, outdoor advertising and at point of sale.
  On the contrary, there isn't a national law or regulation that is completely
banning direct advertising of all tobacco products in the international
magazines and newspapers.

 There are national laws and regulations that are completely banning
promotion of all tobacco products and brand names by free distribution of
tobacco products in the mail or through other means .

BACKGROUND

LCD GROUP DEFINITION, WORK, GOALS AND OBJECTIVES:

Lina Creative & Development Group (LCD Group) is a leader in the fight to
reduce tobacco use in Jordan by changing public attitudes and public policies on
tobacco. LCD Anti- Tobacco group campaigns were the first who integrated
Health, Sports and tobacco advocacy, promoting healthy lifestyle through medical
testing, awareness, entertainments and sport activities.

LCD Group as a member of the Global Frame work Convention Alliance on

Tobacco Control (FCTC) and appointed FCA focal point of Jordan working on
adopting FCTC articles to promote education on the risks and effects of smoking,
LCD group worked with the Jordanian custom and in association with LHAP
another NGO issued Jordan Status in Capturing Illicit Trade (article -15) report and
presented it at the INB4 2010 ,also followed and pushed intensively the formation
of a local alliance that includes all stakeholders in tobacco combat field to achieve
effective and comprehensive smoking control legislation in Jordan, On September
30, 2010 the Social Development Ministry approved the initiation of "The National
Civil Community Organizations Alliance to Combat Tobacco". The Alliance
consists of the following active organizations in the field of fighting tobacco:
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1. Al- Hussein Cancer Center (president)

2. National Jordanian Anti- Smoking Society (deputy)
3. LCD Group (Secretary)
4. Land and Human to advocate Progress (LHAP) (member)
5. Right to play (member)
6. Jordan's Stars (member)
7. Baitna Society (member)
8. Jordan Menopause Society (member)
LCD Group Work and Findings

According to the protocol for observational data gathering stated by FCA, LCD
Group has been gathering data on three basic forms of tobacco advertising in order
to verify compliance with national law (Attachment #----):

1. Point of sale (POS) advertising

2. Outdoor advertising
3. Print media advertising.
Accordingly, LCD Group recruited ( 8) volunteers to gather the required
observational data using a specific data gathering format (Attachment #----) in the
following chosen locations as shown in the attached map (Attachment # ---) :

1- The main city Amman: the population density is 2,027,685 and the location is
Queen Rania Street which is a long avenue cross from the Jordan University where
few of the team members are already students in this university and have all the
requirements from local hospitals, pharmacies, fast food restaurants, small shops,
big supermarkets, several coffee shops, and few fuel stations with selling points
inside.

 2- Zai, Located in Salt smaller suburb: the population density is 349,580. The
same featured avenues and university were selected where also few members of
the team are students there. This facilitated the members' job and made it easier for
them to go around and gather the observational data.
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3- Aqaba: with total population equal to 107,115. A small village not far from the
port with similar features was selected. Although this location is 4 hours trip from
the capital Amman, the team travelled to this village several times to collect the
required data.
The team documented the gathered data and supported it with pictures that display
the streets and shops names.
Moreover, LCD Group chose to deal with local and international media to spread
widely its publications in regard to tobacco combat in Jordan. An example for this
media:

1-   JO Magazine (Social, Business & Cultural English Language Magazine in

Jordan) - http://www.jo.jo/   Jo Magazine Monthly edition.

2-   Achabaka Magazine (Lebanese monthly magazine).

3-   Layalina (Social & Cultural Arabic Language Magazine in Jordan .

4-   Sayidati.net  (international monthly magazine) headquarter Dubai

5-   Al-Ghad Jordanian Daily News paper) (Independent), Amman

http://www.alghad.jo/

6-   Al-Ra'i (Jordanian Daily Newspaper). (Pro-government), Amman

http://www.alrai.com/

LCD Group strengthened its findings by collecting articles, meeting with

publishers and discussing with them the findings. Currently, there is a plan to
broadcast these findings through Television, appearance Radio Talk show, and
more few press releases.

The completed observational data forms concluded very important information in

regard to article no. 13: "Tobacco advertising, promotion and sponsorship" which
can be divided into three categories:

1. Tobacco advertising:
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 There isn't Outdoor advertising such as billboards, posters, etc.(see author

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comments ).

 There isn’t a National advertisement in print media such as magazines,

newspapers, etc.

 The display and visibility of tobacco products at points of sale is not

prohibited.
 Jordan has instituted a comprehensive ban on all tobacco advertising,
promotion and sponsorship.(Refer to Author Comment).

 Jordan is cooperating with other parties in the development of technologies

and other means necessary to facilitate the elimination of cross-border
advertising.

 They are imposing penalties for cross-border advertising equal to those

applicable to domestic advertising, promotion and sponsorship originating
from its territory in accordance with national law.

 the party is precluded by it constitution or constitutional principles from

undertaking a comprehensive ban on tobacco advertising, promotion and
sponsorship, the following was found:
1. The preclusion doesn't apply to restrictions on all tobacco advertising,
promotion and sponsorship.
2. The preclusion apply to restrictions on cross-border advertising,
promotion and sponsorship originating from Jordan's territory with cross-
border effects, prohibiting those forms of tobacco advertising, promotion
and sponsorship that promote a tobacco product by any means that are
false, misleading, deceptive or likely to create an erroneous impression
about its characteristics, health effects, hazards or emission.
3. This preclusion requires that health or other appropriate warnings or
messages accompany all tobacco advertising, promotion and sponsorship.
4. At the same time, this preclusion doesn't restrict the use of direct or
indirect incentives that encourage the purchase of tobacco products by
the public.
5. It doesn't require the disclosure to relevant Government authorities of
expenditures by the tobacco industry on advertising, promotion and
sponsorship.
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 The restrictions on tobacco advertising, promotion and sponsorship apply to

the radio and television, but it doesn't apply to print international media,
domestic internet and global internet.

2. Tobacco Promotion:

 The ban covers the display and visibility of tobacco products at points of
sales.
 The ban covers the domestic internet but not the global one.
 The ban covers the product placement as means of advertising or promotion
and the deception of tobacco or tobacco use in entertainment media
products.
 Moreover, it covers the cross-border advertising, promotion and sponsorship
originating from Jordan's territory or entering Jordan's territory for which
domestic regulations apply.

3. Tobacco Sponsorship & signed agreements :

 On ----- 2010, LCD Group sent official letters to four Governmental

Entities which are: Ministry of Health, Ministry of Social
Development, Youth Higher Council and the Olympic Committee.
LCD Group met with them and asked these Governmental Entities to
provide a list of tobacco companies’ activities and campaigns that are
supporting, funding or sponsoring the various youth, development and
social activities according to them there is no more sponsorship taken
directly from those companies, in the past there were a supported
camping by BAT and the MOH “prohibiting selling cigarettes to
under 18 in Aqaba but it stopped and no more sponsorship accepted
after. The BAT has signed an agreement (attachment #----).

 On ----2004 The Aqaba Special Economic Zone Authority (ASEZA)

in Jordan and British American Tobacco (BAT) recently signed a
memorandum of understanding aimed at protecting the trademarks of
the company's products, and preventing the entry and distribution of
counterfeit and smuggled cigarettes. The MOU calls for information
sharing and joint cooperation between ASEZA and BAT surrounding the
inspection of suspected containers, with the BAT Research and Development
Department providing analysis for suspected products (attachment#)
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 According the MOH assessments report the ban covers tobacco sponsorship
of international events or activities and participants therein.
 Additionally, it covers contributions from tobacco companies to any other
entity for socially responsible causes and/or other activities implemented
under the umbrella of "corporate social responsibility" by the tobacco
industry.
 The restrictions on tobacco sponsorship don't apply to internal events and
activities and participants therein.
Jordan UNRWA presented interesting facts in its Global Youth Tobacco Survey
for the ages (13-15) in regard to the same discussed subject (Attachment #---):

1. 65.0% saw anti-smoking media messages, in the past 30 days.

2. 70.4% saw pro-cigarette ads on billboards, in the past 30 days.
3. 59.3% saw pro-cigarette ads in newspapers on magazines, in the past 30
days
4. 16.9% have an object with a cigarette brand logo.
5. 14.5% were offered free cigarettes by a tobacco company representative.

It is important to know that 74.2% of the studied category want to stop smoking,
74.9% tried to stop smoking during the past year but 82.4% have ever received
help to stop smoking.

On June 15, 2010, LCD Group sent a letter to the FCA shadow reporting
committee. The letter stated clearly that LCD Group initiated 3 groups to do the
walking tours and gather the required data. These groups checked the official
reports and status in Jordan; they toured the points of sales, clubs and public
places. Moreover, they scrutinized the magazines, movies, TV, radio and net
advertising.

As a result of this initial assessment, LCD group come up with the result that
“there is comprehensive advertising ban including cross-border advertising”.
(Attachment #----)

LCD Group as an active fighter in the tobacco control battle, held several
campaigns and activities which had and will continue to have productive impact on
changing people attitudes, behaviors and legislations in the field of tobacco
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combat:
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1. (Thank you for enforcing the law 2009\2010) campaign: LCD group has
been working closely with the government for the past 5 years educating
decision makers on the impact of smoking and encouraging them to enforce
the existing laws. For the year 2007-2008, LCD designed a signature and
awareness campaign and organized a march to the House of Parliament
where the amendment of the health law 2008 was ratified. Additional
campaigning took place throughout the years 2009-2010 around malls and
 public places recognizing the PPL who helped in enforcing the law and
honored them.

2. (Retails campaign2010/2011): LCD group is developing a comprehensive

retailer education campaign to raise awareness about regulations regarding
the sale and distribution of cigarettes to minors, having retailers part of our
community kids protection. This campaign will support and assist in
enforcing the law and in decreasing the numbers of lose cigarettes being sold
to minors.

3. (Shop Busters 2010\2011) LCD group has been working on enforcing the
law through its “Shop Busters” group by training volunteers to go around
and try to buy lose cigarettes from shops around their schools. These
volunteers advocate the owners of these shops to follow the laws. In case
the violation continued, they give warnings to the shops owners and file an
official complaint to the law enforcements and Ministry of Health. They
support their complaint by documenting numbers of visits and monitoring
the selling to others around the schools.

4. (We are the Law campaign, 2010\2011): LCD group is developing a

comprehensive public education campaign using the media and authority
figures encouraging the citizens to enforce the law regardless if they are
smokers or non-smokers. This campaign will educate smokers on the
benefits of applying the law and encourage them to quit. On the other hand,
non-smokers will speak up nicely and ask smokers to not smoke around
them to reduce the tobacco smoke exposure (ETS).

Authors Comments
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Although MOH assured WHO in its Needs Assessment report that there are
national laws that are completely banning promotion of all tobacco products and
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brand names by free distribution of tobacco products, the new trend that
invading the country (usage of Nargeeleh ) where its served in all cafes and many
restaurants, free samples of its flavored tobacco(‫)معسل‬is offered in many
restaurants and cafes especially to youth. also we found out that by doing a simple
search through internet, long lists of tobacco companies that are promoting their
new products Nargeeleh and its flavored substance” ‫ معسل‬maasel” to all groups of
the Jordanian community. (Attachment #---- ) this new trend is taking new step
from being served inside the restaurants and cafes to be delivered to your door
steps (HALLO Argeeleh)service , although the government has been addressing
this issue and issued many violation tickets to cafés and restaurants which provide
this service , evidence shows that this services do exist .

Moreover, messages are sent through mobiles from different restaurants inviting
people to have lunch and Nargeeleh for free. According to Dr.Habashneh the
government is aware of this new trend and the severity of these acts, and took
serious step and will not lease any new coffee shop that serve Nargeeleh as of
April 2010.

 In the same assessment its been mentioning that ,There is in Jordan a

nicotine replacement therapy that can be legally purchased in a pharmacy
without a prescription and is covered by the national/federal health insurance
or the national health services. These services are NOT covered by the
national/federal health insurance. They stated also that the smoking
cessation support is available in some of the health clinics or other primary
care facilities and communities but according to our findings this services
only provided through private clinics not public health clinics.

 Jordan applies with the national laws that completely ban tobacco smoking
indoors in health care facilities, educational facilities, universities, offices,
public transport. Still the implementation of this ban is not even on a
satisfactory level especially in Universities.

 Jordan has instituted a comprehensive ban on all tobacco advertising,

promotion and sponsorship. There is another form of advertising that taking
place where many local society gathering snap shots in local magazine
(layaleena) a national local magazine contain people smoking cigarettes, and
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Narggelah.
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 *******It is worth mentioning that by February 23, 2010 at least 35

countries/jurisdictions have finalized requirements of picture warnings as
shown in the international summary published by Canadian Cancer Society.
(Attachment # -----)

 Attachment #--- displays the largest-sized cigarette package warnings by
country/jurisdictions.
REFERENCES

1. FCTC Needs Assessment for the implementation of the WHO Framework

Convention on Tobacco Control October 2009.

2. Conference of the Parties to the WHO Framework Convention on Tobacco

Control, third session, Durban, South Africa, 17-22 November 2008,
published on 16 February, 2009, reference FCTC/COP/3/DIV/3.

3. Protocol for observational data gathering document.

4. Canadian Cancer Society, International Summary by Rob Cunningham

February 23, 2010.

5. Land and Human to advocate Progress (LHAB), small grants project annual
report, Framework Convention on Tobacco Control Advocacy Grants,
American Cancer Society-Cancer Research UL-FCA, October 26, 2009.

6. Dr. Malek Habashneh, Director of Health Awareness and Media department

at MOH, work plan to enforce health law no. 47/2008.

7. Dr. Heba Ayoub, Director of Protection from Dangers of Smoking

Department at MOH, presentation for MOH achievements in the field of
smoking combat.

8. International Union Against Tuberculosis and Lung Disease, Fact Sheet 03,
Tobacco Control at the Union, United for a tobacco-free future.
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ATTACHMNETS:
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1. Articles
2. Photos