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Background Turkey is praised by the global health sector as an exemplar for tobacco control being the first country in the world to pass all policies into law. Tobacco use that decreased in 2009- 2013, increased again after 2013 along with respiratory-related mortality rates. This study is carried out to detect the challenges to effective implementation, to analyze the weaknesses and develop recommendations for securing tobacco control sustainability. Methods Tobacco production and sales data, tobacco industry activities, legislative and litigation process, civil and public infrastructure for tobacco control was investigated between 2009-2016 by media monitorization, political mapping and website surveys. Results Domestic cigarette sales decreased by 15.8 billion sticks between 2009 -2013 and increased by 13% between 2014- 2016. Similar trends were recorded in other tobacco products. Water-pipe tobacco sales which increased by18 %, and 'roll-your-own' tobacco by 126 %. The factors which elevated this reversal include; tobacco industry interference and corporate social responsibility (CSR) activities, government incentives to the industry, the legal challenges instigated by the industry that have delayed the passage of new tobacco control laws in particular on labeling, weakened implementation and enforcement of tobacco policies in bureaucracy and at local level. Burnout experienced by the public and tobacco control stakeholders contributed to the trend. Conclusions The implementation of financial and structural strategies such as having a portion of tobacco excise taxation dedicated to a health promotion fund, a national focal point for tobacco control, ensuring civil society representation on national advisory committees, regular data collection for tobacco related mortality, morbidity and social costs, and having a national evaluation framework can assist in reducing tobacco use in Turkey. Key underpinning policies may include; enacting FCTC Article 5.3 as a cross-governmental policy, and establishing a policy to prevent tobacco industry CSR activities. |
