Tütün Kontrolü Strateji Belgesi ve Eylem Planı

Objectives

The 2018–2023 Tobacco Control Strategy Document and Action Plan provides a six-year national roadmap to protect everyone from the health, economic, environmental and social harms of tobacco products. It prioritises preventing initiation, particularly among children and young people; reducing tobacco demand and access; supporting cessation; eliminating exposure to tobacco smoke; regulating products and commercial practices; combating illicit trade; and strengthening coordination, monitoring and evaluation.[1][2][3]

• Prevent tobacco use initiation through education, awareness-raising and measures that reduce children’s and young people’s access to tobacco products.[2][4][5]
• Reduce tobacco use among people aged 15 and over from 31.6% to 24% by 2023, and reduce use among 13–15-year-olds from 17.9% to 10%.[6]
• Increase cessation motivation and service effectiveness, including a target to raise the smoking-cessation clinic one-year success rate from 16.4% to 36% by 2023.[7]
• Reduce exposure to second-hand smoke through smoke-free indoor and expanded outdoor environments, with particular protection for children, young people and pregnant women.[8][9]
• Use information and awareness, cessation, pricing and taxation, smoke-free protection, advertising restrictions, and control and disclosure of product contents as the principal demand-reduction areas.[2]
• Restrict advertising, promotion and sponsorship; standardise packaging; strengthen health warnings; regulate contents and emissions; and prevent misleading claims about tobacco, electronic cigarettes and novel tobacco products.[10][11][12]
• Reduce illicit trade and improve controls on access, including sales to people under 18, individual-cigarette sales, retail displays and waterpipe tobacco.[13][4][14]

Implementation

The plan combines legislation, fiscal policy, public communication, education, healthcare-based cessation, inspections, product regulation and multi-sectoral governance. It is designed for nationally coordinated implementation with local delivery, defined indicators and annual targets, drawing on previous tobacco-control experience, stakeholder input, research and international good practice.[15][16][17]

• Coordinate national implementation through the Ministry of Health, including its General Directorate of Public Health, supported by an addiction-control High Council, Addiction Control Board, technical working groups, provincial governors, provincial health directorates and local tobacco-control boards.[18][16]
• Engage ministries, universities, municipalities, civil-society organisations, media representatives, professional groups and local administrations in policy development, delivery and review.[16][19][20]
• Deliver prevention through formal and non-formal education, peer education, youth centres and camps, role models, school clubs, sports activities, public-sector training and campaigns targeted at priority populations including young people and women.[3][21][19]
• Provide cessation support through smoking-cessation clinics, the ALO 171 Smoking Cessation Advice Line, brief interventions during health-service encounters, digital tools, follow-up, pharmacological treatment and cognitive-behavioural support.[22][23][24]
• Expand cessation provision across primary, secondary and tertiary care, integrate tobacco-use recording into health information systems, and link the Family Medicine Information System with ALO 171.[24][25][26]
• Apply taxation and automatic price adjustments to make tobacco less affordable, including increases in special consumption tax and measures linked to per-capita domestic product and minimum-wage trends.[27][28][29]
• Enforce smoke-free measures through routine, complaint-triggered and cross-jurisdictional inspections, using the ALO 184 Tobacco Reporting Line and Green Detector application, with approximately 1,500 inspection teams operating nationwide.[30]
• Strengthen retail, advertising and industry controls through point-of-sale inspections, age-verification requirements, restrictions on product visibility, online monitoring, penalties, publication of fines and six-monthly review of tobacco-industry interactions and support.[31][32][33]
• Establish an independent accredited national tobacco-product laboratory, increase inspections across production, import, storage and sale, use electronic notification of contents and emissions, and publish relevant analysis results for the public.[34][35][36]
• Monitor progress through final and intermediate indicators, annual targets, tobacco-use surveys, targeted research, indicator-monitoring cards, online data entry, annual reporting and public sharing of results.[15][16][37]
• Use provincial data to assess local administrative performance, and track implementation of board decisions, timely completion of activities, achievement of approved project objectives, and participation by universities and municipalities in joint projects.[38][17][39]
• Provide operational budgets for tobacco-control boards and councils, while the supplied material does not specify a consolidated programme budget, total costs, funding gap or comprehensive financing framework.[37][40]

Monitoring & Evaluation

The plan establishes a national monitoring, evaluation and accountability framework for tobacco control, combining outcome indicators, annual targets, surveillance research, implementation tracking, inspection data and public reporting. It covers final and intermediate objectives, with indicators and targets linked to initiatives and activities for 2018–2023.[15][1][17]

• Monitor population outcomes including tobacco use among people aged 15 and over, initiation and use among 13–15-year-olds, cigarette consumption, intention to quit, cessation outcomes, passive exposure, tobacco-attributable acute hospital presentations and lung-cancer rates.[6][2][8]
• Track annual progress against defined targets, use reference-source baselines, undertake research where data are missing, and update targets when baseline data change.[1][27]
• Conduct surveillance through the Global Adult Tobacco Survey every four years, the Turkish Statistical Institute Health Survey every two years, tobacco-specific surveys in intervening odd-numbered years, and provincial-level data collection to support annual national monitoring.[38]
• Use provincial data to assess the performance of provincial governors and other local administrators.[38]
• Develop indicator-monitoring cards specifying indicator names, data-collection frequency and calculation methods; introduce software for online entry of stakeholder data, online reporting and publication of evaluation reports.[37][41][42]
• Report activities annually and share results publicly, while using impact assessments to determine whether interventions should be expanded or updated.[15][16]

Monitoring extends to service delivery and implementation. Smoking-cessation indicators include one-year abstinence after clinic or ALO 171 support, brief interventions during healthcare encounters, smoking-status recording and cessation advice. The clinic success-rate target rises from 16.4% to 36% by 2023, while the ALO 171 target rises from 8% to 15%.[23][7]Inspections monitor smoke-free compliance, tobacco sales, age-verification practices, advertising, product presentation, illicit trade and hookah establishments.[43][44][30][45]

• Maintain routine, complaint-triggered and cross-jurisdictional inspections, including 24-hour, seven-day inspection activity responding to reports through the ALO 184 Tobacco Reporting Line and Green Detector application.[30]
• Assess enforcement through indicators such as the two-hour response rate for complaints, violation-detection rates, numbers of inspections, closure-penalty follow-up and compliance at licensed premises.[46][47][48]
• Monitor process performance through the implementation of board decisions, timely completion of activities, achievement of project targets, and participation by universities and municipalities in joint projects.[17][39]
• Apply performance assessment to provincial tobacco-control board members and link performance records to sanctions under institutional regulations.[47][49][50]
• Review tobacco-industry information and documents every six months through a multi-institutional commission, and publish fines imposed following inspections to support accountability.[32][33][51]

The Ministry of Health leads coordination, secretariat and implementation follow-up through its General Directorate of Public Health, while provincial health directorates implement activities under provincial governors. National and local tobacco-control boards, the National Tobacco Control Coordination Committee and addiction-control councils support cross-sectoral oversight.[52][18][53]Detailed audit methods, a single consolidated reporting timetable and an independent evaluation body are not fully specified in the supplied extracts.[15][17][54]

Costing & Financing

The plan contains limited explicit costing. It primarily uses fiscal policy to reduce tobacco demand and potentially mobilise resources, while identifying selected budget needs and in-kind resource requirements without providing an overall programme budget, expenditure total, funding gap or comprehensive financing framework.[55][27][37][40]

• Increase tobacco taxes and prices in relation to per-capita gross domestic product, minimum-wage growth and purchasing power; maintain automatic price updates and increase special consumption tax in January and July.[27][28][29]
• Use taxation as a demand-reduction instrument, with cited evidence that a 10% tobacco-price increase is associated with a 4% reduction in consumption in high-income countries and a 5% reduction in middle- and low-income countries.[55]
• Report an average tax burden of 85.3% on a packet of cigarettes, comprising two types of Special Consumption Tax and value-added tax.[55]
• Align tax rates for cigars and cigarillos with cigarette taxation, increase taxes on imported tobacco, and consider an additional general-budget tax on tobacco-product suppliers linked to amounts invoiced to retailers and hookah establishments.[28][56]
• Use proceeds from the proposed additional supplier-linked tax to support tobacco-control activities through the general budget.[28][56]

Resource requirements include free tobacco-dependence medicines and nicotine-replacement therapy through cessation clinics, continuity of pharmacological treatment, system-integration software, possible additional cessation units, a national tobacco-product testing laboratory, inspection teams and communication activities.[57][34][58][26]The plan also identifies the need for sufficient budgets for tobacco-control boards and addiction-control councils, performance-related payments for inspection teams from provincial tobacco-control board budgets, and a defined software budget for a cessation smartphone application, but gives no monetary amounts for these items.[47][37][59][40]

Explicit financial figures in the extracts include annual amounts for tobacco-harm information activities, rising from 300000 in 2018 to 2000000 annually from 2021 to 2023; neither currency nor funding source is specified.[60]A media-incentive budget was to be defined in 2018 and then increased by 10% annually from 2019 to 2023, without an absolute amount.[61]The extracts do not specify whether the listed annual activity amounts are budget allocations, expenditure estimates or another financial measure.[60]