Tobacco Epidemic in the Maghreb Region: A Systemic Failure
The tobacco epidemic is a pressing issue in the Maghreb region, where a 12-year-old Algerian child can buy cigarettes individually in front of their school. This paradox, revealing a systemic failure that transcends borders, was at the heart of a medical meeting that brought together Algerian, Tunisian, and Libyan practitioners in Tunis on June 2, at the initiative of med.tn, a digital health platform and the first online medical professional network in Tunisia. The meeting resulted in not only a shared diagnosis but also the outline of a coordinated regional strategy to combat an epidemic associated with over 30 distinct diseases by the World Health Organization.
The Alarming Reality
The initial finding is brutal: a quarter of Algerian students aged 11 to 19 already smoke, and the first cigarette is often lit before the age of 10. At the university level, 9% of students are affected, with a marked male predominance, while 26% of industrial workers and 18% of healthcare professionals are smokers themselves. This last figure undermines the credibility of preventive messages, as emphasized by Algerian epidemiologist Souad Bouaoud. These numbers still underestimate the reality: in the three countries, social stigma surrounding female smoking leads many women to not report their consumption. In Libya, political instability prevents any reliable data collection, but the situation is likely comparable to that of neighboring countries, according to pneumologist Hssan Mosrati, who also points out the fragmentation of responsibilities as an aggravating factor.
The Need for Adapted Solutions
According to Tunisian cardiologist Dhaker Lahidheb, when a patient consults a specialist, it is often too late to act upstream. While countries like Australia, New Zealand, or Scandinavian states have successfully reduced the impact of tobacco through proactive policies, experts believe that the Maghreb region must develop solutions adapted to its own social, economic, and cultural realities.
Silent Victims: Non-Smokers
Involuntary exposure adds an additional dimension to the urgency. A person sharing space with a smoker inhales the equivalent of four to five cigarettes from a whole pack; a hookah session corresponds to the consumption of ten to fifteen cigarettes. In many Maghrebian households, smoking in the presence of children does not provoke a social reaction, exposing women and minors to substances they never consented to. Legal bans in public places exist but remain unenforced due to a lack of effective control and sanction mechanisms, laments Bilkhir.
Fiscal and Legal Challenges
Fiscal policy constitutes one of the most powerful and underutilized levers. Price differences between neighboring countries fuel cross-border trafficking, which cancels out the effects of national tariff increases. "If we increase prices in one area and not in others, we've done nothing. The strategy must be unified," Lahidheb asserts. Algeria has indeed introduced specific taxes, recalls Bouaoud, but their impact remains marginal outside a harmonized regional framework, accompanied by the allocation of part of the revenue to prevention and oncological care.
The Application of Existing Law
The application of existing law represents a challenge of equal urgency. Algeria has signed and ratified the WHO framework convention, and its legislation formally prohibits the sale of tobacco to minors and consumption in public spaces. In reality, the law remains ineffective: 12-year-old children buy cigarettes individually, and non-smoking areas exist only on paper.
Solutions
Prevention of tobacco use must target children from the age of 10-11, before the critical initiation age of 13-15. Experts recommend using marketing tools and social networks to counter the influence of the tobacco industry, which already exploits artificial intelligence in its campaigns. They also emphasize the importance of strengthening support for smoking cessation, as the majority of smokers are aware of the risks of tobacco but do not know how to quit. Developing support structures and providing free access to nicotine substitutes are among the priorities.
