No smoking: How one city is cutting the hookah haze

For years, this kingdom has struggled to kick the habit.

Going cold turkey was out of the question; not even a fatwa, or religious edict, could shame people into putting out their cigarettes in public.

No government office or police station would be complete without a haze of smoke, or desks littered with cigarette-stuffed coffee cups. Wedding hosts who failed to serve cigarettes to guests on a silver platter were considered rude. Public service announcements and images of diseased lungs stamped on cigarette packets did little to slow down the nation’s nicotine intake. Raising cigarette prices twice failed to do the trick.

Jordan is home to the second-highest smoking prevalence in the world, with more than 60 percent of adult citizens and 70 percent of adult males smoking, according to Jordan’s Health Ministry. The World Health Organization warns that the tiny kingdom is poised to knock off Indonesia for having the highest number of smokers per capita in the world. 

With health costs rising and medical experts linking smoking to 26 percent of male cancer cases, Jordan’s Parliament passed a law in 2008 banning lighting up in government offices, shopping centers, malls, airports, hospitals, and schools.

Compliance was, officials and citizens say, “minimal.” Many openly flouted the law. Teachers still smoked in the hallways of government schools, doctors and nurses lit up in examination rooms, and government ministers dragged on cigarettes while addressing Parliament on national television.

So in 2017 Amman Mayor Yousef Shawarbeh decided that if the nation couldn’t comply, then the municipality would try to enforce the ban itself.

“Half of Jordan lives in Amman, and the other half come here to do business and visit their relatives,” says Mervat Mheirat, deputy director of the health and agriculture department at the Greater Amman Municipality (GAM). “If we can change the culture in a diverse capital city, when people go to their home towns and villages, they will start to bring that culture with them.”

Mr. Shawarbeh and the GAM in 2017 teamed up with Partnership for Healthy Cities, a 54-member global alliance sponsored by Bloomberg Philanthropies to tackle noncommunicable diseases and public safety issues ranging from diabetes to smoking and traffic accidents.

The Partnership for Healthy Cities linked Amman with municipal workers and health officials from across the globe waging their own health campaigns. From Cape Town and Jakarta, Amman officials learned how other developing countries were tackling tobacco. The municipality trained 22 health inspectors to patrol parks, museums, malls, and restaurants across the capital to enforce the ban.

“We believe in the significant role of cities in influencing national governments and legislatures by providing a positive model, and Amman has run with it,” says Kelly Larson, director of Partnership for Healthy Cities.

The municipality also had a secret weapon: an acute understanding of Jordanians’ smoking habits.

With youth, a borderline crisis

Unlike the United States, Europe, and most of Asia, Jordan has to contend not only with cigarette smoke, but with shisha. The tobacco water pipe, or hookah, made famous in Ottoman-era Turkey and Egypt, has become widespread in much of the Arab world over the past two decades.

With flavors such as bubblegum, watermelon, and Red Bull, shisha became particularly attractive to Jordanian teenagers and children as a socially acceptable alternative to cigarettes and alcohol, becoming the pastime in Amman, with the water pipe creeping into restaurants, cafes, and public parks.

It was a phenomenon bordering on a crisis: More than one-fourth of Jordanian children age 13 to 15 regularly smoke shisha, according to the Health Ministry.

The Amman municipality passed an edict banning the issuance of any new shisha permits, but already-licensed cafes and restaurants could renew each year in perpetuity. 

Then, through intensive lobbying alongside the Health Ministry, the municipality encouraged members of Parliament to pass an amendment to the law in 2017 to include restaurants, hotels, and cafes in the smoking ban, requiring establishments to restrict smokers to walled-off smoking sections, and prevent the entry of people under the age of 18.

Under the amended law, individuals smoking in public areas face fines from $140 to $280. Establishments in violation may be fined a stiff $1,400 to $4,200 per infraction, and owners face a potential of three months in prison.

The Amman municipality took it one step further and banned restaurants and cafes from advertising tobacco products, particularly shisha. Now cafes cannot even include an image of a water pipe in brochures, menus, and posts on Facebook, Instagram, WhatsApp, and Twitter.

Cultural shift?

Two years in and the city-based approach is making a noticeable difference. City buses no longer reek of smoke, and drivers stop passengers before they can reach for their lighters. Public parks have mostly been cleared of water pipes used by young men, women, and children.

Fear of inspections has led most government ministries and offices to section off smoking areas; many have plans in place to gradually restrict smoking to outside government buildings.

More than 200 out of the 300 registered tourist restaurants are complying with the regulations by walling off separate smoking sections, in addition to 160 cafes, according to the Jordan Restaurants Association.

Cafes now turn away young unaccompanied minors, and workers warn those lighting up in the nonsmoking section, saying, “We don’t want the municipality to catch us.” In the last three months of 2018 alone, the Amman Municipality raised almost $68,000 in fines from institutions and restaurants. It issued 982 fines last year in total.

Perhaps one of the biggest changes is the emergence of a new establishment: the smoke-free Jordanian eatery.

Dahab, an upscale restaurant a stone’s throw from the US Embassy, became the first restaurant to comply with ministry and municipal regulations in 2017, walling off half of its restaurant for smokers. At 2 p.m. on a Wednesday, after the lunch rush hour, there are four full tables in the nonsmoking section. In the glass enclosure, some 15 people recline in chairs and puff away on 12 shishas.

Customers were indignant at the changes at first, staff say, but they are catching on.

“We are not talking about enforcing a law, we are talking about changing a culture and attitudes, and that takes time,” says Bilal Amra, general manager of Dahab. “But people are learning that you can indeed go out with your family, enjoy a meal or a coffee, and not sit in a cloud of smoke. And more people are demanding it. This is the future.”

Despite the success, the question remains whether an urban campaign can reach the outer, rural provinces, where small communities often pressure officials – their relatives – to bend the rules.

The Amman municipality and Bloomberg say they have a model ready for those willing to try.

“We have proven that if you have the political will and commitment to clean the air in a city of 4 million, we can do it in a town of 40,000 or a village of 4,000,” said Ms. Mheirat, the Amman Municipality health director.