This report, based on a household survey conducted in 2006, discusses options for discouraging qat consumption in Yemen. It draws on a survey - the first representative data collection exercise aimed specifically at assessing the qat consumption phenomena - which confirms that the use of this drug is widespread. Qat is consumed by men, women and children; its use is extremely time consuming; it drains the family budget; has adverse health effects; negatively affects work performance and thus contributes to poverty.

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Weaning consumers from the qat habit will be difficult, because its production accounts for some 6 percentof GDP and 14 percentof total employment. Qat consumption requires around 10 percentof the household budgetof all income groups, which comes at the expense of basic food, education and health. To reduce qat consumption, this note recommends a setof economic and non-economic policy measures. These include: increasing the tax burden; building public awareness; incorporating training on the hazards of qat in the school system; enforcing public policies aimed at discouraging qat consumption (e.g., extension of working hours); closing knowledge gaps and developing viable crop diversification programs.

Executive Summary

Qat (Catha edulis) plays a major economic role in the Yemeni economy. It accounts for around 6 percentof GDP, 10 percentof consumption, one-third of agricultural GDP, and provides employment for one in every seven working Yemeni. As the predominant cash crop, the income it generates plays a vital role in rural economies. But it also depletes scarce water resources and has crowded out production of essential food crops and agriculture exports.

Until the 1960s, qat chewing was an occasional pastime, mainly for the rich. Now, it is chewed several days a week by a large share of Yemen’s population. Widespread qat consumption has grave consequences: its use is linked to widespread child malnutrition and household food insecurity since spending on it pre-empts expenditures on basic foods and essential medicines. The adverse health effects of qat are many and include high bloodpressure, under-weight children (when pregnant women chew qat), cancer (from consuming pesticide residues), and dental diseases. Consumers spend, on average, nearly 10 percent of their income on it, and the physical actof using the drug requires several hours in a day. The culture of spending extended afternoon hours chewing qat is inimical to the developmentof a productive work force, with as much as one-quarter of usable working hours allocated to qat chewing.

Discouraging qat use is a complex task. In recent years, the Government has taken bold steps to initiate a debate on qat (notably the 2002 national conference) and to encourage cultivation of substitute crops. Despite these measures, qat production and consumption continues to rise at a blistering pace. A better understanding of the extent and nature of qat consumption is needed if the Government is toformulate effective policies aimed at encouraging consumers to reduce qat use. What is known about qat consumption is often drawn from small samples and anecdotal observation. To help fill this knowledge gap, a sample survey of qat consumption habits was conducted by the World Bank in April-May of 2006. The survey covered 4,027 Yemenis above the age of 12 in seven of Yemen’s 21 Governorates, including the Sana’a Capital Secretariat, Sana’a Governorate, al-Hodayda, Ta’izz, Marib, Aden and Hadhramawt.

The survey results show that qat is a nationwide habit. Some 72 percentof Yemeni males reported that they chew qat, compared to 33 percent of females. Most Yemeni’s are habitual users-more than half of those who chew do so each day of the week. Moreover, qat use incidence is highest in those parts of the country where it is cultivated or where the consumption habit has a long history.

Yemenis start to consume qat during their teenage years, with first use occurring on average between 16 and 24 years of age. Men tend to use qat until they reach old-age, at which point consumption tapers off (as other illnesses set in). By contrast, women tend not to use qat before they are married, and the older they get, the more likely they are to use it. Qat is predominately chewed in the home, and some 75 percent of qat users declare that they chew during their leisure hours. Men are more likely to relax and chew (82 percent), while some 44 percent of the women combine work and chewing.

Most consumers start their qat habit because of peer pressure: Some 66 percentof the men and 72 percent of the women claim that the reason they started to chew qat is because “all my friends and family chew”. Those who abstain do so because they are aware of the adverse health effects and the high cost of using qat.

Users do know that qat is harmful to their health. Some 80 percent of all male users and 70 percent of all female users report health disorders that are perceived to be related to qat consumption. In addition, a quarter of all users suffer from chronic sleeplessness that is related to qat use. Practically all of the qat users self-treat these ailments with a range of traditional cures and modern medicines.

Qat use hampers productivity and directly contributes to poverty. The enormous amount of time spent chewing qat is time that, in other countries, is typically spent in productive activities. Some 36 percent of the users spend 2-4 hours per day; 35 percent spend 4-6 hours a day, and an astonishing 22 percent spend more than 6 hours a day chewing qat. Most users believe that qat enhances their immediate work performance, but about a third reports that work performance is impaired the day after chewing qat. The overwhelming majority of qat users are aware that its use is costly, and that it has a detrimental effecton their ability to afford basic foods, medicines and other essentials. Some 94 percent of non-chewers and 77 percent of chewers report that qat has a negative effect on the family budget. Tragically, just under a fifth of all qat users are forced into debt to finance their chewing habit.

Most users believe that qat is bad for them. More than 70 percent of the respondents describe qat chewing as a “bad habit”, that is also bad for the economy and bad for the nation’s image. Users want to “kick the habit” but they cannot. Either because of social pressures, or because of the psychological dependency resulting from prolonged use, users do not feel that they can stop using qaton their own. Some 53 percent of all male and 61 percent of all female respondents declare that Government intervention is necessary to address the qat problem.

What can the Government do? The Government can begin to take steps to curb the widespread demand for qat. National leaders need to be engaged in campaigns to reduce qat use, and they can start to show their support by vigorously enforcing the policy measures adopted since 1999 to curb the qat habit. In the future, the Government can help discourage qat use by making it a far more expensive habit. If cigarettes are a fair comparator, then consumption can be taxed at a substantially higher rate, and by shifting from ad valorum to specific taxes and by using tax stamps, those taxes could be far more effectively enforced. Over time, the Government can help to convince consumers that qat use is a bad habit and should be stopped.

Building on the findings from this survey, a well-targeted public awareness campaign could be launched, to let consumers know more about the adverse effects of qat use, including the fact that most users know it is a bad habit; the vast bulk suffer adverse health effects; it drains user’s budgets and puts them into debt; and that users would like Government help to kick the habit. Information campaigns should initially be targeted to young people, both inside the schools and out, since preventing the qat habit from starting could have a major effect on national demand in a decade or less. Working together with leading NGOs, a combination of a well-targeted public awareness campaign, peer-to-peer education, and positive examples set by leaders and cultural figures could be used to convince consumers, and especially the youth, that qat use is harmful to themselves and society.

Government support is also needed to promote effective substitutes for qat consumption. For youth, there is a pressing need for greater access to sports, youth centers, and cultural activities. For the adult population, the main challenge is to boost employment demand. Policies aimed at making the economy more competitive and conducive to private initiative will increase the opportunity cost of the tremendous amount of time now devoted to chewing qat.

Research on the causes and consequences of qat consumption, and the behavioural pressures associated with qat uptake is limited in number and scope. While demand control interventions are being implemented, parallel research activities into these issues may help to refine the targeting of interventions, such as those designed to improve health information for the poor, for maximum effect. More research is also needed to identify an appropriate package of supply-side measures that could be used to mitigate the likely long-term effects of qat cultivation on employment and rural incomes. A combination of legal reforms, crop diversification measures, improvements in water resource management, and social safety net measures will be required to facilitate the shift in resources that now go into producing qat into other forms of productive economic activity.