Tobacco control in EU

Vesna-Kerstin Petrič

Uliana Bakh

• Tobacco - the biggest public health challenge

in Europe

• Tobacco control measures in EU

• FCTC

• Implementation in the countries

• Projections

• What next

• Tobacco consumption is the single largest

avoidable health risk, and the most

significant cause of premature death in the

EU.

• It is responsible for nearly 700,000 deaths

every year. Around 50% of smokers die

prematurely (on average 14 years earlier).

WHO has estimated that tobacco use is

currently responsible for 16% of all deaths

in adults over 30 in the European Region,

with many of these deaths occurring

prematurely.

In 10 years the whole

population of

Source: World Health Organization. WHO global report:

mortality attributable to tobacco. Geneva: WHO, 2012.

Based on the slide from

Helena Koprivnikar, Public

Health Institute of the

Republic of Slovenia

10 deaths/day

Celje Sremska Mitrovica

Increased risk of dead from cardiovascular diseases in smokers

compared to non-smokers (risk rato and confidence interval)

Vir: N A Rigotti, C Clair, Managing tobacco use: the neglected

cardiovascular disease risk factor, European Hart Journal, 2013

• Premature mortality attributable to smoking in the six main smoking-related disease categories, expressed in monetary terms €517billion

Downloded in Oktober 2019. : http://ec.europa.eu/health/tobacco/docs/tobacco_liability_final_en.pdf

~ 5% GDP

<

Sources: Ministry of finance RS (income from the excise tax); GHK, University of Exeter, Public Health Advocacy Institute. A

study on liability and the health costs of smoking. DG Sanco 2008/C6/046, updated final report, Downloaded in April 2012. :

http://ec.europa.eu/health/tobacco/docs/tobacco_liability_final_en.pdf

The NPHI of RS

70% of the estimated treatment costs for cases

directly attributable to smoking were for three

sets of conditions –cardio-vascular disease

(36%), chronic obstructive pulmonary disease

(CPD) (20%) and lung cancer (14%) cases.

Tobacco control and economic and

social development

Goal 3. Ensure healthy lives and promote

well-being for all at all ages

• Despite considerable progress made in recent

years, the number of smokers in the EU is still

high – 27% of the overall population, 29%

among young adults.

EU regulation

• Council Recommendation (2003/54/EC) on

the prevention of smoking and on initiatives

to improve tobacco control

• Council Recommendation of 30 November

2009 on smoke-free environments

• Tobacco Advertising Directive (2003/33/EC)

replaced by by the Audiovisual Media

Services Directive (2010/13/EU)

• Council Directive 2011/64/EU on the

structure and rates of excise duty applied to

manufactured tobacco

• The Tobacco Products Directive (2001/37/EC)

replaced by The Tobacco Products Directive

(2014/40/EU)

The Tobacco Products Directive (2014/40/EU)

entered into force on 19 May 2014 and became applicable in EU

countries on 20 May 2016.

• Regulates the manufacture, presentation and sale of

tobacco and related products in the European Union

(EU).

• Improves the functioning of the internal market for

tobacco and related product.

• Ensures a high level of health protection for European

citizens.

• Covers cigarettes, roll your own tobacco, pipe

tobacco, cigars, cigarillos, smokeless tobacco,

electronic cigarettes and herbal products for smoking.

The Tobacco Products Directive (2014/40/EU)

entered into force on 19 May 2014 and became applicable in EU

countries on 20 May 2016.

• Regulates the manufacture, presentation and sale of

tobacco and related products in the European Union

(EU).

• Improves the functioning of the internal market for

tobacco and related product.

• Ensures a high level of health protection for European

citizens.

• Covers cigarettes, roll your own tobacco, pipe

tobacco, cigars, cigarillos, smokeless tobacco,

electronic cigarettes and herbal products for smoking.

In particular, the Directive:

● prohibits cigarettes and roll-your-own tobacco with

characterising flavours

● requires tobacco industry to report to EU countries on

the ingredients used in tobacco products

● requires health warnings on tobacco and related

products: combined health warnings (picture, text and

information on how to stop) must cover 65% of the

front and back of cigarette and roll-your-own tobacco

packages

● sets minimum dimensions for warnings and prohibits

small packages for certain tobacco products

● bans promotional and misleading elements on

tobacco products, e-cigarettes and herbal products

for smoking

● introduces EU-wide tracking and tracing to combat

the illicit trade of tobacco products

● allows EU countries to prohibit internet sales of

tobacco and related products

● sets out safety, quality and notification requirements

for electronic cigarettes

● obliges manufacturers and importers to notify EU

countries about novel tobacco products before

placing them on the EU market

EU Rules on Tobacco Products

https://ec.europa.eu/health/tobacco/products_en

EU Rules on Tobacco Products

https://ec.europa.eu/health/tobacco/products_en

EU Rules on Tobacco Products

https://ec.europa.eu/health/tobacco/products_en

FCTC

The WHO FCTC was developed by countries in response to the

globalization of the tobacco epidemic.

Key measures:

•Price and tax

•Protection from exposure to tobacco smoke

•Regulation of the contents of tobacco products

•Regulation of tobacco products disclosures

•Regulation of packing and labelling of tobacco products

•Education, communication, training and public awareness

•Comprehensive ban on tobacco advertising, promotion and sponsorship

•Promoting the cessation of tobacco use and offering support and treatment

for tobacco dependence

•Ensuring elimination of all forms of illicit trade

•Prohibit sale to minors

•Promote viable alternatives for tobacco workers, growers and sellers

FCTC

The WHO FCTC was developed by countries in response to the

globalization of the tobacco epidemic.

Key measures:

•Price and tax

•Protection from exposure to tobacco smoke

•Regulation of the contents of tobacco products

•Regulation of tobacco products disclosures

•Regulation of packing and labelling of tobacco products

•Education, communication, training and public awareness

•Comprehensive ban on tobacco advertising, promotion and sponsorship

•Promoting the cessation of tobacco use and offering support and treatment

for tobacco dependence

•Ensuring elimination of all forms of illicit trade

•Prohibit sale to minors

•Promote viable alternatives for tobacco workers, growers and sellers

FCTC

• Article 5.3 is one of the most important cross-

cutting provisions of the Convention, and one for

which implementation guidelines have been

adopted. It requires Parties to protect their

tobacco control and public health policies from

commercial and other vested interests of the tobacco

industry.

During 2010-2019 30 countries

in Europe improved their

policies regulating protection

from exposure to tobacco

smoke

19 out of them introduced total

ban on smoking in enclosed

public places

FCTC implementation

Total smoking ban in enclosed public

places

Strong restrictions regulating

smoking in enclosed public places

Restrictions regulating smoking in

enclosed public places

Limited restrictions regulating

smoking in enclosed public places

In 2017 Czech Republic

introduced total ban on smoking

in enclosed public places;

Total ban on smoking in public

places in Austria is pending for

enforcement.

In 2019 Montenegro introduced

strong restrictions regulating

smoking in enclosed public

places

In 2019 Sweden introduced total

smoking ban Map: 2016

FCTC implementation

•PRICE: excise taxes account for at least 75% of the retail prices of

tobacco products. Serbia: 61.25% excise tax and 16.67% value added

tax.

•SMOKE FREE ENVIRONMENTS: all public places completely smoke-

free. Serbia: 100% smoke-free only in health care, educational and

governmental facilities and public transport.

•QUIT-LINES AND CESSATION SERVICES: at least three types of

clinical cessation interventions (national quit line, as well as both

nicotine replacement therapy and some cessation services, with

costs covered).Serbia: No quitline, limited cessation and brief

intervention services in PHC.

•BANS ON ADVERTISING AND SPONSORSHIP: a comprehensive ban

on all forms of direct and indirect advertising of tobacco products.

Serbia: Bans on several forms of direct advertising, limited bans on

indirect advertising, promotion and sponsorship.

•PICTORIAL WARNINGS: large pictorial health warning labels on

cigarette packages with all appropriate characteristics. Serbia: no

pictorial wornings.

Protect people from tobacco smoke in

Serbia

Health care facilities, education facilities including universities,

government facilities and public transport in Serbia are

completely smoke free. Smoking violations consist of fines on

the establishment and the patron. Funds are dedicated for

enforcement; however, no system is in place for citizen

complaints and further investigations.

Source:

WHO

Ireland was the first country in the world which introduced

law with 100% ban on smoking in enclosed public places and

workplaces (2004).

•Total ban on advertising, promotion

and sponsorship of tobacco products

•Ban on presentation in radio or

TV programs

•Ban on exhibiting tobacco and related products

•Ban on selling to minors (less than 18 years old)

•Registration of sellers of tobacco products

•Plain packaging (May 2016)

Ireland

Proposed changes of legislation

in Ireland, October 2019

•A ban on the sale of e-cigarettes to under 18s

•A ban on the sale of tobacco products from vending

machines and at locations or events where children are

likely to be present

•A new licensing system which will force shops to pay an

annual fee to the State if they want to sell “tobacco

products and nicotine-inhaling products such as e-

cigarettes”

•A separate license for each individual shop where the

products are sold, which will also carry an annual fee

•“Additional enforcement tools” including fixed penalty

notices and a name and shame list for shops which fail to

adhere to the rules

Ireland

Following the implementation of legislation to make workplaces

smoke free:

• 12% reduction in admissions for acute myocardial

syndromes was observed;

• an immediate 13% decrease in all-cause mortality;

• 26% reduction in ischemic heart disease;

• 32% reduction in stroke, and

• 38% reduction in chronic obstructive pulmonary disease

mortality.

Nearly 4,000 deaths have been prevented in

Ireland as a result of the smoking ban

introduced in 2004.

•Total ban on smoking in enclosed public places

•Total ban on advertising (except in specialised shops where

only health warning signs are obligatory)

•Ban on vending machines

•Ban on exhibiting tobacco and related products except in

specialised shops

•Ban on selling to minors (less than

18 years old) and on smoking in

the presence of minors in cars

•Plain packaging (maj 2016)

In England, Wales and Northern Ireland, retailers DO NOT

need a licence to sell tobacco but if you break the law by

selling tobacco to someone under 18 years of age, you could

have your right to sell tobacco removed – this is known as

negative licensing. ... So no, you do not need a licence.

Great Britain

England

Smoke-free legislation resulted in a statistically significant

reduction (−2.4%) in the number of hospital admissions for

myocardial infarction (MI).

A study looking at the impact of the law in particular

communities found a general pattern of smokers cutting down

their tobacco consumption.

14,7% regular smokers (18+)

Another study found a statistically significant

increase in the number of people making a quit

attempt at the time of the legislation (300.000)

(July and August 2007).

•The first country in the world signing FCTC (2003)

•Adopted a comprehensive strategy: „A tobacco free

future“ – step by step towards tobacco free society

•Total ban on smoking in enclosed public places

including at the entrance of health and educational

institutions

•Total ban on sponsorship, direct and indirect

advertising of tobacco and all related products

•Ban on selling to minors and on purchasing for

minors (less than 18 years old)

•Total ban on sale from vending machines

•Ban on promotional distribution of tobacco and

related products free of charge

•Licensing at local level (control also at the local

level)

Norway

Norway

• 20% of daily and occasional tobacco users reported that

the 2010 ban on advertising at the point of sale - POS

made it more difficult for them to buy tobacco products

• 31% said that it had made it more difficult for them to

choose a brand ‒ the latter issue being more common

among the youngest age groups.

• While the adult smokers were often critical in their

reflections concerning the effect of the ban on their

own behaviour, they talked positively about how

restrictions and denormalization can contribute to

preventing tobacco use among youth.

Slovenia

• Total ban on smoking in all

enclosed spaces (smoking cabins

an exception)

• Introduction of cessation

programs (quit line and PHC

programs)

• Plain packaging, enforcement on

the 1st of January 2020

• Registration and licensing of all

points of sale

• Ban on sale to minors (less than

18 years), ban on vending

machines

• Total ban on advertising,

promotion and sponsorship

Total ban on smoking in cars in presence

of minors

PPolice and health working

together to inform parents

•65% support for rising prices

•69% support for total ban on advertising

•80% support for licensing

•68% support for ban on cross border distance

sale

•91% support for ban on smoking in cars in

presence of minors

Public opinion pools!

Slovenia

Projections

• WHO has projected that the prevalence level

in 2025 among males will be 31% and among

females it will be 16% (23% both sexes).

• Taking the years from 2010 to 2025, this

means a projected relative reduction of 22%

among the male population, and of 25%

among the female population.

• The WHO European Region would thus need

to accelerate its efforts in tobacco control in

order to achieve the global target of a 30%

relative reduction by 2025.

Ambitions strategic goals

Finland: tobacco free Finland by 2030

Scotland: tobacco free Scotland by 2034

Ireland: tobacco free Ireland by 2025

Slovenia: less than 15% of smokers in

population in 2025

Serbia

Based on the current level of adult smoking in Serbia,

premature deaths attributable to smoking are projected

to be more than 1.2 million of the almost 2.5 million

smokers alive today and may increase in the absence of

stronger policies.

Source: WHO

Health impact of tobacco control policies in line with the WHO

Framework Convention on Tobacco Control on Serbia

Within 15 years, the effects of individual tobacco control policies when fully

implemented in line with the WHO FCTC are projected to reduce smoking

prevalence by:

16% by increasing excise cigarette taxes from its current level of 61% to 75% and

prevent much youth smoking;

7% with more comprehensive smoke-free laws and stronger enforcement;

6.3% by increasing from a low-level to a high-level mass media campaign;

6.2% by banning just some forms of direct and indirect advertising to have a

comprehensive ban on advertising, promotion and sponsorship that includes

enforcement;

4.5% by requiring strong, graphic health warnings added to tobacco products; and

3.6% by increasing from minimal provision to a well-publicized and comprehensive

tobacco cessation policy.

With this stronger set of policies and consistent with the WHO FCTC, smoking

prevalence can be reduced by 29% within 5 years, by 37% within 15 years and by

44% within 40 years. Almost 535 000 deaths could be averted in the long term.

http://www.euro.who.int/__data/assets/pdf_file/0008/312596/Tobacco-control-fact-sheet-Serbia.pdf?ua=1

What next?

Novel Tobacco Products

These include cigarettes, roll your own

tobacco, pipe tobacco, cigars,

cigarillos, smokeless tobacco,

electronic cigarettes and herbal

products for smoking

“the threats of these novel products to human

health are seriously looming in the horizon,

flooding our streets and shops. The public health

community and authorities have to be vigilant in

countering the aggressive tactics by the industry

to market its products to youth, cleverly using

the loopholes of existing legislations. Moreover,

the history of the harms of use of tobacco and

tobacco-like products should not be allowed to

be rewritten based on unproven and misleading

claims. Vaping is a treacherous and flavored

camouflage of a health disaster yet to happen if

no action is taken now’’.

- Dr. Vera Luiza da Costa e Silva, Head of the Convention

Secretariat

Social media: promotion and sale

“Giving up smoking is the easiest

thing in the world. I know because

I've done it thousands of times.”

Mark Twain