Universal health treaty to discourage smoking

In 2003 the WHO adopted the Framework Convention on Tobacco Control (WHO, 2003). The purpose of this treaty was to reduce the percentage of smokers and the exposure to smoke. The agreement entered into force on 25 February 2005 (WHO, 2005b). More than 150 contracting parties have committed themselves to:

• placing restrictions on tobacco advertising, sponsorship and promotion;
• establishing new packaging and labelling for tobacco products;
• establishing clean indoor air controls; and
• strengthening legislation to tackle tobacco smuggling.

The national implementation of the guidelines of the treaty is monitored by the European Network on Smoking Prevention (ENSP).

Tobacco Control Scale shows increasing commitment to tobacco control

The Tobacco Control Scale (TCS) quantifies the implementation of tobacco control policies at country level (Joossens & Raw, 2006), by allocating each tobacco control policy a particular number of points out of 100 (see the TCS for more details). Using this scale, it can be shown that most European countries have increased their commitment to the reduction of tobacco smoking since the implementation of the Framework Convention on Tobacco Control. In 2007 the UK, Iceland and Ireland ranked the highest, achieving 93, 74 and 74 points respectively. For an overview of the progress made see Progress in Tobacco Control between the years 2005 to 2007.

Health warnings are present on tobacco-products in most EU-countries.

In most EU countries smoking hazards are outlined in large, direct health warning labels on cigarette boxes and other tobacco products. Since 2004 it has been possible to accompany such warnings with a picture. Belgium was the first country to make use of this option.

Price increases decreases the number of smokers

According to the World Bank the price rise of tobacco products is the most cost effective deterrent - especially for young people and others with low incomes. A price rise of 10% decreases consumption by about 4% in high-income countries (Joossens & Raw, 2006). The effect depends on the size of the tax hike and the initial price. However, since the price of tobacco products varies greatly from country to country in Europe, the overall effect may be weakened by cross-border shopping.

Most EU-countries do not have indirect-advertising bans.

Denmark, Finland, France, Iceland, Norway and Portugal are the only countries in Europe that have total bans over all forms of tobacco advertisements including indirect-advertising (e.g., events sponsored by tobacco-brands, or 'brand stretching', in which trade names of tobacco-brands are starched to another line of products such as clothing). No EU countries allow direct television advertising for tobacco, and in most EU countries there are limitations on tobacco sellers, such as not selling to teenagers younger than 16. In Finland, Iceland, Ireland, Norway, Sweden and Switzerland the minimal age is 18 (Byrne, 2004).

Increasing numbers of EU countries are prohibiting smoking in cafes and restaurants

So far Ireland, Italy, Malta, Norway, Sweden, Belgium, England, Scotland, Iceland, Lithuania, Estonia and Germany prohibit smoking in cafés and restaurants. On 1 July 2008 a law to this effect will also enter into force in the Netherlands.

Intensive smoking discouragement policies lower percentage of smokers

Particular countries outside of Europe have had anti smoking policy in place for many years (Van der Wilk et al., 2007). Among these countries are Australia, USA and Canada, in which the percentages of smokers are 17.4% (2004), 21.6% (2003) and 20% (2004), respectively. In 1988 California raised tobacco tax by 25 US cents and directed 20% of the profits from this raise toward the prevention of smoking. The percentage of smokers accordingly decreased from around 23% in 1988 to 14% in 2005. For comparison of smoking prevalence see also Percentage of daily smokers aged 15 in the EU-27.

Areas for improvement

Joossens & Raw recognized several areas for improvement in reducing tobacco smoking (Joossens & Raw, 2007) . They recommend that:

• Tobacco control programmes should be comprehensive and should include at least the six measures described by the World Bank.
• Countries should spend a minimum of € 3 per capita per year on tobacco control.
• Countries should introduce comprehensive smoke-free legislation. This should include a total ban on smoking in work and public places, including bars, restaurants, health and educational facilities, and public transport.
• Regular increases in tobacco taxes should be policy at EU and Member State levels. The number of cigarettes that can be imported for personal consumption between EU countries should be reduced to 200 per person.
• Pictorial health warnings on the two main sides of tobacco product packages should be mandatory for all EU countries.

Also see Policies tackling socio-economic inequalities in smoking and the EUphact Smoking.