Six cost-effective policy interventions at (sub-)national level

Tobacco-control interventions are among the most cost-effective investments in health (ASPECT, 2004). There is strong consensus among international experts and researchers as to what policy measures are cost-effective and should be included in (sub)national tobacco-control programmes. WHO’s Health Evidence Network (HEN), the World Bank and the ASPECT research consortium all point towards six policy interventions (WHO, 2003a; World Bank, 2003; ASPECT, 2004):

• permanent price increases (scaled to inflation), notably through higher taxes on cigarettes and other tobacco products;
• comprehensive bans on advertising and promotion of tobacco products, logos and brand names;
• bans or strong restrictions on smoking in work places and public spaces;
• good consumer information, education and counter-advertising campaigns;
• large, direct warning labels on cigarette boxes and other tobacco products, and
• treatment and help for smokers who wish to quit. This should include good access to counselling, nicotine replacement therapy (NRT) and other cessation therapies.

All these measures are included in WHO’s Framework Convention on Tobacco Control (WHO, 2005g).

Most impact attributed to price and taxation policies

Based on an analysis of effective tobacco control policies in 28 European countries – the EU-25, Switzerland, Norway and Iceland – A ‘tobacco control scale’ has been drawn up (Joossens & Raw, 2006) to allocate a relative weighting to the impact of the six policy measures. Most impact was attributed to price and taxation policies. Smoking bans in workplaces and public places were judged to have the second largest impact. An overall tobacco control budget, advertising bans, health warning labels, and tobacco dependence treatment followed in decreasing order of importance.

Comprehensive policy packages are important

While each policy measure can be expected to have an impact in its own right, both the WHO and the World Bank stress the importance of a comprehensive package of policy measures. Different measures are likely to complement each other. Tobacco control programmes should, therefore, be of a comprehensive nature in order to maximize the reduction of smoking (WHO, 2003a; World Bank, 2003).

New developments give rise to new policy challenges

EU policy can have added value

While the EU can support Member States’ national policy, it’s competence also allows for specific policy measures to be developed and implemented at EU level. Not surprisingly, therefore, regulatory measures feature relatively prominently in the EU’s potential package for action.

Aiming to inform policy making at Member State as well as EU-level, the ASPECT Consortium pointed out that the European Commission could act on all previously mentioned evidence-based pillars for intervention (ASPECT, 2004) by:

• creating a European tobacco and nicotine products regulatory agency;
• creating a nicotine and tobacco product regulation advisory committee;
• developing a co-ordinated EU research strategy;
• proposing an FCTC protocol on illicit trade;
• implementing a new and comprehensive regulatory framework for all tobacco and nicotine products;
• introducing a requirement for the reduction and removal of specific harmful ingredients of tobacco and tobacco smoke;
• rescinding the requirement for tar, nicotine and carbon monoxide yields to be displayed on cigarette packs.

Also see National policies and strategies and Policies tackling socio-economic inequalities in smoking.