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Tobacco control in EU Vesna-Kerstin Petrič Uliana Bakh

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  • 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)

    http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELLAR:220cd0f2-82d0-4734-8a7f-e0dff6c8fc5dhttp://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELLAR:220cd0f2-82d0-4734-8a7f-e0dff6c8fc5dhttp://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELLAR:220cd0f2-82d0-4734-8a7f-e0dff6c8fc5dhttp://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32003L0033http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32003L0033http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32003L0033http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32010L0013http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32010L0013http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32010L0013http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32010L0013https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX:32011L0064https://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdfhttps://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdfhttps://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdf

  • 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

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

  • EU Rules on Tobacco Products

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

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

  • EU Rules on Tobacco Products

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

    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

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