Examples of national and international policy recommendations and implemented policies aiming to decrease tobacco use or exposure to tobacco smoke

WHO Framework Convention on Tobacco Control (2003, 2005)

The objective of the Convention ( WHO FCTC 2003 (pdf)) is to protect ‘present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke’. More details here.

Scientific associations, institutions and authorities that have issued recommendations to implement and enforce WHO FCTC measures or other relevant policies

The EU and its Member States, as signatories of the WHO FCTC, periodically report on their implementation of the convention to the Conference of Parties. These reports are public (WHO FCTC database) and the Global Health Observatory provides data by country (WHO Global Health Observatory).

Several EU Member States have developed action plans and roadmaps on tobacco control, with different levels of measures and protection proposed (ECL 2019) that include among others, endgame planning (initiatives to eliminate permanently the tobacco epidemic; e.g. Ireland (HD 2013, pdf), Finland (STM 2014, pdf)) and comprehensive tobacco control policies (e.g. Finnish Tobacco Act (FINLEX 2016, pdf), French Code of Public Health (Legifrance 2021, pdf)).

Smoke-free laws

Smoke-free laws (e.g. total bans of smoking in public places, including all indoor workplaces) aim to protect people from other people’s smoking in public places such as healthcare facilities or educational facilities, the hospitality sector, indoor workplaces in general, and public transport. They have been passed or enforced in most EU Member States and many third countries. Twelve EU Member States have banned smoking in private cars when minors are present (ECL 2019).

Recommendations:

Council Recommendation on smoke-free environments (2009)(EU 2009 (pdf))

The Council recommended EU MS to provide effective protection from exposure to tobacco smoke in indoor workplaces, indoor public places, public transport and other public places as stipulated in the WHO FCTC. Children and adolescents are to be particularly protected.

American College of Preventive Medicine (ACPM 2013)

The ACPM recommended the expansion of clean indoor air policies to workplaces, restaurants and multi-use family housing. ACPM also recommended clean air policies for university campuses, secondary school campuses, primary schools, child care centres, and city landmarks.

Barriers to initiate and consume tobacco

Raising taxes and other pricing policies are barriers to prevent people from consuming tobacco. Age limits to the sales of cigarettes are, together with the above, effective barriers to specifically prevent youth from initiating and consuming tobacco.

Recommendations:

European Respiratory Society (2013) (ERS 2013)

‘European countries should strengthen their tobacco control laws and introduce stronger measures such as higher taxation and pricing, more restrictive rules on advertising, plain packaging, more prominent health warnings, a ban on smoking in public places and support for people who want to kick the habit’.

European Commission

The February 2020 European Commission’s evaluation (EC 2020 (pdf)) of the functioning of the Tobacco Tax Directive (EU 2011), in line with the better regulation agenda (EC 2020 (pdf)), concluded that a more comprehensive approach, taking on board all aspects of tobacco control including public health, taxation, the fight against illicit trade and environmental concerns, is needed.

Tobacco use cessation

Quit lines exist in most MS and are publicised via the warning text in tobacco packaging. Tobacco cessation interventions are part of primary and specialised care in EU healthcare settings. Pharmacological treatment, including nicotine replacement therapy, and other cessation services are available for people wanting to quit smoking, and their costs are covered at least to some extent by the health-care system in all EU MS (WHO 2019)(NVC 2018 (pdf)).

Bans on tobacco advertising, promotion and sponsorship

In all EU member states, tobacco advertising and sponsorship are prohibited across all forms of audiovisual commercial communications (EU 2003)(EU 2018, EU 2010). Cross-border tobacco advertising and sponsorship of events or activities involving or taking place more than one country (or having cross-border effects) are also banned in the EU. Outdoor advertising of all tobacco products is restricted in most EU MS. Several EU Member States, including France, Ireland and Finland, have banned tobacco advertising at point of sale (ECL 2019).

Packaging

Plain packaging aims at reducing the attractiveness of tobacco products, and eliminates the packaging advertising and promotion effect. Plain packaging restricts or bans the use of logos, colours, brand images etc, other that brand and product names displayed on a standard colour and font style. It also eliminates design techniques that may suggest that certain products are less harmful than others, so as to increase the effectiveness of health warnings.

The adopted guidelines for implementation of the WHO FCTC Articles 11 (Packaging and labelling of tobacco products)( WHO FCTC 2008/11 ) and 13 (Tobacco advertising, promotion and sponsorship)(WHO FCTC 2008/13) recommend that countries consider the adoption of plain packaging. In December 2012, Australia was the first country to introduce plain (standardised) packaging. Since then, other countries including EU Member States France, Hungary and Ireland have passed laws, and other countries have initiated legislative processes (WHO FCTC 2018 (pdf)).

Warn/inform about the dangers of tobacco

In the EU, tobacco packages are required to carry health warnings covering at least 65% of the front surface.

Anti-tobacco activities are prominent in e.g. social media, with national and international public health campaigns. According to the Global Health Observatory data repository, a great majority of EU Member States (22 of 27) declared having held high-quality national campaigns of at least 3 weeks within the last 10 years (WHO Global Health Observatory).

Counter-tobacco advertising includes national and international campaigns. On World No Tobacco Day 2020, WHO launched a worldwide provocative campaign to prevent children and adolescents from taking up smoking (WHO 2020).

Some EU-wide anti-smoking campaigns:

‘Feel free to say no’ (2002-2004)
Anti-smoking campaign using a road show to help combat smoking among young people.

‘Help: for a life without tobacco (2005-2010)
It focused on smoking prevention, cessation and passive smoking, targeting young Europeans between 15 and 25.

‘Ex-smokers are Unstoppable’ campaign (2011-2016)
A campaign to help people quit smoking, combining advertising, social media, events and an interactive health tool (iCoach) to reach smokers.

Monitor tobacco use and prevention policies

Key data on tobacco use for youth and adults are collected periodically via national population health surveys and school-based health surveys. Other sources are specific surveys (special Eurobarometer (EC 2017); health surveys -HBSC (HBSC 2020)- or drug use surveys -ESPAD (EMCDDA/ESPAD 2020)- for school-aged children). These data are collected at national or supranational level and reported periodically to the Conference of the Parties of the FCTC. The data can be accessed through the WHO FCTC implementation database (WHO FCTC database).

Other resources

Directive on structure and rates of tobacco excise duty (2011) (EU 2011 (pdf))

The Directive requires MS to levy a minimum rate of excise duties on cigarettes, consisting of

• A specific component of between 7.5% and 76.5% of the total tax burden (TTB), expressed as a fixed amount per 1000 cigarettes
• An ad valorem component, expressed as a percentage of the minimum retail selling price.

The overall excise rate must in addition be at least EUR90 per 1000 cigarettes, and at least 60% of the weighted average retail selling price. Since these are harmonised minimum rates, MS are free to apply excise duty rates above these. The full list of excise and VAT duty rates (DG TAXUD (pdf)) applied in EU MS is updated regularly.