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WILL EUROPE SUCCEED IN REDUCING SMOKING PREVALENCE BY 30% BY 2025 ?Armando PerugaProgramme Manager Tobacco Free Initiative
WHY 30% BY 2025 ?
• In 2010 WHA endorsed the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020 • Target 1.- 25% relative reduction in risk of
premature mortality from CVDs, cancer, diabetes, chronic respiratory diseases
• Target 5.- 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years
OUTLINE
1. SMOKING PREVALENCE IN EUROPE IN 2010
2. PROJECTION FOR 20253. P OF ACHIEVING TARGET BY 20254. BARRIERS TO ACHIEVING TARGET
• POLICY IMPLEMENTATION• THE TOBACCO INDUSTRY
PREVALENCE OF CURRENT ADULT SMOKERS IN EU 2010
LMI MEN HI MEN LMI WOMEN LMI WOMEN0%
10%
20%
30%
40%
50%
60%
70%
2%6%
12%
0%2%
17%
8%
0%
32%
41%
16%
64%
% EURO COUNTRIES BY PREVALENCE IN 2010 BY SEX
31%+
<21%
21-30%
prevalence 31%+
<21%
21-30%
prevalenceMEN
11%+
<4%
4-10%
prevalence 11%+
<4%
4-10%
prevalenceWOMEN
% O
F CO
UN
TRIE
S
PROJECTIONS 2010-2025
BASED ON EXPERIENCE
FROM 2000 TO 2010
IF NOTHING CHANGES
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
RELATIVE CHANGE IN AGE-STANDARDISED PREVALENCE OF CURRENT SMOKING 2010 -2025
(15+)
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
PROBABILITY OF 30% REDUCTION IN TOBACCO USE 2010-2025
ASSUMING CURRENT TRENDS CONTINUE
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
RELATIVE CHANGE IN AGE-STANDARDISED PREVALENCE OF CURRENT SMOKING 2010 -2025
(15+)
PROBABILITY OF 30% REDUCTION IN TOBACCO USE 2010-2025
ASSUMING CURRENT TRENDS CONTINUE
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
PERCENTAGE OF COUNTRIES THAT WILL ACHIEVE THE SMOKING TARGET BY 2025
LMIC MEN
HIC MEN
LMIC WOMEN
HIC WOMEN
AFR 5% - 50% -
AMR 55% 4% 60% 38%
EMR 0% 0% 74% 0%
EUR 9% 16% 10% 13%
SEAR 80% - 96% -
WPRO 1% 8% 82% 2%
SUBTOTAL
38% 25% 85% 40%
TOTAL 35% 76%
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
NUMBER OF CURRENT TOBACCO SMOKERS (15+) IN EUROPE FROM 2000 TO 2025
IF NOTHING CHANGES ONLY 7 EU COUNTRIES WILL REACH THE 30% REDUCTION TARGET IN 2025
COUNTRY30% REDUCTION
IN SMOKING PREVALENCE
COUNTRY30% REDUCTION
IN SMOKING PREVALENCE
Austria Italy
Belgium Latvia
Bulgaria Lithuania
Croatia Luxembourg
Cyprus Malta
Czech R. Netherlands
Denmark Poland
Estonia Portugal
Finland Romania
France Slovakia
Germany Slovenia
Greece Spain
Hungary Sweden
Ireland UK
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
GLOBAL CONCLUSIONS• During 2000–10, the prevalence of tobacco use in
– men fell in 125 (72%) countries– women fell in 156 (88%) countries
• If these trends continue, countries on track to achieve their targets are for – men only 37 (21%) – women 88 (49%)
• Rapid increases are predicted in Africa for men and in the eastern Mediterranean for both sexes
IS THERE ROOM FOR TOBACCO CONTROL POLICY ACTION IMPROVEMENT?
WHAT CAN BE CHANGED?
EU COUNTRIES WITH HIGHEST LEVEL OF ACHEIVEMENT IN MPOWER POLICIES
SMO
KE F
REE
POLI
CY
CESS
ATIO
N P
OLI
CY
LARG
E PI
CTO
RIAL
WAR
NIN
GS
MED
IACA
MPA
IGN
S
TAPS
BAN
S
HIGH
TO
BACC
OTA
XES
SMO
KE F
REE
POLI
CYLA
RGE
PICT
ORI
AL W
ARN
INGS
TAPS
BAN
SHI
GH T
OBA
CCO
TAXE
S
EU COUNTRIES WITH HIGHEST LEVEL OF ACHEIVEMENT IN MPOWER POLICIES
SMO
KE F
REE
POLI
CY
CESS
ATIO
N P
OLI
CY
LARG
E PI
CTO
RIAL
WAR
NIN
GS
MED
IACA
MPA
IGN
S
TAPS
BAN
S
HIGH
TO
BACC
OTA
XES
SMO
KE F
REE
POLI
CY
LARG
E PI
CTO
RIAL
WAR
NIN
GS
HIGH
TO
BACC
OTA
XES
WILL THE POPULATION BE RESPONSIVE TO POLICY IMPROVEMENT? THE HARDENING HYPOTHESIS
THERE IS ROOM FOR TOBACCO CONTROL POLICY IMPROVEMENT
CORRELATION SMOKING PREVALENCE / HEAVYNESS OF SMOKING INDEX
Fernández E. et al. Preventive Medicine, Volume 81, December 2015, Pages 314–319
CORRELATION SMOKING PREVALENCE / HEAVYNESS OF SMOKING INDEX
Fernández E. et al. Preventive Medicine, Volume 81, December 2015, Pages 314–319
WILL THE TOBACCO INDUSTRY REACT?
THERE IS ROOM FOR TOBACCO CONTROL POLICY IMPROVEMENT AND THE POPULATION IS NOT HARDENING
…Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.
Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny, PhD, Fazel Randera, MD
THE MAIN VECTOR OF THE TOBACCO EPIDEMIC IS THE TOBACCO INDUSTRY
THE TI ITERFERES TO AVOID EFFECTIVE REGULATION
• fabricating support through front groups;• discrediting proven science; and• intimidating governments with litigation or the threat of
litigation.
• manoeuvering to hijack the political and legislative process;
• exaggerating the economic importance of the industry;
• manipulating public opinion to gain the appearance of respectability;
EVOLUTION OF POLICY CONTENT OF TPD
Oct-09
Dec-09
Feb-10
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
Feb-14
Apr-14
Jun-140
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
RAND TECH-NICAL RE-
PORT
EC PRO-POSAL
FINAL LEGIS-LATION
SWEDISH MATCH AL-LEGATIONS
HEALTH COMMIS-SIONER RESIGNS
Publ
ic h
ealth
pol
icy
posi
tion
calendar
EUROPEAN COMMISSION EUROPEAN PARLIAMENT AND COUNCIL
PMI alone used 160 lobbyists
PMI met with 1/3 of
MEPs
High nonhealth
Officials met with TI 12
times
TI mobilized >150 third-
parties
TI sent 85000 comments , mostly
duplicates
Costa H, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051822Peeters S, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051919
POLICY POSITION ON TPD
ORGANIZATION TYPE
EU DOCUMENT
Health Industry Original FinalHealth* 1.71% 0.87% 1.50% 1.21%Warn* 1.68% 0.69% 1.57% 1.18%Econo* 0.05% 0.14% 0.00% 0.25%
% OF KEY WORDS IN DOCUMENTS
Costa H, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051822
EU RULES ON DEALING WITH TOBACCO INDUSTRY INADEQUATE The Commission should ensure that the
proactive transparency policy put in place by DG Health, requiring the
publication online of all the meetings its staff have with tobacco industry
representatives and the minutes taken of those meetings, should apply across
all of the Commission's services irrespective of the seniority of the official concerned and including,
specifically, members of its Legal Service.
THREE THINGS TO REMEMBER
1. THERE IS SUBSTANTIAL PROGRESS
2. A LOT REMAINS TO BE DONE IF WE WANT TO ACHIEVE OUR TARGETS
3. THE MAIN VECTOR OF THE TOBACCO EPIDEMIC IS THE TOBACCO INDUSTRY
Thank youperugaa@who.int
ORGANIZATION TYPE EU DOCUMENT
Health Industry Original Final
Health* 1.71% 0.87% 1.50% 1.21%
Warn* 1.68% 0.69% 1.57% 1.18%
Econom* 0.05% 0.14% 0.00% 0.25%
EVOLUTION OF POLICY CONTENT OF TPD
Oct-09
Dec-09
Feb-10
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
Feb-14
Apr-14
Jun-140
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
RAND TECH-
NICAL RE-PORT
EC PRO-POSAL
FINAL LE-GISLATION
SWEDISH MATCH AL-LEGATIONS
HEALTH COMMISSIONER RESIGNS
Publ
ic h
ealth
pol
icy
positi
on
calendar
EUROPEAN COMMISSION EUROPEAN PARLIAMENT AND COUNCIL
PMI alone used 160 lobbyists
PMI met with 1/3 of
MEPs
High nonhealth Officials met
with TI 12 times
TI mobilized >150 third-
parties
TI sent 85000 comments , mostly
duplicates
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