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

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CESS

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BAN

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BACC

OTA

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SMO

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REE

POLI

CYLA

RGE

PICT

ORI

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ARN

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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

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REE

POLI

CY

LARG

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CTO

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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

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FINAL LEGIS-LATION

SWEDISH MATCH AL-LEGATIONS

HEALTH COMMIS-SIONER RESIGNS

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pol

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posi

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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

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Jun-11

Aug-11

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Dec-11

Feb-12

Apr-12

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Aug-12

Oct-12

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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