It is widely accepted that tobacco use is one of the most important NCD risk factors: it is estimated that, every year, approximately 700 000 EU citizens die prematurely because of tobacco consumption (a loss of up to 10 years of life  expectancy is estimated in smokers). According to data available in 2003, (when the EU comprised only 15 countries), at least 13 million people suffered from one or more of the six main disease categories associated with smoking, including bronchitis and other lower respiratory infections, COPD, asthma and lung cancer. If the 2003 estimate was 13 million, what is the figure today with 28 countries? The picture is dramatic: today, tobacco is responsible for 9.94 million lost life-years annually which, according to the EU, is equivalent to a cost to society of €517 billion (see ‘Willingness to pay’). In this context, one of the major advances of the past 10 years has been the ratification of the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is a powerful legal instrument to help fight the tobacco epidemic. In the WHO European Region, 48 countries plus the EU itself have ratified the treaty. However, seven countries are still not party to the FCTC, and in some of the others translation of commitment into action has been relatively weak. There has, however, undoubtedly been progress: many European citizens can now enjoy clean air when they go to a restaurant or bar. The ERS is very proud of this development as it is one of the very few European medical organisations that constantly supported and funded action in support of tobacco control in Europe, including the setting up and constant support (in collaboration with Cancer Research UK, the European Heart Network and Action on Smoking and Health UK) of the Smoke Free Partnership (www., which aims to promote tobacco control at EU and national levels. The ERS will continue to strengthen its tobacco control activities by facilitating access to scientific evidence on the link between tobacco consumption and respiratory diseases and supporting the implementation of the FCTC.

  • 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.

  • The success of the FCTC depends on everyone – civil society, medical organisations, researchers, health professionals and the public – but it cannot be achieved without policy-makers.

‘Willingness to pay’

To evaluate the cost of premature mortality due to smoking, the EU analysis used a ‘willingness to pay’-based methodological approach. A value is attached to each life-year lost based on what society would have been ready to pay to regain that life-year, not on what that life-year’s loss has cost society. The EU uses the values established in its ExternE research project, according to which the typical range for the value of one life year (VOLY) is €50 000–100 000. The EU sets the intangible value of the loss of 1 year of life at €52 000, irrespective of the age or country of residence of the victim. Peto’s ‘Smoking Attributable Fraction’ (SAF) is a key component of the costing model used. The SAF is an estimate of the proportion of those who died due to a given condition that can be attributed to smoking. It is based on the fact that smokers are more likely to develop certain life-threatening conditions.

See the entire Recommendations and policy Chapter