Legislation and prevention of smoking
The 2005 WHO Framework Convention for Tobacco Control was the first international treaty negotiated by WHO and offers a blueprint for tobacco control. All EU countries are among the 176 nations that have signed it, but effective enforcement of the FCTC requires firm political commitment to achieve the WHO goal of a 40% reduction in global smoking prevalence between 2010 and 2025.
Taxation as a tool to prevent tobacco use
Price is probably the most powerful tool for reducing tobacco use. The relationship between price and reduction of demand for smoking is described by the price elasticity. Overall, there is a 3–4% fall in consumption for every 10% increase in price. A recent examination of this relationship in 11 EU countries carried out by the Pricing Policy and Control of Tobacco (PPACTE) project found it to be robust overall, but noted several further important aspects. For instance, lower socioeconomic groups and young people are most sensitive to price increases, while increases in income reduce price elasticity.
The tobacco industry usually opposes tax rises and often successfully persuades finance ministers that a price increase will lead to a loss of revenue through an increase in smuggling. There is evidence from many studies, including PPACTE, that this does not happen. Price is not the only – or even the main – cause of increases in smuggling. Smuggling depends on other factors such as the existence of established distribution networks, high levels of corruption, criminal involvement, low penalties for smuggling, and low probability of detection with poor implementation of controls. In the EU, these are compounded by nearness to land borders with countries where a high volume of cheap cigarettes is available.
Restriction of access to tobacco by minors
It is often argued that the sale of tobacco should be banned entirely. Some countries, such as Finland, foresee that they may be able to ban its use in 2040 but no country in Europe is ready to ban tobacco outright today. There are much better data on the feasibility and usefulness of banning sale of tobacco to minors and properly applied restrictions do reduce teenage smoking. The importance of such measures is driven home by the fact that some 85% of smokers take up the habit in their teens.
The EU Tobacco Product Directive
The banning of advertising, sponsorship and promotion is obviously an important aspect of tobacco control, and such bans are widespread in the EU, backed by an EC directive on advertising. This directive is not universally adhered to and is of course not applicable outside the EU. In developing economies, tobacco advertising is still widespread.
In the EU, the battleground has shifted to tobacco packaging. Currently, Directive 2001/37/EC (the Tobacco Products Directive) is being revised with a view to further strengthening of the regulations. The use of health warnings and, more recently, graphic images of diseases caused by tobacco has become common on cigarette packages in many countries. Cancer images, usually showing advanced disease, are among the most often used. These images are thought to be effective in changing attitudes to smoking. Australia has led the world in introducing what is known as ‘plain packaging’, where the iconic logos of the tobacco industry are replaced by a simple description of the brand, and health warnings and images are used to discourage tobacco use. In Australia a law has been passed to end the general availability of cigarettes in 2035, after which they will only be available on prescription to buy in pharmacies. Similar proposals have been made in other countries. The European Respiratory Society (ERS) has been very active in the field of smoking prevention, with its Tobacco Control Committee focusing on the preventive and legislative aspects of tobacco control and lobbying the EU in this area.
Variation within Europe
Despite the universal ratification of the Framework Convention of Tobacco Control within the EU, tobacco control legislation varies widely across the continent. In 2011, the Association of European Cancer Leagues published a report into tobacco control activity in 31 countries, grading them on a 100-point scale according to their rules on pricing, smoke-free environments, tobacco advertising and promotion and packaging, as well as the provision of public information campaigns and smoking cessation services. Only five countries scored more than 60 points (figure 3), with the UK taking the top spot. Eight countries scored 40 points or fewer, with Austria and Greece having the least effective control measures in place.