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Why is tobacco control still a problem in Europe?

By Ann McNeill, Lorraine Craig, Marc C. Willemsen & Geoffrey T. Fong

In Europe, rates of smoking prevalence and premature death attributable to tobacco are still a cause for real concern.  Governments in the region will point to progress such as the introduction of smokefree laws, increased taxation on cigarettes, pack warnings, and the fact they have become signatories to the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) — as has the European Union (EU) itself.  But signing up to the FCTC marks another step along a journey, rather than being an end in itself.  A significant gap remains between the recommended best practice and country or region-specific legislation.

We know this because The International Tobacco Control Policy Evaluation Project (the ITC Project) is conducting research to evaluate the implementation of the FCTC across 23 countries, including five EU countries: UK, Ireland, France, Germany, and The Netherlands. Recently, we contributed a special supplement of seven empirical articles and a commentary to the European Journal of Public Health. The papers covered a variety of topics, ranging from whether European citizens on lower incomes find it more difficult to quit, to whether the comprehensiveness of tobacco control legislation has an impact on public acceptance and compliance with that legislation (the answer in both cases is yes).  Our studies offer compelling accounts of how effective policies can change human behaviour, but because of the tobacco industry’s increasing attempts to influence governments in the policy process, best practice legislation is not always enacted or enforced.

This interference is most evident in the Netherlands. A recent analysis conducted by STIVORO found that The Netherlands is not fulfilling 8 of 14 important FCTC obligations. Our studies show that Dutch consumers are very poorly informed about the risks of smoking and secondhand smoke.  Smokefree policies have been watered down and are poorly enforced.  Last year, the government did not send a representative from Amsterdam to the UN High Level Meeting on Non Communicable Diseases, where so many were hoping to set real targets for the reduction of tobacco use.  STIVORO, for so long a centre of excellence in tobacco control and a positive force for change in The Netherlands, is faced with closure. The Netherlands’ tobacco control infrastructure, once one of the best, is being systematically dismantled. We now know why this is the case. Investigative journalists have identified close links and frequent contact between government ministers and advisors and the tobacco industry. They have even found that the tobacco industry influenced the Dutch government’s position at major international public health meetings.  In short, national and international tobacco control and public health policies are being unduly influenced by the tobacco industry.

However, this is not just a Dutch problem; similar tactics are being deployed across many countries and with the European Commission (EC) itself.  Currently, the tobacco industry is lobbying hard against possible revisions to the Tobacco Products Directive, like the introduction of plain packaging (no doubt, pointing to the lawsuits against Australia and Uruguay), and country-specific  comprehensive smoking bans, tax increases, point of sale display bans and so on.

The industry decries such policies, but we show that tobacco product branding still carries misleading connotations for a significant proportion of consumers.  Equally, we found clear evidence across France, Germany, the Netherlands, and the UK that support for smoke-free policies increases over time, and that comprehensive smoking bans had a positive effect on quit attempts or quit success. These are issues of knowledge and education, not of “national character” or “cultural norms”. Well-informed people comply with laws they feel are justified. This is why mass media campaigns are so important in communicating the true dangers of smoking and secondhand smoke, as recommended under Article 8 of the FCTC, but many countries are cutting back on this, too.

In part, Europe’s problem is that several of the main tobacco companies are headquartered or have substantial activities in European countries.  The tobacco industry uses its industrial presence to gain the ear of government ministers, both at a country level and within the EC.  In addition, it has used its involvement in the EU’s ‘Better Regulation’ agenda to try to influence pan-European policy.  Tobacco industry involvement in the formation of public health policy both at a country and EC level is in clear contravention of the FCTC.

Tobacco control in the EU is at a crossroads. Ideally, politicians and civil servants will clearly delineate and make transparent all contacts with the tobacco industry and those in their pay, as per Article 5.3 in the FCTC. We also call on European governments and the EU to take a more robust stance and legislate more effectively to protect European citizens. The first test of the EC’s willingness to do so will be the revision of the Tobacco Products Directive. We await the outcome of that process.

The European Journal of Public Health has granted free access to the full supplement on this topic, entitled “Progress on Tobacco Control in Europe”.

Ann McNeill is a Professor in Health Policy and Promotion, UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, at The University of Nottingham, UK. Lorraine Craig is Project Manager, ITC Project in the Department of Psychology at the University of Waterloo, Canada. Marc C. Willemsen is a Professor in Tobacco Control Research, School for Public Health and Primary Care (CAPHRI), Department of Health Promotion at Maastricht University. Professor Geoffrey T. Fong is Chief Principal Investigator, ITC Project in the Department of Psychology at the University of Waterloo, Canada.

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Recent Comments

  1. Don Sigal

    All tobacco use is the same? 500 years of global experience means nothing? Science can once again be seen as an agenda that shuts out any evidence that might contradict even a small part of it?

    From a pipe smoker’s point of view, it’s difficult to know if honest ignorance is involved or if it’s something much worse.

  2. Dave Atherton

    Before I begin let me say I am not remunerated, paid or expensed by tobacco companies, subsidiaries, affiliates or nominees. However I have been paid and expensed by Pfizer who make smoking cessation drugs.

    Paragraph 11 of the FCTC 5.3 says “The measures recommended in these guidelines aim at protecting against interference not only by the tobacco industry but also, as appropriate, by organizations and individuals that work to further the interests of the tobacco industry.”

    As I say in the disclaimer I am not paid by tobacco to companies to write this but as an ordinary member of the public who objects to being not allowed the freedom of assembly, to meet with consenting adults on private property to enjoy a legal substance. That is not being allowed to smoke inside in a bar or pub. Clause 11 I find particularly pernicious as it seems I am not allowed to partake in the democratic process. Like the smoking ban you wish to take my rights away.

    A recent survey in the UK found that 97% of smokers can name one fatal disease associated with smoking, so we are making a very informed decision to smoke. 90% of lung cancer patients are smokers, as are emphysema patients and an RR of 2-3 for heart disease. Seven years early mortality on average is expected.

    One of your major problems is that while active smoking evidence is overwhelming, passive smoking is far more contentious. The 1998 WHO/Boffetta report was actual proof that second hand smoke (SHS) was harmless. The results for spousal exposure was with 1.16 95% CI = 0.93-1.44) and work 1.17 95% CI = 0.94-1.45). Also for controlling for educational level and type of residence more than halved the SHS-workplace risk from unadjusted Odds Ratio 1.17 in the article to OR 1.08. Furthermore: Eliminating 7 Portuguese cases (out of 650 cases in total) with incomplete data reduces the ratio to OR 1.02.

    How can we take the WHO seriously on SHS on this basis?

    I see Professor Fong is a co-author of this blog. His paper on PM2.5 levels in cars with smokers has been widely cited in the UK media. The British Medical Association (BMA) quoted the figure of 23 times worse than the smokiest of bars. This was nonsense and the BMA were forced to retract it. Having the paper 2 out of the 5 scenarios where all 4 windows are open or the smoker’s window are open suggest it is near or below EPA safe levels. Furthermore the EPA in the USA have been served a Freedom Of Information Act on experiments that the EPA did into massive PM2.5 exposure. The levels reached 750 micrograms of PM2.5 per cubic meter, 21 times higher than recommended and no ill effects were observed.

    People have grown tired of the nanny state especially as tobacco control is used as the blueprint for alcohol and obesity. The phrases ‘passive’ drinking and ‘passive obesity’ have been coined. We are all smokers now, metaphorically.

    The WHO are unelected bureaucrats and have no business in telling a sovereign state like the UK how it should deal with its citizens, until they stand for election.

    What troubles me most is imposition of laws that infringe on private property. With private property there is no obligation to enter it, and with free enterprise if there is a market need, capitalism will fulfill it too. Shrill calls of ‘think of the children’ are authoritarian and a precursor to banning smoking in cars and the home. This is Orwellian.

    So in conclusion Europe has grown tired of an overbearing nanny state and you do not have popular support. The SHS gambit is highly dubious and you are playing fast an loose with democratic and property rights.

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