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WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2021 Addressing new and emerging products fresh and alive Electronic Nicotine Delivery Systems (ENDS) are addictive and not without harm. 2 | WORLD HEALTH ORGANIZATION WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC 2021 | 3 4 | WORLD HEALTH ORGANIZATION ENDS should be strictly regulated for maximum protection of public health. WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC 2021 | 5 Children and adolescents who use ENDS can double their risk of smoking cigarettes. 6 | WORLD HEALTH ORGANIZATION WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC 2021 | 7 m Monitor tobacco use and prevention policies p Protect people from tobacco smoke o Offer help to quit tobacco use w Warn about the dangers of tobacco e Enforce bans on tobacco advertising, promotion and sponsorship r Raise taxes on tobacco Tobacco control efforts must remain focused on reducing tobacco use and avoid distractions created by tobacco and related industries. WHO report on the global tobacco epidemic, 2021: Addressing new and emerging products is the eighth in a series of WHO reports that tracks the status of the tobacco epidemic and interventions to combat it. WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC 2021 | 9 WHO report on the global tobacco epidemic 2021: addressing new and emerging products ISBN 978-92-4-003209-5 (electronic version) ISBN 978-92-4-003210-1 (print version) © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout by optimadesign.co.uk 10 | WORLD HEALTH ORGANIZATION WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2021 Addressing new and emerging products Made possible by funding from Bloomberg Philanthropies CONTENTS 15 Foreword by Dr Tedros Adhanom Ghebreyesus, WHO Director-General 17 Foreword by Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases 19 Foreword by Dr Adriana Blanco Marquizo, Head of the WHO FCTC Secretariat 20 SUMMARY 24 THE WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL AND THE PROTOCOL TO ELIMINATE ILLICIT TRADE IN TOBACCO PRODUCTS 30 NEW AND EMERGING PRODUCTS 44 TOBACCO INDUSTRY INTERFERENCE 50 TOBACCO AND THE COVID-19 PANDEMIC 59 EFFECTIVE TOBACCO CONTROL MEASURES 60 Monitor tobacco use and prevention policies 64 Protect people from tobacco smoke 68 Offer help to quit tobacco use 72 Warn about the dangers of tobacco use 76 Anti-tobacco mass media campaigns 80 Enforce bans on tobacco advertising, promotion and sponsorship 86 Raise taxes on tobacco 94 National tobacco control programmes 98 Electronic nicotine delivery systems 108 CONCLUSION 110 REFERENCES 119 TECHNICAL NOTE I: Evaluation of existing policies and compliance 128 TECHNICAL NOTE II: Smoking prevalence in WHO Member States 130 TECHNICAL NOTE III: Tobacco taxes in WHO Member States 139 ANNEX I: Regional summary of MPOWER measures 153 ANNEX II: Electronic Nicotine Delivery Systems 179 ANNEX III: Year of highest level of achievement in selected tobacco control measures 193 ANNEX IV: Highest level of achievement in selected tobacco control measures in the 100 biggest cities in the world 199 ANNEX V: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate Illicit Trade in Tobacco Products 207 ACKNOWLEDGEMENTS WEB ANNEX VI: Global tobacco control policy data WEB ANNEX VII: Country profiles WEB ANNEX VIII: Tobacco tax revenues WEB ANNEX IX: Tobacco taxes, prices and affordability WEB ANNEX X: Age-standardized prevalence estimates of tobacco use, 2019 WEB ANNEX XI: Country-provided prevalence data WEB ANNEX XII: Maps on global tobacco control policy data Annexes VI to XII are available online at http://www.who.int/tobacco/global_report/en “Despite the challenges of the COVID-19 pandemic, over the past year many countries have persisted in advancing tobacco control as a key health priority.” Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization 14 | WORLD HEALTH ORGANIZATION 5.3 billion people are now covered by at least one MPOWER measure at the highest level of achievement Since the last WHO report on the global This is encouraging progress. At the Political leaders must stand up to the tobacco epidemic in 2019, the world same time, we must remain vigilant to powerful vested interests that profit has changed immeasurably. Despite the the challenges posed by new products from tobacco. challenges of the COVID-19 pandemic, such as electronic nicotine delivery All countries have the obligation to over the past year many countries have systems and heated tobacco products. protect the health of their people by persisted in advancing tobacco control The WHO report on the global tobacco beating back the scourge of tobacco, as a key health priority. The progress epidemic 2021: addressing new whatever form it takes. presented in this report is testament to and emerging products highlights that perseverance. how these products are promoted Tobacco-attributable diseases include aggressively as “safer” or “smoke-free” lung and heart diseases, chronic alternatives to conventional cigarettes. respiratory diseases, cancers, and Although their full risks remain diabetes – all of which may increase unknown, the impact of nicotine the severity of COVID-19. Protecting delivery devices is clear. populations from the harms of tobacco While framing these products as a has never been more important. contribution to global tobacco control, The implementation of the WHO the tobacco and related industries Dr Tedros Adhanom Ghebreyesus Framework Convention on Tobacco employ the same old marketing Director-General Control is a recognized global tactics to promote new tools to hook World Health Organization development priority with a dedicated children on nicotine and circumvent target in the Sustainable Development tobacco legislation. At the same time, Goals. Reducing tobacco use is they continue to fight measures and critical to reducing the burden of legislation designed to protect people noncommunicable diseases, which from the many harms of tobacco across account for 71% of deaths globally. the globe. Today, 75% of countries and 5.3 Tobacco is one of the world’s largest billion people are protected by at preventable causes of premature least one tobacco control measure at death, accounting for more than 8 best-practice level and 50% by at least million deaths and costing the global two measures. And globally, smoking economy US$ 1.4 trillion each year. prevalence among people
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