EUR/06/5062780 15 January 2007 E89842 ORIGINAL: ENGLISH The European Tobacco Control Report 2007 Control Tobacco The European The European Tobacco Control Report 2007 World Health Organization Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Denmark Tel: +45 39 17 17 17 Fax: +45 39 17 18 18 Telex: 1200 E-mail: [email protected] Web Site: http://www.euro.who.int THE EUROPEAN TOBACCO CONTROL REPORT 2007 ABSTRACT The European tobacco control report describes the tobacco control situation and the status of tobacco control policies in the WHO European Region as at late 2006; reviews progress following the adoption of the European Strategy for Tobacco Control (ESTC) in 2002; and establishes a baseline for monitoring implementation of the WHO Framework Convention on Tobacco Control (FCTC) in the Region. The document presents an overview of the situation regarding tobacco use and related harm in the WHO European Region during the period 2002–2006 and of Member States' policy responses and implementation of national tobacco control measures in line with the recommendations of the ESTC. Reference is also made to the status of policies in countries in the light of the specific requirements of the WHO FCTC. Lessons learned and challenges faced during the policy-making process are illustrated by several short national, regional and subregional case studies attached to the Report. Keywords SMOKING – adverse effects – prevention and control HEALTH POLICY HEALTH PROMOTION TOBACCO – legislation TOBACCO INDUSTRY – legislation INTERNATIONAL COOPERATION INTERSECTORAL COOPERATION TREATIES EUROPE ISBN 978-92-890-2193-7 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/pubrequest. © World Health Organization 2007 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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 the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted 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 the World Health Organization 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. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. ACKNOWLEDGEMENTS This report was prepared by the WHO Regional Office for Europe in collaboration with the network of national counterparts for the European Strategy for Tobacco Control whose contributions of data, comments, suggestions and overall guidance were invaluable. The network of national counterparts/alternates included: Roland Shuperka, Albania; Joan Martinez-Benazet, Andorra; Alexander Bazarchyan, Armenia; Alice Schogger, Cornelia Franta, Austria; Nadir Eyvazov, Azad Gajiev, Azerbaijan; Paul van den Meerssche, Belgium; Aida Ramic-Catak, Zivana Gavric, Bosnia and Herzegovina; Andrei Sekach, Belarus; Masha Gavrailova, Bulgaria; Vlasta Hrabak-Zerjavic, Croatia; Charitini Komodiki, Cyprus; Hana Sovinova, Czech Republic; Ulla Skovgaard Danielsen, Denmark; Gaby Kirschbaum, Germany; Andrus Lipand, Estonia; Olli Simonen, Finland; Pascal Melihan-Cheinin, France; Akaki Gamkrelidze, Levan Baramidze, Georgia; Maroulio Lekka, Greece; Tibor Demjen, Hungary; Solveig Gudmundsdottir, Iceland; Marie Killeen, Ireland; Yair Amikam, Israel; Daniela Galeone, Italy; Aigul Tastanova, Kazakhstan; Chinara Bekbasarova, Kyrgyzstan; Gelena Kriveliene, Lithuania; Simone Steil, Luxembourg; Janis Caunitis, Latvia; Mario Spiteri, Anne Buttigieg, Malta; Denis Ravera, Monaco; Agima Ljaljevic, Montenegro; Pieter de Coninck, Netherlands; Rita Lindbak, Norway; Witold Zatonski, Poland; Emilia Nunes, Portugal; Tudor Vasiliev, Liubova Andreeva, Republic of Moldova; Magdalena Ciobanu, Romania; Galina Sakharova, Russian Federation; Davide Rosa, San Marino; Isabel Saiz, Spain; Natasa Lazarevic-Petrovic, Serbia; Elena Kavcova, Slovakia; Tomaz Caks, Slovenia; Margaretha Haglund, Sweden; Patrick Vuillème, Switzerland; Ziyovuddin Avgonov, Tajikistan; Mome Spasovski, The former Yugoslav Republic of Macedonia; Rejep Geldiev, Turkmenistan; Toker Erguder, Turkey; Alla Grygorenko, Ukraine; Nick Adkin, Andrew Black and Tim Roberts, United Kingdom; Shukrat Khashimov, Uzbekistan. Special thanks go to Claude Vilain for data collection and preparing the first draft and Patsy Harrington for cross-checking the data and technical editing. The contributions of Luk Joossens, Stella Bialous, Kerstin Schotte and Rifat Atun in drafting, respectively, the sections on illicit trade, industry tactics, smoking prevalence and the case studies are much appreciated. Kari Paaso and Shubhada Watson provided valuable support in the technical review and Gail Denner in the publishing process. Haik Nikogosian provided overall coordination, review and guidance in the development of the report. Acknowledgements are extended to the committee of experts (Carolyn Dresler, Anna Gilmore, Luk Joossens, Martina Pötschke-Langer and Tibor Szilagyi) for their valuable comments and suggestions during the drafting process. Kathleen Strong and Regina Guthold in WHO headquarters gave important support in the cross-country analysis of smoking prevalence. Valuable comments, data and suggestions on different aspects of the report were received from the Tobacco Free Initiative in WHO headquarters, various WHO Regional Office programmes, the European Commission, the European Network of Quitlines, the WHO collaborating centre in Heidelberg and other colleagues and institutions to whom we extend our sincere thanks and appreciation. Contributions received from the European Commission, national counterparts, experts and institutions and WHO colleagues for the respective case studies deserve special appreciation. Acknowledgements are also extended to Rosemary Bohr for overall editing and layout and Gill Paludan- Müller for preparing the graphic material. The Regional Office is especially grateful to the governments of France and Ireland for hosting the meetings of national counterparts in the process leading to the preparation of the report. CONTENTS Page Summary ........................................................................................................................ 3 Introduction....................................................................................................................... 6 Background ............................................................................................................... 6 Process and data sources ........................................................................................... 8 PART 1 Tobacco consumption and tobacco-related harm................................................ 11 Summary ...................................................................................................................... 12 Prevalence of tobacco use................................................................................................. 12 Smoking prevalence among adults ............................................................................ 12 Smoking prevalence among young people.................................................................. 18 Socioeconomic differences........................................................................................ 21 Tobacco-related harm....................................................................................................... 22 Summary ................................................................................................................ 22 Burden of disease attributable to tobacco use ............................................................ 23 Tobacco-related mortality ......................................................................................... 24 Tobacco-related costs .............................................................................................. 28 PART 2 Tobacco Control Policies................................................................................... 29 Measures to reduce the demand for tobacco products ......................................................... 30 Price and taxation policies ........................................................................................ 30 Exposure to tobacco smoke (passive smoking, environmental tobacco smoke) ............. 36 Advertising, promotion and sponsorship....................................................................