Challenges ahead to reach the goal set up in Tobacco End Game 2025 Dr Vera Luiza da Costa e Silva Head of the Convention Secretariat WHO FCTC 12 June 2018 Towards the end game 1. Where are we? 2. What do we want to achieve and by when? 3. What do we need to do? 4. What will be the challenges? 1. Where are we? Tobacco epidemic in Sweden Male Female Total Current smokers 14 14 14 Daily smokers 8 10 9 Current smokeless tobacco users 21 5 13 Daily smokeless tobacco users 18 4 11 2018 WHO FCTC Global progress report for Sweden Source: Public Health Agency of Sweden (2016) 2. What do we want to achieve and by when? - Reduction in daily smoking to 5% in men and women by 2025 Trends in daily tobacco smoking among persons 15 and older in Sweden Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025 Trends in daily tobacco smoking among persons 15 and older in Sweden 25 20 Men 15 Women Voluntary target: 10 30% reduction between 2010 and 2025 5 0 2000 2005 2010 2015 2020 2025 Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025 (2018) Age specific rates of current daily smoking in Sweden Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025 (2018) Trends in daily tobacco smoking among persons 15 and older in Finland and Norway Finland Norway Trends in daily tobacco smoking among persons 15 and older in Finland and Norway and Sweden 35 30 25 20 Sweden Finland 15 Norway 10 5 0 2000 2005 2010 2015 2020 2025 Some tobacco control measures in these 3 countries Sweden Finland Norway Price (International 7.21 6.57 12.46 dollars) Taxes (most sold 68.5% 84.9% 66% brand) Smoke free Smoking allowed Smoking allowed Banned in all Policies enclosed public enclosed public indoor public places places places Health warnings 65 (F65,B65) 65 (F65,B65) 48 (F43-B53) cigarettes 15 rotating 15 rotating 16 rotating PP Health warnings 30 (F30, B30) Smokeless banned 15 (F30-B0) smokeless Only 1 Only 1 Illicit trade protocol Signed. Not ratified Signed. Not ratified Signed. Not ratified Point of sale Not banned Banned Banned advertising With the exception of Sweden, the sale of snus is prohibited in the European Union (EU). Article 17 of the 2014 EU Tobacco Products Directive 3. What do we need to do? First step: Fully implement the WHO FCTC The WHO FCTC Legally binding global Treaty . Aims at protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke (Article 3) . Comprehensive and multisectoral approach to tobacco control Parties to the WHO FCTC 180 countries and the European Union Sweden is a Party since 2005 90% of the world’s population covered by the treaty provisions Supply reduction measures WHO FCTC & Guidelines Sweden signed the Protocol on 6 Jan 2014 but has not yet ratified Other obligations under the WHO FCTC International cooperation Reporting Implementation of the WHO FCTC provisions - Sweden Article 8 & Guideline • Smoking is allowed in designated smoking areas in most workplaces and public places and public transport. • There are only limited outdoor smoking restrictions; namely, in outdoor areas of premises intended for childcare, school activities, or other activities for children or young people. 2018 WHO FCTC Global progress report for Sweden Implementation of the WHO FCTC provisions - Sweden Article 13 & Guideline • Advertising and promotion is allowed at points of sale, provided it is not visible from outside the point of sale. • Tobacco product displays are also allowed at points of sale. • There are some restrictions on tobacco sponsorship and the publicity of such sponsorship. 2018 WHO FCTC Global progress report for Sweden Proposed end game strategies Product-focused endgame proposals • Regulate nicotine levels to make tobacco products non-addictive or less addictive • Redesign the cigarette or tobacco products to make them unappealing • Harm reduction strategies User-focused endgame proposals • Smoker's license • Prescription to purchase tobacco • Restrict sales by year born-tobacco free generations Source: adapted from Malone et al, 2015 Proposed end game strategies (II) Market/supply-focused endgame proposals • Licensing, outlet restrictions, display bans and price controls • Quota/’sinking lid’ • Price caps for wholesale prices Institutional structure-focused • Tobacco control agency • Regulated market model • State takeover of tobacco companies • Performance-based regulation Integrated endgame strategies Public support for endgame proposals Endgame considerations Short term 1. Develop an endgame dialogue, narrative, and communications plan 2. Take specific actions to constrain the tobacco industry Longer term 3. Create a tobacco regulatory authority with monitoring and regulatory powers 4. Develop incentives to gradually reduce the number and density of tobacco retail outlets 5. Create a national plan for addressing gradual reductions in tobacco company workforce and tax receipts. Source: Cancer Research UK Endgame: Finland example What will be the challenges? We need to change permanently the structural, political and social dynamics that sustain the epidemic - Consensus and unity amongst public health community - The public must be prepared to believe in and support ending the tobacco epidemic - The policy makers must be willing and be prepared for tobacco Industry attacks - We should target communities that are more affected Challenges faced by Parties to the WHO FCTC WHO FCTC GLOBAL PROGRESS REPORT 2016 Forms of Tobacco Industry Interference Manoeuvering Exaggerating Manipulating Fabricating Discrediting Intimidating to hijack the the economic public support proven governments political and importance of opinion to through front science with litigation legislative the industry gain the groups or the threat process appearance of litigation of respectability Source : ACS Tobacco Atlas, 2018 ENDS Sales globally E-cigs dollar sales worldwide 2008-2017 Source: The Statistics Portal Possible next steps • Fully implement the WHO FCTC provisions and Guidelines • Become Party to the Protocol to Eliminate Illicit Trade in Tobacco Products • Decide whether the Endgame comprises other tobacco products such as narguiles, snus and heated tobacco products? • Address social determinants of the tobacco epidemic .