HNP DISCUSSION PAPER Economics of Tobacco Control Paper No. 18 The Tobacco Epidemic in South-East Europe About this series... Consequences and Policy Responses This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank’s Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into Ivana Bozicevic, Anna Gilmore and Stipe Oreskovic account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. 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THE WORLD BANK WORLD HEALTH ORGANIZATION 1818 H Street, NW Avenue Appia 20 1211 Washington, DC USA 20433 Geneva 27, Switzerland Telephone: 202 477 1234 Telephone: 41 22 791 2126 Facsimile: 202 477 6391 Facsimile: 41 22 791 4832 Internet: www.worldbank.org Internet: www.who.int Tobacco Free Initiative E-mail: [email protected] E-mail: [email protected] March 2004 World Health Organization THE TOBACCO EPIDEMIC IN SOUTH-EAST EUROPE Consequences and Policy Responses Ivana Bozicevic, Anna Gilmore and Stipe Oreskovic March 2004 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network (HNP Discussion Paper). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. 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The findings, interpretations, and conclusions expressed in this paper are entirely those of the author/s and should not be attributed in any manner to the World Health Organization or to the World Bank, their affiliated organizations or to members of their Executive Boards or the countries they represent. The Economics of Tobacco Control papers are edited by Joy de Beyer ([email protected]), Ayda Yurekli ([email protected]) and Anne-Marie Perucic ([email protected]). For free copies of papers in this series please contact the individual author whose name appears on the paper, or one of the editors. Papers are posted on the publications pages of these websites: www.worldbank.org/hnp and www.worldbank.org/tobacco ISBN 1-932126-58-9 © 2004 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Health, Nutrition and Population (HNP) Discussion Paper ECONOMICS OF TOBACCO CONTROL PAPER NO. 18 The Tobacco Epidemic in South-East Europe: Consequences and Policy Responses Dr Ivana Bozicevic (MD, MSc)a, Dr Anna Gilmore (MBBS, DTM&H, MSc, MFPH),b and Professor Stipe Oreskovic (PhD)c aSchool of Public Health “Andrija Stampar”, Zagreb, Croatia; and London School of Hygiene and Tropical Medicine, London, UK bLondon School of Hygiene and Tropical Medicine, London, UK cSchool of Public Health “Andrija Stampar”, Zagreb, Croatia This report is the result of the Stability Pact Partnership Project to Reduce Tobacco Dependence in South- East Europe, initiated by the Andrija Stampar School of Public Health in Croatia and funded by the Network Public Health Programs, Open Society Institute (OSI) NY. The project was carried out by the Andrija Stampar School of Public Health with support from the London School of Hygiene and Tropical Medicine. Earlier drafts of the report were presented at the OSI conference on “Effective Advocacy and Movement Building for Tobacco Control” held in Bucharest in April 2003 and at the sixth meeting of National Co- ordinators from South Eastern Europe organized by the Stability Pact Initiative for Social Cohesion in Sarajevo in May 2003. Abstract: This report gives an overview of the tobacco epidemic and tobacco control policies in the countries of south-east Europe: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Macedonia, Romania and Serbia and Montenegro. It brings together data on tobacco consumption, smoking prevalence and the disease burden from tobacco use, reviews issues on the economics of tobacco, the tobacco industry and the policy responses developed to date to control the tobacco epidemic in south-east Europe. These data, combined with the evidence presented on the impact of tobacco control policies, can be used to underpin the development of stronger national and regional tobacco control policies. Keywords: tobacco, tobacco control, south-east Europe, Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Macedonia, Romania, Serbia and Montenegro, Yugoslavia, Former-Yugoslavia, tobacco tax, cigarettes, prevalence, smoking, cessation, tobacco dependence, passive smoking, second-hand smoke, ETS, tobacco epidemic, burden of disease, lung cancer, cigarette tax, economics of tobacco, economics of tobacco control, smoking, tobacco policy, tax policy, price elasticity, demand for cigarettes, tobacco tax revenues, tobacco industry, tobacco farming, smuggling, FCTC. Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank or the World Health Organization, their Executive Directors, or the countries they represent. Correspondence Details: Dr Ivana Bozicevic, MD, MSc; Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine Keppel Street, London WC1E 7HT, UK. Phone: +44 020 7927 2317; or +385 91 798 4138 Fax: +44 020 7580 4524; Email: [email protected] iii iv LIST OF ABBREVIATIONS B&H Bosnia and Herzegovina BAT British American Tobacco CAFAO Customs and Fiscal Assistance Office CARDS Community Assistance for Reconstruction, Development and Stabilisation CEE Central and Eastern Europe CINDI Countrywide Integrated Non-Communicable Disease Intervention Programme CPI Consumer Price Index DALY Disability-Adjusted Life Year DIN Duvanska Industrija Nis DIV Duvanska Industrija Vranje EEC European Economic Community ERC Economic Research Service ESPAD European School Survey Project on Alcohol and Other Drugs ETS Environmental Tobacco Smoke EU European Union FCTC Framework Convention on Tobacco Control FR Yugoslavia Federal Republic of Yugoslavia FSU Former Soviet Union FTFA For a Tobacco-Free Albania (NGO) GYTS Global Youth Tobacco Survey HBSC Health Behaviour in School-Aged Children IARC International Agency on Research on Cancer ICD-10 International Statistical Classification of Diseases