TOBACCO OR HEALTH IN THE EUROPEAN UNION PAST, PRESENT AND FUTURE Prepared by the ASPECT Consortium with financing from the Directorate-General for Health and Consumer Protection European Commission Directorate-General for Health and Consumer Protection Manuscript completed in October 2004 This report was financed by and prepared for the use of the European Commission, Directorate-General for Health and Consumer Protection. It does not necessarily represent the Commission's official position. These views have not been adopted nor approved by the European Commission and should not be relied upon as a statement of the views of the DG Health and Consumer Protection or the European Commission. The European Commission does not accept responsibility for any use made of the information contained in the report. Europe Direct is a service to help you find answers to your questions about the European Union New freephone number: 00 800 6 7 8 9 10 11 A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). Cataloguing data can be found at the end of this publication. Luxembourg: Office for Official Publications of the European Communities, 2004 ISBN 92-894-8219-2 © European Communities, 2004 Reproduction is authorised, except for commercial purposes, provided the source is acknowledged. Printed in Belgium Foreword At a conservative estimate, tobacco kills over 650,000 people each year in the European Union. Fighting tobacco use has been a public health priority for the European Community since 1985 and the launch of the “Europe Against Cancer” Programme. Since those early days, Community tobacco control has developed into three broad areas - legislation; mobilising European and International action and programme actions. With the Products Directive in 2001, the Community has introduced strict regulation around the sale and marketing of tobacco products, becoming the first region in the world to ban the use of misleading descriptors on cigarette packets, such as “mild” or “light”. The European Community and its Member States can also boast the most comprehensive advertising legisla- tion for tobacco in the world. On an international stage, the European Community has been instrumental in designing and achieving consensus on the World Health Organization's Framework Convention on Tobacco Control, the world's first global health treaty. As this Report shows, there is evidence that these and other measures by the Community and within the Member States have had a positive impact on smoking rates.Nearly two decades ago smoking prevalence for males was often around 50%. Although results vary from country to country, many Member States have reduced their prevalence of male smokers - some by as much as 15-20%. This translates into thousands of lives saved and sends out the important message: tobacco control works. However,while we have won many individual battles, it is clear that we have yet to win the war. Smoking remains the largest single cause of preventable death and disease in Europe. Smoking rates for females are increasing in some Member States and the average age to start smoking is now 11 years in some European countries.The tobacco industry is increasingly aware of the 3 need to target children and young adults to assure its future market. Therefore, despite our many achievements, it is clear that we cannot afford to rest on our laurels.We must keep up the momentum. This Report fills an important gap in tobacco-control policy for Europe. It represents the first attempt to draw together in one comprehensive book an analysis of tobacco-control policy (past, present and future) in the European Union.The Report presents the extent of the public health and economic cost of smoking and tobacco to European society. It provides a review of the effectiveness of previous tobacco policies and an analysis of the extent to which the tobac- co industry has sought to undermine and influence political decision making at all levels. The evidence presented is built up from a review of the currently available science, expert analysis and from the findings of a number of expert workshops and international conferences, such as the Limerick Tobacco Control Conference “Change is in the Air” that took place in June 2004 under the Irish Presidency of the European Union. Most importantly, the Report presents a set of recommendations. I hope that these will feed into and inform policy discussions,at European level or within Member States,and help to define a European tobacco-control policy for the future. David Byrne European Commissioner for Health and Consumer Protection Consultation process for the ASPECT (Analysis of the Science and Policy for European Control of Tobacco) report The preparation and drafting of the ASPECT (Analysis of the Science and Policy for European Control of Tobacco) report has involved one of the most extensive consulta- tions and peer reviews ever undertaken in European tobacco control. A consortium created for the purpose of writing the report and consisting of GOPA- Cartermill (GC), the European Heart Network (EHN), the European Network for Smoking Prevention (ENSP) and the European Respiratory Society (ERS) convened an Expert Panel drawn from a wide range of relevant disciplines to provide expertise and peer review of the report.Tobacco control experts from the 28 countries covered in this report were appointed as National Counterparts to advise on matters of fact and accu- racy relating to their countries.Additionally, a panel of International Experts was appoint- ed to provide a global perspective and advice on the latest developments in other leading tobacco-control jurisdictions.A list of the Expert Panel and National Counterparts, as well as a list of International Experts can be found in Annexes 1, 2 and 3, respectively. The report was written and circulated for comment between March and September 2004. Five workshops were organised to identify state-of-the-art policy and research and to facil- itate discussion and consensus building: one on tobacco product regulation in Brussels in March 2004 and a second on smoking in the workplace in Kracow in May 2004.The three final workshops on tobacco-control research, civil society, and product regulation and harm reduction were organised jointly with the Office of Tobacco Control, the Irish Department 4 of Health and the European Commission and took place during the High Level conference on tobacco control held under the Irish Presidency in Limerick in June 2004.The timing of all five enabled extensive consultation on and discussion of the recommendations of the report to take place.A list of speakers and topics covered in these workshops can be found in Annexes 4, 5 and 6. Report Coordinators Scientific: Dr Ann McNeill Honorary Senior Research Fellow, University College London Editorial: Fiona Godfrey EU Policy Advisor, European Respiratory Society, Brussels Administrative: Walter Koehn Senior Consultant, GOPA-Cartermill, Brussels General: January to April 2004:Andrew Hayes, European Cancer Leagues April to October 2004: Fiona Godfrey, European Respiratory Society Chapter coordinators: Chapter 1 Dr Ann McNeill, Honorary Senior Research Fellow, University College London, London, UK Chapter 2 Dr Hana Ross, Economist, University of Illinois at Chicago, International Tobacco Evidence Network, Chicago, USA Chapter 3 Luk Joossens,Tobacco Control Manager, Belgian Cancer Federation, Consultant to the European Cancer Leagues, Brussels, Belgium Chapter 4 Luk Joossens, Brussels, Belgium Chapter 5 Dr Ann McNeill, London, UK Chapter 6 Professor Gerard Hastings, Director of Cancer Research UK Centre for Tobacco Control Research, University of Stirling and the Open University, Scotland Chapter 7 Fiona Godfrey, EU Policy Advisor, European Respiratory Society, Brussels, Belgium Dr Ann McNeill, London, UK About the contributors Kathryn Angus is Editorial Assistant at the Cancer Research UK Centre for Tobacco 5 Control Research, University of Stirling and the Open University, Scotland. She has contributed to volumes for the Food Standards Agency, the European Commission and the WHO and has also coordinated the peer-review process for a special issue of Marketing Theory. Kathryn Angus was instrumental in developing Europe's first online database of internal tobacco industry documents. The archive features documentation relating to the advertising and marketing activities of UK tobacco accounts: www.tobac- copapers.com. Fiona Godfrey is a lawyer and tobacco-control advocate. She qualified as a solicitor in England and specialised in occupational health and safety law, personal injury and criminal litigation. She now works as a consultant on European Union health policy to the European Respiratory Society in Brussels and has previously acted as a consultant on European tobacco-control policy to the European Commission, the International Union Against Cancer and the WHO. Prof. Gerard Hastings is the Director of the Cancer Research UK Centre for Tobacco Control Research, University of Stirling and the Open University, Scotland. He was the first UK Professor of Social Marketing; founder/director of the Centre for Tobacco Control Research, the first centre of its kind in Europe. He is a Principal investi- gator on the International Tobacco Control Policy Evaluation Study; Special Advisor to the House of Commons Select Committee on Health and an advisor on tobacco to the Scottish, UK and European Parliaments,