Tobacco control in the WHO European Region 1

REGIONAL CONTEXT 2

Tobacco Kills nearly 6 million people globally each year 1,6 million people die in the European Region 3

Current Mortality Attributable to Tobacco in Europe No room for complacency WHO Region Deaths attributed to tobacco EUR16% AMR16% WPR13% SEAR10% EMR7% AFR3% Global12% 4

Current Tobacco Use in Europe No room for complacency WHO Region Male prevalence Female prevalence Both sexes EUR38%19%28% WPR47%3%25% EMR38%4%22% AMR26%16%20% SEAR34%4%19% AFR22%7%15% Global36%8%22% 5

4 Youth Prevalence of Tobacco WHO European Region has high prevalence of youth tobacco smoking Prevalence of female youth considerably higher in European Region than in other Regions

Youth and smoking Smoking behavior is typically established during adolescence Most smokers had their first cigarette, or were already addicted, by the time they turned 18 Duration and number of cigarettes required to establish nicotine addiction are lower for adolescents than adults, so addiction is established more quickly 7

Youth and smoking (cont) Tobacco use is related to other risk behaviors and negative health outcomes in young people, including unhealthy diet, high levels of alcohol consumption, bullying, poor self-rated health and low life satisfaction Should be considered as part of a broader group of unhealthy behaviors that cluster in adolescence 8

GLOBAL SOLUTION 9

10

10 Years since the WHO FCTC 11

Tobacco Policy in Europe Moving in the right direction Ratification Taxes01525 Smoke free places 449 Cessation477 Ban on advertising 113 Large pictorial warnings

Ashgabat Declaration Ministers of Health commit -Fully implement the WHO FCTC -Share ambition of working towards a tobacco-free European Region -Work together to make the global target on NCDs related to tobacco use a reality 13

14 Cost effective best buys → protect people from tobacco smoke → warn about dangers of tobacco → enforce ban on tobacco advertising → raise taxes on tobacco products

Intersectoral action is essential Multiple factors inside – and beyond – the health sector are driving the rise in smoking Health sector has a key role to play, but so too do other sectors Relying just on the health sector to reduce the tobacco epidemic is not enough 15

GLOBAL CHALLENGES 16

UN General Assembly September UN High-Level meeting on NCDs POLITICAL DECLARATION ON NCDs Heads of State and Government and representatives of States and Governments, recognized the fundamental conflict of interest between the tobacco industry and public health 17

Article 5.3 of the WHO FCTC Principle 1: Fundamental and irreconcilable conflict between the tobacco industry’s and public health policy interests Principle 2: Countries, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent Principle 3: Countries should require the tobacco industry and those working to further its interests to operate and act in an accountable and transparent manner Principle 4: Because their products are lethal, the tobacco industry should not be granted incentives to establish or run their businesses 18

Practical examples available Vast majorities of Parties have yet to fully implement Article 5.3 and its Guidelines Progress made on some aspects, but often not across all governmental sectors Hungary: National Institute for Health Development's website provides information on tobacco industry strategies, Finland: interaction with industry is limited to open requests for comment, Norway: Government Pension Fund divested of tobacco 19

Electronic cigarettes E-cigarettes are big and evolving business Experimentation among youth has doubled from Huge variation of country regulations as consumer, therapeutic or tobacco products, or no regulation 20

WHO recommends Impede e-cigarette promotion to non-smokers and young people Minimize potential health risks to e-cigarette users and nonusers Prohibit unproven health claims about e- cigarettes Protect existing tobacco control efforts from commercial interests of the tobacco industry 21

Are e-cigarettes helpful or harmful? Hazardous to youth, pregnant women and non-nicotine users For adult smokers, well-regulated e- cigarettes are likely to be less toxic than cigarettes IF well-regulated and IF adult smokers use them as a complete substitution for cigarettes 22

Recent developments - CoP Adoption of the decision on electronic nicotine (and non-nicotine) delivery systems, known as electronic cigarettes Decision acknowledges the need for regulations along the lines of policies concerning other tobacco products, including banning or restricting promotion, advertising and sponsorship of ENDS 23

What next?

Endgame of tobacco is a profound social change process where changes in people’s habits, intentions and attitudes go hand in hand with respective regulatory and legislative changes! 25

The reduction in smoking in many countries has gone so far that many countries are considering the endgame of tobacco Finland, New Zealand, Norway, Australia, Ireland Ashgabat Declaration 2013 (53 European health ministers committment) European Child and adolescence health strategy for Europe, September 2014 Roadmap of actions for FCTC implementation 2015–2020 in the European Region

27 "If all the harms caused by tobacco were known earlier on, tobacco products would never have been approved as safe for human consumption, could never have been marketed and sold like any other consumer product“ Director General of WHO, 2013

Thank You Ačiū Kristina Mauer-Stender Program Manager WHO Regional Office for Europe Ingrida Zurlytė WHO Country Office, Lithuania