Smoking-related deaths annually cause an estimated 7.2 million deaths worldwide, killing half of all smokers over time — more than AIDS, malaria, and tuberculosis combined. The WHO Europe region reports the highest prevalence of tobacco smoking among adults — 28% versus 21% worldwide, and the smoking rate among European women is more than double the world average — 19% versus 7% worldwide. To draw global attention to the tobacco epidemic and the preventable death and disease it causes, the WHO World Health Assembly instituted the World No Tobacco Day (WNTD) in 1988, to be celebrated on 31 May each year. The annual changing theme of WNTD is intended. to cover the range of measures set out in the 2005 WHO Framework Convention on Tobacco Control (FCTC), which includes national actions for best practice on public smoking bans, tobacco advertising restrictions and taxation on tobacco products. This year’s theme is “Commit to Quitting”, focused on the FCTC endorsed measures to support the estimated 780 million people around the world who want to quit smoking.

Although 50 of 53 countries in the WHO Europe region have ratified the FCTC, only ten have comprehensive public smoking bans, and only five — Albania, Moldova, Russia, Spain, and Turkey — have a total ban on all forms of direct and indirect tobacco . advertisements. Strike policies have also been implemented to a lesser extent, with only nine countries – the Czech Republic, Denmark, Ireland, Luxembourg, the Netherlands, Slovakia, Sweden and Turkey – offering the best policies to help people quit. Although the overall smoking rate has declined over the decades, it is still high in the European region. Russia has reduced its overall smoking rate from 39% in 2009 to 31% in 2016, but it still has the largest adult smoking population in the region, with an estimated 35 million people over the age of 15 smoking. Three other European countries that have succeeded in reducing smoking rates are Greece (40% in 2005 to 27% in 2017), Israel (30% in 2000 to 20% in 2019) and the United Kingdom (25% in 2006 to 14). % in 2019). Meanwhile, smoking rates in France and Germany have hardly dropped at all, with a stagnant adult smoking population of around 30%, reflecting the overall sluggishness trend in Western Europe.

The overall modest improvement in European smoking rates is deeply worrying and calls for the implementation of stricter measures and policies to lower the smoking rate in the region and prevent tobacco-related diseases and deaths. In this month’s issue of The Lancet Regional Health – Europe, Gredner and colleagues modeled the impact of full implementation of tobacco control policies to prevent future lung cancer cases in 30 European countries. The results show that, over a period of 20 years, an estimated 1.65 million lung cancer cases (21.2%; 19.8% in men and 23.2% in women) can be avoided. The data indicate the greatest potential for prevention in countries with currently high smoking rates and relatively indulgent policies: up to 24.5% in Western Europe, and more than 20% in Southern and Eastern Europe. Countries in Northern Europe, with high control policies and low smoking rates, have the lowest, but still significant, potential for further prevention (12.5%). Despite being one of only two countries in the world that has already adopted all WHO FCTC measures at the highest level, the country’s decline in overall smoking rates is slow, and smokers are still 30% of the population. A study by Breda and colleagues published in the February issue of The Lancet Regional Health – Europe showed that more than 4,500 deaths a year could be avoided if Turkey could reduce the smoking rate by 30% in 2017.
These encouraging projections by Gredner and colleagues can be achieved as laws are strengthened and updated to include emerging trends in tobacco use. An important new development that legislators need to consider when drafting new legislation is the changing landscape of tobacco products, with the advent of heat-non-combustible tobacco devices (heated tobacco products, HTP) and electronic nicotine delivery systems (ENDS), which may does not immediately fall under the current tobacco policy. These products are actively marketed by the tobacco industry to appeal to young people with the false promise of being safe or “smokeless”, while releasing many of the same harmful chemicals linked to traditional tobacco smoking. The € 160 billion tobacco industry is also actively supporting legislators in Europe this year, ahead of the review of EU tobacco policy. Europe’s response to the FCTC’s call to “protect policies against commercial and other vested interests of the tobacco industry” will determine whether the new law will be able to bend current trends to those projected in the best policy scenarios.

Without comprehensive and pragmatic action to change current smoking trends, Europe will be the only WHO region not to reach the global non-communicable disease target to reduce tobacco use by 30% by 2025. A new target — around a smoking rate of 5 to reach% or lower by 2040 — is part of the EU’s Beating Cancer Plan released in February 2021. These targets, while ambitious, are achievable if WHO FCTC’s best practices, agreed upon for more than a decade, can be fully implemented. Previous surveys show that more than half of European smokers are interested in quitting, and data show that their success can be doubled by government measures such as free quit-smoking phone lines and health insurance-covered nicotine replacement therapies. The lack of government initiative has prevented the implementation of these strike programs in the past, and has not avoided the disease burden on millions of people. Change in policy is only possible under strong political will and in 2021 we are still waiting for the European political commitment to stop tobacco.

The Lancet Regional Health – Europe