TECHNICAL EDITORIAL

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ПАНОРАМА ОБЩЕСТВЕННОГО ЗДРАВООХРАНЕНИЯ ТОМ 6 | ВЫПУСК 2 | ИЮНЬ 2020 Г. | 223 – 339

The WHO European Region is a leader in global tobacco control. European countries are implementing some of the most comprehensive tobacco control measures and achieving some of the greatest reductions in prevalence of tobacco use in the world (1). European countries are among those taking the strongest stand against the tobacco industry (2–4). European countries are making the boldest commitments – to create a tobacco-free society (5). Europe can be the exemplar in global tobacco control and lead the world to the endgame – making tobacco a thing of the past (6) (Interview with Dr Adriana Blanco Marquizo).

Great progress has already been made – progress that only 20 years ago would have seemed unachievable (Interview with Professor Mike Daube). While such progress is a cause for celebration, and standardizing these achievements across the European Region will save millions of lives, all governments, all sectors and all stakeholders should understand that tobacco control in Europe is unfinished business. Tobacco remains a

major public health problem. Europe has some of the highest levels of tobacco use in the world and it is the region with the highest rate of tobacco use in women and girls (7). As well as the health burden, tobacco harms economies, environments and development in all countries in Europe.

We are 15 years on from the entry into force of the WHO Framework Convention on Tobacco Control (WHO FCTC), we have 10 years remaining before 2030 to achieve the Sustainable Development Goals, and yet only six countries in the Region are on track to reach the global target of a 30% reduction in tobacco use (7). We are in the throes of the COVID-19 pandemic, a disease which causes greater harm to people who smoke and to those that have the underlying illnesses caused by smoking (8), and yet 26% of the population of Europe currently use tobacco. Now is the time to come together to implement the WHO FCTC fully in all countries in Europe and push forward to a tobacco-free society (9).

TECHNICAL EDITORIAL

Stepping up to 2030 in the WHO European Region: now is the time to deliver on tobacco control

Nino Berdzuli

Director, Division of Country Health Programmes, WHO Regional Office for Europe

Kristina Mauer-Stender

Programme manager, Tobacco Control, WHO Regional Office for Europe

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Now is the time to address the changing trends in tobacco use, so that we leave no one behind. As the pattern of tobacco use in Europe and the tactics of the tobacco industry change, tobacco control needs to adapt. Through regional and national surveillance (10) and improving digital access to data and intelligence, we can support each other to keep ahead of the trends and target people with the greatest needs.

The highest prevalence of smoking has been reported in the Commonwealth of Independent States (CIS), where prevalence in men reaches over 50% and there is an associated very high risk of premature death from noncommunicable diseases (11).

However, in the CIS and other parts of Europe where men have historically smoked more than women, the trends in relation to smoking among women are an increasing concern, as the rates of reduction are very slow or have been reversed. We need to work together to correct these trends and counteract the tobacco industry’s aggressive targeting of women and girls (12). To do so, tobacco control in Europe needs to acknowledge gender as a significant social determinant of health and actively incorporate it into every stage of policy and research (Women and tobacco marketing in the WHO European Region: time for gender-responsive action).

Now is the time to protect young people from tobacco, and to do so for future generations. This year, the focus of World No Tobacco Day is protecting children and young people (13).

They are also being targeted by the tobacco industry, which sees young people as an “emerging market” both for traditional tobacco use and novel products (14–16). Currently, 12% of girls and 14% of boys between the ages of 13 and 15 years use tobacco in Europe. The figures have been decreasing over the years as a result of effective tobacco control, but more must be done. Tobacco use and exposure to second-hand smoke not only increase the risk of a range of illness, infection and sudden death in children, they also lead to a lifelong addiction with ever-mounting harm. The industry wilfully sells this deadly dependency to young people, and this year we have the impetus to stand up against it stronger and more united than ever, and to share best practices to protect children ( 17).

Now is the time to identify new avenues for tobacco control, so that we can maximize our impact. The WHO 4x4 framework for the main noncommunicable diseases and risk factors ( 18) has been expanded to a 5x5 framework to include mental health and air pollution ( 19, 20). Mental disorders are a leading cause of disability and the overall disease burden in Europe (21). There is a bi-directional rationale for strengthening tobacco control for mental health and removing exemptions to smoke-free policies in mental health facilities (Supporting policy implementation: introducing a tobacco free campus

policy in Irish adult community mental health day services). In one direction, there is a much higher prevalence of tobacco use and related premature mortality in people with mental health problems, such that targeting this group will have a large beneficial impact. In the other direction, tobacco use is associated with worse mental health outcomes, so to provide exemptions leads to harm and creates a vicious cycle that counteracts tobacco control efforts (22).

Tobacco control in the context of mental health, and more broadly, is also a human right (23). Effective tobacco control is part of our right to the highest attainable standard of mental and physical health (24), and any exemptions for people with mental health problems are a violation of rights by discrimination (25). Building this dimension into national and regional policy processes will increase the number of stakeholders involved, including other government departments, and strengthen the legal case when defending policies against industry interference (Advancing tobacco control with human rights).

Now is the time to accelerate tobacco control, so that all of Europe can step up to achieve the Sustainable Development Goals. We have a greater number and breadth of motivating factors for the scale-up and rapid implementation of the WHO FCTC in Europe than ever before, with synergies for comprehensive tobacco control that go way beyond health (26–

28). The economic case is stronger than it has ever been (29).

Through strong partnerships between Member States and the WHO Regional Office for Europe we can support countries with investment cases and multisectoral backing for comprehensive policy implementation (30). With the potential for massive and irrecoverable damage caused by climate change, the focus on climate action gives another string to the tobacco control bow in Europe. The environmental harm caused by tobacco production and consumption, from deforestation to soil degradation, water and air pollution, brings tobacco control into the climate arena and presents yet another case for urgent action across sectors (31, 32).

We are at a pivotal moment for tobacco control in Europe. If

we work together across Europe and at every level to support

multisectoral implementation of the WHO FCTC (Interview

with Dr Fenton Howell; Making Smoking History in Greater

Manchester; Make smoking invisible: tailoring a global health

priority to a former mining town in England) we will achieve

the global target to reduce tobacco use, we will strengthen our

resilience to COVID-19 and other health emergencies, we will

improve our environment and our economies, we will save

lives and we will protect our children and future generations.

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ПАНОРАМА ОБЩЕСТВЕННОГО ЗДРАВООХРАНЕНИЯ ТОМ 6 | ВЫПУСК 2 | ИЮНЬ 2020 Г. | 225 – 339

Now is the time to step up to 2030 and build a pan-European culture which enables everyone to make healthy choices and in which tobacco is a thing of the past.

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