Framework Convention measures remain too weakly implemented in the WHO European Region

A study published in Tobacco Induced Diseases[1] assesses the implementation of WHO Framework Convention on Tobacco Control (FCTC) measures in 53 countries in the European region. Implementation of these measures remains highly uneven across the region and overall, only countries that have announced targets to achieve a tobacco-free generation in the coming years have implemented strong measures.

For this study, six areas were taken into account: the ability (i.e. tobacco control infrastructure in the country, strategies, resources, implementation and enforcement mechanisms, measures to prevent industry influence and hold industry accountable); taxation and pricing policies (including measures to prevent illicit trade); other key national regulations (such as smoke-free spaces; regulation of the content and emissions of tobacco products; packaging and labelling of tobacco products; advertising, promotion and sponsorship; and retail measures to prevent access by young people); public awareness and communication (publication of industry data, campaigns, training); smoking cessation (resources dedicated to smoking cessation), and follow-up of the epidemic (availability of various key data and promotion of research).

The evaluation is part of the perspective of the exit from tobacco in countries through the concept of the "Endgame". Also, only the most protective and most comprehensive provisions of the FCTC which are implemented in conjunction with the implementation guidelines have been retained.

Substantial differences at a general level of public policies have been observed between countries.

Significant differences between countries in the Europe region

In the WHO European Region, approximately 27% of adults are regular tobacco users. To end the tobacco epidemic, the concept of “Endgame” has been put forward. There is no single definition for this concept, but it generally refers to the situation in which the tobacco epidemic needs to be eradicated and not just controlled. “Endgame” targets and strategies proposed by some countries include reducing smoking prevalence to a minimum level in the population (<5%) or creating tobacco-free generations within a specific time frame. In Europe, 9 countries already have official targets, with different definitions. These are Belgium, Finland, France, Ireland, the Netherlands, Norway, Slovenia, Sweden and the United Kingdom.

The highest percentage of implementation was found in the area of monitoring, where among the 50 Parties to the FCTC in the WHO European Region, 21 achieved full implementation and 32 achieved 80 % or more of the maximum score. Only San Marino achieved a score of 0.

The second area where countries have made efforts is in the adoption of key national regulations. Of the 50 Parties to the FCTC in the WHO European Region, 27 achieved 80 % or more of the maximum score. The percentage of implementation ranged from 25 % in Poland to 99 % in Slovenia. However, none of the Parties in the region reported full implementation of the texts.

In the area of taxation and pricing policies, 30 of the 50 Parties to the WHO FCTC in the WHO European Region achieved at least 80 % of the maximum score. A total of 14 Parties to the WHO FCTC reported full implementation. The lowest percentage of implementation was 21 % (San Marino).

In the area of public awareness and communication, 19 of the 50 Parties to the WHO FCTC in the WHO European Region achieved at least 80 % of the maximum score. A total of 6 Parties reported full implementation. The lowest percentage of implementation was 15 % (Denmark). In the area of smoking cessation, only 3 of the 50 Parties to the WHO FCTC achieved at least 80 % of the maximum score. The percentage of implementation ranged from 6 % in San Marino to 91 % in the United Kingdom. None of the Parties in the region achieved full implementation.

The other weakness is the dimension of country capacities. In this area, none of them have put in place a comprehensive system. Only 5 of the 50 Parties to the WHO FCTC have achieved at least 80 % of the maximum score. The percentage of implementation ranged from 17 % in Ukraine to 91 % in the Netherlands.

Efforts are needed to achieve an effective reduction in consumption

The authors of the study indicate that there is still much to be done to maximise implementation of the WHO FCTC measures and its implementation guidelines. No country currently ranks among the top ten in the world in terms of full implementation of the identified areas. Only Ireland comes close, being in the top 10 in five of the six areas. There were significant differences in the implementation of the FCTC measures between countries that have formal strategies to achieve tobacco-free generations. However, even those countries that have set this target are not meeting all of the required provisions.

France has announced a goal of a tobacco-free generation by 2032. The assessment made gives it an implementation percentage of 73% of the measures selected for the different areas. This is the lowest score among the nine countries that have announced a tobacco exit strategy. Efforts are needed in the area of public awareness, communication, smoking cessation and especially capacity with the question of the effective application of the texts adopted.

Based on these results, the feasibility of achieving the goal of a European tobacco-free generation within the framework of Europe Against Cancer appears to be hampered by the weak implementation of the measures cited by the countries concerned. Therefore, the authors recommend that policy makers include the full implementation of the FCTC and additional measures on their political agenda.

Keywords: WHO, Europe, smoking, tobacco, endgame, tobacco-free generation, CCLAT, Framework Convention, MPOWER

©Generation Without Tobacco

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[1] González-Marrón A, Koprivnikar H, Tisza J, et al. Tobacco endgame in the WHO European Region: Feasibility in light of current tobacco control status. Tobacco Induced Diseases. 2023;21(November):151. doi:10.18332/tid/174360.