Status of tobacco control in the European region

In a report, the World Health Organization analyses the progress of countries in the European region in the fight against tobacco use, in light of the provisions set out in the WHO Framework Convention.

The WHO European Region is a group of 53 countries, extending well beyond the borders of the European Union, and including Turkey, Israel, and some Central Asian countries such as Turkmenistan.[1].

Prevalence and mortality figures

Between 2000 and 2022, smoking prevalence (daily and occasional) decreased from 34.4% to 25.3%. The European region now has 179 million smokers, compared to 229 million in 2000. Although significant, this decrease of 17% is still well below the WHO target of a 30% reduction in smoking between 2013 and 2020. The region observes strong gender disparities, with male prevalence set at 32% in 2022 (114 million smokers), and female prevalence at 18.5% (65 million). WHO projections estimate that smoking prevalence in 2030 is expected to be 28.3% for men and 17.9% for women, respectively. Only six countries recorded a smoking prevalence of less than 15% of their population in 2022, including Iceland, Norway and the United Kingdom. Conversely, France, Hungary, Cyprus and Bulgaria are among the 14 countries in the region with a smoking prevalence of more than 30%. Overall, smoking causes the premature death of one in five people in the region.

Taxation of tobacco products

In 28 countries in the European region, taxes accounted for at least 75% of the retail price in 2022, compared to 16 countries in 2008. More and more countries are moving towards effective taxation systems, allowing for an increase in retail prices while reducing the gap between brands to avoid consumption shifts to the cheapest products. Since 2012, tobacco has become less affordable in only 19 countries in the region. The price of tobacco has not changed since 2012 in 24 countries, and has even decreased relatively in nine others. Given the effectiveness of tax increases in reducing tobacco consumption, WHO considers this finding “worrying”, especially since tobacco prices have been less affordable since 2020 in only six countries in the region.

In line with Article 6 of the Framework Convention, WHO encourages countries to implement tax increases that are regular, significant and above inflation. WHO also recommends that countries simplify the tobacco tax structure and allocate a portion of the revenues generated to tobacco control.

Passive smoking and smoke-free spaces 

According to WHO, almost two-thirds of countries in the European region have insufficient regulation regarding protection against passive smoking, with partial bans on smoking in public spaces (healthcare and educational establishments, universities, offices, restaurants and cafes, public transport, administrative and state establishments).

European countries are increasingly extending smoking bans to other public places, including cultural venues (34 countries), retail outlets (31 countries) and indoor transport waiting areas (30 countries). However, only 19 countries have adopted total smoking bans in airports, with no designated smoking areas. Half of the countries in the region ban smoking in outdoor areas reserved for children, and 14 have made smoking illegal in cars carrying minors. WHO also recalls that the guidelines of Article 8 of the Framework Convention on Tobacco Control (FCTC) state that “each Party should strive to achieve universal protection within five years of the entry into force of the FCTC”. To date, 32 countries have not yet implemented this measure at the highest level, despite the deadline having expired.

Stopping aids

Between 2007 and 2022, the number of countries with a national quitline and covering the cost of nicotine replacement therapy increased from three to eleven. However, nicotine replacement therapy is not available in seven countries in the region, and is included in the list of essential medicines in only 13 countries. These products are most often available in pharmacies (39 countries), although the sale of substitutes is also authorized in general stores in some countries (7). In view of this observation, the WHO recommends that countries set aside funding for quit assistance, develop smoking cessation training for all health professionals, and emphasizes the need to systematically ask the patient's smoking status during any medical consultation.

Consumer information, health warnings and plain packaging

Between 2007 and 2022, the number of countries requiring large health warnings on cigarette packs increased from three to 41. In 38 countries in the region, these warnings are also mandatory on smokeless tobacco products, such as heated tobacco. However, the size of the warnings varies greatly from one country to another, ranging from 30% in Azerbaijan to 93% in Turkey. In addition, thirteen countries have adopted plain packaging, including the United Kingdom, France, Belgium, Georgia and the Netherlands. Article 11 of the FCTC requires Parties to adopt and implement “effective packaging and labelling measures within three years of the entry into force of the FCTC”. However, nine countries have exceeded this deadline without having implemented this provision.

Finally, between July 2020 and June 2022, less than half of the countries in the region conducted a national tobacco prevention campaign in mass media (49%).

Advertising ban

Thirteen countries in the Europe region have banned all forms of direct or indirect tobacco advertising in 2022. However, advertising in the media, on billboards, on the Internet, but also product placements or free distribution of tobacco products are prohibited in most countries in the region. However, the various restrictions and bans on advertising have pushed the tobacco industry to turn to point-of-sale advertising, which is only banned in 19 countries in the region. The observatories conducted by the CNCT also show that in France, the ban on point-of-sale tobacco advertising is not respected with regard to new products, in particular the strong presence of advertising for heated tobacco in tobacconists. Similarly, behavioral placements are strategies regularly used by manufacturers to circumvent the ban on product placements in cultural works. Finally, 38% countries still allow the sale of tobacco in vending machines, while 58% allow online sales.

[1] World Health Organization, New WHO/Europe fact sheets show uneven progress on tobacco control in the European Region, 02/12/2024, (accessed 03/12/2024)

©Tobacco Free Generation

FT