Progress in Tobacco Control in 30 European Countries 2005 to 2007
Overall there has been a big improvement in Europe in the last two years because of the 2003 EU directive banning tobacco advertising, and because of new smoke-free laws. The adoption by the European Parliament and Council in 2003 of Directive 2003/33/EC banning tobacco advertising and sponsorship with a cross-border dimension in all EU Member States was a very important development, and resulted in strengthening the legislation on advertising in many European countries (9). The adoption of laws banning smoking in public places was feared by the tobacco industry decades ago and in our 2006 paper we showed that the financial world concurred with this judgement and rated smoke-free legislation as having a significant impact on the market.
Trade analysts Citigroup Smith Barney made the following comment on the Irish market in September 2004: “Once again, the month-by-month data continues to look worrying. Overall, we believe the ban has probably reduced consumption by 5%. It will also make recruiting new smokers, and marketing to all smokers, much harder, we believe” (10). In April 2005 they said: “Investors currently are most concerned about the impact of bans in bars and public places. The impact in Ireland has been quite severe, probably between 5-7% on volume” (11).
The investment bank Morgan Stanley speculated on the possible impact of a smoking ban in the UK: “According to our estimates a complete UK smoking ban may reduce consumption by an incremental 4%-5%, but we would expect manufacturers to offset the impact of lost volumes through price increases, an approach which seems to have worked in Ireland” (12). Even the impact of the Italian law, which is less strict than the Irish ban and which allows closed, designated and ventilated smoking rooms, was feared by the stock analysts. Morgan Stanley described the situation in Italy in their 29 June 2005 analysis thus: “Italy. Indications from the most recent Nielson retail data that despite increasingly warmer weather – which would presumably moderate the adverse impact of the January 2005 indoor smoking ban – the pace of cigarette consumption decline has unfortunately not significantly moderated” (13). Data from Italy show that 28.3 million kg of cigarettes were sold in the period January to April 2005, compared with 31.1 in the same period in 2004, a reduction of 9% (14).
We think that one of the lessons of tobacco control over the last few decades is that it is important to keep the pressure up and maintain a high level of activity. In fact our data bear this out in the sense that several countries that maintained their tobacco control score nevertheless slipped down the table, as other countries improved their scores and overtook them. According to the stock analysts Morgan Stanley: “Of the various measures available to governments in reducing demand for tobacco, clearly the one that concerns the cigarette companies the most is rising taxation” (19). High price remains the most effective tobacco control measure, thus it is important to note that the price of tobacco products varies greatly in Europe. On 1 January 2007 a pack of Marlboro cigarettes ranged from € 1.17 in Latvia to almost € 7.89 in the UK and € 8.17 in Norway. Some European countries (France, Germany and the Netherlands) increased tobacco product taxes substantially in 2004, with a considerable effect on prevalence. However, the effect has been weakened as a result of cross-border shopping, so we recommend that the number of cigarettes that can be imported for personal consumption between EU countries, now at least 800 cigarettes, should be reduced to 200 per person. According to Morgan Stanley again: “The other two regulatory environment changes that concern the industry the most are homogenous packaging and below-the-counter sales. Both would significantly restrict the industry’s ability to promote their products” (19). Countries in the European Union have the option of requiring picture-based warnings on tobacco products (20). Pictorial warnings are a cost-effective way to inform smokers about tobacco products (21). So far Belgium is the only EU country to require pictorial warnings on cigarette packets (since 1 June 2007). Picture warnings are under consideration in other EU countries. Pictorial health warnings should become mandatory on the two main sides of tobacco products for all EU countries. The pictures should be renewed on a regular basis, with the aim that the whole pack would become a platform for mandatory health promotion messages. On the basis of the research reviewed in our introduction and our results, there are some serious short-comings in tobacco control in Europe at the moment. There is an urgent need for more investment. In the EU only the UK spent more than € 2 per capita per year on tobacco control. The 2004 ASPECT report recommended that EU Member States immediately increase per capita spending by € 1-€ 3 (22). No European country had banned smoking in bars and restaurants by January 2004. By July 2007 ten countries had introduced smoke-free bars and restaurants, and more countries are planning to do so. The most comprehensive European smoke-free legislation (a complete ban on smoking at the workplace – including bars and restaurants – with no exemptions at all) has been introduced in Ireland, Scotland and England. Genuinely comprehensive smoke-free legislation, which includes a total ban in all work places (including bars and restaurants), public places (including health and educational facilities) and public transport, should be a priority for every European country. Most European countries have adopted smoke-free legislation which does not comply with the guidelines agreed at the second Conference of the Parties (COP2) of the World Health Organization’s Framework Convention of Tobacco Control (FCTC), held in Bangkok in July 2007 (23). The guidelines emphasise that effective protection of health requires the creation of 100% smoke-free environments and that ventilation and designated smoking rooms are not acceptable approaches.
Here we comment briefly on individual countries, in reverse order of their ranking.