Ever since the European Commission dedicated a Directorate and Commissioner for Health & Consumer Protection (DG SANCO) at the start of this century, tackling tobacco use and smoking has been at or near the top of its priorities. When the first specific Commissioner, David Byrne, held a consultation on the components of a health strategy, it became clear that strengthening the existing available legislation would be a consistent priority. Why?
By Clive Needle
As the EC says, tobacco consumption is the single largest avoidable health risk in the European Union. It is the most significant cause of premature death in the EU, responsible for nearly 700,000 deaths every year. Around 50% of smokers die prematurely (on average 14 years earlier). In addition, smokers have more life years in poor health. Many forms of cancer, cardiovascular and respiratory diseases are linked to tobacco use, which causes more problems than alcohol, drugs, high blood pressure, excess weight or high cholesterol.
Despite considerable progress made in recent years, the number of smokers in the EU is still high – 28% of the overall population and 29% of young Europeans aged 15-24 smoke. While WHO provides technical assistance, guidance and action plans for governments on tobacco control and prevention, the EU has legal competences which can provide added value in the largest single cross border market in the world. Taking into account the significant cross border trade of tobacco products and diverging national legislation, EU-wide rules are necessary. The rules ensure that consumers are equally protected across the EU.
More than ten years have passed since the adoption of the first Tobacco Products Directive (2001/37/EC), making it necessary to update the Directive in order to bring it in line with market, scientific and international developments in the tobacco sector. The Council and European Parliament have also repeatedly called on the Commission to address the weaknesses, gaps and loopholes in the previous rules.
The revised Tobacco Products Directive governing the manufacture, presentation and sale of tobacco and related products was officially adopted by the Council on 14 March 2014, following its formal approval by the European Parliament on 26 February 2014. This new Directive aims to improve the functioning of the internal market for tobacco and related products, while ensuring a high level of health protection for European citizens.
This is a major achievement for tobacco control. The new Directive sets in place more stringent rules for tobacco and related products and focuses on limiting their appeal, in particular to young people. The new measures cover labelling, ingredients, tracking and tracing, e-cigarettes, cross-border distance sales, and herbal products for smoking and will facilitate the smooth functioning of the EU market for tobacco and related products. These include cigarettes, roll your own tobacco, pipe tobacco, cigars, cigarillos, smokeless tobacco, electronic cigarettes and herbal products for smoking.
In particular, the new Directive:
- prohibits cigarettes and roll-your-own tobacco with characterising flavours,
- requires the tobacco industry to submit detailed reports to the Member States on the ingredients used in tobacco products, in particular cigarettes and roll-your-own tobacco,
- requires that health warnings appear on packages of tobacco and related products. Combined (picture and text) health warnings must cover 65% of the front and back of cigarette and roll-your-own tobacco packages,
- sets minimum dimensions for warnings and eliminates small packages for certain tobacco products,
- bans all promotional and misleading elements on tobacco products,
- introduces EU-wide tracking and tracing to combat illicit trade of tobacco products,
- allows Member States to prohibit internet sales of tobacco and related products,
- sets out safety and quality requirements for consumer electronic cigarettes,
- obliges manufacturers to notify novel tobacco products before placing them on the EU market.
EuroHealthNet provided background information to decision makers and stakeholders throughout the difficult process from the initial EC consultation to the inter-institutional agreements. As a partnership of many of the bodies responsible at national or sub national levels for advising on policies and implementing programmes in health promotion and health determinants, EuroHealthNet participants contributed specific information relevant to national circumstances and evidence based advocacy support. EuroHealthNet congratulates all responsible for adoption of the Directive in the EU Institutions, Member States and stakeholders. Now it will seek to play its part in the effective implementation, evaluation and dissemination of national approaches.
The revised Directive comes when WHO Europe is also seeking faster progress on non- communicable disease (NCD) prevention. EuroHealthNet participated at the inter-governmental negotiation of the Ashgabat Declaration in 2013, which included progress towards a tobacco free Europe, an aim we wholly support and will work to achieve. Details may be found here.
Crucially, a Tobacco Control Status Report published then revealed that, to achieve the global target of a 30% relative reduction in tobacco use by 2025, many European states need to accelerate progress, as most are a long way from full implementation or to take a comprehensive approach.
So the challenge is to ratify and apply the Directive provisions in all states, for EuroHealthNet is gradually extending into states in South Eastern Europe and elsewhere which are not yet EU Member States, and will work closely with both the EC and WHO Europe to support national initiatives. Already EuroHealthNet is encouraged by initiatives in countries such as Ireland, Wales and England which suggest better legislation on e-cigarettes and packaging. We hope more will use all tools available to implement measures.
Lastly from my personal perspective, as someone who has been involved in campaigning against tobacco use for almost two decades, I express my respect and admiration for those experts and policy makers who have had to endure unacceptable pressures at every step towards the admirable objectives of removing from our communities a (sadly) legal product that kills. Tobacco advertising and sponsorship on television was prohibited already since 1989 by the Television without Frontiers Directive (89/552/EEC). I experienced personally the difficulties for any policy maker supporting these approaches while working on further legislation and was involved in gradual progress on smoke free environments, which now has EU support and significant measures in place in most states.
Much of the painstaking gathering and assembling of evidence is made more difficult by the (pun intended) smoke-screen that is put into the decision making process, not by a single industry as is often alleged, but by a collaboration of vested interests and those who genuinely believe that it should be an individual right to choose, even though overwhelming evidence continues to grow of the harm caused and, I would argue, the myth of choice. The fact that the EC website has to publish ‘’Myth buster’’ facts about certain products demonstrates the strength of emotions, the extent of misinformation, and the limits of the powers of states to act alone.
I have learnt much about the nature of consumer behaviours and addictions driven by producers, not least at the 11th World Conference on Tobacco or Health in Chicago in 2000. There I first heard about how new technology driven products rather than inconvenient cigarettes would be used to deliver nicotine in future. That future is regrettably coming to pass with e-cigarettes, and I hope EuroHealthNet will be among those responsible bodies which ensure their effective regulation only as part of careful tobacco cessation services, and absolutely not as gateways for new users, particularly those who are more vulnerable.
Public health has been too slow in policy terms to adapt to rapidly changing markets and must learn lessons to ensure more effective evaluation and information. The adoption of the TPD gives us all a better basis for playing our part. We will strengthen our role through both the new Health Promotion Europe and the new Platform for Health & Social Equity that we are establishing in 2014, plus the liaison that our Centre for Innovation, Research & Implementation has with current EU research projects building more evidence on tobacco and health equity. We welcome proactive inputs from all EuroHealthNet participants.
Clive Needle
Clive advises the EuroHealthNet Executive Board and managing director on policies relating to health for all EU activities and actions on social, economic and environmental determinants of equity and wellbeing. He was formerly overall EuroHealthNet director for thirteen years and continues to work in support of WHO and other international organisations and projects in Europe.