The battle against the global tobacco epidemic is far from won, even as more countries adopt measures such as smoke-free environments and warnings on packaging to curb its use, a new report has revealed.
The report from the World Health Organization reveals that lives are still at risk from tobacco, with billions of people living in countries that have not yet fully implemented even one of six effective measures to control tobacco recommended by the organisation. These include offering help with quitting smoking, raising taxes on tobacco, banning tobacco advertising and warning people of the dangers of tobacco.
It is estimated that about 1.1 billion people are currently smokers. According to the WHO, about half of those who use tobacco will die as a result, with about 7 million smokers and 1 million non-smokers dying every year from tobacco use – the latter as a result of passive smoking.
Launched in Brazil, the new report is the latest from the WHO to look at progress in tackling the global tobacco epidemic, scrutinising which countries have put in place six measures recommended by the organisation. These interventions support the Framework Convention on Tobacco Control (FCTC) that almost all countries, bar some such as the US, have committed to.
The report’s findings reveal an uptick in the provision of best-practice services that help people to quit smoking, with the number of people living in countries with such provisions having increased from 0.4 billion in 2007 to 2.4 billion, although these measures have only been fully adopted by 23 countries. What’s more, 3.9 billion people now live in countries with best-practice graphic warnings – an approach adopted by 91 countries.
And there are other signs of progress: in the past two years 10 countries including the Gambia, Saudi Arabia and Slovenia have introduced widespread bans on advertising, promotion and sponsorship of tobacco, and another 10, including Australia, have raised taxes on tobacco products to comprise at least 75% of retail price (the best-practice level) bringing the the total number of countries employing this step to 38.
Dr Vinayak Prasad, head of the WHO’s tobacco control team, said there was cause for optimism despite the power of the tobacco industry. “We have a very solid opponent, but having said that if you look at the progress since the last report I haven’t seen any major rollbacks [of policies],” he said. “That is a huge win.”
The team say, importantly, that progress is not confined to developed countries, with 17 of the world’s 34 low-income countries now adopting at least one of the WHO’s measures to the highest level.
However, about 2.6 billion people are living in countries without even one such stringent measure to control tobacco use.
Only two countries – Turkey and Brazil – have adopted all six of the WHO’s recommended steps to the fullest degree. What’s more, progress has slipped in some parts of the world: the provision of cessation services has fallen from the highest level in six countries, including Israel, Estonia, Malta and Iran.
Prasad said there were a number of barriers to improving the global situation, including tobacco companies launching new products and issues around political will – and more needed to be done to boost awareness that raising taxes on tobacco could help generate large sums to invest in health services.
However, the new report welcomes even small steps as movement in the right direction, for example partial bans on smoking or less prominent messages on packaging. “Incomplete or partial policies are a stepping stone to complete policies,” it states.
The WHO report comes a month after research published in the BMJ found the FCTC treaty did not appear to have sped up progress in reducing global cigarette consumption: while smoking rates have declined in some high-income countries, Chinese and Indonesian consumption increased in the decade to 2013.
Prof Linda Bauld, an expert on tobacco use and public health at the University of Edinburgh who was not involved in the latest report, said the two studies were not necessarily at odds. “What [this WHO report] definitely underlines is how gradual the progress is and how much time it takes for countries actually to get to grips with this treaty and all its articles,” she said.
Bauld added that some countries were struggling to provide basic healthcare, and did not have the resources to enforce policies they introduced – and were more vulnerable to lobbying by the powerful tobacco industry.
“We are moving in the right direction but progress is too slow,” she said. “People are dying all the time who don’t need to.”
