Challenges ahead to reach the goal set up in Tobacco End

Challenges ahead to reach the goal set up in Tobacco

End Game 2025

Dr Vera Luiza da Costa e SilvaHead of the Convention Secretariat

WHO FCTC12 June 2018

Towards the end game

1. Where are we?2. What do we want to achieve and by

when?3. What do we need to do?4. What will be the challenges?

1. Where are we?

Tobacco epidemic in Sweden Male Female Total

Current smokers 14 14 14Daily smokers 8 10 9Current smokeless tobacco users 21 5 13Daily smokeless tobacco users 18 4 11

2018 WHO FCTC Global progress report for Sweden Source: Public Health Agency of Sweden (2016)

2. What do we want to achieve and by when?

- Reduction in daily smoking to 5% in men and women by 2025

Trends in daily tobacco smoking among persons 15 and older in Sweden

Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025

Trends in daily tobacco smoking among persons 15 and older in Sweden

Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025 (2018)

0

5

10

15

20

25

2000 2005 2010 2015 2020 2025

Men

Women

Voluntary target: 30% reduction between2010 and 2025

Age specific rates of current daily smoking in Sweden

Source: WHO Global report on trends in prevalence of tobacco smoking 2020-2025 (2018)

Trends in daily tobacco smoking among persons 15 and older in Finland and

Norway

Finland

Norway

Trends in daily tobacco smoking among persons 15 and older in Finland and

Norway and Sweden

0

5

10

15

20

25

30

35

2000 2005 2010 2015 2020 2025

SwedenFinlandNorway

Some tobacco control measures in these 3 countries

Sweden Finland NorwayPrice (International dollars)

7.21 6.57 12.46

Taxes (most sold brand)

68.5% 84.9% 66%

Smoke free Policies

Smoking allowed enclosed public places

Smoking allowed enclosed public places

Banned in allindoor public places

Health warnings cigarettes

65 (F65,B65)15 rotating

65 (F65,B65)15 rotating

48 (F43-B53)16 rotating PP

Health warnings smokeless

30 (F30, B30)Only 1

Smokeless banned 15 (F30-B0)Only 1

Illicit trade protocol Signed. Not ratified Signed. Not ratified Signed. Not ratified

Point of sale advertising

Not banned Banned Banned

With the exception of Sweden, the sale of snus is prohibited in the European Union (EU). Article 17 of the 2014 EU Tobacco Products Directive

3. What do we need to do?

First step: Fully implement the

WHO FCTC

The WHO FCTC

Legally binding global Treaty

Aims at protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke (Article 3)

Comprehensive and multisectoral approach to tobacco control

90% of the world’s population covered by the treaty provisions

Parties to the WHO FCTC 180 countries and the European Union

Sweden is a Party since 2005

Supply reduction measuresWHO FCTC & Guidelines

Sweden signed the Protocol on 6 Jan 2014 but has not yet ratified

Other obligations under the WHO FCTC

ReportingInternational cooperation

Implementation of the WHO FCTC provisions - Sweden

Article 8 & Guideline

• Smoking is allowed in designated smoking areas in most workplaces and public places and public transport.

• There are only limited outdoor smoking restrictions; namely, in outdoor areas of premises intended for childcare, school activities, or other activities for children or young people.

2018 WHO FCTC Global progress report for Sweden

Implementation of the WHO FCTC provisions - Sweden

Article 13 & Guideline

• Advertising and promotion is allowed at points of sale, provided it is not visible from outside the point of sale.

• Tobacco product displays are also allowed at points of sale.

• There are some restrictions on tobacco sponsorship and the publicity of such sponsorship.

2018 WHO FCTC Global progress report for Sweden

Proposed end game strategies

Product-focused endgame proposals• Regulate nicotine levels to make tobacco products non-addictive or less

addictive• Redesign the cigarette or tobacco products to make them unappealing• Harm reduction strategies

User-focused endgame proposals• Smoker's license• Prescription to purchase tobacco • Restrict sales by year born-tobacco free generations

Source: adapted from Malone et al, 2015

Proposed end game strategies (II)Market/supply-focused endgame proposals• Licensing, outlet restrictions, display bans and price controls• Quota/’sinking lid’• Price caps for wholesale prices

Institutional structure-focused• Tobacco control agency• Regulated market model• State takeover of tobacco companies• Performance-based regulation

Integrated endgame strategies

Public support for endgame proposals

Endgame considerations

Short term1. Develop an endgame dialogue, narrative, and communications

plan2. Take specific actions to constrain the tobacco industry

Longer term 3. Create a tobacco regulatory authority with monitoring and

regulatory powers4. Develop incentives to gradually reduce the number and density of

tobacco retail outlets5. Create a national plan for addressing gradual reductions in

tobacco company workforce and tax receipts.

Source: Cancer Research UK

Endgame: Finland example

What will be the challenges?

We need to change permanently the structural, political and social dynamics that sustain the epidemic- Consensus and unity amongst public health

community- The public must be prepared to believe in and

support ending the tobacco epidemic- The policy makers must be willing and be prepared

for tobacco Industry attacks - We should target communities that are more

affected

Challenges faced by Parties to the WHO FCTC

WHO FCTC GLOBAL PROGRESS REPORT 2016

Manoeuveringto hijack the political and legislative process

Exaggerating the economic importance of the industry

Manipulating public 

opinion to gain the 

appearance of 

respectability

Fabricating support 

through front groups

Discrediting proven science

Intimidating governments with litigation or the threat of litigation

Forms of Tobacco Industry Interference

Source : ACS Tobacco Atlas, 2018

ENDSSales globally

E-cigs dollar sales worldwide 2008-2017

Source: The Statistics Portal

Possible next steps

• Fully implement the WHO FCTC provisions and Guidelines

• Become Party to the Protocol to Eliminate Illicit Trade in Tobacco Products

• Decide whether the Endgame comprises other tobacco products such as narguiles, snus and heated tobacco products?

• Address social determinants of the tobacco epidemic