|Fact sheet No 118: The Tobacco Epidemic: A Global Public Health Emergency Tobacco Use - May 1996 (WHO, 1996, 6 p.)|
From 1970 to 1995, the World Health Assembly adopted 14
resolutions, all without dissent, in favour of tobacco control measures. Several
of these resolutions called for comprehensive tobacco control programmes and
· Although these resolutions were adopted without dissent, many Member States have experienced difficulty in effectively implementing the comprehensive tobacco control strategies called for by the WHA resolutions. Among Member States, the range of policies and programmes which have been implemented vary widely.
· Many elements of an effective comprehensive national tobacco control policy will eventually involve some form of legislative action, whether in the form of adopting or amending laws, regulation or government decrees. However, even though countries may adopt legislation, in a number of cases, ineffective enforcement may render the legislation ineffective.
· In the early 1990s, about 25 countries had laws that prohibited the sale of cigarettes to minors, with the age of prohibition ranging from 16 to 21 years of age. In some cases, other related measures have been enacted, including bans or restrictions on cigarette sales from vending machines, prohibitions on sales of tobacco products and smoking in schools, prohibiting the sale of single cigarettes and banning the offering of free samples of cigarettes.
· In order to provide complete protection from involuntary exposure to tobacco smoke in indoor locations, smoking must be prohibited entirely or restricted to a few separately ventilated smoking areas. Some degree of protection is also provided by restricting smoking to a few specific rooms, even if separate ventilation is not feasible. Many jurisdictions have laws that ban or restrict smoking in public places, workplaces and transit vehicles.
· Effective health promotion and health education programmes are part of a comprehensive tobacco control programme. These include such features as celebration of no-tobacco days, media advocacy, the use of paid media advertising, school-based health promotion programmes, community-based health promotion programmes and sponsorship of cultural, sporting and community events. Many countries have successfully offset the costs of operating such programmes with a portion of the revenue collected from tobacco taxes.
· Smoking cessation strategies work best when they take place in as part of a comprehensive tobacco control programme. The best smoking cessation strategies would train all health professionals in the providing of smoking cessation counselling and advice. It would also be desirable to make available a broad range of cessation strategies, including group counselling, physician advice, and where appropriate, nicotine replacement therapy.
· There are active programmes to train pharmacists in smoking cessation counselling in Belgium, Denmark and the United Kingdom, with more European countries expected to follow suit. Telephone counselling services (quit lines) to assist people who wish to quit smoking are offered in a number of Member States. In Australia and South Africa, quit line telephone numbers are included along with required health information printed on every package of cigarettes.
· In the early 1990s, about 80 countries required health warnings to appear on packages of tobacco products. However, in most of these countries, the warnings are small, inconspicuous and provide little information about the many serious health consequences of tobacco use. By the mid 1990s, however, a number of countries had adopted more stringent warning systems, involving direct statements of health hazards, multiple messages, and well as large and prominent display. Such warnings are presently required in a number of countries including Australia, Canada, Iceland, Norway, Singapore, South Africa and Thailand.
· A number of countries have successfully passed law to ban all or nearly all forms of tobacco advertising. In a number of countries, further legislative active has proven necessary to tighten advertising restrictions, as tobacco companies have attempted to circumvent the ban by the use of indirect advertising.
· As of 1990, 27 countries reportedly had total or near-total bans on advertising. Since then, however, the number has declined to 18. While Australia and Kuwait recently implemented bans on tobacco advertising, tobacco advertising bans that had been in place became inoperative in Canada and the newly independent states of Central and Eastern Europe. However, Canada and many Central and East European countries are considering draft legislation to re-establish bans on tobacco advertising.
· Financial measures are an important component of comprehensive tobacco control strategies. A number of studies have shown that for every 10 per cent increase in the price of cigarettes, consumption can be expected to decline by two to eight percent, with even larger declines found among adolescents.
· Among Member States, cigarettes prices were found to vary widely. However, global comparison can be made by measuring the price of cigarettes in the minutes of labour required to earn the price of a packet of 20 cigarettes. Using this method of comparison, cigarettes were found to be most expensive in such countries as Jamaica, Costa Rica and Belize, while relatively inexpensive in Argentina, Japan and Spain.
· Regular increases in tobacco taxes which increase tobacco prices at rates faster than the general growth in prices and incomes will both reduce consumption and raise government revenue. Several countries were found to have taxes representing 60-80% of the retail price of cigarettes.
· A number of countries have successfully used a portion of tobacco taxation revenue to offset the cost of operating their comprehensive tobacco control programmes. In several Australian States, tobacco taxes are used to finance Health Promotion Foundations. A similar foundation exists in New Zealand funded from general revenue. In Finland, 0.45% of tobacco taxation revenue is allocated for tobacco control activities. In other countries, such as Nepal, Portugal, Romania and Switzerland, a portion of tobacco tax revenue is used to finance specific health or social programmes.
· Several WHO Member States have long-standing comprehensive tobacco control policies, built up gradually since the 1970s. As of the mid 1990s, Finland, Iceland, Norway, Portugal and Singapore fit into this category. Other countries, such as Australia, France, New Zealand, Sweden and Thailand have more recently implemented truly comprehensive tobacco control programmes which encompass most or all of the nine elements called for by the 1986 World Health Assembly resolution.
For further information, please contact Philippe Stroot, Media Relations, Health Communications and Public Relations, WHO, Geneva. Telephone (41 22) 791 2535. Fax (41 22) 791 4858.
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© WHO/OMS, 1998