Many countries not adequately implementing anti-smoking policies — WHO report

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Many governments are making progress in the fight against tobacco, with 5bn people today living in countries that have introduced smoking bans, graphic warnings on packaging and other effective tobacco control measures – four times more people than a decade ago. But a new World Health Organisation (WHO) report shows many countries are still not adequately implementing policies, including helping people quit tobacco.

The seventh WHO Report on the global tobacco epidemic analyses national efforts to implement the most effective measures from the WHO Framework Convention on Tobacco Control (WHO FCTC) that are proven to reduce demand for tobacco.

These measures, like the “MPOWER” interventions, have been shown to save lives and reduce costs from averted healthcare expenditure. The MPOWER report was launched in 2007 to promote government action on six tobacco control strategies in-line with the WHO FCTC to: monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn people about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; raise taxes on tobacco; and tobacco cessation services must be stepped up

The focus of the latest report is on the progress countries have made to help tobacco users quit. It is being launched in Brazil, a country that has become the second, after Turkey, to fully implement all the MPOWER measures at the highest level of achievement.

Dr Tedros Adhanom Ghebreyesus, WHO director-general, said governments should implement cessation services as part of efforts to ensure universal health coverage for their citizens.

“Quitting tobacco is one of the best things any person can do for their own health,” said Tedros. “The MPOWER package gives governments the practical tools to help people kick the habit, adding years to their life and life to their years.”

Progress is being made, with 2.4bn people living in countries now providing comprehensive cessation services (2bn more than in 2007). But only 23 countries are providing cessation services at the best-practice level, making it the most under-implemented MPOWER measure in terms of number of countries offering full coverage.

Tobacco cessation services include national toll-free quit lines, “mCessation” services to reach larger populations via mobile phones, counselling by primary health care providers and cost-covered nicotine replacement therapy.

Michael R Bloomberg, WHO global ambassador for noncommunicable diseases and injuries and founder of Bloomberg Philanthropies, said the report shows government-led efforts to help people quit tobacco work when properly implemented. “More countries are making tobacco control a priority and saving lives, but there’s still much more work to be done,” said Bloomberg. “The WHO’s new report shines a spotlight on global efforts to help people quit using tobacco and it details some of our most important gains.”

The report, funded by Bloomberg Philanthropies, showed that while only 23 countries have implemented cessation support policies at the highest level, 116 more provide fully or partially cost-covered services in some or most health facilities, and another 32 offer services but do not cost-cover them, demonstrating a high level of public demand for support to quit.

Tobacco use has also declined proportionately in most countries, but population growth means the total number of people using tobacco has remained stubbornly high. Currently, there are an estimated 1.1bn smokers, around 80% of whom live in low- and middle-income countries (LMICs).

Since the last report, issued in 2017, the WHO report on the global tobacco epidemic, 2019, also finds that: 36 countries have introduced one or more MPOWER measures at the highest level of achievement; over half of the world’s population – 3.9bn people living in 91 countries – benefit from large graphic pack warnings featuring all recommended characteristics, making it the MPOWER measure with both the highest population coverage and the most countries covered; and 14 countries have implemented large graphic warning laws at best practice level, making it the MPOWER policy with the greatest growth in terms of country uptake during the last two years.

The greatest growth in population coverage was seen in tobacco taxation. The population coverage from this MPOWER policy has almost doubled from 8% in 2016 to 14% in 2018. But while being the most effective way to reduce tobacco use, taxation is still the MPOWER policy with the lowest population coverage.

Of the 5bn people protected by at least one MPOWER policy, 3.9bn live in LMICs (or 61% of all people in LMICs). 59 countries have yet to adopt a single MPOWER measure at the highest level of achievement – 49 are LMICs. In the world’s 34 low-income countries, 17 today have at least one MPOWER policy in place at best-practice level compared to three in 2007, showing that income level is not a barrier to best-practice tobacco control

For each MPOWER measure, there have been new countries that have implemented some of the measures at the best practice level since the last report: 7 (Antigua and Barbuda, Benin, Burundi, Gambia, Guyana, Niue and Tajikistan) have adopted complete smoke-free laws covering all indoor public places and workplaces; 4 (Czechia, Saudi Arabia, Slovakia and Sweden) advanced to best-practice level with cessation services. But during the same period, six other countries dropped from the highest group, resulting in a net loss of two countries; 14 (Barbados, Cameroon, Croatia, Cyprus, Georgia, Guyana, Honduras, Luxembourg, Pakistan, Saint Lucia, Saudi Arabia, Slovenia, Spain and Timor-Leste) adopted large graphic pack warnings; 10 (Antigua and Barbuda, Azerbaijan, Benin, Congo, Democratic Republic of the Congo, Gambia, Guyana, Niue, Saudi Arabia and Slovenia) introduced comprehensive bans on tobacco advertising, promotion and sponsorship; and 10 (Andorra, Australia, Brazil, Colombia, Egypt, Mauritius, Montenegro, New Zealand, North Macedonia and Thailand) raised taxes to comprise at least 75% of retail prices.

World Health Organisation material

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